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Rx Assistance (Medicare) ♦ Manufacturer
AB 339, by Assembly member Richard Gordon (D-Los Altos), would prevent insurers from placing all of the prescription drugs to treat a certain condition in the highest-cost tier of a drug formulary. CA Health Line 2.19.2015
The healthcare payment world is justifiably upset over the escalating cost of treating those carrying the hepatitis C virus, which leads to 19,000 deaths a year from cirrhosis and liver cancer. A 12-week treatment with Sovaldi costs $84,000—approximately $1,000 a pill.
The pharmaceutical industry’s defense of the price tags placed on specialty drugs such as Sovaldi hasn’t changed in decades: Their price reflects the cost and risks of research and development. Gilead also points to Sovaldi’s comparative effectiveness. It has a 90%-plus cure rate with minimal side effects. Interferon, the prior treatment, is only half as effective, triggers flu-like symptoms with every shot and still costs up to $50,000 a year –4.7.2015 Sacramento Bee Modern Health Care
Sometimes our clients can give us insight that we might not see,
as we haven’t been there or gotten the T Shirt:
They had to do a study to figure this out????? DUH! It only takes about 5 minutes on the medicare.gov website to figure this out and you know they will do the same in their ACA plans if they can, and do. The major difference is of course, that you can get and are eligible for co-pay support offered by the drug companies if you have an ACA insurance plan. You are not eligible for co-pay support if you are on Medicare part D plan; this is a government rule, not the insurers. It is believed that more Medicare patients would take the biologic drugs if they allow copay support. Sure, you want to take a drug that can cause many other problems including cancer (by suppressing the immune system) just for FUN!!!!!! Jee, we are only trying to stop our joints from crumbling…..it ain’t the same as osteo-arthritis…My total costs for the year before any treatment or doctors visits, just premiums and copays for drugs will be about $8k. And that’s WAY over 9% of my income.
For example, there are NO Advantage Plans available in Santa Cruz that cover biologics, and most don’t cover Celebrex; they seem to only cover generics. I don’t know if Kaiser covers the biologics, but they don’t offer any plans in this county, just in the Bay Area. And of the Part D plans, the biologics are typically subject to a 33% copay, so your costs are about $4800 per year including the premiums and you are on catastrophic coverage by March.
I wish when they write about this problem they would stop focusing on HIV patients (I’ve seen other discussions like this about high cost drugs); there are WAY more people in the country with rheumatoid and psoriatic arthritis, fibromyalgia and the like that use the biologic drugs that cost, in my case $38k per year, and our problem is not something you develop from your lifestyle choices (children who get it from an HIV+ mother, of course, excepted, and the odd ones who had a bad batch of blood transfused, if they are still alive.) You won’t get any sympathy from many policymakers using HIV as the example.
But at least they are on to the insurers. What else did they expect!??
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