When the Affordable Car Act passed in 2010, it did so with major concessions to insurance companies and pharmaceutical giants. By bandying the words “socialism” and “un-American” about, cash-laden-contribution-pledging Congressional lobbyists – even pre-Citizens United “buy your influence” case – agreed to support this controversial bill by carving out some of the most pro-consumer proposals and depositing them into the Congressional legislative garbage bin. They eliminated any direct governmental insurance involvement – even a simple expansion of Medicare – to insure (yes, pun intended!) that all that extra business would have to be funneled into their private sector coffers.
But the most despicable compromise was to the biggest pharmaceutical players. First – under some profoundly misguided, mendacious and self-serving notion that we could not trust the quality of drugs sold in such third world nations as Canada and the United Kingdom – they precluded Americans from being able to purchase their prescriptions at lower prices even at trusted venues outside the U.S. Further, unlike the programs in most of the developed world where such negotiations are routine, government agencies (state and local) were forbidden to try and use the power of the volume of their new healthcare program(s) to negotiate lower costs for prescription drugs.
To this day, the United States charges average prices for most patent-covered medications at levels staggeringly above the costs for those same prescriptions in any other developed country in the world. In the eyes of most of those governments and the people who are the beneficiaries of those healthcare systems, American consumers are the biggest losers. With the GOP still demanding repeal of the overall provisions of the Affordable Care Act – with no specific alternative program on the table – rest assured that their goal is to increase the revenues to the corporate interests, even if more consumers are denied coverage or if the price has to rise.
But without the ability to use its “power of a volume buyer” to negotiate lower prescription costs – something most governments around the world can do – and without a Medicare governmental insurance program alternative – the government appears to be powerless to contain the rising cost of healthcare. Hey, folks, that was designed by corporate interests into the bill! Further, as specialized drugs are developed to treat a narrow band of afflictions, or as more powerful and effective drugs enter the marketplace to replace older and less-effective prescriptions for more prevalent ailments, the size of the new pricing structure for these drugs, void of any governmental price-containment program, is nothing short of absurd. Are they worth it or should patients get use to the fact that insurance carriers will fight tooth and nail against paying the extra cost?
The September 10th CNN.com provides some facts and supporting numbers: ‘The prices seem more and more to many people to be decoupled from a consideration of how much value they bring to patients,’ said Dr. Steven D. Pearson, president of the Institute for Clinical and Economic Review, a nonprofit research organization that evaluates the use and pricing of new drugs… Far and away the biggest driver of prices, according to respondents in the Kaiser survey, was pharmaceutical companies and their desire to make a profit…
It used to be that you did not have to break the bank to treat high cholesterol. Statin drugs have been available for decades, and a year's worth of pills only costs between about $50 (for generic versions) and $800 (for name-brand).
But this summer, the FDA approved two new cholesterol medications with price tags that could hurt your wallet: $14,600 a year for Praluent and $14,100 for Repatha. Even though these medications probably do provide benefits for patients who have very high cholesterol or who experience bad side effects from statins, it is not enough to justify the cost, Pearson said.
A recent report by Pearson and his colleagues at the Institute for Clinical and Economic Review concluded that the annual cost of Praluent and Repatha should be between $3,615 and $4,811, based on how much they are estimated to increase life expectancy and quality of life, Pearson said…
Earning their reputation for soaring costs, most new cancer drugs are $10,000 to $15,000 a month, and the treatment can last anywhere from a month to years, said Dr. Daniel A. Goldstein, a fellow in hematology and medical oncology at Emory University. Although Medicare and private insurers typically cover these medications, the co-pay can still be hefty, Goldstein said.
These price tags may not necessarily be out of line for ‘game-changer’ drugs, such as Gleevec, Goldstein said. "It's important to incentivize high-quality innovation," but insurers should be willing to cover more of the cost of these drugs so that patients can afford them, he said.
However, unlike Gleevec, most of the new cancer drugs provide much less benefit and do not merit their price tag, Goldstein said. A recent study he led found that a lung cancer drug called necitumumab, which is not yet approved by the FDA, should only cost between about $500 and $1,300 per cycle based on the fact that it only gives patients a few more weeks of quality life. ‘Basically a tenth of the going rate for drugs entering the market place,’ Goldstein said…
Four new drugs for hepatitis C virus, including Sovaldi and Harvoni, have got a lot of attention recently because of their ability to cure more people of the virus and cause fewer side effects than older drugs. Their price tag has also made headlines: A 12-week course of Sovaldi costs $84,000, or $1,000 a pill. Even with Medicaid coverage, patients are set back about $600 a pill.
‘Hepatitic C (drugs) were a real shocker because they were priced at the level of cancer drugs, but for a much larger patient population,’ Pearson said. An estimated 3.2 million people in the United States have hepatitis C…
New diabetes medicines are a big part of the reason for increased spending on prescription drugs overall in the United States in recent years, according to a report by IMS Health, a market research firm.
Although these medications are based on old-fashioned cheap insulin, the new formulations, in pens instead of syringes, drive up the cost. Pens typically cost about $30 to $40 each, a cost that some insurers do not cover, whereas a box of 100 syringes is about $10. One type of pen, called Lantus, has a long-acting form of insulin, and is the top-selling drug for diabetes…
Promising new therapies have come out for multiple sclerosis, and they carry price tags that match.
A recent analysis found that the cost of new oral MS drugs such as Aubagio has risen between 8% and 12% each year since they were approved by the FDA several years ago. And these new drugs may have paradoxically driven up the cost of older MS drugs, from about $8,000 to $11,000 in 1993 to $60,000 a year in 2015.
A study of so-called biologic drugs for another autoimmune disease, rheumatoid arthritis, found that they cost between about $10,000 and $20,000 a year, and that patients incur about a third of that cost out of pocket.
What can you do about all this? Write your Congressional representatives – in the Senate and the House – as well as your state legislators that healthcare bills need one huge change to benefit consumers: the government has to be empowered to use the power of volume to negotiate with the pharmas to contain the cost of prescription drugs. For those with more gumption, push for a simple expansion of Medicare for everyone as well.
I’m Peter Dekom, and if you really care about containing rapidly-rising healthcare costs, do something about it!
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