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    April 22, 2019
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Ask a Health Professional Paul Farley PharmD M-F: 9a-6p Sat:9a-lp.(715) 582-0898 960 Frontage Road Peshtigo, Wi uestion: Why Do Medications A: Over the course of my Another factor in high drug costs is career as a pharmacist, the the drug manufacturers t eoften is "Why does it cost ext question 1 have heard most Research and development can be expensive and time con- healthcare suming. Your costs are covering those x, but here is an expenses for getting that drug to market industry is very overview of some of the reasons why as well as the ex ication costsare pharmacy benefit government expenses for all the dr medications cost as much as hey do. that failed to make it to market. Some The three primary entities driving med estimates have shown that it costs man approximately S2.6 million dollars agers (PBMs). drug manufacturers, and over 10 years to get a drug to market, lthoagh that number is disputed manufacturers increase are costs is by raising the prices of exist 3rd party administrators of drug plans, ing medications, often times greatly They perform functions such as creating exceeding the rate of inflation. A few a formulary (list of approvedovered commonly known examples are vari Another way Pharmacy benefit drugs by your plan), contracting with ous types of insulin and ications with drug manufacturers, and 2007 to 2016. From 2002 to 2013, insulin processing/paying claims. Mostpatients prices tripled. These drugs were already hings, but it almost always the PBM on market so had little reason to doing these things up. Price hikes like this may be related the scenes to the rebates paid to PBMs and with very little oversight. When mary function was to process and role and thus t PBMs were first developed, their pri Finally, government plays a role in the cost of medikations in many direct and expandedt indirect ways. There is a t on pricing regulation by the FDA which increases greatly ovwer the years. There is very little the cost of production. Much of this is competition in that industry as well. The needed to ensure safety and efficacy, but top3PBMs control 78% of the market. there ulato y burdenis higher in the United States than many other coun- laim that their services tries. Medicare Part D plans include drug costs for consumers, buut a coverage gap many are seeing just the opposite effects, hole" which requires patients to pay full 1 practices that raise drugs price for medications after you and you Some PRM plan have already paid for a specified ion of expensive amount of medication, There is a limit to hone much you will pay in the donut from manufacturers, hole before your drug coverage kicks in pricing describes the practice of again. Patent law in the United States arging your health plan mach more also allows a drug manufacturer to have brand name to rebates r cots exclusive rights to production of a med and what is actuall y). The PB to the ication fo r approximately 20 years afte e, and the cost of your health plan soars to cover those costs, Clawbacks of that time often makes it to occur when a PBM actually charges other companies from making the same termined worth does the research and development of just charging a lower copay. Gag clauses As you can see, there are many factors apatien if the cash price of a medica- issue is very complex. PBM reform is pharmacy to fill a prescripnedtion at a cheaper price. This is presumably to reward the company that ment from the patient than the de of the prescription and collect that dit the medication. ference from the pharmacy instead of pharmacy from telling that contribute to high tion is cheaper than what your PBM is very important and legislation is cur charging you. Finally, PBMs receive renily being discussed in Wisconsin to s from drug manufacturers limit some of the damaging practices of y to these companies. If you have any ques ensure placement on your formulary, tions about this issue, feel free to stop by Ihis is often in place of a cheaper alter. Hometown Pharmacy in Peshtigo. We'd la ge r native that is just as effective.