Cut high prescription costs

The bouncing, smiling anti-depressant pill that we’ve come to know through drug ads as Zoloft tells a sad story about the high cost of prescription drugs. And Maine legislators who understand the story may do something about it this year by requiring disclosure of drug marketing, of secret kickbacks, and of pharmacy prices of drugs.

Zoloft and a competing pill, Paxil, are two of the top 10 selling drugs in the United States despite the fact that a generic version of Prozac is cheaper and works almost exactly the same. Studies show that patients do equally well on any of the three drugs.

However, many doctors prescribe first the more expensive Zoloft and Paxil because these more expensive drugs are heavily marketed. There are no sales people, free trips to sunny shores or advertising to encourage doctors to prescribe the generic version of Prozac. Drug companies don’t market and advertise to us to improve our health. They market to steer us to higher-priced drugs, even when cheaper drugs will work just as well. We pay a steep price for the billions of dollars in marketing that the drug companies spend each year.

In this one example, we know we pay more than twice as much. Thirty pills of Zoloft cost $70, and of Paxil $78, compared to the $34 cost of the generic Prozac. (Prices are based on 20 or 25 milligrams from a U.S. mail order house.) Paying the higher prices drains our state budget and depletes the ability of our businesses to offer health benefits to workers, make profits and still compete.

We are spending more money than ever on expensive drugs. We spent 12 percent more on prescription drugs last year, which was on top of a 17 percent increase in 2001. We know that something is amiss when drug companies pay billions of dollars to advertise drugs that are desperately needed by people who cannot afford them.

For example, one of five seniors reports spending less on food, heat or other necessities so they can afford to buy their medications, according to a study reported by Georgetown University’s Institute for Health Care Research and Policy.

The bouncing, smiling faces of Zoloft and other drug ads coming into our homes through our television screen and our news and entertainment magazines are only a fraction of the marketing that drug companies buy. The drug companies spend about twice as many billions of dollars marketing prescription drugs to doctors and other health professionals as to consumers. In its most flagrant forms, this marketing attempts to buy influence with doctors about which drugs they prescribe.

As patients, consumers and taxpayers, we should be alarmed. Drug companies should not pay Maine doctors $75 or $100 to listen in by telephone to someone talk about a new prescription drug. The leading drug companies should not spend twice as much on marketing and administration as on drug research. Drug companies should not pay for expensive outings and trips for doctors. Doctors should not rely on the drug companies for most of their continuing education on drugs.

These practices add to our prescription drug costs and corrupt our health care system. For understandable reasons, no other developed country permits drug companies to use marketing and promotion to drive up health care costs like what is occurring in the United States. We all know there’s big money in prescription drugs, and we are watching that money corrupt ethics, the marketplace and our national politics.

By necessity, states like Maine have become the battleground to try to reform the prescription drug market and lower costs. While Maine’s most innovative programs like Maine Rx and Healthy Maine work their way through legal mazes, the Maine Legislature has more ideas for reducing the cost of prescription drugs. One, LD 254, will require drug companies to report to the state how much they spend on marketing in Maine each year.

This reporting requirement is the first step to understanding the scope of the problem. Now, no one knows, so we are left to speculate. Drug companies facing a disclosure requirement may rein in their spending on marketing in Maine. If we can slow the drug companies’ excessive marketing, we might slow the shift to more expensive drugs that is driving up the cost of health care to all of us in Maine.

Another bill, LD 554, will require disclosure of secret kickback deals made by the drug companies. Governments and insurers sometimes employ specialized middlemen (called pharmaceutical benefits managers or PBMs) to negotiate drug prices with manufacturers. Some of these PBMs have made secret deals with drug companies that increase the use of more expensive drugs, all of which drives up health care costs.

LD 554 will expose these secret deals and require that the money that is kicked back by the drug companies is passed through to reduce costs.

A third bill, LD 102, is modest but significant. The bill requires that pharmacies print the full price of a prescription drug on the receipt so that consumers know the actual cost of their prescription drugs.

Typically, those of us who have insurance coverage are aware only of our co-pay and don’t know the actual price of the drug unless we are willing to pester the pharmacist. Consumers who are aware of price will respond differently to marketing.

Drug industry lobbyists will tell Maine legislators again this year that nothing is broken, but the people watching the ads for prescription drugs priced beyond their means know that isn’t true. Legislators may need to hear that message from you so they know that we’re not happy about the bouncing, smiling faces.

Tom Bradley is staff attorney for the Maine Citizen Leadership Fund, a nonpartisan, nonprofit organization which works for affordable prescription drugs. Information about prescription drug prices is available at MCLF’s Web site, www.RxMaine.com.