Canada Values Health

Patented Prescription Drugs 2009-04-01 09:15:21

Are new patented prescription drugs good value or are most set at high prices and offer little therapeutic benefit?



Your responses
New Voice For Payers
Hugh Paton
Posted: 2009-10-27 07:40:13

Roto, you only have to spend $0.50 per employee per year, not $200 - $300.  This is the cost to join the Health Plan Payers of Canada.  This non-profit organization is pushing hard for better Rx supply chain results.  Members and their employees/ retirees will benefit from these initiatives.  Contact me at hugh@patonconsulting.ca and join the movement!
DRUGS. stay in school.
LiquidFire
Posted: 2009-06-10 14:18:16

Keep in mind that i am only 14. so please do not criticize, i am bored and want to be heard. I think Patented Prescription Drugs are  considerably expensive, and people who need them cannot always purchase them 
Prescription Drugs
Roto
Posted: 2009-05-31 11:15:20

Well said Hugh

The difficulty is we have taught employees that our health system and drugs are free, paid for by someone else.

Most plan sponsors are too small too challenge, the status quo so just get to the point of saying no to drug programs as they are too expensive.

Large plan sponsors are often not concerned or do not wish to be the first one to challenge the cost, some organizations have a vested interest in keeping prices where they are.

For example a recent study oultined drug costs average about $648 per person in Canada to private plan sponsors.

To challnege the system, I need to put my employees out there challenging the provider and making good choices. If I do this I will save between $200 and $300 per employee.

If my total compensation for my average employee is $60,000 a year, how much effort and employee relation problems do I put into saving this amount.

It was easy to get people to turn off the lights when they leave a room or to recycle, how easy is it to outline that you need to discuss with your doctor about the cost of the drug he is prescribing as to whether an alternative exists. Then you go to thepharmacist and find out he carries the brand name and another generic but not the one discussed by you and your doctor.  Then bring in the insurer and the drug card provider to determine if they can administer the program.
Payers Need Stronger Voice
Hugh Paton
Posted: 2009-05-17 17:05:12

Private drug plan sponsors need to develop a stronger say in which drugs are covered, and how much their plans will reimburse for those drugs.  Many lower priced drugs should become the reference point for the reimbursement limit for all therapeutically similar drugs.  Plan payers need to tell their insurers, claims payers, pharmacy benefits managers to raise the bar, and provide better service in this area.  We need to pay more cost-effectively than we are now, in order to sustain our plans.
More regulation required.
pdworatz
Posted: 2009-05-11 09:02:25

Most of our health care system is governed by a 'not for profit' framework; however, prescription drugs and technologies are not. We, as a society, end up spending a lot of money on these important aspects of the system; however, I wonder if there was some way that the government could ensure that these essential aspects of our health care system are not robbing us blind.
Generic Drug Pricing
Roto
Posted: 2009-05-04 10:37:29

Not sure I would worry about new breakthrough medications, imagine the savings to governments, plan sponsors and individual purchasers if the prices were lower.

Our Health Care system may then truly become less expensive than other countries.

Again our utilization of generics is also not that high, we have an overutiilization of brand names where equivalent generics are available.

Plan sponsors could see savings of 30% of their health care costs with full utilization of generics and lower prices.

This might have taken close to $2 an hour out of a GM/Chrysler wage rate. 

Patients and Doctors are often uninformed or not concerned with the price because someone else is paying.
What about the price of generic drugs in Canada?
Linda Wilhelm
Posted: 2009-05-04 09:26:49

We constantly hear about the high cost of patented medicines, what about the extremely high prices of generic drugs in Canada? If a generic equivalent exists, it is what drug plans will cover. Common sense tells us that means the majority of our prescriptions are generic. A recent report from the competition bureau states that our generic drug prices are among the highest in the world, with no clear reason why. Perhaps if Canada could find a way to lower it's generic drug prices, there would be additional money for new, breakthrough medicines.

Prescription drugs
Roto
Posted: 2009-05-01 11:54:25

The debate continues, clearly applying the three "R's" is the best way to address our Health Care Costs and more importantly the Health of our population.

The three"R's" being the "Right Drug at the Right time at the Right Price".

So Mr. Williams is correct that through best practices and compliance, drug therapy would save us a great deal of money and imporve our health outcomes.

At the same time, Joel is also correct in that we have far too many "me too" drugs that are priced on what the customer will pay and often that has little to do with the "right" price.

We have an entitlement mentality and plan sponsors and we have individual consumers going through the system being given drug therapies paid by a third party, whether it be Government, an employer sponsored plan or private insurance.

In the US, mail order in the late 80's and 90's created a preferred provider system which cut costs by managing the process, now we are seeing retailers deliver drugs at the same or lower costs because of "transparency" and competition or some would say as the mail orders increased in volume they also increased in cost ( too many in the rebate game??).

Canadian generic costs are the highest in the world so it is not only the brand names which cause us issues.

We need provider networks, real competition and transparency but that means many who make a great dela of money now will have to give it up.
Some benefit, some harm done
citizenp
Posted: 2009-04-28 19:06:05

As Joel Lexchin says, we are fortunate to be the recipients of some major drug advances in Canada. I for one am eternally grateful for the prolactin-lowering pill that made it instantly possible to conceive two treasured daughters after years of "trying". That said, I am alarmed by the plethora of new drugs being allowed onto the market without enough study. Why is the industry being allowed to conduct their most widespread experiments on the Canadian public? We ARE the post-marketing study!  If we really want to discover where the true innovation lies, let's test medications on larger sample sets and for longer durations, so that we aren't forced to "recall" medications that not only represent little innovation over their predecessors but in fact cause harm and should never have been brought to market in the first place. 
Little innovation, lots of promotion
Joel Lexchin
Posted: 2009-04-18 13:53:48

Let's give the drug companies their due. Some drugs have been major advances and we are truly better off for having them. Drug therapy has transformed AIDS from a death sentence into a chronic disease and a few new cancer drugs are significant advances. However, despite what Russell Williams claims most drugs do not offer any advantages over existing ones. It's interesting to speculate on the evidence that Mr. Williams uses for his assertion, since virtually all of the trials that drug companies sponsor are either non-inferiority or equivalence trials, that is, they are not designed to show that one product is better than another. Moreover, when a new drug in a class is introduced it is not tested in people who have failed an existing product in the same class. How then can we know how much additional value new drugs have?

The drug bulletin La revue Prescrire looks at new drugs and new indications for drugs in the French market and between 1996 and 2006 undertook almost 1000 such evaluations. Two products were major therapeutic innovations in an area where previously no treatment was available and 38 had value as important therapeutic innovations but with limitations. Even including drugs with some value but that do not fundamentally change present therapeutic practice we are still left with 85% of new drugs and new indications that fail to provide any new therapeutic value.

When new patented drugs are marketed in Canada their prices are typically set at the level of the most expensive product in their therapeutic group regardless of whether or not they offer any incremental therapeutic value. Companies charge what they think that the market will bear not what it costs to research and produce the drug. When drugs come off patent and generic products appear, brand name companies still refuse to engage in price competition.

Utilization and demographic changes are partly responsible for driving up expenditures on prescription medications but Mr. Williams omits one of the major cost drivers which is the substitution of older less expensive drugs by newer more costly ones; newer ones that are generally no better than the existing drugs. Thiazide diuretics cost pennies per day and the ALLHAT study showed that they were at least as good, if not better than, the calcium channel blockers and angiotensin converting enzyme inhibitors that cost dollars per day.

One of the main causes of this shift in prescribing patterns is the aggressive promotion of new drugs. Work that I co-authored showed that in the United States companies spend over $57 billion per year promoting products to doctors. While we don't have any exact Canadian figures, even dividing by 15 means that in Canada companies could be spending $3.8 billion annually, almost 4 times what they spend on research and development. What's more, most of that promotional spending is going toward new drugs for which we have only very incomplete safety information. Finally, nearly all of the literature that looks at the relationship between using promotion as a source of information and prescribing behaviour finds that prescribing deteriorates the more doctors listen to the messages from drug promotion.

Mr. Williams cites a study that claims that had the rest of Canada increased drug spending at the rate that Quebec did we could have saved over a billion dollars in other health care costs. Mr. Williams should have mentioned that this study was sponsored by an unrestricted grant from his organization, Canada's Research-Based Pharmaceutical Companies. A more glaring ommision is the fact that Quebec's policy on paying for medications means that even if a generic version is available, the Quebec government will continue to pay the price of the brand-name version for up to 15 years.

We should pay for innovation, unfortunately in the case of drug therapy too often we are paying for the promotion of new drugs that offer no new therapeutic value.