On being a good doctor – working around prescription costs!


Category : Medical Rants

This article should frustrate everyone – The Soaring Cost of a Simple Breath

Everyday that I make rounds, we have discussions about prescription drug costs with the students and residents. We are all learning to become adept at finding low cost alternatives to high drug costs.

This particular article describes a most troubling problem – the ridiculous cost of asthma inhalers. I do mean the adjective ridiculous. This pricing is obscene. It leads to patients not being able to afford to treat their disease.

In the adult inpatient service we mostly see COPD patients. I almost never prescribe inhalers. Inhalers work well, but for price reasons we use nebulizer machines instead. Nebulizer machines are much less expensive than a single inhaler, and then we can prescribe generic asthma medication solutions to use with the nebulizer. They are inexpensive through Walmart, Walgreens and other pharmacies. Often we can get patients a free nebulizer in our hospital, and then the costs become reasonable.

For hypertension, we have become adept at using generic drugs. We try the same for diabetes, left sided heart failure and even lipid medications.

We have a responsibility to our patients to weigh the costs of their medications. We should learn the unreasonable costs of prescription meds and work around those costs.

The pharmaceutical manufactures will lower their prices if they see that high prices lead to fewer profits. We physicians must lead the charge to think of the patient’s finances first!

Comments (11)

How about po vanco for C diff? Vanco has been around for 50 years, yet the po formulation, made by ViroPharma, costs $2000 to $3500 for a 2-4 week taper, give or take. Compounded generic vanco made by a compounding pharmacy for the same course? About fifty bucks. Half of my residents have never even heard of compounding pharmacies.

Great point!

Although you are presenting a very bright image of how a clinician is always working on the patient side, I do not think that it is an adequate solution for many cases here in the US. After being exposed to various healthcare systems in USA, Europe, Asia, and the Middle East, I do sincerely think that as long as the market remains deregulated in the US, prices will never go down. Many pharmaceutical companies that sell the same medications in the US are the same providers for the British NHS, yet they charge the UK a fraction of what they make here in the US because the NHS keeps them checked. The deregulation of the US market is a double edged weapon, it creates opportunity, maintains US scientific/medical leadership and generates funds for the nations, but it is depriving a huge segment of disadvantaged populations from vital drug supplies. The issue is a matter of policy, and politicians in the US, as many other free nations, are reflections of voters. We, doctors, need to raise awareness among the general public to facilitate healthcare policy shift, or at least make the general population aware of the consequences of their voting choices.

Thanks !

One of the biggest problems here is our own system of regulations. We had generic inhalers at one time. But due to EPA regulations we lost all of our generics. While all of us want to be environmentally responsible, we may be spending millions of extra dollars to accomplish nothing. CFCs occur naturally as well. Are we really making an appreciable difference by escalating costs of life saving meds?

Another thorn in the side with medications is colchicine. It was grandfathered in at the creation of the FDA. Tons of studies had been done. Mountains of information was known about this drug. But the FDA decided to pull it as it never went through the routine FDA studies. One company jumps on the bandwagon, and now we pay brand name only prices on this drug. Please, please no one tell the FDA that water never went through the typical FDA studies.

From the other side of the desk I have watched the rush to provide insurance for a large part of the population as a solution to providing medical care. What has been ignored are the possible 40% co-pays and that taxpayers will be on the hook for all of the subsidies. Combine this with a cost cap of several thousand dollars and we have not solved our access problem.

Prescriptions are an extension of the issue. Ask a suburban doctor for a generic and you will be told they do not prescribe them because newer is better, and besides you have insurance. The reality is many doctors want all the free lunches they can get and who else will give them a pen.

My sister got caught in this trap as she was taking two medications twice a day, not a difficult schedule, at a total cost of $20 per month. Her doctor prescribed the new combo pill at $400.00 per month and when she called she got the you have insurance speech along with you can never spend too much on your health.

Prescriptions are the other half of the health equation and without access to affordable medications many will simply not get better and continue to be hospitalized with the same issues costing the system even more money.

Steve Lucas

Your story is a sad one. All physicians should strive towards high value care – that does mean looking for low cost alternatives.

Steve- we will always have some individuals who will knowingly or unknowingly chose to write the more expensive drug- I recently went to a training course and main discussion among the peers on the dinner table was regarding who speaks for which pharm company? I was surprised to see the ease in which was going on… Hopefully this was an isolated incident. We will have to see if sunshine act can rein this in which I doubt.

One more issue is common medicines going out off hospital formularies with no clear answers- if someone knows, please tell me why we don’t have I’VE bacterium for last two years and is there light at the end of the tunnel?

IV Bactrim*


Evan S. Levin MD wrote a great book a number of years ago What Your Doctor Won’t (Or Can’t) Tell You. In the book he describes being excluded from his father’s care. Upon returning home he discovers all, all, of his father’s prescriptions were changed.

Investigating he found that the hospital had a back door deal to write prescriptions for certain drugs at a discount to them and the drug company would then make it up when the patient refilled.

These changes were for more expensive drugs often at twice the cost of a patients existing medication. Additionally many doctors were not aware of the harmful side effects of the new prescriptions making even a change in a statin a life threatening possibility when taken with a blood thinner. Pg. 192.

While this book was published almost 10 years ago I have no reason to believe it is not as relevant today and when it was first released. A quick read worth the time.

Steve Lucas

The problem also has deep roots in the sources of information docs use for meds. Go to a conference and you will hear polished presentations by academic “experts” owned by multiple drug companies. Look at guidelines, where the sausage makers may (or may not) be grinding in some tasty drug company morsels.

Successful propaganda needs to control the information sources.

Steve, unfortunately, I haven’t been able to get new drug company pens for a couple years, although the home health and oxygen supply folks have tried to fill the gap.


There is a petition out of England, AllTrials that is requesting the NHS along with the EU not allow a drug company to sell a new drug without publishing the entire drug trials associated with that new drug, both good and bad. The object is to give doctors more information regarding what they are prescribing.

Billion dollar fines have become just the cost of doing business and a look at the original data behind many of these settlements has revealed drugs that were known to have very negative effects, or are of no use for the marketed issues.

They make a pitch for money, but are really looking for signatures.

This should make a difference in the drug approval process. I have seen some of the math and it is frightening to see drugs approved with the results given and then find that those results were not just cherry picked, but manipulated.

Steve Lucas

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