Advertisement
  1. Opinion

Editorial: When is the high cost of prescription drugs too high?

New cholesterol drugs that hold great promise for combating heart disease carry an eye-popping price tag that could destabilize Medicare if used on a wide scale and add billions of dollars to the nation’s drug bill.
Published Sep. 4, 2015

New cholesterol drugs that hold great promise for combating heart disease carry an eye-popping price tag that could destabilize Medicare if used on a wide scale and add billions of dollars to the nation's drug bill. These expensive new medications may outperform traditional statins and save the lives of some patients. But other patients who gain only marginal benefit also may request the new drugs because the whopping extra cost does not affect them directly. Medicare's lack of controls and authority to negotiate with pharmaceutical companies make these new drugs a textbook argument for why America's fragmented health care system sorely needs to start balancing the price of drugs against their incremental effectiveness.

Medicare has so far managed to absorb the cost of a few extremely expensive drugs, as long as the drugs are aimed at relatively few patients for a limited time. The cholesterol drug market is different. One out four adult Americans take them, often for life. PCSK9 inhibitors, approved last month by the Food and Drug Administration, showed remarkable capacity in clinical trials to reduce dangerous LDL cholesterol levels. Early signs are favorable that they will also reduce heart attacks and strokes, although it is unclear whether they will be more effective than statins. The cost conundrum arises from the multitude of patients who might switch to these $14,000-a-year medicines from traditional statins, which can cost pennies a pill. If PCSK9's become the new normal, Medicare cannot sustain the pharmaceutical industry's unfettered ability to set whatever prices it chooses.

Though statins such as Lipitor, Crestor and their generic equivalents have a sterling track record for managing heart disease, a small number of heart patients have a genetic makeup that neutralizes statin therapy — which makes them perfect candidates for the new PCSK9 inhibitors. It's the majority of statin patients who present the financial challenge. Most improve their cholesterol levels with statins but do not reach ideal targets set by doctors, sometimes because they fudge on diet and exercise. An estimated 1 million to 3 million patients say they cannot tolerate statins, reporting muscle weakness, fuzzy thinking and other side effects that may or may not be caused by the statins. With many of these patients cutting back on dosages or refusing statin therapy altogether, doctors will be hard-pressed to refuse them a shot at the new therapy.

Yet the cost would be unmanageable. Medicare covers 55 million elderly and disabled people. If 4 million switch to the new cholesterol drugs, Medicare would shell out another $50 billion a year, nearly one-tenth of its current spending for all services.

The Veterans Administration, Medicaid, private health plans and other countries negotiate drug prices with manufacturers and often receive deep discounts. Congress, yielding to Big Pharma's lobbying power, forbids Medicare from negotiating drug prices. The industry says this largesse underwrites the steep cost of innovation.

In some cases, expensive drugs make economic as well as moral sense. The new hepatitis C drug Solvadi, for example, costs $80,000 to $100,000 for a full course of treatment. But it cures the disease and justifies its price tag by reducing hospital and doctor bills. The new PCSK9 inhibitors are unlikely to produce similar cost effectiveness if used on a wide scale, with doctors and patients making treatment decisions with no regard to price. Without tighter cost controls, Medicare faces a financial mess.

The new drugs are injected by doctors once or twice a month, which makes them a Part B service, where patients are responsible for a 20 percent co-payment. Most patients on traditional Medicare cover co-payments with supplement policies that usually cost $2,000 to $3,000 a year. If hordes of patients switch to a single drug that generates a $2,800 co-payment, the cost of supplement policies will soar. Monthly Part B premiums, now $104.90 for most people, would also have to rise because they cover 25 percent of Part B costs. Medicare Advantage plans, popular with low-income people, are required to cover approved classes of drugs and will face price pressure, even if they manage to curtail some PCSK9 usage with preauthorization requirements.

Other countries establish formulas that force drug treatments to prove cost effectiveness. By their nature, these systems place a dollar value on human life and suffering, an unpleasant prospect that America has so far avoided. Somehow, though, Congress must allow Medicare to find ways to limit costs — including allowing Medicare to negotiate with the drug companies. Tax money for health care is not unlimited. When a drug that can eat up the average Social Security check can tap into a market with millions of potential users, the era of unbridled drug pricing must end.

ALSO IN THIS SECTION

  1. Leonard Pitts undefined
    Don’t wall ourselves off from contradictory opinions, writes Leonard Pitts.
  2. President Donald Trump, right, and former New York Mayor Rudy Giuliani pose for photographs as Giuliani arrives at the Trump National Golf Club Bedminster clubhouse in Nov. 2016 in Bedminster, N.J.
    Here’s some interesting commentary from the opposite poles of the political spectrum.
  3. (left to right) Nupar Godbole, medical student at USF, and Tiffany Damm, medical student at UCF, take part in a papaya workshop at the University of South Florida Medical Students for Choice Second Annual Florida Regional Conference held in the Morsani College of Medicine on February 24, 2019 in Tampa, Florida. Some of the instruments used in abortions, like the manual vacuum aspirator, are used in an exercise with a papaya, to simulate an abortion. MONICA HERNDON  |  Times
    Here’s what readers had to say in Sunday’s letters to the editor.
  4.  LISA BENSON  |  Lisa Benson -- Washington Post Writers Group
  5. Exhaust rises from smokestacks in front of piles of coal in Thompsons, Texas. [Associated Press]
    A proposed rule masquerades as transparency when it actually is a favor to polluters.
  6. Using a tool provided by NOAA, this map shows what parts of the Tampa Bay region would be underwater if sea levels rose 8 feet, which could happen by 2100. NOAA
    The real-world impacts of climate change are accelerating for us in Tampa Bay.
  7. An architect's rendering of a foster care village proposed for Lake Magdalene. Ross Chapin Architects
    Here’s what readers had to say in Saturday’s letters to the editor.
  8. Campbell Park Elementary School is one of the seven schools included in St. Petersburg City Council member Steve Kornell's plan to help homeless students in the school system. SHADD, DIRK  |  Tampa Bay Times
    The City Council appears poised to help homeless families find places to live more quickly.
  9. Kimberly Clemons, 41, a resident of the Kenwood Inn, St. Petersburg receives a free Hepatitis A vaccination from Fannie Vaughn, a nurse with the Florida Department of Health Pinellas County, Tuesday, October 22, 2019. The health department has issued a state of emergency over the hepatitis A outbreak in Florida.  SCOTT KEELER  |  Tampa Bay Times
    The strategy regarding vaccinations is working and benefits all residents.
  10. Fiberglass planters remain in place at Lykes Gaslight Square Park on Friday, July 5, 2019, five months after city workers removed all of its benches for refurbishing. There is still no sign of them returning. DOUGLAS R. CLIFFORD | Times
    Quit clogging up precious downtown green space.
Advertisement
Advertisement
Advertisement