Tuesday, June 3, 2014

More on fancy new drug costs

$1,000 per pill or $84,000 for the full treatment. Those are the costs for a new Hepatitis C drug which is basically curring patients of what was previously a chronic, lifetime ailment which can cause liver problems and then death.

That price tag is a bit steep. The manufacturers developed their pricing based on their costs and what they think they can recoup before the patents expire and/or competition begins forcing them to lower their prices.

The claim is that patients are so much better that they are saving millions of dollars in future medical costs by curing the patients.

I have a problem with the price. And so do insurance companies. Its become instantly the must have drug in the Hepatitis C community - quite understandably so.

The problem is because of the cost:

"But under pressure from insurers, which worry about even greater payouts as more hepatitis C patients clamor for the new pill, state health officials are drafting guidelines advising which patients need to be covered immediately.
The guidelines would help insurers set priorities for treating a virus that can remain dormant for years, or even decades..."

"...State government and insurance industry leaders say patients whose doctors prescribe Sovaldi will be able to get it eventually. But some patients who have been told to wait say they’re the victim of health care rationing — long a taboo in US health care.
Insurers in Massachusetts don’t call it rationing. But they say they will have to adopt a “gated” approach to reimbursing doctors and hospitals for the high cost of the drug if they want to stay in business..."

As more and more breakthrough drugs are discovered with similarly high costs for larger patient groups, this problem is not going away. Patients want the new medications. Manufacturers want to sell them. The problem is the payment part - they are too expensive for the system.

So more pressure on both the system to change and on manufacturers to recalculate their pricing structure. The new medications may be lifesavers but they may make a clear division of the haves and have nots - choosing who can afford them and who can't.

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