I get asked this question on a daily basis - what can I do to cut the amount I pay for medicines? This is a common problem patients face, and doctors grapple with.
First, why do medicines cost so much? Because drug companies have to pay scientists to design drugs, put it through testing first in a lab, then on animals, then in humans, then in a large scale human trial, just to get it in front of the FDA. The FDA has become much more demanding of the pharmaceuticals after getting egg on their face from drugs like Vioxx, Propulsid, and Troglitazone that were pulled from the market AFTER the FDA approved them. Now the FDA dictates to the pharmaceutical companies how many patients they need in a trial (usually in the thousands) to be considered for approval. Clinical trials cost a lot of money. Additionally, 9 out of ten drugs in a company's pipeline don't ever make it to market, so they have to recoup those expenses. the recently pulled drug Bococizumab, involved in the SPIRE trials cost Pfizer over a half BILLION dollars, for a failed drug. The patent life on a new FDA approved drug is 12-14 years depending on how long it took for FDA approval after the drug inventor got a patent. That is how long the company has to recoup their losses and make whatever profit they can make. After all, these companies are provate companies who's goal is to make a profit for their shareholders.
Second, what can we do to reduce an individual's medicine costs?
1. Obviously, we need to look for redundancy in medications. Often patients will have two or three doctors writing prescriptions, and one doctor may not know what another doctor has written prescriptions for. I have seen duplicate cholesterol medications, duplicate diuretics, different doses of the same BP medication, or four to five antidepressants for a patient who is still clinically depressed. Because of the multiple doctor problem, I require that my patients bring all their medications in their original bottles to their visits, EVERY visit.
2. In addition to reducing what we call "polypharmacy", we can make choices of drugs that are generic, and usually cheaper. Some drugs have a narrow therapeutic window, such as Coumadin and Dilantin. Substituting for a generic that may or may not have the identical response could be dangerous - bleeding risk for those taking Coumadin, seizure risk for those taking Dilantin. Some drugs have advantages over their generic counterparts. Brand name Tricor can be taken at any time of the day, whereas the generic of Tricor, Fenofibrate, needs to be taken within 30 minutes of your fattiest meal of the day. Other generics are equivalent - Generic lisinopril is equivalent to Zestril. generic sotalol is equivalent to Betapace. Cardiology is in a good situation currently, in that every major class of drugs we typically use have generic alternatives. We have available to us generic beta blockers, generic ACE inhibitors, generic ARBs, generic statins, and generic anti-platelet agents.
3. In some cases, a class of drugs will have one generic (older medication) and brand name agents (newer medications). Typically the newer medications have advantages. We know that clopidogrel is subject to genetic variations in the general population. One third of patients will not metabolize clopidogrel, essentially making it no different from not taking the medication. the newer drugs in this class of drugs do not have that type of genetic variability. In addition, the older clopidogrel has an interaction with the two most commonly used gastric reflux drugs - omeprazole and esomeprazole (Nexium). These two GERD medications neutralize the effects of clopidogrel. This interaction does not occur with GERD medications and the two newer anti-platelet medications.
The ugly side of government and politics. We can all debate the advantages and failings of the current and the proposed healthcare plans the government is toying with. One thing we need to know about the Affordable Care Act, which is 10% about the people, and 90% about governmental control of healthcare, is that it was designed to 'cut costs' of healthcare, but due to the many millions of dollars given to politicians in the form of campaign contributions, they did not limit the prices that drug companies can charge for medications, and it did not limit the price insurance companies can charge for premiums. meanwhile, they keep cutting payments to healthcare providers (doctors, hospitals, clinics). So if you have the time and the passion, write your congressman and your senator, and voice your concern that there are no caps on medicine costs and no caps on insurance premiums, and ask them why.
In summary, this is a complex topic with many nuances. Here is what you can do - bring all your medicines with you to every doctor you see. Ask them if there are any medications in your regimen that you can do without. Ask if there are any drug interactions that are present with your medications. Ask if there are any brand named drugs that can be switched safely to generic alternatives. together you and your doctor can work to keep your medicine cost as low as possible.
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