Zipping the zap out of sticker shock - (6/25/2019)

By Dr. Ron Gasbarro

Mrs. Anderson fainted right there on the pharmacy floor. The pharmacist was able to arouse her with an ammonia popper under her nose. The first words she said after regaining consciousness were “My doctor didn’t tell me that drug would cost so much!” Mrs. Anderson was understandably upset. The pharmacist announced that her new medication would cost $1,450. Moreover, the drug would continue to be exceedingly expensive until she met her deductible – which would take several more months. 

Mrs. Anderson saw an ad for this drug on TV. The ad showed happy people, seemingly oblivious to their life-threatening condition, riding on merry-go-rounds, eating cotton candy on a perfect summer day. Mind-cringing possible side effects are tossed at the end of the ad (e.g., nausea, vomiting, hives, rash, sudden death). But happiness is Mrs. Anderson’s if only she could afford it. 

Well, Mrs. Anderson may now receive the medication’s sticker shock right in the comfort of her living room. In May, Health and Human Services (HHS) Secretary Alex Azar announced that TV drug ads must include the list price of the drug – that is, the Wholesale Acquisition Cost – if that price is equal or greater than $35 for a month’s supply or the usual course of therapy. 

“Patients deserve to know the list price of the drugs they need because many of them will pay the list price or a share of it,” says John O’Brien, Senior Advisor to the HHS Secretary for Drug Pricing Reform. For the 47% of Americans with high-deductible health plans, the price they will see in ads essentially is the price, until they hit their deductible. Every Medicare Part D plan requires coinsurance for particularly expensive drugs, which can range up to 30% of a drug’s list price – still out of reach for many patients.

One may even see TV ads for drugs that insurance rarely covers, knowing that patients may ask their doctor about a drug without realizing its exorbitant list price. One of the most commonly advertised drugs, used for plaque psoriasis, has a list price of $3,400 a month. Yet, it is only covered by one of the 25 stand-alone Medicare Part D plans in the Washington DC area. For the vast majority of Part D beneficiaries in the DC area, the list price is the price the patient must pay for that drug. The 10 most commonly advertised drugs have list prices ranging from $488 to $16,938 per month or usual course of therapy. Patients deserve to know what a drug costs as they discuss their options with their prescriber.

Surveys have shown that consumers want this pricing information. But will it do anything to lower actual drug costs? The US, which leaves pricing to market competition, has higher drug prices than other countries where governments directly or indirectly control medicine costs, such as Brazil and India. That makes the US the most profitable market for pharmaceutical companies, leading to complaints from manufacturers that Americans are successfully obtaining their drugs from non-US markets such as Canada and Europe. Drug companies say decent returns are needed to reward high-risk research. They also point to higher US survival rates for diseases such as cancer. However, by making drug prices more transparent, drug companies may effectively be shamed into lowering costs charged to consumers. 

In 2015, Turing Pharmaceuticals of New York City hiked the price of Daraprim, used for parasites, from $13.50 a tablet to $750. Following public scrutiny, the company has since promised to roll back the increase. Perhaps consumer pressure from people like Mrs. Anderson will shift the tide.

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Read more at


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