Word has just come from Express Scripts, the big pharmacy benefit manager, that per capita drug spending in the U.S. increased more than 6 percent last year. When high prices for specialty drugs like the hepatitis C medicine Sovaldi is factored in, the increase is even greater. There are more expensive specialty drugs in the pipeline, and prices of traditional drugs especially generics are rising too. We know that if we’ve refilled any prescriptions.
The National Coalition on Health Care, a group of businesses, healthcare providers, consumer groups and faith-based organizations, has warned, “getting these prices under control is imperative. All the new therapies won’t do much to improve health if Americans can’t afford them.” We know that, too.
And that brings up what we might not know. What can we as patients do to be better consumers of medicines and help lower our own spending for costly drugs. And since flu season will be with us for a bit longer, the drug Tamiflu came to mind.
Obviously hundreds of drugs improve health and save lives, but many others are more questionable, and the benefits are less clear. Tamiflu may be one of them.
Throughout this flu season the media citing recommendations from the Centers for Disease Control and Prevention (CDC) suggested people take the drug. In fact CDC Director Tom Frieden told journalists at a press conference when this year’s flu season began that if he or a member of his family got the flu or a flu-like illness, “I would get them or me treated with Tamiflu as quickly as possible.” Much of the press reported uncritically on that advice.
But what’s the evidence that the drug, which generates millions of dollars in sales each year, actually does any good? Larry Sasich who is a founder and publisher of http://www.patientdrugnews.com/ Patient Drug News, which offers unbiased clear information about the use and safety of medicines based on scientific evidence, says “for almost 15 years the FDA has said the drug is minimally effective in shortening the number of days you have flu symptoms, and there’s no convincing evidence it prevents serious bacterial complications of the flu.”
Sasich cited the FDA’s 1999 professional product label written for doctors and pharmacists which notes that taking the drug may result in a 1.3 day reduction in symptoms for adults and adolescents who already have the flu and a one day reduction for people over 65. (That result was not statistically significant.) For people who didn’t have the flu but were exposed to someone who had it, the drug taken once daily for 42 days reduced flu cases from 5 percent to 1 percent.
In 2000 the FDA changed the product label to indicate that although serious bacterial infections may begin with flu-like symptoms or may occur as complications “TAMIFLU has not been shown to prevent such complications.” That finding still stands. Consumers can find it on a website called DailyMed, at http://dailymed.nlm.nih.gov/dailymed/index.cfm, a service of the National Library of Medicine. The website lists more than 70,000 drugs and is the official provider of FDA labeling information which anyone taking medicines should consult.
The FDA and the CDC seem to be telling Americans different stories about Tamiflu. Sasich told me the difference appears to be the quality of the evidence each agency has used to make its warnings and recommendations. The FDA has used randomized controlled trials, the gold standard for scientific work. The CDC has used observational studies, often considered less reliable, in formulating its advice.
Sasich says he favors the FDA recommendation, and believes consumers should think hard about spending their money on a drug that doesn’t prevent influenza and minimally reduces symptoms of the flu. Tamiflu isn’t cheap. The website http://www.goodrx.com shows prices generally in the $133 to $143 range. The retail price at my local pharmacy is $152 for 10 75-milligram tablets.
Whether you buy the drug at the first sign of a sniffle comes down to whether you want to plunk down more than $100 for a marginally useful remedy especially if you are still in the deductible period of your insurance policy and paying out-of-pocket. We may not be able to change the way the drug industry prices its products, but we can examine the evidence and make an informed choice to take a drug that doesn’t help much.
We want to hear about your experiences with the high cost of medicines. Write to Trudy at trudy.lieberman@gmail.com.
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