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Comment by blackguardx | Hacker News Reader

The problem is that most doctors don't take treatment costs into account when writing prescriptions. They may not even know the cost themselves. And patients can't really be expected to keep up with the prescription drug industry enough to request cheaper alternatives.

There are competitors to the Epipen but they don't get prescribed as much. I would surmise that has something to do with marketing budgets. Maybe we should join the rest of the world and ban drug advertisements? Oh, and allow Medicare to negotiate a bulk rate for drugs rather than pay MSRP[1].

[1] https://en.wikipedia.org/wiki/Medicare_Part_D#Criticisms

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> They may not even know the cost themselves. And patients can't really be expected to keep up with the prescription drug industry enough to request cheaper alternatives.

In Australia we solved this by requiring pharmacies to offer generic alternatives.

And in Norway, and I think the UK, and probably lots of other places.

Including the US. Unless your doctor names a specific brand and includes the phrase "dispense as written" on the prescription slip, you'll almost certainly get a generic.

That's already the law in the US. Pharmacists have to fill with a generic unless otherwise specified.

>And patients can't really be expected to keep up with the prescription drug industry enough to request cheaper alternatives.

You don't have to keep up with the Rx industry to research different treatments and pricing for your individual condition. When I went to the dermatologist for skin cancer screening, she prescribed me Picato for my actinic keratosis. When I called the pharmacy and found out it would cost $200 after insurance, I called BCBS and spoke with their pharmacist about alternatives. She gave me a short list of brand names and generics, from $10 up, and at the end I decided to go with the doctor's Rx because it had the shortest treatment and recovery time. I did find an online coupon, however, which my doctor didn't tell me about.

Why should that burden land on patients? Many patients will have trouble understanding the pros and cons of different meds; especially if there is any polypharmacy going on.

Because it's the patient's health and their money? It's not like they have to make the decision on their own. The grandparent mentioned he called his insurance company's pharmacist and got advice.

Another problem is that the software doctors use sometimes presents a drop down list of medication, and the expensive version is at the top of the list.

https://twitter.com/drmarkporter/status/765569736423927813

> Q for SystmOne GPs: is there a simple way to ensure default drugs offered when prescribing are cheapest versions most commonly prescribed?

https://twitter.com/drmarkporter/status/765570038048911360

> For context: our default omeprazole version (20mg) is currently 5 times price of one 4 down. Easily repeated costly error when busy.

I have a friend who recently became a pharma shill. Job pays far better than running the biomed lab, and comes with fantastic perks (and expense accounts) for simply educating doctors about drug options.

There's no way a GP can keep up with everything that's out there. Less expensive remedies have no one to fight for them either.

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