High medication costs make baby Jesus cry

October 27, 2009 8:15 AM

Why do my medications cost so much? Are there ways to save money on my pills?

Are generic drugs equal to the brand name?
Is a generic option available for the drug I'm taking?
Or maybe my medications are causing my health problems?
Can I just take the expired pills in that old bottle?

posted by dances_with_sneetches (37 comments total)

In order:

- Because R&D and testing is expensive. This is, however, as it should be, because putting unproven drugs on the market costs society a lot more.
- Yes.
- Yes, by and large they're chemically identical.
- Probably, if it was put on the market more than a decade ago.
- Talk to your doctor about contraindications.
- No, for two reasons. One, many medicines do become less effectual over time and two, because if you have a bunch of it lying around it probably means you didn't finish your prescribed program of medication the last time, which is also really bad. Go talk to your doctor.

Wait, this isn't AskMefi. What's all this about?
posted by mhoye at 8:21 AM on October 27, 2009 [6 favorites]

Why do my medications cost so much?

This needs the Andy Rooney voice for full effect.
posted by Joe Beese at 8:23 AM on October 27, 2009 [8 favorites]

Because R&D and testing is expensive. This is, however, as it should be, because putting unproven drugs on the market costs society a lot more.

Or, alternately, because we have linked R&D to profits, rather than treat it as a social responsibility that we should collectively be paying for; as a result, we end up paying for the cost of the medication on the back end, in paying for them, rather than on the front end, in using taxes to develop drugs. The results are that the pills will always cost more, because the drug company is in business to make a profit.
posted by Astro Zombie at 8:30 AM on October 27, 2009 [24 favorites]

Is there a central article here that brings everything together, or just a bunch of articles that touch on a common theme?
Is there a way we could make this easier to read?
How many of those articles is it important to read before we can understand the gist of this post?
posted by scrutiny at 8:31 AM on October 27, 2009

Drugs are expensive because they are made by public companies who are obliged to maximize profits. They set the price of a drug to make the most money possible.
posted by bhnyc at 8:34 AM on October 27, 2009 [3 favorites]

The 'available' link, listing major stores and downloadable PDFs of their drug costs is awesome. A lot of really useful reference info here.
posted by iamkimiam at 8:36 AM on October 27, 2009

R and D is not the main thing that drives up drug costs. It's funny that drug companies cite the costs of launching a new medicine as 600 million to 1 billion dollars but include marketing in that figure.
As for talking to your doctor, it is unfortunately, a two edged sword. In theory doctors can be part of the solution, but as a pharmacologist, I have found doctors are more often part of the problem. Gross overprescribing, prescribing drugs to treat the side effects of other drugs, prescribing what the drug rep brings in. Drug reps and direct to consumer advertising are very effective - and they do not have the patient's interest in mind. Furthermore, most doctors are poor people to talk to about contraindications
- and contraindications are not the same as medicines causing health problems. Adverse drug effects kill 100,000 per year (US) even when the medicines are prescribed correctly.
As a patient, you need to practice defensive health care, with the physician being the offense. Out of my last five or so visits to doctors (interestingly, four different doctors) for my own sake or for my family, each had problems with the medications prescribed.
1 a prescription with two weeks worth free samples for a drug that was the most expensive of its group - and, being new, one that would not have a generic alternative for several years.
2 for a finger injury, the doctor prescribed Celebrex when aspirin would have been sufficient.
3 the doctor wrote a prescription for gel cap aspirin when regular aspirin would have suited me fine (and cost about a tenth of the price).
4 One wanted to put me on a cholesterol lowering agent even though my cholesterol is not high. (Can't be too low, I was told.)
5 Another was for two medicines that were clearly incorrect and had significant side effects.
I would blame drug reps for #1, 2, 4 (and maybe 3).
posted by dances_with_sneetches at 8:37 AM on October 27, 2009 [3 favorites]

Drugs are expensive because they have to be grown in Vancouver and transported over national borders and state lines.
posted by localhuman at 8:37 AM on October 27, 2009 [12 favorites]

...if you have a bunch of it lying around it probably means you didn't finish your prescribed program of medication the last time, which is also really bad.

I've had prescription painkillers in the past that I ended up hoarding. I had one that was "take every 4 hours," so they gave me 180 pills a month? I was sleeping a lot them and only woke up to take a painkiller. I used about half the prescribed amount.

No way I was throwing them out though. I am an adult. I know that when I hurt my back on the ice I'll end up just getting pain meds. There's nothing worse than sitting around in pain waiting for Monday to roll around so you can see a doctor to have him tell your what you already knew.
posted by cjorgensen at 8:39 AM on October 27, 2009 [2 favorites]

"- Because R&D and testing is expensive. This is, however, as it should be, because putting unproven drugs on the market costs society a lot more."

That would be great, if they did that.

Drug companies spend more on marketing than they spend on R&D.

The researchers’ estimate is based on the systematic collection of data directly from the industry and doctors during 2004, which shows the U.S. pharmaceutical industry spent 24.4% of the sales dollar on promotion, versus 13.4% for research and development, as a percentage of US domestic sales of US$235.4 billion.

posted by mullingitover at 8:40 AM on October 27, 2009 [8 favorites]

Or, alternately, because we have linked R&D to profits, rather than treat it as a social responsibility that we should collectively be paying for; as a result, we end up paying for the cost of the medication on the back end, in paying for them, rather than on the front end, in using taxes to develop drugs.

Considering how much basic and applied pharmaceutical science is directly funded by government agencies like the NIH and performed by researchers at state-run universities, I would say a decent portion of R&D is already socialized.

It seems you could recoup much of these costs if the government and universities were a bit more reserved when giving away this potentially valuable intellectual property, as is now the case. I don't know how that would impact the overall cost of bringing a new drug to the market, though.
posted by TBAcceptor at 8:40 AM on October 27, 2009 [3 favorites]

Finishing my degree + making money at home!
posted by shakespeherian at 8:41 AM on October 27, 2009

The links I've read so far have been worth reading, whatever you may think of the presentation. The first and last ones were especially eye-opening for me. Thanks, d_w_s.
posted by gimli at 8:41 AM on October 27, 2009

Oh, and on the subject of expired pills, it isn't just that the active pharmaceutical ingredient itself deteriorates and loses effectiveness. It's that often the thermal, oxidative, or photochemical degradation products are harmful. For example, that old ibuprofen sitting in your medicine cabinet is slowly turning into a variety of poisons.
posted by TBAcceptor at 8:45 AM on October 27, 2009

That Atlantic article is excellent too. It's sadly, stunningly accurate.
posted by iamkimiam at 8:46 AM on October 27, 2009

"Mail thinks this message is Junk Mail."
posted by Demogorgon at 8:47 AM on October 27, 2009

The author of the Atlantic article is a bio-ethics professor at the Uni here in the Twin Cities. His book Better Than Well is quite an interesting read.
posted by localhuman at 8:50 AM on October 27, 2009

While it may be true that, in most cases, a generic will perform perfectly well, I can attest that it is not always the case. Both myself and my son have experienced severe problems when using generic versions of Welbutrin. My son, especially, became almost suicidal when using the generic versions. He had previously been on the name-brand version and had no issues. Of course, insurance began to decline coverage of the brand and insisted we move him to generic. We couldn't afford the brand without the coverage.

We did see lesser side-effects when he was on a generic from a different manufacturer. So, when it came time to refill his prescription, we had to call-around to different pharmacies to inquire as to who the manufacturer was of their current supply of generic welbutrin. I lost count of how many times we had to move his prescription around because we were chasing a manufacturer that was "acceptable." I say "acceptable" because, no matter how good a generic was, it was never as good as the brand.

As for myself, when I had to move from brand to generic, I started experiencing severe agitation and increased depression. When I was on the brand version, I never had those problems.
posted by Thorzdad at 8:52 AM on October 27, 2009

Act One of a This American Life from a few weeks back was also pretty interesting in showing the ongoing battle between drug and insurance companies over the cost and the perceived cost of drugs.
posted by robocop is bleeding at 8:56 AM on October 27, 2009 [1 favorite]

I came to post the same thing robocop just did. The entirety of the This American Life double feature is worth listening to really, but the piece on the battle between generics, non-generics, and your insurance company was really interesting.
posted by rollbiz at 9:22 AM on October 27, 2009

continuing on mullingitover's remark,

... First, research and development (R&D) is a relatively small part of the budgets of the big drug companies—dwarfed by their vast expenditures on marketing and administration, and smaller even than profits. ...

and

Over the past two decades the pharmaceutical industry has moved very far from its original high purpose of discovering and producing useful new drugs. Now primarily a marketing machine to sell drugs of dubious benefit, this industry uses its wealth and power to co-opt every institution that might stand in its way, including the US Congress, the FDA, academic medical centers, and the medical profession itself.

marketing drugs directly to the consumer falls just short of travesty, in my book. yes, i agree that consumers have the right to make informed decisions regarding their own health & well-being; no, i do not consider marketing = informed decisions.
posted by msconduct at 9:27 AM on October 27, 2009 [2 favorites]

Economist Dean Baker (of the Center for Economic and Policy Research) here argues for The Reform of Intellectual Property with regard to "The Inefficiency of Drug Patents and Copyrights," and suggests alternatives to the current system of drug patents.
posted by Auden at 9:32 AM on October 27, 2009

As far as I have been able to find out, generics are a lot less reliable when you are dealing with anything neurological -- so antidepressants, anti-seizure medications, etc are problematic. There are a lot more variables (apparently) in neurological reactions, and this, along with poorly-understood mechanisms mean that a certain dose of a drug will work for one patient, but the generic will do nothing or something bad. Worse yet, the switch may make it ineffectual to go back, so "try it and see" is not really an option (especially for antidepressants, as I understand it). Here's a statement by the American Academy of Neurology on generic anti-seizure medications.
posted by GenjiandProust at 9:44 AM on October 27, 2009

marketing drugs directly to the consumer falls just short of travesty, in my book. yes, i agree that consumers have the right to make informed decisions regarding their own health & well-being; no, i do not consider marketing = informed decisions.

Yes.
posted by ob at 9:46 AM on October 27, 2009

However, if you have placebo neurological pharma in your medicine cabinet, expiry dates aren't a problem: placebos have actually become more effective with time.
posted by anthill at 9:50 AM on October 27, 2009

Anyone recommend a good online pharmacy?
posted by gottabefunky at 9:58 AM on October 27, 2009 [1 favorite]

Myth: Generics are not as safe as brand-name drugs.
Fact: FDA requires that all drugs be safe and effective and that their benefits outweigh their risks. Since generics use the same active ingredients and are shown to work the same way in the body, they have the same risk-benefit profile as their brand-name counterparts.

The catch is that the inactive ingredients are often different. If you have allergies to food or medicines, that can be a pretty big difference. For example, a friend of mine has to get brand-name because the generics come with no guarantee of being free of $her_allergen.

Another topic being repeatedly brought up is that we socialize the cost of R&D. Believe me, research universities do everything in their power to obtain IP and extract concessions from pharma.
posted by a robot made out of meat at 10:16 AM on October 27, 2009

single-payer health-care systems have the power to negotiate lower drug prices.

Theoretically, so do big private insurers... and yet, many Americans choose to buy their prescriptions from Canadian internet pharmacies...

Just sayin', is all.
posted by Artful Codger at 10:35 AM on October 27, 2009

Then there are marketing driven studies promoted as R and D, called "seeding trials."
And there was this post on drug reps a couple of years back. To full appreciate the duplicity, you need to realize "Dr Graham, associate director in the FDA’s Office of Drug Safety, said an estimated 88,000 to 139,000 Americans had heart attacks and strokes as a result of taking rofecoxib."
posted by dances_with_sneetches at 11:14 AM on October 27, 2009

Most of the practices discussed in the Atlanta article are no longer done. The new Phrma code even discourages providing pens and pads to doctors any more.
posted by caddis at 11:17 AM on October 27, 2009 [1 favorite]

This is yet another result of our slavish supplication to the "free market" and our corporate overlords. The Congressional whores take insane amounts of "campaign financing" from companies and then hide behind the "philosophy" that we can't do anything in this country that might "hamper" corporations' ability to "conduct business" and "create jobs".

Blind adherence to this "philosophy" is demonstrably wrong and evil, has benefitted the few at the expense of the many, regularly kills citizens who don't have the means to fight back, and has pushed our country and economy down a rat hole. Just the fact that there is any argument whatsoever over whether corporate profits should take precedence over citizens' right to live and die says volumes about how misplaced our priorities have become.

Teddy Roosevelt saw the ramifications more than 100 years ago: Corporations don't give a fuck about the general welfare; even to the point of destroying the public they ostensibly serve. To hand over the health of the country to them is the height of insanity.
posted by Benny Andajetz at 11:18 AM on October 27, 2009 [1 favorite]

Generics are fine most of the time. However, their rate of absorption only has to be in the range of -20% to +25% of the brand name drug. That sounds huge but dosing is an imprecise science so it works out fine most of the time. One big trouble area is where the blood levels must be tightly controlled and the patient gets a different generic. If he was on one that was -20% and now gets one +25% that could lead to dangerous blood levels.
posted by caddis at 11:29 AM on October 27, 2009

I'm not even going to put this in small text: if you can not comment on MetaFilter without calling someone a retard, do not comment on MetaFilter. Thanks.
posted by jessamyn at 12:40 PM on October 27, 2009

R&D does eat up costs but so do those lovely pharmaceutical advertising salaries.

Most of the copywriters are at a minimum of 65k (most are in the 6 figs)
Creative director --6 figs
art director (see copywriter salary)
account manager 6 figs
traffic coordinator a little lower than a copywriter
add some interactive flair
a dab of inflated hourly billing prices
a smidge of travel expenses, associated costs billed back to client

You got one heafty bill you need to pay for.

Throw it back on the consumer

Ah those were the days. (If i wasn't so incredibly BORED with writing fair balance copy and shoving the word "efficacious" everywhere.)
posted by stormpooper at 1:46 PM on October 27, 2009

Here's a statement by the American Academy of Neurology on generic anti-seizure medications.

Didn't see a lot of data in that statement, just a lot of statements. This may be an example of an interesting dynamic, in which Big Pharma spends a lot of resources getting physicians on their side, providing them with the sorts of talking points like those in that "statement." Part of the strategy is to conflate generic substitution - substituting chemically identical brands - with drug substitution - substituting, say, one statin molecule for another statin molecule. Any real problems tend to get overblown by the drug companies and some problems get made up (see hypothetical). I would have expected a scholarly presentation of the research backing up their claims. The absence of such citations leaves me a little suspicious.
posted by Mental Wimp at 2:09 PM on October 27, 2009 [1 favorite]

Can't we just legalize human testing in developing nations?
posted by Phssthpok at 2:16 PM on October 27, 2009

Over the past two decades the pharmaceutical industry has moved very far from its original high purpose of discovering and producing useful new drugs.

I just lol'd all over my keyboard.
posted by atrazine at 12:48 AM on October 28, 2009