The C2S blog draws on the arts, the social and biological sciences to explore the many meanings of health and "dis-ease." Designed to be a locus where patients, their families and professionals can meet on a level playing field, it is the natural off-shoot of the Cell 2 Soul Online Journal. We encourage the submission of ideas, essays, poems, stories, humor, and timely reviews relating to the humanities and health care.
Although geriatricians and researchers have warned for years about the potential hazards of polypharmacy, usually defined as taking five or more drugs concurrently; it continues to rise in all age groups, and has reached disturbingly high levels among older adults. A recent study showed that 39% of people over age 65 in the U.S. take 5 or more different prescription medications a day (not yo mention other over-the-counter meds and supplements).
This is a concise, lucid and useful article by one of the Times best health reporters. It might pay to read it and remember its warnings.
In the United States, just three pharmaceutical giants hold patents that allow them to manufacture insulin: Eli Lilly, Sanofi and Novo Nordisk. Put together, the “big three” made more than $12 billion in profits in 2014, with insulin accounting for a large portion.
What makes this so worrisome is that the big three have simultaneously hiked their prices. From 2010 to 2015, the price of Lantus (made by Sanofi) went up by 168 percent; the price of Levemir (made by Novo Nordisk) rose by 169 percent; and the price of Humulin R U-500 (made by Eli Lilly) soared by 325 percent.
Besides these pharmaceutical companies, [s]omething else is most likely contributing to the rising price of insulin: a very powerful and largely invisible group of middlemen, known as pharmacy benefit managers, or P.B.M.s.
The biggest P.B.M.s are out to make a buck. They get “rebates” from drug manufacturers — payments based on sales or other criteria, which look suspiciously similar to kickbacks. The rebates are not publicly disclosed, but they are sizable. Industry analysts estimate that those payments, and other back-room deals, amount to as much as 50 percent of the list price of insulin.
The three biggest P.B.M. — Express Scripts, CVS Health and OptumRx — bring in more than $200 billion a year in revenue. They control over 80 percent of the P.B.M. market.
In much of Europe, insulin costs about a sixth of what it does here. That’s because the governments play the role of pharmacy benefit managers. They negotiate with the manufacturer directly and have been very effective at driving down prices.
PhRMA and the P.B.M.s care making a killing while many patients have a hard time with co-pays for their insulin.
I saw a patient today with no drug insurance today who needed a cream for skin lesions. His pharmacy quoted him a price of $297. I had told him about GoodRx and he went to their website. The price there varied between $103 and $214. He wound up getting it for $154 at Walmart.
There are two websites that can help patients without drug coverage save significant sums on generic medications.
A few entrepreneurs are aiming to fundamentally change the way people buy drugs, bringing the industry into the digital age by disclosing the lowest prices for generic prescriptions to allow comparison-shopping.
The spotlight on drug prices could not come at a better time for at least two online ventures. One company, GoodRx, collects drug prices at pharmacies around the country and connects consumers to coupons to help them pay. Another, Blink Health, takes the process a step further by allowing customers to pay for their drugs online, then pick up the prescription at nearly any pharmacy.
Many uninsured consumers do not know that the price pharmacies charge them is far higher than the rate that insurers pay the pharmacies for the same drug, health care experts said. And even insured customers are not always getting the best deal. Many people have insurance plans that require them to pay a flat rate of $10 or higher for generic drugs, even though the rate the insurers pay the pharmacy is often less.
Becoming familiar with GoodRx and BlinkHealth can save you, a family member or BFF a considerable amount on generic prescriptions. If you need a drug that presents a significant expense, it would be wise to check both of these sites for the cheapest price.
These commandments appeared in the British Journal of General Practice. While they refer mostly to therapeutics, they are applicable to most doctor-patient interactions. We have edited the BJGP article as it was too verbose. Please feel free to edit what we provide as it can still be improved.
In the U.S. today, drugs prescribed by doctors (myself included) kill more people than street drugs. This sobering fact was brought home by a recent article in the NY Times (reported widely elsewhere, too).
"In 2008, for the first time in nearly 30 years, more people died of poisoning than in car crashes. Poisoning is now the leading cause of injury death, and 90 percent of poisonings were caused by drugs. Opioid painkillers like morphine, hydrocodone (sold as Vicodin and other brands) and oxycodone (Percocet and other brands) were involved in more than 40 percent of drug poisonings in 2008. These drugs were implicated in more poisoning deaths than heroin or cocaine. Opioid analgesics accounted for 14,800 of the 36,500 fatal drug poisonings in 2008. For full article see: Download Poisoning Kills
If you are a doctor, read this and weep. If you are a patient, digest this. If you are a family member of a patient, be vocal.
An amazing NY Times article describes sleazy narcotic "clinics" in Florida.
"Florida has long been the nation’s center of the illegal sale of prescription drugs: Doctors here bought 89 percent of all the Oxycodone sold in the country last year. At its peak, so many out-of-staters flocked to Florida to buy drugs at more than 1,000 pain clinics that the state earned the nickname “Oxy Express.”
One clinic alone, prosecutors say, was responsible for 56 overdose deaths.
Why have the last several generations of children born in the U.S. suddenly developed ADHD, anxiety, depression, and bipolar disorder in epidemic proportions? Has there been some sort of random genetic drift at work on the molecular level in this population? Or could it be that we are dealing with a medical paradigm shift — the way in which we consider what constitutes the origin of illness in human beings? more»
Brian T. Maurer has practiced pediatrics as a Physician Assistant for thirty years. His "Marginal Notes" column appears periodically in the Cell2Soul Blog. The title "Marginal Notes" is taken from a quote by Henry David Thoreau: "I love a broad margin to my life."