The release of several new, astonishingly expensive, specialty medications has renewed the discussion over prescription drug pricing. The new hepatitis C drugs, Harvoni ($94,500 for a 12-week course) and Sovaldi ($84,000 for a 12-week course) are emblematic. Kaiser Health News reported, “If all 3 million people estimated to be infected with the virus in America are treated at an average cost of $100,000 each, the amount the U.S. spends on prescription drugs would double, from about $300 billion in one year to more than $600 billion.” The new cholesterol-lowering PCSK9 inhibitors are not quite as pricey ($14,000 per year) but would be applicable to a much larger population of patients.
At the Fall Board of Governors meeting, we heard an address from Jerry Avorn, Professor of Medicine and Chief of Pharmacoepidemiology at Harvard. He spoke to the issue of medication costs and educated on sources of information, such as the Campaign for Sustainable Rx Pricing. Another topic of discussion was the controversial 21st Century Cures Act, which seeks to promote development and shorten the approval of new drugs and devices, but at what appears to be the cost of neutering the FDA – more accurately, encouraging the agency to accept lower forms of evidence to support approval. In June Dr. Avorn coauthored a Perspective piece in the New England Journal of Medicine on the subject which last week engendered several interesting replies. In his address to the BOG, he also asked us to pick up the mantle of education through academic detailing. An excellent resource for this is the Alosa Foundation, which has a number of modules that reinforce evidence-based medication use. In keeping with ACP’s High Value Care initiative, it is important to recognize that the issue is not only cost, but value – how much benefit for the money spent. But the other critical step towards reining in pharmaceutical costs is to get legislation that will allow Medicare to negotiate drug prices. Check out this Wall Street Journal piece on that topic and look for the link to the report from Carleton University and Public Citizen. This is something for which we should continue to advocate.
This is obviously a complex topic, about which I have only scratched the surface. I encourage you to maintain awareness and lend your voice to the conversation.