St. Louis Post-Dispatch, November 24, 2018
President Donald Trump’s proposal that pharmaceutical ads must include drug prices is a fool’s errand. It reminds me that I always try to pick the restaurant when going out to dinner with a particular friend of mine. If I let her decide, we wind up at a very expensive place, often enduring food that’s not nearly as good as what we can get at the cheaper local dives that I prefer.
She’s not that unusual. People often use price as a substitute for quality, particularly when they don’t have the ability to identify quality.
If President Trump gets his way and requires drug companies to include prices in their ads, this pattern will soon become rampant in pharmaceuticals and could drive prices even higher than they are today.
Researchers once tested the power of price on placebo pain pills. They gave volunteers tiny electric shocks and had them declare a numeric pain score. The researchers then had them swallow a sugar pill that they said would reduce the pain, and then remeasured the pain level after a second electric shock. Not surprisingly, those sugar pills worked; they all said the electric shock hurt less after the fake pain pill. But those placebos were far more effective when the researchers told the volunteers that the pain pill costs $4 than if they told them it cost 4 cents.
It’s hard to imagine that this is not precisely what will happen if we start requiring manufacturers to include prices in their advertisements. People will feel cheated if their insurance company denies them affordable access to the most expensive drugs.
I’ve seen this again and again with my own patients: They ask me to prescribe a specific drug they saw advertised. I know that this particular drug is a perfectly reasonable choice to treat their problem, but it’s only one of a dozen such reasonable choices. I’m willing to prescribe that advertised drug, but when I try to tell them about a less expensive and clinically comparable choice, those with insurance often tell me that the price doesn’t matter. Sure, the drug may list at $10,000 instead of $1,000, but the difference in their insurance copays are far less extreme.
If there is a clinically important reason that they need this expensive drug, I’m relieved when the price is not a driving factor in the selection. But when an expensive drug is just one choice among many less expensive alternatives, some patients are skeptical that the outrageously priced drug doesn’t provide a vital advantage. Doctors are careful to be seen as an ally and patient advocate, rather than as a barrier to medications reserved for the high-heeled.
Drug prices are badly out of control in the United States. Americans pay twice as much as the rest of the modern world does, for the very same drugs produced by the very same manufacturers in the very same factories. It’s a crisis that renders many of my patients unable to afford to treat things like diabetes, taking their insulin every other day instead of the prescribed twice daily.
Ultimately, this naively futile attempt at budgeting increases the cost of their health care. Early treatments are often the most prudent strategy, delaying or fully avoiding more expensive end-stage failures like kidney failure, strokes and heart attacks.
The good news is, we know of several strategies that would drive down the prices of prescription drugs. Several of my colleagues at Physicians for a National Health Program laid them all out in a recent article in the British Medical Journal. We should establish a single national formulary of prescription drugs and provide all Americans with full coverage of those drugs. We should negotiate the prices for those drugs with the patent holders and compel price gougers to license their patents to generic manufacturers. We need to stop allowing patents for trivial changes to existing drugs. And we need to eliminate the current tax deductions for drug advertising.
We know how to reduce the cost of prescription drugs. Sadly, President Trump’s strategy is likely to have the exact opposite approach in this case.
Dr. Ed Weisbart is a family physician in Olivette and chair of the Missouri chapter of Physicians for a National Health Program.