Pharma firm CEO insists its $89,000 muscular dystrophy drug is affordable

[fleur-de-lisa]

http://www.rawstory.com/2017/02/pharma-firm-ceo-insists-its-89000-muscular-dystrophy-drug-is-affordable/

When Marathon Pharmaceuticals' $89,000 price tag for a year's supply of its newly approved muscular dystrophy drug sparked outrage earlier this month, the company's CEO responded with another figure: $20. That's how much he expected Duchenne muscular dystrophy patients would pay per prescription of the drug, he wrote in a letter posted on the company's website. Insurers would cover the medication, and patients would pay only their typical copays. He touted the company's patient assistance program to help patients defray out-of-pocket costs.

It was a line of defense from a company within an industry besieged in recent years by criticism over drug prices. Martin Shkreli of Turing Pharmaceuticals took heat for raising the cost of a drug by 5,000 percent, Mylan faced vitriol over its EpiPen prices and now it's Marathon's turn in the hot seat. But the arguments that insurance will cover much of a drug's cost and that patient assistance programs will decrease out-of-pocket expenses don't always reflect the reality patients face when it comes to pricey drugs, experts say.

Those who need costly medications can face thousands of dollars in deductible and co-insurance payments, depending on how their insurance plans cover drugs and whether they get help from patient assistance programs. Even with insurers covering most of the expenses, that coverage can come at a cost to all consumers in the form of higher premiums.

"This idea that the vast majority of people out there are just paying flat $20 copays, it's based on an old understanding of what insurance (does)," said Rena Conti, a University of Chicago associate professor of health policy who studies drug prices.

When asked to comment for this story, Marathon gave a statement saying, "We are focused on providing access to this important drug to every young patient who needs it." On average, people with insurance through large employers spent about $144 out-of-pocket in 2014 for retail prescription drugs, according to a Kaiser Family Foundation analysis.

But some people pay much more. About 2.8 percent of people with insurance through large employers paid more than $1,000 out-of-pocket. Those people were much more likely to be diagnosed with conditions such as diabetes or mental illness, according to the analysis. It's true that some insurance plans charge $20 copays for prescription drugs, said Katherine Hempstead, a senior adviser at the Robert Wood Johnson Foundation. But other plans may require patients to pay the full cost of their prescriptions out-of-pocket until they meet their deductibles.

Still other plans may require consumers to pay a percentage of the full list price until they meet their deductibles or out-of-pocket maximums. "There are many, many permutations," Hempstead said.

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1. Make sickness a profit center, and this will inevitably happen

"Hey, if you can't afford $89,000, maybe you shouldn't have gotten muscular dystrophy!"

[Phoenix61]

2. So insurance covers the cost of a super

expensive drug then raises their rates to cover their costs. It still ends up coming out of the patients pockets. What a total asshole.

[napi21]

3. I'd like to talk to some of those people who spent $144/yr and had more than 1 Doc visit!

Everything depends on whether your insurance co. HAS your drug in their formulary, and what tier price level they put it in. Everyone I know has a deductible they must cover before ins. pays even a penny. My insurance broker told me to try to stay away from any tier 5 drugs (the ones where you pay 20%e of the cost). I asked how you tell if a drug is rier 6 and he said everything that's advertised on TV! Either Big Pharma doesn't KNOW what patients are required to pay of they just don't GAS!

[TexasBushwhacker]

5. Yeah, my guess is that this MD drug will be classified as "specialty"

like many chemo drugs for cancer.

[Initech]

4. Shkreli will always be the poster boy for the pharma criminal class.