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Tuesday, July 16, 2024

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News + PoliticsHealthcareSinging the insanity of the US healthcare system

Singing the insanity of the US healthcare system

Big Pharma spends a fortune on ads— but hardly anyone can figure out how much the medications really cost (and fewer can afford them).


America’s healthcare system is bonkers. And the way it handles prescription drugs is one of its most insane corners—a fact that two recent examples really drove home.

If you watch much TV, you can’t avoid commercials for prescription drugs. The one that most annoys me—admittedly, it’s a tough competition—is the ad for Jardiance that blanketed a number of channels this summer and early fall. If, like me, you regularly watch Chris Hayes and Rachel Maddow on MSNBC, you’ve probably seen it dozens of times at least.

In the ad, a cheerful young woman surrounded by dancers sings exuberantly, “I have type 2 diabetes but I manage it well/It’s a little pill with a big story to tell.” She spends a full minute singing and dancing about her medicine, ending with the carefully considered medical opinion that “Jardiance is really swell.”

This is obnoxious on so many levels that I barely know where to start. For one, it trivializes type 2 diabetes, a serious, complex disease with potentially life-threatening consequences. The message in essence is, “Just pop our little (very expensive) pill and you don’t have to worry.”

A song and dance doesn’t make people healthier.

In fact, per the CDC, while drugs like Jardiance can often play a role, there’s a lot more involved in managing type 2 diabetes, including diet and monitoring of blood sugar levels. Meanwhile, the required list of scary and potentially deadly drug side effects is, as usual in such ads, blitzed through as quickly as possible by a monotone-voiced narrator who’s clearly been instructed to make this information as uninteresting as possible.

Is this sort of commercial the best way to handle tricky and expensive prescription medicines? Most countries don’t think so. The U.S. and New Zealand are the only countries that allow direct-to-consumer advertising of prescription drugs. I’m old enough to remember when the US didn’t permit it either, allowing ads directed at healthcare professionals only.

Most-advertised doesn’t mean better

Big Pharma spends lots of money advertising a relative handful of high-priced drugs. In 2022, Jardiance ranked number five on the list, with $145 million spent on TV ads alone. That’s less than half of what was spent pushing the number one drug, Rinvoq—an anti-inflammatory used to treat eczema, rheumatoid arthritis, Crohn’s disease and other conditions—which racked up over $315 million in TV spending.

Drug companies don’t spend that sort of money promoting cheap medications with low profit margins. They push newer, pricier drugs on which they can make a killing.

Per Jardiance manufacturer Boehringer-Ingelheim, this “little pill with a big story to tell” lists for $570.48 for one month’s supply. That’s brutal for those without insurance and represents a potentially huge cost for insurers, given that more than 37 million Americans have type 2 diabetes. Even those with insurance could be stuck with a whopping copay. (Meanwhile those with type 1 diabetes, who generally need to take insulin every day, will get no immediate help from California—Gov. Gavin Newsom recently vetoed legislation that would have capped insulin copays at $35.)

But Jardiance is cheap compared to Rinvoq, the most advertised drug. Rinvoq lists for $6124.96 for a one-month supply, per drugmaker AbbVie.

All of this might make sense if the most heavily advertised drugs were the most effective for the conditions they’re designed to treat, but recent research suggests they’re not. In one study published earlier this year, researchers from Yale, Harvard and Dartmouth found, “Fewer than one-third of the most common drugs featured in direct-to-consumer television advertising were rated as having high therapeutic value, defined as providing at least moderate improvement in clinical outcomes compared with existing therapies. Manufacturers’ television advertising spending on included products rated as low therapeutic value was $15.9 billion from 2015 to 2021.”

A second recent study, out of Johns Hopkins, reported similar results: “…a higher proportion of promotional spending allocated to direct-to-consumer advertising was associated with drugs rated as having lower added clinical benefit than for those having higher added clinical benefit.”

Meanwhile, Big Pharma is suing to block Medicare from negotiating lower prices for a handful of widely-used drugs, a long-overdue effort authorized by President Biden’s Inflation Reduction Act.

Generic drugs get crazy, too

Drug pricing madness is not limited to fancy, brand-name drugs. It can get seriously weird with generics as well. As regular 48hills readers may remember, I’ve been dealing for over a year with peripheral neuropathy—painful nerve damage—caused by COVID-19. There are no great treatments for this, but a couple drugs seem to help some people.

Lately, I’ve been taking one of them, called pregabalin—brand name Lyrica. Since there are generic versions available, that’s what I’ve gotten. But the pricing is downright demented.

My initial prescription was for a 30-day supply of 75 milligram capsules. My Medicare drug plan, run by a company called Wellcare (don’t get me started on the Republican madness that led to Medicare prescription drug coverage being handled by private insurers), informed me that the price of the drug was $130, of which they would pay $17.98 and I would be charged $112.02.


That dose didn’t really help, so my neurologist suggested upping it to 150 mg. I was frightened to contemplate what that might cost, but when the news came, I got a pleasant surprise: The price for a 30-day supply of 150 mg. capsules was $65, of which I’d only have to pay $44.

That’s not a typo. The same number of capsules with double the dose is cheaper. Lots cheaper. Both are generics, packaged similarly, so… WTF?

I called WellCare, spending over half an hour on the phone with a rep. She managed to explain that my higher copay for the lower dose was because I hadn’t yet met my deductible for the year, a one-time situation until the new year starts.  But she had no explanation why the drug itself cost twice as much for half the dose.

So next I emailed the pharmacy that had handled both prescriptions, CVS/Caremark. Perhaps they could explain why half the dose cost twice as much. Here is their initial response:

We understand your concern. A lot of factors go in to [sic] the pricing, the demand for the medication, cost to make the medication, sometimes pharmacies may get a limited number of drugs at a lower cost and may be required to limit what they charge. For further information regarding plan design, please contact WellCare with the phone number on the back of your member id card.

I wrote back, this time specifying that I planned to write about this situation in an article on drug pricing and suggesting that if they wanted to give a more substantive response, this would be a good time. No luck. Their second response simply indicated that the price indicated was “the contracted rate” for each dose and added, “The actual drug cost is determined by the drug’s manufacturer and may increase/decrease at any time.” CVS/Caremark did confirm that if I ordered the 75 mg. capsules again this year, my copay would be $44, not $112. 

It appears that the two doses of pregabalin came from different manufacturers: The 75 mg. was produced by Cipla Limited and the 150 mg. capsules came from Rising Pharmaceuticals. That’s a puzzle because Drugs.com indicates that both companies make both the 75 and 150 mg. sizes, along with several others.

So what’s going on? I still don’t know. Having spent many years covering healthcare regularly, I can guarantee that a call to the companies themselves would just produce more unverifiable boilerplate. That’s all you ever get from drug companies when you ask them to explain their pricing, and no law or regulation requires fuller disclosure. I may never know why half as much pregabalin costs twice as much.

But never forget that our system of funding healthcare produces the highest cost per person of any high-income country. And this staggering expenditure produces the lowest life expectancy of any wealthy country.

Tell me again, why do we put up with this?

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