Patients Paying Premiums Getting a Whole Lot of Nothing?
Last week, patients and biopharmas alike got support from an unlikely ally in the battle for access to specialty medicines. The New York State Attorney General’s office issued subpoenas to 16 health insurers, including major commercial plans in the state. The investigation is the latest milestone raising questions about why patients who are prescribed hepatitis medicines are rejected by the very insurers to whom they pay monthly premiums. The NY attorney general’s office found most insurance plans are restricting access to hepatitis C drugs until patients’ livers are damaged. In fact, the state estimates that up to 50% – 90% of patients whose doctors prescribed the drug Harvoni were denied coverage by their insurers. The New York Health Plan Association, which represents payers, contends the NY probe is overly broad and blames the cost of hepatitis medicines for the problem. Drug makers like Gilead argue these therapies offer cures that ultimately save health system costs.
Our Take: The latest NY investigation may finally start to complicate a previously binary dialogue perpetuated by payers, who have blamed the lack of patient access to medicines as solely the fault of pharmaceuticals charging “too much” for medicines. Culpability for the lack of patient access to medicines is surely multifactorial, yet accusing payers cannot be an argument taken on by any one pharmaceutical company alone for fear of losing desirable access and tiering in insurance plans. The NY Attorney General’s investigation may illuminate onerous rationing, prior authorization and utilization management requirements that insurers are applying to deny patients access to medicines. Seemingly hard working Americans are paying expensive premiums exactly to have access to medicines when they need them…and are still being denied… So, it’s about time someone – governmental or otherwise — called attention to other contributors to the issue.
$3 Billion in Cancer Drugs Tossed in Trash Annually
Ugh. That is reaction that many of us who work in the healthcare industry should be having when reading headlines about wasted cancer drugs…especially at a time when the industry is under fire for affordability of cancer medicines. The New York Times reported on research from the British Medical Journal that found US drug manufacturers sell one-size-fits-all vials of oncology therapies, mostly for infused and injected drugs. It claims, in effect, that a petite grandmother of five is subject to pay for the same quantity of medicine that Gronk (the looming tight end on the Patriots) would, despite the fact that she needs a lower dosage. The problem lies in the fact that all patients are required to pay for the cost of a full vial and remaining quantities of the medicine cannot be “reused” or “shared” with another patient who may potentially require a smaller amount. The end result, according to the study, is that good medicines are discarded and Medicare and private insurers overspend up to $3 billion a year purchasing cancer medicines that go unused. The cost is ultimately passed on to patients and taxpayers thereby fueling insurance premium increases.
Our Take: BMJ’s research concludes that system waste could be reduced to $400 million if manufacturers could modify their current packaging to allow more customization in dosing for cancer patients. In an environment where pharmaceuticals are seemingly bearing the brunt of the blame for lack of access to life-saving drugs, if one were the maker of a breakthrough cancer medicine, one might consider pledging to revisit the production strategies and dose sizes of one’s drug… or, will surely be forced to consider this in future.