Posted on 06/24/2015 11:22:00 AM PDT by Oldeconomybuyer
Expensive specialty medicines used to treat cancer and chronic illnesses have forced some very ill Americans to choose between getting proper treatment and paying their rent.
To ease the financial burden, the California agency that governs the state’s Affordable Care Act marketplace issued landmark rules recently that will limit the amount anyone enrolled in one of those plans can be charged each month for high-end medicine.
Covered California board member Marty Morgenstern said the agency should do even more by going to the root of the problem: the pharmaceutical companies.
“They charge irrational prices,” Morgenstern said, “on specialty drugs, and on all drugs, as a matter of fact.”
Insurers say it’s only a matter of time before the costs of specialty drugs will force them to raise monthly premiums for everyone in the health plan.
The pharmaceutical industry adamantly defends its prices.
“The cost and time it takes to bring new medicines to the marketplace is increasing, as biopharmaceutical companies go after harder and harder to treat diseases,” said Robert Zirkelbach of the Pharmaceutical Research and Manufacturers of America, the drugmakers’ trade group known as PhRMA.
(Excerpt) Read more at khn.org ...
My understanding is that one of the main drivers of high drug prices in the US is the fact that OTHER countries, such as Canada, impose price controls (as California is doing now). This means that the US consumer pays the difference when they buy the same drugs here. So we subsidize their lower prices.
Are there any Freepers with insider knowledge in this area that can confirm this?
I, and probably others here, have prostate cancer.
Two new drugs became available recently, Xtandi and Zytiga. They suppress androgen production from the adrenals.
List price for them is around $7,000 per month. You have to be in the 0.1% wealth level for that not to matter. Very few retail buyers. Medicare knocks 80% off of this, but $1,400 per month would be painful for most of us.
On the other hand, these drugs in conjunction with other therapy extend life considerably.
Black market drugs. Yeah, there’s where I want to go get my blood pressure medication.
If drug developers cannot make a profit from the hundreds of millions of dollars it takes to bring a new drug to market, they simply won’t do it.
Price caps = shortages
ALWAYS
Since you are a NAVY Veteran, if you haven’t already done so, check with the VA to see if the Drug you require is on their Formulary List.
That might be an option for you. My Father is a WWII NAVY Veteran and some Years ago he went to the VA and he received some Prescription Drugs that were Cheaper than he was Paying through his Medicare Coverage.
In the age of Obamacare, things may have changed but hey, it doesn’t hurt to ask.
Because price controls work.
Because price controls work.
Nice, but the government does not have the right to set prices, minimum or maximum.
They can sue but the question is who. The health insurance companies are strongly protected by ERISA which prohibits any compensation apart from the financial cost of the denied treatment (excluding cost of any medical complications resulting from the denied treatment and null and void if the patient dies first).
Some chemicals are very, very hard/expensive to make.
I worked at a medical product company that relied on a chemical that took 6 months to make. They could only afford to make a few gallons at a time. One simple mistake/accident in a complex process could have a severe impact on production, wrecking a gallon or two of the stuff with ease.
Just because it’s in convenient bland-looking pill form doesn’t mean it was easy to make. Yes, that one pill may very well cost $1,500 _each_ for good reason.
I guess I need to reconcile myself to going and trying the VA even though this is nothing service related. I haven’t been to the VA since 1970. Yikes. Now I feel older.
The well-worn road of Socialism is that prices are capped and then innovation stops. In 30 years, there will be no new drugs because no one will be incentivized to make them. If you let Capitalism work the way it is supposed to, these drugs will be pricey for a couple years, then they will drop in price as new ones come onto the market so that, in 10 or 20 years, they will be commodities and wonderful new drugs will be on the market.
This is correct. The US pays for the world’s innovation, with few exceptions.
There are several mechanisms used by other countries, such as reference pricing and outright price controls. Many countries have a tender process for buying medicines. If the tender is not won, then the drug will simply be unavailable within the public health system, which could be 80%+ of health expenditures.
With the exception of outliers such as N. Korea, all of the so-called state run health systems are in fact two-tiered. The private systems in Canada and Europe, for example, have a quality of care (in terms of technology, wait times, outcomes, etc) on par with that of the US. However, in many countries it is doubtful that the public program will cover any expenses incurred in these private institutions.
In some countries, such as Mexico, drugs are paid for mostly out of pocket by the patient. As a result, there is good availability of innovative drugs, and prices are more rational in terms of response to competitive pressure than even in the US.
You are absolutely right, we will all pay MORE to make up for CA tries to limit. We already pay higher than need be except we are subsidizing Canada and Europe’s price controls.
Why do leftists refuse to learn basic economics?
Thanks for the details!
That’s because Americans are subsidizing their price controls.
I tried going to the VA once and they told me to go away unless I was homeless.
They will sue the doctors, claiming that if they coded the case differently or used some other form, the drug would be paid for.
When you get a drug for a patient that insurance doesn’t want to pay for, each hoop you have to jump through is smaller than the last one. That is to say, after each “no”, the next one up the line takes more time to contact, a longer explanation or more forms, until eventually (if they don’t give up) the time involved becomes unsupportable.
That’s for one patient. Two patients, three, five? Impossible.
But, the insurance company always has the out of saying, “The doctor did not follow our (impossible) procedure”.
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