dave_j

I'm a cynic and I'm afraid it will probably never happen while those who are in a position to make this happen continue to accept goodies for not making it happen.

Am I suggesting a degree of sleaze? I think so because the amounts involved are sufficiently large and it's been going on for so long that the skeletons need to be kept well and truly locked away from prying eyes.

Like hospital parking, to misquote our northern friends, 'where there's sick there's brass'.

Stinkypup

Who do you suggest is involved here Dave? and what "goodies"do you feel that they receive?

scrubbedexpat091

Politicians/political parties getting contributions from drug companies?

A couple years old, and not huge amounts in the big picture.

B.C. Liberals a favourite of big pharma

dave_j

I tend to look at what and how things happen or don't happen. A short look on Google generated the following: The full version can be viewed at: [URL]http://health.costhelper.com/albuterol-inhaler.html[\URL]

" Albuterol is a medication used to treat wheezing and other breathing difficulties... The generic drug is known as Salbutamol.
Typical costs:
Patients without insurance can expect to pay between $30 and $60 for their albuterol and the inhaler. Those with insurance will pay.... from $5 for the generic version to $50 for a brand name.....
......Generic albuterol nebulizer solutions cost about $.40 for 10 doses and brand name versions can cost up to $12.10 for 10 doses...."

It's clear that pharmaceutical companies charge what they can get away with for brand name products even though generic alternatives are that much cheaper... but are these alternatives always made available? Are generic alternatives prescribed at the GP level? Are pharmacists encouraged not to stock generic alternatives? Are patients given advice on alternatives available?

Q.
Who benefits from this pricing strategy?
Who could change the system but chooses not to do so and why not?
Why does the health industry support such a perverse arrangement and who benefits thereby?

Generally speaking, individuals and groups act the way they do because there are benefits to be gained by doing so.

But importantly, who pays in the end?.. We the people do and we should make our voices heard.

Shard

I buy generic Paracetemol/Ibuprofen. Think it's about 30p for 16 capsules. Oops...sorry...thought this was the random thought thread.

Stinkypup

You would make a great politician Dave, not answering my question without going round the large housing estate... Is the culprit "the health industry" (I am not at all sure what you mean by this term) Please clarify who you feel is at fault-is it the politicians, the policy makers, the doctors, "Big bad Pharma" or the pharmacists?

You are relying American data here as you are using American drug names-Albuterol- this is indeed salbutamol here and indeed typically patients are prescribed salbutamol-these inhalers are at reasonable cost. Please try and use local data-As you know, the health systems are entirely different as are funding implications

Typically we have a setting on our EMR and where possible, patients will receive the cheaper generic prescriptions. This is then followed through by the pharmacist although we have no jurisdiction over them aside from stipulating if branded prescriptions have to be prescribed due to reactions as a result of generic drugs-an uncommon event, seemingly the opposite situation to the one that you suggest.

Obviously every day I work with patients who have financial issues with paying for medications, I am perhaps therefore in a reasonable position to usefully comment without resorting to supposition, hearsay and Dr Google. You do ask a good question with regard to whether the patient's are advised with regard to alternatives. I always advise them that generics are typically as good as branded drugs in most cases-I have no idea as to whether the pharmacists are doing likewise, ultimately I am not their policeman.

I do sometimes wondered Dave whether you live under the shadow of a tin foil helmet to protect you from the evils in life

scrubbedexpat091

We buy generic Ibuprofen as well, Wal-Mart typically 3.50 or so for 24 regular strength, although name brand Advil was cheaper the other day, hit or miss if generic is cheaper for OTC.

BristolUK

My doc writes virtually every prescription as the brand name. When I need a renewal, I write down the generic names (if there are 2 or 3 needed) and he looks at the note and still writes the brand name.

When I was on the Province coverage (the one because of my wife's $7k a shot Remicade) the pharmacy would automatically substitute the generic version. When that coverage ended I discovered the pharmacy only substituted if you asked. And then by accident.

The doc prescribed me something - don't remember what it was - when only my wife had the Province coverage and it was too much on top of everything going on at that time so I didn't take it.

Shortly after, he prescribed the same thing for her and when I went to get it, they'd substituted a generic version. I could have managed that for me had it been made known earlier.

Do you buy it in such small quantity?

I bought store brand Tylenol/Acetythingummybob (500mg dose) the other day. 100 @ $7 or $8 worked out quite a bit cheaper than smaller amounts but I bought a bottle of 500 for only $17 instead - a little over twice as much for five times as many.

I appreciate the $17 might be a bit difficult in one go but even on a credit card and spreading the cost over a couple of months it would work out cheaper than small packs.

Subject to having a credit card of course.

Stinkypup

Every prescription that I issue has a tick box checked off that allows the pharmacist to switch to a generic at their discretion. Obviously some drugs are purely available on brand-typically it is shall we say the slightly more old fashioned type or lazy GPs that prescribe branded meds- There is one in our office-again for the most part, the pharmacist switch to generic- as they have been given discretion to do so by the prescribing doctor
In the UK-all prescriptions were prescribed generically

Why don't you just ask the GP to prescribed generically ?

scrubbedexpat091

My doctor writes (well types and prints) the scripts with name brand names, but there is a little box at the bottom with something like do not substitute with generic, which he never checks, so the pharmacy defaults to generic on everything which is pretty much the only thing our coverage will cover. Although I did manage to get the province to cover name brand once, but the medication in question has/had no generic.


Oh and Bristol we usually buy the bigger bottles as per pill it's cheaper, but sometimes you just run out at the wrong time and have to buy the smaller bottle.

BristolUK

Nice idea

Mine's not old fashioned - although maybe his religion influences it - and he doesn't strike me as lazy, although I do think his knowledge on this aspect of prescribing leaves a lot to be desired. (I may have said that previously )

I'm always impressed by the pharmacy we use. They've picked up things that I would expect the doc to have known. But both me and my wife had been getting the Province coverage and every prescription written by the doc in the brand name had been replaced by a generic version when one was available.

Then I lost my coverage while she still had hers and suddenly they tell me the cost but didn't say "or you can have the generic at a big saving."

I suppose it was partly my fault for not specifically asking if there was a generic but after 5 years of what must have been at least 20 different drugs at different times and always being generic (except maybe once) I assumed that it was generic unless brand asked for, because generic was what they always did even when brand was on the script.

We live and learn.

BristolUK

Fair enough. I can relate to that.

Most offers on Pepsi rely on buying four bottles to get them for a buck each.
Sometimes we "need" some today and the dollar a bottle price is from "tomorrow", not today, so I'll make do with one @ $2 to tide us over for the evening.

I could have throttled my stepson when he came back with 4 for $8 (for the 3rd or 4th time)

dave_j

You will have gathered from my various rants that, like so many others, I'm not a health professional just merely human and simply a customer and as such am ignorant of much that goes on. I welcome the odd brickbat that comes my way. Nevertheless, every so often I tweak the odd nose or two and they sneeze. Boogers everywhere.

What I'm gathering from the sharp end is that a GP has a little box to tick on a prescription that informs the pharmacist whether or not he may substitute with a cheaper generic. I suspect that it's only in exceptional cases where a generic is unacceptable and thus would ask the question why the pharmacist would not be informed in all cases. I have never noted this box until mentioned, but I'll surely look at it in future.

As the sharp end start to blunt a little, we see a few questions creeping in, such as 'Why not deliver a generic at the point of sale in all possible cases?'. Here we see the shiny influence of coin overtly creeping in for the first time. It must be more profitable, and perhaps encouraged, to hand over an expensive brand name than a cheap generic, so the temptation to prey on the unwary, ignorant or like me just plain lazy probably influences the decisions of many pharmacists, and where pharmacists are employed by a chain then management no doubt pass on their requests with a golden boot. And the question must surely be asked 'When is a generic not a generic?' A. When the insurance isn't paying.

Further up the chain as the sharp end recedes into the far distance we encounter the health professional politician, the individuals who sit on committees that advise on possible lawmaking governing the delivery of pharmaceuticals in the differing provinces. What can they do to ensure that the customer gets the best deal possible? Well first of all they can suggest that a directive is proposed to ensure that all delivered pharmaceuticals are generic unless specifically ordered so by the GP instead of leaving it to chance. Secondly they can agree to appoint a joint Canadian negociating group to ensure that Canada gets the best possible deal for it's citizens. So why isn't this done, it seems like common sense to me. And here's where coin enters the arena again. I refuse to believe that such ideas aren't driven into the long grass using solid gold golf clubs deposited into the accounts of political parties and politians who have influence over such decision making by the pharmaceutical industry.

And how do I know that the phamaceutical industry pulls out all the stops marked 'inducements' to further their political interests and to sell their highly priced goods? Because it's what I would do in their place.

dbd33

Well, of course they do, it's what salespeople do, but for such inducements no one would ever attend a Maple Leafs game.

However, I've never been to a doctor in Canada or the US (or for that matter a vet) without the cost of the various treatment options being discussed. I'm currently on a single drug, $40 the bottle, because the doctor said "may as well try that before the $120 cocktail".

I've no doubt that there's corruption related to the drug business. I'm sure there are instances of drug consumers being guided to financially poor choices but I'm not convinced that it's any more the case for healthcare than it is for banking or housing. If you're taking the drugs and cost is a concern then you should ask about a generic option (though, as I say, I've never had to, no doctor mistook me for being carelessly rich).

BristolUK

I'm just counting up the number of doctors who have issued prescriptions to me, my late wife, stepkids and mother in law.

So far I'm at 15 different doctors and not one of the prescriptions had such a box.