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#  The Truth Behind Spiraling Drug Costs … From the Front Lines

HEALTH CARE POLITICS--I've heard it all, whether it's from the social justice warriors (who don't know a thing about economics and medicine, although they sure think they know it all) to the capitalist overlords of medicine (who think they have all the power, although they're in for some very rude awakenings): the cost of health care is going up, and the front-line doctors/providers are really not being talked to on this issue.

Written by Kenneth S. Alpern.

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August 10 2017

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HEALTH CARE POLITICS--I've heard it all, whether it's from the social justice warriors (who don't know a thing about economics and medicine, although they sure think they know it all) to the capitalist overlords of medicine (who think they have all the power, although they're in for some very rude awakenings): the cost of health care is going up, and the front-line doctors/providers are really not being talked to on this issue.

But to the SJW's and the pharma/insurance gurus who think they know it all, and who think they have all the answers, here's a tough truth-nugget for you to chew on: when someone needs affordable care, and has a triple-digit cost for a generic, that person doesn't go to you. **They go to me. Or to my fellow doctors, nurse practitioners, and physician assistants.**

We're the ones who deal with everything from opioid addiction, cost-inequities between patients, lack of access to health care providers, and the realities that range from cancer to chronic disease to all sorts of "inconvenient truths" (to paraphrase Al Gore's famous movie whose sequel, interestingly enough, has flopped big-time).

We're the ones who know that even large health care groups who are favorable and amenable to HMO's and affordable PPO's won't take many Covered California and its equivalents in other states because they're not enough to sustain a medical business.

We're the ones who know that fewer health plans are staying in the Affordable Care Act (cute name, huh?) Exchanges, and that either time and/or presidential lack of continued health insurance subsidization will have this plan just fall apart.

We're the ones who know that "single payer" sounds great in theory, works for some, but won't hold fiscal water to survive in this nation any more than the currently-downspiraling Affordable Care Act.

We're the ones who treat Medicaid/Medi-Cal HMO patients who are probably the only good thing that has come out of past state and federal efforts to create affordable and accessible health care for the lower middle class.

We're the ones who know the difference between a safety net, and truly comprehensive and superb health care coverage.

We're the ones who know the difference between Medical Necessity and what some patient and/or provider wants that is 2-3 times, or even ten times, a cheaper alternative course of care with similar clinical outcomes.

We're the ones who distinguish between older treatments that should be dirt cheap, and newer treatments that are understandably anything but cheap.

And we're the ones who deal with the hellish truth that when we try to prescribe generic drugs, and when we try to work with local pharmacies belonging to larger pharmacy chains, we find out just how crazy prices are.

In particular, we find that topical creams and oral medications out for decades (often out for longer than we've been alive) are high-cost triple digit expenses for no legitimate reason whatsoever.

"Pharma Bro" [Martin Shkreli just got his day in court](http://money.cnn.com/2017/08/04/news/martin-shkreli-verdict/index.html), and got nailed for fraud as a hedge fund manager but won't be the last one of his ilk to either lie on Wall Street or inappropriately jack up life-saving or life-improving generic medications.

We begrudgingly owe Shkreli a big "thank you" for at least putting a face on the generic overpricing crisis affecting our nation.

But the [generic crisis isn't going away](https://www.propublica.org/article/generic-drug-prices-are-declining-but-many-consumers-arent-benefiting), and isn't close to getting fixed. So long as generic companies buy out other companies to create monopolistic, money-squeezing monoliths, we'll not get affordable generic drugs.

And so long as major entities such as those representing my own profession, dermatology, continue to bemoan but not take action on ridiculous [generic costs](http://jamanetwork.com/journals/jamadermatology/article-abstract/2623533?utm_medium=alert&utm_source=JAMA+DermatolLatestIssue&utm_campaign=09-08-2017), we'll not get the answers our patients need.

The Generic Answer to Generic Over-Pricing? Simple:

1\) We find out the costs of production of a given generic that is ten years old, twenty years old, thirty years old, etc., and create legal limits to what can be charged. Many triple digit generics can be legally mandated to become double digit generics virtually overnight...and if companies don't want to sell in the United States, well...good luck to their financial survival.

2\) If companies collude to raise prices in unison, then there will be pharmaceutical executives going to jail or facing personal fines against their own individual property holdings and personal savings.

3\) Generic companies will be "graded" in the same manner that health plans and health care groups are "graded" with respect to patient support and appropriate pricing.

I've no doubt that this sounds like Socialism, but much of this can and should be pursued by health plans and other payers if they do their jobs right. Open their mouths, and decry the unsustainable and predatory actions of generic manufacturers who are doing the equivalent of what Shkreli did when he threatened the lives of HIV patients by making a critical antibiotic unaffordable.

Monopolies were and are broken up to encourage, and not destroy, the intent of competition and capitalism. This should apply to generic drug manufacturers as well.

Not hard to figure out. And perhaps when front-line doctors and other health care providers are finally consulted on the ridiculous and life-destroying costs of health care, something like this will happen.

Lowering generic drug costs to affordable levels?

Why, that's just what the doctor (or at least THIS doctor) ordered!

*(Kenneth S. Alpern, M.D. is a dermatologist who has served in clinics in Los Angeles, Orange, and Riverside Counties, and is a proud father and husband to two cherished children and a wonderful wife. He is also a Westside Village Zone Director and Board member of the Mar Vista Community Council (MVCC), previously co-chaired its Planning and Outreach Committees, and currently is Co-Chair of its MVCC Transportation/Infrastructure Committee. He was co-chair of the CD11 Transportation Advisory Committee and chaired the nonprofit Transit Coalition, and can be reached at* [*alpern@marvista.org*](mailto:alpern@marvista.org)*. He also co-chairs the grassroots Friends of the Green Line at* [*www.fogl.us*](http://www.fogl.us)*. The views expressed in this article are solely those of Dr. Alpern.)*

*-cw*

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