Finding Health Information Online

Online Health Information Resource List

For finding health information about diseases, conditions, medications, and healthcare resources online, use these government websites for the best information:

  1. Medline Plus

Website: https://medlineplus.gov/

  1. Health Reach

Website: https://healthreach.nlm.nih.gov/

  1. National Library of Medicine Multiple Languages

Website: https://nnlm.gov/consumer-health-information-many- languages-resources

  1. Health Finder

Website: https://healthfinder.gov/

 

Other good resources for more health information:

 

  1. WebMD

Website: http://www.webmd.com/

  1. Mayo Clinic

Website: http://www.mayoclinic.org/

  1. HealthWeb Navigator

Website: https://healthwebnav.org/

 

PRAPARE Survey Tool:

https://docs.google.com/a/novascriptscentral.org/forms/d/e/1FAIpQLScCrqB-H2WOc5fiqesBzsASwCnZBLn9zIlJawMAZr7Y4efVbw/viewform?c=0&w=1

Advertisements

Combating the Rising Costs of Prescription Medication

By Emily Do, PharmD Candidate ’19

Summary

            The rising healthcare costs are a problem for the United States. An important contributing factor is the increase in spending on prescription drugs due to the rise of medication cost.1 Prescription costs in the US are the most expensive in the world, impacting Americans, regardless of insurance coverage and income-level.2 Drug pricing caps, a new pricing system that takes into account therapeutic value, and external reference pricing are three solutions that need to be considered in an effort to combat high prescription costs. Reducing medication costs is a way to start decreasing overall healthcare costs.

 

Background

The US has the highest prescription drug prices and the greatest amount of prescription drug price inflation in the world.3 The average price of medications can be double to ten times what patients in all other countries pay for the same medication.4 A 2015 study found that the average price of Cymbalta in the US is 75% more than the average price in Canada.5 Another study found that the prices for brand-name insulins like Humulin and Lantus in the US were increased to 160% of their original value between 2007 and 2014 by manufacturers.6 A General Accounting Office (GAO) study concluded that Americans pay 32% more for similar drugs than Canadians do.7 Overall, a study concluded that drug prices are up to 198% higher in the US than in Australia, Canada, France, Germany, Switzerland, and the United Kingdom.8

High prescription medication prices are inversely impacting people with insurance. For seniors with private insurance or coverage under Medicare, total prescription drug spending rose an estimated $44 million, according to Congressional records.9 Rising prescription costs are causing insurance companies to restrict access to highly expensive drugs, which is leading to patients not getting all of the medication that they need.10 Increasing pharmaceutical costs are also causing an increase in the amount health insurance companies have to spend per patient.11 As a result, patients in the US face higher out-of-pocket costs than in any other country.12 In 48% of medical bankruptcy cases, out-of-pocket prescription drug costs were cited as a contributing factor. The out-of-pocket medical costs averaged $17, 943 for all medically bankrupt families with an average of $26,971 for uninsured patients, $17,749 for those with private insurance, $14,633 for those with Medicaid, $12,021 for those with Medicare, $6,545 for those with Tricare, and $22,568 for patients who initially had private insurance coverage but lost it.2

High medication prices are also having an impact on uninsured and low-income Americans. A US Public Interest Research Group found that uninsured Americans are paying twice as much for drugs than their Canadian counterparts. Lower income adults, as defined as adults living with income levels under $11,770 a year, are reporting more cost-related access problems to medication than higher income adults.13 One third (35%) of low-income Americans in 2010 reported not filling prescriptions or skipping doses, which is far greater than the rate among low-income adults in other countries.12 Every year, higher shares of household budgets are going to health care costs, causing 1 in 10 people to delay or go without care when they need it, and that rate is even higher for uninsured and low-income populations.5

Prescription drug prices in the US continue to be the highest in the world due to a lack of consumer protection from rising drug prices.9 The US Trade Commission stated that pharmaceutical companies operating in the US can price their products freely.14 The Center for American Progress added that this occurs due to a lack of direct price regulations from government.6 A study noted that the negotiation of prices and the process by which drugs are priced in the US lack transparency and remain largely unknown to the American public.15 In contrast, the price of medication in Canada is controlled by the Patented Medicine Prices Review Board that sets a determined range on the price of each medication produced.16 In Belgium, a price limit is determined by the Belgian Ministry of Economy and in Germany, pharmaceutical companies are allowed to propose a price to the government, but are required to state justifying reasons for that price. If approved, a process is then followed to set the price of the drug. Under the Medicinal Products Price Act (Wet Geneesmiddelenprijzen), the Netherlands also uses a medication price limit.17

The American Enterprise Institute states that the main problem with drug price regulations is that they cause a decrease in available funds for pharmaceutical research and development.18 However, a 2001 study showed that companies receive up to $600 million in additional profits per year from Congress as an incentive for R&D. The study also showed that the costs of R&D are reduced by about 55% due to taxpayer-funded research.19 Drug manufacturers are taxed about $4 billion a year less than other industries due to the foreign tax credit, possessions tax credit, and research and experimentation tax credit and the orphan drug tax credit.20 Congressional investigators from GAO found that the drug industry spends about $262 million every year on federal lobbying, campaign contributions, and ads for candidates instead of on R&D.19 78% of the new drugs brought to market in the last two decades were drugs that replicated already existing successful drugs instead of new innovative treatments.21 The Pharmaceutical Research and Manufacturers of America (PhRMA), the pharmaceutical industry’s US trade association, has the largest lobby in Washington that consists of over 675 lobbyist (including 26 former members of Congress) and more than $91 million of their revenue from drug sales each year goes to maintaining the large size of PhRMA.22          

 

Recommendations

            The US should set drug pricing cap. A report by the US DHHS looked at the impact of past pricing regulation policies and found that they were effective in limiting drug spending.23 The RAND Corporation modelled the impact of drug price caps in today’s society and concluded that price regulations would reduce annual per capita spending on medical care and drugs for Americans by about $9,000 per person.24 A 2006 study looked at the effect of drug pricing regulation on drug prices from 1962-2001 and found prices would have been 28-38% higher in 2001 if not for drug price controls.25 In 2014 it was shown that drug price regulation can lead to an increase in the number of patients who purchase prescription medication.26 As of 2015, the state governments of Delaware, Louisiana, Maine, Maryland, Montana, New York and Vermont have already implement policies to limit the amount privately insured patients pay out-of-pocket on prescription medication.27

The US should also require drug manufacturers to justify their pricing based on therapeutic benefit. Without knowledge of the therapeutic performance of a drug after it has been made available in the market, providers lack the information necessary to make the best treatment decisions for their patients. This has led to the use of high-cost treatment with no consideration of cost-effectiveness relative to other less costly procedures.28 The US DHHS discussed that requiring price transparency from manufacturers would give the public actual and accurate information about the drug price, make pharmaceutical companies more accountable for prices, and increase efficacy in the prescription drug market.3 In Germany, prior to 2010, no policies were in place requiring manufacturers to demonstrate that their drug created a greater improvement in patients in comparison to existing standard treatment.29 After 2011 reforms, manufacturers were required to show that their drug had added benefit to the patient using benefit assessments and comparative effective research. The price was then re-evaluated based on if added benefit was found or not.29 In the US, California, Massachusetts, and North Carolina have already began to look at requiring more transparency from manufacturers, and have proposed laws requiring justification of high drug prices.27

External reference pricing is a supplementary solution for the US to consider. It is a strategy where the price of a drug is compared to the price in other countries. The number countries and countries that are chosen are determined by the government and typically share similar economic backgrounds and/or geographic proximity.30 In other countries, a variation external reference pricing is used or it is used in combination with other medication pricing regulations. France uses the average price of generic medications in the EU while Spain, Italy, and Poland use the lowest price found. Japan uses a formula to determine a range that manufacturers can price their products at, with the average price of its reference countries being the median price.31 In Austria, Croatia, Czech Republic, Estonia, Finland, Latvia, Lithuania, Malta, Slovakia, Slovenia, and Switzerland external reference pricing is used only for publicly reimbursed medication such as Duloxetine.32 In the instance when reference prices are not available in one or more other countries, an alternative method is used. In Bulgaria, Croatia, and Cyprus, the government chooses different sets of reference countries until a price can be determined. In Belgium, Denmark, and Latvia, the government considers only countries where the price has been approved instead of their original reference countries.32

Despite all of these variations, advantages found in all countries that use external reference pricing policies in place are that manufacturers are transparent in the pricing process and patients from all economic backgrounds consider medication to be affordable.33 Studies found that Canadian patients experienced a national average total of $6.7 million a year in savings.34 In 2012, Poland introduced external reference pricing policies and patients saved an average national total of 460 million EUR (about $499 million USD) and 430 million EUR (about $466 million USD) the year after.35 The Colombia School of Business did a meta-analysis that looked at all the countries with external reference pricing policies and concluded that external reference pricing increases savings for all patients purchasing medication in all countries.36 The positive effects of reference pricing in countries that have regulations implemented are substantial. If similar reference pricing policies were used in the US, it would cause a decrease in medication prices for American patients, government spenders, and providers, which would be a start to reducing the rising cost of healthcare.37 Continue reading

Why Generic Medications

By Tiffany Lee 2018 PharmD Candidate

8 out of 10 prescriptions filled in the U.S. today are for generic drugs, but many patients still have questions about generic drugs. Here’s a quick rundown on brand versus generic drugs and why we at NOVA ScriptsCentral mainly dispense generic drugs.

Brand drugs

A brand name drug has to go through many years of research, testing, and clinical trials before it can be approved and sold to the public. In part due to the amount of money that is needed to go into research and development of a brand name drug, the company that produces the drug first is given a patent, which allows only that company alone to make and sell the drug for a certain number of years. However, once this patent expires, other manufacturers can copy and sell generic versions of the medication once the FDA has approved them.

Generic drugs

Generic drugs are effectively a copy of brand name drugs. The FDA requires generic drugs to have the same active ingredient, strength, dosage form, and route of administration as the brand name drug. However, generic drugs differ in appearance because of the patents that brand name drugs hold. So, generic manufacturers create generic drugs with different colors, shapes, sizes, or flavors, but the performance still must match that of the brand name drug before they can be sold to the public. As such, a generic drug is as effective as a brand name drug, and the FDA also monitors them just as strictly as brand name drugs.

 So why generic drugs?

Generic drugs can be sold at lower prices because first, generic manufacturers do not need to put time and money into researching and developing the drug from scratch, which is extremely costly. They also do not need to repeat the costly clinical trials that new drugs need to go through to prove their safety and effectiveness. As the brand name manufacturer has already proven the drug’s safety and effectiveness, generic manufacturers simply need to demonstrate that their generic version performs the same as the brand name drug, and that they meet the same manufacturing, packaging, and testing site quality standards as the brand name drugs. Second, in addition to not needing to run expensive clinical trials, generic manufacturers do not pay for advertising, marketing, and promotion. Lastly, as lots of companies are allowed to produce the generic version of the drug, the competition helps decrease the price of the drug even further. Combining all these factors, the average cost of a generic drug is 80-85% less than its brand name counterpart.

 As a result, at NOVA ScriptsCentral we dispense many generic drugs because they are more cost efficient and work just as well as brand name drugs. If you have any questions regarding your medications, talk with your health care provider or pharmacist and see what they can do to help you.

Resources

“Facts About Generic Drugs.” Food and Drug Administration, 19 Sept. 2012. Web. 10 June 2015.

Hupila, Matthew, and Dorothy Smith. “5 Common Questions About Generic Drugs.” Consumer Health Information Corporation, 2008. Web. 10 June 2015.

“Generic Drugs: Questions and Answers.” Food and Drug Administration, 7 Jan. 2015. Web. 10 June 2015.

Greene, Jeremy A., and Aaron S. Kesselheim. “Why Do the Same Drugs Look Different? Pills, Trade Dress, and Public Health.” New England Journal of Medicine N Engl J Med (2011): 83-89. Print.

The Rising Costs of Generic Drugs

By Aneeza Ahmad, PharmD Candidate, 2015

Generic drug prices are exponentially increasing at alarming rates, with no end in sight. Despite being less expensive overall than their brand name counterparts, generics have saved U.S. patients more than $1.5 trillion dollars in the past decade. The increase in generic drug prices is putting millions of people’s health at risk. In this report we will discuss two of the main points, the resulting effects on the general population and possible solutions.

Generic Drugs

Generic drugs were meant to lower health care costs, and as a result the industry has grown drastically around the world over the past few decades. In the U.S. generic drug prescriptions have climbed from 57% of all medicines dispensed in 2004 to 86% in 2013. 95% of medications that have a generic form are dispensed as a generic instead of the brand name. Overall a patient receives the exact same effect from the generic’s branded counterpart but at a cheaper price. However, this is becoming less and less true every day. Many generic drugs that used to cost a few cents per pill and now cost one or more dollar per pill. So what is a generic drug?

The main difference between a brand name drug and a generic is that they will not physically look the same due to many different inactive ingredients and each manufacturer’s preference, however the active ingredients are chemically identical to their branded counterparts. Once a brand name drug’s patent has expired the drug can be manufactured by any company that completes an abbreviated new drug application and receives the FDA’s approval. This also means there is no need for further clinical research thus reducing time and cost it takes to bring a drug to market. Traditionally generic drugs are significantly cheaper for patients on Medicaid and Medicare, populations who are on incredibly strained and static incomes. Through negotiations done through PBMs, GPOs with group purchasing power, patients saved between $8-$10 million at retail pharmacies and billions of dollars more when hospitals prescribe and fill generics.

Drug Pricing in the US

The U.S.’s drug market is a free market. There are no maximum or minimum prices that are set as they are in much of Europe. Since prescription drug prices are not regulated or negotiated nationally in the US, this helps with price competition. However manufacturers of generic drugs that legally obtain a market monopoly are free to unilaterally raise the prices of their products. The Federal Trade Commission will not intervene without evidence of a conspiracy among competitors or other anticompetitive actions that sustain the increased price.

In the past few years only half of generic drugs (49.8%) declined in cost. The median decline was -6.8%. Only 16% of the sample experienced declines greater than 10%. Half of the generic drugs (50.0%) increased in cost. The median increase was +11.8%, much higher than the median decrease. Some products had significant increases. Among the nearly 2,400 generic drugs, 224 (9.4% of the total) increased by more than 100%. These prices result from some of the biggest generic drug companies, Mylan, Actavis and Teva Pharmaceutical Industries, that have been aggressively snapping up other manufacturers in recent years, reducing the number of players in the market. With only two or three manufacturers making generic medications and with less competition, prices have been increasing. Additionally prices are being driven up due to shortages of raw materials. These shortages are frequently cited as a reason for higher drug prices. The lack of transparency creates a difficulty of knowing what’s actually happening throughout a drug’s supply chain, which often begins in China or India, making it harder to know whether a shortage is the result of deliberate moves. When genuine shortages typically occur manufacturers may exit a market if profit margins are insufficient.  Genuine shortages can come from manufacturing glitches which can cause supply disruptions and FDA crackdowns on plants with production lapses.

An example of where this occurring is with Tetracycline, made by Actavis who ended up discontinuing 250mg and 500mg tablets. An Actavis spokesman said “There has been a lengthy period of time where tetracycline has not been available due to a shortage of active pharmaceutical ingredient.  Manufacturers had to qualify new suppliers of the API.  I believe that there is one manufacturer in the market right now which accounts for pricing.  We are in the process of working to relaunch our product”. However the other manufacturer of Tetracycline, Heritage Pharmaceuticals says that there is no shortage according to the FDA. Then there is Digoxin, an older drug that treats atrial fibrillation and heart failure, which has no new patent or formulation, there are no shortages of the active ingredient and it is not hard to make. By late 2013, a number of generic manufacturers had largely stopped producing and distributing digoxin. The then cheap medicine saw it’s usage declining further pushing more manufactures out, leaving only two companies dominant in the market.  One of those companies began a price increase, and the other soon followed. The company, Lannett, responded when asked about the price changes and said: “On occasion, and for a variety of reasons generic drug makers can and do raise prices.” Those factors, it said, included problems acquiring raw material, increased costs of complying with FDA requirements and manufacturers exiting the market. However Lannett has benefited greatly. Their reported sales for cardiovascular products (including digoxin) rose to $16.9 million from $4.5 million in just a few months, according to company conference calls with investors.

Effects

The effects of these price changes fall most heavily on the patients that rely on these medications. If patients can’t afford the medications they won’t buy them. If they won’t buy them they cannot adhere to their appropriate medication or treatment regimen leading to an overall negative impact on the patient’s health. Eventually this will lead to a greater health burden to the patient, provider, and insurer later on down the road. The changing costs have more been burdening consumers more often in the past two years than in the decade before. In 2010 consumers and insurers paid an average of $13.14 per prescription for the 50 most popular generics. By 2014, both parties are paying $62.10, a 373% increase. Today, more than a third of available generics cost insurers and consumers more than $100 per prescription. With the increasing prices, and even the unreliability of acquiring some of the medications many insurers now have no “preferred” generic medications for some chronic disease states even though those drugs are considered 1st line based on evidence and clinical guidelines. Unfortunately this implicates that these patient’s may not be getting the medication they truly need to treat their illness in its entirety, not necessarily just a symptom.

Beneficiaries

These price changes are benefiting anyone who creates the medications, and those that distribute them. Generic manufacturers benefit the most by selling higher-priced drugs while brand-name manufacturers are experiencing unexpected sales boost for brand-name drugs that have lost marketing exclusivity. In some instances, a brand-name drug with a manufacturer rebate is less expensive than a generic drug that has experienced hyperinflation. Wholesalers benefit because price increases can be passed directly to pharmacy customers when the wholesaler’s mark-up remains constant; gross profit dollars are increasing along with drug costs. Generic inflation is lifting wholesaler revenue growth (expected to decline once generic deflation occurs, should it happen). Over time, pharmacies will benefit from these price increases, because gross profit dollars per script will grow. If prices start declining again, pharmacies will still benefit as reimbursement lags behind the lower acquisition costs.

Global Medication Pricing Strategies

In Europe, 80% of the countries have some form of drug price regulation. Another solution that is presented and utilized to keep costs down in other nations is reference pricing. Generic reference pricing is associated with a significant increase in the generic share of drug utilization and a decrease in drug prices for the products subject to the policy. This method is used mostly in countries with national or provincial health systems, including Australia, Belgium, Germany, Hungary, Italy, the Netherlands, New Zealand, South Africa, Spain and the Canadian province of British Columbia. The concept of reference pricing is that a payer, such as a private health plan or a national health system, sets payment for a group of similar drugs based on a benchmark. The benchmark, or reference price, for a group of drugs may be determined in a variety of ways, such as the price of the lowest-cost drug in the group or some type of average price. The consumer pays any difference between the reference price and the price of the prescribed drug. With this system in place, the health plan or other payer uses reference pricing to set the amount to be paid for the drug, not the manufacturer’s price for the drug.

Canada has a highly regulated pricing market for prescription medicines. In 2014, more than 30% of generic drug sales in Canada were priced at a maximum of 18% of the brand name drug price. In 2006, generics on average were priced at about 65% of the brand. Prices have come down dramatically, resulting in substantial savings for public and private sector drug benefit plans. In fact, Canadian prices of generic drugs have decreased by 80% between 2009 and 2014. Overall price reductions have made both public and employer sponsored drug programs viable. However, Canada’s drug prices in general are slightly higher than the international drug price average The Canadian Generic Pharmaceutical Association has recently negotiated a three-year agreement with The Council of the Federation on a pricing model to introduce more predictability in drug spending and pricing levels, he said. “The savings you have today are going to grow and get larger over the next few years in a relatively predictable way.” As it stands currently only 66% of prescription drugs filled in Canada are generics, compared to the U.S.’s 86%.

Solutions

The U.S. is facing a drug crisis if no controls are placed on the skyrocketing drug prices sooner than later. Rep. Elijah Cummings (D-MD) and Sen. Bernard Sanders (I-VT) recently started their search for answers by sending letters to more than a dozen producers of 10 generic drugs, some of whom expressed a willingness to cooperate, after receiving complaints from constituents and pharmacists about the rising cost of generic medication. Earlier this week, the two lawmakers issued calls for a more widespread congressional investigation. “The first thing we need to understand is why these drug companies are raising their prices so dramatically in such a short period of time, which is why we asked for information about the costs to produce these drugs compared to the prices they are now charging.” Cummings, a ranking member of the House Committee on Oversight and Government, told the New York Times earlier this week. “Once we receive that information, we will be in a better position to evaluate the root causes of these massive increases and, if necessary, consider reforms.”  Another motion presented by Amy Klobuchar (D-MN) along with Sen. John McCain (R-AZ), introduced a bill over the summer called “The Safe and Affordable Drugs from Canada Act” that would allow U.S. citizens to import drugs from Canada and bring greater competition into the pharmaceutical market. The bill is currently in committee in the Senate. Others are finding alternative ways to deal with the rising cost of generics. For instance, HealthSpan an insurance company, which has 100,000 members in Ohio, Indiana and Kentucky, is launching an initiative known as a Health Savings Medication list, which will cap copays for generics at $4, $6 or $8 starting in January. “The two main functions are to help our members save money and help improve adherence by ensuring that members can afford their medications,” said Laura Dunn, a plan spokeswoman.

Still other insurance companies say they are not doing anything special related to the rising cost of generic drugs. “Even while the costs of generics rise, they remain more cost-effective than brand-name drugs,” said Mary Beth Chambers, a spokeswoman for Blue Cross and Blue Shield of Kansas. “We are not currently planning to tier generic drugs or prefer a brand name over a generic. Our primary focus continues to be balancing the costs of high-dollar specialty drugs and brand names, and their impact on premiums, with the medical needs of our members.”

To see Aneeza’s resource material and citations click here.

To review the original presentation click here.

We signed the Declaration for Affordable Medicine

We support access to affordable healthcare for all persons. We do not discriminate due to age, gender, disability, national origin, sexual orientation, religion, creed, marital status, veteran status, political faction, economic status, or any other factor. To limit access due to any one of these factors or any other reason is deny a person their basic human rights. It is to deny them their equality as a fellow human being. The U.S. Declaration of Independence states, “That all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” If we deny someone health care access do we not interfere or potentially jeopardize their life? By not allowing them to sit at the table to discuss healthcare do we not impede their liberties?

NOVA ScriptsCentral (NSC) was founded on the belief that the healthcare system in Virginia is incomplete and unable to meet the needs of poor and uninsured. We provide lifesaving medications to our patients that live with chronic conditions that they would not be able to receive or otherwise easily afford. With the signing of this declaration NSC would like to take our first of many steps into the realm of advocacy and make sure that our patients are represented at the table involving conversations of equal and affordable healthcare access.

“I speak not for myself but for those without voice… those who have fought for their rights… their right to live in peace, their right to be treated with dignity, their right to equality of opportunity, their right to be educated.” –Malala Yousafzai

If you are interested in signing the Declaration for Affordable Medicine click here!

We need help for Medicaid Expansion in VA

Virginia is one of the few states in the United States that has chosen against expanding medicaid. They have chosen to do this again and again despite the overwhelming detriment it causes Virginians, you know those average Joes the legislators are supposed to legislate for? So why don’t they want to do it? Honestly your guess is as good as mine, especially since the Federal Government is willing to cover it and it would cover over 250,000 low-income Virginians. But don’t just listen to me rant on expansion when it has been more excellently said herehere, or here, and here.

Folks it is time to get serious about this, even if you aren’t motivated for social reasons, let me provide an economic one. For every patient that has an ER visit without insurance, the community–that’s right YOUR tax dollars pay for their visit, about $8,000. If we keep everyone healthy so there are no ER visits it is significantly cheaper to the community and is also shared among a greater population (the entire state instead of city/county).

Please contact your local representative and tell them that this is a must-top-priority-you-won’t-get-elected-again-unless-you-do-this. Community health is everyone’s problem and everyone’s responsibility. It is the advantage we sought back when we left individual/nomadic assistance to settle in villages, that everyone helps each other, seriously read Benedict Anderson’s Imagined Communities. Help us help everyone, now.