In another brilliant move falsely couched as helping patients, Secretary Sebelius has ruled that drug manufacturers can pay the out-of-pocket costs for patients taking their expensive drugs … the very drugs in many cases you are very familiar with from incessant television advertising.
Promotion to doctors to get them to prescribe, advertising to patients to ask for the drug and financial incentives to do so, what’s wrong with this picture?
Shouldn’t a drug be taken solely on its clinical merits (and reasonable costs?) 😷 Surely you jest! I recall years ago having a friendly discussion with a fellow who worked with the maker of Rogaine. I said flat out it didn’t work as many people anticipated. He said it did, in some cases. My retort was simple, if that product really worked do you think heavy advertising would be necessary? It’s value would more than stand on its own once word got out. I’d be first in line as a matter of fact.
Of course, there is nothing new here unique to Obamacare, these payments have been made for years.
Pharmaceutical Benefit Managers also get rebates for placing a drug on their formulary which is why your plan may cover drug X while you have to pay triple the co-pay for drug Y.
Excerpt from the WSJ November 4, 2013
Drug makers scored a significant win last week in their effort to increase sales from the rollout of the health-care overhaul, when the Obama administration cleared a path for the companies to help pay patients’ out-of-pocket costs of prescriptions…
Pharmaceutical companies were among the earliest backers of the Affordable Care Act. They are contributing $85 billion to $90 billion in fees, drug-price discounts and other givebacks under the law, according to Prevision Policy LLC, a health-policy analysis and forecasting company. In return, they have been counting on drug spending to increase $120 billion from next year through 2022 as a result of millions more Americans receiving insurance.
But drug makers have been concerned that high copayments and deductibles on plans sold on the exchanges could deter newly insured people from filling their prescriptions, said Dan Mendelson, president of consulting firm Avalere Health LLC. He said the average “silver” health plan offered through the exchanges has a $2,500 deductible, while the average “bronze” plan’s deductible is $5,000.
Ironically …
Federal law bars drug makers from giving copayment assistance to patients insured by federal programs such as Medicare and Medicaid. The law considers the aid an illegal kickback that encourages unnecessary spending. Until last week it had been unclear whether that prohibition applied to insurance sold through the new online marketplaces, where people can get federal subsidies to help pay for coverage.
In addition, there is a movement in Congress to apply a surtax on Medigap premiums when the plan pays 100% for deductibles and co-payments under Medicare in the belief low or no out-of-pocket costs encourage over utilization of health care.
Apparently it’s okay to encourage unnecessary spending if it’s private health insurance (sort of), but not under a government plan. What the heck? Could it be that the Sebelius decision was politically motivated? 😏 No way, she would never do such a thing.
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