FOX 11 Investigates: Cost of prescription drugs

(WLUK) -- Whether it's the EpiPen to treat a life-threatening allergic reaction, or a simple pill for pain, prescription drug prices are shooting up.

If you think lower cost generic brands are the answer, think again.

"Sometimes normal 25 cents a pill is now $9-$10 a pill," said Kristene Stacker, executive director of the Partnership Community Health Center in Menasha.

Most of those seeking care at the center are on medical assistance through the state's BadgerCare program or covered through the federal Affordable Care Act. Yet Stacker says the high costs of some drugs, even with insurance, are unaffordable.

"People do make choices all the time and unfortunately, very sad, they have to choose between their groceries or paying their rent, or gas in their car to get to work or their medications," Stacker said.

"The overall cost of the situation is definitely at a crisis level," said Dr. Ashok Rai, CEO of Prevea Health in Northeast Wisconsin. He says healthcare itself is very regulated. But prescription drugs, not so much.

"How they sell the drug, how they price the drug, how they market the drug -- which is a lot of the cost right now -- is not a regulated area," Rai said.

Without regulations, Rai says, pharmaceutical companies have been able to raise prices on a wide range of drugs over the past several years. Some drugs have soared in cost, others up moderately.

John Toussaint is CEO of Catalysis, an Appleton-based company looking to improve the value of health care for consumers.

"2014-15 was a 12 percent increase in prescription drug costs and 2015-16 was a 9 percent increase, so that's significant," Toussaint said.

The problem is where you get your prescription drugs can play a big part in how much you or your insurance company is paying.

"That is definitely true depending on what pharmacy you use the prices can be very different," Stacker said.

In Green Bay, FOX 11 wanted to know the cash price charged for the six, most prescribed drugs.

Not all pharmacies felt comfortable quoting specific prices since prescription drug costs can fluctuate day to day. So to be fair, at a pharmacist's recommendation, we gathered cost information from GoodRx and WellRx, the leading online sources for prescription drug prices.

These prices include any coupons or discounts offered by the various pharmacies and represent prices listed on Feb. 1, 2017.

Shopko Pharmacy had the best or second-best cost for five of the six drugs. For the generic version of Nexium to treat gastroesophageal reflux disease, Shopko's lowest listed price was $70.67. Walgreens had a price of $90.82; Walmart at $131.28; and CVS at $140.89. In all there was a range of more than $70 -- twice the Shopko price -- for the same 30 tablets at 40 milligrams each.

FOX 11 Investigates reached out to all four pharmacies to better understand the price discrepancy between the low and high cash prices charged.

Shopko responded, stating: "Shopko does everything we can to provide great savings for our customers, including securing low drug costs and partnering in generic drug savings programs."

Walgreens also mentioned its drug savings program and added: "When choosing a pharmacy, we encourage patients to select one based on overall pricing and the services available..." Walgreens also suggested: "It's also important for patients to use a single pharmacy so that pharmacists can monitor their medications and avoid potential drug interactions."

CVS responded by pointing out: "Prescription drug price surveys do not accurately reflect what the vast majority of Americans pay for their prescriptions. Approximately 98% of our pharmacy business is covered by third party prescription insurance in which customers pay only a co-pay -- not the full price -- for their prescriptions."

FOX 11 Investigates acknowledges the claim that most consumers are covered by insurance, which picks up the majority of the prescription cost at any given pharmacy.

"It may be only $16 at the window but it's a lot more on the insurance side," Rai said.

Rai says the result of overall higher prices for drugs is ultimately higher insurance premium costs.

When asked if it's really all of us that are paying more, Rai replied, "Yes. That's why I do refer to this as a national crisis and needs to be addressed."

U.S. Sen. Tammy Baldwin, D-Wisconsin, introduced bipartisan legislation last year calling for more transparency and detailed accountability on the part of the drug companies. Her plan calls for drug companies looking to raise prices on any given drug more than 10 percent to give advance warning and explanation for the price hike.

"This should never happen in America and it is deeply disturbing to me and we have got to take action," Baldwin said. "This should be one of several strategies we use to bring drug prices down."

Rai supports the Fair Drug Pricing Act, but says over-regulation by Congress can also hurt.

"Some of the regulation that creates the excess cost exists within the federal government," Rai said.

Such is the case with current law that doesn't allow the government to negotiate the best drug prices for Medicare.

"I think it's just another example of the system being rigged and the powerful interests coming in and writing their own rules," Baldwin said.

Baldwin supports current legislation to remove the Medicare negotiating provision.

"I think as a country as a whole we have to get a handle on the rising cost of health care in general," Stacker said.

But as Congress looks for answers to combat higher drug prices, and explores changes to the health care system, the problems continue.

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