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When drug prices threaten patient care

The debate over high drug prices has raged for decades, thanks to the inherent tension between delivering innovative and cost-effective patient care. But recently something has changed, and it’s one that may have major ramifications for how we take care of patients– hyperinflation in drug pricing.

This good news is that this new wave of hyperinflation in the pharmaceutical industry has been receiving attention on Capitol Hill. As chief clinical officer for St. Vincent Health in Indianapolis, a faith-based health system that is a member of Ascension, the largest non-profit health system in the U.S. with 2,000 sites of care, I was privileged to testify recently at a hearing before the Senate Special Committee on Aging. Of particular interest to the committee was the action of Valeant Pharmaceuticals International, a company that has been exceptionally aggressive in raising its prices. 

{mosads}Healthcare providers can’t offer the quality care that patients expect without the partnership of the pharmaceutical industry. We need to protect intellectual property and reward innovation. We also understand that in certain circumstances the price of a drug may be at a reasonable premium when that drug represents a true clinical advancement or breakthrough in treatment. 

However, what I find particularly troubling is when drugs that have been around for decades are suddenly and steeply increased with no apparent justification. In some cases, these increases have topped 500 percent, 1,000 percent and even 3,000 percent on select branded and generic products.

As a cardiologist who specializes in electrophysiology, I have seen firsthand the impact of price increases on two drugs in particular: Isuprel and Nitropress. Isuprel is a drug that increases slow heart rates and is commonly used in procedures to treat heart rhythm problems. Nitropress, which I first used as a medical student in the mid-1980s, is an intravenous drug used to treat life-threatening elevations in blood pressure.

When Valeant purchased these drugs in 2014, St. Vincent Health saw the price of Isuprel increase from approximately $200 per vial to approximately $1,260 per vial. We saw Nitropress increase from about $200 per vial to $730. 

Combined, these two drugs alone resulted in a nearly $900,000 increase in annual expense to St. Vincent, and a combined $12 million increase to Ascension.

Like our colleagues across the healthcare industry, Ascension and our 137-hospital system are facing a time of transition. We’re moving away from fee-for-service reimbursement– receiving payment for each service to a patient – to a fee-for-value payment system – receiving incentives to make the system more effective and efficient. This shift is essential to creating a healthcare system that is truly patient centered. 

The rise in drug prices jeopardizes our ability to make this important shift. 

These stratospheric increases in prices contribute to higher insurance premiums and higher costs for patients. More immediately, the decreased margins limit the ability of health systems to provide other patient-centered and mission-based services. 

At St. Vincent, we’re proud of the work we do to serve those who are most vulnerable. Through our Rural and Urban Access to Health (RUAH) initiative, we send health access workers to help the underserved connect with key resources and sign up for insurance. We’re also active in developing initiatives to battle the opioid epidemic. These are crucial programs, but increasing budgetary pressures from higher drug costs affects our ability to expand or even continue them. Unfortunately, this problem – which has become worse in recent years – is not expected to subside without a focus on policy designed to turn the tide. 

To that end, I urge lawmakers to focus on solutions that emphasize price transparency, fast track approval for drugs, especially generic competitors, and continued support for the federal 340B Drug Pricing Program, an initiative that equips safety-net healthcare providers to extend services and provide low-cost prescription drugs to low-income and vulnerable populations. These are important steps that could make a real difference. Certainly, the recent spike in drug pricing is only one of many financial pressures facing healthcare, but it is a serious one applying outsized pressure on the delivery of high-quality, cost-effective patient care. 

Skyrocketing drug costs are a crucial problem that must be addressed if we as a country are serious about improving our healthcare system. 

Richard Fogel, MD, FACC, FHRS is chief clinical officer of St. Vincent Health.


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