Heart Attack
“Just $5 for those drugs”
Something eventually catches you with your health. There are some segments of our world that enjoy some incredible longevity and health into old age – the so-called Blue Zones that are populated by elderly people living full and healthy lives into their 90s and 100s and even beyond. But even in those communities there.is still disease. It gets us all at some point in our lives and as you age the incidence of disease increases in the case of cardiovascular or heart disease your chances are 1 in 2 of getting some heart disease.
For those in the younger age group – it is worth paying attention to this now. Given the inexorable progression of heart disease and the amazing progress we have made in understanding it, we can prevent the damage before it occurs. In many cases or urgent presentation of life-threatening cardiac problems – the causal agent has been developing over years. Preventing cardiac disease requires we pay attention to our health when we are young and modify our behavior and prevent the damage before it has catastrophic consequences, albeit years or decades later. Good news if you are interested listen in to the Cardiac series on Healthcare Upside Down for the month of February at Healthcare Now Radio or download it from Soundcloud.
Clot Busting
Clot-Busting
For my mother-in-law, the presentation was classical myocardial infarction (MI) or heart attack – crushing central chest pain radiating to her arm. No prior history or treatment for any elements of heart disease. The good news in all of this is the Irish healthcare system worked and worked well. She was admitted to a local/regional hospital (comparable to. a rural hospital) that initiated thrombolytic (clot-busting) therapy.
With this therapy failing to stabilize her, she was transferred to a specialist urban center that was cable of performing angiography and placing stents. Angiography was done, and some recanalization was achieved with ultrasonic ablation and a stent placed. Recovery was uneventful and ultimately discharged home with 7 heart-related medications.
The next few days were focused on recovery and adapting. As part of this, I had to visit the pharmacy on a number of occasions. Not everything was available immediately with Ireland suffering some. of the same shortages we see in all areas and countries. But that offered me the same opportunity to observe the pharmacist at work as I waited for 15 minutes or so while things were prepared.
Like the US the pharmacy team was overworked, running in many cases from one task to the next helping a steady stream of customers. The flow of patients never slowed or stopped but there was something really striking about this when I compared it to the same experience in a pharmacy in the US.
In the US in the 15 minutes. I stood watching the stream of patients lining up to pick up their medications, most were unhappy and many were angry, oftentimes extremely angry. Their anger was of course taken out on the front-line pharmacist, all of whom are trying to do their best in the face of insurmountable system failures. The majority. of anger was centered on drugs that were not available to the patient, more often than not because it was too expensive or the insurance or pharmacy insurance (this is typically the groups referred to as pharmacy benefit managers or PBMs but I find that term factually incorrect since there is no benefit to patients from these groups) refusing to cover the medication. Anger, frustration, and more stress on already stressed-out patients because of the lack of coverage and unnecessary eye-watering drug prices that are unaffordable, even if you have health “insurance”
Compare this to the steady line of patients in the Irish pharmacy, all happy, receiving their drugs, no eye-watering prices, and having a personal and engaged relationship with their pharmacist. My experience, collecting 6 drugs necessary for cardiac health and maintaining the patency of the stent for the big sum of €5 (a little over $5 at current exchange rates). I’d be terrified to pick up those same drugs in the United States
A quick search suggests the supply I got for 30 days would have cost
- $35 A drug that went generic in 2012 (uninsured cost $280)
- $18 A drug long off patent (uninsured cost $22)
- $70 A drug that went generic in 2012 (uninsured cost $430)
- $20 A Drug that went generic in 2008 (uninsured cost $60)
- $20 A Drug that went generic in 1996(uninsured cost $25)
- $13 A Drug that went generic in 2001 (uninsured cost $38)
So an insured patient (or one shopping around with coupons) would pay $176 (for a year $2,112)
An uninsured patient would be paying $855 (for a year $10,260)
That’s just the drugs. The hospital stays above probably amount to tens of thousands of dollars possibly rising to 6 figures which for most people will mean huge bills, fights with insurance over denials, and large cash payments to cover deductibles, co-insurance, and “out-of-network” excesses. But that’s yet another story and another blog post, this one is focused on drug prices.
Fare Prices for Drugs
There was a campaign in London many years ago, (“Fares Fare“) run by the General London Council (GLC) that pushed for reduced public transportation fares – a resounding success pushing many people to use public transportation and decreasing traffic. We need this for drugs. We need fare prices. Fare prices for drugs that have been decades off patent such as Insulin (seeing increasing legal action to force the issue) whose original patent, financed by public funding as much research is was sold for a total of $3 yet we find Insulin is costing patients $1,500 per month
The healthcare system is not serving the patients. The tired narrative that we need to pay more for our drugs in the United States otherwise innovation will be stifled makes no sense. We have been paying more, a lot more, for our drugs for decades past their generic introduction.
- Patients need fair drug pricing
- Doctors need fair drug pricing
- Pharmacists need fair drug pricing
- Society needs fair drug pricing worldwide
