Now Is the Time to Make Our Voices Heard

Philip Muskin, M.D.

When the entrepreneur-owner of a start-up pharmaceutical company earlier this year bought up the rights to a drug long used to fight parasitic infections, then jacked up the per-pill price by more than $700, it caused a public outrage.

The story, and others that appeared of the sometimes rapacious conduct of pharmaceutical companies, brought home to the wider public something to which we as physicians and prescribers have long been accustomed: access to even the most standard kinds of treatments is driven not only by what is best for individuals or the public health, but by many other factors that may be antithetical to individual and public health.

For better and for worse, we do not practice medicine in a vacuum. Pharmaceutical companies can cease to produce a very effective medication, for which there is no replacement, for “business reasons.” Insurance companies can charge outrageous prices for branded medication, even though patients have done poorly on the generic.

Is it good patient care to have an insurance company “require” that a patient fail on a generic medication after doing well on a branded version of the same medication? How can we best help our patients when there are so many forces trying to push us out of the arena of having the primary responsibility for them?

As prescribers of medications that we know can help our patients, these questions and observations bring to the fore the importance of advocacy and the need to organize and make our voices heard for quality patient care.

Our APA has joined with the AMA and many other medical specialty organizations to express concern about rising pharmaceutical prices. At the recent policymaking meeting of the AMA, organized medicine called for a ban on direct-to-consumer advertising (DTCA). Physicians there noted that although some patients may be prompted to visit a physician because of increased awareness of an illness or treatment stemming from advertising, the ultimate goal of DTCA is to drive demand for a product, resulting in increased pharmaceutical prices.

At that same meeting, organized medicine also raised the alarm about the specter of giant insurance company mergers that threaten competition, touted as the hallmark of a proprietary system through which the majority of insured Americans receive their health care. Such mergers would allow the remaining companies nearly monopolistic freedom in pricing and choice of products. APA continues to fight for enforcement of the federal Mental Health Parity and Addiction Equity Act and protest discriminatory practices by insurance companies with regard to access to effective medications.

Pharmaceutical companies continue to develop and market drugs that can help our patients. The FDA has this year approved two new second-generation antipsychotics for treatment of schizophrenia: brexpiprazole (Rexulti) and cariprazine (Vraylar), both D2 partial agonists associated with risk of akathisia. (Cariprazine is also approved for the treatment of manic episodes in bipolar disorder, while brexpiprazole is approved as an adjunct treatment to antidepressants for major depressive disorder.)

Pharmaceutical companies and insurance companies have their own agendas—not always in line with individual or public health. We ought to take this time at the end of the year to reflect on our commitment as physicians to advocacy for affordable, quality care and support the valuable work that APA does in representing that commitment. ■