American healthcare: no conscience, no empathy

KEY TAKEAWAY:  Vertex received approval for a new two-drug therapy called Orkambi, designed to treat 8,500 cystic fibrosis patients over the age of 12 who have the most common mutation for this disease. Vertex has priced this drug at $259,000 per patient annually and, not surprisingly, many are outraged. One patient said ““It’s egregious, this is more than five times the annual salary of the average American family. How can they in good conscience charge that much?

Vertex Pharmaceuticals Inc. paid its chief executive $28.1 million in total compensation in 2015.The smaller pay package for Jeffrey M. Leiden was mainly because last year’s total of $36.6 million — the highest for the head of a Massachusetts public company — included a one-time retention bonus valued at $14.9 million.  Does Mr Leiden have a conscience?

If you think that high drug prices are not a problem you’re living in Candyland.

Patients are getting hammered, not only by high drug prices, but by higher healthcare costs as well.  According to a survey from Health Insurance Barriers to Quality Cancer Care: The Real Life Experiences of Patients Undergoing Treatment health insurance premiums for cancer patients are increasing. Among cancer patients between 18 and 44 years old, 91% have seen premium hikes over the past year, with 45% of them reporting increases of over $100 a month.  At the same time, a majority of cancer patients (54%) say their medical insurance deductible has risen over the past 5 years. The average deductible increase is $898, with 18-44-year-olds seeing an increase of $1,549.

Claim denials are a common occurrence. 57% of patients faced denied claims, and 27% of those aged 18-44 had 5-6 rejected claims.

While there are new treatments becoming available for a variety of conditions, cancer patients have it really hard.  The survey says:

  • 86% of those surveyed want to have access to targeted therapies recently approved by the FDA called immunotherapies that free up the body’s immune system to recognize and destroy specific cancer cells.
  • 83% say “Not getting to take the drug your doctor prescribed can mean taking a less effective treatment or one with more side effects,” and 35% of those surveyed say, “Many cancer patients are required by their insurance plan to take a different drug than the one their oncologist thought was best.”
  • 77% believe that “step therapy” or “fail first” causes cancer patients to take potentially ineffective treatments instead of the therapy prescribed by the oncologist.
  • A majority of respondents, 52% say “prior authorization” is often reviewed by an insurance representative without medical training.
  • 70% of cancer patients surveyed say that when they began cancer treatments that they did not know which therapies were included in their health plan’s formulary.

STAT news recently reported that the National Cancer Institute advises physicians and patients to understand that cancer’s financial impact affects both family budgets and patients’ health. According to the institute, when a loved one develops cancer, the family’s risk of significant financial hardship becomes startlingly high:

  • Between 33 percent and 80 percent of cancer survivors exhaust their savings to finance medical expenses.

  • Up to 34 percent borrow money from friends or family to pay for care.
  • For those who fall into debt, the level of debt is substantial. In a study of colon cancer survivors in Washington state, the mean debt was $26,860.
  • Bankruptcy rates among cancer survivors are 260 percent higher than among similar households without cancer

American healthcare is in trouble.  While insurance and pharma CEO’s rake in tens of millions of dollars in salaries patients are dying because they can’t get the treatments they want and need. Pharma has been silent too long about this but yet they are willing to point fingers at others for the high cost of healthcare.  Is it any wonder that the public mistrusts the healthcare industry?