Monday, December 12, 2005

specialty / biotech medicines

     Opening “Annual Health Care Enrollment Material” for 2006 I was surprised and also not surprised to see a special cover page, with bold type headline:



     The piece masterfully identifies the alarming cost of “specialty / biotech” medicines with “annual costs ranging from $10,000 to $500,000 per patient” and how this new category and increases in these special co-pays keeps the overall cost of a prescription drug benefit down and co-pays low for rank and file participants and their families using traditional prescription medication. (In other words basically pigeonholing those who use them from the plans’ rank and file participants.)

     Patti’s level of disability has made MS specific medicines a non-factor and this does not affect her directly. However, I can’t help but wonder how it would have impacted our lives if she was still taking Avonnex. (a "specialty medicine") Could we afford to continue with dramatically higher co-pays? Or increased reviews to determine effectiveness of arbitrarily changing levels of expected results?

     Sadly nowhere does the logic attempt to look at why the “specialty/biotech” manufacturers charge so much for their product. It just accepts the cost and works out from there placing the “problem” on the people who need the medicine.

     Our health care insurance system is so broken that one stop gap brick at a time is not going to fix it. The 2005 hurricane season obviously will have a catastrophic ripple effect through the insurance industry for years to come.   

     The many heads of the insurance industry hydra will be sniffing for every opportunity to save itself and its stock holders. Economic self preservation is understandable to me and millions of Americans have their retirement funds invested in portfolios that contain insurance industry stock. The hunt just seems unfairly focused on the consumer end and not the manufacturer side of the equation.

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