My father has been on dialysis for eight years. He has Wegener’s Granulomatosis, a rare autoimmune disease, and it destroyed his kidneys very suddenly in 2001. His illness came out of the blue, following a lifetime of good health, and has given my parents an up-close look at our health care system. Because he has kidney failure, my father qualified for Medicare. But until the advent of Medicare Part D in January 2006, my parents had to pay for all of his medications out of pocket.
Dialysis does not remove phosphate, so my father has to be on a drug that prevents phosphate from building up in his blood. In 2002, he was on PhosLo, a brand name drug, because the generic wasn’t available. At that time, a three month supply cost $108.25. Now, seven years later, he takes the generic version (calcium acetate) and a three month supply is $528.29 (a 488% increase in price). Humana, his Medicare D carrier, picks up the tab, but we all know that claims costs are eventually passed along to insureds in the form of higher premiums or reduced benefits as time goes by.
Let’s not forget about the double digit percentage of revenue profits that most of the big pharmaceutical companies rake in. Nor about the fact that part of Medicare D specifically disallows government negotiation with pharmaceutical companies when it comes to drug prices. PhosLo is only indicated for patients on dialysis, the vast majority of whom are also on Medicare. The makers of PhosLo are likely well aware that the majority of patients who take their drug will either be paying for the medication out of pocket (if they don’t have Medicare D), or they will be covered by a drug plan that prohibits the government from negotiating with the drug maker to lower the cost.
My father’s story is just one of many. Over the last few years, the majority of the individual health plans available in Colorado have added separate prescription deductibles or started offering plans with no prescription coverage at all. It’s not hard to see why, when we consider the increasing cost of prescription drugs, combined with increasing utilization.