Prescription drugs have always stirred up debates, more now than ever, with their increasingly hefty price tags.

To tackle this, various healthcare personnel have been exploring ways to curb this pressing issue and lighten the burden on patients and the healthcare industry.

Insurance companies take the reigns to promote generic medications

Notable high-profile cases that have sparked controversies are such as the reported 400% increase for Mylan’s Epipen and 5,000% spike for Turing Pharmaceuticals' Daraprim. Numerous agencies have attempted to give doctors academic research on pill effectiveness or even simply removed expensive drugs from coverage lists.

Some global medical societies and consumer unions have attempted to increase awareness about this matter. Companies such as ‘Startup GoodRx’ even allow patients to compare retail prices online.

A New York-based insurance company Capital District Physicians' Health Plan (CDPHP) is recruiting former pharma representatives and utilising them to sell cost-effective medicine. Mike Courtney, one of the company’s employees, says that he calls on doctors and advocates for generic drugs that are frequently cheap and work similarly to the expensive brands he used to promote as a pharma representative.

Two years ago, Valeant Pharmaceuticals hiked up the price of Glumetza medicine for lowering blood sugar to USD81,270 annually but a similar, generic version can be purchased for just a penny per pill. This resulted in millions in extra costs and steep patient co-payments.

Hence, Courtney and his colleagues approached doctors and most of them switched to the generic option, metformin. This move saved roughly USD5 million a year.

Alan Sorensen, an economist at the University of Wisconsin who studied drug prices said, “It's a great idea. Even a small moving of the needle on their [doctors'] prescribing behaviour can have a pretty big impact on costs”.

In his latest research, Sorensen found an increase in prescription of generic medication amongst doctors with access to data about drug costs and insurance coverage.

A Princeton economist, Uwe Reinhardt bluntly explained the reality of this matter. He explained that educating physicians about drug prices is all part of a greater move for “transparency” in an industry where consumers undergo the same experience as a “blindfolded person shopping” at a department store.

A change in dosage could reduce cancer drug prices

A group of oncologists in the US are using clinical trials to prove that numerous cancer drugs can be taken for shorted periods or at lower doses without affecting their effectiveness.

For example, the dose of abiraterone for advanced prostate cancer can be reduced by three-quarters and will still be as effective as consuming the standard amount. This is as long as the drug is taken with a low-fat breakfast, such as cereal with skim milk, as opposed to on an empty stomach, as advised on the label.

“It's inefficient, even wasteful, to take this medicine while fasting,” said University of Chicago oncologist Russell Szmulewitz. Studies indicate that the dosage reduction of the USD9,400-a-month drug could lower costs significantly and lessen side effects such as stomach issues.

To further study whether doses of other oral oncology drugs can be reduced due to the “food effect”, Szmulewitz and his colleagues now want to conduct full-fledged trials.

Moreover, they intend to investigate if the duration of some prescriptions can be shortened and whether some cheaper non-cancer medications can be substituted for expensive cancer ones. For example, a reasonably priced immunosuppressant sirolimus has many similarities to everolimus, a pricey medication, for the treatment of breast and kidney cancers.

“This is the most practical and realistic way we have available right now to reduce the cost of cancer therapy and to increase value,” said Allen Lichter, a former president of the American Society of Clinical Oncology.

He continued, “It doesn’t require Congress to do anything or regulators to approve imports. It involves careful clinical study to show the oncology community some of these drugs can be used better.”

“This is a win-win situation if we can show it works — fewer side effects and much better access for our patients.”

Some doctors disagree with this theory and suggest sticking to the original dosage on the labels because these drug companies would have ran large-scale trials proving this dosage to be effective and safe.

However, they agree with researchers conducting more studies to investigate this as Lichter said, “As a patient, I'd want to know that I can safely take this lower dose and not sacrifice any of the benefits.” MIMS

Read more:
What is the US doing to bring drug prices down?
Drugmakers under global pressure to lower prices
Pharma giant under fire in the UK for hiking up cancer drug prices across Europe