by John Hunt, MD
Chief Medical Officer, Liberty HealthShare
You have probably noticed that prescription medications are extremely affordable in some cases and terribly expensive in others. There are several reasons for this phenomenon. Some drug prices benefit from free markets and generally free international trade, with prices dropping to nearly zero (think Walmart and all the pharmacies that followed them with their $4 low prices). These days, some antibiotics are even free. Don’t believe me? Just Google it. But for every cheap or free prescription, there are just as many or more astronomically expensive drugs out there.
There are two main forces that lead to the painfully high prices of many pharmaceuticals. For starters, counterproductive US Food and Drug Administration (FDA) regulations make drug development unaffordable for the majority of small companies that try to compete with large pharmaceutical companies. This keeps drug prices high. And the supposed benefits of the FDA regulations? Well, the number of early deaths that have resulted from FDA delays in approving medications far outweigh any safety the FDA claims to have enhanced. One reasonable conclusion is that, for the safety of Americans, the FDA should revise and shorten its drug approval process. Unfortunately, politics and influence peddling often play a part.
Additionally, only FDA-protected pharmaceuticals ever get marketed to physicians, and they get marketed hard. The result is when they see you in their office, physicians think first about expensive drugs, as opposed to cheaper and totally functional older medications. The newer, more expensive drugs are only occasionally better than the older drugs.
The other driver in skyrocketing pharmaceutical prices is the third-party payer system. For patients who are covered by traditional insurance or a government-funded program, it has become very easy to spend an unlimited amount of someone else’s money. As far as patients are concerned, the payers are faceless strangers and generally despised because they charge so much, so why not spend that distant company’s money on the newest and most expensive therapy? Pharmaceutical companies are very aware of this psychology, so they set prices high because they know that a) the doctor doesn’t care about price, b) patients don’t care about price, and c) the payer can only influence prices by interfering, denying access, or otherwise finding ways to avoid their contractual obligation to pay for their customer’s decisions.
As you know, the Liberty HealthShare Sharing Guidelines state that the members do not share in the costs of an individual member’s long term maintenance prescription pharmaceutical expenses. This puts the decision regarding price vs. quality fully into the hands of the individual member, who is best positioned to make those determinations. Despite the freedom and control this gives our members, we understand that the question remains, how can our members deal with the artificial price elevations that result from bureaucratic intrusion into the medical system?
First and foremost, before being prescribed a medication, tell your doctor that you are one of those enlightened people who care about the costs of your decisions, and ask him or her to help you choose the best quality for the price. This will encourage your doctor to start caring about your costs.
Second, thanks to the beauty of the free market, patients can shop around through many of the technologies they use every day. Shopping around for best prices yields three important results: it saves you money, it saves our membership money, and it brings competition back into the medical marketplace, which can only benefit patients.
As part of your Liberty HealthShare membership, you have access to the SavNet Health Savings Program. SavNet is a national organization that provides many health cost-saving tools, the most used of which provides for prescription medication discounts. SavNet groups pharmaceuticals into price tiers which are easy for you and your doctor to understand. The trick to saving oodles of money is to bring the SavNet Doctor Prescribing Guide that lists those tiers with you whenever you visit the doctor. You should have received the Doctor Prescribing Guide in the mail (or you can click above to download it). Show it to your doctor, and it should only take them a moment to choose the least expensive, highest quality alternative for you. Without this information, doctors are much more likely to write a prescription for the most aggressively-marketed (otherwise known as the most expensive) drug. Don’t let that happen. Remember that new drugs are rarely any better than older, less expensive drugs!
SavNet also offers important additional assistance. For medications that cost over $100 per month, SavNet provides special advice to access pharmaceuticals through various pathways that are available only to self-pay patients like our members. The medications often end up being provided at little to no cost. In a future email, we will teach about how this works, but for now, you can contact SavNet directly. Just let them know you are a Liberty HealthShare member.
Between discussions with your doctor with SavNet’s Doctor Prescribing Guide in hand, and other resources that are now widely available, you can work with your doctor to find ways to drastically cut your prescription drug costs. Not only will this save you money as you plan for your healthcare needs, but it will also help infuse a little bit of price competition back into the medical marketplace. And that, more than anything, will help America take back control of healthcare costs.