By Dr. Geoffrey Modest
The Boston Globe had a front page article on a relatively new face of drug companies’ relentless, seemingly inexorable pursuit of profit, this time extending more into generics. A recent blog mentioned a few generics with unconscionable price increases, noting that Daraprim (pyrimethamine) had a dramatic increase in cost (though this was apparently decreased after public outrage), as well as doxycylcine going from $20/bottle in 2013 to $1849 eighteen months later (see https://stg-blogs.bmj.com/bmjebmspotlight/2015/09/30/primary-care-corner-with-geoffrey-modest-md-and-the-drug-company-shenanigans-continue/ ). The new Boston Globe article comments on several generic drugs increasing by up to 75 times their price over the past 2 years (see http://www.bostonglobe.com/business/2015/11/06/generic-drug-price-increases-alarm-insurers-providers-and-consumers/H3iA9CSxAUylnCdGjLNKVN/story.html?s_campaign=email_BG_TodaysHeadline&s_campaign= ). I will include below the examples they gave, since they did not come out in the link provided.
Details:
- Globe examples (comparing 2013 to 2015 prices):
- Amitryptyline 100 mg, was $0.04/pill in 2013, now $1.03 (a 2,475% increase)
- Captopril 12.5 mg was $0.11/pill, now $0.91 (a 727% increase)
- Digoxin 0.25 mcg was $0.12, now $0.98 (a 717% increase)
- Tetracycline 250 mg was $0.06, now $4.60/pill (a 7,567% increase)
- Clobetasol, a very potent topical steroid, increased from $0.27/gram to $4.15/gram (a 1496% increase), meaning that a 30 gram tube went from around $8 to $125!!!
- Generics comprise 80% of all prescriptions, so I guess it is not so surprising that the drug companies are targeting these drugs. And even though they are not nearly the price of the new hepatitic C drugs, many people are on these meds and often for a long time.
- A survey by the National Community Pharmacists Association found “that virtually all were grappling with ‘large upswings’ in the costs of generics, with ‘overnight’ price changes sometimes exceeding 1,000 percent”
- The issue is that drug prices are not regulated in the US (as opposed to many other countries), so there are no constraints on drug company price setting. And, there is no way that we guys in primary care have the time or ability to track these daily huge changes in pricing. And the issue is made worse by increasing mergers (e.g. the recent one of the generic-maker Teva Pharmaceuticals buying the generics division of Allergan PLC of Ireland in a $40.5B deal), decreasing the potential for competition
- In case you thought that overall the drug companies are fair and responsible, and that they incur great R&D costs to develop new and really important drugs, see doi: 10.1136/bmj.e4348, which highlights how few really significant innovative drugs are actually developed (only a small minority, on the order of 10-15% are not simply look-alike drugs, such as yet another ACE inhibitor), that 80% of basic research costs actually come from public sources, and that the drug companies have a remarkably inflated assessment of the costs of drug development (which, of course, they highlight whenever questioned about the high cost of drugs). And, of course, with regard to generics, there is $0 in R&D…
So, what’s wrong with this picture???