Announcement

Collapse
No announcement yet.

$26,662.08

Collapse
This topic is closed.
X
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • $26,662.08

    Today I had the dubious pleasure of holding in my hand a bottle of medication that cost more than my car.

    I was floating today in a store near my house that I work at very infrequently, when the regular pharmacist needs a day off. They don't do that much volume, but some of the meds they do dispense are crazy expensive.

    Case in point. This one patient with hepatitis C. The doctor prescribed Viekira and ribavirin. Prior authorization's been taken care of, so I bill the insurance. It goes through for a wonder, I check that we've been paid more than it cost us (sometimes we aren't; we always have to check) and we did in fact turn a nice profit for a change.

    Then I see the label, and discover that this poor guy has a copay of $1692.25.



    So we make some phone calls. Seems that his plan has a 5% coinsurance for prescriptions. So when you have a drug that retails for $33,845 for a 28 day supply, then yeah, he's going to be out of pocket for five percent of that.

    (Not that they actually paid us the full retail less the copay; we got maybe 28 grand, including the copay, with the rest presumably going into the pockets of the PBM. Did I ever mention that I hate PBMs? Our profit is in any case less than the copay, so it's not like we can waive it even if we were allowed to, which we ain't.)

    No way he can afford that, so I start looking for discounts. Turns out there's a manufacturer's coupon you can download that knocks the copay down to $5.00. Sounds great; I do so, but it says it needs to be activated by the patient. He's not here, but we are, so we call them. The agent says that even though it says it needs to be activated, it doesn't really, so we should just go ahead and process it. Claim rejects: patient is on Medicare part D, which we hadn't known, and there's a law barring patients on any government insurance (Medicare, Medicaid, Tricare, etc.) from using these coupons.

    So the boss asks them if there's anything else he can do to help this patient out. Agent directs him to a charity (Hep C Foundation or something like) which pre-approves him for a grant of $15,000 a year to help with the copays on this and the ribavirin, which is another $110/month, but it's predicated on his having low income, so we need to find out how much this guy makes in a year.

    So we then call the patient, for the first time in this chain of events. He's understandably shocked by the copay, and wants to know why it's so much?

    Boss tells him it's the drug manufacturer who sets the prices, not us. Then he comes out with a statement that I never would have thought of in a million years, but makes perfect sense in retrospect:

    "This medication cures Hepatitis C. You take it for three months, and you're done. It's not something you take forever. This means that sooner or later, once everyone with Hep C is done taking it, the market for this drug is gonna die, and they won't be able to sell it anymore, so they're trying to take as much profit as they can now."

    I also thought that even if it does cost a hundred grand for a course of therapy, it's still cheaper than a liver transplant.

    (The one I was holding in my hand was a different, and even more expensive, Hep C drug for a different patient. That one's called Harvoni, and my wholesale cost for 28 tablets is $30,240.00, or nearly eleven hundred bucks a tablet. I wonder how that compares to the price of gold, or cocaine.)

  • #2
    I can't ultimately disagree with the company's logic because I'm sure developing a safe cure for Hep C is an overwhelmingly expensive process and this is the only way they're going to recoup money.

    But OW.

    Comment


    • #3
      And here I thought my roommate's medication cost a lot!

      While I can't disagree with the idea behind the medication, the price is just --- wow. Paying a one-time cost of $1,600 for a cure versus having to live with the disease for the rest of your life isn't a hard decision. Expensive, yes, but if I had it I'd pay that co-pay so fast....
      Eh, one day I'll have something useful here. Until then, have a cookie or two.

      Comment


      • #4
        actually, it may or may not be possible to completely eradicate hep C- I can't remember off the top of my head if Hep C is a human-only disease. if it isn't, then it is impossible to wipe out entirely.


        I agree that that is ouch for the drug price. I also admit that if it was necessary, I'd probably find a way to pay it.

        though Android Kaeli, it's not $1,600 for a cure. that's a 28-day supply, the course of treatment is 3 months, so it's actually more likely the poor guy needs to pay for 90 days, which means he'll need to shell out something like $5,000 to cure his Hep C. Still better than a liver transplant, but damn expensive. ( I say it would cost about $5,000 because if it's available for a max of 28 days at a time, he'll need 3, plus a smaller one for the last 6 days.)

        Comment


        • #5
          Developing new antibiotics is an even worse deal for the drug companies.

          If an antibiotic is used correctly, it's used sparingly (to provide minimum opportunity for the bacterium to evolve to defend against it), and only when that particular antibiotic is the best one for the job.

          Contrast that with a pill for ... oh, blood pressure management, or diabetes management, or any of the other pills which treat something a lot of people have and which they take once a day for the rest of their lives. Yeah, drug company can make a nice profit off that.

          It's a pity that new antibiotics are the only way we're going to defeat multiply resistant bacterial diseases.
          Seshat's self-help guide:
          1. Would you rather be right, or get the result you want?
          2. If you're consistently getting results you don't want, change what you do.
          3. Deal with the situation you have now, however it occurred.
          4. Accept the consequences of your decisions.

          "All I want is a pretty girl, a decent meal, and the right to shoot lightning at fools." - Anders, Dragon Age.

          Comment


          • #6
            I owed over $2000 for my first month of Valcyte after my kidney transplant. (Helps prevent CMV infection from acting up during the initial immune suppression.) i needed the Valcyte for a year since I had trouble before. After that then I owed about $325 a month for it because I went through the donut hole. I am also on Medicare Part D and can't use the coupons. Luckily my dad gave me the money.

            It's frustrating but CMV almost killed me years ago and I lost that kidney. At least so far I'm ok with this one. I can understand why this guy might be willing to pay the huge copay to avoid a liver transplant.

            Comment


            • #7
              I work in a hospital pharmacy. Some of the things we make are crazy. I have made IV bags that cost 128,000. It is crazy some of the costs out there.

              Comment


              • #8
                I've held bottles of 20 tablets or less that are worth $5,000 or $8,000, wholesale....

                It's unfortunate, but, economies of scale apply to RXs as much as washing machines or cars, you have that one-of-a-kind pill? It costs one-of-a-kind prices to buy
                - They say nothing good happens at 2AM, they're right, I happen at 2AM.

                Comment

                Working...
                X