Still pushing drugs American style

There is no justification whatsoever for running expensive advertisements on television that end with the line “Ask your doctor whether…is right for you.” There is no need to make the patient into a sales representative for a product that the patient may end up buying. If someone has, say, osteoporosis, then it should be sufficient for the physician to suggest a range of possible treatments, and to tell the patient the desired effects and the likely side effects of each of the possible treatments. And that information should be given directly to the physician in the form of the results of clinical trials, not in the form of slick presentations delivered in the context of work-vacations at expensive resorts. The cost of disseminating objective information is relatively low, whereas the cost of trying to persuade a physician to prescribe product A rather than the almost-identical product B is much higher.
Pushing drugs, American style

Still as concerned about the high cost of healthcare in the United States as I was when I wrote those words in February 2017, during the past week I made a note of prescription drugs that were advertised   on television programs I happened to be watching—mostly network or cable news programs. I then looked up the advertised products on the Internet to discover more about them, including pricing information. I then calculated approximately how much it would cost to take each of these products for a month, bearing in mind that a patient carrying insurance would probably not pay the full price out of pocket. Nevertheless, the prices listed do reflect the amount of money the pharmaceutical company marketing the products aspires to get from some combination of an insurance plan and a patient's co-pay. Here is a list of the prescription drugs I saw advertised in alphabetical order.

• Austedo (deutetrabenazine). This drug is used to treat involuntary movements (chorea) caused by Huntington's disease. The initial dose is 6 mg orally once a day. Tho dosage may be increased in increments of 6 mg/day at weekly intervals up to a maximum dose of 48 mg/day. The cost for Austedo oral tablet 6 mg is around $4,286 for a supply of 60 tablets.
• Biktarvy This drug is used to treat HIV, the virus that can cause acquired immunodeficiency syndrome (AIDS). Dosage is 1 tablet orally once a day. The cost for Biktarvy oral tablet (50 mg-200 mg-25 mg) is around $3,553 for a supply of 30 tablets.
• Cabenuva (cabotegravir and rilpivirine). Cabotegravir and rilpivirine are antiviral medicines used to treat HIV. The cost for Cabenuva intramuscular suspension, extended release (200 mg-300 mg/mL) is around $4,144 for a supply of 4 milliliters.
• Caplyta capsules contain lumateperone, an antipsychotic medicine. Caplyta is a once-daily capsule used to control the symptoms of schizophrenia in adults. The cost for Caplyta oral capsule 42 mg is around $1,470 for a supply of 30.
• Cosentyx (secukinumab) is an immunosuppressant that reduces the effects of a chemical substance in the body that can cause inflammation. The dosage is 150 mg subcutaneously every 4 weeks. The cost for Cosentyx subcutaneous solution (150 mg/mL) is around $6,200.
• Dupixent (dupilumab) is used to treat moderate-to-severe eczema that cannot be controlled with topical medicines applied to the skin. A maintenance dose is usually 300 mg subcutaneously every other week. The cost for Dupixent subcutaneous solution (200 mg/1.14 mL) is around $3,354 for a supply of 2.28 milliliters.
• Gardasil 9  is used to prevent  human papillomavirus (HPV), a sexually transmitted disease. The cost for Gardasil intramuscular suspension quadrivalent is around $175 for a supply of 0.5 milliliters. The typical dosage is two or three 0.5 ml injections, making the cost of full vaccination around $525.
• Humira (adalimumab) is used to treat psoriatic arthritis. The usual adult dose of Humira is 40 mg taken subcutaneously every other week. The cost for Humira subcutaneous kit (40 mg/0.8 mL) is around $6,240 for a supply of 2 kits.
• Imbruvica (ibrutinib) is a cancer medicine that interferes with the growth and spread of cancer cells in the body. The typical dosage is 560 mg orally once a day until disease progression or unacceptable toxicity. Imbruvica costs $484 per capsule/tablet regardless of the strength (70mg, 140mg, 280mg, 420mg, 560mg). This works out to $13,546 for a supply of 28 tablets/capsules.
• Ingrezza (valbenazine) is used to treat symptoms of tardive dyskinesia, a nervous system disorder that causes repetitive uncontrolled muscle movements, usually in the face. The initial dose is 40 mg orally once a day, which is increased to 80 mg orally once a day after one week at the initial dose. The cost for Ingrezza oral capsule (40 mg-80 mg) is around $7,362 for a supply of 28 capsules.
• Jardiance (empagliflozin) is an oral diabetes medicine that helps control blood sugar levels. The recommended dose is 10 mg once daily. The cost of 10 mg oral tablets is around $582 for a supply of 30 tablets.
• Keytruda (pembrolizumab) is a cancer medicine that interferes with the growth and spread of cancer cells in the body. According to the Keytruda website, “The list price for each indicated dose of Keytruda when given every 3 weeks is $10,268.72. The list price for each indicated dose of Keytruda when given every 6 weeks is $20,537.44.”
• Opdivo (nivolumab) is a medicine that is used alone or in combination with other medicines to interfere with the growth and spread of cancer cells in the body. According to its website, “For patients receiving Opdivo 240 mg every 2 weeks, the list price is $6,779 per infusion. For patients receiving Opdivo 480 mg every 4 weeks, the list price is $13,559.”
• Otezla (apremilast) is used to treat active psoriatic arthritis in adults. A typical maintenance dose is 30 mg orally twice a day. The cost for Otezla oral tablet (10 mg-20 mg-30 mg) is around $890 for a supply of 27 tablets, so a month's supply would be around $1780.
• Rybelsus (semaglutide) is used treat type 2 diabetes mellitus. The maintenance dose is 7 to 14 mg orally once a day. The cost for Rybelsus oral tablet 3 mg is around $899 for a supply of 30, so if one were taking 14 mg daily the monthly cost would come to around $2687.
• Toujeo (insulin glargine) is a man-made form of a insulin that is used to treat diabetes. The cost for Toujeo SoloStar subcutaneous solution (300 units/mL) is around $415 for a supply of 4.5 milliliters.
• Vraylar (cariprazine) is an antipsychotic medication used to treat schizophrenia or bipolar disorder type I in adults. The recommended dosage range is 1.5 mg to 6 mg once daily. The starting dosage is 1.5 mg daily. The dosage can be increased to 3 mg on Day 2. The cost for Vraylar oral capsule 1.5 mg is around $892 for a supply of 20. Taking two pills a day would come to a monthly cost of around $2676.
• Xiaflex (collagenase clostridium histolyticum) is used to treat Dupuytren's contracture in adults. This condition causes an abnormal thickening of the tissue in the palm of the hand. Xiaflex is also used to treat a related condition called Peyronie's disease in adult men, a condition resulting in an abnormal curving of the penis during erection. The dosage is 0.58 mg as a single injection and up to two follow-up injections at 4 week intervals, if necessary. The cost for Xiaflex injectable powder for injection 0.9 mg is around $5,687 for a supply of 1 powder for injection.

No doubt people who are suffering from the afflictions that these pharmaceutical products are designed to treat are grateful when their conditions are ameliorated, but seeing slick television advertisement for those products is not what provides the relief. Relief comes when a qualified physician makes a diagnosis and prescribes a medication. Being asked by patients whether a given product is right for them is not likely to help the doctor make an accurate diagnosis or prognosis or prescription of treatment. It is the physician's job, not the patient's, to know which treatments are most likely to be effective in curing or at least bringing some relief from an affliction. It is the physician's job, not an advertising company's, to inform a patient about what the possible treatments are. Costly television commercials serve to do little but add unnecessary expense to pharmaceutical products.

If legislators are serious about finding ways to make medical care more affordable and less likely to drive patients into bankruptcy, one of the many legislative tools to consider is a ban on the advertising of medications.