We often forget that in addition to other drugs certain foods can have unpleasant interactions with our prescriptions. An article in The Gazette (of Colorado Springs) is reminding us that especially during the holidays (we’re not saying you eat too much!) it is important to check what foods and beverages interact with your prescriptions and over-the-counter (OTC) drugs.
Below is a list of the most commonly prescribed drugs, their purpose, and the foods that could create a dangerous combination.
LIPITOR; high cholesterol; grapefruit
TOPROL XL; high blood pressure, heart failure and angina; take on an empty stomach
SINGULAIR; asthma and allergies; no restrictions
LEXAPRO; depression and anxiety; alcohol
NEXIUM; gastrointestinal reflux disease and gastrointestinal ulcers; no restrictions
SYNTHROID; hypothyroidism; no feeding through tubes
PREVACID; gastrointestinal reflux disease and gastrointestinal ulcers; take on an empty stomach
PLAVIX; stroke and heart attack; no restrictions
NORVASC; high blood pressure and angina; grapefruit
You could say that ads for prescription drugs were the camel’s nose under the tent. Once you start advertising prescription drugs like they’re shampoo or fabric softener, what’s next? How about medical devices? Or even surgical procedures? Heck, why NOT? If you’re going to turn medical treatments into a consumer commodity, why not go whole hog, as it were?
Well, because, of course, it’s a terrible idea. Medical treatments, be they pills, devices or procedures, are not consumer goods, and we shouldn’t treat them like consumer goods. It minimizes their importance, causes people to use them when they shouldn’t, and most fundamentally, promotes the notion that health care is a “product” that we “consume.” It is a triumph of marketing over medicine that we now consider ourselves health care “consumers” rather than “patients.”
Some might argue that this can be a good thing, given people’s interest in being informed, empowered consumers; that it’s a further shift from the old “doctor knows best” days when we were passive recipients of whatever our doctors deemed was in our interest. But medical marketing doesn’t necessarily turn us into empowered consumers — it just as easily turns us into the unpaid sales force for drug and device companies — and the target we’re trying to sell to, ironically, is ourselves, and our doctors.
Now a new frontier is opening in health-care advertising that may be even trickier to evaluate: ads for medical devices and procedures.
A raft of ads for everything from hip replacements to radioactive seeds to treat prostate cancer has hit the airwaves over the past couple of years, as companies tap the aging population to boost sales. And like most commercials, the ads don’t pull any punches. A spot that launched in January for Medtronic’s implantable defibrillator, used to revive someone who’s suffered cardiac arrest, promises a longer life for patients. “If you’ve had a heart attack or have heart failure, inside this little device, you just might find 10,000 more kisses, snow, 200 more football wins…
We here at PAL frequently argue that drug ads are on balance a bad thing, and in making this argument, we frequently pose the hypothetical of medical procedures being advertised. “Most people,” we like to say, “would think it a bad thing if they saw an ad for open heart surgery, or a coupon for 20% off your next colonoscopy.” Yet that’s exactly the type of promotion that the market is starting to move towards.
Here’s one example of a TV ad for a medical device:
Want to give the breast holiday present ever? How about the gift that keeps on giving: Plastic surgery!
We’ve all heard about high schoolers begging for — and getting — nose jobs for graduation or sugar daddies funding their girlfriends’ lunchtime lipo, but now, just in time for Christmas, you can give the one you love a BOTOX® Cosmetic (Botulinum Toxin Type A) gift card. Just wait until you see the (lack of) expression on her face when she unwraps what she thinks is a $50 Bed, Bath & Beyond gift certificate but is actually the pathway to three-to-six months of eternal youth.
“Dear Journalist,” the press release addressed to me read, “For your Holiday Gift Guide, please consider a story about taking the stress out of finding the perfect holiday gift! A recent international survey found that 52% of women ‘of a certain age’ would like to receive cosmetic injectables as a gift, which begs the question … how do you wrap it?”
One question about ads for medical procedures and devices is whether they contain adequate information about risks and side effects. Obviously, a medical device has one key difference from a drug: You can stop taking a drug at any time, but you can’t just yank out a knee replacement, gastric band or cardiac defibrillator. If you have a problem with a medical device, or if new information about risks comes to light, you usually have to have surgery to remove it — which can take time, be costly, and have its own risks. Consumer Union, the publisher of Consumer Reports, recently petitioned the FDA to require that all ads for implantable devices warn consumers about the risk of hospital-acquired infections and the expected life span of the advertised device. Here’s an excerpt of the press release:
Advertisements for Medical Devices, Implants Should Carry Warnings of Dangerous Side Effects, Infections
Consumers Union petitions FDA to require clearer warnings on DTC device ads
(Washington, DC) – Consumers Union has filed a petition with the FDA requesting it require all advertisements for implantable devices – such as knee, hip and heart valve replacements, cosmetic implants and heart stents – carry a warning about the possibility of dangerous infections or failures of the devices once they are in the body.
Implantable device makers recently have launched a wave of direct-to-consumer advertisements for their products, and Consumers Union said a review of these ads show that most lack basic information about the possibility of severe or fatal side effects.
“There is no question that many of these devices can restore high quality-of-life in patients, but we are concerned that serious and possibly deadly side effects like infections are consistently understated in these device ads,” said Bill Vaughan, senior policy analyst for Consumers Union, publisher of Consumer Reports.
“We’re asking the FDA to require clear warnings about the dangers of infection during and following such surgery, and information about how long the devices are likely to last once they are in the body,” Vaughan said.
(The full Consumers Union FDA petition can be found here.)
All of this begs the larger question of whether advertising medical treatments — drugs, devices, procedures — at all is a good idea. Most countries don’t allow so-called “Direct-to-Consumer Advertising.” Yet the pharmaceutical industry alone spent more than $5 billion advertising prescription drugs in 2006, and that number has been growing steadily since 1997. The reason? It’s extremely profitable. Estimates vary, but on average every dollar spent on drug ads produces $1.50 to $4.20 in sales — quite a handsome return on investment. Other industries, particularly the medical device industry, are no doubt eager to hop on board this gravy train. But we rightly should ask whether it’s for our benefit… or their bottom line.
Last week, we here at PAL joined 11 other consumer and public interest organizations in filing a amicus curiae (“friend of the Court”) brief in the case of Tafas / GSK v. Dudas et al. Details are below. PAL believes that manipulation of the patent process by pharmaceutical companies has a detrimental effect on consumers’ access to prescription drugs. The brief was written by the Public Patent Foundation, a member of the PAL coalition.
Consumer and Public Interest Groups Back New U.S. Patent Rules That Would Curtail Abusive Behavior By Applicants
ALEXANDRIA, VA – December 20, 2007 – A coalition of consumer advocacy and public interest groups today filed legal papers supporting new U.S. Patent Office (USPTO) rules that would curtail abusive behavior by patent applicants and improve patent quality.
In a friend-of-the-court brief filed in U.S. District Court in Alexandria, VA., the groups urged that an injunction blocking the proposed rules be lifted and they be implemented immediately.
The proposed new regulations ask applicants to justify the need for more than two continuations per application and to assist the USPTO in performing initial technological research on applications that contain an excessive number of claims.
The groups joining in filing the Public Interest Amici brief are: The Public Patent Foundation (“PUBPAT”), Computer & Communications Industry Association (“CCIA”), AARP, Consumer Federation of America (“CFA”), Essential Action, Foundation for Taxpayer and Consumer Rights (“FTCR”), Initiative for Medicines, Access & Knowledge (“I-MAK”), Knowledge Ecology International (“KEI”),Prescription Access Litigation (“PAL”), Public Knowledge (“PK”), Research on Innovation (“ROI”), and Software Freedom Law Center (“SFLC”).
“The public interest overwhelmingly supports the USPTO’s Final Rules for at least two significant reasons,” the brief said. “First, they will enable the USPTO to curtail abuses of the patent application process made by those patent applicants who seek to pervert the system to gain an unfair advantage. Second, the Final Rules will help the USPTO
improve patent quality, which is a critical issue for ensuring the patent system benefits the American public.”
The new rules were to have been implemented by the patent office on Nov. 1, but were blocked by suits brought by drug maker GlaxoSmithKline and inventor Triantafyllos Tafas.
Under current rules which allow unlimited continuations, USPTO examiners who have repeatedly rejected an application often face an endless stream of continuation applications that “may well succeed in ‘wearing down the examiner’, so that the applicant obtains a broad patent not because he deserves one, but because the examiner has neither the incentive nor will to hold out any longer,” according to professor Mark A. Lemley of Stanford Law School and Kimberly A. Moore, now a Circuit Judge on the U.S. Court of Appeals for the Federal Circuit.
Pharmaceutical companies are most likely to use continuations in order to help them keep monopolies over their drugs. According to the publication Nature Biotechnology, from 1995 to 1999, 41% of drug patents issued were based on continuations. In contrast only 22% of the patents issued in mechanical engineering were based on continuations.
The consumer and public interest groups’ brief said the new rules would:
– Curtail abuse of continuation applications and unlimited claiming,
– Help the USPTO improve patent quality, and
– Increase patent office efficiency.
The legal papers, available below, also noted that while briefs filed opposing the new rules claimed they were acting in the “public interest”, in fact they represented the narrow interests of patent holders and patent attorneys.
“Congress has intentionally implemented a patent system that balances the incentives provided to patentees with the benefit to the public of the disclosure and ultimate dedication of the resulting inventions to society,” the consumer groups said. “Thus, the public interest lies in an efficiently functioning patent system, not one that is subject to abuse and manipulation.”
The consumer and public interest groups said that despite having various missions and activities, they are united in their belief that patent law and policy should be crafted to ensure that it benefits the public interest. They “firmly believe that the Final Rules would significantly advance both the general public interest and the specific aspects of the public interest that they each separately exist to represent. Thus, the Public Interest Amici have united in this brief to express a single voice in support of the Final Rules.”
Papers Filed By Public Interest Amici Curiae, Public Patent Foundation et al., in Tafas / GSK v. Dudas et al.
It’s open enrollment season for seniors joining or changing their prescription drug coverage, so advice abounds on how to choose a Part D plan, how to comparison shop, etc. But what about once you’re on a plan? Merrill Goozner, of Gooznews, wrote a post last week about why the government isn’t tracking how many seniors are falling into the infamous donut hole, the gap in coverage during which your Part D pays nothing towards your drug costs:
Beyond the Donut Hole: Who’s Watching?
The famous donut hole in the Medicare prescription drug benefit — where seniors have to pick up 100 percent of costs once total expenses go beyond $2,400 a year until it hits $3,850 — was a major bone of contention when the bill passed in 2003. So you’d think the Center for Medicare and Medicaid Services would keep a close eye on how many seniors are falling into the donut hole so they can make sure they get picked up once their drug costs go above the $3,850 mark.
As they like to say in New York: fuhgeddaboudit. A new report from Health and Human Services department Inspector General Daniel Levinson shows that nearly a third of insurance companies selling drug benefit plans to seniors have not bothered to report to CMS how many seniors have fallen into the donut hole. The law required the reports.
And what is CMS doing aobut it? The agency said it had received “few complaints” from beneficiaries about companies failing to accurately calculate their out-of-pocket costs, but it would work to improve its reporting system for drug companies.
Bottom line: Seniors should closely track of their own bills to make sure their insurance companies start paying the catastrophic benefit when they reach $3,850. It’s either that or rely on your insurance company, since this government isn’t paying attention.
Critics of drug ads have been calling for restrictions ever since the ads hit the airwaves back in 1997. The pharmaceutical industry has always been able to block any Congressional attempts at putting meaningful regulation into place. This past year, a number of Congressional Reps and Senators tried to put in place a “moratorium” in which new drugs would not be able to advertise to consumers for a certain length of time (say, two years). Even that modest reform was removed from the final bill, which became the FDA Amendments Act of 2007. (FDAAA, which we prefer to pronounce as though it’s “open wide and say FDAaaaaaa….”).
One reform did make into the final legislation, however. But don’t fret — the ad agencies that produce drug ads won’t be showing up on your street corner with “Will Shill for Food” signs anytime soon. The FDA has never had the power to require drug companies to submit their ads before they hit the airwaves, and they still don’t. But, now, drug companies can voluntarily submit drug ads to the FDA for “pre-broadcast review.” If they choose to do so, they have to pay a fee for that review. And the FDA has just announced that the fee for each ad in 2008 will be $41,390. That’s a pretty modest fee – most ads no doubt cost much more than that to produce and to air.
How did the FDA arrive at this seemingly odd number? Why $41,390 and not $57,642? The FDAAA called for the FDA to raise $6.5 million for the program in the first year. The FDA asked drug companies to estimate how many ads they’d submit in 2008, and then divided $6.5 million by that number. Which means that drug companies estimated that they’d be submitting 157.04 ads for pre-broadcast review in 2008 (I, for one, look forward to seeing the .04 ad – I imagine it won’t get past “Ask you doctor ab…”).
What if a drug company goes over its estimate? It pays a 50% surcharge.
Now one might reasonably ask “Why would a company submit an ad for pre-broadcast review if it’s voluntary?” And that’s a good question. Arguably, many won’t. Those that will are hoping to avoid the FDA later issuing an enforcement letter citing violations in their ads. Better to get “clearance,” if you will, beforehand, than a rebuke after the fact. This is the reverse of the old saw that it’s better to seek forgiveness than permission.
Here’s what’s unclear: What legal status will an FDA pre-broadcast approval of an ad have?
What if, for instance, consumers are deceived by an ad that overstates a drug’s effectiveness or understates its risks, despite the FDA’s pre-broadcast review, and file a lawsuit claiming that the ad violates state consumer protection acts? I have no doubt that drug companies will argue that an FDA pre-broadcast approval of an ad “preempts” any claims under state law that an ad was unfair or deceptive. The industry has been arguing that virtually any claim under state law that a person was harmed, deceived, injured or even killed is “preempted” by the FDA’s authority to regulate prescription drugs. (We’ve written about the preemption issue ad nauseam on this blog — see archived posts on the topic here).
Arguably, the standards that the FDA will apply in its pre-broadcast review are different than those that are relevant to state consumer protection laws, which aim to protect the public from “unfair or deceptive” conduct in the marketplace. The FDA is primarily concerned with making sure that drug ads do not “misbrand” drugs a term from the Food, Drug and Cosmetics Act and the FDA’s regulations.) Conduct that is “unfair or deceptive” under state law is arguably broader than conduct that constitutes “misbranding.” But conduct that constitutes “misbranding” is most likely also “unfair or deceptive” under these state laws. This is a good example of how state consumer protection law and the FDA’s authority are complementary, rather than contradictory. So I would argue that an FDA pre-broadcast approval should not insulate a drug company from liability under state law. Whether or not courts will agree is an open question — the jury, as they say, is still out on the issue. The Supreme Court just recently took up the preemption issue generally in the case of Riegel v. Medtronic, a case that concerned medical devices, not drugs. (PAL joined an amicus brief in that case, and we’ve blogged on it here before.) The Supreme Court’s ruling on preemption in that case is likely to have some effect on how Courts address drug preemption issues, although not as much as if the Supreme Court directly addressed the question of preemption in the realm of drugs.
It will be interesting to see how the FDA pre-broadcast review program shakes out in its first year. Will it result in fewer enforcement letters being issued? Will it change the tone and tenor of drug ads in any meaningful way? To find out, all you’ll need to do is stay tuned to your TV, where drug ads will continue to bombard you on a regular basis. Enjoy!
PAL coalition member Breast Cancer Action today issued a statement on the FDA’s denial of Genentech’s [NYSE:DNA] application to have its drug Avastin approved for treatment of metastatic breast cancer. Avastin is currently approved for treatment of metastatic colorectal cancer and advanced non-small cell lung cancer. Genentech has been in the news recently for restricting the availability of Avastin to pharmacies that divide vials of Avastin for use as a treatment for the eye condition macular degeneration. These “off label” uses of Avastin are much less expensive than Genentech’s drug Lucentis, which is approved for macular degeneration. Genentech also came under fire in 2006 for greatly increasing the price of Avastin, in what many saw as a preemptive move in anticipation of what Genentech hope would be FDA approvals for lung cancer and breast cancer. The FDA did approve the drug for advanced non-small cell lung cancer.
Here is Breast Cancer Action’s statement on the Avastin denial:
Breast Cancer Action (BCA) applauds yesterday’s recommendation by a Food & Drug Administration (FDA) advisory committee to deny approval of Avastin as a breast cancer drug for metastatic patients.
In a letter to the Oncologic Drugs Advisory Committee (ODAC), BCA urged denial based on the fact that the drug’s maker, biotech giant Genentech, did not provide data indicating that Avastin improved overall survival or quality of life.
By a 5-4 vote, the committee agreed, indicating that the toxic side effects outweighed the potential benefits of the drug. ODAC member and patient advocate Natalie Compagni Portis told the New York Times that she voted no because while it’s painfully true that metastatic breast cancer isn’t curable, “I don’t think that means that we should just say, ‘Well, here, try this,’ if there isn’t meaningful data to support it.”
BCA Executive Director Barbara A. Brenner told the San Francisco Chronicle, “It’s not necessarily a bad drug. We just don’t know if it’s a good drug.” Brenner also criticized the estimated $100,000 a year price tag for Avastin.
BCA believes that a drug should increase overall survival or improve quality of life before being approved. Additionally, it should be more affordable than the available alternatives.
The recommendation now goes to the FDA commissioner, who will make a decision in February. We will continue taking action–and asking you to do so–on the issue, so stay tuned.
The LA Times ran an article today, High court may bar claims for FDA-approved drugs, discussing two cases that are currently before the U.S. Supreme Court. The cases address whether lawsuits that are based on on state common law claims alleging that patients were injured by dangerous drugs or medical devices are “preempted” by the FDA’s authority under federal law.
This seemingly-obscure but important legal fight will determine whether or not patients who are injured, killed or merely ripped off by illegal activities by drug and medical device companies are able to get compensation and relief in the Courts.
This is an issue we’ve written about here frequently on the PAL blog — see previous entries here.
PAL also signed on to an amicus curiae (“friend of the Court”) brief in the Riegel v. Medtronic case. The brief was written by Community Rights Counsel and can be found here.
Alison Zieve, from Public Citizen Litigation Group and counsel for the Riegels, had this to say about the preemption argument:
she said the preemption argument was more central to the case, calling it “essentially a get out of jail free card.”
If the court upholds Medtronic’s position, Zieve said, it means that “no matter who messed up, you can’t sue the company.
The Savannah Morning News reported on Saturday that Montel Williams verbally threatened three of its reporters following a Partnership for Prescription Assistance event in Savannah, including a high school student intern:
Television talk-show host Montel Williams threatened to find and “blow up” the homes of three Savannah Morning News reporters Friday while he was in town promoting free prescriptions for poor people.
The incident took place at the Westin Savannah Harbor after an event in Johnson Square for the Partnership for Prescription Assistance’s “Help is Here Express.”
Before the event, Williams took exception to a question asked by Morning News high school intern Courtney Scott and abruptly ended a videotaped interview.
Later, Scott, web content producer Joseph Cosey and intern Phillip Moore went to the Westin for an unrelated assignment featuring gingerbread houses at the hotel.
Williams and his bodyguard were in the lobby, too.
“As we were preparing to film, Montel walked up with his bodyguard and got in Courtney Scott’s face pointing his finger telling her, ‘Don’t look at me like that. Do you know who I am? I’m a big star, and I can look you up, find where you live and blow you up,’ ” Cosey said. “At this time he was pointing randomly at all of us.”
The incident is a huge embarrassment for Montel Williams, for the Partnership for Prescription Assistance (PPA), and for PhrMA, the Pharmaceutical Researchers and Manufacturers of America, which created the PPA. What’s surprising about the whole incident is how innocuous the student reporter’s initial question was. Watch the video below to see the offending question.
The question was whether Montel thought that drugmakers would be discouraged from research and development if profits were restricted. This is not even a softball question. In fact, it’s practically an engraved invitation to regurgitate one of PhRMA’s most overused talking points. PhRMA responds to any attempt to do anything at all to reduce drug prices by saying that reducing drug industry profits will hurt R&D, and thus by implication, prevent lifesaving new blockbuster drugs from reaching the market. This answer, of course, is completely absurd and belied by numerous facts — such as the fact that the pharmaceutical industry still spends about twice as much on marketing and administration as it does on research and development, and earns on average as much as or more in profits than they spend on R&D.
So why was Montel so angered by this question, a question which arguably invited a stock answer that PhRMA reps repeat dozens of times a day? It’s not as if the reporter asked “Why doesn’t the pharmaceutical industry make its Guiding Principles on Drug Advertising mandatory and enforceable?” And it’s not as if the reporter asked some obscure question on some obtuse point of, say, patent law or the issue of follow-on biologic drugs. It’s surprising that the industry’s main spokesperson for its patient assistance program was so poorly prepared to answer such an easy question.
But perhaps all this is beside the point. Does it ultimately matter if Montel Williams answers questions about the industry’s priorities and policies, or any questions beyond the mechanics of this patient assistance program?
The answer is, yes, it does. Montel Williams has become one of the most visible spokespeople for the industry. He lends his name and his credibility to the cause of burnishing the image of America’s pharmaceutical companies, and is paid (presumably handsomely) to do so. So it’s entirely fair that he be asked questions about the industry. Although perhaps Ken Johnson, PhRMA’s Senior Vice President of Communications, is the better person to ask this kind of question, Montel is fair game as well — by accepting the industry’s money, and acting as his spokesperson, he has to take what comes with that — including fair questions about the industry’s misplaced priorities.
The New York Times ran an article on Saturday on a reported written on the state of the FDA by 3 members of the F.D.A. Science Board. According to the article, the report concludes that:
over the last two decades, the agency’s public health responsibilities have soared while its appropriations have barely budged. The result is that the F.D.A. is falling farther and farther behind in carrying out its responsibilities and understanding the science it needs to do its many jobs.
“F.D.A.’s inability to keep up with scientific advances means that American lives are at risk,” the report stated.
Other excerpts from the report were:
“Reports of product dangers are not rapidly compared and analyzed, inspectors’ reports are still handwritten and slow to work their way through the compliance system, and the system for managing imported products cannot communicate with customs and other government systems”
“F.D.A.’s ability to provide its basic food system inspection, enforcement and rule-making functions is severely eroded, as is its ability to respond to outbreaks in a timely manner.”
It is hardly surprising that the FDA cannot do its many vital jobs, given the inadequacy of the appropriations it receives every year. The FDA is responsible for regulating the safety of our food supply, and of the drugs and medical devices used to protect health and cure illness. It should have funding that is robust enough to allow it adequately protect the public from unsafe food and drugs, but does not.
The FDA’s review of new drugs is now funded by the very drug companies who stand to profit when those drugs are approved. The more drugs reviewed and the faster they are approved, the more funding the FDA receives from drug company “user fees.” The agency, like so many federal agencies, has a constantly-spinning revolving door between itself and the industries it regulates, so much so that its decisions seem geared more towards protecting those industries than protecting the public.
Short-changing the FDA is the ultimate in “penny-wise, pound-foolish” thinking. Every new crisis in food safety or drug dangers briefly raises the public’s awareness of and concern for the FDA and its ability to do its job, but the underlying crisis with the FDA soon fades from public consciousness. What we need is for the public to pressure Congress to take the FDA and its incredibly important roles seriously, and ensure that it has adequate funding not just now, but for the long haul. But funding does not necessarily equal good monitoring and enforcement. We need leadership at the FDA that is willing to take on and challenge the industries that it regulates, and that don’t just act as industry’s rubber stamp.
Until that happens, the next catastrophe will always loom just around the corner.
The Los Angeles Times ran an article today by Fran Kritz, Heading to the drugstore? Clip a coupon — but read the fine print. The article talks about the growing use of retail “coupons” by drug companies anxious to stave off competition, from cheaper generics or other drugs. Coupons are better suited to regular consumer products like shampoo, fabric softener and breakfast cereal than to medical treatment. This is why we here at Prescription Access Litigation oppose the use of coupons for prescription drugs, and why last year we called on the FDA to ban them.
PAL’s director is quoted in the article:
Last year, the FDA posted a federal register notice asking for public comments on the proposed study. The agency has since pulled the notice, spokesman Sandy Walsh said, in order to refine the parameters of the study, but in the meantime, comments voicing opposition to coupons came into the agency. The Prescription Access Litigation Project, for example, a group devoted to lowering the cost of prescription drugs, filed comments representing 23 consumer groups calling for an outright ban on prescription drug coupons. Among the complaints: that coupons interfere with a doctor/patient relationship by leading consumers to ask their doctor for a drug for which they’ve seen or received a coupon, and that they deceive consumers into using high-priced brand names over generics.
“A $10 coupon is nothing compared [to] the long-term savings from using a cheaper generic drug, particularly for long-term maintenance drugs,” says Alex Sugarman-Brozan, the group’s director.
The prices of brand-name drugs that don’t face competition from less expensive generics are completely arbitrary — the manufacturer just sets a price that it thinks the market will bear. So what does a coupon mean in that kind of situation? We compare it to a store that one night raises its prices, and then the next morning announces a sale. How do you know how much you’re really saving? How do you know if you’re getting a good deal? The answer is — you don’t. And brand-name drug companies count on that. They also count on the fact that people think they’re getting a better deal when they get some kind of discount (sale price, coupon, etc.) than when the base price of a product is just lowered. So drug coupons create a false sense of savings.
Drug coupons are also intended to do an “end-run” around health plans’ efforts to steer their members to less expensive but equally effective generic drugs. Let’s say your health plan charges a $10 co-pay for a generic heartburn drug, and a $20 co-pay for an expensive brand-name heartburn drug. The difference to you, the patient, is $10. If you get a $10 coupon for the brand-name drug, you don’t pay any more for the brand-name than the generic. But the generic usually will work just as well as the brand-name. So what’s wrong with that, people may ask.
The difference to the health plan is usually much more. The health plan might be paying $40 or $50 more for the brand-name drug than the generic. So what, you might say. That’s their problem, not mine. That $40 or $50 more the health plan pays doesn’t come out of nowhere — it comes out of your premiums. So next year, your premiums might go up that much more. In prescription drugs, as in life, there’s no such thing as a free lunch.
The article also points out that the savings with a coupon often still don’t match the savings on a generic:
Synthroid, for example, a brand-name drug from Abbott Laboratories that treats thyroid hormone insufficiency, costs $13.99 per month at drugstore .com, versus $8.99 for the generic. But the coupon Abbott is now promoting only takes $3 off of each prescription, making the generic cheaper by $24 per year.
So, next time you see a coupon for a prescription drug, be wary. Ask your doctor if there are generic or even Over-the-Counter options that work as well as the brand-name drug. If you have health insurance, see if your insurance (if you’re insured) has lower co-payments for generics — some insurers are even starting to charge zero co-payments for generics. If you don’t have health insurance, check out RxOutreach.org, a Patient Assistance Program offering deeply discounted generic drugs. And whether you have insurance or not, check out Consumer Reports Best Buy Drugs to see what drugs are the “best buy” for the condition you have.
To read our comments to the FDA, calling on them to ban drug coupons, go here.
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