Drug Costs... Why?

[imoldernu]

I have just spent three hours trying to understand the What? and Why? of drug costs, starting with a personal situation.

A year ago, I, along with 2.6 million other Americans, have been diagnosed with Atrial Fibrillation (AFIB). The most commonly prescribed drug to lower risk of heart attack, or stroke, is Xarelto. Until today, the cost of thirty 20mg pills has been $36.00 with my Medicare D Supplement plan. Without the plan, the cost full U.S. retail price would have been $102.

Today, when renewing my 30 day supply, the Plan D price is $115, and the full retail price is $420...

Simplifying... my cost for a year now $1398.00 up from $432.00
w/o a drug plan, Full price 1 year $5100.00
.
This change for me occurred between August 15 and July15, this year.
........................................................................................

Because my risk factor is low on the CHAD2 Score, I'll go back to .81mg aspirin, or no drugs at all. (risk factor goes from 11% to 7% w/Xarelto).

I'm not concerned but I wonder how many of the other nearly 3 million AFIB patients will die because they can't afford the expense. The drug companies usually offer lower costs for those who can't afford the drug, but when going to the sites to check, find that the "affordability factors" don't qualify for that lower price.

It's easy to pass this off as "They do, because they can" but consider that this is just one drug, out of thousands of patent drugs which have protection against competition, but no limitations on price. Egregious because Pharmaceuticals often spend more money protecting their patents than they do in developing the new drug.

Wikipedia has what I consider to be a particularly good and well researched article about the subject here:
https://en.wikipedia.org/wiki/Generic_drug

it's about generics, but explains patent drugs in detail.

 

[razztazz]

I have just spent three hours trying to understand the What? and Why? of drug costs.......

Because they can

 

[aja8888]

Because they can

Yeah, DW's Forteo for here osteoporosis is just under $4000.00 per month. Part D gets it down to around $900 and $50 for the 30 needles. How nice.

She's going to see her bone doctor this week and if there is no significant improvement after 6 months of daily injections, we are going to explore another course of action which could include doing nothing.

 

[Mo Money]

Funny, what a coincidence that you made your post: I manage my parents' finances, and I was just checking my dad's medical bills for scripts. His Xarelto script just went up to $503 for a 30-day supply. Good God...

 

[GrayHare]

Because they can

Exactly. Similar has happened with collge costs during the last 3 ot 4 decades. The more loans that became available to students, the higher the tuition. Thus the futility of providing insurance for something that everyone (or lots of people) want or need.

 

[Crewer]

I was just about to type "because they can" ...

 

[H2ODude]

Find it interesting that you've applied a pretty reasonable cost benefit decision to this. Not a drug analysis statistician but frankly the ability to slice and dice one's apparent risk to 7 vs 11% seems questionable. As in likely not all that precisely knowable. If it were me I wouldn't spend a whole lot to secure that level of risk reduction. Good luck IOU, enjoy your posts.

I guess to answer your actual question, Mr. Skrili didn't get turned loose to do this did he? Capitalism is great but he is a rather odious example of it run rampant.

 

[Amethyst]

aja8888, I'm interested in Forteo because - unlike Boniva and other popular drugs - it is supposed to help the bone-building process, rather than inhibiting bone breakdown (which is why women get bone necrosis, since your bone cells are supposed to break down after a while, not hang around forever).

So if your DW does have success, and I very much hope she does, I hope you will return to this thread and let us know.

Thanks,

Amethyst

Yeah, DW's Forteo for here osteoporosis is just under $4000.00 per month. Part D gets it down to around $900 and $50 for the 30 needles. How nice.

She's going to see her bone doctor this week and if there is no significant improvement after 6 months of daily injections, we are going to explore another course of action which could include doing nothing.

 

[Tadpole]

This is the increase on one of my husband's drugs (3 mo. supply):
2009 $779.00
2013 $1226.75
2017 $1840.03
Before anyone insists that the research must be paid for, this is NOT an American company but it did enjoy patent protection. The cost in the home country is less as is the cost in Canada, UK, Mexico, etc. Generics are available in other countries also. Permission to sell a generic in the US was recently granted to the company that makes the brand drug. That is hardly competition. The generic price is, thankfully, a lot lower but not cheap.

 

[aja8888]

aja8888, I'm interested in Forteo because - unlike Boniva and other popular drugs - it is supposed to help the bone-building process, rather than inhibiting bone breakdown (which is why women get bone necrosis, since your bone cells are supposed to break down after a while, not hang around forever).

So if your DW does have success, and I very much hope she does, I hope you will return to this thread and let us know.

Thanks,

Amethyst

Amethyst, she sees her Doc later this week and I will update here on what the progress has been.

She was diagnosed with "severe" osteoporosis in January or February (can't remember for sure) after several spinal compression fractures and subsequent surgery to glue them back together.

In order to be prescribed Forteo, I understand the patient must have already experienced fractures. At least that is what I remember.

aja8888

 

[imoldernu]

Re: Forteo... Prolia is different, but does treat osteoporosis. DW took it for a few years, after a fall and a break, and on Dr. recommendation. W/Medicare D, about $2000./yr (2 injections). $2600 full price.
Whether because of the Prolia or just luck, no further breaks, and current Dr. has taken her off the medicine. Have had some 'falls", but no breaks and scan shows better results.

 

[ShokWaveRider]

[-]You[/-] They have to pay for all that CONTANT TV Advertising somehow.... Most other countries do not allow drug advertising and thus their drug prices are lot more reasonable.

 

[razztazz]

Exactly. Similar has happened with collge costs during the last 3 ot 4 decades. The more loans that became available to students, the higher the tuition. Thus the futility of providing insurance for something that everyone (or lots of people) [-]want or [/-]need.

Yes. They should die so the books balance.

When I said "because they can" that has nought to do with insurance.

So we have insurance so people can afford what they need? The reason for the price (not to be conflated with cost) does not need to go up. Nobody is holding them down and committing unnatural acts on them with a crowbar to raise prices. They do not have to increase anything because of insurance.

 

[H2ODude]

IIRC New Zealand is only other country that allows advertising of prescription drugs. Always meant to ask the doc if people asking "is ______ right for me" drove him nuts.

Do watch the national news at night; when the baby boomers die off there will be nothing to support national network news since it seems only drugs are advertised on these time slots.

 

[Amethyst]

I'm so glad it works for her. Prolia is an osteoclast inhibitor - keeps the old bone from breaking down.

Re: Forteo... Prolia is different, but does treat osteoporosis. DW took it for a few years, after a fall and a break, and on Dr. recommendation. W/Medicare D, about $2000./yr (2 injections). $2600 full price.
Whether because of the Prolia or just luck, no further breaks, and current Dr. has taken her off the medicine. Have had some 'falls", but no breaks and scan shows better results.

 

[GrayHare]

When I said "because they can" that has nought to do with insurance.

Why not? Generally prices go up when there is more money available.

 

[razztazz]

Why not? Generally prices go up when there is more money available.

Non sequitur.

 

[Souschef]

Wait until you hit the "doughnut hole". We will have to pay $4500 OOP before the catastrophic coverage cuts in.

 

[aja8888]

Wait until you hit the "doughnut hole". We will have to pay $4500 OOP before the catastrophic coverage cuts in.

Yep, we are there now! Isn't getting old fun!

 

[tuckeverlasting]

I get Xarelto 20 mg from a Canadian pharmacy for under $1,000 a year. I did not buy a Medicare Part D prescription plan but do well enough getting most of my meds from Costco. It is worth something just to avoid the hassle of dealing with a parasitic middleman like a pharmacy benefit manager.

Also, warfarin is a low-cost alternative to Xarelto. I was unable to make it work due to my personal dietary requirements.

 

[LOL!]

Is it possible that there is just less demand (less prescriptions) for Xarelto now because it doesn't seem to be too effective and physicians have stopped prescribing it? With less pills sold, I would guess that the manufacturing and marketing costs per pill sold have gone up.

I would ask my physician about using another medication.

 

[pgiyer]

Part of the problems appears to be a selective application of capitalism. Let the markets dictate the price, but we will not allow you to import from other countries freely (as would be the case for most other goods). Any number of reasons are thrown up in support....fake drugs, poor quality. People in Canada and Europe must be dying in droves due to fake drugs.

 

[RonBoyd]

I don't know how much this will add to the conversation but I have had A Fib for over ten years -- when it was discovered, I, apparently, had it for "quite some time."

I am one of the lucky few who are asymptomatic -- I have no indication that something is wrong. I use Coumadin/Warfarin to regulate my blood clotting factor. And, FWIW, I don't have any dietary restrictions other than not to change my eating habits without changing the dosage. (in other words, the dosage is determined by ones current diet and is infinitely adjustable.) My INR is checked every two months and has never varied from 2.0/2.1 in over six years with the same dosage.


Anyway, what I started this post to say was that my Coumadin/Warfarin cost is $10 to $15 for a ninety day supply (Walmart) with Medicare Advantage. I could get it at no cost by using the mail-order process recommended by the Insurance Carrier.


Furthermore, I am only guessing but I suspect that monitoring Coumadin/Warfarin is much more accurate than for Aspirin (quality control being the biggest factor). The risk of Stroke seems too great to take a chance on that theory.

 

[meierlde]

Is it possible that there is just less demand (less prescriptions) for Xarelto now because it doesn't seem to be too effective and physicians have stopped prescribing it? With less pills sold, I would guess that the manufacturing and marketing costs per pill sold have gone up.

I would ask my physician about using another medication.

To boot the ads from Lawyers about adverse reactions to Xarelto and suing the manufacturer. (lawsuits do cost money for the defendant)

 

[Scuba]

Yes, I believe that the US is somewhat unique in the litigation possibilities. This drives up healthcare costs relative to other countries that don't allow such lawsuits or dramatically limit potential awards.