Rising health care costs have many looking for ways to ease patient burdens and maximize health outcomes. Despite taking up only 10% of health care expenditures, prescription drugs have become the highlight of discussion and target for most proposed cost-cutting measures. And with these drugs, pharmaceutical manufacturers have become easy scapegoats for the many ills that plague a fragmented health system. This past election cycle saw much grandstanding and proposals of policies purportedly aimed to help patients. But when proposed policies are aimed more to legislate ideology, they do far more harm than good. Such is the case for AB 265 (Wood), which would ban patients in California from receiving copayment assistance from a pharmaceutical manufacturer when a therapeutically equivalent drug is available at a lower cost.

The lower cost drug is not a suitable option for some patients for any number of reasons. The bill is not clear on what is deemed therapeutically equivalent and who would make this determination. Some generic drugs even with the same active ingredient might be inadequate due to differences in the inactive ingredients that might cause allergy or potentially render the active ingredient less effective. This might especially be the case for long-acting, or controlled-release drugs. Many patients are on long-acting drugs because they are easier to take and cause fewer side effects. Patients are more adherent to these drugs, which naturally improves outcomes and saves downstream costs.

This is also of particular concern regarding newer biologics that provide cures for diseases like cancer or might be the only treatment to suppress the effects of awful conditions like Crohn’s Disease. I have the experience not only as a pharmaceutical economist but also as a father to a teenager with severe ulcerative colitis who had to endure weeks of blood transfusions and emergency room visits before being placed on a biologic that changed her life trajectory. It was difficult bearing the wait for the insurance company to approve the use of the biologic therapy she needed.

Health insurers who receive rebates from manufacturers approximating 30-40% of drug costs are those most responsible for determining what patients pay for medicines. Increasingly, patients are in high deductible plans with hefty copayments and co-insurances. Drug manufacturers administer programs that assist patients with these copayments. If such programs are banned, patients would not receive the help needed to be placed on the most effective therapy. The alternative for patients like my daughter would have been drugs like prednisone whose side effects make it unsustainable to take for any significant length of time. Would someone have judged prednisone to be a “suitable alternative”?

The fact that only 10% of patients take brand-name medications underscores physician and pharmacist knowledge of therapeutic alternatives when such alternatives are viable. The overwhelming majority of those 10% really need the innovator medicine, and it is manufacturer coupons that enable these patients to afford these medications in the face of high out-of-pocket payment insurance plan designs.

Pharmacists, technicians, and social workers are on the front lines and need help taking care of patients and offering economic assistance. Going after the pharmaceutical industry to score political points does little more than to hurt the very patients being purported to help. With estimated health care expenditures approximately $8,000 per capita in the U.S, removing as much as half pharmaceutical manufacturer profits will reduce that per capita expenditure to around $7920; hardly a dent in overall costs. Let’s gear our efforts toward effective policy that helps, not compounds problems for needy patients.

Shane P. Desselle, RPh, PhD, FAPhA
Professor, Social and Behavioral Pharmacy at Touro University California College of Pharmacy
Editor-in-Chief, Research in Social and Administrative Pharmacy (RSAP)
President, Applied Pharmacy Solutions