A report published last week detailed how much Medicare spends on prescription medications.
In 2013, Medicare spent $103 billion on drugs. (I’m guessing the total will be more in 2014 and 2015, when they get around to publishing that data.)
Federal officials said they hoped that disseminating the data would lead to new revelations about the prescribing patterns of doctors and for particular drugs.
Dan Mendelson, the CEO of Avalere, a Washington, D.C., consulting firm, said the data could provide patients with new questions about their prescription history when they visit their physician. “It’s really important to stimulate conversations that get patients more actively engaged in their care,” he said.
While I certainly agree patients need to be more aware of their choices when it comes to prescription medications—Is the drug really necessary? Is there a cheaper alternative?—I question how many will actually see or read this report.
Looking at the data myself, however, I believe many of the most expensive medications could be replaced with generics, or not prescribed at all. Think of the cost savings!
The costliest prescription, based on price and the number of prescriptions filled, was Nexium. That’s right, the Purple Pill, which is used to treat gastroesophageal reflux disease, or GERD.
Medicare paid out over $2.5 billion for Nexium, even though there are cheaper generics available that treat GERD just as effectively.
Related post: Nexium – Brand, generic, prescription or OTC
The second costliest drug was the Advair Diskus, which treats asthma and chronic obstructive pulmonary disease (COPD). With sales of $2.26 billion dollars from Medicare alone, it’s one of Glaxo’s best-selling drugs. Interestingly, while the drug combination used in Advair is no longer on patent, the unique purple inhaler device it uses is, so a generic will not be available until the end of 2016, at the earliest.
The third drug on the list was Crestor, a brand name statin. Not only are there many cheaper generic statins on the market, there is also much debate about the over-prescribing of statins. Recent guidelines have markedly increased the number of patients being prescribed statins even though there is little evidence to support their usefulness.
Related post: The overuse of statins
The fourth and fifth spots on the list are occupied by the antidepressants Abilify (actually an anti-psychotic) and Cymbalta, at $2.1 and $1.9 billion, respectively. Depressing.
Related post: The Age of Abilify
However, he [the Avalere consultant] noted that some doctors may not take kindly to a more inquisitive patient and longer conversations. “In the shorter term, I think it will irk some physicians,” he said.
Maybe. But good physicians want to practice value-based care. They want to engage in health conversations with patients even though prevailing business models conspire to limit physician-patient contact as much as possible.
Whether you are a Medicare patient or not, always have a discussion with your doctor about the necessity of medications, the alternatives to drugs, and whether there are cheaper generics available.
Pharmaceutical companies spend more money every year marketing their high-priced drugs than developing new ones. Don’t fall for the commercials; don’t insist on brand names.