Fred Goldenberg: High cost of Rx drugs a tough pill to swallow

·4 min read

Nov. 7—When the Medicare Part D prescription drug program was enacted in 2006, there was a collective sigh of relief by seniors everywhere. Finally a program designed to reduce drug prices. But for more than a decade we've seen drug prices continue to rise without any relief in sight.

AARP has been tracking the increases since 2006 and recently published a report on the outrageous price gouging we Americans, especially seniors, have been subjected to.

From 2015 to 2020 these widely used brand name medications have increased at a staggering rate:

* Duexis, used for pain relief. Price increased by 60 percent, from $18,287 to $29,342.

* Lyrica, treats fibromyalgia and diabetic nerve pain. Price increased 47 percent, from $5,827 to $8,562.

* Symbicort, treats asthma and COPD. Price increased 46 percent, from $2,940 to $4,282.

* Victoza, treats diabetes. Price increased 42 percent, from $7,936 to $11,300.

* Lumigan, treats glaucoma and high eye pressure. Price increased 42 percent, from $1,689 to $2,400.

* Bystolic, treats high blood pressure. Price increased by 41 percent, from $1,239 to $1,747.

But the one that gets me is Humira. AbbVie, Humira's manufacturer, kicked off 2020 with a price increase in excess of 7 percent on its mega-blockbuster brand-name treatment, which is used to treat rheumatoid arthritis, psoriasis and Crohn's disease. The increase followed total Humira price hikes of 19 percent during 2017 and 2018, according to the nonprofit Institute for Clinical and Economic Review, which deemed the increases unjustified.

The cost of Humira, which is injected via syringe, was more than $72,000 a year on prescription drug websites this week, and is not expected to come down until at least 2023.That's not a typo — $72,000 a year. The price of Humira has gone up more than 138 percent since it was introduced in 2014.

AbbVie makes a big deal in advertising that if you can't afford your Humira you can get help and the cost could be a little as $5. But when you read the fine print, you find that:

"Eligibility: Available to patients with commercial prescription insurance coverage for HUMIRA who meet eligibility criteria. Co-pay assistance program is not available to patients receiving prescription reimbursement under any federal, state, or government-funded insurance programs (for example, Medicare [including Part D], Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs) or where prohibited by law or by the patient's health insurance provider."

What else is there?

Every possible insurance program available to seniors, and for that matter most people, isn't eligible for the program. So who are they kidding? To make matters worse, Humira is a Tier 5 drug on most formularies, so it has higher copays and prior authorization requirements. So even if it is covered, you will still be responsible for around 30 percent of the monthly cost.

Forbes reported that there are five generic alternatives already FDA approved ready to go — but AbbVie, to protect its $20 billion a year baby, entered into partnerships with the other manufactures in which they agreed not to produce the lower cost drug in exchange for a piece of the billions of dollars Humira wrings out of Americans every year. And somehow this is legal?

Early this week, Democrats reached a deal on including — as part of the $1.75 trillion infrastructure package — a section aimed at lowering prescription drug prices. Senate Majority Leader Chuck Schumer said, "Fixing prescription drug prices consistently has been a top issue for American's year after year. This deal will stop price gouging and change both drug company and health insurance incentives to make sure our country's drug pricing system benefits patients, not corporations."

Medicare now will be able to negotiate prices for drugs that still have market exclusivity, like Humira. That's a good thing, but it is unknown what other benefits we'll gain, if any. Everyone is patting themselves on the back because they intend to cap insulin at $35 a month (down from $700), but will they be able to do the same for the 400 drugs that saw increases since January of this year?

With the GOP sitting on the sidelines rooting against the success of the plan and the drug manufactures circling the wagons, it's a heck of an upward battle — one I hope we as Americans win.

Fred L. Goldenberg is a Certified Senior Advisor (CSA) and the owner of Senior Benefit Solutions, LLC, a financial services, and certified health insurance organization, now affiliated with Michigan Planners, in Traverse City. Questions or comments about this column or interest in our monthly Medicare classes can be directed to (231) 922-1010 or fred@srbenefitsolutions.com.

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