The drug pricing debate isn’t going away, but it took a new turn after a study suggested that high-priced speciality drugs could well represent good value for money after all.
In 2013, the class of hepatitis treatments that include, Solvadi, accounted for less than 1% of US prescriptions and yet swallowed one quarter of all spending on prescription meds. How can they possibly be offering good value for money?
It all depends on how you measure it…
A study in Health Affairs journal measured benefit of 58 speciality drugs and 44 traditional drugs in terms of “quality-adjusted life years” (QALY). In essence, to what extent a drug enhances a patient's quality of life over that offered by other treatments.
Maybe the fact that speciality drugs performed so well by this measure isn’t too surprising as most are used against complex conditions for which there may be few alternative treatments. A small improvement in life quality has got to be better than none at all – right?
It depends on who you ask…
To the patient, benefits are relatively clear but insurers and US employers are balking at the cost of these treatments. In some cases because of the rather bleak logic that it is not they who will benefit from the fact that the patient is healthier in 10, 15 or 20 years’ time.
The outcome is that patients can be asked to contribute to the cost of these treatments – sometimes by paying as much as half of the cost. The affordable care act does limit annual out-of-pocket costs, but at $6,350 for an individual and $12,700 for a family they are still prohibitive for some. As a result advocacy groups representing US HIV and AIDS patients have filed anti-discrimination lawsuits against some health insurers.
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