• Prescription drugs Prescription drugs Not so very long ago, most Americans paid for the medications they used out of their own pockets. As recently as 1990, about 60 cents of every dollar spent on prescription drugs came directly from
• Prescription drugs
Prescription drugs
Not so very long ago, most Americans paid for the medications they used out of their own pockets. As recently as 1990, about 60 cents of every dollar spent on prescription drugs came directly from the people who took the medicines.
If that seems old-fashioned, it’s because today that figure has been stood on its head. Prescription drug coverage has become widespread. Now, individuals chip in about onethird of the real cost of their medicines. But over the past couple years, employers have increasingly asked their workers to pick up a larger share of the tab – especially if they want to use the newest, most expensive drugs.
So-called tiered coverage has become common. Those plans have a low co-pay for inexpensive generics, a higher co-pay for “preferred” brand name drugs and the highest co-pay for nonpreferred drugs.
The idea is simple: Get workers to think about the cost of their drugs, and if possible to use a less expensive alternative. But research published this week in the New England Journal of Medicine suggests tiered plans may have unintended side-effects. Confronted with big increases in what they’re asked to pay, many people simply stop taking medicines, Harvard researchers found.
That people chose to switch or stop taking medications altogether is, by itself, not necessarily a bad thing. We’ve long known that people with drug coverage fill more prescriptions than those without it – about 33 percent more, by one study. People can switch from an expensive new allergy drug to a cheaper, older medication without putting their lives at risk, in most cases.
Far more troubling, however, is that many people taking drugs for serious, chronic conditions like high holesterol, heart disease or high blood pressure decided to stop. Those problems typically don’t produce symptoms, so patients don’t feel sick. But left untreated, they can result in serious disabilities or even death. Insurance companies deserve some of the blame, though not for designing tiered plans, which they did in response to employer demands to hold down costs. But insurers often place drugs on “preferred” lists based on the size of the discount the drug makers provide. That’s medically inappropriate.
Drug-makers also deserve some blame. They set prices so high that their products are out of reach for many Americans without insurance. Their heavily advertised new medicines are often only marginally better than older, less expensive drugs.
That would be more apparent if new drugs were compared head-tohead against existing medications. Then doctors could make betterinformed decisions about what to prescribe. Some money to fund such comparisons has already been appropriated in Congress but more is needed. The ultimate solution is not more, but wiser, spending on prescription drugs.
St. Louis Post-Dispatch
