Tuesday, 15 March 2011

The Cost Of Living #TBofBTT

by Latentexistence (@latentexistence)

I have just started taking pregabalin (Brand name: Lyrica) to treat the neuropathic pain that I have been suffering from. When I was discussing it with some friends I discovered something that seemed quite shocking to me. In the USA there are people that need this drug, have been prescribed it by their doctors, but have been deprived of it because their insurance companies have refused to pay for it. This refusal could be because they do not think it appropriate, or do not accept the reality of an illness that is not necessarily detectable in tests, but the most common reason is expense.

It hadn’t actually crossed my mind that pregabalin might be an expensive medicine. My doctor has a nice flowchart of what drugs to try for my illness and what order to try them in, and this one was next on the list. In my blissful ignorance, I simply take the prescription from the doctor to the pharmacy, and walk away with the drugs. All costs covered by the NHS. Since I have long term chronic illness, I am exempt even from paying the £7.20 prescription charge that most people would pay for their drugs.

All of this got me thinking; what if I had to pay for my medicine? Would it even be possible? I currently have twelve medicines on prescription. If I were to pay even the standard prescription charge, with the NHS covering the rest, my medicine bill would come to £86.40 per month. At the moment we are struggling to even pay for our rent, bills and food, so this cost would be crippling. But without the NHS? My drugs would cost much much more. I did some research, and I present here what I would pay for my most important drugs.

* Metformin (Glucophage) £12.28
* Gliclazide £1.86
* Olmesartan Medoxomil £10.95
* Bendroflumethiazide £0.91
* Pramipexole £35.66
* Sumatriptan nasal spray (Imigran) £35.39
* Naproxen £4.20
* Pregabalin capsules (Lyrica) £64.40
* Codeine £5.39
* Paracetamol £1.62

Total cost: £172.66 per month.

In the USA it would be even worse. Here are the best prices that I could find. (Via www.pharmacychecker.com)

* Metformin (Glucophage) $50.40
* Gliclazide $17.22
* Olmesartan Medoxomil $18.20
* Bendroflumethiazide – no price found
* Pramipexole $29.68
* Sumatriptan nasal spray (Imigran) $114
* Naproxen $11.76
* Pregabalin capsules (Lyrica) $161.28
* Codeine – no price found
* Paracetamol (Acetaminphen) – no price found

Total cost: $411.54 (£255.68)

That is an astonishing difference between UK and US price.If I had to pay all of it myself, I would have to go without many of my medicines, which would basically leave me unable to control my diabetes and my migraines. Apart from the Lyrica, my pain medication is actually very cheap and I would still be able to afford that. Without diabetes medication I would be practically unable to eat and would still have hyperglycemia. Without sumatriptan, my painkillers would not help and the other symptoms of migraines would keep me firmly in my bed. Fortunately the NHS covers my costs and I have some chance at recovery and leading a relatively normal life. Some people will no doubt argue that it is unfair for me to drain so much money from the NHS. They have failed to understand how this system works. When Aneurin Bevan launched the NHS in 1948 he gave the NHS three aims:

* That it meet the needs of everyone
* That it be free at the point of delivery
* That it be based on clinical need, not ability to pay

Treatment for any given individual may very well be expensive, but it all works out in the end. I have paid National Insurance whenever I have been well enough to work. I receive my medicines without paying when I need them. With those medicines, I may well improve enough to work again and pay more National Insurance. The NHS provides for both people that will one day repay their healthcare costs, and people that might not. Even those that will never be able to work and contribute financially will still contribute something to their society by their very existence. And regardless of future financial contribution, would you really want to live in a world that simply leaves the sick to die?

I am very glad that we have the NHS and I will fight as hard as I can to keep it.The government must not be allowed to ruin what we have.


Oya's Daughter said...

I have just come out of hospital and had this conversation with the consultant there as he recognised my Pacific-Northwest accent buried under the British tones. He loves the US but said as a doctor he could never make determinations on who could accept treatment solely on the grounds of who could or couldn't pay for it, which is a primary basis of the US. "They call it 'socialism' in the US and are violently opposed" he said with a look of bewilderment. "How on earth is caring for your fellow man such a horrible thing?"

My tests over a 48 hour period would have cost about $20,000 in the US. Without insurance (which being unemployed I could only get the basic medicaid), they wouldn't have done half of that stuff; after about 10 hours of waiting, a quick listen, a bored look, 'why don't you just lose weight?', some analgesics and I would have been sent home with the distinct impression that I had wasted everyone's time for daring to be ill. No clinics scheduled. No empathy. No chats about Denver with the consultant and copies of my blood and EKGs to present to clinics as there's something going on, they just couldn't quite pinpoint it.

NHS isn't perfect, no system ever is. But when healthcare becomes, first and last, about money, I get worried. We're already getting most of our prescriptions sold offshore because they can be sold for more money elsewhere and everyone is going short. There are tests which aren't available here because they are pricey. I'm not sure what the answer is but perhaps England needs to be more innovative with its medicine and approach to health rather than just buying everything it needs from other countries. I'm just not sure how they can manage that.

All I know is, about 10 years ago, a friend of mine in Seattle died because she had a spider bite she couldn't treat - she couldn't afford the antibiotics that week, so she didn't get them. The wound went septic, and by the time the ambulance was called for her (and ambulances cost money too!) she was far too gone - but then I'm also quite certain they didn't recognise what was wrong and probably just thought she was another weirdo high on drugs, especially as she had no insurance to cover her...so they waited. And she died.

I never want to see that here.

Sue Marsh said...

Very interesting post.
I take Humira, by injection every two weeks. Each shot costs £1000!!!!

In the US, a friend was told her insurance comapny wldn't cover hte cost - it was £19,000 per shot!!

Now that's staggering!