In health care, the big three are cost, access and quality.
William Kissick, a physician who helped design Medicare in 1965, called them the “iron triangle of health care” because it is generally impossible to deliver all three at the same time.
History shows we typically achieve two of the three, but at the expense of the third.
In applying the iron triangle to our current prescription drug delivery process, I thought the industry was delivering on quality and access but struggled to deliver medicines at reasonable prices.
Unfortunately, my opinion was not quite correct.
An example of this is the recent FDA recall of a blood pressure medication that contained carcinogens. The recall was specifically focused on the version of the drug made in China but was subsequently expanded to include products from more drug companies.
There are several things about this recall that grabbed my attention.
First, I did not realize the extent to which medicines delivered to Americans were made outside of the country.
Second, I did not realize what little say that we as consumers have in the prescriptions we are taking.
Research from PharmacyChecker.com, an online pharmacy verification and drug price comparison company, has found that the most medications sold at local U.S. pharmacies are manufactured abroad and then sold here with a much higher price tag. This raises questions about both the cost and quality of these medicines.
Additionally, in 2017 PharmacyChecker.com produced their International Drug Price Savings Reports showing that of 40 popular brand-name drugs sold in the U.S., 70 percent are imported. On the other hand, the FDA reports only 40 percent of finished prescription drugs sold in the U.S. are foreign made.
In my opinion, a discrepancy this large is cause for concern and should be investigated.
Another concern is a recent FDA announcement that the agency will rely on inspection from foreign regulators in Austria, Croatia, France, Italy, Malta, Spain, Sweden and the United Kingdom since the FDA has deemed them capable of applying its standards when conducting inspections of manufacturing facilities abroad.
Please keep in mind that, according to the Government Accountability Office, there are about 1,000 foreign drug manufacturing plants registered with the FDA that have never even been inspected by the FDA. That leads me to ponder the safety of these medicines coming into the United States from foreign countries.
The simple solution seems to be working with your doctor to specify specific medicines or versions of the medicine to be prescribed. Unfortunately in today’s world, what the physician recommends and what you receive could be two very different things.
Ultimately, the product you receive is a result of the formulary or drug list supported by your prescription benefit manager and their process for procuring medicine. This can be both a benefit and detriment.
Also, since physicians often do not know the cost of medicines or where they are made, their recommendations are based on what they know about the medicine itself. Not a bad starting point, but the reality is, with the variety of medications on the market, it is tough for physicians to understand all the intricacies of all of the possible drugs available.
The pharmacist can be a valuable resource since they know where the medicine is coming from as well as the cost of the drug. Often, they are able to make recommendations for alternative products with a comparable effectiveness and a much lower price.
The bottom line is, like with every other health care service, you need to do your homework about the medicines you take.
Check your bottle to understand where your drugs have come from. Talk to your physician and your pharmacist to learn about your medicine and any concerns you may have. And look for opportunities to use coupons or consumer apps such as GoodRx to ensure you are getting the best drug for the best price.
• Diane Hess is executive director of the Central Penn Business Group on Health, an affiliate of the Lancaster Chamber.