Rising cost of prescription drugs threatens health care gains

Story highlights

  • Author: Nine of 10 Americans have health care coverage now, but can they afford the rising cost of prescription drugs?
  • Steps can be taken to rein in drug prices, he says

Dr. Sreedhar Potarazu, an ophthalmologist and entrepreneur, is the founder and CEO of VitalSpring Technologies Inc., a software company focused on providing employers with applications to aid in purchasing health care. He is the author of a book "Get Off The Dime: The Secret of Changing Who Pays For Your Health Care." The opinions expressed in this commentary are his.

(CNN)According to a recent report from the Centers for Disease Control and Prevention's National Center for Health Statistics, an unprecedented 90.8% of Americans now have health insurance.

Sreedhar Potarazu
We'll leave it to the politicians to debate whether Obamacare is a good program or a bad program -- whether it should be maintained, re-legislated or repealed outright. The fact is that only 9.2% of Americans -- the lowest percentage ever -- are uninsured. And while that number is far short of perfect, it's something the White House can rightly brag about.
But the bragging could be short-lived, because Obamacare is officially called the Patient Protection and Affordable Care Act -- and the soaring cost of prescription drugs is well on its way to making health care unaffordable again.
    Prescription drug costs are rising dramatically in the United States. Based on a recent survey by Consumer Reports, 33% of Americans were paying an average of $39 more out of pocket for their regular prescription medications, and 10% were paying as much as an extra $100. Among the drugs that saw the highest increases were medications for asthma, high blood pressure and diabetes, which went up by more than 10% last year.
    For low-income and many fixed-income Americans, paying the rising cost of prescription drugs means cutting back on daily expenses. And while it's one thing to cut back on entertainment and restaurants, it's a whole 'nother thing to cut back on groceries or rent payments.
    According to the survey, one out of four people whose prescription drug costs went up said they were unable to pay their medical or medication bills. Seven percent said they missed a mortgage payment. One out of four stopped getting their prescriptions filled, and one out of five skipped scheduled doses.
    That is hardly a prescription for good health.
    But the impact of these price increases goes far beyond the people who need prescription drugs. The cost increases affect employers and insurers, who are transferring some of these costs to consumers, requiring them to pay a larger share through their monthly premiums and rising copays.
    They also affect state Medicaid programs for the poor and Medicare programs for people with fixed incomes.
    It's a prescription for disaster for far too many consumers who, despite having health insurance and even government assistance to pay for it, are increasingly unable to pay for the care they need.
    So what can be done to rein in the cost? A lot, and the sooner the better.
    1. Consumers, employers and insurance companies require much more transparency on how much prescription drugs actually cost. The negotiated rates between drug manufacturers and distributors are a well kept secret, and if you don't know what a drug should cost, you can't tell if you're overpaying.
    2. Employers need to strongly encourage their employees to use generic drugs and to get them through mail order, because even if your employer is providing you with health insurance, your copays and deductibles may be rising to the point where you can't afford to buy the brand-name drug at the corner drugstore.
    3. There is a need for more competition. The unfortunate fact is that three major pharmacy benefits managers -- CVS Caremark, Express Scripts Inc. and Prime -- negotiate rates between the manufacturers and pharmacies. And now the major insurance companies are starting to merge, leaving even less choice for consumers. Competition always drives prices lower, but we're heading in the other direction.
    4. Drug manufacturers attribute their rising drug costs to massive investments in research and development, but many critics say that's an excuse for price-gouging. Gilead Sciences' Harvoni, a new medication to treat Hepatitis C, costs $1,350 per pill -- $113,400 for a 12-week treatment. Its predecessor, Solvaldi, cost "only" $1,000 per pill -- $84,000 for a 12-week treatment. An estimated 3 million people in the United States have Hepatitis C. At retail, the cost of Harvoni could come to $340 billion. Even at a discounted price, a heavy price will get passed on to consumers. Manufacturers are certainly entitled to cover the costs of research and development, but releasing new drugs into the market at a faster pace, depending on how quickly the FDA can accelerate its approval processes, would increase competition and lower the cost of R&D.
    5. Long-standing patents on medications often create barriers to developing new ones, and they also delay access to generics. Shortening the expiration of those patents would lower overall costs and might create an environment that encourages more options for consumers.
    6. Restrictions on purchasing prescription drugs in other countries and bringing them to the United States -- both through travel and on the Internet -- must be relaxed. This would drive up competition and encourage the companies to lower their prices.
    7. This is the big one: The largest purchaser of health care services in the country is Medicare, but the law forbids Medicare officials -- unlike Medicaid and Department of Veterans Affairs officials -- from negotiating prices with pharmaceutical companies. That makes no sense whatsoever. Changing this law has the potential to change everything.
    In a country where all men and women are created equal, health care must be affordable for all of us, not only for some. The ever-rising cost of prescription drugs is hindering everything we've achieved in health care. We need to keep those costs in check, and we need to take steps to do it now.