It can be a self-rationalizing moment to reconcile prices at the pumps when filling up these days.  If you are not driving an economy car, it can break the bank.  No need to even go near the social conscientious swirl of how big your carbon footprint is, essentially a personal decision of indiscretion.  If you do a bit of research, a graduate degree in economics is not requisite to understand how prices from the wellhead to the pump are influenced by supply and demand through embargos and OPEC controls.  However, it is not as easily understood regarding the rapid rise in costs for several generic medications over the past few years.  For many this can lead to a personal healthcare and financial crisis that is not based upon personal indiscretions, while the drug companies’ explanations just don’t make sense.

With more than eighty percent of all prescription medications being filled as generics rather than with brand name drugs, it is an ugly and unfortunate step backwards to be impacted by the sudden epic price hikes now assigned to generic meds.  Big pharma supports a 180 degree change in business practices for the cost of many generics, based on contrived information. This creates confusion and risk, as there have been significant public health benefits for millions of people who rely on affordable generics.  There had been somewhat of a cost equilibrium established by the entry of generics and the evening out of price competition once patents expired for the generic drug market segment. The affordability of lifesaving medications for people with fixed or low incomes, for the underinsured, or those with high deductible plans is hugely dependent on affordable generic medications.  These generic drug price hikes have created unexpected exposure for health maintenance needs and unnecessary risk for the lives of too many people throughout the nation.

It is antithetical to have obscene increases placed upon some of the most longstanding medications that directly treat widespread public health problems such as Lyme disease, STDs  and some cancers, to list only a few.  “Diane Shattuck filled a prescription in December for a generic antibiotic called doxycycline. With insurance, she paid $4.30 for 60 pills at a CVS store in Orange.  She returned at the end of February to refill her prescription. This time, she was told her cost for the drug would be about $165”. The Los Angeles Times, March 17, 2013. Several generic medications have increased in cost by as much as two thousand percent.

There is something cryptic to the explanations supporting these absurd increases based on supply and demand, market pressures shifting costs, and the need for moving blockbuster drug R&D forward at a faster pace to decrease other healthcare spends.  There are additional anti public health rationalizations, such as paying to delay competitors from bringing more generics to the market once patents have matured.  Additionally, consolidation of manufacturers decreases competition, allowing rapid price fixing. 

Regardless of efforts to create stockpiles of affordable generics, or to impose sanctions on drug companies, patients continue to be priced out and left unable to fill prescriptions that they had come to rely on for years.  Others are unable to fill a prescription for a full course treatment of an acute illness due to lack of coverage by insurers based on the high costs of a drug. Patients are in a quandary, following rapid changes in the pharmaceutical and insurance industries without being held accountable.

Prolonging any process to remedy the mal-aligned decisions that were executed fairly quickly continues to compromise those in greatest need. A unified front is needed for our patients and our practices.


Lukas Kolm, MD, MPH

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Couldn't agree more with your essay.Now retired I am seeing the other side of drug costs we never saw as perscribers-huge jump in cost for some common diuretics, and common drugs still under patent whose cost puts the patient in the Medicare doughnut hole with a single drug.