Prescriptions

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I went to the doctor's this morning, a private doctor on my work PPP. Anyway, I got a prescription for two types of drugs and presented it, warily, since I have been stunned by the price of private prescriptions. Anyway, it comes to £467. So I can't get it til I get paid. WHY should prescriptions, even privately obtained cost that much?: Am I missing something?

-- Anonymous, February 16, 2001

Answers

Cos the drugs are expensive but are subsidised through the NHS?

-- Anonymous, February 16, 2001

Bloody Hell...presumably that's a "private prescription" for Cocaine? If it's for Aspirin I reccommend a cold flannel accross the eyes instead :-)

-- Anonymous, February 16, 2001

There are certain drugs that you can get for a lot cheaper than that....

-- Anonymous, February 16, 2001

Has anybody seen a major drugs company not make a profit? Mind, I'll admit, they do have quite an R&D budget..............I'm with Softie - cold flannel - and perhaps a crate o' Dog??

-- Anonymous, February 16, 2001

You need an answer from Kats on that one since she's the pharmacological scientist on here....

-- Anonymous, February 16, 2001


My gammy knee locked, during a planned dorty weekend in Hong Kong (confined to bed for 3 days, last weekend)- I couldn't bear the pain (I ain't no masochist), so I called a doctor to my room, he gave me a shot in the @r$e (tee hee!) and he charged me US$200 for his 5 mins. of fame!

The injection didn't work either :-((

I also had to stay an extra 2 days in my Hong Kong hotel, at my own expense = not cheap!

Word of advice; don't get sick in Hong Kong

;-7

-- Anonymous, February 16, 2001


Dougal - are you sure it wasn`t my vet you saw? (;o)

Seriously though, did that include the consultation fee? At the Nuffied down here it`s something like £80 per half hour to see a private GP. Even so, that must have been a bit of a shock to the system!

Mind you, some drugs are staggeringly expensive to produce, and I believe that, where a cheaper generic version is available, the NHS are encouraged to prescribe that one. Nevertheless, the cost of subsidising some of these really expensive drugs must really stretch NHS resources.

Dr. Bill? Informed comment please. (:o)

-- Anonymous, February 17, 2001


Hmm well, not wishing to spurn an invitation, I'll enter the arena then. With some trepidation. More Russell Harty than Russell Crowe, kind of thing.

Broadly speaking, drug costs cover three things. No, not including big payoffs in Colombia, this is legit pharmaceuticals. First, production costs - just like any other widget, includes raw materials, labour, marketing etc etc. Second, again like any other commercial outfit, profits for the shareholders. Third, research costs, which are a bit different for pharmaceuticals - they are very variable, but can be a huge proportion of costs.

Basically, there are two types of pharmaceutical companies. The really big outfits go head to head with each other to outpeform their rivals on the research and development of new market-winning drugs - Phizer's very own Viagra would be a classic example. They have the massive research costs. However, once their big brands are out of patent, anybody can make them. This is where the second type of company comes in - no discernible research costs, but produce the unpatented best sellers as competitively as possible - pile em high, sell em cheap. That is the point of the generic prescribing that you refer to, Galaxy - it allows the pahrmacist to dispense the cheapest form of any drug past its patent, whoever produces it.

The response of the big companies is twofold. One, they advertise like mad to push the brand name instead of the generic name, so prescribers will tend to remember the version that will only allow the pharmacist to dispense the right brand for the company. Second, they put a lot of effort into developing new variants of drugs whose patent is about to expire. The point of these variants is that they are chemically similar enough to the original to do the same job, but different enough to be patentable as new. Then they push them to prescribers as better for their patients (easier to take, fewer side effects, bit more effective or whatever). Usually these claims are pretty marginal, but everybody likes a "new" product that is "better" don't they. Of course, the big researchers need massive investment to cover all of this research and marketing activity, so that means they also have to generate better rates of return for shareholders, pushing the price up further.

End result: if you are prescribed a branded drug produced by a big company, or a generic where the patent restricts the dispensing to the one brand, the costs will cover a big slug of research, marketing and profit as well as production. Can be very expensive indeed, as the top of the thread points out graphically. When PPP etc isn't involved, the NHS picks up these costs (ie they are paid for through taxation).

It's no consolation, but there are much more expensive products than this. There is a young lad somewhere on my patch at the moment whose doctors want to give him a pharmaceutical treatment that will cost approximately £3m over the next two years. Now this is not guaranteed to work at all, and at best will give him only a little more relief from his symptoms. Health expenditure is cash-limited, and £3m buys one hell of a lot of hip replacements, coronary bypass surgery or (better) illness prevention. Should we (a) withhold the treatment and put the money into something more effective for more people (b) give him the treatment and cut down on say coronary artery surgery (bit of a priority and waiting list problem, but never mind) or (c) lobby the government to put taxes up by 5p or so to cover all of this sort of thing (at least for the time being). By the way, if you answer (c), you WILL remember what you said when you get to the ballot box, won't you - most people don't seem to.

Personally, I'm off to phone a friend...

-- Anonymous, February 17, 2001


That's the best explanation I've ever heard about drug cost problem. Thanks, Dr. Bill. I never knew the major pharmaceutical companies changed the formulations though. Could that be partly why a drug that works well for a patient, suddenly seems to stop working or the patient starts experiencing side effect they hadn't before? Evne though the drug is supposed to hve the same effect, isn't it possible that some small change could cause an unforseen problem. A sensitivity to an ingredient(even inactive) that wasn't there before or is now in a higher amount? A little scary if the companies messing about just to keep a patent is resulting in more problems for people dependent on these drugs. It must do in the heads of doctors trying to keep up with it all. New and improved isn't necessarily better, or even the same.

-- Anonymous, February 17, 2001

Thanks for taking the time to explain Dr. Bill - that explanation would have cost £250 at the Bournemouth Nuffield(;o)

A very fascinating insight too, into the megabucks side of medicine. It must be so depressing to be a doctor (teacher, even policeman) nowadays and constantly running into the brickwall of `budgets`. Sounds as though very soon the companies who make the products will be the only people with enough money to buy them!

Just out of interest, do any of the big companies get Government grants for research? Don`t undergraduates go and work for them for free too? I suppose what I`m getting at is, could the company who makes the really expensive drug that you were talking about not afford to donate the treatment? I could be barking right up the wrong tree here, it could be that profit margins are not as high as I imagine them to be - so maybe I am doing them an injustice.

As for the tax question - yes I would pay more tax to cover health care (including nursing homes for the elderly) - but I wish I felt confident that the money would be allocated as promised.

Personally I couldn`t cope with the decisions that you doctors are sometimes faced with, especially when the decision is about whether you can `afford` to help someone, rather than `can they be helped`. Must be soul destroying.(:o|

-- Anonymous, February 17, 2001



Gal - it's a very difficult question. In an ideal world, all prescription drugs would be available to all people and nobody would be sick. But it's far from ideal, and very difficult questions like this have to be answered.

I'm grateful that my career took me into an area where nothing so difficult as this is ever asked - I couldn't cope, tho I suspect the training helps an awful lot. I guess with so many difficult things, you just have to become detached - emotions just won't do. Imagine you or someone close to you had a nasty illness. You wouldn't want the medical staff breaking down in front of you, perhaps even explaining the ins and out of financial hardship. So I guess "The Shield" comes up and the cold decision is made.

Of course, this then begs the (even more difficult??) question - what if the expensive treatment is to combat something which is self-inflicted? We all could do with a better lifestyle, diet and less stress. Some of us smoke and some of us indulge in dangerous pasttimes. Some of us simply break things after a heavy night in the Straabeery! Who should pay for treatment required as a direct result of this type of abuse? Can of worms - don't even go there but just thank God that we have medical staff to help, and although not perfect, a Health Service which is general doesn't cost us an arm and a leg. Er, well, you know what I mean ;-)

Most of us would pay extra in taxes. I'm fortunate that my company contributes to a private health scheme, tho it also costs me in tax and contributions. Is this right or should I take my turn in the queue with the rest? Hard one - eh?

-- Anonymous, February 17, 2001


It is indeed a taxing subject. I am relieved that I don`t have to deal with it on a daily basis, and admire and respect those who do.

I`ve been pondering on it all afternoon, and only succeeded in arguing round in circles. (:o|

An the subject is heavy!

-- Anonymous, February 17, 2001


Giving you a headache Gal? Take three aspirins (generic, of course!). I'm off and ain't coming back on this thread again. Ooh - I wish the bliddy footie would start again ;-)

-- Anonymous, February 17, 2001

Ciara - most of the things that you suggest can and do happen from time to time. More common is the understandably confused patient who has been taking the yellow capsules for years, and then finds that she has been given some small white tablets instead. They are the new cheap version with the same active ingredient, but try persuading her that somebody hasn't made a big mistake!

Galaxy - the government doesn't really subsidise pharmaceustical companies to do research as such, only in the form of prices paid by the NHS for drugs. There is a sort of regulatory mechanism which is supposed to avoid excessive profits, but the big companies' evidence to it invariably focuses on the level of exports the industry generates and the amount of risky research needed. On the other hand, the industry sponsors a lot of basic research in academic departments, to pave the way for the next-but-one generation of new products.

Yes the drug companies do make some products available at greatly reduced prices! Unfortunately, this only occurs with very expensive new products, and it only lasts until they have created a demand - amongst patients, families and their doctors. Then the price reverts to the commercial rate with no exceptions. In that sense, there is maybe more common ground between the legit industry and the Colombian drug barons after all.

Please excuse me if I sound a little cynical. Every now and then I still get a (misdirected) flier through my door offering me the chance to attend a week-long eductaional event about the latest treatment for something or other. Sponsored by a drug company, and full of plugs for their products. It's free, including accompanying partner, with plenty of built-in leisure time. It may be in St Moritz, or Barbados, or on the Orient Express - well, you get the idea.

-- Anonymous, February 18, 2001


Thanks again for the explanations Dr. Bill. Nothing like a bit of insider information to help with perspectives! (:o)

-- Anonymous, February 18, 2001


YOu certainly have plenty of reason to be cynical Dr Bill. It must really be crazy for those of you in the profession. Every time I've been to the doctor's office in the past few months, I continue to be astounded at how nearly everything in there is emblazoned with the name of some drug or other. From wall charts, to skeletal models, to what looked like a children's book explaining some kind of illness(!!), to the sheet of stretching exercises I was handed. The only things without 'sponsorship' are his collection of autographed sports memorabilia on the walls. On the upside, he had been given such a large sample stock of Vioxx, that he was able to give me a 2 week supply for free! Half of which I still have since it's only to be taken on an 'as needed' basis.

-- Anonymous, February 18, 2001

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