Business

Drug-price push back, even with cancer medicine

More and more drug companies can't assume that any drug they put forth will automatically be reimbursed by insurance companies at whatever price tag the drug company slaps on the product.

7 comments

Drug-price push back, even with cancer medicine

POSTED: Friday, December 14, 2012, 8:53 AM

David Sell

More and more drug companies can't assume that any drug they put forth will automatically be reimbursed by insurance companies at whatever price tag the drug company slaps on the product.

A Reuters story, whose link is here, reported on a recent example and is based in part on a PricewaterhouseCoopers survey of U.S. health insurers. PwC's survey indicated that four-fifths of insurers polled now require evidence of cost savings or a clear clinical benefit to include new products on their lists of covered drugs.

"In cases where there are co-pays, they really do effect the consumer," said Mark Mynhier, partner, healthcare industries advisory at PricewaterhouseCoopers, according to Reuters. "Patients are saying 'I can't afford to pay 10 or 20 percent of a $100,000 therapy.' "

The story noted that doctors at New York's Memorial Sloan-Kettering Cancer Center opted for a lesser-priced cancer drug. Reuters said they decided in November not to use Zaltrap, a new $11,000 a month colon cancer drug, because it has a "modest" impact on survival, works no better than Avastin, a similar but cheaper competitor, and has worse side effects. The hospital said Sanofi aventis, which makes the drug, offered a discount on the wholesale price, but that was not enough to make the hospital's list of available drugs.

"In order to warrant the price, you are going to have to have better overall survival," said Rhonda Greenapple, chief executive at Reimbursement Intelligence, a consulting firm specializing in medical reimbursement, according to Reuters.

7 comments

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Comments (9)

0 like this / 0 don't • Posted 9:41 AM, 12/14/2012

insurance companies are middle men who provide no benefit to the patient or health system. when will someone complain about their premiums?

— main liner

0 like this / 0 don't • Posted 9:51 AM, 12/14/2012

if insurance companies provide no benefit to the patient, why is there a push to make sure everyone has insurance coverage?

— ekw555

0 like this / 0 don't • Posted 9:50 AM, 12/14/2012

nice to see that 100 years of cancer research has brought us a new $11,000 a month colon cancer drug, with a "modest" impact on survival, that works no better than a similar but cheaper competitor, but with worse side effects.

now, if that isn't progress, what is?

— ekw555

0 like this / 0 don't • Posted 10:57 AM, 12/14/2012

The product end-users should be exposed to some price signals, and they should be the ones who decide if they want to spend the extra money on the more expensive therapy. It shouldn't be the government's decision, it shouldn't be the manufacturer's decision, it shouldn't be the insuror's decision. The customer should decide in the form of paying for the medicine.

— Mr. Smith

Comment removed.

0 like this / 0 don't • Posted 11:36 AM, 12/14/2012

I get that they're businesses. I think it's wrong that they're for profit. We've come to value the dollar more than human life. Some stiff in a cubicle is reading from a book of guidelines on whether a procedure, drug, treatment, etc is covered. Those guidelines were set, not with thought for preserving or improving a life, but to make sure they can justify hurting a bottom line. That's just flat out wrong.

— PotteryPete

0 like this / 0 don't • Posted 11:27 AM, 12/14/2012

This comment has been deleted.

— Vomit Man #1

0 like this / 0 don't • Posted 11:34 AM, 12/14/2012

You make some really good points. But, I think going back to regulation would never have gotten anywhere.

— PotteryPete

0 like this / 0 don't • Posted 11:31 AM, 12/14/2012

Complain about premiums? This is a perfect example of why they shouldn't be for-profit companies. Without the drug there's probably little chance of survival, but with the drug there's a modest chance of survival. Correct me if I'm wrong, but isn't a modest chance of survival better than taking the risk of none, without the drug?

Yeah, we're in a free market. I'm frightened for a society that shows so little compassion for human life when it comes to money. Money is not more important.

— PotteryPete