03/20/2018    Joseph Borreggine, DPM

High Cost of Compound Pharmacies (David Williams, DPM)

Dr. Williams, I must sorely disagree with your
premise statement with respect to the theme of
this article and how the patient was “victimized”
by the physician assistant and the pharmacy. This
is nothing more than the “drive by media”
producing a sensational “fake news” story on how
big pharma is destroying healthcare by
“overcharging” patients for medication that they
may or may not actually need.

The author of this article makes the reader
believe that that this patient who seemingly
well-to-do retiree based on her aforementioned
resident geographic locale on “Capitol Hill” was
taken advantage of without her prior knowledge.

And the author summarily tries to opine in his
discourse that the medication was unnecessarily
prescribed for a condition that was nothing more
than an unwarranted and asymptotic benign
diagnosis of a fungus nail. It’s a good thing
this was not written about a podiatrist which
would have been the icing on the cake.

The fact is that the patient did have an observed
onychomycotic infection of two nails and
prescription may have been ignorantly written by
a health care provided because the cost of said
medicine was not discussed. We do not know the
whole story. Most medical providers never discuss
cost of anything, let alone the prescriptions
they write for patients, because most
surprisingly they believe that insurance will
cover everything!

Sadly, this is the way of medicine especially
because most providers are now employed by a
large group practice, hospital, or multi-
speciality medical corporation, and hence, they
have very little concern on the insurance
benefits of every patient they see. This is a
result of the compensation created by the RVU
system and is a story for another day. But, I
digress.

Another fact that was eluded to in the title of
this article was that Kerydin is a “compounded”
medication and safe to say it is not. So, the
title of this article is misleading to PMnews
readers. If you read this article you will see
that Kerydin is produced by Sandoz, Inc and not a
pharmacy as the reader may have opined
incorrectly. With that said, Kerydin and it’s
competitor Jublia are the latest and greatest
prescription topical antifungals that are
available to the public. And yes, they are
expensive.

The R&D for every new drug that is put out on the
market along with the exorbitant FDA market
approval fees are now into the billions. So, what
other recourse does big pharma have than to
charge a high price for their product? Another
reason for high cost are the advertising and
speaker fees to promote said medication to public
and medical community. Remember the #1 lesson in
capitalism is to get a decent ROI on everything
produced and sold. Yes, make a profit!

So, yes, the cost, in reality, is rather high,
but that price is the “retail” and is “what the
market will bare”. It is rarely is paid by the
public at large either because they cannot afford
it or their insurance will refuse to pay. This
refusal to pay this particular drug benefit is
not based on anything more than the insurance
company wanting the physician to seek “prior
approval” to prove that other OTC and/or other
prescriptions have been tried and failed to
resolve the condition before payment can be made.

Yes, an HSA is an option that most Americans can
have to save for qualified medical expenses and
pay situations just like this, but again the
author wrongly makes the reader believe the HSA
account of this patient was “robbed” with their
permission. This fact, like most “facts” in this
article are unfounded, and again, are untrue. The
pharmacy will never first of just charge an HSA
without the permission of the account holder
because that is illegal. It is interesting how
the author colluded with patient to report it as
something that actually happened based on the EOB
shown in this article. I do not believe it
actually happened that way.

I also doubt highly that this seemingly
intelligent individual just went ahead received
this prescription with prior knowledge of the
price as is normally provided the pharmacy. So,
with that said, this whole story is moot in in
its point that big pharma and medical providers
are destroying healthcare by not educating
patients of the potential high cost medicine.

Again, this a baseless premise. The fact is that
Sandoz, Inc. has a coupon program with a zero
dollar copay for patients who may qualify based
on their insurance benefit and prior approval to
take the burden off the patient. These coupons
are provided by the sales reps to the medical
providers to give to eligible patients or can be
obtained on line:

So, again not having all the facts and producing
a “fake news” story to misinform the public and
those who ignorant of the truth does nothing
nothing more than provide “disservice” to
medicine and its delivery just as Dr. Williams so
profoundly stated.

Joseph Borreggine, DPM, Charleston, IL

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