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Generic Drugs: Shortages, Price Gouging and Other Crimes

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Much attention has been paid in recent years to the unfortunate reality of drug shortages and wild price inflation in The United States. The reasons for this serious problem are complex but the bottom line is (as always in these types of things) money. Almost everyone who has had a need for chronic or even short-term drug therapy has experienced the frustration and upset of having to pay unreasonably high prices for prescribed treatment. Many of these same patients have been told that there is a shortage of medications that have been in existence for decades.

Before I can speak about what you can do to help yourself when drugs are too costly or unavailable, let’s understand how this dilemma came about…

First, it is important to realize that prescription drugs are either available as brand name or generics. Over 85% of the prescriptions written in our country are for the generic, or “off-patent,” version of a medication. Since the majority of prescribed medications are generic, many of these agents have been on the market for decades. One would think that since these medicines have been used for so long, and their safety and effectiveness has stood the test of time, they would be the least costly. In many cases that is true. But in some critical areas of treatment, such as in cancer care, antibiotic therapy, anesthetics and even something as simple as intravenous salt solutions, forces have conspired to create shortages that have led to price gouging by certain large generic suppliers.

In 2007, the FDA said that 154 drugs had become scarce or no longer on the market. By 2012, that number had grown to more than 300. What is causing this? Recently, a report in the journal Global IT quoted the National Center for Biotechnology Information, saying that:

  • Manufacturing difficulties caused a decrease in production pf updated drugs.
  • Shortages of raw materials cause delays in crucial materials.
  • Natural disasters caused shortages in inventories.
  • FDA regulatory issues tied up production and distribution.
  • Simple supply-and-demand issues disrupted the stock of necessary medication

But there are other, more sinister reasons behind the alarming shortages and increase in prices that have resulted in staggering increases in medicines for gout (colchicine, up 50-fold), heart failure (digoxin, up 6-fold) and arrhythmias (isoproterenol, up 5-fold) over the last 5 decades. (One 62-year-old treatment for the parasitic disease toxoplasmosis is up over 5000%, from $13 to $750 per tablet!)

Health Affairs Blog has recently reported that it is the sharp rise in generic drug prices that has affected the consumer most. In February 2016, that journal stated:

“…Stronger generic manufacturers…absorbed numerous competitors…For many drugs…a combination of supply-chain disruptions, manufacturing problems, FDA compliance problems, and business failures…reduced the number of suppliers. As a result,…generic products were left with only 2 or 3 active suppliers…creating a natural monopoly…While generic drugs are still…less costly than brand-name…in 2013 one-third of generic drugs had a price increase, with about 10% of generics posting an increase of 50% or more…”

The article goes on to say that this caused “…President Obama to issue an Executive Order … directing the FDA to take steps to alleviate ‘a serious and growing threat to public health…’.”.

So what is the patient to do about the fact that, according the US Department of Health and Human Services, 22% of the top generics reviewed in the decade prior to 2014 rose faster than inflation? How can we all get a handle on this ever-growing concern?

I have a few ideas:

  1. Always ask your doctor for the least-expensive alternative for your medication. If he or she does not know the answer, check with your insurance plan to see what blood pressure, blood thinner or diabetic medication is most cost-effective AND meets with your doctor’s approval for your treatment plan.
  2. Better yet, TAKE BETTER CARE OF YOURSELF WITH GOOD HEALTH HABITS! Restrict saturated fat, sugar and refined carbohydrates from your diet. EXERCISE! Lose weight! Stop smoking. Think of the freedom you’ll have (as well as the extra money) by not having to take as many medications.
  3. ALWAYS ask your doctor if you need to be on medications that a former practitioner had put you on. Oftentimes, conditions improve or resolve altogether, but patients are still on medication for conditions that are no longer problems. AMERICANS ARE OVER-MEDICATED! I can’t stress this enough.
  4. Get politically active. I know it seems like an impossible task, but if enough citizens got on their senators and congressmen and women about the predatory monopolies in the drug industry, there might be some improvement.
  5. Shop for health plans that are large enough and strong enough to have negotiated better pricing for necessary medication.
  6. Consider acupuncture, yoga, meditation, herbal, psycho- or physiotherapy or other non-drug modalities for some of your medical issues. They are almost always better for you than pills!
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