Following up on Sunday’s post about drug costs, the FEHBlog noticed this LifeHealth Pro article about how prescription benefit managers and insurers are pushing back against a prescription drug manufacturer Gilead that is charging $1,000 per pill for a Hepatitis C medication — that’s $84,000 for a 12 week course of treatment. Gilead has leverage because Hepatitis C is a serious illness with few treatment options that affects a lot of people. The article explains that
Express Scripts Holding Co., Catamaran Corp., Aetna Inc. (NYSE:AET) and CVS Caremark Corp. among others are already pushing back against the high cost of Gilead’s drug. They’re discussing how to pit similar drugs against each other, refusing coverage for some, or subjecting treatments to more review by outside experts and refusing to pay a premium based on one drug being more convenient to take than another.
Good luck with that.
Yesterday, three senior Republican Senators introduced a bill to replace the Affordable Care Act. The FEHBlog The FEHBlog read the position paper last night. The proposal certainly is worth discussion.
Finally Congress created a three month sustainable growth rate formula (“SGR”) patch in the budget deal. That patch expires at the end of March. The SGR is the flawed statutory formula for reimbursing doctors under Medicare Part B. Former CMS administrators are suggesting that Congress should suspend the SGR for five years in order to allow time to develop a sensible replacement. This Medpage article reports that the administrators believe that their approach would cut the cost of the repeal and replace approach in half. Of course, Congress passed the SGR in 1997 so there already has been over 15 years to fix it.