The Prescription Escalator

Ask anyone and they will tell you that their prescription costs are rising. But generic drug prices are falling (also here) and generics are 80-90 percent of all prescriptions. Moreover, although branded drugs are expensive total out-of-pocket costs for the population as a whole are flat or even decreasing as Michael Mandel points out:

[A] May 2019 research report from the Agency for Healthcare Research and Quality reported that average out-of-pocket spending for prescribed medications, among persons who obtained at least one prescribed medication, declined from $327 in 2009 to $238 by 2016, a decrease of 27 percent. Data from the Bureau of Labor Statistics Consumer Expenditure Survey shows that average household spending on prescription drugs fell by 11% between 2013 and 2018.

Moreover, OECD data shows that average out- of-pocket spending on prescribed medicines in the United States ($143 per capita in 2017) is actually lower than countries such as Canada ($144), Korea ($156), Norway ($178), and Switzerland ($215).

So are people simply mistaken about what they are experiencing? Not quite. Mandel uses the metaphor of the prescription escalator to explain the apparent paradox:

It turns out that an escalator is the appropriate model for prescription drug costs for individuals. As people get older, they unwillingly ride the prescription escalator, with their average spending on prescription drugs rising by about 5-6% per year. This figure assumes no change in the underlying price of drugs. Rather, people fill more prescriptions as they age.

In other words, every individual experiences an increase in prescription costs as they age even though for the population as a whole prescription prices are flat or falling–a form of Simpson’s paradox. The driver of higher costs is usage not price. People aged 65-74 have on average 25 (!) prescriptions to fill, more than two and half times as many as people aged 25-34 (about 9 per year).

Understanding the prescription escalator is important because regulating drug prices–aside from being a bad idea–won’t solve the perceived problem.

…even if drug reform efforts were successful and there were no more increases in drug costs, every individual would still face a 5.6% increase each year in drug spending as they got older. That would total 30% after five years, and 70% after ten years, across the board.These are enormous increases.

Indeed, the prescription escalator is a sign of success. If drugs weren’t successful we wouldn’t buy more of them when we were older and sicker and costs wouldn’t rise.

Comments

Indeed, the real problem with healthcare is there is a literally unlimited desire for it. With no brakes on demand, price goes up. if you remove this market mechanism, the amount of money society will spend on health care will likewise explode. if you think the US spends a lot on healthcare now, wait until it's free!

I thought limiting acess to treatment Washington "death panels". Oh, I forgot. It is OK if Big Business kill Americans to make an extra buck or one billion extra buckse here and there.

I can sue Big Business.

But where people wno went to Heaven will get lawyers?

Good point. There are no lawyers in heaven.

And you can turn a bad government out of office.

This isn't a comedy blog.

You may wish to ask Matt Bevin (R - KY) how funny he finds it.

The people who already consume the most health care / prescriptions have massively subsidized to "free" coverage. I'm not sure how extending coverage to younger, healthier people will cause a greater "explosion" than that already driven by an aging, subsidized population.

I don't suppose you've ever heard of a medical condition called "pregnancy.'

This is why we need to keep sensible premiums, copays and deductibles in place where and when we can. But those seeking more free stuff will still have to endure any inconvenience in accessing the care, obtaining the meds, testing or treatments.
And in the end all this free stuff is mostly uncomplicated and cheap medical stuff. The real expensive HC cost drivers are not typically ones that are easily put off or elective.

Healthcare desire is not unlimited. It's quite finite, bounded by the parameters of an individual's health.

I take the results if the study to mean as we age, we need more health care. As our lives get longer and longer, we pay more and more for less and less health. If I were a frail 100 year old and was offered 1 year of 20 year old health for $1,000,000, I'd likely do it if I could, and if it were free, or at least someone else was paying, why not?
That's is what is meant by having no limits to health care demand. If the market doesn't constrain consumption, government will. While some would welcome this change, I consider the implications horrifying.

I live in your nightmare every day in Australia. We live longer than Americans and we spend half as much per person on health care. Join us! It is bliss!

Well, it's better than being uninsured in the United States at least.

One of the advantages of our system is families love for each other is not used as a weapon against them to extract money to pay for almost useless treatment for people at deaths door. And without that system in place, people approach death in a much more realistic manner:

AUSSIE DOCTOR: Bloody hell, woman! You're so close ta death you could cut the ends of your cigars with his scythe! Yeah, we could operate, but, nah, you're odds are worse than the dog food factory not winning the Melbourne cup.

GRANNY: Bugger that! I've had enough. I'll finish me durry and then self medicate until I'm pumped full o' more drugs than Cold Chisel combined.

But even in your example you stipulate a limited amount: a million dollars. And more significantly you stipulate something wildly unrealistic. There are no such treatments.
Can we not have these discussions based on reality and not on fantastical elements? If you're relying on magic to prove a point, you've pretty much admitted the point is invalid.

Ooohh, someone didn't get it all this morning.

... so older folks have more health problems and therefore spend more on drugs and medical services -- seems very obvious, but does not impact the primary issue of excessive prices for prescription drugs.

Massive government interventions into the U.S. pharmaceuticals "market" cause massive price distortions -- and harm all consumers.

The distortion is, that, unlike many purchasers of goods, the government is unable to negotiate a price for the persons who use the drugs it pays for.. The price is set by the drug companies.

Other countries which negotiate prices have much lower prices. You can see that massive distortion by just traveling to Canada.

That's not entirely true. While there is a "non-interference clause" with respect to the Medicare Part D program, the US government can and does negotiate drug prices for the Medicaid and Veterans programs.

+1, informative

If Medicare could use VA drug prices, it would save $14 billion a year: "Medicare Part D could save $14.4B using VA drug prices: "The analysis revealed that annual net Medicare Part D spending on the top 50 oral drugs ranged from $26.3 billion in 2011 to $32.5 billion in 2016. If Medicare Part D used VA prices in 2016, the cost would have been $18 billion, for a savings of $14.4 billion or approximately 44%.

Researchers found that results were similar when looking at estimated savings from 2011 and 2015, which ranged from 38% to 50%." https://www.healio.com/primary-care/pharmacology/news/online/%7Bf6967882-2578-41e6-bcb2-191c2c782a22%7D/medicare-part-d-could-save-144b-using-va-drug-prices

I know that, particularly for the VA, but you cannot negotiate for Medicare. As for Medicaid, Medicaid gets the lowest payer price, and states have managed care plans where the manager may negotiate for discounts beyond that.

Do PBMs negotiate? Is this a market you understand and have experience in? Reading your comments my takeaway is you don’t work in the pharma industry and are riffing off of NYTimes op-Ed’s.

The only negotiating leverage comes from refusing to add branded drugs to formulary. Which means it’s out of pocket.

Medicare for All refusing to add drugs to formulary means...the consumer will still pay out of pocket.

PBMs do this literally every day. And the market is consolidated.

There’s no way to eliminate the “ I only want brand X and it’s not covered ..” problem.

The fix for this is dramatically tightening the rules for extending patents. That’s where the abuse and high prices come from. Instead we get fairy tales and magical thinking.

Dude, put some data where your mouth is.

I doubt those drugs, especially non-generic drugs, are manufactured in Canada. Since the pharma companies are selling into a global market, those low prices are subsidized by other nations like the USA.

It takes a lot of cash to do the research and clinical trials to bring a new drug to market. The incentive to do so is money.

Tocquevilla was prescient.

Another factor at play is the wide dispersion of costs. Some medications that are literally life-saving can cost tens of thousands or even $100,000 per year. I find the drug companies that charge so much to be immoral. It's not about funding innovation, no one needs a 10,000% markup.

Even generic medications have widely variable costs. I depend on a drug that has been off patent for decades, and is sold by at least 4 companies. It still costs nearly $500/month. (I estimate the cost of goods as less than $20) Fortunately, Medicare covers most of that, at least until I hit the donut hole.

"no one needs a 10,000% markup"

Wrong

"is sold by at least 4 companies. It still costs nearly $500/month. (I estimate the cost of goods as less than $20) "

Or maybe your estimate is wildly off?

"I find the drug companies that charge so much to be immoral." Yup, better that all their employees work for nothing - just as you no doubt do.

"...work for nothing..."

He said he's on Medicare, pre donut hole, so it's possible he does "nothing for work".

Do nothing get nothing.

There aren't that many drugs you could be truly dependent on that costs $500/month and off patent for decades. Which one is it- I can tell you pretty quickly what the cost of goods actually is. I ask, because with 4 FDA approved sources, it is unlikely the cost of goods is actually $20.

Anyhow the price discrimination in medicines and health services between the insured and uninsured should not exist
http://teawithft.blogspot.com/2009/06/but-there-is-minimum-minimorum-reform.html

"If drugs weren’t successful we wouldn’t buy more of them when we were older and sicker"

Actually, there's little evidence to support that causation argument.

Older folks simply have more HC risks and needs for more types of meds. If the meds were not useful they would not gain a medical foothold. Generally at least. Of course some meds are essentially placebo, ineffective or even dangerous.

Based on my observations of my own parents and grandparents, we could slash drug use in half or even two-thirds, and they would be in fact overall healthier.

"People aged 65-74 have on average 25 (!) prescriptions to fill"

Which means that some people that age have more than 25 prescriptions. Holy cow. I would guess for many of these people you could go into their medicine cabinet and throw out half the containers randomly and they would end up healthier.

Okay, I see McMike made the exact same point. Guess I should've read the whole thread...

“ I would guess for many of these people you could go into their medicine cabinet and throw out half the containers randomly and they would end up healthier.”

Random, huh? Nice. Try it with your mom and dad for four weeks then report back to us.

uh, yeah.

It is in fact highly recommended that competent people go over the prescription list with their elderly loved ones, UNDER THE SUPERVISION of a doctor, to identify interaction risks and unnecessary meds. I have gone though this exercise more than once and indeed identified several items to remove or modify.

Hey McMike, if your parents’ pharmacist is not doing this as a matter of course please have them immediately change pharmacies.

This is an egregious violation of professional standards and an actual violation of their legal obligations to the patient. This is illegal and potentially prosecutable.

Unless your parents are throwing a dart at a map and going to random mom and pop pharmacies, Rx history should be maintained at their local chain. And their entire job is to check for interactions and issues.

thanks. the reality is a little more complicated than blatant label-warning interaction concerns. I am meaning problems a little subtler than that. More like taking three things with depression /anxiety as a side effect, then taking something for the anxiety.. much of which is really just treating old age.

my dad used to call me and be like: my neck hurts and I'm dizzy when I stand up. And i'd be like, dad, I checked it out, and the book says you are 88 years old. In usa 2019: there's a pill for that.

thanks again, but again, even this post is an oversimplification. nevertheless the main point is the point: badly overmedicated

I could be wrong, but based on what I see with actual patients and my quick pubmedding of the literature, I think that 25 average counts each refill separately.

Polypharmacy Among Adults Aged 65 Years and Older in the United States: 1988–2010

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4573668/

They are listing the average number of prescriptions as 4 with 39% taking 5 or more.

This far more reasonable for my early boomers. Statin (which has a low threshold to be on), ACE/ARB, metformin, and an nsaid are likely making up the majority of those scripts.

Polypharmacy is a problem and I try to get folks to see a gerontologist who can help prune down the medications. The problem comes that few doctors are comfortable managing problems against the wishes of the specialists. Certainly only the most direct of medication interactions/side effects ever will bring on malpractice claims.

Like many things in medicine, there is a well thought out plan to manage these issues ... it just costs money and effort that many folks are unwilling to spend.

Probably doesn't equal the number of medications being taken- sometimes fill the same prescription two or more times a year.

That's *per year*. Most people aged 65-74 have ongoing, refillable prescriptions for common conditions like high blood pressure or high cholesterol. These can be considered preventive because they ward off heart trouble, strokes, etc. Two prescription refills a month is not a lot of prescriptions.

My family’s deductible tripled under Obamacare. Now it’s 1/2 of that but still higher than the old deductible. My premiums have continued rising, but now the family’s med costs are sometimes $0.00.

I’d rather have higher co-pays and prescription costs and a lower out-of-pocket.

I personally think when one gets used to paying nothing, one becomes entitled and one disenfranchises oneself.

People can manage to find $.25 - $1.00.

Especially if more of the money spent on the poor actually got to the poor and not diverted.

Do you have Obamacare or private insurance?

I bet you are not on it. So, what you are talking about is private coverage.

Correct?

"Obamacare or private insurance?"

It's not an either/or.

There's no such insurance as "Obamacare". People are either on a public plan, a private one, or on their employer's plan (which may be largely self-funded).

Obamacare is the Obamacare exchange set of plans.

-5 points for pedantry and tediousness.

Skeptic, JonFranz was responding to We Live, not you. His response is clear, it is not either/or. Look up the word pedantry, and your comments are getting tedious, particularly when Jon's comments are clear and your's are...well, I can't describe how incomprehensible they are.

Skeptic, It is either/or. It is not not either/or. Sorry for the confusion. Jon's comment remains correct, and your's is still incomprehensible and pointless.

"the price discrimination in medicines and health services between the insured and uninsured should not exist" {... in a normal market}

But there is no normal market for health services in U.S. -- government politicians & bureaucrats dictate its economic structure.
Guess what should be removed from our health services structure?

"there is no normal market for health services in U.S.": speaking as a sympathetic foreigner, that's my impression. The US makes intelligent use neither of free markets in health care nor of government organisation of it. (For what it's worth, my experience of the NHS means that I recommend that you don't experiment with government provision of health care.)

"...my experience of the NHS means that I recommend that you don't experiment with government provision of health care..."

But it's free!!!! Yay!

9 prescriptions/year at ages 25-34! I'm amazed it's so much. I'm 36 and I think I had only 1 prescription for the last 10 years.

I am 76 and, if I remember well, I had just one prescription for the last 5 years. But I have noticed my friends have increased their prescriptios for psycopharmaceuticals

Is this nine different drugs per year, or nine prescriptions filled? How are refills counted?

If refills/individual fills are what's being discussed, then these numbers seem very reasonable. If you're on any drug long-term (e.g. psychiatric, bone density, heart health, ...) that's 12 fills/year/drug.

Searching for primary literature suggests that it is 4 distinct prescriptions per year with many refills.

I read through plenty of med-recs and even for our nursing home patients (who see me when they try to die), very few have 25 distinct prescriptions.

That amazed me as well. I’m 46 and I can’t remember having a prescription since I left school. Apart from a couple of bipolar friends, I don’t know anyone regularly taking any drugs. It would be interesting to see a comparison with Europe/Canada/Australia.

Sad anecdotal reality from me: through age 50 -- no prescriptions. 50-55: One prescription. 55-60: Three prescriptions 60-63: Six prescriptions. Just wait....

"If drugs weren’t successful we wouldn’t buy more of them when we were older and sicker and costs wouldn’t rise."

? - I am not at all sure my prescription-loving father would any better perceive the results of his medications than their costs. (To be fair, I've not heard him complain about the latter; cheapness is not generally one of his flaws, except where the funeral industry is concerned - that's his one bugbear for some reason.) "I'm still on the escalator" is, I guess, the chief evidence for their efficacy.

My parents see savings on grapefruit, though. My father's a strong believer in the grapefruit/prescription drug takeup nexus. I didn't have to buy grapefruit for 20 years - they always sent out dozens of boxes to friends and family at Christmas, but no longer do, because the way his mind works: if he's no longer eating grapefruit, no one is. That one's obvious.

Every single senior I know closely eventually ended up on too many medicines, and ended up worse off than without most of them. Eventually leading to an over-medication crisis, and unnecessary chronic poor health under the weight of side effects.

(This is due to to the expressly prohobited interactions, the remoteness from some of the intended uses, or dubious value for common ailments, and the yo-yo of dueling side effects, and particularly due (at least in my view) to the sheer negative impacts on a body of bombarding oneself with so many chemicals).

Every single senior I know closely

IOW, your mother.

I assume that was supposed to be some clever snark. was it a “your mama” joke? because otherwise it makes no sense

It's actually not obscure at all. Try again.

I'm pretty sure this has nothing to do with Simpson's paradox. Simpson's paradox arises when there are distinct subsamples of different sizes. In general, one subsample swamps the others so that
the direction of correlation in each subsample is opposite to that of the sample as a whole. I can't see how you can structure this phenomenon in a parallel fashion. You could do correlations of drug outlays by years and aggregate individuals, but then there would be no paradox because total outlays would increase in aggregate too. What's driving this is that the sample itself is changing over time.

I think focusing on out-of-pocket expenditure misses out on a lot of what's going on in the drug market since out-of-pocket expenditure makes up a small portion of the total. Here are 2 highlights from the same AHRQ report (https://meps.ahrq.gov/data_files/publications/st522/stat522.shtml):
"In the U.S. noninstitutionalized population, the average total prescribed medicine expenditure for persons who obtained at least one outpatient prescription medication increased by $458, from $1,497 in 2009 to $1,955 in 2016, a 30.6 percent increase.
Among persons who obtained at least one outpatient prescription medication, average total prescribed medicine expenditures increased from $2,635 in 2009 to $3,288 in 2016 for the elderly and from $1,227 to $1,539 for the non-elderly."
Note, this is per person expenditure that includes all sources of payment (not just out-of-pocket). The mean number of prescription fills per person as reported in the Medical Expenditure Panel Survey (which is what the report uses) has stayed around 10 per year since 2004. This means the rising mean expenditure is not from use but from prices. MEPS also has data on expenditure per prescription fill. I don't have time to pull the appropriate inflation index and deflate the expenditures (AHRQ provides good guidelines on what indices to use), but I'm sure Alex could have one of his grad students do it and get the numbers on expenditure per prescription fill and put it in a follow-up post.
Maybe people's perception of rising expenditure comes from increased utilization as they age (and also not actually knowing what is actually being paid by their insurers), but the actual increase in expenditure is being driven by prices.

"the mean number of prescription fills per person"

Is this adjusted for 30 day vs 90 day fills? My impression and experience is that the pharmacies, both retail and mail order, encourage 90 day fills. Its usually not much/any cheaper for me, but its considerably more convenient.

It's just the mean number of fills, unadjusted. I'm not sure whether there has been any shift in the mix of prescription lengths over that time, but I haven't see anything in the data that would suggest some marked change in the average length of prescription over time.

An anti-Brazilian jacquerie has started in São Tomé e Príncipe. America keeps talking about defending minorities and human rights. What will it do? Side with the aggressors or with the innocent?

That's in Africa - nobody gives a fig.

OTOH - I propose we give every hot babe in Brazil a Green Card immediately.

Why not? If we can flood the market with illiterate Mexican Indios to drive down wages of the entitled, white, high-school educated, low-skilled American workers we can certainly drive down the marriage market power of entitled, white, fat, ugly, American women that would rather be a corporate officer than a wife and mom. Bring 'em on. Bryan Caplan says it's their human right to come here. Let's start small and bring in the hot Brazilian women. It's the only fair and moral thing to do!

"That's in Africa - nobody gives a fig"

It is not that simple. We are talking about an anti-Brazilian pogrom. How long shall they kill Brazilians while America stands aside and looks?

"How long shall they kill Brazilians while America stands aside and looks?"

We Americans should stand aside until we get tired, then we should sit.

Let Brasil solve the problem. Why should we do anything? Am I supposed to send my two boys there to get killed? For what? F*ck that. We have done that in the past all we get for it is death, dismemberment, and hatred and contempt from the beneficiaries.

"They all hate us anyhow,
so let's drop the big one now."

So America will lead from behind once again. That is how Brazilians are being paid for having fought besides America in WW I, WW II and in the invasion of the Dominican Republic. America is read to protect Germans and Japanese (after Iwo Jima, Pearl Harbor and Omaha Beach), but refuses to support its most faithful ally. "That is how Empires die:
Next year we are to bring all the soldiers home/For lack of money, and it is all right./Places they guarded, or kept orderly,/We want the money for ourselves at home/Instead of working. /And this is all right./It's hard to say who wanted it to happen,/But now it's been decided nobody minds./The places are a long way off, not here,/Which is all right, and from what we hear/The soldiers there only made trouble happen./Next year we shall be easier in our minds./Next year we shall be living in a country/That brought its soldiers home for lack of money./The statues will be standing in the same/Tree-muffled squares, and look nearly the same./Our children will not know it's a different country./All we can hope to leave them now is money."

"Ask anyone and they will tell you that their prescription costs are rising".

Not for me but I won't tell you why because then I'd be accused of being a socialist.

Or you could say that the my cost is rising but I'm not the one paying it. That's a more realistic, and bracingly unsocialist, way to phrase it.

I'm no economist, and I'm woefully ignorant of economics, but I nonetheless have a dumb theory. Tabarrok writes, "Understanding the prescription elevator is important because regulating drug prices–aside from being a bad idea–won’t solve the perceived problem."

My theory is that if a Democratic presidential candidate won and had, as a prominent part of her platform, regulating drug prices, then most media outlets would (1) say that the program was a success, and give data, however bad, to back up their claim; (2) they would do this even if regulating drug prices was not a success; (3) right-wing news outlets would say that the program was not a success; (4) they would say this even if it was a success; (5) there would be no stories in mainstream (save for Fox News) outlets about how people's drug prices are rising; (6) there would be stories about how they're falling; (7) there would be stories about a right-wing effort to convince people that their prices were rising, despite "clear evidence" and a "consensus" among "health care experts" that they're falling; all leading (8) most people who follow the news to think, regardless of their personal experience, that drug prices are falling.

Why is the title of the piece, "The Prescription Escalator" when everywhere else it is noted as a prescription elevator?

Personally, I think escalator is the better metaphor.

This post is a little funny, because, unless you believe that the demographic profile never before had these demographic groups (24-34, etc) the post is not saying anything: unless it is a claim (which is not asserted in the post) that one part of the age profile is growing faster than it has in the past.

I mean the post iis silly and misleading at best to say: 24-34 year olds spend less on prescriptions, when, guess what, there were a different cohort of 24-34 year olds 10 years earlier. What would be relevant is the change in composition, but that cannot be offered as the explanation of drug cost changes.

The point of the post is that the perception of drug cost rising is false . To the individual, the cost is rising because you are aging. To the entire population, it is not.

That is also not logical. People have been aging for centuries, and, the composition of the population in demographic groups has not changed so much that ALL people have these perceptions.

Also, your statement is also false that this is a perception: it is a fact:

"The report, published Monday in the journal Health Affairs, found that the cost of brand-name oral prescription drugs rose more than 9 percent a year from 2008 and 2016, while the annual cost of injectable drugs rose more than 15 percent.

"The main takeaway of our study should be that increases in prices of brand-name drugs were largely driven by year-over-year price increases of drugs that were already in the market," says Inmaculada Hernandez, an assistant professor of pharmacy at the University of Pittsburgh, and the lead author of the study." https://www.npr.org/sections/health-shots/2019/01/07/682986630/prescription-drug-costs-driven-by-manufacturer-price-hikes-not-innovation

This post's argumentis an example of

Economic Gaslighting.

And what happened to generics? You know, 90% of the market? Incredibly disingenuous.

The gaslighting is from you. Ignoring 90% of the market to make an inane political point.

Just be direct, you believe ideologically all health spending should be paid for via taxes and borrowing.

Okay. Until Warren stands up and says I’ll cut nurse salaries to the EU average of $25,000, we know you’re full of bullsh*t.

Your comment is incoherent, and the price increases are what they are. You can't deny them. Tell me what data you have and post it below.

I notice that, as another commenter below noted, you offer no evidence, Dude.

I wonder if a parallel exists with electricity. There are a lot of populist politicians railing against "skyrocketing" electricity costs, yet there's not much evidence to show the costs going up beyond the general rate of inflation. I have to wonder if many people are being bamboozled by the fact they are using far more electricity than before. I suspect people do not realise that charging small devices like phones, laptops, and tablets actually use a huge amount of power. When you plug it into the wall before bed you don't think about it costing you $0.50 every single night. And now with mom, dad, and two kids all charging multiple items all day every day...

"When you plug it into the wall before bed you don't think about it costing you $0.50 every single night. And now with mom, dad, and two kids all charging multiple items all day every day..."

You should always do the math before making such statements. Those common wall transformers are around 5 watts, while actively charging. They don't draw much of anything when not charging. (If a transformer is hot while not charging it should be replaced.)

So assume it takes 3 hours to charge. That's 15 watt hours per device. If you have 10 of them, that's 150 watt hours per day. For a month, that's 4,500 watt hours or 4.5 kWh.

Assuming your power rates are at the national average of $0.12 per kWh: $0.12x4.5 = $0.54 per month (for 10 of them).

http://energyusecalculator.com/electricity_cellphone.htm

Closer to 50 cents a year.

Indeed, the prescription escalator is a sign of success. If drugs weren’t successful we wouldn’t buy more of them when we were older and sicker and costs wouldn’t rise.

Seriously? You cannot be saying this with a straight face. Tell me, has this massive increase in the use of prescription meds resulted in, say, a doubling of healthy life span over the past 40 years? Of course not. Clearly this massive increase in the use of meds has not resulted in significant benefits.

My father died at age 73. Without blood thinners, blood pressure medications, and treatment for Parkinson's, he would have died in his late 50s from heart failure at a minimum. The alternative would have been open heart surgery to replace 4 blocked arteries with grafts.

Nothing will prevent aging yet, so your standard for doubling is pretty fucking stupid.

Yes, but did all of those meds reverse the underlying molecular biology that caused the problems in the first place?

I want you to say that to me and my doctor face to face. The reaction will be priceless. I was diagnosed with severe high blood pressure at 53. I take three medications for it and I'm fine. Without the medications I would have died within a few years. That was 12 years ago. I also take statins for cholesterol and my numbers are way below the preferred range - I have less than half the cardiac risk of a typical person my age. This is because of the pharmaceutical industry, which invented this stuff so they could make a profit. God bless them.

I find this report on the number of meds that people consume to be astonishing! I find it even more astonishing that you guys actually believe it represents "successful" medicine.

i’m no economist but isn’t it still a problem for the system as a whole if prices are increasing regardless of Out Of Pocket growth? we end up paying one way or another.

more importantly — apparently generic drugs are likely fake and we are “saving money” by paying for fraudulent drugs from india and china. i submit this is a bad deal for us.

Alex,

How do you think the patent cliff we recently experienced affected those numbers?

How does the trend towards specialty medications impact OOPC calcs for individuals when nearly all of that spend gets covered by a third party? What would have happened to drug insurance rates in the absence of that spend?

"that average out-of-pocket spending for prescribed medications, among persons who obtained at least one prescribed medication, declined from $327 in 2009 to $238 by 2016"

How is this supposed to mean anything. If I add a bunch of people taking atorvastatin that were previously taking nothing, won't that make my spending per person go down a lot? Does that mean that insulin got cheaper?

How do more and more people being eligible for heavily subsidized government drug insurance effect OOPC? Is that good or sustainable for the system?

What are your thoughts on the gross to net bubble? How are individuals taking drugs heavily effected by gross to net not seeing constant double digit price increases when costs are flat.

Another useless pile of garbage from Alex.

" But generic drug prices are falling," but perhaps the relevant question is whether the quality of generic drugs is falling faster than their prices? There have been more than a few scandals regarding generic drugs produced in India and China and imported to the USA with inadequate oversight by FDA.

As with most things (but especially prescription drugs), value is often more important than price. Can one say that a low-cost generic drug that has substandard potency, or contains dangerous impurities, be said to be not merely inexpensive but also a good value?

And what about the medicine show that the supplements industry has become in the USA? How many of these supplements even contain everything their labels say they contain and nothing their labels don't say they contain? Freedom to try may be great (sometimes), but does anyone even know what the risk vs benefit ratio looks like here?

Although placebos (but especially ones that are not inert but contain palliative remedies) just might be a solution of sorts if the goal is to provide medical care for all with no rationing or excessive waits. And all at with very affordable public and private costs!

I only take one type of medication: insulin. Guess how many prescriptions I have. Six: Long-acting insulin, rapid-acting insulin, emergency glucagon, needles, test strips, and lancets. Oops, I forgot that I also have an Epi-pen prescription. There's seven. If I go on a cruise or a trip to Cozumel, I might fill a prescription for antibiotics for traveler's diarrhea and another for anti-dengue meds; then I'd be up to the 9 Rx average. What if I have a minor accident or an elective surgery? I'll get a Rx for at least one kind of temporary pain med. If I get a bad cold, I might end up on a course of antibiotics. Flu shots are filled prescriptions, too...

It's totally believable that people take a lot of prescriptions over the course of a year. People underestimate how much health care they use. The only way that's going to change is if the government starts monopolizing health care or setting up price controls. Then there will be shortages and people will quickly realize how much they need the medications that make ordinary life a little better.

The majority of meds are generics, and they're pretty cheap already (yes, with exceptions). They won't be much affected one way or another by the dreaded price controls, and there won't be shortages and most of us will be unaffected.

Alex, your data are clearly wrong. The average geriatric patient is not taking 25 prescription medications. Not even close. I have personally never treated a patient with 25 different, active prescriptions, nor have I ever heard of one from a colleague. Do a basic search on NCBI/NIH and you’ll find most studies show it is down in the 10-15 range.

Here, someone taking 10 drugs would go through over 20 prescriptions a year.

It's really difficult to do cross country comparisons without knowing exactly what's being referred to.

I think each med would need 3-11 refills per year. So us older folks might average a few to a half dozen specific meds.

How much do developed countries spend on treatment of mostly preventable chronic diseases such as diabetes II.type (and metabolic syndrome in general?)

How much do they spend on subventions for sugar producents, so that sugar could be as cheap and as available as possible?

Tell me something about rational government decisions...

While many slap themselves on the back, why does anyone think out-of-pocket costs are the metric to use here? This seems to ignore higher private insurance costs and greater govt costs. Does anyone want to mandate out of pocket costs to zero so they say hip-hip-hooray?

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