The Price of a Pill

Commerce. Alliances. Supply and demand.  At their core, each is a basic concept that is relatively easy to understand. But drop any into the real world, and it gets complicated. After all, things are never that neat when you extrapolate those roots to global trade, world diplomacy or monetary policy. That's why Harry Truman's explanation of economic cycles is so powerful. It takes a system that is complex and reduces it back to its essence: "It's a recession when your neighbor loses his job; it's a depression when you lose yours." Of course, politics being politics, Ronald Regan added the corollary "And recovery is when Jimmy Carter loses his."

Drug pricing would seem to fall into this arena. On the surface it would seem to be a pretty simple and straightforward equation. You take the cost of the materials, add in the overhead it costs to make and market the pills, tack on some profit, and you arrive at a price to charge the public. There might be variances for the brand, premiums for specific features or discounts for stuff that faces competitive pressures. But in concept it should be no different from buying shoes or potato chips.  

But pharmaceuticals also boast factors that are somewhat unique and complicate the picture. For instance, it can take 10 to 15 years to develop a new medication, so R&D is a hard number to quantify.  And since only about 20% of products actually make their way out of the lab and onto the shelf at CVS, there's a lot of time and effort that has to be accounted for that goes into failures.

And that's just on the development side. On the delivery side, it's not just doctors and pharmacists, but giant prescription fulfillment firms and insurance companies that all have a say. The result is that who you are, where you are and what kind of coverage you have all factor into how much you shell out to relieve your aching back or silence your cough.

I bumped into the system head first when I opened a bottle of pills to find it nearing the end. Like millions of people, for several years I have taken simvaststain to help control cholesterol. While our coverage has shape shifted with the ongoing remake of the healthcare landscape, I have been able to get the pills at a cost of about thirty bucks for a 90 day supply, a price which seems to be the about average, regardless of supplier.

Finding no more refills allowed on my current script, I reached out to my physician and asked her issue a new one. The office said they would e-scribe it, and I checked online to make sure the order had been transmitted. Sure enough, it was shown as "in progress." But I noticed one itty-bitty discrepancy from my last order: the $30 price tag had jumped to $248.40.

Perhaps I missed the notice since I last ordered the pills that they were now being made with diamonds. So I picked up the phone and called in, seeking to talk to an actual person. The rep I got was most helpful: "Yes sir, I have your account right here. How can I be of help?" When I pointed out the mismatch, she said, "Wow! Quite a difference, huh? Let me see. Well, it says here you have no health insurance. And the uninsured price is indeed $248.40." I assured her that I did have coverage , that nothing had changed on my side since I last ordered. She asked for a minute, went away, and came back shortly. "Sorry about that. Indeed, there was a miscoding in the file. I have reset it, and the price is now the same as it was before, $30. Sorry for the scare. Can I put a rush on that for you?"  In the space of 60 seconds, the price of my medication dropped 800%.  

A look at any medical bill shows the same kind of imbalance. Nominal charges or uninsured costs seem insanely high, while the insured variant seems to undervalue the service being provided. Regardless of your politics, it hard not to agree that the system is wildly out of whack. There are no easy answers, but experts say I experienced the first step: between payment and product we need to reconnect the disconnect.

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Marc Wollin of Bedford thinks he is basically healthy. His column appears regularly in The Record-Review, The Scarsdale Inquirer and online at http://www.glancingaskance.blogspot.com/, as well as via Facebook, LinkedIn and Twitter.

One Trick Button

Let's say you are a coffee drinker. If you're like most addicts, it's the stuff that gets you going and keeps you going. And that means you always want to have a supply of Joe at the ready; perish the morning you come down and find barely a scoop remaining in the tin. Now, if you're the look-ahead type, that wouldn't happen because the last time you made a batch of brew you noticed you were getting low. And so you put it on your shopping list to pick up some on your next grocery run.

But then you had an early morning meeting, and the traffic on the way to the store was crazy, and you had to race to get your kid, and and and. So you put it off. Since you knew you had at least another morning or two in the can (so to speak), you didn't go out of your way. But then the weekend came, and man, how you looked forward to brewing a pot and curling up with the Times. Only when you opened up the can there was barely any left. Seems your better half made a pot or two, and neglected to mention it. That's not a happy face you're wearing.

When you come right down to it, you're not having a coffee shortage problem, you're having a coffee procurement problem. And to solve it (other than cursing loudly, then chasing the offender into the car and screaming at him to go the store and get more Maxwell House, because after all, the offender is most likely to be a "him"), you can now turn to the leader in "I want it now, I gotta have it now" technology. Forgot Apple and its watch. Amazon has got the button.

It's called the Dash Button. It's a little branded button, a bit smaller than a contact lens case. It comes either with a hook to hang it on your keychain, or an adhesive back that lets you affix to it to an appropriate place. It integrates with your home Wi-Fi system, and talks to your smart phone. Then when you press it, it does one thing and one thing only: orders a single product straight to your door.

Available for Amazon Prime members now, with wider rollout expected, each button is mated to a product, and has that product's logo on it. There are buttons for Clorox wipes and Tide detergent, for Kraft Mac & Cheese and Huggies diapers. Currently, about 130 items are available. So whether it's Larabar Uber Cherry Cobbler, Gluten Free bars or Gillette Fusion razor blades, all you have to do is press. The order is transmitted to Amazon HQ, and probably on your doorstep before you can say "Honey, we're running out of cat food."  

They are even taking it one step further. Starting this fall, for select products, you won't need to add the button or even press it. Certain devices are being designed to self-monitor your usage, ordering for you when the time is right. Called Dash Replenishment Service, you will find it in a Brita water pitcher, as well as the Quirky self-grinding coffee maker and a new model of Brother printer. In each case, when the time is right, the appliance will talk to your phone and automatically place an order for filters or beans or ink as needed. Then all you need to do is wait for the Amazon drone to drop it off on your front porch.

Do you really need this? You probably already have Amazon bookmarked, and the account info is likely memorized in your phone. But you still have to call it up, and boy, what a pain that is. It calls to mind Louis CK in his concert film "Hilarious." There he coined the term "white people problems" for the headaches that affect Americans in the middle to upper class. As he describes it, "This is when your life is so amazing, that you make up stuff to be upset about: ‘Why do I have to choose a language on the ATM machine? That's crap, I shouldn't have to do that!'" (Mind you, if you know Louis CK's work, you know I cleaned that up. A lot.) Or as Louie says it best, everything is amazing, and nobody's happy.

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Marc Wollin of Bedford orders more from Amazon then he would like to admit. His column appears regularly in The Record-Review, The Scarsdale Inquirer and online at http://www.glancingaskance.blogspot.com/, as well as via Facebook, LinkedIn and Twitter.

Disease State

It seems that whenever I flip on the TV, I'm confronted with people leading much fuller lives than I. I'm not talking about the doctors on "Grey's Anatomy" or the lawyers on "The Good Wife." Sure, they seem to have incredibly challenging careers, filled with interesting people and demanding situations. They have witty conversations, drive nice cars and have perfect wardrobes. But their personal lives seem to be a total wreck week after week, a condition they never seem to be able to resolve. No thanks, I'll pass.  

No, the ones I envy seem to have tipped the work-life balance hard to the side away from a cubicle. You only ever see them going fishing and playing golf. They go boating on beautiful lakes, and jog effortlessly on immaculately groomed paths. They have fabulous dinners on patios and in designer kitchens that I can only dream about. They even do things I thought only kids do, like play Frisbee on the beach, roast marshmallows over campfires and play quoits. Quoits! I can't tell you the last time I played quoits.

To be fair, they also have diabetes, over-active-bladder disease and skin conditions, but hey, into every life a little rain must fall.

I don't know about you, but the last time I had any medical issue, no matter how small, the last thing on my mind was marshmallows. What I'm hoping for is something that will enable me to get back to my normal routine. And daydreams to the contrary, that usually doesn't involve taking selfies in a classic car. It's more like I have a cough, and all I want is something that will enable me to get some sleep, or find a seat on the train where those around me don't treat me like I'm Typhoid Mary.  

That's what I want from a medication. But I guess I've set my sights too low. Because if you watch almost any pharmaceutical commercial, it seems that drugs can do so much more than merely control a chronic condition. Forget being able to just enjoy spicy foods or take a walk in the sun. No matter how serious your situation, taking them can not only bring your PH level into balance, it can enable you to get back to water skiing, right after you've mountain biked to the beach.

I mean, I never ask about those kinds of side effects. All I want to know is if it will make me sleepy or hungry. But whether it's Xarelto for irregular heartbeat or Nexium for persistent heartburn or Humira to control psoriasis, the commercials seem to treat the actual medicinal action almost as an afterthought. To be sure, the spots talk about the efficacy of the drug, and recite a list of possible secondary responses which aren't so nice. But the associated visuals hardly focus on how taking the medication enables you to feel good enough to go grocery shopping or attend the weekly staff meeting. Rather, going on that particular therapeutic regime actually seems to turn your life from one of suffering to one where every day is a vacation.

Take a commercial for a drug called Farxiga. According to the spot, I shouldn't think of it as a diabetes medication that functions as a "sodium-glucose co-transporter 2 (SGLT2) inhibitor that blocks the reabsorption of glucose by the kidney, increases glucose excretion, and lowers blood glucose levels," as it explains on its web site. Rather, taking it will encourage me to walk on the beach with friends, play guitar by a campfire or play fetch with my dog in the water. To be fair, they do show it in a work setting, though the last time I saw construction workers dancing next to a dump truck was, well, never. Maybe I just never saw a diabetic construction worker. So there.  

Make no mistake, I don't wish these conditions on anyone. But for all the lip service paid to not sitting inside on a sunny day, it never occurred to me that having a real medical problem would be the answer to a fuller life. I mean, I'm sorry for guys who have "that thing that can't be named or this will get caught in your spam filter," but how cool would it be for my wife and I to have a vacation home with a pair of bathtubs in the yard overlooking the mountains?

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Marc Wollin of Bedford hates taking any drugs. His column appears regularly in The Record-Review, The Scarsdale Inquirer and online at http://www.glancingaskance.blogspot.com/, as well as via Facebook, LinkedIn and Twitter.

Missed Opportunity

Suzanne was a lovely person, a marvelously creative individual, and a friend and associate. Over the past 30 years or so, I had the good fortune to work with her any number of times in a variety of venues. Sometimes I would engage her to help me; other time the roles were reversed, and I helped her on one of her projects. For me, it was always the kind of work experience I hoped to repeat, one characterized by mutual respect, true collaboration and most importantly, laughs.  

Of course, there were many others with whom she worked, including those who spent far more time with her than I, and who developed deeper relationships. When we chatted, she often told me of friends she had both local and distant. And she was fortunate to have a husband she loved and who loved her, and 2 adult girls making their way in the world of whom she was rightfully proud. But all of us share a profound sense of sadness as she lost the battle with the cancers that dogged her over the past 15 years, and passed away this past week.

She and I spent a good deal of time sitting together and chatting over the years, and more recently, when our paths didn't seem to cross as much as they had in the past, connecting via phone every few months or so. Still, it would be arrogant of me to spin it as any more than an intermittent connection. Those many others who knew her better that I are more equipped to paint a complete picture of her as a mother, a friend and a professional. But I can certainly say without reservation that she was the kind of person that you enjoyed spending time with under any circumstance, not a commodity in ample enough supply.

But for me at least, in some ways it was a missed opportunity. For as often as we worked together, we often said that we should try and get together away from the pressures of a project. Perhaps she and her husband would come up our way, or my wife and I would head towards their place. We both agreed it was a good idea, but the rendezvous never took place. There was always something else that seemed to intercede on the calendar; nothing special, just life as we know it.  

And now that opportunity is gone. And that's sad. Certainly not as sad as Suzanne's passing itself, or the pain and loss that her family feels. But sad none the less, because I let the chance slip away. It's something we all do frequently, not by intent. But all too often we make a connection and then let it go, not appreciating how rare such an opportunity is.  

In business, the equation is couched in shear economics: it's cheaper, easier, and more effective to retain current customers than it is to acquire new ones. But friendships are really no different. While you should certainly be open to new ones, it's a mistake not to nurture the ones you have, and help them bloom to their fullest potential. It's a gift there for the taking, but like many things, you have to work to get the most out of it.

The online service Craigslist has a section called "Missed Connections." In it, people who had a fleeting encounter with another person list the circumstance and some pertinent facts to maybe, perhaps, hopefully turn a swing into a hit. My situation with Suzanne was different only in degree. I had the good fortune to make that initial connection, even expand it a bit, but unfortunately never developed it to the fuller potential it might have been. Yes, it's trite to trot out John Donne's famous line that "every man's death diminishes me." But just because it's trite doesn't make it any less true. And that's because in this case it's personal.  

To be sure, I feel most sorry for those closest to Suzanne who will feel her absence most acutely. But for those of us who knew her, yet who could have known her even better, it is a loss as well. It's only potential, it's only possibility, but you just don't get that many chances in this world.  And so I am sad not just for what was lost, but for what was never had.

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Marc Wollin lives in Bedford. His column appears regularly in The Record-Review, The Scarsdale Inquirer and online at http://www.glancingaskance.blogspot.com/, as well as via Facebook, LinkedIn and Twitter.