The Politics of Medicine – An Expensive Bitter Pill

If you are rich, there are very few medical barriers that matters. Need an expensive doctor’s appointment to get a US prescription for a medicine that is widely considered an over-the-counter drug in most other developed nations?  So what? Even if you have insurance, your deductible or co-pay can still render that choice too pricey. And if you are still uninsured…

Interestingly enough, in the “good old days” – where an illegal abortion was a plane ride to a jurisdiction where it was legal… or a trip to a local medical butcher with “a way to get rid of that fetus” – money solved that problem easily. Butchers were the cheap choice, but not every woman survived the process. Richer folks flew to jurisdictions where trained physicians in clean facilities did what needed to be done. As the GOP gathers steam and ultra-conservative appointments to the federal bench, expecting Roe vs Wade to continue is hardly a safe bet. Might happen again.

Getting the FDA involved in ordinary and most common prescriptions – those sold over-the-counter almost everywhere else – adds the massive expensive of qualifying for FDA approval, securing a doctor’s prescription, and often adds a layer of political priorities that usurp both common sense and medical realities.

Right now, amidst the Senate hearings to consider whether the House impeachment merits removing Donald Trump from office, both parties are considering legislation to facilitate access to ordinary medications that needlessly require prescriptions by taking the FDA out of the mix. Birth control, part of that evangelical bugaboo called “family planning” (where abstinence is the only universally accepted method), lingers in controversy for both Dems and the GOP.

“Switching a drug from prescription to over-the-counter status also typically causes its price to fall. For instance, the price of a day’s supply of the anti-heartburn medication omeprazole fell nearly by half, from almost $4.20 to $2.35. The price of the antihistamine loratadine also fell by half, to just $1 per pill. Prices for drugs that become available over the counter often fall below what many insured patients had been paying in copays.

“Neither the Republicans’ bill nor the Democrats’ would deliver lower prices [for birth control pills] because neither would make the pill available over the counter. Instead, each leaves that decision with the executive branch — the same branch that blocked access to ‘Plan B’ emergency contraception (a.k.a. the morning-after pill) — for political reasons for more than a dozen years under Republican and Democratic administrations.

“Neither the Republicans’ bill nor the Democrats’ would deliver lower prices because neither would make the pill available over the counter. Instead, each leaves that decision with the executive branch — the same branch that blocked access to ‘Plan B’ emergency contraception (a.k.a. the morning-after pill) — for political reasons for more than a dozen years under Republican and Democratic administrations.

“Adding insult to indifference, the Republicans’ bill would entrench existing prescription requirements, while the Democrats’ bill would increase prices for contraceptives. The FDA imposed the current prescription requirement, which means the agency has the authority to remove it. The Republicans’ bill would lock in that requirement with regard to minors by requiring an act of Congress to remove it — a much higher hurdle.

“This makes no sense. The American College of Obstetricians and Gynecologists urges over-the-counter access to all hormonal contraceptives ‘without age restrictions.’ Congress already leaves minors free to purchase Plan B — and even lethal doses of acetaminophen, aspirin and other over-the-counter drugs — without a prescription. Yet the GOP bill would deny minors access to a low-risk drug that prevents pregnancy and reduces the incidence of abortion.

“The Democrats’ bill attempts to expand access by requiring insurers to pay 100% of the cost of over-the-counter contraceptives for their enrollees. But after the government phased in an identical requirement for prescription contraceptives in 2014, prices for hormones and oral contraceptives stopped falling and instead skyrocketed. By 2019, they had risen three times as fast as prices for prescription drugs overall.

“Again, the Democrats’ bill would not make birth control available over the counter. But if it did, such a mandate would make it more expensive.” Michael F. Cannon, director of health policy studies at the Cato Institute and Jeffrey A. Singer, a Cato Institute senior fellow and a general surgeon in Phoenix writing an OpEd for the January 27^th Los Angeles Times. Even some conservatives, like Texas GOP Senator Ted Cruz, a fan of deregulation, favors making the “pill” ubiquitous. Or we could cling to the belief that young teenagers just do not have sex. Oh, in March, birth control pills will be available in… wait for it… California. Of course.

            I’m Peter Dekom, and depoliticizing medical issues, resorting to common sense, is just one necessary track to bring down the most expensive prescription drug prices in the developed world: ours!