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How High Drug Prices and Lousy Coverage Led to a 68% Increase in Unfilled Rx's

It's no coincidence that drug prices in the U.S are on average twice what they are in other industrialized countries, that 68 percent more patients are failing to pick up their filled prescriptions, and that the number of Americans without healthcare coverage is growing toward 50 million at a rate of about 700,000 people a year.

These events, reported separately in the media this week, are plainly linked. Let's get into the weeds: Sen. Herb Kohl (D-Wisc.) sent letters to AstraZeneca (AZN), Novartis (NVS), Sanofi-Aventis (SNY), GlaxoSmithKline (GSK), Eli Lilly (LLY) and Pfizer (PFE) asking them to explain why they charge so much more for their drugs in America than they do in the U.K., Canada, France and other industrialized nations. Americans spend $878 per person on prescriptions, compared with $446 in costs for foreigners, Kohl says. Some examples:

The short answer is that America, unlike any other industrialized nation, does not have a proper, modern healthcare system that exercises leverage on drug prices on behalf of consumers. Instead it relies on the free market and some government programs to provide a patchwork of coverage that has many holes. That patchwork is bad at negotiating lower drug prices -- so we end up paying more than everyone else.

Congress may fill some of those holes this week if it can get President Obama's healthcare reform bill passed, but even then it would be mendacious to call the result a "system."

Many Americans who have health insurance are against reform. They might not be if they saw the results of a new study by Wolters Kluwer Pharma Solutions into prescription "abandonment," the industry euphemism that describes patients who never come back to the pharmacy to pick up their prescriptions.

Abandonment is up 68 percent since 2006 for brand name drugs. That's not just uninsured people who decide they can't afford the medicine they need: 14.4 percent of all prescriptions go unfilled because of a combination of "abandonment" and insurance companies denying coverage. Average copays rose $5 in 2009 to $31 (up from $26 in 2006).

Wolters has some offensive language to describe this problem:

"Today, patients wield more power and are more inclined to exert that influence in decisions about their prescription drugs," said Mark Spiers, President & CEO, Wolters Kluwer Pharma Solutions. "During tough economic times, consumers tend to think more with their pocketbooks. We're seeing increasing price-sensitivity to co-pay, and bolder moves by patients in making decisions about their drug therapy ..."
Patients wield more power? They make bolder moves? This is how the pharma industry people describes unemployed people without coverage? It gets worse: Dea Belasi, a consulting practice leader at Wolters, told MM&M:
"What's peculiar is that the rate of increase among patients walking away is almost unprecedented," Belasi told MM&M.
There's nothing peculiar about it. It's the least mysterious phenomenon in the drug business today: As drug prices rise, and healthcare coverage rates decline, and Congress fails to pass a reform bill, there will be an increase in both insured and uninsured people deciding they don't have the money for the medicine they need.

Image by Flickr user bartificial, CC.

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