The link between some doctors and costlier prescription drugs

Published 10:00 pm Monday, August 8, 2016

Like many seniors, I take prescription drugs. For the past few years my drug costs have been fairly consistent and my health insurance plan has done a good job of covering most of my costs.

Recently, I was put on a new medication. At first I didn’t think much about it, because I got a free 30-day supply from the pharmaceutical company and my first full prescription had a reasonable deductible.

The shock came with my second 90-day order of that same drug. My insurance company called asking for my credit card to pay the deductible for that new medication. I asked about the cost, and that’s when I learned that my new drug cost was $1,100 for a three-month supply and that order put me into the Medicare Prescription “Donut Hole.”

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The Donut Hole in 2016 starts when your insurance company’s payments plus your co-payments for drugs reach the limit of $3,310. You then pay 100 percent of the next $1,540 out of pocket until you reach the level of “Catastrophic” coverage at $4,850 when the cost to you drops dramatically.

As many of you already know, some of these newer drugs can knock your socks off with their costs. If you can’t afford to pay, you risk your own health or must decide what other basics of your life you can live without to pay for your new prescriptions.

While this wasn’t the case for me, I wondered why some doctors change a patient’s prescription drug, if the existing lower-cost drug is still available and works for the patient. Well, no surprise here, follow the money.

In a recent national study done by ProPublica, an independent, non-profit news organization, the researchers discovered that, “Doctors who receive payments from the pharmaceutical and medical device industries tend to prescribe brand-name medications far more than physicians who don’t accept payments, gifts or other honoraria.”

They found that physicians who received, “… more than $5,000 from drug companies and others in 2014 for speeches, meals, consultations or other promotional activities typically had the highest brand-name prescribing percentages.”

Not surprisingly, the doctors who do change their patients from lower cost prescriptions that have been effective, to the newest, higher priced medicines did so because of larger payments. Yes, this is unethical, but it happens.

Please understand that I am in no way accusing any physicians in this area of being part of this type of unethical practice. The purpose of this article is to make you aware that as with every profession, there are some “bad apples.” If nothing else, if your doctor changes your prescription medications you might ask this simple question: Why?

Like many of you, I, too, come from the school of, “If it ain’t broke, don’t fix it.”

Ron Kauffman is a consultant and expert speaker on issues of aging, Medicare and Obamacare. Ron is the author of “Caring for a Loved One with Alzheimer’s Disease,” available as a Kindle book on Amazon.com. His podcasts can be heard weekly at www.seniorlifestyles.net. Contact Ron at 828-696-9799 or by email at drron561@gmail.com.