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Hussain Lalani: The true price of high drug costs

Hussain Lalani

Hussain Lalani

As a future physician, I will be unable to fulfill my Hippocratic duty if patients can’t afford the drugs I prescribe to heal them.

One of my patients came to clinic experiencing severe pain in his hands and knees. He had difficulty walking and looked particularly thin. He had rheumatoid arthritis, a condition where the body’s immune system mistakenly attacks its own tissues. At 63, he was unsuccessfully treated with anti-inflammatory drugs and steroids, and he needed something more.

I knew he was a prime candidate for a class of breakthrough biologic antirheumatic drugs including Humira, Remicade, Orencia, or Enbrel. These medicines could have reversed his condition, made him feel better, and enabled him to live a relatively pain-free life.

But he didn’t get the treatment. Why? Each of these drugs costs at least $20,000 per year, and he didn’t have the money.

As a medical professional, I felt I’d failed him, even though I had no control over his insurance or the cost of drugs.

Next May, I will graduate from medical school and take the Hippocratic Oath vowing to act in the best interest of my patients and to “First, do no harm.” But, I feel increasingly uneasy about how well I can meet that promise when patients struggle to afford lifesaving medications.

In Maryland, and across the U.S., patients are forced to make tough decisions — even as significant as selling their homes — to pay for their medications. Dr. Stephen Rockower, president of the Maryland State Medical Society and a practicing orthopedic surgeon, says his patients can only afford to take their medications for a few days.

The high cost of prescription drugs will make it hard for me to “respect the hard-won scientific gains of those physicians” who came before me, as I will swear in my oath. I fear it will be difficult to apply “for the benefit of the sick, all measures which are required” if my patients can’t afford the drugs they need.

I may swear the oath, but the policies surrounding how we deliver and pay for health care say otherwise.

State legislation

Given the recent comments by President Donald Trump about tackling the cost of prescription drugs, there is uncertainty about action at the federal level. Therefore, I strongly support efforts by state lawmakers and the Maryland Citizens’ Health Initiative to make prescription drugs more affordable for all. Their two bills (HB 631/666 and SB 415/437), known as the Prescription Drug Affordability Initiative, introduce greater transparency on drug pricing that can lower the cost of drugs for Maryland residents.

First, the initiative requires corporations selling expensive drugs in Maryland that exceed an annual cost threshold to disclose the cost of research and development, including research funded by taxpayers, intellectual property, manufacturing, production, marketing, and financial assistance.

Today, we don’t know how expensive drug development is, particularly for high-priced drugs. We lack transparency on the direct costs that pharmaceutical corporations incur. Transparency can inform negotiations, thereby increasing affordability, and patients and doctors deserve to know for the greater public good.

The initiative also requires public notification before a price hike of greater than 10 percent annually or 15 percent over two years, so that patients can consult their physicians and develop a plan of action. For example, if a cholesterol medication is scheduled to increase in price, then a physician can help patients find an equally effective and cheaper alternative.

Generic medications

Finally, the initiative gives the State Attorney General the legal authority to address price gouging of essential generic medications. Far from being a consistent low-cost alternative, some generic drugs have become unaffordable. According to the U.S. Government Accountability Office, 315 generic drugs, or 22 pecent, covered under Medicare “had at least one extraordinary price increase of 100 percent” during 2010 and 2015. Some had over a 1,000 percent increase. The cost of doxycycline, an old antibiotic from the 1960s, rose 8,000 percent in 7 months, from $20 in October 2013 to $1,849 in April 2014 for 500 pills.

When patients see the cost of necessary medications skyrocket, it’s no surprise 75 percent of Maryland voters are personally concerned about prescription drug costs and 84 percent favor price transparency.

I’m training as a physician because I want to heal the sick. But the high cost of prescription drugs makes it difficult for doctors to meet their ethical obligations. Greater affordability will allow patients to benefit from scientific advances and to live a higher quality of life. And I’ll be able to swear to the Hippocratic Oath without reservation.

Hussain Lalani is a MD/MPH student at Duke University School of Medicine and the Johns Hopkins Bloomberg School of Public Health. He is the Baltimore chapter leader of the Young Professionals Chronic Disease Network.