The High Cost of Medicine
Freddie was a patient I had in my case load. His psychiatrist put him on a new drug named Consta. Actually,
Consta is just an injectable, long acting form of Risperdal. Injectables have certain advantages for patients who are often unwilling to take their medication regularly or are unable to take their medication properly due to their thought disorder. Therefore, Consta was a good choice for Freddie.
It is my job to make sure patients have a place to live once discharged along with continuing treatment AND a steady supply of their medication. In Freddie's case, he had Louisiana Medicaid, and it was the kind that pays for medication. This scenario is the best I can hope for, because we just have to call his prescription into a pharmacy and he can pick it up with a $3 copay. Now Consta is not a medication a patient can administer themselves. Since Freddie attended the local mental health clinic, they could take care of that little task. I have been doing this job long enough to know not to take anything for granted. I called Medicaid just to make sure Consta was on their formulary (list of drugs they administer.)
What follows is the typical "catch 22" where healthcare and medication are concerned. Medicaid did not cover the medication yet. No surprise, they just put aspirin on the formulary last week. Now I had to dig deeper into the social work playbook. I called the drug company and told my story to the requisite 5 people before I got transferred to someone who could help me.
Most of the time, drug companies sample new medications. They give it away so MD's will try it. The thought being, if you try it you will like it. Consta, however, was not sampled because it cost $500 per dose. A dose can last from 2 weeks to 1 month. Freddie needed $1000 worth of Consta per month. I am not sure, but I think crack cocaine is cheaper and their customer service department is more user friendly. The catch 22 is that there was no patient assistance program for Freddie because he had drug benefits (Louisiana Medicaid.) I explained to the nice lady that LA Medicaid did not have Consta on the formulary. She said, "I know, it's kind of a catch 22 huh?" I am no stranger to situations like this. Deeper into the social work playbook I dove. "If I call our drug rep could she help somehow?", I fished. "No sir, at this time, we are not sampling Consta because it is too expensive." I knew I was defeated at this point unless I could pull, either a large sum of money or a large supply of Consta from my ass.
"Ok," I continued and thinking ahead, "this patient cannot stay on Consta. What is the equivalent of regular Risperdal, since we have to convert him to that drug?" So we talked, and after her disclaimers about she couldn't really say, and the doctor really needs to be the one to do this, and I am not really saying this, but. . . (lawyers are responsible for this crap) . . . she finally gave me an answer. Freddie was switched to regular Risperdal and the great Consta experiment was over. Consta may be a fine drug, but the population it is designed for cannot afford it.
I have talked to drug reps and they always give me this line how they spend so much on R&D. They say a drug takes years to develop and the cost is a means of recovering their investment. It seemed rational, but I do not believe it anymore. There is nothing wrong with making profit, but don't masquerade as a human service organization when you are only about money and drug companies are only about money.
Why are drug costs less in Canada? Because the United States subsidizes them. Canada has national healthcare. They say in essence. We will pay X for this drug, take it or leave it. The drug companies take it, because they can bilk the US citizens to make up for it.
Here is an interesting little chart I found
here.
Drug companies spend almost twice on marketing what they spend on R&D. I knew the cute girls in short skirts bringing lunch and passing out expensive pens could not be cheap. Drugs do not need this kind of marketing. If the drug is good, MD's will find out. The drug compainies pay physicians consulting fees, which is just money under the table to Rx thier drug over some cheaper, equally effective version. The devil is in this I know it.
I do not have the answers. This is a huge problem. I have health insurance and medications are expensive for me. Those without insurance and not eligible for government programs cannot afford medicine. They get sick and go to an emergency room. The emergency room must treat the person or be in violation of EMTALA laws. The government loves to penalize hospitals. We are in a quagmire of policy, law, free enterprise, politics, and a lot more. Bush can't fix it, neither can Kerry or any president or party. They are part of the problem.
The drug companies are companies who answer to stock holders and are profit machines. It is not in their best interest to sell medicine cheaper if they can get higher prices. Still, if they could see Freddie, a guy who lives in a group home and has nothing to his name except a drug bill greater than the drug executives annual green fees. Who will help the Freddies of the world?
I don't know.
Until the next time
John Strain