Dr. Am Ang Zhang was a child psychiatrist for 30 years, and is outraged by Pfizer’s off-lable marketing of the drug Geodon, which has only been approved to treat adults with schizophrenia or bipolar disorder. Pfizer has been marketing the drug to treat a slew of disorders, and has also been marketing it directly to child psychiatrists – even though it has only been approved for people age 18 – 65. In addition to Geodon, Pfizer was also illegally marketing Bextra, Lyrica, and Zyvox. They have just settled the civil and criminal suits for a record $2.3 billion – but Dr. Zhang points out that the sum is equal to three weeks of sales at Pfizer. Seems a bit paltry when you think about it. It’s like fining the average family a couple thousand dollars. Sure, it would sting a bit, but it wouldn’t really take that long to pay it off and forget about it. And it doesn’t seem like it would really be a deterrant against future transgressions (which may or may not be caught) that hold the promise of additional profits.
When we started working in the health insurance industry in 2002, most of the health insurance carriers in Colorado offered at least a few policies with “traditional” drug benefits. Policies were readily available with no prescription deductible, and copays for drugs were in the range of $10 – $20 for generics, and $30 – $60 for brand names. Seven years later, policies like that are rare. Nearly every company now has a separate prescription deductible ranging from $250 to $1000 (some still offer generic drugs without a deductible, but generics tend to be pretty inexpensive anyway). There are numerous policies available in Colorado now that have no prescription coverage at all, or only cover generic drugs. There have always been options like that, but they are becoming more common.
The Pfizer story makes me wonder how many other similar cases are going undetected. I assume that a good chunk of the profit generated by the drug industry is being paid by the health insurance industry. Which means it’s being paid by all of us who pay health insurance premiums. As the drug industry makes more money – including profits from illegally-marketed drugs – we all pay more for our health insurance. And health insurance companies continue to reduce presctiption benefits as costs and utilization soar. But now we have to wonder just how much of that utilization is really necessary and how much is encouraged by drug companies trying to drive profits. All in all, not a good scenario.
I found Dr. Zhang’s article in Grand Rounds, hosted this week at MedicBlog999.