One of my patients is 51 and lives with diabetes. Despite weight loss, diet changes and walking his two kids to school every day, his blood sugar level still wasn’t where it needed to be. I prescribed three medications to help prevent the kidney failure, heart disease, stroke, blindness and foot infections that disable too many Americans with this complex disease. He lacks health insurance, but two pharmacies each offered a low price for two different medications and a third we ordered through an access-to-meds program via our clinic.
At our last visit, his sugar control had worsened. He admitted that one drug was too expensive, and the pharmacy that offers the discount on the other generic medication was too far away.
This patient isn’t alone. His story is like that of millions of Americans living with chronic disease who depend on medications to enable them to work, care for their families and avoid permanent disability or death.
Generic medications account for 80 percent of all prescriptions written in the U.S. Sometimes they’re more affordable. However, an alarming number of off-patent medications have crept up in price. Finding a route to gathering prescription medications from different sources is circuitous, and for patients with limited means or complicated schedules, often impossible. In some cases, the problem is made worse by certain unscrupulous corporations that acquire the rights to old, inexpensive drugs and jack up the price to astronomical levels, simply because they can, not to recover the discovery and research costs of those developing new treatments.
An extreme example of that was Turing Pharmaceuticals, which in 2016 — with now-disgraced Martin Shkreli at the helm — rebranded and raised the price of an old anti-parasitic medication used in HIV/AIDS patients by 5,000 percent. Why? As Shkreli put it, “To make a profit on the drug.”
I see the more mundane cost of unaffordable generics in my practice every day: 20 capsules of doxycycline, an antibiotic used for rosacea and pneumonia, will cost up to $105 without insurance or a discount. This “generic” is too expensive and therefore not an option for many patients. Similarly, I have patients with life-threatening allergies who have faced sticker shock as prices for the generic auto-injectable epinephrine have spiked in recent years. They’ve chosen to hope for the best and go without a prescription.
There is no simple explanation for why generics are expensive. Mergers of manufacturers of generics eliminate competition. Safety concerns shut down plants, decreasing availability and raising prices. And maddeningly, generic pricing varies because pharmacy benefit managers negotiate different contracts with different retailers. A 2017 Consumer Reports analysis showed up to a 447 percent price variance for five commonly prescribed generic medications in one area. This is why the diabetes patient needed to travel to three different pharmacies.
President Donald Trump has been promising to take action on high drug prices for over a year. But nothing has changed. In Washington, a number of bills aimed at leveraging negotiating power, stopping price spikes and curbing monopoly abuses sit in Congress.
This leaves an opportunity for the states. In February, Illinois state Rep. Will Guzzardi, D-Chicago, sponsored the Illinois Generic Drug Pricing Fairness Act. If enacted, this law would give the Illinois attorney general the power to stop price gouging of essential off-patent or generic drugs. Pharmaceutical companies that increase prices sharply would have to prove that they’re raising prices because of an increase in the cost of production.
It’s a start. Illinois could join Maryland, which passed a generic drug bill in 2017, in taking the lead on curbing exploitation of our state’s most vulnerable _ and sickest _ patients. Millions of Americans are waiting.
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