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Award winner explains how she dug into the reasons for high U.S. drug prices Date: 11/17/15

No other country in the world pays as much for drugs as the United States — not even other wealthy countries such as Canada, Germany, Japan or France. Using studies, published analyses, news stories and expert interviews, journalist Roxanne Nelson dug into the reasons for the big disparities in drug pricing between the U.S. and other countries in her Medscape story “Why Are Drug Costs So High in the United States?” (registration required).

In the following Q&A, Nelson explains her reporting and writing process for the piece, which earned second place in the Trade Publications/Newsletters category of the 2014 Awards for Excellence in Health Care Journalism.

Roxanne Nelson

By Tara Haelle

Q: What led you to begin reporting on this story? How did it come about?

A: I have been writing about issues in healthcare, and particularly oncology, for quite a while now. Writing about policy has become my preference, in fact, over the more clinical and straight health topics. I have previously written on cost of care, access to care, disparities in care, insurance and Medicare issues — the whole 9 yards. In fact, I much prefer writing about issues than clinical topics.

This particular article came about after an editorial meeting at Medscape when the editor-in-chief said that we should do an article about drug costs. We had some discussions online, I gave some comments on it, and the next thing I knew, it was mine to write. It took a while to plan it out as it covers so much territory and involves so many players — patients, physicians, insurance companies, pharmaceutical companies, advocacy groups and so on. Since I write primarily for the oncology group, the article was slanted towards cancer drugs, but I included other high-priced drugs that have recently come on the market for other conditions, and the input from the insurance and pharmaceutical industry were applicable to any drug and patient population.

Q: What was the biggest challenge as you got started?

A: Since I have already written on this topic, I already had a lot of resources, such as studies, on the topic. The biggest challenge was determining the angle to take and how to tackle this giant topic. Drug costs in the U.S. are very complex, as the whole structure of our health care system is very different from those of other industrialized nations. There are many stakeholders involved in the price of a drug, and unlike in other countries, cost can vary tremendously, depending on the type of insurance you have, what is covered, what type of "deal" an insurer may have with a pharmaceutical company and so on. The main thing is that I didn't want this to be a soapbox sort of thing, with fingers pointing at the different industries. There are very vocal critics of the pharma industry and of our healthcare system in general, and I wanted to give all sides their turn.

Q: How much did you rely on medical studies to do your reporting? How did you sift through them and find the ones you wanted or needed? Were they primarily cost-effectiveness or comparative-effectiveness studies?

A: I used published medical studies quite extensively which looked at cost. I already had quite a few in my files from previous work, and I found new ones doing old-fashioned research (or new-fashioned as the case may be) by using Google and PubMed. Also, I followed links and citations within studies themselves, which link to other papers on the topic. I also used stories published in places like Bloomberg and Business Week, Fierce Pharma and similar websites, as they have a lot of pharma information and do analyses — and I cited them and linked to them. Some of the studies I used were cost-comparative papers, such as comparing the costs of specific drugs in different countries. I also received information from some of the experts I spoke. For instance, the trade associations for pharmaceutical industry and for the insurance industry shared information with me and sent me papers and links.

Q: Did you encounter any difficulties in understanding the studies you used? If so, what were they and how did you overcome them? If not, how had you prepared yourself previously to be able to make sense of them?

A: No I didn't have any problems. I have been reading scientific papers for a long time, and my background is in nursing. So while that doesn't make me an expert in all fields of medicine, it does give me a good solid background for grasping a lot of medical lingo. Some of the statistical analyses can be confusing, but I didn't need to figure that out for my article.

Q: What advice would you have for other reporters interested in such a large scale story that deals with both real people and medical research and advances?

A: I would say give yourself some time to work on it. I realize that many reporters have deadlines, but this wasn't breaking news. You really do need time to sort out the information, contact sources, wait for them to get back to you, do interviews, sift through all your data and then put it together. I think its always good to get a balanced view, although that’s not always possible. But stories generally have more than one side to them, and if it’s a large scale story, it can be approached from a number of angles.

I left out one part of the drug story because there just wasn't any more room, but then I did a second story, kind of an update, on this one aspect that was about generic drugs and patent issues. That really was a whole story in and of itself, and I couldn't have really done it justice in my initial article. But some readers had commented on that and mentioned the issues with generics, so I did a second story.

Roxanne Nelson is a Seattle-based writer specializing in health and medical subjects. She also has a strong clinical background, having worked as an registered nurse for ten years, primarily in maternal-child health, and having worked with HIV/AIDS patients and in the pediatric ICU. She has written two health related books and contributed a chapter to a third. She has freelanced for a wide number of consumer magazines, including Scientific American, GQ, Woman's Day, A & E's Biography and Good Housekeeping, as well as profession journals such as Hospital Pharmacist Report, RN and Nurseweek.