29/10/2013

Speaking Up for Big Pharma

Photo courtesy Bart Heird. Used in accordance with Creative Commons guidelines. Photo courtesy Bart Heird. Used in accordance with Creative Commons guidelines. 

Last week, Barry Werth published Why New Drugs are So Expensive,” a must-read piece on pharmaceutical companies and drug pricing in the MIT Technology Review. Werth’s article hit particularly close to home with me.  Over the last twenty years, my family has been engulfed by the American health care system.

One brother survived the mysterious disappearance of his entire immune system at 22 months; thanks to IGG infusions and a team of incredible doctors at the University of Minnesota Children’s Hospital, he is a healthy, productive college student today. Another brother survived childhood leukemia thanks to the Mayo Clinic, but struggles with debilitating epilepsy which may be related to the cancer treatment he received as a toddler. My dad wasn’t as fortunate as my brothers. He was diagnosed with Stage IV colon cancer in 2008 and, despite aggressive treatment and several surgeries, died on Bright Monday 2011 at 52 years old. My wife was diagnosed with Crohn’s disease at age 15, and while her health was relatively good through much of our relationship, since the summer of 2012 she has had four surgeries, five hospital stays, a complete treatment overhaul, and one gastroenterologist essentially abandon her after determining she was in over her head. For most of my life — not just my adult life, but my entire life — my family has been at the mercy of insurance companies. It probably won’t surprise you to learn that my opinion of our health care system is abysmal and trending downward.

The one bright spot, at least as far as there can be one, has been how the industry in the best position to profit off my family’s misfortune, Big Pharma, has essentially saved my wife and me from at least one bankruptcy. More than once has my wife’s insurance company, The Alliance, attempted to thwart treatment plans developed by her gastroenterologists — some of them very major figures in GI medicine — by reviewing” her case internally with doctors who have never examined or even met her. More than once has this review came back with a firm denial of the treatment plan developed by doctors who have actually examined her, including the world-class doctor at the University of Chicago who first diagnosed her and was her GI for over a decade. These reviews would invariably recommend half the drug treatment my wife’s actual doctors had recommended. Drugs that treat Crohn’s are very expensive; some of them are also used to treat multiple sclerosis, ulcerative colitis, and rheumatoid arthritis, among other conditions.

Fortunately for us, my wife’s doctors have been very adept at figuring out alternative means to obtain the drugs she needs. Most of the time this has come in the form of patient assistance from major drug companies. In effect, people like us help Big Pharma keep itself from paying higher taxes by providing desperately needed medicine at steeply discounted rates. We’re talking thousands of dollars here. My wife is currently taking a drug for which our insurance company wanted to charge us $7500 a month, while Big Pharma has provided the drugs for free for an entire year. A copay for a previous drug would have cost us $3500 per month under our insurance. We got that drug for free from a different Big Pharma company over a couple years of treatment. Big Pharma gets a lot of bad press in this country, some of it richly deserved. Every time I hear this, I want to tell people that our insurance company would have thrown us to the wolves long ago. Big Pharma is the reason we haven’t yet lost our house. 

Once I feel more prepared to talk about it there will certainly be a few posts on the Affordable Care Act in this space. My under-educated view of it is very dim. Essentially, it gives more money to the insurance companies, an industry I consider an a plague infesting our health care system. Not all insurance companies are terrible. My dad was fortunate that his union and my stepmom’s union both believed in purchasing quality insurance, insurance which kept my dad from worrying about his family losing their home, first as cancer forced him into retirement, and later as he was dying. My wife’s insurer, retained by her former employer (an accounting firm) is good for covering routine visits to the doctor and normal medications, but when you ask them to cover things for which one generally pays protection money to insurance companies — catastrophic health changes, chronic illness, etc. — they balk and review” the case to determine to what degree they’re going to leave you hanging.

Werth’s article sheds some useful, needed light on the pricing schemes Big Pharma uses to support itself and — certainly as crucial — reward it investors. Hearing about how the sausage is made can cause dismay and anger. Big Pharma is far from faultless and should not be excused from merited reproach. But I wanted to add one small data point to explain another side of Big Pharma alongside Werth’s article, the side that frightened, needy patients and their families sometimes see — the sight of Big Pharma riding to the rescue.


health care insurance


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