Sunday, January 6, 2019

Nothing is certain except taxes and death. Oh, and sky high drug prices

Just a quick scroll through your social media feed, or a spin on your radio dial in the car or remote on your TV - it isn't hard to see that, as a country - we split more now in our beliefs as Americans. 

However, drug pricing isn't one of them.  

Remember Martin Shkreli?  The "Pharma Bro" who starting Turing Pharmaceuticals, purchased the drug Daraprim and overnight raised the price from $13.50 per pill to $750 per pill.  A villain pulled directly out of a Victorian crime novel, with a smirk that would later haunt him in sentencing when he was sent to jail for securities fraud, was known as the most hated man in America, by everyone.

Or how about Heather Bresch, the Mylan CEO who took a medication that literally can save a life in a moments notice from $103.50 to $608.61 in 2016.  Outraged ensued when Bresch said that Mylan had to raise the price to be able to provide more access to the medication, taking no responsibility for the cost increase.  In the end, Mylan ended up pushing out a generic version of the pen that sold for $300.  Still almost $200 more than the price in 2016.

In October of 2018, the Centers for Medicare & Medicaid (CMS), administrator, Seema Verma announced that CMS would propose that all pharmaceutical companies publish costs for all medications in television ads.  

When you look at the insurance premium as a healthcare dollar, your top 5 costs are broken out as follows:

$0.233 - Prescription Drugs 
$0.222 - Doctor Services
$0.202 - Office & Clinical Services
$0.161 - Hospital Stays
$0.047 - Taxes

Prescription drugs account for 23% of your premium costs.  That is a burden the consumer, insurer & employer are carrying.  A prime example is a recently released Hepatitis C medication - Harvoni by Gilead Sciences - the 12-week regimen costs $94,500.  And I can tell you, there is not much negotiation in this cost, I have seen about $90,000 negotiated costs so we are talking approximately 4%.

Congress has been talking about tackling pricing and it seemed as if, everyone was on board to try to tackle an every growing problem in this country. 

Even with all this outrage and data, 2019 has ushered in over 250 price hikes to medications.  Just some examples of the increases are:

  • Humira (to treat: arthritis, plaque psoriasis, Crohn's disease, and ulcerative colitis.) + 6.2% increase
  • Restasis (to treat dry eye) + 9.5% increase
  • Tecfidera (for MS) + 6%
  • Eliquis (to prevent blood clots) +6%
  • Jardiance (Type 2 diabetes) +6%
  • Morphine (injectable pain relief) +10%

Note, these increases do not account for rebates or potential patient reimbursement programs.  But, remember, we already know that pharmacy costs represent 23% of your insurance premium - so this will have an even higher effect on these costs.  These increases are outpacing inflation which was 2.14% in 2017 and projected to be 2.54% in 2018 & 2.44% in 2019.

As a country, getting a handle on these costs will have a positive impact on healthcare in many aspects.  We should allow Medicare to negotiate with drug companies, we should push for lower drug pricing - as other countries have it already.  In 2018, Jardiance cost $17.33 a pill in the United States but cost $3.33 per pill in Canada - an 81% savings.

Our healthcare reform act, was not a panacea for our healthcare woes, it was reform on the insurance industry.  Just one of the numerous reforms we need to put in place to curb costs and provide affordability.  

Illness and disease don't care who you voted for or what your party affiliation is. 

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