I want to keep this short and sweet. I ended yesterday’s article about the high cost of multiple myeloma chemotherapy drugs this way:
Like a good attorney, I can concede the defense’s point that high drug prices are needed to support past, current and future research–there is plenty of other evidence proving unfair pricing and inequities in the system. How are drug prices set? How high is too high? Why do patients pay more for oral chemotherapy meds than IV drugs? Tomorrow I will explore how our insurance system helps promote and support sky high drug prices.
Insurance companies and Medicare are complicit in rapidly rising, sky high chemotherapy drug pricing. Here’s why.
Have those of you with health insurance ever taken a close look at the bill? In most cases, there are several different prices. Let’s examine this simple example:
Six weeks following my last quarterly check-up with the oncologist, my bill arrived in the mail. The office visit cost over $438. But the “amount allowed by insurance” was only $158. Whether my deductible has been reached and my Cigna insurance is paying the bill, or if I am paying, the reduced cost remains in force. In this case, I paid the $158.
The same goes for my blood tests and MRI. Insurance mandated price reductions cut the actual cost more than 70%.
The fact that our bizarre health care system requires those of us with health insurance to pay less than someone with cash (Shouldn’t it be the other way around?), isn’t the point. The point/question is why don’t the insurance companies extend this principle to the cost of drugs?
Sure, they encourage the use of generic substitutes whenever possible. But when is the last time a chemotherapy drug was available as a generic? Certainly not for multiple myeloma patients. Heck, thalidomide has been around forever, yet Thalomid isn’t even available in generic form.
That’s OK. When the $7800 bill arrives for last month’s 14 Revlimid capsules, the actual cost will be less than half that—just like doctor’s visits or blood tests or x-rays or MRI’s—right?
Wrong! Full price. Again, the fact I oh-so-fortunately only have to pay a $30 co-pay isn’t the point, either. Why hasn’t Cigna insisted the cost of Revlimid be reduced?
Let’s look at this another way. I’m sure whoever sets the costs for a visit to see my myeloma specialist at Moffitt Cancer Center has taken the reduced billable amount, mandated by Cigna, into the overall pricing structure. In other words, one could argue—or possibly even justify—the really, really high cost of that doctor’s visit, knowing,in most cases, the actual amount paid will be far less than the amount billed.
But Celgene can’t make that argument with Revlimid, can they? What they demand is what they get—whether insurance pays or the patient pays cash.
There is no justification or excuse for charging Almost $8000 for 14 capsules. No justification.
Tomorrow’s story: Caught Between A Rock & A Hard Place: How Can I Be Critical Of The Company Which Is Literally Saving My Life?
I might even have trouble sleeping—“angsting” over my dilemma—if it wasn’t for my anti-neuropathy gabapentin capsules (less than $3 each, I might add) which knock me out like a light the minute my head hits the pillow.
Feel good and keep smiling! Pat