But many of the priciest medications are available for free if you have a coupon.
Theyre giving up that smidge of profit to be able to charge your insurance company for the rest.
Heres whats going on.
So the patient gets these drugs for free, and the insurance company pays.
The drug company, of course, advertises to the patient.
This is a no-win game.
But private insurers cant fall back on that law.
(For what its worth, we now know the price isabout $800a month.)
Its simply not in drug companies best interests to be clear about how much a drug costs.
And even when you know the drugs list price, that doesnt tell you what anyone is actually paying.
Ms. Retzlaff:
So we have introduced a hospital discount program
Yeah, give me a number.
What would they have to pay?
So for a 100-count bottle, it would be roughly $35,000.
For a 30-count bottle, it would be $11,000 [reflecting a 50% discount].
What about if I had Blue Cross Blue Shield and it was covered?
What would Blue Cross Blue Shield Pay?
So that would depend on what the copayment and coinsurance was.
About 25% of patients on Daraprim have commercial insurance.
What if they were on [Medicaid]?
What would be the cost for that pill?
And that actually represents two thirds of Daraprims business.
And so, who pays the rest of that, if the patient gets it for one penny?
Thats the way pharmaceutical pricing works in the industry.
Thats assuming the insurance company actually pays the $750 a pill price without negotiatingbut theydo negotiate lower prices.
So the actual price paid is still a mystery.
The Problem Isnt Martin Shkreli.
Its the Whole System.
But hes really kind of irrelevant.
You know how you might tell?
Shkreli isno longer the CEO of Turing, butTuring did not lower the price of Daraprim after he left.
The price (whatever that means) is still $750 a pill.
Shkreli got arrested, butnot for jacking up prices.
That was totally legal.
Mad about high drug prices?
Get a load ofthese nine drugsthat all cost six figures or more per year.
Read up onValeants track record of buying drugs and jacking up their pricenot once, but repeatedly.
Notice that two of the three Super Bowl ads were for pricey, new Valeant drugs.
than about the entire issue of drug prices.
(Trade Deal May Undercut Efforts to Control Drug Pricesis a typical…yawn…top result.)
Legislators dont get it either.
Valeants interim CEO was at last weeks congressional hearing, but he wasnt the headlining act.
The cost to any individual is pennies.
Its infuriating and correct because the whole pharma industry plays the same games.
Prices are risingon tons of drugs.
Drug price hikes account for at least13% of the reason for increasing insurance premiums in 2016 plans.
Apharmaceutical industry grouppoints todata showing that the growth in costs is actually lower this year than in previous years.
Second, its not because of the drugs value.
(They refuse to pay if the cost perquality-adjusted life yearis more than what theyve determined its worth.)
Basically, drug companies charge whatever they can get away with.
Im in over my head here, and I worry that legislators are, too.
First, about those couponsI wont tell you not to use them.
What would help a little is tonotask your doctor about name-brand drugs.
and Is this hot new drug any better than the old one?
Real change will probably require government action.
But for now, the system is broken.Fill your scripts at Costco, I guess?
And try not to get sick.
Illustration by Sam Woolley.
