The Food and Drug Administration recently approved the latest in cancer treatment – CAR-T cell therapy, at a cost of approximately $475,000 for a course of treatment.
The therapy is restricted to those with a type of blood cancer called lymphoma, but the technology may soon be applied to other cancers as well.
Scientists herald this as a breakthrough in cancer treatment. Shouldn’t everyone have access to the latest therapies available, regardless of cost? Although most people would not be able to afford the treatment, insurance pays for it, so the cost doesn’t matter, right?
No, that price is paid for by all of us.
What you buy at the pharmacy affects medical insurance costs for everyone.
Cory Lum/Civil Beat
When was the last time the cost of health insurance went down? Premiums are on the rise, and directly related to the overall cost of care for everyone enrolled in the plan. Insurance companies are required to spend 80-85 percent of their income on patient care, and if the costs exceed the amount collected, that has to be made up somehow, usually by increasing the premiums.
Why do certain medical treatments cost so much to begin with?
Some egregious price increases hit the mainstream media recently, which made people pay more attention:
• Epipen: the lifesaving epinephrine shot that rose 400 percent in price to $600.
Newly developed drugs have also cost significantly more in the United States, demanding payment from us for the research and development costs.
• Harvoni: The first FDA approved Hepatitis C treatment that initially cost $1,000 per pill in the United States and $4 a pill in places like India. The medication is taken for 12 weeks, and many of the U.S. patients who need this are on Medicaid.
The price of the medication is determined by the pharmaceutical company that developed the product, and the federal government has prohibited any negotiation for drug prices in the Medicare program.
If no one else is looking out for the taxpayers who support Medicare and Medicaid, we are going to have to start looking out for ourselves.
Recently Massachusetts petitioned to allow Medicaid to negotiate prices, and also to restrict medication coverage to one drug in each class, rather than the generous coverage provided for any FDA-approved medicine that currently exists.
So, who is the real stakeholder in the rising costs of prescription drugs?
We are. Every single patient is directly affected by the costs of medical care, including pharmaceuticals and expensive immunotherapy.
Not only are we affected as patients, or as consumers of health insurance, but we are also at risk as taxpayers, since Medicare and Medicaid are taxpayer-funded.
Given this situation, what can each of us do to help?
The first thing we can do if we are on medication is to ask for generic alternatives. FDA rules require the active ingredient in a generic medication to be the same as in the branded formula, minus some of the pretty packaging or nice colors.
I take fexofenadine for allergies, and buy the generic version at Costco. Although not every medication has a generic version available, there are often certain classes of drugs that do have these less expensive options on formulary. Sometimes, mentioning this to the doctor opens up the discussion of less expensive alternatives to current medications.
The second way to reduce costs overall is to think twice about manufacturer coupons. If the maker of a medication offers a coupon, it may cost less at the pharmacy for a prescription, but the higher cost is still billed to insurance. This could be on the order of 10 times as much, even though to the individual, there really wasn’t much discount. Remember, higher costs for medication are factored into health insurance premiums, so it may not be the bargain that people might think.
The next step is to stop falling for marketing tricks. Only New Zealand and the U.S. allow for pharmaceutical companies to advertise directly to consumers, suggesting the need for their products. Unfortunately, the FDA does not require head-to-head comparison studies as part of their approval process, so there is no research to suggest that a newer drug is going to be more effective or better than an older version. Medically, there is no reason why five of the very same types of drugs should be developed and sold on the market. But when people see ads for something new and different, it seems like there is an improvement over the other versions, even when it’s not.
Another bigger commitment is to lobby local, state and federal legislators regarding the need for better price controls for medications. President Donald Trump promised to reduce the cost of pharmaceuticals, but thus far, this hasn’t happened. There is no current control of the cost of medications or therapies, and as a nation, we need to insist that value-based pricing be used as a model.
Given the fact that that FDA has no legal authority to investigate or control the prices set by manufacturers, there is not much that it can do about the cost of medications it reviews. However, other agencies have taken up the cause, and are trying to help control the bottom line cost to consumers.
The Institute for Clinical and Economic Review has proposed looking at not just the efficacy of approved medications and treatments, but also the cost. This new approach gives the public the ability to research high value care that has been proven to work well and offer reasonable benefits in relationship to cost through their website.
As science advances, there will always be new treatments that are supposed to advance the practice of medicine, but it should not be done at the risk of bankrupting the American public while enriching pharmaceutical companies.
If no one else is looking out for the taxpayers who support Medicare and Medicaid, along with their own health insurance premiums, we are going to have to start looking out for ourselves.
The post Health Beat: What You Can Do To Help Us All Afford Our Insurance appeared first on Honolulu Civil Beat.