Category: Healthcare Cost

Magical Thinking and Aduhelm

Check this out. What you will see, unless I am missing something, is a statement of the obvious. To me not surprising is the fact that Biogen reported Aduhelm sales of a mere $300,000 for 3rd quarter 2021. Somewhat more surprising was that this was up against analysts’ consensus of $14 Million.

Yup, sometimes things turn out just like you think they will. On launch, this drug was panned for being FDA approved despite lack of clearing what were deemed to be appropriate clinical trial efficacy hurdles. Its $56,000 annual price tag per patient doesn’t help sales, nor does the collective impact that this price would have on the Medicare budget if the product’s coverage is approved.

Bottom Line. Despite all of the above, predictions are still being heard that in 2022, the drug will get traction, with a $9 Billion peak sales figure being bandied about. At the same time, talk is also being heard of the possibility of Biogen abandoning the drug. 

The moral of the story? Forecasting based on magical thinking is always a little dicey!

Why Do “Ancient Drugs” Cost So Much?

Once again, our friend the “Country Doctor” poses an interesting question. Check this out. If the line of reasoning supporting high prices for drugs is the cost of their development, why the heck do drugs that have been around forever cost so much?  Insulin, albuterol inhalers, and epinephrine are offered as examples of such apparent malfeasance. BUT. Scroll down and check the response offered by one reader. Dr. JKH notes that “designer” delivery systems for old drugs are modern inventions that permit new patents and raise prices. Another explanation. The impact of “Big Government” and its policies.

Bottom Line. This is an interesting discussion when you dig into the details. BUT. Most people don’t dig this deeply, and “old drugs at new prices” is bad optics to the general public. AND. Likely no amount of rational argument can make this perceptive go away.

How Much???

Check this out. What you will see is yet another story that highlights a very bothersome aspect of the cost of healthcare in America. The key word here is uncertainty.  

Usually when we read of the surprise factor in U.S. healthcare, it has to do with huge hospital bills that patients receive, often because of strange factors like the hospital that they used was in their insurance network, but one of the physicians who took care of them wasn’t. Blindsided!

Not this time. This time we see the patients even asking in advance for the price of a test to be administered in a doctor’s office, and the provider not being able to answer the question about the final cost. Translated, that means that physicians can typically tell patients what they will be billing for a test, but NOT what percentage of this charge their insurance will leave them to pay out of pocket. “Cost shifting” to patients is reported in this Forbes article as being apparently increasingly common, and as being especially problematic for patients with high deductibles and copays. 

Bottom Line. I find the number of ways that healthcare costs can bite a patient to be astounding. The same physician who penned this article recently wrote a blog noting that physicians’ offices in the U.S. are spending $30 Billion a year on billing expenses, with much of this sum being attributable to confusion and inefficiency.  

Fascinating set of circumstances. A situation devilishly troublesome for physicians and their patients alike!!!

What Is Your Mental Image Of An “Expensive Medicare Patient?”

Do me a favor. Conjure up that image before you check this out.

Odds are, like me, you are picturing a patient who has spent a really protracted period in the hospital running up a major tab of tests and bed charges, and/or has been readmitted to the hospital multiple times. 

Nope. The most expensive patients rack up their bills as outpatients, with a combination of outpatient treatment costs and medication expenses being the causative factors here.  Moreover, these patients also tend to be not only the most expensive patients in a given year, but year after year as well.  

AND. I bet you believe that many of the costs incurred by expensive Medicare patients are wasted money. NOPE. As this article reveals, only a relatively small percentage of expensive patients’ expenses represents money flushed down the drain.  

Bottom Line.  Ah, the risk of making assumptions!

Medical Care Coupons

You probably already know about this. I didn’t. Check this out. What  you will see is an article that describes how Groupon is being used to market medical services such as imaging. Read it and think about the meaning of this phenomenon.

As the writer points out, there is a lot going on here. First, the concept of shopping for a “screening scan” without guidance from your physician is a little bizarre. How does the average lay person know what tests to order, or how to interpret the results?

AND. What impact is this medical care couponing having on the finances of hospitals from which the patients are likely being drawn by the coupons to freestanding sites?

AND. What kind of care can be provided at discounts ranging up to 90%. With the coupon companies taking up to half of the revenue generated, the dollars that are left can get mighty thin.

Bottom Line. Without a doubt, the most profound thought expressed in this article is the comment that it makes on the state of medical care in the United States. Clearly, the people that are using these coupons are looking for “a deal.” In point of fact, it might be the only way that they can afford the service being purchased. AND. In an era where newspaper articles about surprise hospital bills and medically induced bankruptcies are increasingly ubiquitous, the opportunity to know a fixed cost in advance before having a procedure has an obvious appeal.

Given all of that, the big question before the house is whether such couponing will flourish, remain static or disappear. 

Stay tuned!

Should The Government Pay People For Their Kidneys???

That’s a dicey question! Check this out. As you can see, dialysis is costing the Federal Government a significant percentage of its healthcare spend. And, as my sister-in-law who just experienced total kidney failure would testify, it is inconvenient as hell. She can only consume 34 ounces of liquid every day, is restricted from eating food that contains phosphates and a bunch of other things and feels as bulbous as the Michelin Man by the time she makes it back to the dialysis center for her next appointment. Kidney donation rates in the U.S. are abominably low when compared to other first world countries. Only 21,000 kidneys were available for transplant last year, and there are over 100,000 people on the waiting list. BUT. The Federal Government paying people for their kidneys sounds sort of ghoulish. Issues include at least the appearance that this system lets the wealthy take advantage of the poor. It also raises the question as to what happens to a donor if the remaining kidney is injured or becomes cancerous. Bottom Line. Lots of things to things to think about here, but as this Forbes article clearly explains, there are potentially huge quality of life benefits for the recipients, and astronomical potential savings for the Government. In fact, this article points out that, ironically, paying people to donate their kidneys is one of the few practical things that can be done to significantly lower healthcare expenditures.  I think this makes sense! Your opinion?

If At First You Don’t Succeed

Aw c’mon.  Check this out.  I am really getting a lot of blog mileage out of this. I posted when the Feds tried to require LIST prices to be shown on all DTC advertisements. At the time, I called that a really stupid form of disinformation for patients, virtually none of whom would wind up paying anywhere near this amount, and many of whom might be scared away from taking medicine that they really needed.

And then, I posted when a court ruled against that regulation. I applauded.  

And now, here we go again. The Feds are once again taking a shot at requiring list prices on all DTC advertisements. 

Bottom Line. What can I say this time that I haven’t already said? Sharing LIST prices of drugs with patients is both vapid and dangerous. Hopefully, the plug will get pulled on this again.  

Watch for it!

Does The Cost Of Insulin Really Keep Patients From Treating Their Diabetes?

Check this out.  What you will see is fact checking on Kamala Harris’ recent proclamation that ¼ of Type I Diabetes patients in the U.S. are forced to let cost drive their use of insulin. Let me cut to the chase. Having examined several different studies dealing with this matter, the author of the article reports that about 25% of Type I diabetes patients do indeed either ration their insulin or stop medicating for a period altogether because they can’t afford the drug. Yikes!

Let’s face it. If you watched any of the recent Democratic presidential debates, you are well aware that healthcare is going to be a BIG issue in the 2020 election. And you heard very specific comments indicating that a major focus within this issue will be the cost of prescription drugs. Moreover, Type I Diabetes makes a wonderful poster boy for this issue, with the high incidence of the condition, the fact that the cost of insulin has doubled in recent years, etc. helping to make this disease likely to draw a lot of attention in the month to come.  

Bottom Line. It will be interesting to see what impact on all of this will be had by Lilly’s recent announcement that it will begin manufacturing a generic version of its own product at 50% off list price. My bet is that most of the candidates who are most rabid on this issue will pick up on this announcement as an admission that drug prices are too high, even at this discounted rate.  

Stay tuned! This will likely get interesting!

How Much Will My Heart Attack Cost?

Check this out. If you liked yesterday’s riff about the stupidity of requiring DTC drug advertisements to include the medication’s “list” price, you will love this one. Today we see that in their never-ending quest to provide healthcare pricing “transparency,” the Feds are now requiring hospitals to post their master charge list on line. Every single thing that they might bill a patient for. Thousands of items, ranging from aspirin tablets to brain surgery. All posted at “list.” And what, pray tell, are patients expected to do with this “information.”  

Some interesting terminology included in this article. Like the description of this “information” as “useless” to the average patient. Yup. And the word “fiasco” being used to describe the outcome of this exercise. Uh-Huh!!!

Nonetheless, some do-gooder is quoted as describing this as a “tiny step forward” in the direction of transparency. People, any time useless stuff is distributed to unsuspecting recipients, clogging the system and taking attention off of doing real things to help patients understand healthcare pricing, I would argue it is a major step. Backwards!!!

Bottom Line. Somehow, we need to get the Federal Government (and everybody else!) to understand that “full disclosure” of meaningless pricing information about drugs, hospital costs or anything else for that matter is not a laudable public service. Rather, it is a travesty that actually detracts from accomplishing outcomes that really help patients.  

This is so evident that I am not sure why this is not understood. How can we help?

And the Silliness Continues!!!

You may recall that a few weeks ago, I sent you to a URL that described the new Federal regulation that will require drug manufacturers to include the “list” price of the drug in any DTC advertising. If you remember that, you may also recall that I shared my perspective that this was a really, really bad idea. Most patients don’t pay anything that even vaguely resembles the list price, so what are they to do with this (dis-) information? Probably the same thing that they do with the lists of side effects that already weigh down drug ads. Nothing. BUT, I shared my concern that being exposed to this financial marker might actually convince patients not to have a prescription for a required medication filled. Nice work!

So, check this out. No great surprise here. Just the announcement that several pharmaceutical companies have banded together to sue the Federal Government to block the enforcement of this new regulation. Who couldn’t see that one coming?

Bottom LineAs so often happens, I am of two minds about this legal action. On the one hand, I believe that it is only reasonable that someone stand up against this HHS requirement. If the Government wants the U.S. to join virtually every other country in the world in forbidding DTC advertising of prescription drugs, why don’t they just make that the law of the land? I am not sure that would be such a bad idea, and certainly would make more sense than weighing down the advertisements with all of the extra baggage of side effects and safety concerns, price, etc. 

HOWEVER. My other perspective on this is based on my concern about what yellow journalism will be doing with this suit. I can see the headlines now. “GREEDY PHARMACEUTICAL INDUSTRY SUES TO KEEP ITS RAPACIOUS DRUG PRICES A SECRET.” Just the kind of PR our already beleaguered industry needs.

Stay tuned folks. It is my prediction that at some point, either the Federal Government will tell us to stop doing DTC or pharmaceutical companies will decide that in this regulatory climate, it is simply not worth doing. Watch for it!