Standard Mischief

Here’s a chart of prices that I have assembled so far:

All prices are for a 30 day supply, one per day.

[1] Prorated, price was $26.99 for 42 pills

[2] Prorated, price was $9.99 for 60 pills

[3] Prorated, price was $10.28 for 120 pills

[4] Generic

I’ve found that I can get ballpark quotes for scrip prices online at drugstore.com. This can be useful, as pharmacists seem to hate to give prices out over the phone. They are sometimes - but not always - the cheapest, but sometimes they have an anomaly, such as their price for OTC Prilosec. (I’ve included their price for generic Omeprazole 20 mg, though it’s still not as cheap as the brand name at Shopper’s. I imagine that they have some old stock left over from when it was prescription only, and patent protected. )

All of the above are proton pump inhibitors, except for the Ranitidine. I’ve included that because that’s what I use.

Yes, it’s hard to believe, but I’m satisfied with taking just one of these a day. I might take a second one if I’m going to a family get-together or something, but one little 9 cent pill preemptively takes care of any sour stomach problems I might have and retails at 50 times less than the Aciphex scrip I was taking before. There are several other OTC pills, but from research in my PDR and other sources, I’ve come to understand that this over the counter drug has the fewest side-effects. My doctor cleared my choice for daily use, although he said it was not as effective as my former prescription. That doesn’t matter, because it’s good enough for me and was less than half the cost of my former co-pay of $30/90 days.

So what’s my point here? I’m trying to demonstrate that having consumers pay the full market value of prescription drugs, instead of heaping the majority of the cost upon everyone else in the same insurance pool, can lead to a dramatic cost saving. That does not even take into account the effect of a large pool of consumers who suddenly start price shopping for medical services. I’m sure the standard economic rules will be in effect there too.

Is this switcharoo going to work for everyone? No, but the consumer choice of this pill over the pricey patented pill by a segment of the population will put downward pressure on the price of the prescription pills.

I’m not arguing that we should do away with medical insurance, I just think medical insurance ought to be more like a safety net rather than a hammock. Having the consumer pay for day to day ordinary expenses out of their own pocket creates a network-effect of driving down costs for everyone, while that safety net can kick in and cover any dramatic medical emergencies.

First off, it’s July Fourth, so happy interdependent day!

Oh wait, I meant Happy Independence Day. Sorry about that.

So where was I? Oh, OK um, “lifestyle drugs”. Wikipedia defines them as “.. a medication designed to improve the patient’s quality of life by addressing relatively minor and non-life threatening conditions..” If you plug “lifestyle drug” into Google, the very first result is this blog, talking about Britain’s National Health Service (emphasis mine):

This is a pharmaceutical which is taken not to relieve or cure a medical condition, but to improve the quality of life of the person taking it. But there is dispute about what constitutes a medical condition that needs treatment and what is just cosmetic, discretionary or even unnecessary. The phrase is commonly used disparagingly by journalists, especially in Britain, where it is feared the cost of fashionable treatments may cause financial problems to the cash-strapped National Health Service. The matter has come up recently concerning Viagra, a new drug to treat male impotence that has created huge public interest both in the USA and Britain (though sales in the US are now reportedly already only a third of the level reached soon after its launch earlier this year).

So should our impending HillaryCare (Canadian style health care, single-payer health care, socialized medicine, universal health care…) cover “lifestyle drugs”? I suppose that depends on your special interest lobbying group. Perhaps the Feminists will compromise, as long as they get their unfettered right to one specific medical procedure, perhaps Viagra will be covered up to a certain number of pills a week. Of course, the chemotherapy people will call for wigs to be covered and we can’t forget the emergency response team of grief counselors that we’ll need to keep on hand so we can fly them in to any disaster.

If this is all starting to look like our bloated federal budget, well that’s the point. That’s why I’ve highlighted the “cash-strapped” part in the quote above. Also, if you drill down into the comments over at that post I’ve referred to over at Lean Left, you’ll see that even the proponents of the universal rationed health care whine about the inevitable underfunding of the program:

KTK Says:

The most telling point is that every single example cited, and virtually all of the issues commonly raised as objections to single-payer plans, is caused by one simple thing: lack of funds.

It’s not underfunding so much as every special interest group getting to throw their slice of pork on top of the steaming, festering pile. And then of course comes the decree to force everyone else to pay for it. That’s not even mentioning the fact that any government health care scheme would tend to reduce or eliminate any profit based desire to increase efficiency. But I suppose KTK is right in the fact that if we could magically fund government health care to unlimited levels, we would be able to offer fantastic care at the all-you-can-eat free health care buffet. Anything less than unlimited funding and you will get lines, rationing, and government mandated therapy restrictions.

So the other day I was talking about acid-reflux medication. Are they “medically necessary” or are they “lifestyle drugs”? Well, I suppose the reason why the drugs are so popular is not only the relief they provide, but the ability for the consumer to eat foods that they used to enjoy. I know my daily acid reducer keeps me in chili peppers, caffeine and chocolate, but I’d do just fine on a bland diet of steamed veggies, boiled barley, and poached chicken breast meat, sans any spices of course. It’s just that I’d hate to subsist on that diet. I’d hate far further having some bean counter somewhere deciding whether or not my chosen therapy is covered under some sort of cost control plan for our future socialized medicine system. That decision should be between myself and my doctor.

The solution, of course, is Health Savings Account (HSA) with a medical High Deductible Health Insurance plan. Under this system you, and not some faceless bean counter gets to decide whether or not extra birth control pills (so one could time one’s period) are covered or not. You get to decide if that expensive acid reflux pill is really worth the cost. You, and not some bureaucrat gets to decide how much extra of a critical lifesaving medicine you get to buy and store in advance of some possible emergency.

So what are these Health Savings Accounts? Well, first off I’d like to state that they are not the use-it-or-lose-it Medical Savings Accounts that may have be offered by your employer. Nope, they’re an entirely different critter. Beyond that, well I’m going to be going into that in another blog post.

This blog post was brought to you today by the lifestyle drugs Generally Recognized as Safe food additives: caffeine, taurine, and Yellow Dye Number 5.

Ah yes! The Free Market again. Just think, every browser with my referrer string that I send ebay’s way is another vote to yank this illegal sale. Tisk tisk, fresheggsrus, you do not have the required government permission slip! Don’t you know that drugs of this caliber can only be safely dispensed by a licensed pharmacist?

http://cgi.ebay.com/7-Nexium-40-mg-40mg-Capsules_W0QQitemZ220120945524

Coral Cache

The Scene: K-mart-Sears, or Sears-K-mart, or whatever that store is down the street that sells everything from kitchen stoves to snack food, and has redecorated to add a “internet cafe” - sans any coffee - and to remove the pizza! pizza! cheezy snack bar. Your host, Standard Mischief, walks in. He’s on a mission. He walks up to the pharmacy counter and waits politely. He has timed this just right, it’s early in the morning and there are no other customers. A pharmacist is taking a personal call on the phone.

Standard Mischief: “I’m not in a hurry, I was just looking for a price check.”

Pharmacist: “What can I help you with?”

SM: “Well, I was looking for some prices on proton pump inhibitors.”

Pharmacist: “Well, what is your co-pay?”

SM: “No, no. I’m paying cash. I’m looking for a price on Nexium, once per day, 20 milligrams, 30 day supply”.

Pharmacist: “If you are paying cash, you definitely do not want that. I think you should try this” He pulls out a package of Prilosec OTC.

SM: “Yes, but that’s over-the-counter, I can price check that myself.”

Pharmacist: “With Nexium, you will pay through the nose.”

SM: “I was willing to bet that’s the case, but I wanted to get a check on the full range of options before I go into the Doctor’s office. You see, he only gives me fifteen minutes of his time and I need to have my ducks in a row. Also, I only get those fifteen minutes if I’m lucky and one of those drug company sales reps isn’t trying to take up some of my time.”

Pharmacist: “It’s very expensive.”

SM: “Is it really that hard to look up? I thought you had a computer? Don’t you do that all day long?”

Pharmacist: (begrudgingly) “Well, let’s see. The 30-day supply is $175.”

SM: “Thank you very much, I suppose I’ve taken up far too much of your time to get any more prices, I appreciate it.”

Standard Mischief exits stage left. On the way out, he price checks OTC ranitdine (Zantac), and picks up one bottle of brand name saline nasal spray. It’s a pricey $3.29 for something that is essentially sterile salt water, but he needs it and it’s far, far cheaper that that still-under-patent prescription steroid nasal spray he used to use, and it isn’t habit-forming like the OTC stuff he was using before that. Oddly enough, here at K-sears, the generic brand saline is actually more expensive. He decides to stock up on the cheap generic stuff next time he sees a sale.

–

Scene two: Our hero walks up to the pharmacy counter inside Shoppers Food Warehouse. It’s still early, so there’s only the Pharmacist on duty. He’s putting that four to six year degree to good use by counting out pills from a bulk package and sticking labels on little vials. Upon seeing a customer, he immediately puts down his busy-work. Standard Mischief smiles. Good service is such a rarity nowadays.

SM: “Hi, I’m looking for a quote on Nexium.”

Pharmacist: “Well, what strength do you need?”

SM: “20 mg, let’s say once a day and a 30-day supply if that’s a convenient way for you.”

Pharmacist: “Well, that’s $154.95. But we’ll price match any competing store in the greater Bowie area.

SM: “Oh, that’s interesting, do you do that with all your prescriptions?”

Pharmacist: “Yes, oh, and let me see what the price is on the other strength.

SM: “Ah, that should be 40 mg, right?”

Pharmacist: “Yes. (pause) Well, the other strength is the exact same price.”

SM: “That’s interesting, and if I remember correctly that’s a capsule, not a pill, so I could not use my pill splitter, right?”

Pharmacist: “That’s correct.”

SM: “Could I get one more please? Say Prevacid at 30mg, once per day?” Obviously, that research with his copy of 2001 Current Medical Diagnosis and Treatment was paying off. “I of course need to talk to my doctor first, but I wanted to check first.”

Pharmacist: “Sure, no problem. OK, that’s going to be $163.95 for 30 days.”

SM: “Thanks for your help today.”

–

I originally was going to gather a few prices on common heartburn or acid reflux drugs and make a chart, but I decided that this exchange, all of it true, was a far better example. I’ve cleaned up the dialog a bit, but that’s it. From this short exchange anyone can draw out a number of important points.

By price shopping only two stores, I’ve manages to save a hypothetical $20.05. That’s only considering the fact that I was shopping for one drug. Furthermore, the Pharmacist at the second store offered to match prices. Clearly even the most left-leaning soul on the planet can see the Free Marketâ„¢ at play here, doing exactly what it is suppose to do.

Although it was tough slogging to get an actual price from the first Pharmacist, he wasn’t trying to push snake oil on me. According to this Wikipedia entry, AstraZeneca, the manufacture of Nexium, used to push Prilosec as their star acid-reflux drug. According to this other page:

But that was then, and this is now, and the world’s former best selling prescription drug suffered a timely fate, it’s patent expired. AstraZeneca didn’t let it’s most profitable drug slip away so easily, however:

The main patent on Prilosec expired more than a year ago. Under normal circumstances, that would have triggered the arrival of a generic version on the market, followed by a host of generic rivals. With so much low-cost competition, we would all be enjoying lower drug costs. But that didn’t happen. Through lawsuits, the makers of Prilosec have managed to keep the generics at bay while unleashing a half-a-billion-dollar marketing blitz to move people off Prilosec and onto Nexium, their costly, patent-protected new Purple Pill, which even their own studies show to be barely more effective than the original.

The article that I’m linking to is somewhat dated. but after Prilosec’s patent expired, AstraZeneca pensioned to move the drug over to OTC. Perhaps at one time, over the counter drugs were a class of medication that was supposed to be safe enough for just laypeople to be able to dose themselves on, but nowadays it’s all about the marketing. There’s tremendous pressure on doctors to write scrip for prescription drugs, instead of telling patents to try something OTC. By moving Prilosec to OTC, I’m sure that they also managed to cut into the projected profits of the manufactures of generic Prilosec.

It also seems that Nexium really isn’t all that more effective that the now cheaper Prilosec:

Dr. Doug Levine, AstraZeneca’s executive director for gastrointestinal clinical research, says Nexium represents a clear improvement over Prilosec. But in most of the company’s trials, the effects of 40 milligrams of Nexium were compared against 20 milligrams of Prilosec. In the two instances where they were compared at equal strength, only one showed a statistical difference, and that was a 3 percent shorter healing time.

So as long as some other entity was picking up the majority of the cost of Nexium, The first Pharmacist was more than happy to sell it to me. That brings me to our next point: Almost no one price shops for pharmaceuticals. Is it any wonder that drug prices are sky high? If your prescription cost you a $20 co-pay, are you really going to shop around or are you going to go to the pharmacy that’s most convenient to you? Furthermore, if OTC Prilosec is priced at $19.29 for a 30 day supply (darn right I price-checked it), but the prescription purple pill is just a $20 co-pay – with the majority of the actual cost taken up by your insurance provider, which one are you going to choose? Now is it clear why pharmaceuticals prices are out of control?

You will also notice that I was price shopping for saline spray. I’ll tell you the truth, after I started paying the full real price for medicine, and that very real cash was coming out of my pocket, I was more than willing to try other therapies to get some relief. I know this will not work for everyone, but the simple saline spray once or twice a day works better for me than an expensive steroid spray like Flonase, Nasacort or Nasonex. By doing a better job at keeping my sinuses clear, I’ve drastically reduced the number of times I have had to seek professional care for an antibiotic scrip to fight off a sinus infection, saving both myself a co-pay and also saving my insurance company from having to come up with the balance of the doctor’s payment.

Update: There’s just one more point I need to make, It’s a pain in the ass to price prescriptions drugs. I’m convince that this is the case because there’s no market forces demanding prices (short of seedy no-prescription-needed gray-market ‘net pharmacies, none of which I’m willing to quote in my blog). Why should there be, when all drugs cost the same, the price of your co-pay. Most times a good doctor will have a feel for what’s expensive, but if I’m going in expecting to get a certain kind of scrip, I try very hard to control my out-of-pocket costs myself. This means bugging pharmacists, unless I can find another online pharmacy with open prices (sadly,an old online source I use to use is now defunct).

About the Author: Standard Mischief is the pseudonym of a person without any “piled higher and deeper” letters behind his name. He is in no way qualified to dispense medical advice, and is in fact explicitly not doing so. He has classified this blog post into the “not intended to diagnose, treat, cure or prevent any disease” blog category for that very reason. Please seek medical advice before acting on any non-advice contained in this blog. While you are waiting in the waiting room, please ponder living in a world where this type of incantation - meant to try to ward off a frivolous lawsuit - would not be needed. Think of a world where our legal system, suppose to be “of, by, and for the people”, would dismiss such suits with prejudice before even incurring a single billable hour by a several hundred dollar per hour lawyer.

Again, over at Lean Left. digglahhh Says:

Not to mention that elective surgery fields are siphoning off more and more of our most talented medical students.

Why have to worry about chasing down payments from begrudging insurance companies and bureaucracies when you can make what is basically straight cash to, as Kanye West would say, “throw some D’s on that bitch.”

The (un)ethical spillover from the American medical model infects, and promotes the infection of other spheres of our culture. How can we expect our citizenry to have a healthy view of health in general when our mechanisms to ensure it are in such disrepair, and ill-conceived at root?

Oh my yes! Why, D-503 is stealing his services from the One State! Square root of negative one!