Last month, my colleague Brian Rosman was in a part of Manhattan near a major medical center. Passing a local deli, he couldn’t help but notice a large sign in the window – “Drug Reps: Get Your Party Platters Here!”
A new coalition starts today on a key aspect of health care cost control. Health Care For All is joining forces with consumer advocates, non-profit organizations, insurers, and providers to launch the Massachusetts Prescription Reform Coalition (MPRC). We are taking action against pharmaceutical marketing practices that wastefully inflate prescription drug costs.
Why drugs? Cost control is critical to the financial viability of health reform. Controlling inappropriate drug marketing should be a key item on any list of meaningful cost control measures. Prescription drugs are among the most commonly used forms of health care today. Over 72 percent of American households have someone taking a prescription medication. And drug prices continue to rise. The average price for the most widely used brand-name drugs rose nearly 50 percent from 2000 to 2006 – more than twice the rate of inflation.
Pharmaceutical marketing is an obvious place to start. Drug companies invest $7 billion yearly in marketing to physicians. They give gifts to prescribers and purchase information from our prescriptions to micro-target their messages (called “data-mining”). The cost for these practices is passed to all of us who pay for drugs – consumers, insurers, businesses and government. These tactics drive up prescribing of brand name drugs that are no more safe or effective than lower-priced generics. If you doubt the impact of prescriber marketing, take a look at Dr. Daniel Carlat’s first-hand account of his experiences in Massachusetts with gifts and data-mining in the New York Times Magazine. One of many shockers in that piece – today about 1 in 5 US physicians is acting as a paid agent for a pharmaceutical company.
The state should heed Dr. Carlat’s warning. We should follow the lead of UMass Memorial Medical Center and Boston Medical Center, two local institutions that have recognized the danger of inappropriate marketing and taken voluntary action to sever ties between the industry and their staff. While prescription drug cost control is not a silver bullet, inappropriate drug prescribing is an important part of our cost crisis.
As we attempt to construct “smart” cost controls – controls that eliminate inefficiency and inappropriate activities – it makes sense to curb these practices as part of the solution. We hope Senate President Murray will consider this arena for reform as she constructs her cost control legislative proposals.
John McDonough
Executive Director, Health Care for All
In the past, Massachusetts has been at the forefront of similar public policy and health issues, ranging from tobacco legislation to health care reform. This case is no different. Massachusetts must again carry the baton and take the lead in shaping a broader, national policy dealing with prescription drug marketing.
In the past year, the federal government mulled over legislation that would prohibit the marketing of any new prescription medication for the first two years after FDA approval. Hence, the new medication would be widely known only within the medical community, and would be applied and / or prescribed based on it’s merits, not it’s mascots. Not surprisingly, the bill has not been passed, and we, as health care consumers (read: citizens) continue to be bombarded with advertisements for medications and treatments for every conceivable ailment and condition imaginable.
The detrimental effects of this kind marketing go beyond cost, as well. By broadly ascribing medical values to their products, many manufacturers present their products as “cure-alls” for everything from allergies, to arthritis to anxiety and depression. By injecting this kind of consumerism into the most widely used form of medical treatment in the country – medication – these manufacturers, and the physicians who prescribe their products, are working towards the detriment of public health, by being too quick to give in to consumer demand.
What’s worse is that these same potentially harmful marketing tactics are also incredibly expensive, and that cost gets passed on not only to the direct consumer of the product, but to each and every health care consumer (read: citizen) in the country.
It will not be easy to reign in this sort of rampant abuse of the free market system, but our legislature must advance this topic, for interests both economic and humanitarian. I urge the MPRC to take action to drastically curb the marketing of brand name medications, and to work to pass the baton to the rest of the nation, as well.
Very happy to happen upon this blog. As a former grunt with the former Rate Setting Commission and Asst AG on medigap rate hearings and the like I still maintain an active interest in health coverage although I no longer work on these issues.
Two questions I’ve been meaning to ask someone:
1) Why was a whole new bureaucracy required (H.C. Connector) when the Commonwealth already the Group Insurance Commission with long standing expertise in negotiating and managing insurance coverage for state employees? Couldn’t the GIC have been the core entity for universal coverage? To me, the Connector smacked of the same old excuse for political patronage.
2) Why isn’t anyone looking at the impact of the $4 generics being sold at Walmart and Target on overall health care costs since drugs are singled out as driving increased cost. I take 4 generics and, since purchasing them at Target, my insurer has gone from having to pay a few hundred dollars a month after my co-pay to $0. I think my premiums should go down as a result.
It would be interesting to know what impact $4 generics are having on insurers’ drug costs. It is certainly true that even insured patients can save money on hundreds of different Rx drugs by going to one of these big chain pharmacies. This, combined with the upcoming patent expiry for a number of brand-name blockbusters (e.g. Lipitor) may, indeed, slow the increase in Rx spending. Insurers should be transparent about any savings, and the patient ought to get a share of any reduction in total costs. But the advent of $4 generics comes against a background of years of rapidly increasing health care costs (of which drugs make up a small, but ever growing share). Don’t look for premiums to fall any time soon.
In reply to #1 of Fran’s very important questions stated above: Countless other people in the Commonwealth have asked the same question here on this blog (why was the new and expensive layer of bureaucracy “The HC Connector” required?) as well as asking legislators and “advocates” who support the Connector approach, and to my knowledge none of us have ever received an answer.
This silence is disappointing to put it mildly. It leaves us ordinary folk to try and interpret what the silence means and most people I talk with come to the same conclusion that you express above (political patronage, and corporate money-driven policymaking).
I’d also add that the silence leaves many of us with the impression that our concerns are easily ignored. Let’s see if our refusal to submit to completing the new Tax Form, the 1099 HC, is as readily ignored. Have people noticed that on that new state tax form it asks religion-related questions?
We shall see if the silence continues. I wonder if Fran will get a response on this post. I also plan to cross-post Fran’s important question about the HC Connector and pose it to Speaker DiMasi as a comment on the Speaker’s recent Commonhealth blog post (http://www.wbur.org/weblogs/commonhealth/?p=343#comment-5863)
I have been asking questions on this blog since it began and our questions go unanswered for the most part.Why the powers that be are arrogant enough to think we do not deserve any answers when they are ELECTED officials who job it is to answer these and all quetions.I have been ignored by all of them over and over.The fact is we must vote them out and elect people who care about the citizens of Massachusetts and we have the power to do it.This chapter 58 law is the worst law that has come along in my lifetime.The unfairness of the over charging the very ones who cannot afford it and to make matters worst fine us.
The poor get free care,the wealthy get great care,the middle class get no care!