What good is a miracle drug if you can’t afford it?
That’s the question raised in a recent “60 Minutes” piece “The Cost of Cancer Drugs.”
The story examines the six-figure price tag associated with some specialty pharmaceuticals, and the drug companies that are preying on the wallets and emotions of patients who are desperate to find cures.
The issue is taking center stage in communities across America, which are battling over how to afford rising health care costs. Specialty drugs, which constitute less than 1 percent of all prescriptions in the U.S., accounted for more than a quarter of the country’s total pharmacy costs in 2013.
The problem runs rampant in the oncology community, where the cost to treat cancer increased by more than 10 percent last year — a recipe for disaster when you consider the fact that eight million Americans are currently living with some form of cancer and another 1.6 million are expected to be diagnosed this year.
Only the beginning
But cancer is just the beginning.
Drugmaker Gilead Sciences is grabbing headlines and causing a fierce debate over a pair of Hepatitis-C treatments that are being called “revolutionary” in the fight against the liver-destroying disease.
The drugs Sovaldi and Harvoni each cost more than $1,000 per pill. They are prescribed for a period of 12 weeks, which brings the total cost of these treatments to a whopping $94,000. According to the Centers for Medicare and Medicaid Services, treating all Americans who have Hepatitis-C with a Sovaldi-like drug would cost $227 billion. Currently, the U.S. spends $260 billion a year in all drug costs combined.
According to a spokesman for America’s Health Insurance Plans, Brendan Buck, “Pricing like this drives up premiums for everyone, decimates public programs, threatens jobs, and more importantly, puts promising treatments — like this one — out of reach for many in our society.”
Pharmaceutical companies argue that it costs a billion dollars to bring a new drug to market. That, they say, is the price you pay for innovation. In the meantime, Gilead is raking in the bucks. Sovaldi alone accrued more than $7 billion in U.S. sales over the last nine months, while Gilead shares rose more than 60 percent.
No one can deny the effectiveness of drugs like Sovaldi. But we cannot allow a handful of specialty pharmaceuticals to bankrupt the nation’s health care system.
Recently, the National Association of Medicaid Directors called on Congress to either enact price controls on drug manufacturers or provide federal disaster relief for states trying to afford Sovaldi and Harvoni.
Because a high percentage of Hepatitis-C patients are either low-income or aging, government-funded programs like Medicaid and Medicare are especially hard hit.
Given the significant impact on taxpayers who will be footing the bill for these high-cost treatments, state and federal lawmakers — who are often quick to regulate the insurance industry — should consider some common-sense legislation to bring these costs down for all New Yorkers and Americans.
Despite the effectiveness of these drugs, their use requires our physicians to think about the community at large and be good stewards of health care dollars.
Do all their patients need the drugs immediately?
Do they all fit criteria that indicate a high chance of cure? Because the price of these drugs, absent action to restrain costs by government or a sudden community conscience on the part of Big Pharma, has the potential to bankrupt our entire health delivery system.
The rising cost of specialty drugs is creating a complex dilemma for doctors, payers, patients and policymakers, all of whom want the very best for the American public.
We hoped for a day when miracle drugs like Sovaldi would cure Hepatitis-C. Now that we’re here, we must come together to make these drugs affordable, for everyone.
Dr. John Bennett is president and CEO of CDPHP in Albany.