To the editor:

Susan Levenstein is an American born-and-raised physician who has lived in Rome and practiced medicine in Italy for many years. She recently came to the United States for a medical conference and was stranded in Berkeley, Calif., due to the COVID-19 pandemic. While here she got to experience the “exceptional” American health system close up and personal. What follows is a description of her personal experience with one prescription:

“You pays your money and you takes your choice.

“Elsewhere in the world, drugs cost what they cost, the price is the same in any pharmacy, and it’s always a tiny fraction of what it would be in the U.S. People on their national health service pay if anything a tiny fraction of that tiny fraction. Alvin and I take thankfully few medications and pay zero for them – except for one. It’s not covered by the Italian National Health Service, so I have to pay the price that’s printed on the box, about $11 per month, which I have always considered obscenely expensive.

“Until, that is, I became a coronavirus refugee in the very exceptional United States of America. I had no difficult getting a physician friend to call in our prescriptions to the local CVS, or  strolling over in mask and gloves. But once there I got told by the pharmacist that my pill, made by the same company and with the same brand name, would set me back $228 for a month’s supply. More than 20 times the already exorbitant Italian price.

“I have Medicare Parts A and B but not the drug coverage in Part D, so that $228 is what I would have handed over. If, that is to say, the kindly pharmacist hadn’t taken pity on my ‘furriner ignorance’ and tipped me off to a website called GoodRx. There I learned that the ‘list price’ of my pills varied, among the eight pharmacies within range of North Berkeley, from $204 to a dizzying $268 a month. And that GoodRx, out of the pure goodness “of its heart, would award me discount certificates that would bring all those prices down by about 15%.

“As if that weren’t bewildering enough, I eventually figured out, at the same site, that there were multiple generic versions of the same substance, some labelled with their own brand names and some not, each of them with its own array of list and discounted prices. After balancing off price and distance from the drug store, I wound up paying only $47.”

Dr. Levenstein also commented on the TV ads for medications and the quickly mumbled warnings about what the advertised drug can do to you. Do the companies publish these warnings for your protection? Are you kidding? They do it solely to cover their own derrieres in case a gullible shopper is injured or dies because of their product. And guess who pays for these ads? You! We are led to believe that our costs are driven by the “costs of research” incurred by their companies. Fact: American pharmaceutical companies spend between twice and up to 10 times more money on advertising than they do on “research”. And somebody has to make sure that those costs don’t affect the bottom line.

All Americans are aware that they are suffering pain and possibly poverty at the hands of COVID-19. They are apparently not aware that many Americans (including themselves) suffer the same situations at the hands of Big Pharma.

Brendan Walsh


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