Commentary: Make drugmakers justify their price increases

And bills in the Legislature would bring some transparency — and maybe more control — over prices.

By Hervey Froehlich

For The Herald

As a physician, I prescribe for my patients the medications they need to get well and stay well.

I recommend lower cost or generic drugs whenever I can, but I would never forgo prescribing needed meds because of what they cost. Unfortunately, some of my patients have to make decisions about whether to ration medications — or fill prescriptions at all — based on cost. In those situations, there’s little I as a physician can do to help.

Some patients must choose between buying food and paying for their medications. It’s unconscionable.

We all know the price of health care in our nation is skyrocketing and we’re all interested in doing something about it. Yet, too often pharmaceutical corporations are left out of the discussion. Right now prescription drug costs make up 23.3 percent of each health care premium dollar in Washington state.

At a time when we at Kaiser Permanente are working hard to find efficiencies that bring down costs, our pharmaceutical costs keep going up. In the last two years, prescription drug prices for Kaiser Permanente in Washington have increased by $70 million.

The situation is even worse for specialty drugs. These higher-cost, hard-to-manufacture, or hard-to-handle/administer medications make up a small percentage of prescriptions, yet by 2020 they’re expected to account for more than half of pharmacy costs in the United States.

For example, take Evzio, a life-saving pre-filled auto-injection medication that reverses opioid overdoses. The price increased 500 percent from $690 in 2014 to $4,500 in 2017. We don’t know why the price went up; it’s the same medication in the same package.

We are also hearing from diabetic patients that the cost of insulin has skyrocketed, becoming prohibitively expensive for some patients. The cost of insulin has more than doubled in the last five years, driving the annual cost of insulin to more than $6,000 for most patients. News outlets have documented how the rising cost has resulted in patients rationing their insulin, sometimes with fatal results. This should not happen.

Part of the problem is that these corporations operate in the dark. Even though affordable access to drugs could mean life or death to our patients, drug companies — and drug companies alone — set the wholesale price of a drug. As a result, drug companies have full control over the starting point of all price negotiations.

Under the current system, drug companies have too much power and not enough accountability. That has caused prices to skyrocket without justification. At the same time, the pharmaceutical companies spend more on marketing than on research and development.

Yet taxpayers are footing the bill for much of the research that has led to innovative new treatments and lifesaving cures. Drug companies cannot justify paying for research as a cost driver when we’re already paying for it.

We cannot in good conscience allow pharmaceutical corporations to continue operating in secrecy while their decisions are putting patients at risk.

That’s why health care allies have come together — nurses, physicians and insurers — with the leadership of our state including Rep. June Robinson, D-Everett, to advocate for a better way. We may not be able to tell the drug companies how to price their drugs, but we can shine a light on what they’re doing and ask them why.

We at Kaiser Permanente have proposed bills in Olympia — HB 1224 and SB 5292 — that will require manufacturers and insurance companies to be more transparent about drug prices and their impact on premiums. Once it’s public, we could use this information to determine how to ensure we’re getting the best value for Washington’s patients.

For example, if a pharmaceutical company increases the cost of insulin, it would have to report that to the state along with a justification for why the price is going up. The mere need to justify price increases should be a deterrent.

Once we know which corporations and which drugs are increasing in price, we can both use that information to choose more affordable equivalents and generics and we can pressure them to do better. It’s a step toward pricing life-saving medications in a way that makes them accessible to the patients who need them.

As a physician, I take seriously my role of both helping patients get well and stay well and as an advocate for my patients’ needs. I’m proud to be advocating for prescription drug price transparency so that no patient has to choose between food and medication.

It’s the right thing to do. Will you join us in calling your state lawmakers?

Dr. Hervey Froehlich is a pediatrician and the specialty chief for the Snohomish district of Kaiser Permanente.

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