Saturday, August 29, 2009

How much SHOULD we pay for prescription drugs?

The other day, there was a man in front of me at the pharmacy counter picking up his prescriptions and he was complaining about the cost.

Now, my husband and I choose not to have prescription drug coverage in our insurance plan because of the cost versus our need (we purchase our insurance ourselves). We have only one drug item we need and it is available in a generic, so the additional money per month in the insurance plan was much greater than just purchasing the drug on its own - especially with the $4 generic prescription program offered by most pharmacies. We made this decision because of our own relatively good health after a cost-benefit analysis. Even if we would need more drugs, we estimate that the overall cost of obtaining them would be less than the cost of prescription drug coverage. We recognize that this may change in the future, and we retain the ability to add drug coverage on the insurance plan renewal dates.

So, considering our own circumstances and our willingness to make a financial decision, I was struck by the man in front of me complaining about the cost of his prescription. He was not that much older than me and he had insurance, so he was paying his co-pay of $15 and was mad that it wasn't less. When the clerk pointed out that the $15 was much less than what the actual cost would have been, he was still angry.

This exchange made me wonder just how much people think they *should* pay for prescriptions. There was a 12-pack of Corona beer in his cart - isn't that roughly about $10-15? (I don't drink beer and hubby is the one who usually buys it so I have no idea...) Why would $15 be too much to pay for a prescription, but not too much to pay for beer? While some might disagree, beer is not a necessity where a potentially life-saving drug is.

In doing some research for this post, I came across numerous articles that cite the average time to bring a drug to market as between 10-15 years. This article, from Healthcare Economist, addresses the cost of drugs:

"The final estimate is that it costs – including the expense of failed drugs – $802 million to take a drug from phase I trials to approval. Over 50% of this figure is the cost of capital needed to finance the R&D over such a long period."

This article, from Dr. Elizabeth M. Whelan, president of the American Council on Science and Health (,, echoes that amount and points out that profits for drug companies are necessary to fund future research:

"New drugs will not be developed and brought to market if there is no economic incentive for investors. To illustrate: if every time a life-saving drug finally came to market, activists and politicians demanded it be distributed free to anyone who needed it, there would be no further miracle drugs because there would be no fiscal incentive for research, development, and running the risk of failure."

So considering the extended amount of time it takes to produce a new drug, the cost of paying researchers and scientists for the 10-15 years to bring the drug to market, the number of drugs that are pursued but never pan out, just how much *should* a 30-day supply of any drug cost? Shouldn't the cost be enough to cover all expenses and set aside some profit for further development of other drugs?

Why do people think that they shouldn't have to pay the actual costs of these items? Why do people complain about the relatively minor cost of something that will save their lives while not even blinking at the costs of other, non-essential things? What is it about the entitlement perspective that makes people think they should have something they 'need' without being responsible for the actual cost of it?

And who do they think is actually paying for the difference between what they're charged at the pharmacy counter and what the drug actually costs? Because someone always pays, even if you don't see it.

I guess I was struck by the man's idea that $15 was somehow too much money to pay for his health, and his misconception that he should have the benefit of others knowledge, technology and product at what he wanted to pay for it rather than at what it was worth. Or, rather, without regard to the actual cost of producing the item.

All this boiled down to my thought that he had no real idea of economics 101 - or that if he did, he wasn't willing to admit to the principles because of his desire to have his money to spend elsewhere. Of course, if others are paying for your necessities, it makes it easy to think you should be able to spend your dollars on amenities.

And that's part of the overall problem with our health care system today. As employers (and/or government) have provided insurance coverage, individuals have been removed from the impact of the spending. They utilize the product without real understanding of the dollars necessary to have the product in the first place. Without that direct relationship, people become accustomed to using without knowledge of the actual costs, so they 'use' and then get mad when others make the decisions about cost-effectiveness or priorities or choice.

I think the best thing that could happen is to put consumers back in charge of the spending on their health.

Will some make bad decisions? Certainly. That is to be expected because we're all human beings and all make a bad choice at some point in our life. But suffering the consequences of a bad decision will help us learn not to make the same - or similar - mistakes in the future.

Will some refuse to purchase insurance because they're in good health and believe they don't need it at this point in their lives? Absolutely. And that's okay, too. And if something should happen and they find they need medical treatment? Then they'll pay for it themselves, rather than expect others to do so for them (unless it's family and friends who've decided on their own to help out).

Will this mean they could owe a hospital huge amounts of money that will take years to pay off? Probably, especially if their need was drastic. But expecting the individual to be responsible for their own decisions is the 'fair' and right thing to do - much more 'fair' than expecting me and others who've set aside funds to cover our own expenses to pick up the bill.

We've got to change the idea and attitude that all people are somehow 'entitled' to treatment for their own health needs at no cost. Should someone injured in a car accident be treated at a local emergency room? Absolutely! Should they expect to have such treatment without accountability for the cost? Never! Should they also have the ability to refuse treatment because they don't want to pay for it? Yes. And if they later die as a result? Then they made a decision that had consequences others don't like - but it was their choice.

Is this cruel and heartless? No - not in any way whatsoever. This is personal responsibility and freedom of choice. That's how it goes in a free world - and I'd rather be free to make such choices on my own, even when they may be contrary to my own best interests, than allow government to make them for me.

Freedom is more important than security.

1 comment:

Hooda Thunkit (Dave Zawodny) said...


I have to agree with you that the guy in front of you doesn't have a real grasp of the drug industry and what it needs in order to prosper, grow, and to continue developing new drugs.

That's why I miss what Kroger (my pharmacy) used to do, which is print on each receipt what I was saving by having insurance coverage.

If he had that information on his receipt, then he too might know and appreciate what his insurance actually provided in savings to him and learn to shut up.

And, pray that he never needs an "orphaned" drug for which there was no support from the so-called "EVIL" big pharma...

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