Prescription drugs are pharmaceutical drugs that need to be legally prescribed to be dispensed. In 2004, a top cancer doctor in one of the editorials in the Washington Post remarked that drugs had been sold at exceptionally high prices that many people cannot afford to buy them. It was observed that more than a decade later, the cost of prescription drugs keeps soaring. One of the most recent increases in the cost of a prescription drug that caused a lot of uproars was EpiPen, manufactured by Mylan, which is used for the treatment of allergy. From 2007, the price of EpiPen has increased by over 600% (Economist, 2016). Despite the uproar, pharmaceutical companies continue selling prescript drugs at exorbitant prices. Statistics suggest that the overall growth of health expenditure in use in 2014 was 5.3% while it was 2.9% in 2013. Within the same period, it was observed that the annual growth in health expenditure associated with prescription drugs rose from 2.4% in 2013 to 12.2% in 2014 (Abramowitz & Cobaugh, 2016). The reasons given by the pharmaceutical companies are many and varied. One of the major causes of drug variation has been cited as payer variations and policies regarding prescription drugs.
Drug costs have been a great concern to the various stakeholders in the US including the patients, policy makers, payers, and prescribers. Comparative studies suggest that the per capita spending on prescription in the US is far much more than in all other countries (Kesselheim, Avorn, & Sarpatwari, 2016). According to Kesselheim, Avorn, & Sarpatwari (2016), one of the major factors that allow pharmaceutical manufacturers to set high prices of prescription drugs is market exclusivity. The companies market exclusivity is protected by Food and Drug Administration approval and patents which give monopoly rights to the companies. Also, availability of generic drugs after the expiry of the period for exclusivity rights ought to translate into cheaper drugs; the authors pointed out that the prices rarely drop due to factors associated with numerous legal and business strategies. One of the strategies used to obtain drugs at lower prices during the period of market exclusivity is negotiation by the payer. However, the stated that payers negotiation is constrained by several factors which include the requirement that most drug payment plans by the government need to cover all almost all products. Kesselheim, Avorn, and Sarpatwari (2016) further stated that another factor is the physician choice of prescription when comparable alternatives can be obtained at different costs. The authors further argued that although the prices are usually justified due to the high cost of drug development, there is no indication that links R&D costs and prices. To them, prescription drugs in the US are priced mainly by what the market is capable of bearing.
An analysis of national data for the costs of prescription drugs presents a lot of challenges. However, such an analysis can provide clues as to the reasons causing variations in the pricing, possible policy solutions, and the costs to consumers (Cohen, 2016). According to Cohen (2016), the first step toward the understanding of the variations in the policies and the cost of pharmaceutical drugs is to look at the payer. Each payer has its policies that guide on various issues such as eligibility, covered drugs, co-payments, and deductibles. Besides the payer, Cohen pointed out that another reason that causes variation in the cost of prescription drugs is the state and federal exchanges under the Affordable Care Act (ACA) where each has its prices for prescription drug coverage and policies. Furthermore, another cause of variation is the ability of large employers to negotiate with insurance companies for both employees out of pocket costs and prescription drug benefits. Instead of lowering the prices, the rules pertaining Medicare helps in raising prices. Medicare has been found to reward doctors when they prescribe costly intravenous drugs (Economist, 2016).
According to Abramowitz and Cobaugh (2016), the increase in the cost of drugs is attributed to the increased prescription of specialty drugs used to treat chronic conditions such as hepatitis C, immune-modulated diseases, cancer, and other chronic medical conditions. However, the authors contend that the pricing of prescription drugs is influenced by other factors. To them, such factors include mergers among pharmaceutical manufacturers, constrained distribution systems, shortages of drugs, costs and availability of raw materials, expiration of patents, and unfair business practices driven by greed to make abnormal profits. Abramowitz and Cobaugh (2016) believe that certain factors such abnormal profit-driven price increase is unethical. While it is expected that the cost of drugs should become cheaper with the expiration of the patents, the authors observed that the cost has been rising.
The ever-soaring prices of prescription drugs have caught the attention of many observers including the journalists, healthcare advocacy groups, social media reporters, state and federal policymakers, and think thanks. Cohen (2016) pointed out that all prescription drugs, as well as their pricing mechanisms, are not the same. Generic drugs comprise up to 80% of the prescription drugs, and they are sold at a lower price. Drugs sold under the brand-name generate huge profits for the firms and to protect their monopoly; pharmaceutical companies employ controversial tactics. Abramowitz and Cobaugh (2016) are of the opinion that while price increase is justified, its pricing should not be an obstacle to a patients access to medications used for the treatment of chronic conditions.
A study on the trends of the price of prescription drugs and politics suggest that there is a close link between politics and the cost of drugs. Cohen (2016) pointed out that new laws and regulations usually prompt an increase in the cost of drugs. The price increases have been associated with the concerns by the pharmaceutical industries about the likely economic effects of the new policies that can affect the companies bottom line. For example, it was observed that price increase of the prescription drugs soared when Medicare Part D was implemented. Abramowitz and Cobaugh (2016) contend that the solutions to the issue of complex health policy are difficult especially in circumstances where regulatory and market-driven solutions have been recommended. They suggested that patients should be considered first when policy alternatives are being considered and during formulation of solutions. The investigators are also of the view that pharmacists must also play a leading role in any policy discussions aimed at addressing the rising costs of prescription drugs. On individuals as professional capacity, they pointed out that pharmacists should serve as advocates for patients interests. Mund (2012) believes that with the passage of Patient Protection and Affordable Care Act, the health care delivery system will improve.
Nurses Influence on Policy
The soaring prices of the prescription drugs have heightened nurses concerns regarding patients welfare. Not only are nurses concerned about how patients are going to pay for the drugs but also whether they can afford out of pocket costs of drugs. Nurses are not concerned about prescriptions given to patients or faxes send to the pharmacists. Beyond prescriptions, nurses are concerned about whether the patients can afford the drugs and obtain the necessary medication. Nurses have ethical concerns regarding the politics as well as the economics of the costs of prescription drugs. Cohen (2016) asserted that nurses have to get concerned because they are the ones who have firsthand encounter with patients and they understand the consequences of lapses in adherence to the prescribed drugs. For example, nurses get more concerned when patients such as diabetic or congestive heart failure return to the hospitals with same symptoms they had when they were first admitted. Cohen is of the opinion that nurses ought to ask patients how they pay their prescription drugs and what they are going to do in case they cannot afford. In line with the views of Cohen (2016), Abood (2007) also contend that nurses are aware of the challenges of todays healthcare system and the need for a change. Abood also agrees that nurses need to play a key role in influencing the changes through the legislative arena. For example, advanced practice nursing (APNs) need to take a political engagement as part of their professional obligation and health policy as an issue that they can shape instead of taking it as something that can happen to them (Kostas-Polston, Thanavaro & Arvidson, 2015). According to Fyffe (2009) argued that despite the fact that much has been achieved in supporting nurses and nursing to influence policy as well as political decision-making there is much more that need to be done to coordinate their actions to ensure that they continue to play an active role in influencing policies. Advice by nurses for a review of the pricing of drugs on the interest of patients will contribute a lot toward the improvement of patient outcomes. Not all patients afford to pay high-priced prescription drugs. Lapses result in readmissions and complication of health conditions. In the end, patients might end up spending more on drugs which they did not benefit fully from. Nurses decision to interrogate patients beyond prescriptions and health conditions helps in gaining valuable information that can help in guiding the patients and their families on what they should do in case they cannot afford expensive drugs.
The health policy issue is complex, and one of the proposed solutions to the rising costs is to employed market-based solutions. One of the main concerns in the issue of the drug costs is the rising cases of chronic diseases and a projected increase in non-communicable diseases in the next three decades due to ageing population. With the increasing occurrence of chronic diseases, it is expected that the spending in healthcare will increase, including the expenditure on prescription drugs (Abramowitz & Cobaugh, 2016).
Representative: Dick Durbin
Richard 'Dick' J. Durbin is a Democrat and US senator born in East Saint Louis, IL born in 1944. He holds a JD from Georgetown University, 1969. He graduated with a BS in Economics and a BS in Foreign Services from Georgetown University in 1966. He has a professor at Southern Illinois University School of Medicine as an Associate Professor from 1978 to1983. Previously, he has been an Attorney between 1973 and 1982. Also, he was Legal Counsel, Illinois Senate Judiciary Committee from 1972-1982. Between 1969 and 1973 he was Legal Counsel, Illinois Lieutenant Governor. Durbin has voted on various policies. Some of the policies he voted and which were successful include, and Zika Response and Preparedness Act; Justice against Sponsors of Terrorism Act; Consolidated Appropriations Act, 2016; and Cybersecurity Information Sharing Act (CISA) of 2017. The senator places his policy emphasis on security, health, trade, and legal affairs (Vote Smart, 2017).
He served in different roles in the state of Illinois since 1976 when he first became Democratic Nominee for Illinois State Senate. Dick Durbin has been the Senator, United States Senate since 1997 to date. He has been acting as the Assistant Minority Leader/Minority Whip of the United States Senate from 2015 to the present. As a senator, he serves on various legislative committees. He is a member of the Appropriations Committee, Judiciary Committee, and Rules and Administration Committee. He also worked Ranking Member of the Subcommittee on Defense and also Ranking Membe...
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