Why are Prescription Dugs so Expensive?

Episode Transcript

Speaker 1 (00:01):
Thirteen ten Wuiba and full scope with Wisconsin's direct care doctor,
doctor Nicole Hemkiss. Of course, doctor Hemkiss comes to us
from Advocate MD, a direct primary care practice for convenient
locations of Advocate MD, West side in Middleton, right on
Glacier Ridge Road, east side of Madison, right on South

(00:21):
fair Oaks Am south south. What do you call that?
South Southern Dane County or southern Madison Fitchburg. Right on
the line there the beautiful location of Advocate MD. Right
at thirty two to twenty seven Road, Janesville, right at
ten twenty one Mineral Point Avenue for those Rock County,

(00:42):
Southern Dane County folks. And I'm getting my southern Dane
County and southern Madison all mixed up this morning. Doctor.

Speaker 2 (00:48):
How you doing, I'm doing Welshne How are you?

Speaker 1 (00:51):
I'm doing great. It's one of those It's one of
those days We've got oh tackling and discussing something that
I think for a lot of folks has been has
been just kind of like one of those perpetual questions,
which is why are drug prices so high in the
United States? And we're going to get into that and
what this recent executive order means when it comes to

(01:13):
drug costs. We'll get to that in just a moment
with doctor Hemkiss. But first doctor mentioned the four clinics
at Advocate MD. There's also that also including yourself. Eight doctors,
eight physicians at Advocate MD. That's a real important part
of what you offered a Advocate MD, isn't it.

Speaker 2 (01:29):
Yeah, you know a lot of direct primary care clinics
and we do now have you know, a number in
the Madison area. Ours is very unique in the way
that we offer multiple clinics and multiple choices of physicians.
And you know, as we've spoken about, we work with
a lot of employer groups, but we also have many
individuals and families that sign up with us. But yeah,

(01:50):
having that kind of variety of locations, if somebody lives
in a certain part of town, even if you're over
at a certain area of town and you live on
the other side of town, you can still utilize any
of our clinics if it's an urgent care need or
something like that.

Speaker 1 (02:04):
It's pretty it's pretty amazing, And I know that the
growth has been very strategic as far as locations and
bringing doctors on you. I know you do a lot
of work to find just the right the right people
at Advocate MD. And it's been great to see the
growth and the response that you've received with Advocate MD.
I know, years ago when you launched Advocate MD, you

(02:25):
were here in Dane County, the player in the game,
and people had kind of picked up to what you're doing, said,
you know what, that's a really cool model, and you
can learn more about Advocate MD and Direct Primary Care.
Great website, Advocates DPC dot com. That's Advocates d PC
dot com telephone number. To make it a point, become
a member at Advocate MD six oh eight to six

(02:45):
eight sixty two eleven. That's six h eight to six
eight sixty two eleven. So doctor drug pricing prescription drugs specifically,
do we know why the United States we've always been
like the country that pays the most for our drugs.

Speaker 2 (03:03):
Yeah, So, you know, it's interesting that this has been
in the news, you know, just to kind of set
the background of this. Recently, I think in the past
week or so, President Trump has come forward with this
executive order, and you know, during his first term as president,
he also had passed some executive orders to kind of
do some price setting or lower the cost of prescription drugs,

(03:23):
especially very expensive things like insulin. So I think in
some ways, I mean, obviously a lot of what Trump
does is controversial, but I think in some ways he
doesn't get enough credit for what he's done in terms
of trying to lower prescription drug costs. And this is
one of the examples. So in the news recently, he
has this executive order where he's trying to force drug manufacturers.

(03:47):
We know, drug manufacturers make billions of dollars off of
these drugs, and many of these manufacturers are based in
the United States. Yet ironically, people in the US are
charged a higher rate for these drugs than people in
Europe or Canada. And you know, and again, these these
drugs are manufactured all over the world. Some of them

(04:08):
are manufactured in third world countries, but some of them
are manufactured here. So so yes, it brings up this
question of you know, why do why do we pay
so much more than other countries. You know, there are
conflicting opinions about this. The drug companies have one reason,
you know, what they actually find seems to be something different.
But this executive order that he passed recently is basically

(04:31):
saying that if the drug manufacturers don't lower the cost
of these drugs, and I think the goal is something
between fifty to ninety percent, and it's different for different drugs,
then the HHS, the government is going to step in
and start doing things. And you know it might you know,
have to do with importing low cost drugs. They mentioned
importing drugs from Canada, and he is targeting these specific

(04:54):
categories of drugs that are notoriously expensive. In some cases
is mind bogglingly expensive, like you know, diabetes meds, especially injectables,
these newer antiquigulence which are blood centers, rheumatoid arthritis meds.
Again some of these are immunologic injectable medications, things for
the you know, immun rheumatoid conditions like soriatic arthritis, and

(05:19):
then cancer drugs. So you know, it is it is
kind of interesting to take a step back and try
to figure out why we pay so much more. But
you know, for for many you know, drug plans, for
many employer plans, uh, the drug costs are one of
their highest line items. So I mean they might be
paying you know, twenty or thirty percent of their overall

(05:41):
spend just on prescription drug costs, you know, and that
includes you know, the medical costs, the er visits, the surgeries,
all of this stuff, and they could be spending you know,
thirty percent just on the drug costs.

Speaker 1 (05:54):
What's what's fascinating to me, doctors as you talk about
you know a lot of these of these are manufactured
or based and have connections to the United States as
well obviously, as you point out, imported also when there's
also some drug companies overseas. What what always is interesting
to me though, is that conversation about research and development

(06:16):
and that that and it makes sense, you know, obviously,
if you spend a lot of money, you spend a
lot of time and resources, and you take the risk
for for trying to develop something new, there should be
some level of protection give you give you of course
when you launch this drug, give you coverage. But that
that conversation about research and development and the costs not

(06:36):
entirely truthful as far as as far as what the
what the big picture there is.

Speaker 2 (06:43):
Isn't it. Yes, So you know, the drug manufacturers and
again some of these drug manufacturers are some of the
most lucrative businesses, you know, corporations, they make billions of
dollars in profits. So their argument would be, well, we
charge so much for this cancer drug, or we charge
so much for this, you know, autoimmune medication, because we

(07:04):
spend so much money in research and development. And they
actually did a study in jama recently that found that
there was no correlation between the amount of money spent
by drug companies and research and development and the actual
cost or price of that medication. I know in the
past that I didn't have time to do a ton
of research on this. I have read before that actually

(07:25):
drug companies spend more in marketing than they do in
in you know, the the R and D. And as
you know, in the United States, we permit direct to
consumer marketing for drug manufacturers. In many countries, in most
countries you know, in Europe, they do not permit this
again because it sets forward a kind of unequal playing

(07:46):
ground for these companies that can afford to spend millions
of dollars or maybe you know, maybe more millions of
dollars in UH marketing because they can you know, put
out a lot of commercials, magazine ads, you know, whatever
it is saying have you spoken to your doctor about this?
You know, and again, it might that medication that they're
talking about that's the newest brand named medication. The efficacy

(08:09):
of it might not even be any more than what's
currently on the market and is one tenth of the price.
But they can market it in a way, you know,
maybe they get a you know, a well known athletes
or actress to sell it, and so people will say, oh, okay, well,
I'm going to ask doctor Hemkis about that. You know what,
what about this medication I just saw on TV? So

(08:30):
again it creates a very almost a challenge even amongst
doctors to be able to have the time and you know,
be able to teach patients like why that drug isn't
necessarily any better than the drugs that they're currently taking
or the generic you know, alternative, because now they've seen
an advertisement that the people are smiling and they're much

(08:52):
happier since they've been taking this drug. So the marketing
piece of it. But they also said that in terms
of this r and D, this research and development argument,
that almost every single drug that's put out in the
market in the United States, the majority or a lot
of the funding is coming from you know, grants, government
grants like NIH grants, so they are already getting money

(09:16):
from the government to subsidize this research, you know, because
obviously we want better cancer drugs, we want you know,
all these diseases that we want to try to find
better cures for. So they're already getting money from the
government for that. And again, you can have the same
exact drug that's made by the same pharmaceutical company, and
the cost in the United States compared to somewhere in

(09:38):
Europe or in Canada, will be probably three to five
times more in the United States. So again it kind
of goes back to this this R and D argument.
So so I think Trumper or one of the leadership
had said, you know, their argument is the United States
is paying the bulk of the R and D or
we're for some reason, we are paying for more of

(10:00):
it than other countries are, So that that part is
kind of interesting too.

Speaker 1 (10:03):
What I also I find interesting you mentioned the amount
spent in a substantial portion of of of their budgets
are going towards spending spending on commercials and other things
on advertising promotion. I've been over the years, have had
friends who end up working in pharmaceuticals. It turns out

(10:23):
to be a quite lucrative career form. And basically their
skill is they're very good looking and they go to
a lot of a lot of doctors with a lot
of a lot of goodies. And that do we see
that having an effect as well as like some of
these doctors may be prescribing a slightly more costly med
because there's you know, because they really want to keep

(10:44):
their their rep happy.

Speaker 2 (10:47):
Yes, it is interesting that that changed a lot I
would say ten fifteen years ago, so yeah, pharmaceutical reps. Notoriously,
I would say twenty years ago. They would these very
attractive young females right out of college. They would pay them,
you know, six figures in some cases. And they've made
a lot of movies or like made for TV movies

(11:09):
about this right where they were hawking you know, viagra
or oxycotton or you know, like so they would go
into these doctor's offices and get meetings with the doctors
and give them free things and bring them lunch. So
they cracked down on a lot of that. The government
cracked down on a lot of it. There is still
some of it that happens. But the other kind of
afairious thing that they would do is that you know,

(11:30):
these drug reps, and this still happens to us a
much smaller extent, would drop off samples of these the
latest again, the latest brand name medication, which might not
be any better than the medication the patient's already taking,
but they drop off samples. They like, Okay, well, here's
some free samples to give to your patients so they
can try it out. And the problem with that is,

(11:51):
you know, so they give you three months worth of
samples or something, and so the patient tries it, maybe
they like it. You know, it's an inhaler, it's a
diabetes medication, maybe it's controlling their blood sugar. But then
once they run out of the samples, right, because they're
not giving you an endless supply of these, and they're
giving you a small amount to give dispersed to maybe
multiple patients, once you run out of these, like okay,

(12:12):
well that just went from being free to being five
hundred dollars a month, right, So nobody can afford that.
So they kind of hook people on these things. And again,
they could very well have been on a medication that
was very similar that was a much lower cost. But
so now they've kind of gotten used to like oh
I like this medication better, Like, how am I going
to get the brand name medication? So yeah, so that

(12:34):
part has always made me have very mixed feelings about
free samples unless I have a patient that like that's
the only medication that they could take, you know, all
the there's no all good alternatives for them. But yeah,
I think that the pharmaceutical rep thing has definitely changed
a lot in the last twenty years.

Speaker 1 (12:51):
Interesting the people I knew that did it is when
we were young and good looking, and I'm lumping myself,
but it is. It's a fascinating world, and I do
want to talk about how folks can can save on
on prescription meds. And of course at Advocate MD, I
know you work very very hard to help the folks
at Advocate MD and your patients get those get those

(13:14):
affordable drugs. We're going to talk with doctor Hempkiss about
that in just a moment. If you haven't had a
chance to check out the website, head on over there
ADVOCATESDPC dot com. That's Advocates DPC dot com. You can
learn more about the practice Advocate MD, the locations the doctors,
learn about options for if you're looking for a high
deductible insurance plan or health share. A lot of great

(13:35):
information available to you right up at ADVOCATESDPC dot com.
Great data. Make an appointment to become a member at
Advocate MD. There telephone number six so eight two six
eight sixty two eleven. That's six h eight two six
eight sixty two eleven. We'll continue our conversation with doctor
Nicole Heimkiss of Advocate MD. We will do that next
here on thirteen ten Wi B A thirteen ten Wi

(13:55):
B A and full scope with Wisconsin's direct care doctor,
doctor ol Hemkiss. Of course, doctor Hemkis. She comes to
us from Advocate MD, a direct primary care practice with
four locations in the area, also eight physicians at Advocate MD.
You can learn more online the website ADVOCATESDPC dot com.
That's Advocates DPC dot com. Great data. To make an

(14:17):
appointment become a member at Advocate MD. Their telephone number
six oh eight two six eight sixty two eleven. That's
six poh eight two six eight sixty two eleven. You've
been listening to the program for a while, and you've
been thinking, I should call doctor Hemkis. I should probably
become a patient at Advocate MD. Again, great day to
do just that. Pickuphone Gemma call six eight two six
eight sixty two eleven at six O eight two six

(14:38):
eight sixty two eleven And doctor, as we're talking this
week about prescription drug pricing and why here in America
we tend to pay more than any other country. I
know something that you and the doctors at Advocate MD
work very very hard at doing is making sure that
your patients are are obviously with the practice saving money,

(15:00):
but also when it comes to two drugs. You work
very hard at keeping drug prices down and helping people
find the best options for their medications, don't you.

Speaker 2 (15:10):
Yes. So we do dispense any generic medication through the office,
so that can be anything that comes in an oral
form or we do also have creams, but blood pressure medication, cholesterol, thyroid,
oral diabetes medications. You know, we do have some you know,
Dirham creams and things like that. We do have access

(15:33):
to vaccines through the clinic, and we order all of
this directly through the manufacturer, so we can get really
good prices on that. For most people even that have insurance,
they're getting their medications through us. And then if we
have patients that for whatever reason, you know, cannot take
a generic there's not a medication that we have in
the office that works for them. Then we help them

(15:53):
figure out, you know, if they're on a brand named medication,
you know, we can order that from Canada. You know.
Some of those specific you know, drugs that President Trump
is trying to lower the cost of are things like
Eloquist and Zerelto, which are very expensive anticoagulants. So right now,
if I have a patient on one of those, we
ordered from Canada, and usually the price is like a

(16:14):
third of what it would cost if I send it
to a retail pharmacy here. But we help the patient
kind of work, you know, man, you know, navigate those things.
And then if it's you know, one of the newer medications.
There are sometimes manufacturers drug programs where the manufacturer will
give you a discount. Usually that's for a very defined
period of time. U there are becoming these are becoming

(16:35):
more common where some manufacturers are selling directly to consumers,
like for example, some of these GLP one, these weight
loss medications, they're selling directly to consumers and that's that's
you know, again a much lower cost option. Usually about
half of the cost of if you do it through
the retail pharmacy. And I also just wanted to mention
this other example that I forgot to mention earlier. So

(16:57):
there's a pro public article that gives an example of
a cancer treatments that's for multiple myeloma called revlements. So
any of these kind of autoimmune like you know, autoimmune medications,
those could be very expensive. So it talked about the
fact that this prescription in the United States. I'm trying

(17:21):
to make sure I give you the right price. So
this company that makes it is called cell Gene, and
they had twenty one billion dollars at net earnings, but
they sell this medication in the United States. And the
cost for one pill where did I write that down?
So it must be an oral medication. And the cost

(17:45):
for one single pill in the United States is one
thousand dollars. And I don't know how often people take
that pill. I don't know if that's a daily or
a weekly. But they said in Europe the cost is
two thirds less than that. And again that just gives
you kind of a dramatic example. And again if that's
you know, so many times companies are insurers because it

(18:06):
is something like a cancer treatment, and of course, you know,
we want patients to have access to whatever possible cancer
treatments are available, so they will be kind of on
the spot where they have to pay these costs even
though they're exorbitant. But again, the mid the manufacturer of
this this pill, doesn't have to cost you know, charge
one thousand dollars a pill because obviously they are making
a huge profit. So how do you rain this in?

(18:29):
And in Europe what they do is they in many cases,
the government price sets things. So they look at similar medications,
similar categories of medication, so whether it's a cancer drug,
autoimmune medication, and they say, okay, well for something like this,
it's going to cost two hundred dollars a pill, or
you know, whatever it might be. So that's one of
the ways, a big way in which they're able to

(18:52):
control those costs, almost like a type of price setting.
But in the United States, because the pharmaceutical drug industry
has a very large lotbby, we don't have the same
ability to price set. And again maybe that's something that
will will change, you know. I think in general, President
Trump and the Republicans are very in favor of free market,
which I think I you know, I am on a

(19:15):
similar page there. But when you get to a place
where the market is, you know, charging exorbitant prices to
patients for things like cancer treatments and you know, life
saving drugs and things like that, then maybe you do
have to step in and regulate them a little bit further.

Speaker 1 (19:30):
It's only free if it's fair, and that's I think
that's I think, as we see right, it's fine to
for competition, but if it's not fair competition, I think
that's where we start start kind of running into running
into some some issues. And as you know, as as
we've as we've all probably experienced, it is crazy and
you start seeing some of you know, this drug thousand
dollars in the United States three hundred dollars. If you

(19:52):
go to Europe, same drug, same everything. It's it's it's
very very sad and very disappointing that it's come to this.
And let's talk about what you're able to do at
Advocate MD. And something you've been doing for years now
is we talk about that advocate part of Advocate MD.
You really do work for your patients, and all the
doctors at Advocate MD really do work for their patients

(20:13):
to keep costs under control, including when it comes to
prescription medications, don't you.

Speaker 2 (20:19):
Yes, so yeah, we will do whatever we need to
do to help the patient figure out the best option
for them. Again, if it's if it's you know, ordering
it from Canada Manufactured Drug Discount program, if it's something
that we can order, will help them with all of
that and so so yeah, I think that because we
have the time, we have a smaller panel of patients,
we can really kind of provide more hands on care

(20:42):
for those things.

Speaker 1 (20:43):
It's a really amazing model. If you haven't had a
chance to learn more about direct primary care and Advocate
MD Today's day, check out the website ADVOCATESDPC dot com.
That's Advocates DPC dot com. You are looking for a
great option for primary care for yourself or your family.
You're an employer looking for great options for your employees
when it comes to primary care. Check out Advocate MD

(21:03):
Today's today to pick up phone, gamme a call six
oh eight two six eight sixty two eleven, make an appointment,
become a member at Advocate MD again that number six
oh eight two six eight sixty two eleven and the
website ADVOCATESDPC dot com. That's Advocates DPC dot com. Doctor
Hemkez always great chatting. You have a great weekend and
we'll talk real soon.

Speaker 2 (21:22):
You too, Sean, thank you.

Speaker 1 (21:23):
This is thirteen ten w ib A