What We are Reading - Cost of Prescriptions

Drug Prices Effect the System

I was reading a post on the Incidental Economist about prescription costs in Medicare plans, it led me down a path to thinking about how we all consider insurance and overall costs. Many of us consider the cost of insurance premiums pretty well, but not the overall cost of the plans. I want to dig into this (admittedly wonky) issue a little bit more. As patients, it’s important that we make these choices with as much information as is possible to obtain.

When considering RX cost, for example, we must also consider the more-expensive care it replaces. There is/was a lot of howling about the cost of Harvoni, the HepC drug, but it eliminates the need for a costly liver transplant. We’re talking about a difference that is several orders of magnitude and a lifetime of costly anti-rejection medications vs. a very costly course or two of a new-on-the-market antiviral drug.

This seems like a no-brainer, but many insurance companies don’t see this kind of preventive care in that framework. They see the short-term optimization and delay of costly interventions as being ideal, because then it might become the responsibility of another insurance company, after you’ve left their plan. I’m sure there are actuarial tables and some sort of care rationing divination rod that insurance companies use to determine whether to provide costly care, but it seems like the average patient doesn’t understand that their low premiums now cost them something in the long term.

As the article at the link highlights, studies have shown that patients are less likely to fill prescriptions they have a higher cost sharing burden for. Whether it’s because those medications are outside their budget or because they don’t understand the need for a preventative drug, patients make the decision that they don’t want the pharmaceutical interventions their doctors have prescribed. That’s deeply problematic on many levels, and demonstrates very clearly that health care doesn’t work like other sectors of the economy. Most people would choose to patch a hole in their roof rather than waiting until the moisture causes damage to the rest of the house.

Making sure patients get/take the drugs they need to prevent more costly care later on isn't necessarily in the interest of insurance companies, but it is definitely in the interest of patients and their doctors. It’s a big reason why I see value based care programs that make your doctors responsible for all your care, incentivizing keeping you healthy, as being a very important part of what PI patients should advocate for. The cost of prescriptions is high, yes, and there’s not a lot we can do about that, but there is something we can do to ensure that we, as patients, understand why we’re taking the drugs we are and advocate for our doctors to get credit for keeping us well