As a physician, far too often, I see the consequences of unfair prescription drug pricing on patients in our community. One of the first patients I ever cared for at the primary care center where I currently practice was a middle-aged man with poorly controlled diabetes. His diabetes is in part uncontrolled because he cannot afford to pay for the medications and supplies needed to manage his condition.
Since his blood sugar cannot be adequately managed, he’s been hospitalized numerous times for diabetes complications, including a heart attack and amputations. With all of his medical complications, he cannot work regularly, and therefore, he cannot afford the high cost of the prescription drugs needed to prevent further medical complications. My patient is suffering because of the high costs of prescription drugs.
The Connecticut General Assembly has the power to contain the cost of prescription drugs and it’s time for them to act.
My patient’s story is not unique in this state. A survey of over 900 Connecticut residents recently conducted by Altarum Healthcare Value Hub revealed that nearly 90 percent of respondents who take their prescription drugs regularly worry about being able to afford their medications. It also found that one in five surveyed either did not fill a prescription, cut pills in half, or skipped a dose because of concerns about cost.
Adjectives like “shocking” were used to describe the survey results. In 2018, this news should no longer be shocking; over the last few years, there has been one news story after another about unfair drug pricing:
- Martin Shkreli, who rebranded and raised the price of an anti-parasitic drug from $13.50 to $750 per pill, a 5,000 percent price increase for a medication that been in use for 65 years;
- Takeda Pharmaceutical Company that raised the price of colchicine, a drug used by the Egyptians since 1500 BC, from $0.09 to $4.85 per pill; and
- Mylan’s increase cost of the EpiPen from $94 to $609.
Unjustifiable cost spikes are widespread, not just limited to these three drugs. According to a 2016 U.S. Government Accountability Office study, on average the cost of well-established generic drugs increased four times the rate of inflation. This study also found over 300 instances when the price of a generic drug had a sudden increase of 100 percent or greater.
What’s shocking to me, is that with such egregious pricing practices and clear data showing Connecticut residents are hurting, why isn’t the Connecticut General Assembly passing legislation to begin to combat this problem?
Some may argue that services like the 340B program, co-pay assistance, and discount coupons are a solution, but these programs don’t address the underlying problems causing high drug costs and they don’t offset the cost enough to make medications and medical supplies sufficiently affordable. For example, despite these programs, I have a patient who pays hundreds of dollars a month for anti-seizure medications leading to psychologic distress rooted in financial insecurity.
Others may contend that developing drugs is a risky business and pharmaceutical companies spend billions on research and development (R&D); however, studies and investigative reporting have clearly shown that pharmaceutical companies spend far more on marketing as well as share repurchases and dividends than on R&D.
The good news is the state of Connecticut could pass legislation that will help contain the cost of prescription drugs. There is a bill currently in Hartford, An Act Concerning Prescription Drug Cost, HB 5384, that takes important first steps by increasing cost transparency and ensuring that patients get discounts and rebates that sometimes only benefit insurance companies and pharmacy benefit managers (PBMs). Also, the bill in its current form requires, in up to 10 instances, pharmaceutical companies to provide justifying information if they raise the price of a prescription drug by 25 percent or more in a year. This threshold should be reduced to 10 percent and the cap of 10 occurrences should be struck from the bill. Oregon and California passed laws with much lower thresholds. There is no reason for the price of a vial of Lispro insulin within one year should go from a retail price in New Haven of $318 to $394 (a 24 percent increase) without justification.
Connecticut residents have made it clear that they want action. The state legislators must seize this opportunity to pass meaningful legislation to contain the cost of prescription drugs in Connecticut. They can do it and they should do it now.
Ross Kristal MD is a resident primary care physician at Yale School of Medicine.