The High Cost of Your Health

Paying for adequate health care has always been a major cost of living, but recent years have seen soaring medical costs for many Americans. An increased focus on precautionary testing and the proliferation of expensive procedures such as MRI scanning have contributed significantly to this trend. A modern MRI scanner can cost $1.8 million or more, and a state-of-the-art PET/CT scanner can cost $2.5 million and up.

However, prescription-drug costs have drawn the most attention. Drug costs have long placed a heavy burden on ailing seniors, cancer patients and others, but many prescription drugs have lately seen stratospheric price spikes. Drug companies typically claim that the high costs of writing off failed development efforts, conducting ongoing research projects and complying with onerous regulatory requirements have forced them to raise prices for their limited portfolios of commercially successful, FDA-approved products.

An investigation launched in late 2014 by the U.S. House of Representatives found startling price increases for many basic brand-name drugs during the short period stretching from October 2013 through April 2014. The average market price of a full course of treatment with a widely used antibiotic, doxycycline hyclate, exploded from $20 to $1,849, and common drugs used to treat asthma, heart disease, seizures and other medical conditions saw smaller but still shocking price increases.

Outrage erupted late in 2015 when Martin Shkreli, CEO of Turing Pharmaceuticals, waved off the impact of suddenly increasing the cost of the company’s newly acquired Daraprim anti-toxoplasmosis drug to a head-spinning $750 per pill from the former $13.50. Patients, insurers and other stakeholders were livid over what they saw as sheer opportunism and naked greed. In December 2015, Express Scripts Holding Co. responded by rolling out its own version of the drug for $1.00 per pill.

More recently, a public furor arose in mid-2016 over the soaring cost of the EpiPen, an epinephrine injector dispenser that can mean the difference between life and death for allergy patients who experience violent reactions to allergenic events such as bee stings or the ingestion of peanut-based comestibles. Mylan N.V., the manufacturer of the EpiPen, apparently interpreted declining competition and the increasing popularity of its product to mean that it would encounter little resistance to steady price increases. It wasn’t until after jacking up the cost of a two-pack of EpiPen injectors from $100 in 2009 to more than $600 in 2016 that public grumbling finally erupted into full-throated fury. The limited availability of less expensive alternatives such as theAdrenaclick, from Impax Laboratories, has done little to damp the rising tide of anger.

In August 2016, the American Medical Association published a study by Kesselheim et al. that examined health-policy publications and peer-reviewed medical literature dating from January 2005 through July 2016 for possible solutions to runaway drug costs. The study singled out market exclusivity, expansive government edicts and limited physician awareness of cheaper alternatives as the primary drivers of rising costs.

A thicket of pharmaceutical patents, regulatory barriers to generics and bureaucratic inertia threatens to further spread the pain. It’s difficult to predict how regulators, lawmakers, insurers and patient-advocacy groups will respond to the specter of uncontrolled pharmaceutical costs. Conflicting agendas and a complex regulatory landscape may mean years of wrangling before the threat of financial ruin for millions of Americans is fully addressed.

In the meantime, individual patients aren’t entirely without recourse. Few doctors are fully briefed on all of the less costly, equally effective generic alternatives to expensive name-brand pharmaceuticals, so explicitly asking for generics may pay off in drastically reduced drug costs. Many manufacturers offer obscure discount programs that may require some research to hunt down, and third-party drug-discount plans often yield significant savings for sharp consumers.