Healthcare Hullabaloo: Don’t Give Me No Lip

We’ve all seen advertisements for prescription drugs on Television. Well, maybe there are a few exceptions.

Perhaps you’ve just emerged from a 40 year coma (like in that Robin William’s movie).

Or, like Tommy, you’re blind, deaf and dumb (speechless, that is, not imbecilic)

Or perhaps you’re Amish.

(Hell, scratch that example. Even the Amish must have seen a prescription drug commercial, even in a fleeting glance through a window as they drove by their English neighbor’s farm in that covered surrey).

Yep, chances are extremely good that, as an American, you’ve seen at least ONE television commercial for a prescription drug. Most of us have seen thousands.

Today, I saw something completely different. I saw a commercial that instead of imploring us to take a drug, it begged us NOT TO STOP taking one.

If you haven’t seen it yet – be patient – you will. It stars a middle aged fellow sitting on his road bike on the side of the road. It seems that someone must have tried to convince him to stop taking Lipitor – and he wasn’t having any part of it.

This is serious business – Lipitor is one of the best selling drug in America. Who would want you to stop taking it?

Well, your health insurance company for one.

There is a Battle Royale being fought between the Pharmaceutical Companies and the Health Insurance carriers. The pissing match has been taking place pretty much behind the scenes, but recently the general public has been allowed to glimpse behind the curtain – and it ain’t a pretty sight.

The pharmaceutical companies have been reaping in huge profits for many years now on their overpriced wares. The Health Insurance companies have capitalized on this red hot market by offering prescription drug coverage – something that you wouldn’t need if the drugs were realistically priced. These two parties are basically a pair of symbiotic leeches living off the lifeblood of our healthcare dollars. Both leeches got fat and bloated on this blood - until the blood supply started to diminish. Now these two bloodsuckers are turning on one another.

Faced with increased government pressure to control costs, the health insurance carriers are targeting Big Pharm and their ridiculously overpriced chemicals. Big Health has a new superweapon that it is using to great effectiveness against Big Pharm – the Formulary.

In effect, your Health Insurance carrier’s Formulary is a Naughty and Nice list of prescription drugs. It consists of different tiers of prescription drugs, and the tiers are differentiated by increasing copayment amounts. If a pharmaceutical refuses to give a Health Insurance Carrier a price break on one of their meds. That drug gets pushed up to a higher tier. So, if you get a prescription to a high tier drug, your copayment might be as high as $100. A similar drug for the same condition (whos manufacturer plays nice with Big Health) might only carry a $10 copayment. By penalizing their subscribers, Big Health is banking on them to reject the higher copayment drugs and ask their physicians to prescribe a lower tier – land lower co-payment – alternative medication. In fact, if you call your Health Insurance Carrier to complain about a high copayment, they will gladly tell you what lower tier drugs are available, and suggest that you ask you doctor for a new prescription.

This is a economic blackmail. It is also very effective. As a result of this formulary favoritism, many patients are seeking out less expensive prescription medicines, and pressuring their doctors to prescribe them.

The Formulary battle lines have been being drawn for years, but Big Health went too far recently. They’ve bumped Lipitor, one of Big Pharm’s Superstar medications, up to the highest formulary tier. Faced with huge monthly copayments, many patients are flocking to low tier alternatives like Simvastatin, which works almost identically to Lipitor but costs only a tenth of the price.

So Big Pharm is fighting back. Witness, if you will, the latest Lipitor commercial.
And since television is only so influential, Big Pharm has deployed their own superweapon – the prescription card. You can now get a free prescription card that will lower your Lipitor copayment to only 4 bucks a month – much less than Simvastatin - thereby cutting the legs off of Big Health.

And this little border skirmish between Big Pharm and Big Health is rapidly escalating into World War III.

Tee hee. I love the smell of Napalm in the morning.

More on this subject in my next post….

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