Super Expensive Medications: What You Need to Know — April 2014


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Super Expensive MedicationsPaying a few hundred dollars a month for your medications can be a challenge, but what if your monthly costs are $6,000? Or worse, $50,000? A quick price check of Soliris, a medication used to treat a rare kind of anemia called paroxysmal nocturnal hemoglobinuria, revealed that a typical, maintenance dose costs $49,336 a month. Or $592,032 a year! And that’s just the cost of the medication; it doesn’t include costs associated with administering it intravenously.

Another medicine called Acthar used to treat multiple sclerosis (MS) flare ups costs roughly $37,920 a day. Fortunately this medicine is only used for two to three weeks, but still the cost of treatment is between $530,880 and $796,320.

Why So Expensive?

For many rare conditions, there’s often only one treatment option. Or for other conditions like MS that aren’t as rare, the disease process is different for every patient, and there is no one therapy that works for all. Therefore, drug companies go through the expensive process of developing and testing drugs that might only be needed by fewer than 10,000 people. Since there is seldom competition to introduce these drugs, pharmaceutical companies can charge huge sums. The more common a condition, the more likely there will be competition among drug companies to manufacture the medications and compete by offering lower prices.
Whether a patient has a more common condition like MS or a rare genetic disorder, knowing there are treatment options to consider is welcome news. Then it is a matter of figuring out how to pay for it.

Will My Insurance Cover It?

It’s safe to say most people can’t afford $37,920 a day for medication. But when people submit such a charge to their insurance company, those claims are sometimes declined. The denial doesn’t always mean the insurer won’t cover the therapy, but rather that a “step process” or “step therapy” must be followed. Often this requires that patients and their doctors provide details about:

  • All lab work that has been completed, as well as full documentation of the results.
  • Other medications that have been tried and what results were obtained from doing so.

Insurers want to be sure that other, less expensive options have been fully explored before trying very expensive medications. They may also require that the medication be prescribed by a specialist, such as a neurologist for MS drugs or an oncologist for cancer drugs, rather than by a primary care provider.

For those who don’t have insurance or for whom insurance doesn’t cover the full cost, there are assistance programs provided by the federal government and drug manufacturers. If you are considering a very expensive medication, you are probably talking closely with your healthcare provider. S/he should be able to assist you with your questions about how to receive coverage. You can also talk with your pharmacist and your KnovaSolutions nurse for more information.

General Cost-Reducing Tips

The high cost of medications can be a bitter pill to swallow. Some who struggle with the cost of their medications admit that they don’t always fill their prescriptions or that they skip doses. Some even say they buy medications illegally from Canada, Mexico or other foreign source because they are less expensive.

These cost-reducing strategies are associated with negative health outcomes, such as poor response to the medication, no improvement in the condition being treated, increased emergency room use or hospitalizations, and cardiovascular events such as stroke and heart attack. Buying medicines sold outside the U.S. is risky too because those drugs are not always the same as those available in the U.S. Fortunately, there are often viable — and safe — ways to reduce the cost of medications.

Anytime you’re looking to save money on something, make sure you know if you really need it in the first place. It may seem basic, but it’s important to know why you take a medication, that is, what condition is being treated. Once you know why your provider has prescribed a medication, you can explore ways to reduce its cost.

  • Ask your provider if you are taking the lowest effective dose. Why pay for a higher dose when a lower dose works?
  • Inquire whether you take a medication that can be safely split (not all medications are safe to split). Because of a quirk in drug pricing, sometimes a tablet that is twice as strong might cost the same or just a little more as one half the strength. Therefore, splitting a higher strength pill in half with a pill cutter gets you two doses for about the price of one.
  • Ask about generic versus brand name drugs. See the KnovaSolutions newsletter link below.
  • Call your health insurer to see what is covered and find out if a lower cost mail order option is offered.
  • Shop around since prices vary from one pharmacy to another. Some pharmacies offer $4/month medications while others offer discount plans.
  • Check out assistance programs offered by drug manufacturers.
  • Look for websites like needymeds.org that offer free drug discount cards.

KnovaSolutions is also an important resource. Let us help you sort out your medication challenges. Give us a call today800/355-0885.

 

Read All About It…

KnovaSolutions likes to keep you informed about important health issues. See our other newsletters related to prescription medications:

 

Click here to view/download the full newsletter.

The information contained in this newsletter is for general, educational purposes. It should not be considered a replacement for consultation with your healthcare provider. If you have concerns about your health, please contact your healthcare provider.

We encourage you to leave a comment or question below and a KnovaSolutions nurse or pharmacist will reply.

 


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