Getting Control Over Prescription Drug Costs

I was listening to the Democratic Debate and I heard plans to reign in prescription drug costs by giving Medicare the ability to negotiate prices.  Does this matter?  You're damn straight that it does!  In 2018 Medicare expenditures were $740B.  Prescription Drugs accounted for 19% of that!  $141B.  Just ten years ago, prescription drug costs were only about 10% of Medicare's expenditures.  First of all, I will fight to my dying breath over the fact that older adults are on far too many medications, most of which have absolutely no evidence behind them.  Our first step should be in educating physicians and other prescribers in the evidence-based principles of Geriatric Medicine.  That is why I'm so passionate about reforming how we educate doctors by reforming Graduate Medical Education (GME), which is subsidized by Medicare!  I've said it before and I'll say it again.  The government spends $10B/year of taxpayer dollars to train physicians how NOT to care for older adults.  This includes training physicians to WASTE tens of billions of dollars on unnecessary medications!

While I agree with the concept of having Medicare negotiate drug prices, I still think that our best bet is to effectively educate and train physicians to appropriately prescribe.  I understand the desire to lash out at the pharmaceutical industry.  In many ways they deserve it, but that approach is a double edged sword.  We limit the industry at the risk of losing what once was the most advanced system in the world for developing new medications.  If we use too big of a hammer, we will destroy the nail.

The take home message is that giving Medicare the ability to negotiate prescription drug prices will save some money.  Is it 5%? 10%?  That would just be $7-14B/year.  Properly educating young physicians on appropriate prescribing could save $40-50B/year!  Our pharmaceutical industry has run amok, churning out new medications that are barely better than the previously unnecessary ones.  Proton pump inhibitors and antipsychotic medications are two costly examples of this.  However, if we only focus on getting rid of the more nefarious aspects of the pharmaceutical industry, we will risk getting rid of the best parts as well.

It's time for the Democrats to stop focusing on the politics of healthcare and to focus on the actual delivery of healthcare.  The only way that I know to effectively describe what needs to happen is by explaining the Geriatrics Approach to Care.  It's our time to make a difference!