Written Testimony of Stephen R. Smith, M.D., M.P.H. on the Health Care
Cabinet Recommendations on Restraining the Cost of Prescription Drugs
January 12, 2018
My name is Stephen Smith. I reside at 899 Montauk Avenue in New London and I am
a family physician practicing at the Community Health Center in New London. I also
serve on the board of directors of the Connecticut Health Advancement and
Research Trust (CHART), the parent organization of the Universal Health Care
Foundation of Connecticut and serve as president of the board of directors of the
Eastern Area Health Education Center (AHEC). I am professor emeritus of family
medicine of the Warren Alpert Medical School of Brown University.
The high cost of prescription drugs erects financial barriers to the patients I serve
and undermines my ability to provide the best care possible. Just this week, I saw a
middle-aged man, whose diabetes had been relatively well controlled, but on
Thursday, I found it badly out of control. He had lost his job and with it his health
insurance. To make matters worse, his brother-in-law had died and no one else in
the family could pay for the funeral expenses, so my patient emptied his bank
account to bury his brother-in-law. Unable to afford the high cost of insulin, he
simply stopped taking it. This patient had also had a heart attack in his early 40s and
was at high risk of having another unless his blood sugar was well controlled.
Fortunately, he has just started a new job that includes health insurance, though it’s
uncertain what his out-of-pocket costs for drugs will be.
My patient’s story is hardly unique. According to a recent survey by Consumer
Reports, 1 in 7 patients don’t fill their prescriptions because of the cost. That’s why
the recommendations of the Health Care Cabinet are so timely and so desperately
needed. I heartily endorse all the recommendations and urge the legislature to take
speedy action to adopt them. I also suggest that the cabinet consider another action
that wasn’t included on your list of recommendations, but could save patients
money on their prescriptions, namely, therapeutic substitution, which I explain
below.
One way I try to help my patients afford their medications is to write prescriptions
for generic drugs whenever possible. You are probably familiar with generic
substitution in which a pharmacist can substitute a less-expensive generic version
of a drug for the brand name, for example, substituting amoxicillin/clavulanate for
Augmentin. This practice has been around since the 1980s and has proved both safe
and economical. About 70 percent of prescriptions are filled using generic
substitution.
While I’m sure you are familiar with generic substitution, you may not be familiar
with a related concept called therapeutic substitution, which a number of states—
but not Connecticut—permit. If I write a prescription for a drug for which no generic
drug is available, then the pharmacist cannot substitute another drug that does the
