08/23/2019    Robert Teitelbaum, DPM

A Tale of Big Pharma--A Podiatry Perspective

To make a very long story short, I have been
dispensing celecoxib 200mg from a supply in my
drug fridge for a couple of years now. I might
give out 4 of them, taken once daily, for four
days following a heel pain syndrome injection. I
asked four pharmacists a couple of years ago
"What would be your choice for an NSAID?", and
they all said Celebrex. They thought that for
short-term, the fact that it works in a different
cyclo-oxygenase cycle, makes it less irritating
to the lining of the g.i. tract.

A major paper in The New England Journal of
medicine about four years ago looked at the
cardiac history five and ten years down the road
of taking the drug and concluded (as the Editor
did, in an editorial they have in every issue)
that it is "maybe safer than Motrin." Maybe the
wrong drug is the over-the-counter favorite.

Recently, I prescribed 24 celecoxib 200mg for a
patient with occasional gouty attacks, where it
can be very effective, as are many of the NSAIDs.
The cost was $175.00. Now, understand this is a
generic drug that's costing $7.29 per pill. Of
course, I got the prior authorization 2 page fax
from the chain pharmacy. Having just read Jon
Hultman's article in PM Magazine about the 700
million hours doctors waste on this task per
year--I was is no mood to go through this
charade.

So I called up my patient, and said "Larry, come
to the office and I'll give you twenty pills for
$10." I've been getting them from Moore Medical
for $23 per 100. Once it was $30 for a bottle.
Big deal. That's still 23, or 30 cents apiece.
So what is the story with this $175.00 cost? The
story is that this is the fraud that Big Pharma
commits every day on us countless of times.

There was a time when Celebrex went off patent
some 8+ years ago. Then, the name brand sold for
$10 a pill and the generic was $7. It took years
until an Indian firm produced them when it was
selling for the $23 price. India, I understand is
the country on earth that has the largest generic
drug industry. No surprise they came up with it.

I made a telephone call to the lady pharmacist
and told her what I paid for them at the office.
The chain pays less than that, obviously. I asked
"Why don't the part D insurance companies
recognize the fact that it doesn't cost that much
anymore?" One thing for sure, the chain is happy
with that. But it is a humongous rip-off. And she
had no answers for any of my questions, which I
understood.

American Medicine has become what I call "The Big
Trough", and we are going to have to end that to
survive ourselves.

Robert Teitelbaum, DPM, Naples, FL

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