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Monday, June 30, 2008

What's it made of...

gold? Well, unless we're talking about a certain compound given for arthritis (aurothiomalate, or Myocrisin for short), then, no, not made of gold.

Oil, maybe. Heh, heh. (Actually, LCD, or coal tar, is a petroleum product but it is quite cheap--go figure.)

So, what to say to these people with such inquiring minds?

How about, "Here's the 1-800 number to Blanketyblankety Labs; why not ask them? And call me back and let me know what they say; I'm kind of curious, myself."

Drugs cost whatever the company that makes them determines they cost. Pretty simple, eh? What goes into the price? Well, research and development, certainly. That's the ol' R & D in the P & L. What else? Marketing. Marketing is actually a bigger slice of the pie than R & D. Why? Well, if you're the CEO of Company XYZ then you probably make a lot of "me-too" drugs, which is the way we pharmacy types designate drugs that really have no great advantage over all the others in that drug's class. Think of Motrin and Aleve (along with Orudis and aspirin). No great shakes either way you toss them. So what to do? You round up your creative, left-brain types and spin some ads. Along with them you round up the sales force posse and have them give some lunches and dinners to the docs. (By the way, I don't go along with the people who spell it doc's: 's is for possessives and some other rare instances for plurals. Ahem.) And then they like to show off at meetings and rent stadiums and such, which must cost a pretty penny.

Then there are the stockholders, those denizens of the financial deep (you and me, probably), demanding their piece of the brass ring.

And then there's the CEO and his minions.

The plants that house these minions, too, must be financial hogs. The equipment, as they say, ain't cheap.

Don't forget the lobbyists, those representatives of industry that serve to grease the wheels of justice and, er, ... let's call it what it is: self-serving, fat-as-hogs, re-election PACs of our heroic congressmen (and women).

So you see, this question is more complicated than it first appears. I have the feeling that many people think that the cost of the drug has a lot more to do with the ingredients (drug + lactose + talc + little bitty things) and the pharmacist's salary. Not so. Rite Aid once commissioned a study on the cost of filling a prescription minus the drug itself. That is, the cost of dispensing an empty vial. This was done in the late '90s. Even back then they found the cost about $6. Now it's probably more like $10. That's the salaries, the electricity, the computer stuff. The whole enchilada, as it were. So when you see some drug costing 128 smackeroos, it's not the pharmacy getting all greedy-like. Most drugs are sold as loss leaders, meaning the pharmacy loses money on them. The more expensive the drug, the less profit they make (it costs a lot to keep up a big pharmacy inventory). Most prescriptions are now filled with some third-party paying at least some portion of the drug cost. That puts a limit on the profit a pharmacy makes. We might fill a prescription for Drug X costing $103 and we might get $3 as a fee, but then they discount our bill by maybe 12 percent. (There are other areas that a pharmacy can make a profit, at the warehouse end, for instance.)

That's the reason why a lot of independent pharmacies are going out of business. They simply cannot make a profit. The big box stores can't either, but they can sell a lot of toothpaste to make up for it. A small independent cannot. As a matter of fact, if it tries to compete in that way, selling some of the same stuff that say, Walmart sells, or CVS, or Rite Aid then woe betide that Silly Sally. The only way to compete against the big boys is to do something they don't.

So what's the drug made of that causes it to be so expensive? Next time I'm asked that I think I'll just say, "Cat's whiskers and Billy Goat tails, sir." They'll like that just about as much as the truth.

Sunday, June 22, 2008

Thank God for Insurance...

O the humanity; O the irony. See, we shouldn't be thanking the insurance industry for anything. Nothing. Nada. Zero.

But inevitably someone comes in -- this happens on a daily basis -- thanking God for insurance. Of course, what they really mean to say is I'm so glad I don't have to pay $637.98 for my bottle of pills. (Pills, btw, are different than tablets or capsules: just a nitpick but a nitpick I just had to get out there.)

What these thankful people don't stop and realize is that the person in back of them isn't going to get their bottle of pills. No, the God-given insurance company that they have paid their money to is going to deny them because they need to take two capsules a day and they only allow one.
Doesn't matter if the doctor has already tried the one per day regimen. Doesn't matter that two per day works just fine.

Oh, and the person who was just ahead of that one who was so thankful? She left because she needed an anti-nausea tablet for her kid's chemo. Denied! No tablet for you! Next! Seems the insurance company from heaven felt the drug was too expensive for its stockholders. No soup for you!

So why did the insurance company pay for that other person, you remember, the one who was so thankful? She would have had to pay $637.98. Seems a lot for the company to pay. But what she didn't know was that they made a deal with Manufacturer XYZ, so that they only pay $98.98. Then they slap a high copay on the patient, say $50, thus getting a neat little profit, good product share in their drug class, and a thankful patient, to boot!

This used to be called payola in the music industry (a contraction of "pay" and "Victrola," btw) and bribery elsewhere, but if the government allows it it is called Good Business Practices.

Thank God for government!

Wednesday, June 18, 2008

Tea Tree oil is a great multipurpose treatment to use on a number of ailments. Whether you are looking to repel insects in your garden or if you are looking to clear up your acne, tea tree oil is a great alternative.

read more digg story

Amazing herbal remedy! Cures Acne! Kills Lice! Empties...

Pockets! (of your cash). Actually, it isn't terribly expensive, but my point is that this isn't exactly science that is being bandied about here. I am not saying tea tree oil is snake oil: there may be benefits to using tea tree oil. But where is the proof? And I'm not talking about what the neighbor said concerning her little Johnny's case of lice ("Here today, gone tomorrow! Amazing stuff. You got to get some!"). I want some double-blind study to look over.

If something is so great -- remember the early buzz on coral calcium? Cancer cure, anyone? -- then we should be able to show that it actually, undeniably, works. Show me the study.

Homeopathy is the greatest example of modern day snake oil being peddled about supposedly curing this and that, while being composed of mainly water (except the pills which are most likely lactose). I was just reading the Digg article above and the replies to same when I came across someone who cautioned (cautioned!) the use of tea tree oil. Seems that he or she was worried that such a powerful medicine might not be used properly and thereby could cause some harm by unknowing practitioners of herbal medicine (spoken with a hushed, but decidedly sinister whisper) simply unaware of how powerful a drug they have got hold of.

Well, I would hope so. I mean they might get a rash or something (from allergy). And if they put it in their hair it might, you know, smell bad.

So be careful out there, people. Please consult your homeopathic witchdoctor before using. And if pregnant or breast-feeding, well, just know it might stink a little.

Monday, June 09, 2008

"Pretty busy over there...

mind if I cash out here?" the guy says. Gee, nope. We were just sayin'--weren't we Sally (Sally over there is my technician, though heck, why would we be needin' a technician when we've got nuthin' to do I just cannot say)--that for the past two hours we done nuthin' but twiddle our thumbs. Mine's about to fall right off. Busy are they? I bet they are. Why they gots to cash out peoples like you and me and me and you and they just go on and on and on. We only have to answer the phone, call the insurance companies, call the doctors, call the hospital, fax the doctors, correct their mistakes, call back the doctors, call back the insurance companies, yell at the insurance companies, fill prescriptions (I like that part, personally)...and then we gots to ring all you fine folk out just like they do up at the front of the store.

Busy are they? Good. Son of a cabbage, that's just jimminy cricket good.