Another reader with the “handle” Jimi d trading, responded to Saturday’s post,
Are Sky HIgh Prices Charged For Anti-Multiple Myeloma Drugs Justified? A Good Place To Start: Just Blame The Insurance Companies!
Since I realize few of you ever go back to check-out comments about articles which have run in the past, let me reproduce his comment for you here. My response to follow:
Let us not forget about the doctors in our quest to find a reason that drug prices are sky high. Yes as you mentioned that insurance companies and Medicare are complicit in the cost and it is from my understanding of the system that Medicare sets the prices of reimbursement to the doctors based on their charges. For example using your numbers for your doctor’s visit of $438 and only receiving payment of $158, if I went in wanting to pay cash and that doctor excepted my payment of $158 for the same service that your insurance company was billed at the higher rate, then the doctor just set the new rate of $158 for their services and now Medicare will pay a reduced fee off of the lower price of $158 leaving the doctor with even less. Now on to the cost of drugs. Are the drug costs a way of pay back to the doctors for not receiving their billed rate of $438. My revlimid was only available through the doctor owned pharmacy because of the patient usage and celgene wanting to control the output. Which is it, does celgene have to control the usage i.e. the phone survey prior to each refill or is it just to repay the doctor. I thought I had a choice to choose my doctor, my hospital, my method of care and also to choice my pharmacy. We tried going through my local pharmacy, a guy both my wife and I grew up with and whom we have trusted for years but I was forced to buy only from my oncology owned in their office pharmacy. Now my question is how much markup does each $7000 bottle of revlimid pay back? So are the doctors free of this discussion of drug prices?
Jim (may I/should I call you Jim?) makes some intersting points. First, I don’t believe physicians are allowed to receive any direct compensation from a drug company for prescribing medication. I also know expensive, chemotherapy drugs like Revlimid are only handled by a few large pharmacies licensed to distribute them. BioScript is an example of one such company. I do know insurance companies may require a patient to use their suggested pharmacy–one which they may profit from. The reasoning: It helps keep the cost of your insurance down. Yea, right!
Is it possible a doc could indirectly profit by requiring a patient to use their in-house pharmacy? Maybe. I’m not clear on this. I also don’t know how much the pharmacy receives for dispensing Revlimid. I will check into that. Any pharmacists out there who might shed some light on this?
Which brings us to another interesting point Jim makes. He clearly explains why docs can’t take lower cash payment. Assuming this is true, I’m sure Jim would share my opinion that one wrong doesn’t make a right! Just because that’s the way Medicare works doesn’t mean it shouldn’t be changed! What a crazy system! I’m not an anti-Medicare guy. I’m just saying…
Thanks, Jim! More tomorrow on “As the Chemotherapy Drug World Turns.”
Until then, feel good and keep smiling! Pat