I love the variety of comments that this site receives. Most of the comments reveal much thought and passion. I rarely comment on the comments, primarily because I just do not have that much time. However, this comment struck me as worthy of a rant:

I’d like to hear more about your views on regulating drug pricing in this country. And by all means, let’s hear what you’ve got to say about restricting drug marketing. We regulate energy pricing (and have catastrophic examples of what can happen when energy pricing is deregulated). We restrict non-print advertising for tobacco and liquor. Why shouldn’t we do the same in another setting where market forces are not truly operational and the public interest is clearly being compromised? I just hope you’ll spare me the tired old story about drug innovation disappearing if the pharmaceutical companies can’t bleed us dry.

I would clearly prefer that we have a sound free market approach to drug prices. We do not at this time. As I (and many commentors) have stated repeatedly, we will not have a free market on drug prices as long as many patients have drug benefits. As a physician, I have a responsibility to understand costs, trying to prescribe the best drug for the patient in the context of expenditures.

I certainly do not understand the particular drug example described in your comment. I will respond with how I would change the laws.

First, I would outlaw direct to consumer marketing of prescription drugs. DTC puts physicians in a difficult situation. We do feel pressure to prescribe the medication that the patient requests. Some of us have the time and presence to resist that pressure, but many physicians are so harried that writing the prescription rather than arguing is the easy way – saving them 5 precious minutes. (And with our current system of reimbursing physicians, 5 minutes is very valuable).

Second, I would markedly restrict detailing. I personally refuse all detailing requests.

Third, I would find funds for independent drug evaluations and comparisons. These evaluations would include cost analyses.

Fourth, I would require standard drug pricing. Let me explain that concept. Currently, some insurance companies strike deals with pharmaceutical companies to get a drug cheaper. The government does this at the VA. I would require a single price for all payors for each drug. We would publicize those prices, making it easy for physicians to make cost comparisons.

Cost comparisons are almost impossible now because each insurance company has a different formulary. Single pricing would bring supply and demand into play.

As an example, many pharmaceutical companies offer low prices to hospitals. This pricing leads to the hospital giving preference to that drug. During the hospitalization, the physicians prescribe the drug on formulary. Once we start a drug, we generally do not change to another drug in the same class at discharge. Thus, the pharmaceutical company makes the hospital pricing a “loss leader”.

Single pricing would end those games. We (physicians) could make rational decisions.

Single pricing would differ from price controls. Companies would actually compete on price if pricing was not so complex as to be indecipherable.

I hope these concepts make my ideas more clear. I would love comments on these solutions.

Related posts:

1. Canadian drug importation is not the answer
2. On Canadian drugs
3. The pharmaceutical industry – the good, the bad, and the ugly
4. Patients learning that many drugs are expensive
5. Answering Roy of Health Care Renewal

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