My patients deserve to know what they’re paying for

My patients deserve to know what they’re paying for

This past week, President TrumpDonald John TrumpPaul Ryan defends Navy admiral after Trump's criticism Trump discussing visit overseas to troops following criticism: report Retired Army General: Trump is ‘acting like an 8th grader’ in attacking ex-Navy SEAL who led bin Laden operation MORE gave a speech at Health and Human Services with Secretary Alex Azar at his side. This prompted me and other physicians to reflect on how times have changed for the drugs we routinely prescribe — and not entirely for the better.

Drug prices are skyrocketing and not just because of the lack of true price transparency. Lack of real competition, global market manipulation and underutilizing generic competition all play a part in increasing drug cost. In addition, the cost of innovation is extremely high.

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The latest cancer immunotherapies — biologics for inflammatory arthritis and skin conditions — as well as the latest insulins are very effective but many times more expensive than their precursors. And the U.S. frequently doesn’t get the best price, even on drugs that are developed here. In fact, a new report this week shows that Medicare Part B is paying almost twice what other countries are paying for many top drugs.

Before

A drug rep used to come to my office bearing Cialis samples, and I would give them out to older male patients who couldn’t afford Viagra. In the end, some of my patients reported they preferred Cialis. Unfortunately, when enough patients were hooked on it, the drug rep stopped coming, the samples dried up and I didn’t know what to do.

Most insurers approved only small quantities for one or both of these drugs or a third erectile dysfunction drug, Levitra. The cheaper generics began to come out there and were too many restrictions to make them easy to prescribe, and too few people knew about them.

Too often, my patients did not know what their prescription drugs cost because they are reflected only indirectly in their rising insurance premiums and co-pays. They also didn’t know what other options were available.

ObamaCare made all of worse by promoting and extending a one-size-fits all insurance product that camouflages prices as well as true cost.

Now

The Trump administration has made several moves in the right direction the past few weeks. Restoring free market forces of competition and choice are the key to lower prices and higher quality.

Earlier this month, HHS Secretary Azar said that since the 1950s, whenever a car manufacturer advertised a new car, the ad has to include the price. This law enables a consumer to shop, compare and buy the best car for their money. The same kind of price transparency holds true for car repair shops. It is a main reason I am able to keep my old 1992 Lexus on the road. When one shop tried to charge me for an inspection that I’d already had, I was able to show my receipt and obtain a refund. Price transparency enables an auto owner to price shop for quality and for cost.

The Trump administration is bringing more market forces to bear on health care. In terms of health insurance, removing the individual mandate opens the door to more variety and choice, both in terms of association plans and skinny plans that are temporary but may also be extended. More middle-sized insurers who were prohibited from being involved by the demands of the essential benefits piece of ObamaCare can now re-enter the market place with plans more suited to younger healthier patients who would otherwise have been forced to pay the penalty.

In terms of prescription drugs, several impactful moves have been made.

Last spring the Centers for Medicare and Medicaid Services brought out a new drug dashboard that revealed which the prescription drugs had the highest rate of increase and which manufacturers were responsible.

Second, FDA has approved the most new generics ever (close to 1,000) in both 2017 and 2018. FDA Commissioner Scott Gottlieb recently said to me that the focus at FDA has been “to create more product competition. Through the development of more efficient routes for generics to enter the market, but also through increased competition to branded drugs from other branded medicines.”

As announced by HHS this week, more outpatient drugs will be shifted from Medicare Part B, where negotiation isn’t allowed, to Medicare Part D, where private insurers are negotiating lower prices on behalf of their patients. In terms of Medicare Part B, President Trump yesterday proposed an international pricing index to use the lesser prices that other foreign countries pay as a benchmark to lower some of our drug prices. 

Lastly, the Trump administration passed two bills at the beginning of the month that compel pharmacists to tell patients about generic alternatives that may even be cheaper than the copay you are shelling out for the brand name drug.

This fits perfectly with the proposal that HHS Secretary Azar announced this week: if this proposal is enacted in 60 days, advertisements for prescription drugs for seniors will have to include prices for a month’s supply, much as car advertisements have been mandated to do since the Eisenhower years.

This means that my elderly Cialis, Viagra or Levitra patients will not only know how much his drug costs before he goes to the pharmacy, but once there, the pharmacist will discuss cheaper generic alternatives.

This free market solution is much more attractive to my patients.

Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent.