by Angela Sams
You get what you pay for, right? Not necessarily. Whether Americans realize it or not, they may in fact be paying $124 or more for the expensive prescriptions of a neighbor, a family member, or a complete stranger!
A recent op-ed article in the New York Times discusses a drug that “is a new class of cholesterol-lowering agents called PCSK9 inhibitors” as an example of a medicine that may result in higher insurance premiums for all of us. This new inhibitor, just approved by the FDA in July, is thought to reduce bad cholesterol (LDL) by up to 60 percent more than a placebo. And, though there is no solid proof that the drug (and others like it) can prevent heart attacks, strokes, and deaths caused by heart disease, researchers are still optimistic.
So what’s the problem with a drug that could potentially improve quality and length of life? The hefty price tag. The companies who create these drugs have disclosed that a prescription will cost more than $14,000 per year, per patient. Multiply this by the number of years that a patient must take that drug, and the number quickly becomes unfathomable. Those costs will then fall to insurers, and eventually trickle down to the rest of us. Policymakers and academics have a couple of proposals that could help save patients money, “such as separating out deductible limits for drugs from deductibles from other health benefits and limiting co-pays for these drugs to $100 to $250.” However, this won’t get rid of the fact that the drugs cost a certain price. That price must still be paid, even if it falls to the insurance company.
Here is where the idea of value comes into play. Are we really getting what we pay for? And how is one to determine the value of a particular medicine? Other items in our economy (think cars, phones, or TVs) are purchased by consumers, depending on whether or not that consumer thinks it’s a good “value.” In the case of medicine, value could potentially be determined by measuring the improved quality of life it gives to patients. Since we are all affected by the rising costs of these prescriptions, it is up to us as a society to determine the value of these medications, and how much they are worth, monetarily.
If the drug isn’t necessary, why don’t they just make users pay for it out of pocket and then the market will drive down its price from the drug company to a reasonable rate that optimizes their profit along the demand curve. This would be much like Pfizer charges for Viagra. It would be expensive but affordable enough for the majority of those who want it. It is this type of thing that forces young people to pay unfair amounts for healthcare premiums and creates perverse system in which insurers provide little to no value but drive up costs 50% and allow for real costs and benefits of particular treatments and drugs to be shielded from the consumer.