Talk:Medication costs

Wiki Education Foundation-supported course assignment
This article was the subject of a Wiki Education Foundation-supported course assignment, between 23 September 2019 and 13 December 2019. Further details are available on the course page. Student editor(s): Kendallkehr, Ktanguilig, Christinegracielin, Jonathanim918, Nancy311. Peer reviewers: Jermakiank, Ahmadyarg, Juliemarienguyen.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 03:47, 17 January 2022 (UTC)

Stop proposed deletion
i would like to dispute the deletion and remove the tag.

1. i appreciate that wikipedia is not a "how-to" guide 2. i have modified the link accordingly 3. i will continue to work to modify it so that it is maximally consistent with the wikipedia

If you have further suggestions, please let me know. I would like for this to be an informational page on prescription costs, and keep developing it to encompass more, possible options include:

1. what comprises them 2. changes over time 3. how they may vary across people or countries

mission/vision/etcPrescription (talk) 15:33, 4 August 2008 (UTC)


 * The deletion proposal was halted years ago.  Blue Rasberry   (talk)  21:29, 1 August 2016 (UTC)

Rename proposal
You have developed the "Prescription drug prices in the United States" article. Over there, you just told me about the existence of this article.

How would you feel about changing the title of this article to "drug pricing"? I prefer saying "drug" instead of "prescription" because in many places in the world, there is not a strong distinction between prescription and non-prescription drugs, and I think this article already covers all sorts of drugs including non-prescription drugs. I prefer the term "pricing" just because there is already a Wikipedia article Pricing and Category:Pricing. Thoughts? I expect you know this article better than me. I am just starting to look at it.  Blue Rasberry  (talk)  20:58, 1 August 2016 (UTC)
 * I again share your sentiment. However, this is no easy decision, because in this international article different terms mean different things in different cultures. Q: do costs always equal price? i think not, check the section Prescription drug prices in the United States for this.
 * I'd prefer the more precise title Pharamaceutical drug pricing (note: in unison with existing pharmaceutical drug, pharmaceutical industry etc), which could be abbreviated as Pharmaceutical pricing rather than "drug pricing" which is imprecise, and slang like, to standardize terminology in that area.
 * I'm pinging for input, since he picked the accurate (but long) article name Prescription drug prices in the United States.--Wuerzele (talk) 21:36, 1 August 2016 (UTC)
 * I support a move to pharmaceutical drug pricing. If we say "drug pricing", that could include street drugs and coffee, which is out of scope. If we say "pharmaceutical drug pricing", then that would include anything at a pharmacy including over-the-counter drugs.
 * I do regret the use of the word "pharmaceutical". I prefer using simpler language for articles of general interest. In much of the world "chemist" is the more common word for "pharmacist", so I am not even convinced that "pharmacy" is the correct term. How would you feel about medicine pricing instead of "pharmaceutical drug"? "Medicine" is less precise, but it is the most commonly used term. I am not sure.  Blue Rasberry   (talk)  14:37, 2 August 2016 (UTC)

Cleanup
I am cleaning this article by moving content here which is not backed with citations to sources, or where the content is original research.

Drugs are made with the intention of curing, treating, or preventing a condition, disease, or illness. This is done either by "adding" or "deleting" something within the human body. Although all drugs incur side effects, these side effects are weighed heavily against the benefit the drug brings. Often, companies will examine the net gain. If there is a serious net gain, pharmaceutical companies can justifiably charge a premium. However, if the net gain is marginal, it would be unreasonable to give a drug an astronomically high price if there are serious side effects or if the benefits are not too great.
 * Benefits and side effects

The drug Lipitor (Calcium atorvastatin), renowned for lowering cholesterol levels, can cause many typical drug side effects such as constipation, diarrhea, nausea, fatigue, gas, heartburn, headache, and memory loss. The ability to lower cholesterol levels is objectively and unmistakably worth the side effects and thus, Pfizer can charge a premium over its long term 20 year patent.

Companies can also look at these side effects and compare them to the side effects of other competitor drugs on the market. If the effects are comparatively better than a competitor, prices can rise without much penalty. However, if there are more side effects, the pharmaceutical must charge significantly less. For example, Lipitor’s competition is generic simvastatin, known to be a cheaper alternative (Lipitor sells for $1 a day without insurance while simvastatin is roughly 50 cents a day). The side effects of simvastatin are the same as Lipitor, except that simvastatin may also induce sleep problems and even depression. Hence, simvastatin must be priced at half of Lipitor's worth as it has more deleterious side effects.

An example of the power of patent protection can be seen in the world's best-selling drug of all time, Lipitor. This drug did something else no other cholesterol drug at the time could do, increasing levels of HDL (good cholesterol) in addition to decreasing levels of LDL (bad cholesterol) faster than any other statin on the market. Pfizer used a patent to protect this approach, and for 20 years, an enormous profit was seen. After loss of exclusivity in November 2011, Pfizer saw a 59% drop in revenue for the drug in 2012, with further declines predicted.
 * Example


 * Patents and competition

Competing drugs and treatments for the same disease tends to reduce costs.

Patent laws give pharmaceutical companies the exclusive right to market a drug for a period, allowing them to extract a high monopoly price. The ability to command a monopoly price is a reward granted by patent law for the invention of new technology, as opposed to prior art.

For example, U.S. patent law grants a monopoly for 20 years after filing. After that period, the same product from different manufacturers - known as generic drugs - can be sold, usually cheaper. The availability of an imperfect substitution erodes prices to a lesser degree than would a perfect substitute.

Some countries grant additional protections from competition for a limited period, such as test data exclusivity or supplementary protection certificates. Additional incentives are available in some jurisdictions for manufacturers of orphan drugs for rare diseases, including extended monopoly protection, tax credits, waived fees, and relaxed approval processes due to the small number of affected patients.

The limited duration of patents is intended to ensure that, in the long run, consumers have access to new drugs at competitive market prices rather than monopoly prices. In the short term, the high cost of drugs during period of monopoly protection is seen as an ethical problem when it prevents some patients from accessing treatments that could prevent serious injury or death. One extreme example is Harvoni, which in the United States typically costs $90,000 for an 8-12 week round of treatment that has a 94% to 99% success rate in curing type 1 hepatitis C. In countries with a single-payer healthcare system, these costs may be absorbed by the government (possibly after negotiating or mandating a lower price). In countries with private insurance, patients are subject to deductibles and co-payments which can be unaffordable for high-cost treatments for those with low incomes, and those without patients would bear the full cost. The enormous cost of curing hepatitis C has even lead some insurance companies and government agencies in the United States to ration care by asking patients to wait for the treatment until they have some evidence of liver damage.
 * Patient access problems and alternatives

Some drug manufacturers have been accused of extending their monopolies to the detriment of consumers. Evergreening of patents involves filing related patents with later expiration dates. With so-called pay for the delay schemes, patent holders pay generic manufacturers to remain out of the market for a longer period, though this technique has been challenged as a violation of anti-trust laws.

Some pharmaceutical companies have patient assistance programs, a form of financial aid where drugs are provided at a discount or free of charge where they would otherwise have been unable to afford treatment. For some rare diseases, the manufacturer of an important treatment has committed to ensuring access to every single patient of the disease worldwide. Some low-volume treatments are provided free of charge to all patients.

There has been some concern that competition among generic manufacturers is insufficient to drive prices close to the cost of production. Many-fold increases in the price of existing treatments such as Daraprim, Alcortin A, Novacort, and epinephrine autoinjectors have caused considerable controversy. Reliance on a small number of manufacturing plants can also result in drug shortages; the U.S. FDA noted a record number of shortages in 2010, largely due to quality and manufacturing problems. Doctors Without Borders is actively lobbying for reductions in the cost of both generic and patent-protected vaccines and treatments for tuberculosis and HIV/AIDS in developing countries.

People with neglected tropical diseases reside almost entirely in developing countries, resulting in limited profit incentives for private developed-country drug companies to invest in treatment candidates. Some infectious diseases are only sporadic threats, providing little opportunity for profit in advances of an outbreak, but necessitating immediate response when one occurs. Pointing out these market failures and access problems created by patent monopolies, some critics have proposed patent reforms or replacement funding mechanisms such as prizes as an alternative to patents. A similar funding mechanism is a guaranteed-purchase announcement or stockpiling as with the U.S. Strategic National Stockpile. Infectious diseases that pose an international threat as natural epidemics or bioweapons, such as Ebola or anthrax receive government funding to develop vaccines and respond to outbreaks, either through grants to independent labs or agencies like the U.S. Centers for Disease Control and Prevention. Neglected diseases and others of concern to developing countries receive direct research and production funding through international aid programs like the U.S. President's Emergency Plan for AIDS Relief, donations from pharmaceutical companies, and non-profits like the Bill & Melinda Gates Foundation, the Carter Center, the Schistosomiasis Control Initiative, and the International Trachoma Initiative.


 * Techniques for individuals to reduce costs


 * Pill splitting

Many pill-form drugs are produced in several different dosages. For example, a medicine may be prescribed at a 25 mg or a 50 mg dose. Some medicines can be prescribed at a higher dose and then the tablets can be split into two or more parts. High-dose pill are often much cheaper per unit weight than their low-dose counterparts. Not all pills can be split, since some come as time release capsules or require very precise dosing.


 * Generic drugs

Generic drugs are much less expensive than brand-name drugs. Many people think that generics are less effective or less safe than a brand name drug, but this is an error. Once a drug is developed, it is protected by patent and sold as a brand name drug for several years, and can be sold as a generic drug or under a different brand when the patent expires.


 * 90-day supply

Some drugs are available in a three-month supply at a lower unit cost than a smaller supply.


 * Stopping medicines that may no longer be needed

Taking a prescription medicine may become so routine that patients continue to take it even when it is no longer necessary. However, many medicines may not be needed indefinitely.


 * Buying from cheaper supplier

Different suppliers may have different prices. There are several government and commercial websites that will compare the prices for a given dosage of a given medication at different pharmacies.

Target followed suit in some locations soon after Wal-Mart. Many other chains have followed their lead, including CVS and Sams Club(owned by walmart). Most chains in the USA now offer some sort of discount plan. This is usually in the form of a special price list, a loyalty discount program, or price matching of other competitors schemes. Prescription pricing has become extremely competitive, with such discounts often resulting in a charge lower than the copay through a patients insurance.


 * Counterfeit medications

There are many counterfeit medicines on the market, posing as both generic and proprietary brands. The counterfeits may be less effective than the real drug, or may have no active ingredients at all. This is a particular problem in countries with poor supervision of the pharmaceutical sector, which often also have many inhabitants with low incomes. Medicines bought over the Internet are also often found to be counterfeit. This can make saving on prescription costs risky.


 * Research regarding out-of-pocket prescription costs

While there are many mechanisms for reducing out-of-pocket prescription costs, pharmaceutical samples actually do not reduce prescription costs. Even after receiving samples, sample recipients remain disproportionately burdened by prescription costs.

For many drugs, especially brand-name antihypertensive fixed-dose medications, the clinical benefits must be balanced with patient financial burden and nonadherence during prescribing.

A study has been done on the cost effectiveness of purchasing a three-month supply, which finds that there is a quantitative cost difference when patients in the U.S. fill larger quantities of a prescription drug for a chronic condition.

Another way to perhaps reduce out-of-pocket costs is to improve physicians' access to health information technology. While physicians with high rates of IT use do not have significantly higher knowledge of drug costs, it has been suggested that health IT should be improved to make it easier for physicians to access cost information at the point of care.

I deleted this datatable outright. It was presented without explanation as WP:PRIMARY information.

 Blue Rasberry  (talk)  15:36, 7 March 2017 (UTC)

New article - Consumer import of prescription drugs
As I was researching this concept I saw some papers on Consumer import of prescription drugs. I just made that as a new Wikipedia article. If anyone has anything to add please post to the talk page there.  Blue Rasberry  (talk)  23:40, 7 March 2017 (UTC)

Effects on consumers
I work for Consumer Reports, which is a United States based nonprofit organization which publishes consumer information on the safety and cost of drugs. I just added a section to this article summarizing some of the major points which my organization raises. Here is a permanent link to the content as I just added it.

I would like to include with this a more international perspective of the effects on consumers but it is challenging to find other sources. If anyone has comments then please share.  Blue Rasberry  (talk)  19:58, 8 March 2017 (UTC)

CP133 2019 Group 23 proposed edits
Group Members: Jonathan I., Nancy R., Karina T., Christine L.

We proposed to clean up the definition section. The current section is not clear and vague without proper citation. We would like to cite reputable resources to give a clear definition. We would also like add a section "Roles of Government and Private Insurance Companies on Drug Pricing". Roles of government determining the price varies among countries. In US, the government has legal rights to negotiate or control the price of drugs. Therefore, it is up to private insurance companies to determine which drugs they would cover. However, the situation is little different in other countries, such as Canada and UK. Also we also propose to write a section "Patent Policies on Brand and Generic". Patent would give an incentive to give a pharmaceutical companies to develop the medication. However, it would also eliminate the competition among pharmaceutical companies to lower the price. Therefore, the section should be added to explain how patent policy would affect prescription prices. — Preceding unsigned comment added by Jonathanim918 (talk • contribs) 03:31, 17 October 2019 (UTC)


 * I added some information on prescription drug coverage by insurance companies. I chose to put these additions under the "United States" section since other countries do not all share this sort of system. However, if anyone has ideas on a better place to move this paragraph, I am open to suggestions. Christinegracielin (talk) 03:07, 23 October 2019 (UTC)


 * I expanded definition with few citations to make the section little bit more clear. I am open to any suggestions Jonathanim918 (talk) 06:38, 23 October 2019 (UTC)


 * I added additional information on obtaining health insurance through the individual market and its impact on prescription cost. Open to suggestions. Nancy311 (talk) 07:48, 23 October 2019 (UTC)


 * I added a section called "Patents" and expanded on how they can contribute to drug pricing. Let me know how best to improve.Ktanguilig (talk) 06:39, 30 October 2019 (UTC)


 * I added information about Medicare Part D to the "United States" section. Thanks for the recommendation, Group 22! Ktanguilig (talk) 03:49, 21 November 2019 (UTC)

CP133 2019 Group 22 Peer Review
Kristine:

1. I believe that Group 23 put in a substantial amount of edits that help to improve the article on Prescription Costs. They overall met the requirements but I think there are a few edits and additions that could help the article continue on the path to becoming a better article. Firstly, it would benefit the article to add more in the summary intro portion to have more on other countries methods of pricing, or remove the country specific pricing option and move it to another location. It is mentioned that in Canada, Europe, and Brazil they utilize external reference pricing, what do other countries do? I really like the addition of what prescription cost is, and I think it helps sets the article up well. Everything in the article is relevant to the topic and nothing stood out to me as distracting. I think there was a good overall flow in the article as well. I think this article has a natural bias towards the US, and heavily focuses on the US system of drug pricing as most of the references and statements made are for the US, although there are some references towards other countries. Also there is a reference of developing countries under developing world where the link is confusing and it’s not clear that there is a reference, which I think would add to the article if added (although I know this is a topic that the group did not write). Also, under United States I would consider adding a Part D section, since that does focus on prescription costs. Overall, I really liked the edits. The definition helped to orient this whole article, the phases and patent sections helped to understand why costs may be high for the United States, and the effect on costs on consumers also helped to understand the burden of costs. I think they did what they set out to do and achieved their goal to improve this article. The links I clicked on were from free access sites, and from reputable journals such as health affairs citation 11, covered California website citation 34, and citation 28 for the commonwealth fund. Additionally, the edits and text were mostly neutral and the information was relevant. Good job group 23!

Part 2: Does the draft submission reflect a neutral point of view?

I think that this article does have a neutral point of view, but it is biased and overrepresented towards a US reader. The claims made are not biased within the US, but for an international article there is an imbalance towards the United States. I don’t think this is an oversight of Group 23, but rather what is available to us as residents of this country, and what articles and websites we have access to. As for perspective, I do not think they wrote in support of the consumer or the developers of drug prices. It had an equal view point of both, for example the section of patents was well sourced explains why prices might change, and used a neutral tone. One statement that has some bias is the statement “If a medication is not on this list, the insurance company will usually not be willing to pay for it,” I think adding a citation and as Gina mentioned rewording the sentence can help remove some of the negative connotation attached to this statement. Same with the UK statement that most people in the United Kingdom get prescriptions partly or totally paid for..” could use a citation to ensure that this isn’t an opinion and remains neutral in talking about coverage. I think also for the section on the United States by Region, adding citations to “Individuals are able to enroll in health insurance plans which often include prescription medication coverage” can help to ensure this claim isn’t an opinion or assumption about health insurance plans. Overall I believe Group 23 provides us with multiple balanced point of views and the article remains neutral. Great job! Jermakiank (talk) 18:34, 6 November 2019 (UTC)

Gina:

Part 1 Group 23’s work improved the article by adding content that is relevant to the topic. For example, the added information about how prescription drug coverage by insurance companies can affect the cost patients pay for drugs and described what formularies are which is a great addition to this topic. To improve, I believe the group could expand on how different tiers can affect the cost that patients pay for a drug and tie it back into the overall topic of prescription drug costs. I would also re-write the phrase “If a medication is not on this list, the insurance company will usually not be willing to pay for it.” This statement seems to general. I would either add a citation to support it or re-word it to “If a medication is not on this list, the insurance company may require patients to pay more for it compared to other drugs on the formulary.” I believe the group achieved its overall goals for improvement and added new sections to the article such as one on “patents” to further expand on the article’s topic.

Part 2: Are the points included verifiable with cited secondary sources that are freely available? If not, specify The group did well at providing citations for everything they included in the article and used secondary sources like articles from the Yale Journal of Law and Technology and the Cambridge English Dictionary. These references were neutral and freely accessible to view. Overall, I think this group did a great job! Ahmadyarg (talk) 18:47, 6 November 2019 (UTC)

Julie:

Part 1: Group 23 chose to work on “Prescription costs” with the goal of clearing up confusing information, adding resources, adding a new section regarding the role of the government, and adding information on patent policies. I believe their edits substantially improve the article because throughout all their edits, they were sure to add citations with reliable sources. For example, one edit greatly added detail about “drug ceiling price” by defining how this decision is made. There were also edits present in the lead that correct grammar, provide a better description of drug price comparison, and better define prescription cost. Each edit maintains a neutral perspective and is backed by a reliable source. One of the edits even removed a somewhat “negative” and poorly cited sentence. Overall, the article has a clear structure and I believe the group achieved its overall goals for improvement.

Part 2: Are the edits formatted consistent with Wikipedia’s manual of style? If not, specify…

Yes, the edits are formatted in a manner that is consistent with Wikipedia’s manual of style. The edits are worded in plain English and avoid both ambiguity and complex wording. Article titles are precise and concise. All of the section headings are presented in sentence case and not title case. Lesser known abbreviations are defined (e.g. National Institute of Health and Care Excellence (NICE)) while more widely known abbreviations are not defined (e.g. UK for United Kingdom). Overall, the style of the article is maintained with proper punctuation and citations. Juliemarienguyen (talk) 18:38, 6 November 2019 (UTC)

Kendall:

1. I also agree that group 23’s edits substantially improve this article. The group made a lot of changes to the article within different headings. I am impressed by the group’s edit of the lead section which added to the initial impact when beginning the article, they made substantial edits to the definition section adding in material with references, made a new heading “Patents” and included relevant information, and added a lot of details about clinical trials. I’m very impressed by the number and length of edits they made and they successfully met the goals they outlined in their proposed edits section. Their edits follow the advice and guidelines set out in the Wiki Education trainings; the information is unbiased, accurate, and does not violate plagiarism or copyright violations.

2. Is there any evidence of plagiarism or copyright violation? If yes, specify…

I looked through each group member’s edits and I don’t believe there is any plagiarism or copyright violation. The majority of the edits are cited and I looked into most of the citations to see where the information was drawn from. I did not see any unattributed plagiarism, plagiarism of cited sources, or close paraphrasing between the cited articles and the wikipedia edits. The group also did not use quotations or exact passages/sentences from the original author. I am impressed by the high quality of the edits. Kendallkehr (talk) 22:28, 6 November 2019 (UTC)

Regarding: Average R&D spending per drug (in $ Millions) in section of "Research and development"
I am wondering the unit should be $ Thousands, instead of $ Millions?

I'm now translating this article into traditional Chinese.

ThomasYehYeh (talk) 06:44, 6 October 2020 (UTC)

I looked into the numbers again, and found the unit of $ Millions should be the right one. Sorry for the trouble.ThomasYehYeh (talk) 14:40, 14 November 2020 (UTC)

Suggest edit of Factors section
While I don’t necessarily disagree with the sentiment, I feel that the end of the Factors section is not in keeping with Wikipedia’s neutral language and should be revamped. Nuka-Cola &#62; Coca-Cola (talk) 18:00, 1 December 2022 (UTC)


 * Agree. For as little as I enjoy the scaving prices of medicine in the US, I'm willing to bet this comes at odds with NPOV. I'm not confident enough to edit this however. MountainKemono (talk) 10:24, 6 December 2022 (UTC)

Suggest new reference
Here is a 2022 book on the issue of medication cost and availability because of patents. Unfortunately the book is in french: COMBIEN COÛTENT NOS VIES ? ENQUÊTE SUR LES POLITIQUES DU MÉDICAMENT, Pauline Londeix, Jérôme Martin, 15/09/2022, EAN : 9782264081476. link. The authors also founded an institution to monitor french politics on transparency of drugs pricing: https://otmeds.org --212.195.197.198 (talk) 09:47, 24 April 2023 (UTC)

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Prescription drugs
Prescription drugs — Preceding unsigned comment added by 41.114.233.254 (talk) 17:04, 31 January 2024 (UTC)
 * Is there a quesion here? &mdash; soupvector (talk) 20:15, 31 January 2024 (UTC)

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