Healthy Skepticism Library item: 94

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Cassels , A .
Pressure to use newer, pricier drugs can give taxpayers heartburn
The Vancouver Sun 2004 Jan 29

Full text:

Mounties hauling boxes of files from the legislature is a disturbing image,
but nothing like seeing a group of drug company executives hauling away bags
of money — millions of B.C. taxpayer dollars — to the United States and
Europe. That’s what I see in my mind’s eye, with BC Pharmacare spending now
more than $770 million per year and climbing at an astronomical $300,000
every day.

I’d admit that the Liberal government is working in the public interest to
try to stop the haulage from growing, but the health ministry faces
formidable opposition. Not the NDP, but from the companies’ public relations
departments.

One of the typical strategies employed by the drug industry is to find or
create an organization of doctors who will complain that “the government is
jeopardizing patient health.” Since these multinational companies have so
much experience resisting cost-containment policies in other countries, all
they have to do is apply that expertise to B.C.

I am still amazed, after a decade of observing drug companies and their
surrogates, at how remarkably effective they are at making politicians
nervous about stemming the growth of prescription drug costs. Only rarely do
governments call their bluff and demand to know what kind of payback we can
expect from all the extra money being hauled away by pharmaceutical makers.

But last July, the Liberal government did just that. They brought in a
policy that restricts automatic payments for the most expensive drugs in a
class of stomach acid suppressants — called proton pump inhibitors, or
PPIs. They enshrined in government policy essentially what consumers
intuitively do — refuse to pay extra for products which have no extra
value.

That doesn’t mean that the more expensive PPIs won’t be covered by
Pharmacare, but that if your doctor thinks you need a PPI he or she can
prescribe the lower cost one first because the five drugs in this class are
basically equivalent. If that one doesn’t work, your doctor can request a
more expensive one. Simple, right? Well, not really.

This kind of cost-saving policy really infuriates drug companies and the
front groups they fund. Last week, industry lobbyists stepped up the
pressure on the Liberal’s PPI policy, claiming that it risks patient health,
limits treatment options and interferes in the doctor-patient relationship.
The industry-funded Canadian Society of Intestinal Research seems to be
leading the chorus in saying how much pain this policy is causing. These are
all serious allegations and deserve to be tested by the best science we can
muster.

One problem with such assertions is that they may not be based on scientific
evidence. Numerous high quality studies published in the New England Journal
of Medicine and the Canadian Medical Association Journal have shown that
B.C.‘s approach to “comparative shopping” on drugs has resulted in sound
government policy. But those are fighting words to the pharmaceutical
companies, who live and breathe by their ability to convince physicians that
pricier, newer drugs are always better — even when they aren’t.

Critics of the PPI policy will say that not all PPIs are the same and
patients could be hurt. But again, I can’t see how that fits with the
evidence. Experts at the Oregon Evidence-Based Practice Center, who did an
exhaustive review of the evidence on PPIs, concluded: “There is good
evidence that there is no comparative difference between omeprazole,
lansoprazole, pantoprazole, and rabeprazole for healing of esophagitis or
relief of GERD (gastro-esophageal reflux disease) symptoms.”

In other words, why would anyone — a patient, an insurance company or a
government — automatically pay for the most expensive drug in a class of
lookalikes?

B.C. taxpayers spend about $40 million per year on PPIs, which can range in
price from 70 cents to $4.50 a day. The cheapest PPI, rabeprazole, is about
40 per cent cheaper than the market leader, omeprazole. A switch to the
cheaper agent could save the government probably $14 million per year.
Cutting your dose in half, or taking it every other day for intermittent
symptoms, could save the government about another $20 million per year. And,
if your physician was able to steer you in the direction of some simple
lifestyle changes that could clear up your heartburn without any drugs
whatsoever, we’d be able to save the taxpayer tens of millions more per
year.

That’s a lot of extra teachers, doctors and nurses who could be hired with
the savings in just one drug class. I can think, off the top of my head, of
half a dozen other examples where serious savings in our drug budget could
occur by applying a science-based “value-for-money” criteria to pay for
newer drugs.

British Columbians need to know if we are getting any additional value from
the bags of taxpayers’ money being carted away from the legislature.