Casualties of War

Navigating the front lines between Big Pharma and Big Healthcare

I recently found myself on the front lines in the war between Big Pharma and Big Healthcare: I woke one morning with a flaming hot red patch on my face. I headed straight to a local urgent care and was diagnosed with an infection that required heavy-duty antibiotics STAT. I was given an injection and put on a 10-day course of Doxycycline. I was asked if I’d like to buy the Rx there because “sometimes it’s more expensive through insurance.” I bought the meds and went on my way.

Today I read in the New York Times about a disturbing new business strategy in the pharma industry where companies buy “old neglected drugs and turn them into high-priced ‘specialty drugs’.” Examples of the practice reported by the Times include (among others) an increase in the cost of Doxycycline, the antiB prescribed for me, from $20 a bottle to $1,849 (full disclosure: I paid $20 for a bottle of Doxycycline at the UC); and an overnight jump in the cost for Daraprim from $13.50 per pill to $750 per pill. (Daraprim is owned by Turing Pharmaceuticals, a startup in the space, run by an ex hedge fund manager, Martin Shrkeli.)

Why the dramatic increases? Just because. No shortages. No improved efficacy. No new formulation or need to recoup R&D dollars. Instead, astronomic price increases just because.

Pop quiz: How can you make the most money by endangering the most vulnerable?

These stories read like bad B-school mock cases. Ones where the challenge is “find a way to make the most money by ripping off and endangering the most vulnerable.” I say endangering because skyrocketing the price for “standard-of-care” meds may cause providers to turn to alternative therapies that may not work as well. Medicaid is protected against price hikes by Federal rules but, the Times reports, “private insurers, Medicare and hospitalized patients would have to pay an amount closer to the list price.”

Enter Big Healthcare. For decades, health insurance companies have blamed rising healthcare premiums on the cost and prevalent use of prescription drugs. (So much so that even at the level of employee benefit plans, employers have asked employees to be mindful of their prescription drug use as a way to help manage costs.) Insurance companies, when faced with these drug price increases, will likely share the cost with patients in the form of higher premiums or by adjusting their formularies in a way that reduces exposure (increasing copays or excluding the drug altogether). Either way, the patient pays.

I have firsthand experience with this: For the past year I’ve had a persistent health condition that has required multiple procedures and hospitalizations. In just about every instance I’ve been advised of a treatment or a med that is recommended but not covered by insurance. I’ve been forced to make care decisions based solely on cost. I worry that I won’t have the best chance of recovery because the out-of-pocket expenses are beyond my means.

And I’m one of the lucky ones! I have a good medical plan (through Covered California, the Affordable Care Act exchange), after enjoying decades of employer-sponsored coverage. And I’m still a casualty of this war.

Patients and consumers, we are all just collateral damage.

Even people with top shelf healthcare plans will see their costs rise as a result of the “who can make the most money” battle between Big Pharma and Big Healthcare. This new breed of “drug rebranding” companies is just the latest battlefield tactic. I’m reminded of medieval battle scenes where the dead are scattered and a crew of bottom-feeders emerge to pick over the bodies looking for anything they can sell. The Times pieces exposes exactly that kind of bottom-feeding.

There’s no end of money to be made packaging the spoils of economic war and selling them on.

(I’m looking at you Wall Street housing crisis profiteers.) The rich get richer, and the most vulnerable are left dazed, confused, and afraid, unable to pay and unable to wield power to make change.

So what can we do?

Remember you are a consumer even when it comes to healthcare! You have a voice and a pocketbook. You can make it clear that you won’t stand for venal, avaricious practices that drive up your healthcare costs without improving your care.

Don’t pick a side. Be on your own side in fighting for affordable healthcare.

Recognize that we are all in this together — The uninsured access care through the most expensive entry point in the health care system, the ER, and usually only when a health condition becomes critical. The costs for this care impact everyone in the system. Think it through and support programs that ensure everyone has access to quality, affordable care.

Avoid partisan politics. Healthcare is the biggest of big business. With so much money at stake, politicians of every stripe will be lobbied hard to make sure the house wins on every health care gamble. Don’t get caught up in “Rep said/Dem said” grandstanding or blaming. Instead become a lobbyist yourself — write, call, text, email, tweet your representatives that Big Pharma and Big Healthcare need stronger checks and controls.

Become a healthcare advocate — For yourself, your family, everyone. Hold your healthcare insurer accountable for every decision regarding your care — call, write, ask questions. Don’t settle for “that’s not covered.” Get on the phone and ask why. Demand answers. And don’t be quiet when you get an answer you don’t like!

Update — in a related late-breaking Times story, Rodelis Therapeutics has returned ownership of Cycloserine, another drug mentioned in the article, to its original owner under pressure from that owner about Rodelis’ extortionate pricing strategy.

If you or someone you know feels trampled by their healthcare insurer, please share these strategies for making noise.