Drug Prices - Unbelievable!

[mbroberg]

I work 2 days per week at a Catholic Charity. One of the things I do is approve or deny requests for financial help with prescription medications. I got a call today from a caseworker requesting a specific medication for a patient of hers that is currently at high risk of having a stroke. The patient had no insurance and was too young for Medicare. I contacted their pharmacy (a large, reputable pharmacy that loves to publicize their commitment and contributions to the cities in which they are located ) and asked what the cost of the medication would be? $1,930.00! Sorry, we cannot afford that. So they "made some adjustments", applied some coupons, "found" some rebates and we ended up paying $136.00. No, wait a minute . They know we are a charity, they know that we run on donations only, they know that our clientele is at the bottom of the economic scale, so how can they justify their original price when they could have led with the $136.00. I didn't think to ask at the time, I was just glad that we would be able to get the person their medication. Are their any Pharmacists out there who could explain how such a price difference can exist?

 

[bsshog40]

Yea, it is rediculous! Now you see why insurance is soo high. They charge the insurance company the first price but basically can drop down to the actual price if have to.

 

[Mr Vic]

Curious if that's a 30 day supply or 1 dose? Either way it's criminal!!

 

[magpens]

"They" are "legally" "killing people" !!!

It's happening here, too !! . Not only in pharmaceuticals .

 

[mbroberg]

Curious if that's a 30 day supply or 1 dose? Either way it's criminal!!

I really don't know. That is not something we need to be concerned about.

 

[monophoto]

There is a related phenomenon associated with non-drug medical costs.

When a doctor or hospital issues the bill, the first number stated is the 'list price' for the service. When the invoice is submitted to insurance, the first thing that happens is that the list price is challenged. Most insurance provider propose a 'covered amount', and in most cases, the the service provider simply says 'OK'; from that point on, that initial list price is no longer relevant, and the discounted price becomes the number that is up for consideration. Sometimes this is called the 'provider's concession', but to me it looks like that initial cost was arbitrarily inflated., but it is not at all clear what purpose that served.

Several years ago, I was diagnosed with a condition that required a series of treatments. Later, I compiled the bills to determine the total cost of that experience. I was amazed to see that the total 'list price' was SIX times the 'covered amount' that eventually was covered by Medicare and my supplemental insurance plan.

This kinda reminds me of the days when the process for buying a car was for the buyer to haggle with the salesman over the prices, after which the salesman went to the sales manager for approval of the deal only to learn that the dealer needed just a little bit more. In other words, its a game, with the rules stacked against the consumer.

 

[budnder]

A fair price would be really hard to figure out without knowing all the R&D costs and expected market size. I too often experience the "one price if you have insurance", "another price if you are paying out of pocket". I assume the "actual price" to be somewhere in the middle with the "insured" financing the discount for the uninsured.

 

[larryc]

Without getting political, I have heard the term "Transparency" lately. Sounds like a good idea to me.

 

[Willee]

A fair price would be really hard to figure out without knowing all the R&D costs and expected market size. I too often experience the "one price if you have insurance", "another price if you are paying out of pocket". I assume the "actual price" to be somewhere in the middle with the "insured" financing the discount for the uninsured.

A fair price would be the same price they charge in other countrys for the same drug.
My last pharm bill was over $300 ... I haggled it down to less than $100.
Folks ... always show them the Good RX price!

 

[MRDucks2]

I actually filled new prescription at a new pharmacy for my wife today. Not the big numbers being discussed but the principle applies. It was submitted from the hospital. Went to pick it up and the price was $16.89. I asked if they had my insurance on file or needed it. They no, that was cash price. Withy insurance card a 5 minutes they called me back up. My price was $1.69. This was the "adjusted" price as I have not yet met any deductible and am paying 100% out of pocket. 10% of the cash price.

 

[renichols]

The cost is not surprising to me. One that I take every 8 weeks is about 6K. I don't remember the price of the 21 that I take daily. Thank god for the VA

 

[magpens]

Thank god for the VA

But the VA is getting ripped off, and that is very irksome !

 

[EBorraga]

After my transplant, i didnt work. I had 1 pill that was $100.00 a pil. Had to take daily for 3 months. I abiut killed over. Told them no way i could pay it. A few calls from transplant center and they gave me a 3 month supply.

 

[budnder]

Last year I received a notice that I was requested for federal court jury duty for a given week. I didn't end up being called, but in prep for that I looked at the cases for the previous month, as I had no idea what my regions federal court did/heard/tried. I was surprised to see it was patient vs drug company, time and time again. The cost of all those legal fees and settlements is a component of the cost of the drug, and I've read where in Canada, for example, you have less consumer protection and recourse and that translates into cheaper drug prices. Some might like that trade off and others might not.

Here's some interesting reading on the subject:

Why Drugs Are Cheaper In Canada Than In The US - Drugsdb.com

There are a number of reasons why many of the same brand name prescription drugs sold in Canada are often significantly less expensive than those found in the United States.

www.drugsdb.com

 

[Woodchipper]

Tried Obamacare for this person?
Wife had a teacher who applied for it since her husband didn't have insurance. Yearly deduction was $10,000!

 

[frank123]

It doesn't make any difference whether it's a pen or a drug, prices are always whatever the market will bear.

You want to sell your product, you adjust your price to what the buyer is willing to pay.

 

[mbroberg]

It doesn't make any difference whether it's a pen or a drug, prices are always whatever the market will bear.

You want to sell your product, you adjust your price to what the buyer is willing to pay.

I respectfully disagree. People's lives do not depend on a pen. People are dependant on medications and are forced (not willing) to pay whatever the manufacturer's demand. The insurance companies and the drug companies work together while the consumers pay these exorbitant prices either through premiums, co-pays, co-insurance, deductibles, or taxes for government supplementation.

 

[dogcatcher]

The drug companies owe it their stockholders to maximize profits. They are not a charity, that is life, profits before being MR "good" guy. If there is no profit, the research will slow. Right now a lot of these companies are gambling a lot of money on cures and relief for a lot of diseases, the big cure in todays news is Coronavirus. What happens if you cut off that ugly head called profit motive? It may take years to develop a drug, th new patents expire, they have to make the money or close the doors.

 

[mbroberg]

The drug companies owe it their stockholders to maximize profits. They are not a charity, that is life, profits before being MR "good" guy. If there is no profit, the research will slow. Right now a lot of these companies are gambling a lot of money on cures and relief for a lot of diseases, the big cure in todays news is Coronavirus. What happens if you cut off that ugly head called profit motive? It may take years to develop a drug, th new patents expire, they have to make the money or close the doors.

That is the argument of the pharmaceutical companies. However......

Here's why many prescription drugs in the US cost so much—and it's not innovation or improvement

In 2014, the price of one kind of insulin increased by nearly 50 percent, even though it had already been on the market for more than a decade. A new study published in the journal Health Affairs finds that some drugs cost more because manufacturers are upping the prices of drugs that are...

www.cnbc.com

Why Prescription Drug Prices in the US Are So High

Americans spend more on prescription drugs than anyone else in the world. It’s true that they take a lot of pills. But what really sets the US apart from most other countries is high prices. In August, Congress passed a law aimed at cutting drug costs for elderly and disabled patients who rely...

www.bloomberg.com

Why the US has higher drug prices than other countries

The Trump administration’s proposal to lower drug prices focuses on discounts. A health policy scholar argues that the US could learn from Europe’s system of measuring drug value and effectiveness.

theconversation.com

 

[Tripletmom]

I have been waiting to respond because I struggle with both sides of this issue and it is a delicate subject. It is also very personal to me. I work in healthcare and I am fortunate to have a self funded high deductible insurance plan. Once I hit that deductible every year my meds are covered. I take chemo that is being charged at $700 a PILL. I take 21 pills every 28 days. It is keeping me alive and I thank the researchers and drug companies that are developing these new breakthrough treatments. My insurance company pays the drug company on the backs of all of the employees premiums who work with me. Do I think that a prescription should cost $14,000 a month- absolutely not. Most people don't pay that - like Mike said- they have rebate cards, co-pay assistance, charity care etc.. I don't know the answer. All I know is the drug companies make billions of dollars in profit and I am 4 years out from a stage 4 cancer diagnosis....
Also- Mike - thank you for advocating for the folks who need help- from a fellow Buckeye- O-H

 

[dogcatcher]

We pay more because Americans are willing to pay more to get the drugs that are prescribed. Again that goes back to the maximizing profits.

 

[budnder]

Well, at the end of the day, lets be thankful first and foremost that a life saving drug exists, regardless of the price. Secondly, worry about optimizing the system that creates it to be more efficient.

 

[Woodchipper]

Pharmaceutical companies make billions? Net income or gross profit? How much time and $$$ is spent to research a drug to determine the effectiveness and its application? What is the cost to save a life?
BTW, the actual manufactured cost of a car versus the dealer cost versus the MSRP will really rock you. Same with markup for furniture and jewelry.

 

[Tripletmom]

Pfizer made 11.1 billion in net profits in 2018.

 

[budnder]

Pfizer made 11.1 billion in net profits in 2018.

You probably have some Pfizer in the mutual funds in your 401K....

 

[Woodchipper]

Pfizer made 11.1 billion in net profits in 2018.

What did that figure per share? How much profit did Walmart make for 2019 and what does that figure out per share? BTW, don't shop at Walmart.

 

[Tripletmom]

Pfizer investors 2018
Hope this link works. Somebody that has more smarts than me might be able to figure out how much a shareholder made....unless the question was rhetorical - in that case then disregard this whole post.

 

[dogcatcher]

There are 5.53 billion outstanding shares pf Pfizer. The profit is less than $2 per share.

 

[FGarbrecht]

My father spent his career as a chemist at Eli Lilly, and he was very proud of the fact that Lilly was, as he put it, an 'ethical' drug manufacturer. In the years prior to his retirement he became increasingly disenchanted with the changing culture at the company as it transitioned from 'ethical' company culture (orphan drug programs, fair pricing even accounting for the huge costs of R&D, balanced priorities to shareholders AND employees AND patients) to a greed driven company like every other pharma in the world now with predatory pricing, and outrageously compensated upper management whose only priority seems to be shareholder return. He encouraged me to join the clinical trials division when I finished my medical training, but the writing was on the wall even back in the 80s, and I chose a different path. I have watched my patients and their families struggle with affording drugs and health care services for decades, and the fact that this country does not prioritize provision of health care as a basic human right makes me sick. Hopefully that changes soon, but I am not optimistic that I'll see that in my lifetime.

 

[wolftat]

The price of Coke is ridiculous around here too.

 

[bmachin]

Since everyone seems to know how much too much is, maybe someone can come up with what the right price is.

Bill

 

[Woodchipper]

Hmmm. I will probably open a rather large container of annelids here. I'm one of the Baby Boomers born after WWII. When we were growing up, we were told- Go to school, study hard, get a good job with good pay and benefits. The government didn't even figure into one's life. You had your own responsibilities for your life and living! Now it's whine, cry, moan and groan and Mommy will give you anything you want.
JMHO and observations for about 73 years.

 

[budnder]

One way of understanding pricing is to look at a company's profit margin (how much they make compared to what they bring in). Pfizers gross profit margin in 2019 was 31%. To roughly equate... your pen making profit margin would be 33% if your all in costs were $7 per pen and you charged $10 for them. Not trying to imply good or bad, just adding a data point to consider.

And just to bring this back to Coke... Remember the old story about how McDonalds would loose money on their french fries (negative profit margin - under price), to entice folks to buy a Coke (which is where they made all their money - overpriced, very high profit margin). Don't know if that was actually true, but I imagine the same is true for a drug company, where they will loose money (under price) on some drugs/drug lines and that is made up for by over pricing on other drugs/drug lines.

What I find odd about the drug industry is the practice of charging highly varying amounts to different customers, which I suspect is the same over/under concept at play... they loose money on some types of customers, and they have to make that up on other types of customers.

 

[FGarbrecht]

Hmmm. I will probably open a rather large container of annelids here. I'm one of the Baby Boomers born after WWII. When we were growing up, we were told- Go to school, study hard, get a good job with good pay and benefits. The government didn't even figure into one's life. You had your own responsibilities for your life and living! Now it's whine, cry, moan and groan and Mommy will give you anything you want.
JMHO and observations for about 73 years.

It really blows my mind that you would make this argument in response to a post about the fact that many people in the richest country in the world cannot afford the cost of prescription medicine and run the risk of bankruptcy from catastrophic health care costs. I'm a boomer too, but let me go out on a limb here and point out that you, as a 73 year old are almost certainly receiving government assistance in the form of the most popular social welfare program of all time (Medicare). I would respectfully suggest you try to grow some empathy; not everyone was born privileged, not everyone was born with the advantages that you and I were born with. Pulling yourself up by your bootstraps is incredibly difficult without those advantages to begin with, and many people fall into difficulty during their lives and need some help.

 

[Woodchipper]

I'm a disabled veteran and do not use Medicare in any way shape or form. I know of a bunch of people on Medicare. Their question is why do they have the "donut" where they have to pay out of their own pocket after reacing a certain level of expense. I was not born privileged, far from it, but took the advice I stated earlier. I made a living but never reached the income level of others that I know.
I recall a senator addressing the issue that his mother couldn't afford her medication. I couldn't believe that someone making a six figure income wasn't paying for her medications.
Sayonara.

 

[pshrynk]

As for the "donut" in Medicare Part D? No one really knows and the best explanation I've ever gotten is because politics.

 

[skiprat]

I have no idea of the total costs but I'm pretty sure I'd be long buried by now if it wasn't for our NHS.
Yesterday, I completed my allotted 6 rounds of chemo for the Multiple Myeloma and about 2 hours ago, I complete my allotted 4 rounds of chemo for the Bowel cancer.
I still have several of the tabs to take at home and will continue to have regular blood tests etc.
I have another scan in about to weeks to see if anything has metastasised (spread to other organs) ...fingers crossed.

Here is a list of the stuff I'm on.....any guesses on the cost? Must be several hundreds of thousands by now,,,
Apixaban - blood thinner
Aciclovir - Myeloma
Bisoprolol - heart AFib
Gliclozide - T2 diabetes
Thalidomide - Myeloma
Velcade - Myeloma
Zomita - Myeloma bone repair
Oxilloplatin - Bowel cancer
Capecetibin - Bowel cancer tabs
Dexamethazone - steroids BC and MM
Colecalciferol - calcium tabs for bones Myeloma
Ondansetron - Bowel cancer post chemo tabs
Aprepitant - pre bowel cancer anti nausea
T2 diabetes blood testing equipment, including lancets etc
Stoma bags
Stoma sealing rings
Stoma adhesive remover spray
Wipes , cleaners, gauze, disposal bags , mirror etc
Bowel cancer open surgery - sigmoid colectomy.
Night in intensive care post op.
3 nights normal ward
Colostomy
1 x Radiotherapy on spine.
3 x Full body MRI scans
2 x CT scans
1 x X ray
Blood tests pre every chemo.
Full day on drip in A&E.
Dental checks- Myeloma
Fluoride toothpaste- Myeloma

And of course all the consultations with surgeon for BC, Two oncologists and specialist nurses.
I have stem cell harvesting and transplant planned in and in 18 months ( from the op in November) I have a stoma reversal planned.......

big big bucks......

 

[FGarbrecht]

Big big bucks is an understatement. In the U.S. this is the kind of catastrophic illness that bankrupts families.
Best of luck to you; you've got a lot on your plate and I wish you well.