The last time I had this mindful conversation with myself was in 1984 and two years post the Great Inflation. Here is my grocery list of budget costs in 1984. Fuel to fill my Ford Escort cost $1.31/gallon, 100LL was $2.40, the rental price of a Cessna 152 was $45/hr. (wet), Ronald Reagan was president, Diet Coke was filling the grocery store shelves, Commodore 64 was the latest video craze, Olivia Newton-John was the hot singer, and prescription costs had the highest price inflation since 1946 at 11.68% (Consumer Price Index, Bureau of Labor Statistics). How in the world is this 20% mortgage rate, new private pilot, father, and pharmacist going to afford these inflationary costs? How in the world are the patients I see in the hospital going to afford their medications?
I ask all of my flight students two questions. What makes airplanes fly, and are you taking any medications? The answer to the first question is money. Suppose there is a positive response to the medication question. In that case, we immediately go to the AOPA list of FAA allowed/disallowed medications for students and pilots with an FAA medical certificate to ensure compliance.
For all the patients under my purview in the hospital, I provide a medication evaluation to guarantee that they are on evidence/guideline-based and affordable medications. The healthcare providers will order medicines that are on the hospital formulary. The formulary is a compilation of drugs a healthcare provider can prescribe for their patients. Before a new or novel medication can be added to the formulary, a review is scheduled by the formulary committee for safety, cost, and benefit. The patient’s charge is a daily per diem fee covering services and medications. The affordable piece upon discharge is not of the highest priority. One hospital put the challenge starkly: last year, the price increases for just four common drugs, which ranged between 479 and 1,261 percent, cost the same as the salaries of 55 full-time nurses (Final Report Trends in Hospital Inpatient Drug Costs: Issues and Challenges, NORC at the University of Chicago 10/11/2016).
The discharged patient with four to five prescriptions may be slightly more surprised when they see what their community pharmacy charges. I provided a service where I took copies of the patient’s prescriptions to the hospital outpatient pharmacy if I knew they had one or more expensive medications. I would ask the pharmacy technician to run the prescriptions through their insurance carrier and give me a cost. I have, on multiple occasions, saved patients hundreds of dollars on their monthly prescriptions. I will discuss the process I performed. Compliance, patient satisfaction, good outcomes, and money saved are crucial in this economy.
According to the U.S. Bureau of Labor Statistics, the prices of prescription drugs will be 1,640.87% higher in 2022 versus 1935. Prescriptions that cost $10 in 1935 would cost $174.09 in 2022 for an equivalent purchase. Prescription drugs experienced an average inflation rate of 3.34% per year from 1935 to 2022. On occasion, it is not just inflation that drives up prescription costs. In 2016, a two-pack of Epi-Pens rose from $100 to $600. Epi-Pens are necessary to stop an anaphylactic reaction to foods, insect bites, drugs, or other substances. The Epi-Pen is lifesaving. In 2015, 3.6 million people in the United States used Epi-Pens. Pyrimethamine is an anti-parasite medication used for patients with toxoplasmosis. The price of pyrimethamine skyrocketed from $175 to $750 per pill. Patients with toxoplasmosis were admitted to the hospital because they could not afford the medication cost.
I have a process for all newly prescribed medications to keep the patient’s prescription costs as low as possible. Community pharmacy chains and mail-order prescription services provide prescription costs online. You can easily navigate their website when checking the prices of medicines. My first step in the medication cost process is to see if a generic medication is available. I next look for the 4-dollar copay list. You will pay $4 per prescription for a 30-day supply or $10 for a 90-day supply. I then check for a free prescription list. Atorvastatin (Lipitor®) is an anti-cholesterol medication used in patients with high lipid levels and post-heart attacks. Before November 30, 2011, atorvastatin cost $150 a month. In patients who did not have insurance that covered atorvastatin, I would call the physician and switch to simvastatin (a statin) which cost $4. After November 30, 2011, I found a big chain pharmacy in my state that charged $0.00 for generic atorvastatin. Patients would fill their heart attack prevention medications at their neighborhood pharmacy, and I would send them to the chain pharmacy to pick up their free atorvastatin. Patients can go on their pharmacy’s website and check their formulary costs for each prescription. Most medications are in drug classes that have generic forms. There will be exceptions to this rule. Recent first-in-class medications will be in the costliest tier for at least 17 years. One other resource is GoodRx®. A first prescription cost that may be on the expensive side can be significantly decreased with GoodRx® by going onto the website where discount coupons are available.
Many more widely utilized expensive medications may have discount cards and programs that significantly decrease drug costs. An example of this type of program is rivaroxaban (Xarelto®). Rivaroxaban is an FAA-approved anticoagulant for stroke prevention for atrial fibrillation and deep vein thrombosis/pulmonary embolism treatment. The patient on rivaroxaban could go onto the pharmaceutical company’s website, fill out some forms, and get the price per month significantly lower. Some healthcare insurances do not cover the rivaroxaban cost of $333. I often had a discount card and a filled-out discount form in my hand and presented it to the outpatient hospital pharmacy. The pharmacy technician would say the copay was $35, and I would call the patient on the hospital medical floors. They were delighted to save $300.
Another mission I have been on is to cut costs for insulin-dependent diabetes. Back in 1978, a vial of insulin cost $20. Short-acting insulin (lispro/aspart) costs around $200.00 per vial. Long-acting insulin (Glargine/Levemir) costs between $226 and $300. Walmart came to the rescue with Regular, NPH, and 70/30 insulin for $25 per vial.
Everything is possible, and I have the will and desire to ensure you and all in my service receive affordable and efficacious medications in this inflationary period. I remember the faces of patients who would get readmitted to the hospital for the inability to afford their medications. This quote was typical: “I have to choose between eating or affording my medications. I apologize, but I would rather eat.” I never want to hear that again. Be well and fly safely.