Expensive Specialty Drugs and Their Consequences

"...whenever the high price of pharmaceuticals is in the news, drugmakers try desperately to change the subject and distract from the issue."

When you have a fee-for-service medical payment system with an insurance buffer between providers, hospitals, pharmaceutical companies and their patients, it's been pretty easy to hide costs.  But it is not sustainable.  In the end, and especially now with Obamacare, we all pay, whether through higher insurance premiums, or higher taxes.

Indeed, whenever the high price of pharmaceuticals is in the news, drugmakers try desperately to change the subject and distract from the issue.

We wanted to bring some reality-check transparency to the situation.  Even if you are blessed not to have the illnesses listed in the above chart, these exorbitant costs affect us all in higher insurance premiums and potentially higher taxes to pay for Obamacare.  We all have to sit up, take notice and hold the drugmakers accountable.

Now more than ever, the industry is under increasing fire for the prices of specialty pharmaceuticals -- some priced at more than $100,000 for a single course of treatment.

Here are some simple facts to consider:

FACT: Astronomical prices for specialty drugs put upward pressure on premiums for all consumers.
At its core, the cost of health insurance is a reflection of the cost of health care. The skyrocketing prices that drugmakers are charging has a ripple effect throughout the system, raising premiums and increasing health care cost for individuals, families, and employers.

FACT: Consumers have out-of-pocket limits that mean health plans and state and federal governments rather than patients are paying the vast
majority of the cost of these exorbitantly-priced drugs. Pharmaceutical companies know that consumers’ out-of-pocket costs are capped
under the Affordable Care Act, allowing them to ask for what amounts to a blank check from insurers and government programs. Not surprisingly, drugmakers are making the law work for them.

FACT: Astronomical prices for specialty drugs will decimate Medicare Part D budgets and force higher premiums for seniors. 

"...some priced at more than $100,000 for a single course of treatment."

An analysis in Health Affairs last week found that the price of the important hepatitis C drug Sovaldi could increase the cost of Medicare Part D and premiums for seniors by 8%. From this one drug alone, seniors on Part D could see an 8% premium hike. 

FACT: Astronomical prices for specialty drugs will devastate state Medicaid budgets and displace important priorities like education and infrastructure.
One recent analysis highlighted on Vox illustrated that, because Sovaldi is so expensive, California could potentially spend more administering the drug for people on Medicaid than it does for K-12 and secondary education combined. Yes, you read that correctly.

FACT: Health plans offer consumers a range of coverage options, including policies with lower cost-sharing.  To distract from their unjustifiable pricing, drugmakers have latched onto distorted coverage comparisons that ignore the range of cost-sharing options consumers can choose from. Hey, anything beats talking about the actual price.

BONUS FACT: Drugmakers have no straight-face explanation to justify the increasingly astronomical prices they have been charging for their medications.
That’s why they want to talk about anything – ANYTHING – other than the prices they are charging.

The most important FACT is that we all want patients to have access to the best treatments. That’s why we cannot afford to allow pharmaceutical companies to have us simply look the other way any longer when it comes to pricing. These unsustain-able drug prices threaten our entire health care system – public and private – access for patients, as well as the very innovation that pharmaceutical companies relish. We cannot have sustainable innovation without sustainable prices to support it, and that’s why health plans and a diverse set of stakeholders have called on drugmakers to come to the table to find a private sector solution to this challenge before the government feels like it needs to.
Source: Buck, Brendan. 6/12/2014 Wow, this drug is really expens — Look! A squirrel!! | AHIP Coverage
http://www.ahipcoverage.com/2014/06/10/wow-this-drug-is-really-expens-look-a-squirrel/ 2/3
Chart: Bloomberg News-DRX Drug Compare/Washington Post/The Fiscal Times