drug companies, even more shenanigans

the NY Times had a rather telling editorial 10/20/2015 about drug company shenanigans (see http://www.nytimes.com/2015/10/20/business/drug-makers-sidestep-barriers-on-pricing.html?emc=edit_th_20151020&nl=todaysheadlines&nlid=67866768&_r=0 ). it turns out that there is a prescription drug on the market called "Duexis", which is a combination of ibuprofen and famotidine (both over-the-counter and cheap drugs) and costs $1500/month. Since insurers are hesitant to pay this amount for the drug, the drug company (Horizon Pharma) circumvents the issue by having a mail-order specialty pharmacy ("Prescriptions Made Easy") affiliated with the drug company simply mail the med to the patient and then deal with the insurance companies.  a few details:

--Horizon has increased the price 10-fold since it was introduced in late 2011. 

--Duexis has had a 72% increase in sales volume in the first half of this year compared with first half of last year, which translates to an increase of 131% to $73.1M. 

--Horizon also purchased the drug Vimovo, a combo of naproxen and Nexium, in 2013 and immediately raised the price 600%, further doubling it more recently, so the price is pretty equivalent to Duexis. 

--71% of Duexis prescriptions and 61% of Vimovo went through the Prescriptions Made Easy program

--one interesting sideline there is that a pharmacist's wife was prescribed Vivomo, his pharmacy could not get the insurance company to approve it, but a specialty pharmacy (Linden Care) was able to send his wife the meds for a $10 copay (the specialty pharmacies do give copay assistance, decreasing the cost to the patient. this is illegal for Medicare and other federal programs since it unfairly prompts using very expensive drugs at a huge cost to the system. so, these specialty-pharmacy drug programs are marketed only to commercially insured patients.) [the 2 largest pharmacy benefit managers (Express Scripts and CVS Health) will not pay for Duexis an Vimovo.]​

--not surprisingly, other drug companies are doing the same: Valeant Pharmaceuticals International (making the news lately for its huge price increases and is being pursued by the feds -- for another NY Times editorial, see http://www.nytimes.com/2015/10/27/opinion/is-valeant-pharmaceuticals-the-next-enron.html?emc=edit_th_20151027&nl=todaysheadlines&nlid=67866768&_r=0 ) uses their specialty pharmacy Philidor Rx Services.

--specialty pharmacies typically dispense complex drugs for rare genetic disorders, cancer, multiple sclerosis, but the ones used by Horizon and Valeant are dispensing common drugs for acne, toenail fungus and arthritis pain.​

so, needless to say, this brings up several issues:

--one of the main issues here is that patients have little say into what medications are prescribed. they entrust their providers to choose the most appropriate meds (as is reasonable, though unfortunately some providers are swayed by the drug companies' advertising and incentives inappropriately)

--another rather perverse feature is that the patient copay for Duexis is actually cheaper for patients than buying the over-the-counter meds (though way more expensive for the health care system)

--also most of us in primary care are unaware of the price of meds. even if we knew the price at one time, these prices often increase dramatically and quickly, and i would wager few of us track these changes.

--and, bottom line, our health care system is moving further and further away from the goal of providing high quality care as our raison d'etre.