The rising cost of prescription drugs has forced physicians to re-think how they prescribe high-cost medications. However, it also provides an opportunity for meaningful discussions with patients about the pros and cons of treatment avenues.
There’s no quick and easy answer to the question of what’s forcing healthcare premiums upward. But the evidence is clear that one key factor is the cost of prescription drugs.
For example, a report from IMS Health indicates that spending on prescription drugs rose 13% in 2014. A second report, this one from Express Scripts, reveals a 30.9% increase in annual spending for specialty medications during the same year.
Damon Raskin, MD, medical director and board certified addiction expert for Cliffside Malibu, isn’t surprised by the numbers.
“Unfortunately, it has a lot to do with the fact that these pharmaceutical companies see the US as a place where they can make their money,” he says. “Because if you look across different countries, some of these same drugs are a lot cheaper, which is unfortunate. And it has to do with the way our healthcare system is set up.”
But, Raskin adds, the good news is that generic alternatives are often available. And that’s where physicians can play an important role in helping to curb rising costs.
Best for the Patient
Raskin says that there are many common conditions he sees every day—high blood pressure, diabetes, common infections—all of which can be treated with generic alternatives. And, there are no head-to-head studies comparing many of these tried-and-true drugs to newer branded products.
“There’s no money in the pharmaceutical companies looking at that,” Raskin says. “They don’t want to see that the generic is just as good as their branded product.” But, he cautions, some patients don’t do well with generics. “The most important thing is doing what’s best for the patient.”
And there are other factors. Ralph Ortiz, DO, MPH, founder and director of Medical Pain Consultants, and a director for the New York State Pain Society, says insurance company prescribing restrictions are contributing to the problem of rising prescription drug costs.
“They’ve put the fear of God into doctors to not write over 100 mg of morphine equivalent doses,” he says. “But here’s what happens with generics. Generics don’t have to meet the same control as the name brand drug. So if they lag by 20 to 35 maybe 40 percent then you need more pills in order to meet the morphine ED. But they still call it 20 mg. So if you took five 20 mg pills to meet the morphine ED, but now you have to use a generic, you can’t meet it with five pills. You have to meet it with eight pills and the insurance company won’t allow that. So you end up under-dosing your patient, or the patient ends up being under dosed, being poorly medicated, or paying it out of pocket.”
Education is Key
Raskin says it’s extremely important for physicians to take on the role of educators where prescription drugs are concerned. Where patients come to office visits armed with information thanks to direct-to-consumer advertising, Raskin uses those opportunities to start positive conversations.
“It’s an opportunity for me and my patient to talk about the topic of erectile dysfunction, for example,” Raskin says. “What does that mean? And if they have that, what other conditions could they be having along with that. And it doesn’t always lead to the fact that we’re going to be writing or using that particular drug, especially when the patient finds out it’s not covered by their insurance, and it’s $30 a pill. Then they say what else is there? And that leads to different conversations as well, which to me is a good thing.”
Ortiz suggests that the best investment a physician can make, and the best way to educate a patient, is to have educated staff as well.
“Educate everyone who is going to be interfacing with the patient,” he says. “That way the patient gets the same message over and over and over again. Even my receptionist knows what to say to a patient when they call on the phone, what to say about the pill count, what do say about the urine. She can educate the patient on many levels many times just as well as the nurse.”
Medical Practice Benefits
Ortiz says that taking the time to educate both practice staff and patients can provide substantial benefits.
“There are fewer mistakes,” he says. “And anyone can help the patient on things that many times are nonmedical, but are still very important to the medical aspects.”
Raskin echoes those thoughts.
“Better communication with the patient translates into higher patient satisfaction, and it’s a spiraling upward,” he says. “I get more satisfied with my job when my patients are satisfied, and then patients feel like they really do have a connection with their physician. So everybody wins.”