There is no question that the cost of healthcare is going up and that the cost of medications is exorbitant. There was a recent article in The New York Times about the cost of insulin, for example. Patients complain to physicians all the time about their inability to afford their meds.
When I was in med school, we learned pharmacodynamics (what drugs do to the body) and pharmacokinetics (what the body does to the drug). We learned mechanism of action, duration of action, half-lives. We learned which drugs are excreted by the liver and which by the kidney. We learned which is the drug of choice, which are safe in pregnancy, what the side effects are of a drug, etc. As new drugs are developed, these are still among the many things I like to know about the drug, along with “how is this better than what is out there now”? Physicians look for comparative studies, we look to bodies of experts to develop guidelines. And after careful consideration, we make a clinical decision.
Yes, we do need to take cost into consideration. There is no point in prescribing a drug that a patient will not be able to take because he can’t afford it. Unfortunately, often, we are forced to choose an inferior regimen because it’s better than nothing. I try to help patients where I can with samples, but I cannot provide for them indefinitely. I just don’t have enough to go around.
I also give them savings cards if they can use them. Unfortunately, people with Medicare or other federal plans like Medicaid or Tricare can’t use savings cards. This alone makes me crazy. Who needs a savings card more than a senior on social security on 15 drugs for their multitude of medical issues? I also encourage people to apply for patient assistance programs to see if they qualify.
I know it’s being ridiculously naïve, but I wish there was a way for my patients to stay healthier without having to choose between paying for their meds or paying their rent.