Living On Biologics At $32,000 A Month?
6 CommentsBy Ed Silverman // November 3rd, 2009 // 7:58 am
The media used to be filled with stories of seniors who can’t afford their pills. The latest manifestation of this war over access and affordability is now extended to biologics, the costly and profitable meds that are the subject of an intense Congressional legislative and lobbying effort. As you know, the issue is the extent to which investments and profits will be protected before lower-cost biosimilars are available.
Meanwhile, there’s Rob Day. No, he doesn’t spend $32,000 a month. “I went 20 years waiting for a miracle cure to come,” the 41-year-old Michigan man with a rare blood condition tells The Port Huron Times-Herald. “Well, I got the next best thing.”
That next best thing is Soliris, a biologic that allows Day to function on a day-to-day basis. The good news is the cost is covered by his insurance plan. The bad news is that, though he’s been on the drug just two years, he has only a few years of eligibility left before he reaches his insurance plan’s $2 million cap on benefits.
“I’m assuming I’m going to have to go off Soliris,” says Day, who works for the paper as a graphic designer and multimedia technician. His blood condition, paroxysmal nocturnal hemoglobinuria, causes red blood cells to break down prematurely and can lead to anemia, blood clots, shortness of breath and severe pain. But once his insurance cap is hit, he has only a couple of options, including more costly independent plans. And he can’t ride a bus to Canada for a lower-cost version. Why? None exists.
Anonymous Patient
No he doesn’t pay $32K a month he pays $500k a year….No wonder his insurance is going to run out….
Surely with all the technology we have today we can figure out a way to bring the cost of this drug and many others down. But, now that there is funding for it, who wants to leave that sort of money on the table?
Competition is the surest way to spark innovations…. Times should be shortened…
bob merold
There is a must read column on how the UK does this - a piece in the sunday london times on June7 2009 entitled “The unbearable cost of living”. It details the debates of the “NICE” commission - essentially concluding that the UK can only afford $20K per year for someone’s drug cost - anything greater than that and they start having to reduce services to many others. Sadly the woman pushign to raise the ceiling wins her case but develops complications before she can actually get the drug and dies.
There are hard, hard questions out there. Folks in Europe are not rationing care out of meanness. Sadly no one can begin to have an intelligent conversation in this crazy dysfunctional political land of ours.
And so, again, we will wind up with the worst of all options because we can’t have an intelligent discussion about choices
Anne PME
Is it me, or does anyone else think that health insurers are not doing as much as they can to ensure that a policyholder (or for that matter taxpayer) plan is not being overbilled, miss-billed and/or extorted?
Aren’t these companies are supposed to negotiate pricing that is favorable to the policyholder and/or plan payer? The same shoud hold true with Medicaid and Medicare.
It is striking to me that pharmaceutical and health insurance executives who are apparently genetically and otherwise superior buy and fly on private planes bought with stockholder and taxpayer money that is ultimately funded off the backs of ‘rebates’.
On the other hand, the growing class of the US population who are ‘genetically defective’, say for example the Bush family females and Obama family females (both families have a history of autoimmune disease in their background) may get a taste of private planes before they rejoin their genetically inferior peers in the lower class flying to India, China, Brazil or Russia in coach to access medical treatment that is reimbursable by their health insurers. You wonder when the health insurance and pharma/device executives will start collecting the ‘medical tourism’ frequent flyer miles to cash in when they need to upgrade the corporate jet.
The real irony to me is that the super rich pharmaceutical and device executives make their money by pushing law abiding citizens who are genetically defective and/or otherwise suffering from an acute medical episode to beg and barter for their lives in the form of medicines or devices to keep them alive.
Why you may ask? So that the genetically defective and/or acutely ill class can get back to work and to their families and support the same extortion er…I meant ‘rebate’ system that certain members of congress, lobbyists and health insurer and pharma/device executives seem to live to promote and thrive off of.
I guess it goes to show you that exposure to street corner drug pushers, begging for and getting large increases in your ‘allowance’ and watching your mom cut coupons religiously to save pennies so that there is money to spend on mounting a good public relations campaign to beg for drugs/devices when you get sick can serve as a positive and very powerful career motivator and enhancer for the genetically superior race…er…I meant the pharma/ exec class and those who work in the industries (govt and otherwise) that ‘support’ them.
Who ever thought that coupon clipping and watching movies like the Godfather over and over again would be so inspirational to generations of US citizens?
Anne PME
That being said…what about Coordination of Benefit (COB) strategies?
If there is any way that the patient in question can divest of most of their assets and their spouse’s assets (i.e. divorce) and shelter enough income to make the policyholder eligible for Medicare/Medicaid? The trick is how to continue to maintain eligibility for their employer sponsored health insurance. Taking steps to make yourself dual eligible might buy time and/or extend the time until the plan caps out.
Medicaid and Medicare cannot collect their previously reimbursed amounts until after you are dead. This can be good or bad for the high payout claimant.
Oh, but I forgot, the health insurer can incorporate their high payout claimant reimbursement amounts for their genetically inferior policyholders into compounded cumulative premium and co-pay increases.
Is it me, or have any of you noticed that while insurance and pharma/device executives are very good at getting and cashing in rebates for themselves, they don’t seem to like to give out any rebates or roll back prices (like Wal Mart) after the high payout claimant dies and there are no more claims to file?
Is this what they mean by ‘value(s) based medicine’?
annonyed
Actually, the pharma executives and higher management that they employ just think that they have found legal ways to exploit the vulnerabilities of other human beings and make a lot of personal wealth while doing so. Their motto in the industry, whether they are aware of it or not, is “we’ve got you between a rock and a hard place, now we will exploit you, use you as a means to our ends”.
There is no need what so ever for Alexion to charge $500k a year for treatment with this drug. This is an arbitrary number dreamed up to appease wall street investors and quickly stuff the pockets of upper management. They need to move fast too, once the public find out they are being ripped off, eventually this portal will close.
The government allowed this to go through only because someone, Alexion in this case, was holding a loaded gun to their head. They had a few patients who benefited from this drug and those patients were ready to start screaming “isn’t my life worth something?” The FDA cannot afford to get in that fight. But, actually, I think the FDA can and should. Wall street will not want to hear it though and the money movers will say it is all in the name of capitalism, and hey aren’t we a capitalist society? Yes we are, but we are also a society that believes in human rights…. The head of Alexion who allows this should be brought up on a charge of extortion. That is what this is….
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