By Mark Lebwohl, MD, June 01, 2015
There is no denying that the medical community has made exceptional progress in researching and developing many innovative drugs and treatments in recent history. However, there is a significant disconnect between the development of these remarkable treatments and patients’ access to them. These drugs are too expensive and are, therefore, out of the reach for many patients. Just in the last five years, the cost of drugs has soared. These costs keep going up and unfortunately there appears to be no control over that.
A lot of finger-pointing goes to the pharmaceutical industry because it would certainly help if these companies would reduce their prices to make these drugs more affordable to more patients. However, a big part of the cost comes from the wholesalers and the retailers who mark up the prices dramatically. For example, on the island of Manhattan you can go to one drug store and see a charge of $1200 for a particular drug, and then go to another drug store and see a charge of $200 for the same medication. But while the retailers, wholesalers, and pharmaceutical companies are making a lot of money, so are the insurance companies by denying coverage for medications. Imagine being in an industry where you can charge people for a service, and then after they have paid you, you decide that you’re not going to provide that service. Unfortunately, there is a lack of control over what the insurance companies are able to do because there is a lot of fine print. Our patients end up being the losers.
So, as caregivers, what can we do? We can make noise. About 10 years ago, the calcineurin inhibitors — Protopic® and Elidel® — came out and cost a few hundred dollars. One of my insurance companies routinely rejected them for every patient because they wanted the patients to fail a list of less-expensive drugs first. I was complaining about this to a patient of mine who was a politician in another state, and he promptly picked up the phone and called the Attorney General of New York at the time, Eliot Spitzer, while I was in the room. I got a call from one of Spitzer’s lawyers that very day asking me to send a letter to the insurance company, copying him. Within a day, Spitzer’s office had contacted the insurance company and the insurance company reversed that decision for that particular patient. Every time this happened to any of my patients, I did the same thing. Ultimately, after a couple of months, I stopped getting denials. As physicians we must appeal these decisions because they’re denying necessary therapy.
Also, when it comes to tackling the overarching problem of the cost of drugs, I call on every member to be politically active when important legislation pops up at the state and federal level. For example, in March, Reps. David McKinley (R-W. Va.) and Lois Capps (D-Calif.) re-introduced the Patients’ Access to Treatment Act, which would increase patient access to expensive specialty drugs. Please write to your members of Congress and support this critical piece of legislation. Additionally, start sending out letters to the press, attorneys general, insurance commissioners, and other politicians. As physicians, when we see something go wrong for our patients, we shouldn’t just take it, we should fight it. The bottom line is that we need more affordable drugs for our patients. Let’s put this issue in the spotlight.