Healthy Skepticism Library item: 10985

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Publication type: news

Fayerman P.
Doctors endorse drastic action to curb drug costs
Vancouver Sun 2007 Jul 25
http://www.canada.com/vancouversun/news/story.html?id=fa2f65ff-480e-4227-8c40-0703e03e2adc&k=18911&p=1

Full text:

Bargain hard with drug makers and limit promotional activities, B.C. MDs say

B.C. doctors are calling for drastic action including aggressive price bargaining between the provincial government and drug companies to curb double-digit growth in prescription spending.

A policy paper to be released today by the B.C. Medical Association says spending on prescription drugs escalated from $259 million in 1985 to more than $2 billion 20 years later.

Annual spending on prescription drugs in B.C. has been growing at an average of 11.3 per cent, to the point that prescription drugs are now the fastest-growing component of health care spending. In terms of total dollars spent, only hospitals gobble up more money.

The policy paper says that a freeze on drug spending for just one year would “free up enough money to hire 8,000 new doctors or 20,000 new nurses.”

The BCMA assembled its prescription-drug project group to come up with recommendations that might help contain costs while at the same time ensuring prescribed medications, which account for 84 per cent of all drug spending, are used safely and appropriately.

“The challenge for health care policy-makers is to determine if and when the investment in prescription drugs, in light of continued growth, is worth the expected return,” the report says.

BCMA president Dr. Geoff Appleton said in an interview Tuesday that drug treatment is the most common approach in modern medicine and that helps explain why costs are a challenge throughout the developed world.

The report refutes the belief that seniors account for a disproportionate share of prescription drug cost increases. It points out that studies have actually found that 80 per cent of the increase in spending in recent years has been on drugs that are merely re-formulations of existing drugs, and that they often have no clinical advantage.

Spending on breakthrough drugs has gone up only incrementally and spending on generic and older brand-name drugs has actually gone down substantially.

The report notes that drug companies spend huge amounts promoting their products to doctors.

A survey last year found that nearly 70 per cent of doctors in B.C. get visits from drug company representatives at least once a month while more than 40 per cent of family doctors are visited several times a week.

It calls on the federal government to set up a watchdog agency to oversee and regulate drug manufacturers’ promotional activities to guard against conflicts of interest by doctors who may be overly influenced by such marketing.

Appleton said doctors are faced with constant barrages from drug manufacturers trying to persuade them to prescribe their products and must take such information with “a grain of salt.”

Patients who want access to the newest medicines after reading or hearing about them also pressure doctors. So researchers studied what is being done in other jurisdictions with similar drug programs to see how the competing challenges are being handled.

They liked what New Zealand has achieved through direct negotiations with manufacturers to drive down drug costs through bulk purchases, but they didn’t like the fact that New Zealand puts a cap on its budget for publicly funded prescriptions, because once the budget has been exceeded, patients must fork over the money from their own pockets, and many can’t afford to pay for their medications.

Countries like Germany, Australia and the Netherlands have programs to give doctors unbiased information on the costs and effectiveness of prescription drugs, and the BCMA is hoping for more such programs here.

Most doctors don’t even realize how much the drugs they are prescribing cost unless their patients happen to mention it — usually in an exasperated fashion, Appleton noted.

In a surprising concession to pharmacists, the BCMA endorsed a role for them to renew prescriptions for a maximum of 30 days when doctors are not readily available, as long as doctors are informed of the renewals.

The doctors do not want to see pharmacists going beyond that because they are not “adequately trained to take a medical history, perform a physical examination, order and interpret appropriate investigations and arrive at a working diagnosis.”

Health Minister George Abbott said he was impressed by the “thoughtful, balanced and constructive” report and said he supports almost everything in it.

The suggestion that government negotiate price reductions with drug manufacturers and wholesalers appeals to Abbott and he said it is currently being pilot-tested with one product used by diabetics to test their blood glucose levels.

B.C. and Alberta have joined forces to do bulk-buying for the product and Abbott said he expects the health ministry will “get more rigorous, from a procurement of supplies and pharmaceuticals perspective.”

Abbott said he was reserving opinion on whether a hard cap for the Pharmacare budget should be implemented.

“The report says don’t do it, but I am not persuaded on that. Some see us as having tight-fisted controls, but when you look at annual growth of over 11 per cent, I can’t outright reject a budget cap.”

Abbott said he likes recommendations that would provide more information about drug costs and effectiveness for doctors and patients and believes it would all have to be Internet-based. “Patient consumers are already engaged with sites that provide health information so this would be helpful,” he said.

Abbott said he was “pleasantly surprised” that doctors are endorsing a limited role for pharmacists, because patients have easier access to pharmacists than to doctors.

“It’s a positive step forward and we are currently assessing if it goes far enough, as we are months away from determining how much of a prescribing role pharmacists should have.”

DRUG EXPENDITURES SOAR IN B.C.

The dollars spent on prescription drugs in B.C. have increased almost tenfold since 1985. Below, some of the recommendations for the B.C. medical system to stem the increase.

Highlighted Recommendations from the B.C. Medical Association report A Prescription for Quality: Improving Prescription Drug Policy in B.C.:

- The government should negotiate directly with drug manufacturers to secure better prices for Pharmacare-insured drugs.

- Doctors, not just bureaucrats and academics, should be involved in drug-funding decisions and there should be an immediate review of the objectivity of those making decisions.

- Drug coverage decisions should be more transparent.

- Cost-effectiveness of older drugs should be assessed no later than the end of the year, as recommended by the auditor-general.

- A prohibition on direct-to-consumer advertising for drugs should continue, but it needs better enforcement.

- Health Canada should appoint a watchdog to regulate drug-company promotional activities to doctors and others.

- Accurate, unbiased drug information should be developed for doctors and patients.

- Pharmacists should be allowed to renew prescriptions on a short-term basis when they can’t get hold of doctors, as long as they inform the doctor they have done so.

pfayerman@png.canwest.com