|
But what if you buy Lexapro 20-mg tablets and take a half-pill
each day? Medically, this treatment is the same. But look
what happens to unit prices. Thirty Lexapro 20-mg tablets
cost $69.99. We need just 10 mg per day, so we split the 20-mg
tablets in half to make our 10-mg doses. (The tablets are
even scored to make this easy.) In this case it costs you
just $35.00 per month or $1.17 per day to get treated. Your
daily price just dropped by half!
Isn't
that amazing? And it's not just an isolated example. If you
do a similar analysis for many other drugs, you'll find that
taking half of a double-strength pill costs substantially
less than taking all of a regular-strength pill. Or another
way of saying this is that the cost of a month's treatment
is driven more by the number of pills involved than by the
total number of milligrams taken.
Is
this an accident of pricing? Should we be whispering about
this? Is this pulling something over on the drug companies?
Hardly. If you think that multi-billion-dollar companies trading
on the New York Stock Exchange make pricing mistakes, then
I've got some choice swamp-land in Florida I'd love to sell
you.
So
why would drug companies create these pricing mismatches (read:
opportunities)? To understand this, let's walk through two
prescribing scenarios. First, suppose a doctor is prescribing
Lexapro to a patient who is lucky enough to have drug insurance.
The patient pays a predetermined co-payment for each month's
worth of medication, so he or she has the exact same out-of-pocket
expense whichever way the prescription is written. So will
the doctor write for thirty 10-mg pills or fifteen 20-mg pills?
Your
guess is probably right—the prescription will be written
for the larger number of lower-strength pills. The retailer
and the drug company will get full price. They're happy. The
patient doesn't need to break tablets in half and the doctor
doesn't need to take time to explain why pills have to be
broken, so they're happy. What's not to like? The only loser
is the insurance company. Do the doctor or the patient care?
(Let's see, how many favors has the insurance company done
for the doctor and patient lately?)
Now
here's the second prescribing scenario. Joe Workingman has
no drug insurance and has to shell out cash to pay for the
full price of medication. The doctor feels that 10 mg daily
of Lexapro is needed. This time, the doctor prescribes fifteen
Lexapro 20-mg pills per month, instructing the patient to
take a half-pill per day. Medically, there is no loss of efficacy.
The patient is pleased to pay less money. The doctor is a
hero for being thoughtful and clever. Because the doctor still
prescribed the same product, the drug company is happy. (The
drug company would rather get half their price than nothing.
Besides, they've already priced this scenario into their drug.)
So
the drug company wins either way, particularly if they're
competing against a similar product made by another company
that the doctor might choose instead. In fact, all it takes
for everyone to be happy is a breakable tablet. Admittedly,
some pills are difficult to break in half (but not excessively
difficult, or else the drug company wouldn't capture the low-end
market). This is where pill-cutters come in handy. Every drugstore
has them. They're cheap because they're made out of nothing
more than plastic and razor blades. They're better at splitting
pills than your thumbs or a paring-knife because they break
pills more evenly, and the pieces don't go skittering across
the counter.
In
the author's practice there are some pill-splitting overachievers
who even manage to break quadruple-strength pills into quarters.
Imagine the savings in doing that.
In
fact, the only obstacle to saving the patient money is if
the drug company puts their product into capsules, because
capsules can't be split. Would a drug company do such a mean-spirited
thing? You betcha.
Lexapro
was the sixth so-called serotonin-reuptake-blocker to come
on the market, so it had to compete with all the earlier drugs
in its class. But the first serotonin-reuptake-blocker to
come on the market had first-mover advantage and was able
to retain market-share even after the competing products arrived.
This first-mover was the world-famous Prozac brand of fluoxetine,
made by the Eli Lilly Company.
So
what did Lilly do after competing products appeared? They
stone-walled the consumer by never ever putting their product
into anything other than a capsule. Moreover, for the entire
time their product was still patent-protected, they never
produced a higher-strength capsule. So if you needed a higher
dose of Prozac, you had the honor of paying for two or three
capsules per day. Why did they choose such a consumer-unfriendly
approach? Because they could. (Everyone now turn toward Indianapolis
and wave to the nice people at Lilly.)
My
medical students look at me strangely when I start talking
about publicly traded companies and market forces while I'm
supposed to be teaching them about medicine. But the way I
look at it, if you don't understand market forces, then you'll
never understand why things in medicine are the way they are.
(C)
2005 by Gary Cordingley
About
the Author
Gary
Cordingley, MD, PhD, is a clinical neurologist, teacher and
researcher who works in Athens, Ohio. For more health-related
articles see his website at: http://www.cordingleyneurology.com
|
