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Tags: pharmaceuticals | ACA | hepatitis | statins

The Way to Fair-Price Healthcare

Kevin R. Campbell, M.D. By Tuesday, 22 September 2015 04:31 PM EDT Current | Bio | Archive

Recently, two significant pharmaceutical breakthroughs have resulted in renewed debate about the costs of drug therapy. In the last year, a new drug class has been introduced by two different manufacturers: a treatment for Hepatitis C, a once-incurable chronic liver disease. These new drugs are effective for nearly 90 percent of patients who are treated with a full course of therapy.

While the new drug class appears to be safe and highly effective, the cost of a curative course of therapy is nearly $80,000. As you might imagine, there are already barriers to access for many patients — including those treated in the Veterans’ Affairs (VA) system, as well as those on government-based insurance programs such as Medicaid.

In the last several months, another remarkable, potentially “game changing” class of drugs has been approved and released to the market. These drugs, made by Regeneron and Sanofi, are intended for patients who do not achieve adequate cholesterol reduction with standard statin therapy.

According to some analyses, when used in the appropriate patient population, these drugs could prevent of thousands of cardiovascular-related deaths.

Yet just like the new Hepatitis C drugs, the price tag for new cholesterol therapy is exorbitant — nearly $15,000 annually. Worse yet the Hepatitis C course of therapy is just 12 weeks; the cholesterol drug, the therapy will most likely be lifelong.

This month a study examining the cost-effectiveness of these new cholesterol drugs concluded that they are far over-priced nearly threefold for the benefit that they produce. Researchers concluded that the drugs should actually cost between $3,000 and $4,000 annually, rather than the current $15,000 price tag.

The purpose of the Affordable Care Act (ACA) — as touted by its authors and other political supporters — was to make healthcare accessible and affordable for all Americans. Certainly, that is a noble goal that we should continue to strive to achieve.

However, the legislation has failed to meet its mark. While addressing physician reimbursement and clinical behaviors (and limiting choice and physician autonomy), the ACA has done nothing to regulate the high price of drugs.

Big Pharma is still allowed to charge whatever the market will bear without regulation. While it is clear that pharmaceutical products must reclaim their research and development costs — and make a profit — the pricing scales for many drugs are simply designed to exploit the system and maximize corporate profits.

In addition, many of the most expensive drugs in the U.S. are sold overseas and in Canada at a fraction of the cost. This seems to me to be clear evidence of the pharmaceutical industry taking full advantage of the inherent wealth in the U.S. today.

Would it not follow that if we placed limits on the prices of new drugs and paid “fair and equitable” charges, that healthcare costs would significantly decline?

Politicians have sought to attack the problem from a few different angles, but have failed to address other significant sources of excessive healthcare spending. While reimbursement for physicians and physician groups are set clearly in the crosshairs of the ACA, it appears industry and litigators are not even on the radar.

There is hope, however. Legislation is being introduced that will allow Americans to purchase drugs from Canada. In addition, pharmaceutical companies would be required to disclose what they charge for the same drugs in other countries.

This is a step in the right direction. But we still must continue to innovate and provide new therapies for all Americans — and do it in a way that is cost-effective.

The latest studies make it clear that many drugs are overpriced. We must find a way to negotiate a fair, reasonable price that promotes and rewards innovation without limiting access to the most effective therapies for those who need it.

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Recently, two significant pharmaceutical breakthroughs have resulted in renewed debate about the costs of drug therapy.
pharmaceuticals, ACA, hepatitis, statins
Tuesday, 22 September 2015 04:31 PM
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