Drug shortages, price spikes affecting care

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The young male patient had a diagnosis of chlamydia.

Fran Beall, a nurse practitioner in Athens, prescribed a seven-day supply of doxycycline, a dependable antibiotic that’s long been generic and inexpensive.

Shortly thereafter, a pharmacist called Beall and asked if she could prescribe another antibiotic for the young man, because he had no insurance.

“Why?” Beall asked. “He can’t afford $5?”

“It’s not $5,’’ the pharmacist replied. “It’s $157.’’

Beall called another pharmacist she knew. The cost there was $135. “There’s a big shortage of doxycycline,’’ the pharmacist told her.

Those high prices for doxycycline hyclate stunned Beall, who has been a nurse practitioner for 38 years. She told GHN that for a long time, the drug was easily available and typically cost $4 or $5. In fact, she said, “just a year ago it was even free at the local Publix pharmacy.”

Doxycycline is not the only drug in short supply. Shortages of dozens of critical drugs have persisted in the United States in recent years, with manufacturing problems cited as a major reason. Some of the drugs in limited supply include anesthetics, chemotherapeutic agents, antibiotics, painkillers and intravenous solutions.

The Athens doxycycline episode, though, also illustrates the opaque pricing of drugs, devices and medical procedures. The health care system provides very few simple ways for consumers to compare costs before they obtain a service or drug.

Doxycline is used to treat many different bacterial infections, such as urinary tract infections, acne, gonorrhea, chlamydia and periodontitis (gum disease), as well as the tick-borne illness Lyme disease. The drug is also used to prevent malaria.

In May, concerned about the shortage of doxycycline, Sen. Susan Collins (R-Maine) called on federal drug regulators to take immediate action. She was joined by Sen. Amy Klobuchar (D-Minn.). Both Maine and Minnesota have high incidences of tick-borne illnesses.

This summer, the CDC advised that because of the continuing shortage of doxycycline, the drug should be used only for conditions that have no alternative treatments. The Atlanta-based health agency urged that use of the increasingly scarce drug be limited to treatment of rickettsial infections (a category of bacterial infections), prevention of Lyme disease after a tick bite, and prevention and treatment of malaria.

The agency also noted that there are alternatives to doxycycline for treating sexually transmitted diseases and Lyme disease, and that providers “should use clinical judgment in making treatment and prophylactic decisions.’’

Doxycycline manufacturers attribute the drug shortage to scarce raw materials and to supply and demand, although not all manufacturers could provide reasons for the shortage, the American Society of Health-System Pharmacists (ASHP) reported, according to the American Dental Association.

Bona Benjamin of ASHP told GHN on Monday that doxycycline availability has improved. So has the overall drug shortage problem, she added, partly because of new congressional legislation that has required manufacturers to report a shortage is imminent.

The effect of a limited drug supply on patients can be significant, Benjamin said. When a shortage of anesthetics occurred, she said, “patients had to cancel or postpone surgery.’’

The doxycycline shortage has boosted revenues of at least one manufacturer, Reuters recently reported.

Hikma Pharmaceuticals said it expected total revenue to rise 20 percent in 2013, up from its previous forecast of 17 percent.

Two generic manufacturers recently stopped making doxycycline, Benjamin noted.

She said the high pharmacy price could reflect the fact that only the brand-name version of doxycycline was available, or it could simply reflect market supply and demand.

Jim Bracewell of the Georgia Pharmacy Association said that a drug price “can go up astronomically” because of supply problems.

Beall, a former president of the Georgia Nurses Association, said she wound up prescribing another antibiotic for the chlamydia patient, one that cost about $25.

Now, she says, another form of doxycycline is available, costing about $40.

Still, Beall wonders about the effect of such price hikes. “That increases health care costs for all,’’ she said.

For more from Georgia Health News, go to www.georgiahealthnews.com.

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Fiat_Lux
13863
Points
Fiat_Lux 10/21/13 - 04:52 pm
6
1

It's just gonna get worse and worse and worse.

I feel sorriest for the cancer patients who can't get the chemo drugs they desperately need. Talk about people going ballistic, you should see a parent's face when they hear their child can't get essential treatment because the manufacturers have just stopped making a basic chemo drug.

Worse is yet to come when all the money for medical care stops going to the people who provide it and the drugs for it and instead wind up in the pockets of federal employees and the entitled elected.

Oh, yes. It's gonna be wonderful!

Bodhisattva
4942
Points
Bodhisattva 10/22/13 - 05:45 am
1
1

????? What the? Federal employees nonsense?

There are no penalties or incentives for drug companies to stop making a cheaper generic form of a drug and convert to making the more expensive brand name version. China and India are emerging economies and have consumers that are demanding improved health care. A number of manufacturers have tried to get by on the cheap and have had pieces of glass and other contaminates floating around in their vials and the facilities have had to be closed. There's a number of reasons, I have no clue what the previous comment is supposed to mean. Government workers get paid on a pay scale. You might want to compare it to the pay of biopharmaceutical company executives to see where the money goes.

http://www.fiercepharma.com/special-reports/20-highest-paid-biopharma-ce...

http://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/2013/g...

nocnoc
30859
Points
nocnoc 10/22/13 - 08:34 am
4
1

Everyone sees it aint working

but it is a political hot potato,
The Liberals and Socialists can't back down without losing political face.
They have too much politically invested in it.

This whole problem boils to:
Are the Lib's & Soc's willing to "Cutting off OUR noses to save THEIR POLITICAL face."

soapy_725
43306
Points
soapy_725 10/22/13 - 09:36 am
0
0

Government jobs are producing Rx drugs? Who knew the shut

Unpublished

down would reach to this little known "essential government jobs". The war on drugs must actually a war on competitive drug producers.

Fiat_Lux
13863
Points
Fiat_Lux 10/22/13 - 10:24 am
0
1

Bod, you haven't a clue about this.

No kidding, and no insult intended. You just aren't aware of what's going on. For instance, while fed employees are paid on a scale, they (1) are paid more than their civilian counterparts receive for the same job, and (2) have you been paying attention to the skyrocketing numbers of federal employees over even the last 6 months? Those two facts alone should tell you something.

And when did Americans ever believe they got better medications from places like India and China? Uh, never. The Chinese are quite infamous for putting stuff like melamine in baby formula to cut back on their production costs. Of course, it tends to kill infants that drink it, but with so many of them, what do they care?

Apparently not much. If they're willing to poison their own babies, just how careful do you think they will be when it comes to adults demanding better care because they are more affluent?

And if our pharmaceutical companies continue to downsize their productivity and outsource it overseas, exactly what do you expect is going to happen to Americans who need the kind and quality of meds we have come to expect as a matter of course?

Pay for you plot now, Bod, so your relatives won't be caught flatfooted.

nyphil
3
Points
nyphil 10/22/13 - 03:45 pm
1
0

Generic Drug Shortages

To understand the real root cause of this travesty, read our op-ed in The New York Times of 9/3/13, "How a Cabal Keeps Generics Scarce": http://www.nytimes.com/2013/09/03/opinion/how-a-cabal-keeps-generics-sca....
Then call your members of Congress and DEMAND that they repeal the Medicare anti-kickback safe harbor, the misguided 1987 statute that gave rise to this public health emergency. Your congressmen and senators know all about this. Congress created the problem, and Congress can fix it---if they care enough to do so.

gargoyle
10171
Points
gargoyle 10/22/13 - 06:00 pm
0
0

“Ulysses S. Grant - “Those damn lobbyists.””

Too much soft money flowing around Washington these days to even think about reforming the time bombs that congress has created . Until election reform and a code of ethics with real teeth in it is adopted legislation to fix the mess is formulated by the highest bidder. Stop the campaign war chests and watch how quick Congress cares .

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