Despite more social media coverage and public outrage regarding the rapid and egregious rise in pricing for many of the most commonly prescribed and generic medications, there is no immediate solution on the horizon.  Providers and patients are usually the last to become aware of the details.  “No wonder, Dr. Lindenberg said that he began hearing from patients requesting a drug change because they could not afford digoxin.  He noted that one patient did not fill her prescription because it would have cost her $1.60 per pill, and that she ended up in intensive care.”  Rapid price Increases for Some Generic Drugs Catch Users by Surprise, by Elisabeth Rosenthal, The New York Times, July 8, 2014. What should be pursued criminally as gaming, and abusing the power of loopholes that go unaddressed during many mergers and acquisitions in the Big Pharma industry, allowing market manipulation by creating monopolies, is perpetuated as an unfair business practice, which, somewhat ubiquitously, continues to force a negative toll on the health and welfare of the most vulnerable.

Patients and providers become even more entangled with logistics of prior authorizations, required by insurers to offset the same cataclysmic hike in drug prices,  that deal devastating blows to the bottom line of hospital pharmacy budgets.  Although I blogged on this issue in January (“Generically expensive”) it is a public health concern equal to all top contenders, that has reached epic proportions, impacting practically every patient encounter  where a prescriptive medication is required.  To drive the point home, whenever there is an opportunity to increase the immediately available profit margins on a drug that’s been available for decades and is cheap and accessible, that has been proven to save lives, that can now be more readily prescribed, why not just go for it?

Here we are in the deep waters of the opiate and heroin epidemic, making Narcan, an affordable medication, more easily available to those most in need, not anticipating the absurdity of drug price fixing suddenly being yet another obstacle, immediately on the heels of legislation passed to support third party prescriptions.  As states continue to share support in the prescribing and distribution of Narcan in attempts to save lives while broader reaching treatment alternatives become more readily available, the price for Narcan more than tripled in less than a month.  The arguments and rationale that the price increases are due to shortages or rapid increase in demand are rarely true and have not held water when investigated.  In practically all circumstances this has been refuted, only to more often unveil well-executed business opportunities.  “Although some price increases have been caused by shortages, others have resulted from a business strategy of buying old neglected drugs and turning them into high-priced “specialty drugs.”  Drug Goes From $13.50 a Tablet to $750, Overnight, by Andrew Pollack, The New York Times, Sept. 20, 2015. Read the article for a compelling reason to pursue Big Pharma CEOs as change agents.

It is unrealistic to change the motivation of big business or to remove the essential component of capitalism from any industry.  However, it is necessary and realistic to regulate the unbridled greed of pharmaceutical companies who continue to impart greater risk on millions of patients with reckless abandon. 


Lukas Kolm, MD, MPH

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