What's New
Office Policy Regarding Pharmaceuticals & Representatives
It has always been the policy of our entire staff at The Healthy Woman to be advocates for our patients. This has proven to be even more challenging in view of the changes that healthcare has undergone. While we have made a staunch battle against the ethics of HMOs and managed care in general, we now find that we are facing another increasingly difficult and significant challenge.
Many of our patients have stated that the cost of medications has made it too expensive for them to purchase their medicines. This has resulted in a significant reduction in patient compliance and subsequent deterioration of their medical status. Many of these patients are on Medicare, are using medications that are "not covered" or have little or no pharmaceutical benefits. The pharmaceutical industry has continually perpetuated the myth that the high prices of medication is a necessity for them to continue research at the current levels and, therefore, assure us a high quality of advanced healthcare through pharmaceuticals. As has been recently pointed out in a Senate hearing (seen on C-Span) and in articles in The Wall Street Journal, these are fallacious contentions.
Just consider these simple facts:
  • Every (repeat every) country, except the USA, has lower prices for the same drugs made by the same manufacturer.
  • Do you really think that the board of directors of any major corporation would allow them to continue to do business in a country if they were losing money? Obviously, they make a profit in every country!!!
  • The combined amount of money spent by the pharmaceutical firms on research in the US was $21 Billion.
  • The combined net profit for these same companies for the same period was $26 Billion!!!

Am I missing something? This includes all the money spent on new and expensive TV marketing as well as all the other usual radio and print media. Call your doctor for further information, the ads say. We are not like attorneys who habitually get reimbursed for phone calls, especially those calls purposely generated by pharmaceutical marketing techniques. We are, in reality, also doing their direct marketing for them for free!

Well, our office is going to really help them cut down costs. We are initiating a new policy, which will begin in January 2000.

These are the main points:
  • We will accept no pens, note pads, or any other items.
    They cost money!
  • We will not partake in any pharmaceutical office lunches.
    They cost money !
  • We will not attend any "educational" dinners, or "outing".
    They cost money!
  • A Formulary will be established in our office and only approved drugs will be put into that Formulary closet.
  • Approved drugs include all those that are proven to be cost effective or the best drug for that condition, regardless of cost.
  • Any provider is free to prescribe any medication that he or she feels is necessary, but will keep in mind our guidelines.
  • We will welcome any educational material in the form of studies, monographs, articles, tapes, CDs, etc.
We feel that these companies want it both ways. They willingly give kickbacks to HMOs and pharmacists for preferential use of their medications and will also form Pharmaceutical Benefit Management Companies to insure that they have a say and financial interest in the distribution of their medications. Ever hear of Merck-Medco? Now, they can't do anything for physicians (they say it's unethical...talk about an oxymoron!), but they could lower prices so that those in need will have access to the medicines they need. As a Gynecologist, I still have difficulty with the price of some of the older oral contraceptives, which are approaching twenty years on the market. The prices are still exorbitant for all women; especially teen-agers and those who can least afford it. It is often not a "covered" medication, except for HMOs.

I am just about at the point of suggesting my patients travel to Mexico for their prescription medications. In fact, I am working on a mail order that they can use directly with a reputable pharmacy in Mexico. All these would be for personal use, of course!
I would be interested if any other physicians or groups feel the same and are concerned about the high cost of prescription medicines. Please feel free to call, write, or e-mail me.
Arthur I. Bassin, MD, MBA