1). Have you checked with Abbott directly to see if you qualify for any company-sponsored discount program? Their web site should have a link to patient assistance programs–you don’t have to be “poor” to take advantage of the program. (That’s sort of a blanket statement on my part). It may be possible to reduce the copay or eliminate it depending on your circumstances.

2). If you’re a Medicare patient (or a senior without coverage) in certain states that have Patient Assistance Programs, those state programs might off-set some or all of the copay. A partial list of states include NY, NJ, IL, OH, PA. These are programs primarily for either the aged or disabled and have income levels. They also “wrap” around Medicare to reduce cost-sharing.

3) If the Abbott site is a problem to navigate, go to PhRMA’s and link to companies that participate in their “discount card” program.

(Disclaimer: I do not own any pharma company stocks or chain drug store stocks except what may be in my state retirement system.)

Please feel free to contact me at freeman@pharmacy.tamhsc.edu and I’ll help if I can, or if you’re comfortable, add more detail to your question on PharmaLot and perhaps others can add advice.

I have been prescribed Humira for my chronic chrones disease. My copay is $150.00 and I cannot afford this. Is there any agency or company out there that can help me with this issue?

Thank you
Sherri

Anyway, I digress except to point out if one does not have coverage one is very much aware of prices and one is charged full price, not the ones that are negotiated by managed care organizations and the like.

Good dialog. I would say though that for the 42 million Americans who cannot access health care, as far as they are concerned the day has arrived where death is an economic reality.

You and I both know that sometimes drug prices are they way they are just to “open a market” and not necessarily because they are more costly to produce.

Interesting comments on Stem Cells - no I do not think they are the panacea, they do have some drawbacks. However, I respectfully disagree with the argument that the use of this technology and personalize therapy in general needs to be so expensive. Once the technology is discovered and honed, it will be applicable to a wide variety of diseases. This is an area of interest of mine. The choice will always be ours, do we out price it, or do we make it accessible to everyone? That depends on whether we want to keep with our elitist approach.

As far as drugs never getting invented because of lack of incentives, not highly likely. For those that have nothing, something will be incentive enough. After all isn’t this how commerce started way back when?

HC: Interesting points on the overuse of health care and co-pays. If it were just a matter of $5.00 here or 0.50 cents there, no problem. But we are talking about co-pays much bigger than that, and this is where I have a problem.

I get statements for what my health care costs when I access it and my monthly premiums remind me of what I am paying. So, I am not so sure I can relate to what you are saying about not being aware of what the cost of health care is.

As for not affording our technical advances - again I would have to ask, then why have we put ourselves in this predicament? Actually this is like saying, “although my desire to drink has turned me into an alcoholic, I just might as well accept the fact that I can’t stop - that is just the way it is”.

Hmm, not to make light of the subject, maybe we need to think in terms of a 12 step program….

Joking aside, Nathan, I hear what you are saying with the analogy of handling commodities like gas and electric. But I would remind you that they are still affordable and to some extent you can chose to make your house greener and to some extent you can control what you pay monthly. This is not the same with drugs and health care. You cannot predict what illness you will get and how much health care you can receive and benefit from. So, it needs a little more thought.

M Helm, to your point, there isn’t a single price in our entire health care system. Instead we have cost-shifting and differential prices throughout, from hospitals to physicians to labs and community pharmacies. Insurance companies price-discriminate, not only on experience but also on single-person contracts vs. family contracts.

Horus, I don’t like cost-sharing for essential services such as mammograms, vaccinations and the like. It is true that people don’t value preventive services so you have only two options: bring the transaction price down to near zero or impose penalties on people who have voluntarily elected to forgo them. I prefer the former over the latter.

Nathan, insurance is best set up to insure against the financial loss from rare events. Actuarial methods tend to be less accurate in forecasting utilization and costs in “small groups”, and this may be as much of the problem as the unit costs of the drugs. As long as we want a pluralistic financing system, we’re going to encounter these problems.

As I have posted before, I am an unapologetic, unrepentant liberal (recovering socialist, more accurately) so I want to see a mandatory universal national health insurance system that provides a safety net for all citizens as is the practice in Europe.

I think we have to accept that we can afford to offer a basic level of care to everyone, and then allow those who want more to purchase it. We do this with food, clothing and shelter. Why should medicine be different?

We also have to look at overuse. If you read some of the physician blogs on the web, you will see that overuse of the system is endemic and significant. This is overuse by those with and without insurance. Medicaid patients who take ambulances to the ER because they don’t want to cough up the money for a bus to the clinic. The patient who has had leg pain for a year, but one night at midnight decides to call the EMTs and go to the ER. On and on. Patients do this because they do not see the cost of what they are doing. If a patient had to pay a basic fee for using the ER (say $10), overuse would probably be cut in half.

That is the problem with any 3rd party payor system. As long as an individual isn’t spending his own money, he will careless about what he does.

I think we should have out-of-pocket costs for everything and for everybody. Even if a Medicaid patient only has to cough up 50 cents, they should have to do it. And any 3rd party payor system should penalize those who do not get their preventive care done. You choose not to pay $5 and get your mammogram? Then you incur a higher cost when and if you get breast cancer.

Those are just some of my random thoughts.

As for why we are in this business, that’s obvious: we should do whatever we can to improve health care for everyone. However, we (as a society) need to recognize that our recourses are limited and we are becoming technically CAPABLE of providing health care that we are unable to afford. Hopefully technical advances will not just provide BETTER health care, but will also provide CHEAPER health care.

In the past, death was a physical reality with no way around it. In another 50 to 100 years, death is likely to become more of an ECONOMIC reality. (ie. I’ll die when I can’t afford to continue the heroic medical measures needed to sustain my life.) Obviously we aren’t there yet — but we are approaching it more rapidly all the time. People talk about stem-cells like they are a panacea. People don’t realize that stem-cell treatments are generally going to be very personalized — not “out of a box” like our current pharmaceuticals are. Treatment will be VERY VERY expensive. Will insurance cover it or will the cost be born by the patient?

Here’s a scenario that Ed’s article seems to be pointing to: What if specialty drugs (cancer medications, etc) become SO expensive that insurance simply won’t pay for them? Patients are forced to use only older generic medications. The cost of specialty medications (and the benefit gained) is essentially only born by the “elite” of society. Once the drugs loose patent protection, then “the masses” have access to them. Is this something desirable? What if we have to choose between this scenario and an alternative scenario in which those same lifesaving drugs simply never get invented because there wasn’t a profit motive for developing the drugs in the first place? Maybe I’m overly pessimistic – but I don’t see a whole lot of “good” options. We’ll be choosing the “least evil” option.

I’m also of the “health care is a social good” philosophy. But, I’m a libertarian (little “l”), so I don’t put a lot of other things in that category. I’m also of the opinion that less is more.

A couple of simple ideas would go along way toward improving access to these (and all) medicines.

First, If there was one price which all customers paid, regardless of their “class of trade,” their ability to negotiate better prices, or their market leverage. This price I believe should include a reasonable return on research investments (those actually incurred, and not already generating a benefit through some tax write-off scheme), as well as a small amount for coverage of medical communication (not DTC advertising of erythropoetin or anti-TNF antibodies on prime time television).

All pricing and returns need to be very transparent. It is shameful that some of the disease specific charities fund basic research which leads to commercialization of products which the sufferers can’t then afford. If you want to compare this to the way we deal with public utilities, go ahead. As a group they tend to do okay, though maybe not as flashy as PhRMA companies.

Second, If there were one set of rules and adminstrative processes to secure coverage this would reduce the burden on providers and patients. Ideally the “one set of rules” would also go with a single payor in each of hundreds or thousands of “health service areas.” Yes, this is a single payer concept - an approach which insurance companies do not want anyone to think about. This would coincidentally wring out most of the wasted 20% or so administrative costs in the system. If the single payer geographic units were small enough, policies could be tailored to specific local problems. Sure there would still be insurance executives around, but they would be bidding on the business in an area and ideally working to the good of all, not attempting to find ways to squeeze more profit out of the money that comes in with premiums and claims processing services.

Here’s the math. If you get to keep 20% of available health dollars you handle, but you cover only 10% of covered lives(and therefore health costs) in an area, you would make just as much money if you only kept 2% of the available funds, but covered 100% of the available lives. The going rate would likely be no less than 4% in “administrative overhead.”

Less duplication, more efficiency, reasonable access to treatments, better patient care, happier providers, healthier paitents - Solving the problems of the world on the blog-o-sphere sure is easy!

Nathan, I am with you that health care is a commodity. Unfortunately, the entitlement mentality means that people think it should come at no apparent cost to them. I wondered, when I read the blog, whether the woman in the blog would consider giving up one of her cars (assuming they have a car payment) in order to buy her Copaxone? What about eating beans and rice twice a week? My experience with many people who “can’t afford their meds” is what they mean is “I don’t want to make the sacrifice necessary to buy my meds.”

The same is true of all our medical care, not just meds. Studies show that when women have to pay a MINIMAL co-pay $5-10 for a mammogram, they quit getting them. Yet I suspect those same women are paying $5 for a pack of cigarettes of $3 for a cup of Starbucks.

And Nathan, you are exactly right when you say we have to start asking ourselves the really hard questions. How much is 2 more months of life worth? One of my docs told me today about a tragic case he had this weekend: a young man had some sort of cardiac event and is in virtual brain death. But the parents are holding out….would they be so desirous of holding on if they were paying out of pocket for his end-of-life care? Insurance and Medicare/Medicaid allow us to duck the ethical questions we need to ask.

Bob, I sell a biologic, and I agree with you that this represents an insurance co. decision to cut costs where they can–MS patients are a minority and don’t have a voice. So they can get away with this sort of co-pay. Some companies are responsive, though; my company has limited the co-pay for any patient to $50/month for one year, hoping that they can use the time to find alternative insurance.