Oral Parity And What Its All About

Oral parity is (in my non medical person, layman English with a touch of chemobrain and fibro fog) where an insurance company covers an intravenous medication as a hospital visit but in a pill form covers it as a pharmacy benefit and only covers a smaller portion -  $2300/month co-pay in one example.

The insurance companies like it this way because its one less thing to cover. From the doctor and patient perspective its a barrier to patients receiving needed treatment. There is a big "who-haw" going on about this in the insurance world as well.

I have never understood why pharmacy benefits are so different and so separate from other medical coverage. And don't get me started on vision and dental care. These aren't optional things in maintaining good health and should all be covered equally.

But this oral parity thing should not be lumped into the same category as other medications. It highlights the problem with the pharmaceutical industry gouging over charging the American patient to 'cover their research costs and high salaries and huge employee perks still offered to all of their employees'.

If you get a new brand name prescription drug, it comes in lovely little packaging, probably has a massive marketing campaign attached to it. I had one that came with the pills were color coordinated (or vice versa) with the bottle's labeling. Another one, have more designer time put into packaging that was needed. Finally, I have one that comes with a 20 minute instructional DVD on how to apply and dispose of the patch in your introductory package from your doctor which includes a coupon to cover the copay on your first month's treatment.

In the marketing world, this is all part of branding. A new product is introduced and all parts of its packaging, positioning, pricing come into play. A marketing plan includes four P's - product, price, place, and promotion.

A target sales price tells a lot about a product. If a prescription cost $5 retail, do you think - why is it so cheap? Does it work? If a brand name orange juice is $3.99/gallon and another of the exact same product is $1.00/gallon. Would buy the cheaper one simply on price or do you think it must be lower quality and read all the packaging to see if its from concentrate? If a prescription costs $5000/month do you think 'It must work really well if its that expensive!'. Pricing implies a lot.

Next is packaging. If that orange juice comes in a carton where you can't see the product vs one in a fancy glass bottle, what do you think? Is there settling in the glass bottle that is hidden in the carton? Do you want to see the juice? Is the fancy glass bottle making it 'greener' or give more value? Same with pills, are they in a jar or those stupid blister packs (that are  hard to open with RA)? Is the box with the blister pack or the jar packaged in a nice little box with all sorts of packaging and promotion and benefits of the medication as well as the warnings.

Finally, positioning is where do you want the product to have the appeal? If they show women of all ages and races in their ads for a bone density product or should they only show little old ladies who don't have the 'dowager' hump because that is what the product is supposed to avoid. They make the packaging and price and add it with the positioning to make the branding to make the high price bearable.

This takes us back to the huge problems inherent in the medical world where insurance companies and providers are making decisions. Oral parity is only a symptom.