“This is the golden age of drug discovery,” said Dr. Daniel Skovronsky, chief scientific and medical officer of Eli Lilly and Company. The burden on patients who cannot afford life-changing new drugs weighs heavily on him and others who work for drug companies. Really?
According to the Times, “For many people using private insurance, innovative medicines are dangling just out of reach. Even when Medicare’s 2025 cap comes into play — or the $9,100 cap that already existed for those receiving insurance under the Affordable Care Act — many will still find drugs unaffordable. Research suggests that many patients abandon their prescriptions when faced with $2,000 in payments.”
Drug pricing is out of control. Researchers for Brigham and Women’s Hospital in Massachusetts found that the median price of a new drug was around $180,000 in 2021, up from $2,100 in 2008.
In 2020, Medicare data included more than 150 brand-name drugs with a cost of at least $70,000 a year to the program — about the average household income for a family. In 2013, adjusting prices for inflation, there were only 40 such drugs.
Out-of-pocket costs can run to thousands or tens of thousands of dollars. Often, even those who can afford commercial health coverage or get it through their employer may face insurers that refuse to pay. Other times, an insurer pays part of the cost, but high co-pays, deductibles, and cost-sharing put treatments out of reach for many.
Revlimid, which treats blood cancers, is three times as high as it was introduced in 2005. A study by GoodRx found that the average out-of-pocket costs for Medicare patients taking Revlimid was more than $17,000 in 2021.
A separate study of Medicare beneficiaries also found high levels of prescription abandonment — from 20 percent to 50 percent — among patients who did not qualify for subsidies and were given new drugs to treat cancer, hepatitis C, and immune system disorders.
Then there is the issue of formularies — the list of drugs an insurer will pay for. If a drug is not on a formulary, patients must pay the full price or substitute another drug, if one is available, which may not work nearly as well. Patients may also try to appeal the insurer’s decision or apply to a company’s patient assistance program.
Then there are stupid decisions based on greed. Vertex Pharmaceuticals is not making its drug, Trikafta, available in poorer countries, where thousands of diagnosed patients stand to benefit. The drug’s maker, Vertex Pharmaceuticals, a large biotech company based in Boston, is not making it available in India or virtually anywhere in the developing world. The company is not trying to sell or allow a local company to make it. Vertex is blocking potential generic competitors by seeking patents in numerous countries.
Trikafta, taken as three daily tablets, is the most powerful and widely used of Vertex’s four cystic fibrosis medications. With a list price of over $322,000 annually in the United States, it is expected to cost millions throughout a patient’s lifetime. An analysis led by researchers in Britain found that a year’s drug supply could be manufactured at an estimated cost of just $5,700.
Vertex has reported more than $15 billion in sales for Trikafta since it was first approved in 2019.
If you’re in the industry and you can read this article without feeling something inside, you’re as bad as Trump. Saying, “we feel for patients” means nothing unless you’re fighting for them.