Why drug prices keep going up: Big Pharma, Copay Charities, Medicare, oh my!

[kickingandscreaming]

Another big rigged system that's costing us $$$$$$.  The real reason Big Pharma wants to help you pay for your prescription.

“Drug companies aren’t contributing hundreds of millions of dollars  [to copay charities] for altruistic reasons”

http://www.bloomberg.com/news/articles/2016-05-19/the-real-reason-big-pharma-wants-to-help-pay-for-your-prescription

[Simon Dog]

I worked on a political campaign with a pharma employee.

What amazed me is that he honestly believed that buying drugs from Canadian pharmacies was literally "theft", and that US patients had a moral obligation to pay the US prices and not purchase from the international market.

[Michael Murphy]

I firmly believe that patent protection should come with a profit limit built in if a pharma company exceeds the profit limit the patent protection should be lifted and made into a generic drug.  Plus excess profits should bring excess taxes.  Finally Medicare needs to be able to negotiate and set the price of drugs instead of paying full retail.  The cost drop for Medicare would fund dropping the donut hole.

[PrimeTimer]

This is a sore spot for me. Don't even get me started....when I see what the full price is of one of my own prescriptions I hit the roof. Without insurance there would be no way I could pay for it. Going without certain meds is rough, been there, done that, don't want to have to do it again. What really ticks me off is that there is no shortage of people who need meds. Quantity is certainly there.

[Charlie B53]

Corporate greed in the purest form.    One Pharma buying another to gain control of a drug, then artificially raise the price a tremendous amount to take advantage of insurances payments.

I don't remember the guys name, Congress had the CEO in for hearings on this issue.  The CEO literally laughed at them.   He knew there were no laws limiting his profiteering.


Pure greed.


Whatever happened to people being happy with a small %?

[Simon Dog]

I guess the moral of the story is buy stock in pharmaceuticals.

[cattlekid]

Want to hear something to make one's blood boil?

When I received my transplant in 2013, generic medications, including mycophenolate and tacrolimus, were $10 for 90 day fills through my employer insurance.  Even though I had Medicare, even when Medicare was primary after my 30 month coordination period was over, I still used my employer insurance to pay for my antirejection drugs because hello, $10? 

Then at the beginning of 2015, the cost shifting started.  Generic mycophenolate and tacro, while the cost to my employer was still the same, the drugs moved to the specialty tier.  This meant that not only did my costs go up to $100 per 30 day fill (yes, you read that right - from $10/90 to $100/30) I had to use Caremark mail order with all of their resulting issues.  I chose to start using Medicare as it saved me a little per month, but not a lot.

Fast forward to last month.  I am now off Medicare.  For 2016, the cost shifting is now in full blown insanity mode.  The drugs still don't cost my employer anything more, but I am now paying $300 per 30 day fill for each (yes, now we've gone from $10/90 to $300/30).  This is for the same GENERIC meds that I have been taking for the entire time.  I do have some stop-loss though as pharmacy counts towards my overall OOP maximum and I can shelter $2500/year in an FSA to at least take advantage of the tax break for some of it.

I met with my financial coordinator at my 3 year appointment and she gave me the copay cards.  I'm now moving to the brand-name Prograf and CellCept.  I understand the whole unholy alliance that birthed the copay card, but there is nothing else that I can see as an option for me at this time until my employer gets their collective heads out of their asses regarding putting generic meds in the specialty tier.  Because we self-insure and CVS Caremark is just the PBM, this could all be adjusted back to the way it used to be with a few keystrokes.   

[iolaire]

  Because we self-insure and CVS Caremark is just the PBM, this could all be adjusted back to the way it used to be with a few keystrokes.   

Can you talk to HR and see if they can get your generics reclassified during the next insurance year?  I think you could make a strong case for their own plan changes are driving you to the extremely high priced non generics and if they moved the generics into another category everyone will save a huge amount of money?

[cattlekid]

I can try but I don't think it will go anywhere.  I work for a Fortune 50 company that has decimated their HR department.  We no longer have an HR representative for our department, we now have to send an email to a generic mailbox and hope that we get some sort of reply.  I used to know someone who was in the area of plan design and communication, I'll have to see if she is still employed or has been shown the door like most of the department.

Can you talk to HR and see if they can get your generics reclassified during the next insurance year?  I think you could make a strong case for their own plan changes are driving you to the extremely high priced non generics and if they moved the generics into another category everyone will save a huge amount of money?

[iolaire]

I can try but I don't think it will go anywhere.  I work for a Fortune 50 company that has decimated their HR department.  We no longer have an HR representative for our department, we now have to send an email to a generic mailbox and hope that we get some sort of reply.  I used to know someone who was in the area of plan design and communication, I'll have to see if she is still employed or has been shown the door like most of the department.

Can you talk to HR and see if they can get your generics reclassified during the next insurance year?  I think you could make a strong case for their own plan changes are driving you to the extremely high priced non generics and if they moved the generics into another category everyone will save a huge amount of money?

Good luck, some how when I hear self insured I think smaller corporations, not the huge ones that probably don't' want to bother....  My employer is about 4,000 people now and I'm in HQ so I think I might be able to talk to someone, but I completely understand how a large multination would be a dead-end...

[Simon Dog]

I  worked for a company of 40,000 employees that self insured.  We were offered standard policies from several vendors that were indistinguishable from non-self insured policies from the same vendors.  The difference is my employer was billed the sum total of all employee claims plus an administrative fee.

[cattlekid]

Our company has an entire department that designs our plan and benefits. BCBS is only paid for administering the plan.  Up until about five years ago, our medical and pharmacy plans were very generous (dental was always a nightmare).  Now, it's death by a thousand cuts as each year they pick and pick and pick at the plan.  If you are relatively healthy, it doesn't really change from year to year but they seem to really like putting the screws to the rest of us.  I think they really want those who cost a lot to just go away quietly.....

I  worked for a company of 40,000 employees that self insured.  We were offered standard policies from several vendors that were indistinguishable from non-self insured policies from the same vendors.  The difference is my employer was billed the sum total of all employee claims plus an administrative fee.

[Simon Dog]

Obamacare was designed to expand health insurance access to those who previously could not afford it.

You cannot give to person "A" without taking from person "B".   The often ignored aspect of Obamacare is that there are both winners and losers with the new changes.   We are seeing it not only in higher deductibles/copays, but also in increasingly common limits on what docs/hospitals are covered by many plans.

[kickingandscreaming]

If you're concerned about access to generic drugs, you should care what happens to Obama's "Trade" Agreement, the TPP (Trans-Pacific Partnership).  If ever there were a "deal" on the horizon that sells us people down the river, it is this one.  It is coming up for a vote in congress any day now and if you don't like it you should raise your voice.

The Trans-Pacific Partnership would provide large pharmaceutical firms new rights and powers to increase medicine prices and limit consumers' access to cheaper generic drugs. This would include extensions of monopoly drug patents that would allow drug companies to raise prices for more medicines and even allow monopoly rights over surgical procedures. For people in developing countries involved in the TPP, these rules could be deadly – denying consumers access to HIV/AIDS, tuberculosis and cancer drugs.

The TPP would also establish new rules that could undermine government efforts to contain rising medicine prices in developed countries like the United States. An analysis of the final TPP text shows taxpayer-funded public health programs would be exposed to pharmaceutical company attacks and constrain future policy reforms to reduce prescription drug costs for Americans. The text explicitly binds Medicare to TPP rules that would limit proposed policy changes to tamp down healthcare costs for seniors.

http://www.citizen.org/tpp-public-health

Proposed intellectual property rules in the TPP would limit competition from generic drug manufacturers that reduce drug prices and improve access to treatment, and would accelerate already soaring medicine and vaccine prices.

http://www.msf.ca/en/trans-pacific-partnership  (doctors without frontiers)

[cassandra]

Same on this site of the water

Please sign

occupylondon.org.uk › TTIP

https://secure.38degrees.org.uk/pages/ttip_home

http://www.globaljustice.org.uk/campaigns/trade

[Whamo]

I'm on a Hep C drug, zepatier, approved in January, and I was taking it in July.  It's $500 a pill, you take it daily, for 12 months.  I'm on week 5.  So far, so good, and while I'm happy my insurance covers most of it (I pay $40 three times for co-pay), it disturbs me that the
pharma companies rip us off so much.

[Simon Dog]

The literature suggests that in-center hemo patient has about a 1/300 chance of contracting Hep-C.   Fresenius now has a policy of paying for one of the new Hep-C drug regimens for in-center acquired Hep-C.

[iolaire]

The literature suggests that in-center hemo patient has about a 1/300 chance of contracting Hep-C.   Fresenius now has a policy of paying for one of the new Hep-C drug regimens for in-center acquired Hep-C.

How does that infection start?  Is it contamination of the blood?  Or something you touch/breath?  Those odds don't seem so good..

[Simon Dog]

How does that infection start?  Is it contamination of the blood?  Or something you touch/breath?  Those odds don't seem so good..

I think the Hep-C virus has to get into your blood.  I don''t think it's airborne or from touch.  It's transmitted in manners similar to HIV, but you have a greater chance of Hep C infection than HIV from an incident such as a needle stick.