Over the past 10 months, the discussion about drug prices in the United States has never been so hotly debated. It has sparked interest and concern from every angle – individual consumers, employers and health plans – no one is immune from the financial pain. The media and political interest on the topic have brought the focus into the living room of every American household.
All of us reading this have either experienced an unexpectedly high price we are asked to pay for a medication or know someone who has. Pharmacy is, after all, the most commonly used benefit in healthcare with over 50% of all people utilizing at least one maintenance medication on a monthly basis. And for those that purchase medications often, there is a sense of unrest each time a refill is requested, with consumers never knowing what unexpected surprise may be in store. Even working in the business for over 10 years, I share that angst when I or one of my kids need something. It's like a roll of the dice. I never know what I’m going to get! That’s why I created Rx Savings – and am dedicated to spreading the word that we are not helpless in the face of increased drug prices. We need to put the power back in the hands of the decision makers – the consumers.
Even pharmaceutical manufacturers feel a pain of sorts – with price increases now being so heavily scrutinized and examined, there is downward pressure on their stock prices as exceeding analyst estimates will have to come from new sources in the future.
To fix this problem, we must first examine and understand the entire, complex system, about the variables that influence the prices paid by the Health Plan/Employer/Member. As you can see from the graphic linked below, there are many steps involved to get the physical drug from manufacturer to the patient. Entities like packagers, re-packagers, wholesalers, and pharmacies may touch the product along the way and subsequently influence or even completely reset the market price. Additionally, although the price may be set by the manufacturer, discounts of various forms (percentage discounts off of manufacturer price, MAC List, various forms of rebates and access fees) and through various pricing “networks” will almost certainly influence what price you pay at the pharmacy.
In addition to the variables affecting price, listed above, there is even greater opportunity to add efficiency to the process and save money by understanding clinically what options are available to treat a given medical condition.
So what does all of this mean for those paying for medication? Extreme confusion. With so many variables in play, it’s impossible to navigate without assistance. I founded the company and use our software every time I purchase a prescription for myself or a family member. Even working in this industry every day, with all of the changing variables, it’s impossible to keep up without the software.
While regulation of drug prices set by manufacturers is being called for on a more routine basis, I don’t believe it will solve the problem. To combat and fight back against all of the economic forces that affect drug prices, we must empower those people making the choices about what to buy, where to buy it and whether or not they’ll make the purchase at all. Those “people” are consumers. Decision support and arming consumers with all of the information including therapy options, drug price, price variation between pharmacies and other medication specific variables are all part of the puzzle that must be solved.