Crippling New Drugs
There is a huge drug campaign in progress for a relatively new medication. The television ads are skillfully created, dealing with the terrible problem of agitation associated with dementia. The ads never actually say a particular drug is being promoted. Instead, it prompts the viewer to go to a website and the first thing you see is the drug Rexulti.
Through some carefully designed studies lasting all of 12 weeks, Rexulti was shown to be slightly more effective than placebo in treating agitation with Alzheimer’s. Embarrassingly, the lower starting dose of Rexulti was actually no better than placebo.
For years, with great caution, many of us in Geriatrics use second-generation antipsychotic medication for this diagnosis, but we are well aware of the increase in death associated with these drugs and the black box warning. In short, it is a last resort. The evidence of benefit is lacking and there is no official FDA indication for this purpose associated with these drugs.
Here comes Rexulti with its official FDA indication, based on some short studies with unimpressive results. There are no head-to-head trials with other antipsychotics and relative safety data is non-existent. It is presumed Rexulti will be just as hazardous as other second-generation antipsychotic medications.
Oh… I almost forgot. Do you know how much Rexulti costs? If you ask the drug reps who are currently bombarding any healthcare professional related to geriatrics care, you are forgiven if you think it might be reasonable.
This is where I love GoodRx to tell the truth: One month of Rexulti is about $1500.00.
For comparison, generic Zyprexa or Seroquel is less than $20 per month.
Don’t expect insurance to pick up the tab. No reasonable plan would cover such a drug with such shabby evidence of benefit. Instead, it will be packed into the monthly nursing home charges and sent to the horrified family paying the bills.
We’ve come a long way in 25 years of drug pricing. Back then, a new drug was about $110 a month. Now, the price point is, very reliably, at least $1500 per month. Rexulti is just following the crowd.
My first job out of residency was providing Primary Care to a very destitute population deep in Appalachia. Initially, my staff and I enjoyed frequent lunch visits from the various drug reps shilling their expensive new medications. In short order, they found all I wrote were the older, tried-and-true medications of times past that could be obtained for a fraction of the price. The lunches/visits ceased as I was placed on a Luddite ‘black list’, but my conscience was clean. I have since limited my practice to rural Emergency Medicine and have found that generic Ketorolac, my drug of choice for mild to moderate pain, is not covered by the Medicaid by which nearly 100% of my patients are covered. The upside is that I no longer have to do prior authorization paperwork. They can pay the $10 (Epocrates $20 for 20 tablets, I write for 10) or take OTC. GoodRx has it for as little as $2.50.
Just a propos of your report there are some new prolonged release meds for ADHD. Each of them costs about $350 per month. 90 of the generic Adderall tabs. 30 mg. can be bought for $25 & if you broke these in half there world be enough to treat a child for 3 months, whereas, 3 months of the newer meds would be $1050. Insurance companies are not in business to give away their money so they would raise premiums to cover the extra costs. If parents had to pay out of pocket I wonder if they would choose to spend $4,020 per year on the newer drugs versus $100 per year for generic Adderall?
And don’t you love how some of these new expensive drugs have some fine print offer by the company to provide the drugs at little or no cost? These constitute scams. Patients who sincerely believe these offers will bombard your office with forms and their income tax filings as proof of their poor financial situation. More work for the office as we are asked to contact the drug company and answer idiot questions about why we are prescribing their expensive new medicine. And then. of course, if the patient continues to contact the drug company, we physicians will receive the ultimate insult. Insurance company will say medicine is not to be provided because doctor did not submit the documentation. The only way around this certain end is to require a “forms fee”- a nominal amount, say $20 for any EXTRA forms. Patient is entitled to free copy of medical record…let them do the legwork.