Quit Wasting My Healthcare

The Doctor is In: Driving Value in the Pharmaceutical Industry

I have previously written in favor of the use of generic medications as a way for patients and employers to save money on healthcare.  Even when a generic does not exist for a specific medication, often there is a generic available that is a therapeutic equivalent.  In my practice, when I feel as though a generic will do my patient just as good as a name-brand medication, I prescribe the generic.  It’s that simple.

The question then comes to mind:  How then can the pharmaceutical industry with it’s higher-priced medications justify their use on a long-term basis for chronic conditions?  How can they show that their medications actually provide value and are cost-effective for patients and employers?  How can they partner with the other players in the healthcare system to be part of the solution to escalating healthcare costs and not be seen as draining patient’s and employer’s budgets?  The answers to these questions are at the heart of a sustainable position for the pharmaceutical industry in the treatment of chronic conditions.

I think the answer to these questions is this:  Use higher-priced, name-brand medications in a coordinated fashion as a means to decrease overall healthcare expenditures.  In situations where name-brand medications can prevent higher utilization of other healthcare services, then their use is of true value to patients.

For example, in the treatment of asthma, the use of brand-name medications such as Pulmicort and Singulair as part of a clinically recommended staged treatment plan could decrease the number of ER visits and hospitalizations for the patient.  A year’s supply of Pulmicort and Singulair is not cheap—it will cost about $3,300 (price from drugstore.com).  However, a typical three day hospital stay costs around $3,600.  So if the brand-name medication can prevent just one hospitalization, then the brand-name medication is cost-effective.

Another example is diabetes care.  Several large employers have found that the cost of complications from their uncontrolled diabetic employees is more than the cost of their diabetes medications and testing supplies.  Their solution—provide the medication and testing supplies for free to their employees to promote better diabetes control and prevention of complications.  In the case of diabetes care, an increase in expenditures on diabetes medications decreases the employer’s overall healthcare spend.

However, in both these diseases, patient education, care-coordination and adherence to clinical guidelines are not effectively implemented by the physician community.  Employers are realizing this fact and creating their own support services for employees—personal nurses, disease management, on-site medical clinics.  It is the appropriate use of medications combined with comprehensive support that is improving outcomes and decreasing costs.

With more healthcare costs being shifted to employees, value-driven medication choices and patient support need to become a more central focus of the pharmaceutical industry.  They provide the basis for rational engagement of the industry with the other participants in the healthcare system and they lead to win-win relationships with patients, doctors and employers.