Q&A: Why does your prescription cost so much?
You've probably had the experience of going to the pharmacy to pick up a medication and being surprised by how much it costs.
Prescription drug costs can be a surprising burden for patients. Benjamin Rome, M.D., M.P.H., a physician at Mass General Brigham, explains that many factors contribute to these high prices. One key factor is the patent protection given to new brand-name drugs, which allows the manufacturer to set prices without competition. Once the patent expires, usually after about 15 years, generic versions become available, leading to price reductions for traditional drugs.
However, for complex medications known as biologics, competition may not arrive for several years, leaving prices high. Rome's research has found that new drug prices have increased significantly since 2008, even after considering differences between new and older drugs. The sticker price set by drug companies is not necessarily what patients pay.
Out-of-pocket costs depend on a patient's insurance plan, including deductibles, copayments, and coinsurance. High out-of-pocket costs can prevent patients from accessing treatments, as they may be unwilling or unable to pay large amounts at the pharmacy. Recent policy changes, such as a cap on Medicare prescription drug out-of-pocket costs, aim to address this issue, but there is still room for improvement.
Rome emphasizes that identifying the most appropriate medication based on a patient's needs should always come first. However, doctors must also consider the financial realities of their patients. Communication with patients about their ability to afford medications and awareness of coverage limitations are crucial, as is advocating for policy changes that improve access and reduce costs.
Mass General Brigham has implemented tools within their electronic health record system to help clinicians choose lower-cost treatment options when multiple medically appropriate choices exist. These tools can guide physicians toward cost-effective medications, such as generic drugs or products with different price points. Rome concludes by noting that the Inflation Reduction Act has made some progress by lowering out-of-pocket costs for Medicare patients and giving Medicare authority to negotiate prices for certain medications.
While this is a positive step, Medicare cannot yet negotiate prices for all drugs, and there is still work to be done to make prescription drugs more affordable for everyone.
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