Point of View

Patients need to understand drugs have prices - and costs

February 18, 2014 

Anyone who pays attention to network television these days has noticed the many advertisements for prescription drugs aimed directly at consumers promoting a specific brand. This is a blatant attempt by the drug companies to do an end run around the prescriber and promote a drug to consumers whether they need it or not.

There can be big money for drug manufacturers in selling specific products. Prescription drugs are especially attractive because the prices can be very high, and the consumer, due to health plans or other intervening payers, does not know the amount of money involved. The decision to use a specific product has a long-term effect, with months and even years of use dependent on the initial dispensing decision. “Cost” and “price” here are not interchangeable, and casual use of these words leads to confusion.

To illustrate, I have chosen two products: Coumadin (warfarin) and Pradaxa (dabigatran). Coumadin is widely used in this country and has been around for decades. I take Coumadin every day after coronary artery bypass surgery and aortic valve replacement years ago. Coumadin is an uncommon drug in that problems can result both from under-dosing and overdosing. It is deemed to be a narrow therapeutic-index drug because the range of concentration between a therapeutically effective dose and a toxic or overdose is very narrow. A 5 mg daily dose of Coumadin is in the normal range, while a 10 mg dose, about the size of a few grains of salt, should set off alarm bells in the head of a pharmacist as a potential overdose.

The Drugs.com website is a good source for data on drug interactions. It cites 755 drugs with 4,993 brand and generic names as interacting with Coumadin. Of this group, 200 are considered major.

Now there is a new entry in this area, Pradaxa (dabigatran). With any new product, there can be some surprises. The Drugs.com website has some eye-catching references to potential problems with abnormally high levels of the drug leading to excessive internal bleeding.

Unlike Warfarin, there is no antidote for Pradaxa internal hemorrhaging. Once someone starts “bleeding out” from Pradaxa, it is often fatal. Studies have shown that over 15 percent of all Pradaxa users might have some internal hemorrhaging as a side effect.

If this happens to you, that would be 100 percent of you, and that is a profound statistic.

David Work of Wilmington is the retired executive director of the N.C. Board of Pharmacy.

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