Yes, this is a scary headline. Almost sounds sensational. It isn't. It is a cold hard fact. At this moment, if you are counting your pennies, trying to scrape up enough to pay for a $4 drug at Wal-Mart or Target, you can not afford an antibiotic that will treat your walking pneumonia---meaning that you could end up in the hospital saddled with tens of thousands of dollars in medical bills.
For years, doxycycline has been a valuable drug for physicians who treat the indigent --- unemployed or underemployed folks without insurance. A staple of $4 drug lists, it can be used to treat everything from bronchitis to "walking" pneumonia to urinary tract infections to skin infections to acne to venereal disease---and it covers some rarer infections like Lyme's and is sometimes used for malaria prevention, too.
For as long as I can remember--and I am pretty damn old---doxycycline, a twice a day form of tetracycline has been widely available and cheap as dirt.
And then, this winter, something surprising and very troubling happened. A patient with a list of medical problems longer than his arm and no income (he was still appealing a Social Security Disability denial) came down with bronchitis, possible early pneumonia--the two can be difficult to differentiate. I wrote him a prescription for doxycycline. He took it to the pharmacy. They wanted over $50 for it. He did not have over $50. He had $4. That was how much the drug used to cost at the same pharmacy.
He is not alone. Here is an LA Times Story about someone who had the same problem last year. Turns out that the difference can depend upon which generic drug manufacturer is making a specific medication at any given time. And apparently, right now, the one making doxycycline charges an arm and a leg for it.
A CVS pharmacist in Los Angeles, who asked that his name by withheld because of fear of retaliation by the company, shared with me the average wholesale price of different makers' doxycycline, as made available to pharmacists by the McKesson Connect online ordering system.Mylan? Where have I heard that name before? Oh, yes. ALEC. As in "The Koch Brothers" and their corporate welfare mentality.
The system shows that the average wholesale price of 100 doxycycline pills made by Watson with a strength of 100 milligrams is $328.20. The same number of doxycycline pills at the same strength made by Mylan cost $1,314.83.
Where else have I heard of Mylan? Oh yes, the great lorazepam price fixing scandal.
The Federal Trade Commission approved a $100 million settlement with Mylan Laboratories, the largest monetary settlement in the commission’s history.Mylan is now the third largest generic drug manufacturer in the world since it acquired an Indian generic drug manufacturer--meaning that it is in great shape to corner the market on these all important key ingredients needed for drug manufacturing.
The agency had charged Mylan, of Pittsburgh, Pa., with conspiring to deny four competitors ingredients necessary to manufacture widely prescribed generic versions of anti-anxiety drugs. The practice resulted in a 3,000 percent boost in the price of the drugs, according to the FTC.
“Anti-competitive acts in the pharmaceutical industry potentially cost consumers millions of dollars in higher prescription prices,” says Richard Parker, director of the commissions’ bureau of competition.
Not so long ago, the nation watched as patent drug manufacturers paid generic drug makers NOT to produce their product---keeping drug prices high. Keep that in mind as you ask yourself why a drug as popular as doxycycline is in short supply. This is not one of those orphan drugs that no one wants to make because almost no one needs it. This stuff sells itself. The more that is made, the more we will see it used. Why isn't supply attempting to keep up with demand? Where is the bottleneck in the so called "free market economy"?
If this were a fictional mystery, I would now tell you why doxycycline has gotten so expensive that poor folks can no longer afford it. Since this is real life, I don't know. If someone out there knows the answer, please tell me. Meanwhile, when a patient without money and without prescription drug coverage comes in which bronchitis/and or pneumonia, I am going to be hard pressed to get him treated with what is currently available on most $4 lists.