Patient complaints about the high cost of prescription drugs are a leitmotif of many office visits, and sometimes they are the main theme. Patients are crying out for our help on this issue, even if the medication is not related to our specialty. One of my elderly rheumatoid arthritis patients recently told me that the cost of his pioglitazone had gone up an additional $50 to reach a staggering monthly cost of $148. Not all that glitters is gold, but it might as well be judging from the price tag. He and his wife gave up their cable television so they could pay for the drug. He didn’t come across as one of those well-heeled retirees who are not eligible for drug company assistance. I went online and printed out the manufacturer’s patient assistance form. I wasn’t sure he’d be able to fill out the form, but I hold on to the hope that getting his cable service restored will be enough of an incentive for him to get this done.
It feels like the only bargains in medicine are the old generic drugs. I know I’m really dating myself with this confession, but I remember when Tagamet (cimetidine) was brand name only. It was the blockbuster drug of the day. When I was new in practice, the Tagamet sales rep pleaded: "I really want you to prescribe a lot of Tagamet, because my holiday bonus is on the line!" This story stands out in my mind as a moment of refreshing candor by a drug representative.
Expensive stomach medications to mend or prevent the onslaught of gastric mucosal damage caused by our nonsteroidal anti-inflammatory drugs (NSAIDs) have always been a part of the background of my rheumatology practice. Although the names of the medications have changed, the high price tags associated with these drugs have remained a consistent feature. But back in omeprazole’s heyday, the first proton pump inhibitor was dubbed "the purple pill." Now that it is available inexpensively over the counter, it has been stripped of its regal purple color. It is now a mousey brown, and its expensive cousin Nexium is adorned with the royal color. Considering the drug’s price tag, they probably should have made it green, like the color of newly printed cash, but I suspect the marketing people didn’t think that "the green pill" had the same sales appeal as the purple pill.
For many patients on chronic NSAID therapy, a second drug to help prevent ulcers and GI bleeding is appropriate, but this raises the patient’s drug costs, and it is very hard to convince asymptomatic patients that they need to take the purple pill, or anything else for that matter, when they don’t perceive it as necessary.