Alas, no more gift links left. Maybe someone else can post one.
2 Likes
We’re dealing with this now. H just went on Medicare and Fasenra is his miracle drug. I hope my link works.
1 Like
Right now between really good private insurance and help from the drug manufacturer, my husband is able to function. Without that, his condition would be crippling and debilitating.
But we will be forced to address Medicare and his very expensive drug when he gets to be that age. It’s so disheartening to know that my husband’s health may be affected by these rules.
I want to say that this article shows some of the pressures that physicians are under.
Hours of talking to insurance, hours getting these medications approved for their patients. Pages and pages of paperwork that has be done every year. All of which are not billable hours. So done outside of office hours. Or hiring someone to do this for them.
I really feel for them and the burdens outside of patient care.
4 Likes
For sure, @deb922. My pulmonologist is working on getting me approved for Dupixent, after many, many episodes of terrible asthma since I had Covid in May. I’ve taken way too much Prednisone and even that sometimes doesn’t help a whole lot. But I know she’ll have to spend a whole lot of time to get me approved. I really appreciate her efforts.
1 Like
I’m sure it doesn’t help that we have endless commercials encouraging patients to ask their physicians about such-and-such a medication. I know that a lot of these require trying other drugs first, so it’s not a simple matter of just prescribing … unless the patient is paying for it without insurance.
2 Likes
I remember a few years ago when the Hepatitis C drug was introduced. I know that it cost around $200,000 for the 8 week treatment. The article I read said that it would be cheaper to fly 1st class to Egypt, spend 8 weeks in a 5 star hotel and fly home 1st class and get the medication there than it would be to take the medicine in the US. I am tired of having to subsidize the rest of the world for medications.
6 Likes
Although the HepC medication is ridiculously expensive, treatment of people with HepC is ridiculously expensive too. I say that as the sister of a man who had a liver transplant before the drug was available. He had three years of reasonably good life and then two awful years before he died of complications of metastasized liver cancer.
1 Like
I’m so sorry.
I had a bil who had an organ transplant and then died 5 years later of cancer. It felt like such a kick in the teeth after the life saving transplant.
I feel the same. I don’t necessarily expect Egypt (as in your example) to step up, but other first world countries like EU, UK, Canada, and Japan should be.
1 Like
I understand that we’re not subsidizing the rest of the world, but the drug companies. They use some of those profits for those foundations mentioned. And while they argue that they invest in research – which they do – they also rely heavily on the acquisition of smaller companies who have successfully taken that risk and have developed the drugs to keep the hits coming.
Then the insurance companies don’t want to pay the high prices the drug companies set, and this is where we land. The system is really broken.
Having had a family member who needed to find foundation funding for her expensive cancer treatment, it’s heartbreaking to experience this “so close but yet so far” health care. And it’s not just a few folks…
3 Likes
It is heartbreaking when people can’t get the meds they need, whether because they are unaffordable, or the country won’t purchase them.
In the US, there’s an affordability issue for some/many, even those with insurance, whereas in some countries with universal medicine like Canada, UK, France (to take a few examples) the government simply won’t purchase certain new meds because they cost too much (so they restrict the formularies). This is one way universal medicine can have lower costs than the system we have in the US. Generally in the US, the private insurers are not paying anything close to list price for drugs (but the contracted price can still be expensive).
2 Likes
Even though it’s not categorized as such on the financial statements, this is a way of investing in research. In this case, research that has already proven successful.
3 Likes
Agreed. But it’s not quite the same as “you have to pay us for all the other things we tried in getter here that didn’t work.” Which is their argument for the high prices.
It’s difficult always to financially justify high costs that benefit few people. Until you’re one of the few…
That’s the only way the business model works…the winners (drugs/products) have to pay for all the losers. There are many more losers than winners. And investors (whether public or private) require a return on their investment.
1 Like
Of course. But the drug company aren’t paying for the losers as they claim. They are paying the shareholders of the winners.
Well, they certainly aren’t going to payoff the shareholders of the losers, as that would be silly.
But consider who the shareholders of the successful companies are. Outside the founders, they are likely VCs or wealthy individuals who placed bets on multiple companies, of which only a fraction succeed. The acquiring company is funding the research behind their winners and losers.
2 Likes
But they aren’t charging the high prices for drugs. There’s a “who pays and gets paid for research” question and then there’s a “who makes money when drug prices are high and who pays high drug prices” question. Different questions, different answers.
When Merck says it needs a high price on x drug because they spend so much on development of unsuccessful drugs, it just isn’t so. Someone else had that cost. Merck plays a different role as manufacturer and distributor. But the notion that the drug companies need high prices because they fund research is tortured at best.
There are a lot of forces at work and at odds here. Capitalism, regulation, politics, community values. There is almost certainly a better way to do this BUT the losers are likely to be those profiting from the current system, so it’s not going to happen without a fight.
But even if we had a “pure” system, as long as resources are finite, there will always be challenges around what we pay for. How much for heroics around end of life care? A drug that will help millions or just a hundred? But what if the hundred are children? This is why, as mentioned upthread, countries with excellent national health care exclude expensive formularies from coverage.
That happens here too…all health insurers, including Medicare, restrict products in their formularies. These restrictions can be based on science (eg, have to try another product first) and/or economics.
And those restricted products can change over time, as new contracts are put in place (or new drugs launch), a different product with a lower price might now be preferred. Some non-preferred products might be completely removed from the formulary, depending on the plan design. So that leads to some people having to change their insulin med, or RA med, or whatever….which no one likes, yet happens all the time.
Big picture, drugs costs are around 8%-9% of the total US healthcare spend, and growing at a lower rate than other pieces of the pie. Of the the drug piece of the pie, generics are about 90% of total prescriptions, but about 20% of the total drug $ spend.