Dropping coverage of popular prescription drugs is sad and shameful
http://www.latimes.com/business/la-fi-lazarus-20141205-column.html
From the article:
Express Scripts, which handles prescription-drug benefits for millions or people nationwide, is dropping coverage for 66 brand-name drugs next month in an effort to keep costs down. Rival CVS Health is dropping 95 drugs from its own list of covered drugs.
Happy holidays.
Soaring drug prices remain one of the chief reasons Americans pay more for healthcare than people in any other country. Prescription meds account for about 11% of the roughly $3 trillion in annual U.S. healthcare spending.
Express Scripts and CVS dropping coverage for dozens of popular drugs is just one illustration of how our system works.
The two companies already steer people to lower-cost generics. Now they want to save insurers billions of dollars more by eliminating name-brand choices for patients, which in turn would help lower premiums.
And that’s undoubtedly true.
At the same time, however, drug manufacturers, wholesalers and retailers will continue pushing pharmaceutical prices higher in an effort to wring profits from a captive market — the sick
Poor Express Scripts only had a net profit last fiscal year of close to TWO BILLION DOLLARS.. and provided NO MEDICAL CARE !
Yes, prices are now high for brand name drugs.. but you have to look back 50 yrs to see how we got here.. in the 60’s their was no PBM’s (Express Scripts & CVS Health) no Medicare/Medicaid.. there was also few generics available… the average Rx price was $4-$5 as opposed to today’s near $100. Wholesale prices were virtually stagnant. Research and Development for new meds was well funded.
First the PBM’s came on the scene.. abt 1970.. a scant few percent of the overall business.. Then Congress decided that Medicaid needed to only pay for generics and established MAC (Maximum Allowable Cost) what they would pay for a Medicaid Rx… as opposed to paying from AWP (Average Wholesale Price). The then FDA Commissioner by the name of Kennedy testified before Congress – concerning MAC – that quality of the medication would never be compromised for a price.. After Congress passed the MAC law.. Kennedy ‘s statement became that we can tolerate a variance in quality to maintain a price.
As more and more meds came off patent.. the more money that was not available for the brand Pharmas to fund Research & Development (R&D) .. so they raised their prices.. because we expected new and improved drugs.. and/or new drugs to treat/cure previously untreatable diseases.
Today we have 80+ odd percent generic utilization and 90+% of prescriptions being paid by a PBM like Express Scripts. Until recently, they could claim that they were saving the system money by forced generic utilization and step therapy that started with inexpensive generics for a newly diagnosed pt.
They have apparently hit a wall … the increases in generic utilization and per-cent of Rxs paid can only grow at a snail’s pace.. so they are “proving their worth” by taking away the option of very expensive meds… If you follow the money.. it is all about all the players making more money.. How many pt’s quality of life or life itself be compromised by the decision of these for profit business like Express Scripts and CVS Caremark.. May never know… who is going to keep stats on this ?
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