July 24, 2008 
Unfortunately, the WSJ Health Blog beat me to it, but I think it’s an interesting perspective that apparently David Snow (CEO of Medco) talked about. High gas prices cause people to reconsider things…like driving to the pharmacy or paying for brand drugs. That would mean that mail order penetration should go up and people should use more generics.
It seems logical, but I am trying to reconcile it with two other economic realities…people not filling their prescriptions or skipping doses to save money and the fact that mail order requires upfront payment for the longer supply. I have always struggled with why someone doesn’t offer a credit card for their mail order pharmacy so that you can save money and spread the payment over three months. In tough economic times, that cash flow can be an issue.
And, for the first time in over a decade, it appears that the growth in prescriptions actually fell as reported on the 16th in the WSJ.
The burden on consumers has increased sharply. The average copay for a preferred drug on an insurance company’s tiered system rose 67% to $25 in 2007 from $15 in 2000, according to the Kaiser Family Foundation. Out-of-pocket costs to cover family insurance premiums were $3,281 per employee last year, up nearly 84% from 2001.
Consumers appear to be skimping on medicines as a result. An April poll from the Kaiser foundation showed 23% of patients who responded didn’t fill a prescription in the last year because of cost, up from 20% in 2005; 19% split pills or skipped doses, up from 16% in 2005. A report last month from the nonpartisan Center for Studying Health System Change in Washington, D.C., said 20% of respondents in a 2007 survey of 18,000 people had put off or gone without medical treatment in the previous year, compared to 14% in 2003.
Data from IMS Health show growth in prescription volume for the first five months of this year slowed to 1.5%, the lowest rate at least since 1996. From 2003 to 2007, annual volume growth averaged 3%. In December 2007, total prescriptions dipped by 2.1%. The decline was 0.2% in April and 0.1% in May.
Enabling Healthy Decisions 
People won’t spend money on prescriptions just because a doctor says they should and drug companies decide what price they want people to pay. Doctors can charge whatever they want and so can drug companies. It doesn’t mean people will pay for it. And both of these entities need to think about the fact that if their customers die so do future payments.