Each month, more new drugs are approved by the Food and Drug Administration. As drugs are developed and approved, the goals of improving the health of current patients and of eradicating many diseases advance. The often cited phrase, “better living through chemistry” applies to more manufactured drugs than ever before but fails to address the unintended consequence of “unable to live life because of the cost of chemistry”. For many patients, the amounts charged by the pharmaceutical companies for new drugs, even when insurance pays part of the cost, are simply not affordable.
In 2018 the FDA approved over 25 new drugs that have annualized costs that range from the low $30,000s to over $500,000. The top 10 of these drugs are:
1) Takhzyro - $ 573,820 (Hereditary Angioedema)
2) Tegsedi- $ 449,800 (Hereditary Polyneuropathy)
3) Vitrakvi - $ 399,069 (Solid Tumors)
4) Tibsovo - $ 317,733 (Acute Myeloid Leukemia)
5) Galafold - $ 315,250 (Fabry Disease)
6) Symdeko - $ 292,000 (Cystic Fibrosis)
7) Xospata - $ 273,750 (Acute Myeloid Leukemia)
8) Lobrena - $ 195,345 (Lung Cancer)
9) Palynziq - $ 178,120 (Phenylketonuria)
10) Talzenna - $ 177,390 (Breast Cancer)
Beyond these new drugs, others were approved in late 2017 that have annualized pricing that extends into the seven figures. Many of the new drugs being developed are classified as cellular and gene therapy, or bio-similars or biologics, or orphan drugs. Often the conditions that these drugs treat are finite populations and the high cost of research may be spread across a small population of patients, resulting in extremely high prescription costs. But beyond these categories of drugs, charges for established brand and generic drugs have increased at unprecedented rates, leaving many patients with higher co-pay and coinsurance costs than they can afford. The quandary for plan sponsors is how to balance the provision of drug benefits with the cost impact on the overall plan and the ability to afford medical stop loss coverage to protest the financial viability of the benefit plan.
As insurers, employers, and now legislators wrestle with the cost of prescription drugs, consumer programs that provide patients with direct purchasing access to lower drug prices are increasing in popularity. In some cases these programs are made available through discount retailers, and in others they are discount coupon programs that monitor the costs of the drugs by pharmacy and provide the comparable pricing to the public. Many do not require a membership and do not have any fees. In most cases these programs obtain drug pricing that is less than a co-pay or coinsurance amount through the PBM and not limited by the PBM formulary. By using these types of programs and shopping for prescription drugs as consumers, plan participants can usually reduce their out of pocket expenditure for their prescription drugs.
