No drug reform, no relief for the poor

This week, two seemingly unrelated stories caught my eye--both addressing issues in managing psychiatric drugs for the poor. Taken together, they point to a crisis that is unlikely to be so much as tweaked by current health reform measures.

One, which appeared yesterday in FierceHealthcare, discusses charges leveled at a Miami psychiatrist whom Sen. Charles Grassley (R-Iowa) considers to be an overprescriber. As you might recall, Grassley suggested that the psychiatrist, who admittedly wrote the most scripts in Florida during an 18 month period, was engaged in grossly inappropriate behavior [1].

Then today, I stumbled across an article discussing a thriving market [2] in street sales of antipsychotic drug Seroquel. Apparently, addicts and other troubled persons who don't have direct access to a psychiatrist are buying and selling the drug on the street. According to the article, which was published in The Boston Globe this past summer, street users buy the drug simply to help them get to sleep. In fact, the Globe reports that some prison inmates fake psychotic symptoms so they'll get a Seroquel prescription.

Seroquel is AstraZeneca's second most profitable drug, with $4.6 billion in annual worldwide sales. It's used for a wide variety of conditions, including bipolar disorder, schizophrenia and even to quiet agitated elderly patients. But it ain't cheap: When bought at retail, it can cost $600 per month or more.

In both the psychiatrist's and the street drug users' cases, we're seeing a small slice of the real problem--that poor people can't afford what can be a life-saving drug. 

Is Grassley target Dr. Fernando Mendez-Villamil an overprescriber? I don't know, of course; but I do know that it's likely some poor people got at least some of what they needed. Should street drug users buy and sell Seroquel? Definitely not, but if they're too poor to buy it at retail, don't have insurance and don't have access to a psychiatrist, they're going to do it anyway, particularly given that many are the untreated mentally ill.

But thanks to some bought and paid for legislators, we get no cheap drug reimportation, no strong price controls for drugs given to Medicaid patients, no significant pressure to curb "pay-for-delay" schemes bypassing generic competition; in sum, the poor are largely on their own.

I say that even if Dr. Mendez-Villamil is overprescribing, he's hacking away at a job that isn't being done elsewhere. Sen. Grassley, maybe you should stand up to the interests that put him in that position in the first place. - Anne [3]