Skip to comments.The Growing Turf War over Who Can Fill Prescriptions
Posted on 06/08/2014 4:01:37 PM PDT by Kaslin
Drug therapy is growing more complex and costly! So-called specialty drugs are gradually displacing traditional drugs as the primary component of drug spending. The market is expanding rapidly. Only about 10 such drugs were available 20 years ago but today there are more than 300.
These drugs typically treat medical conditions that are life-threatening, chronic and often rare. Cancer treatments are the most common type of specialty drugs, making up one-third of total. Drugs for autoimmune disorders, rheumatoid arthritis, and Crohn's disease, medications for HIV and drugs for multiple sclerosis are responsible for another third of specialty drug spending.
Although only about 1 percent of drugs prescribed, specialty drugs now account for more than one-quarter prescription drug spending. This is expected to grow to 50 percent by 2020.
Specialty drug therapy costs from at least $15,000 per year, to as much as $750,000 per year. Most have no close substitutes, rendering health plans traditional efforts by to control costs by encouraging generic substitution largely ineffective. Due to these medications high cost, health plans carefully manage the procurement and administering of these drugs. For instance, health plans are increasingly relying on exclusive preferred pharmacy networks to reduce costs and ensure the quality of specialty drug therapy.
When drug plans create preferred pharmacy networks they negotiate for the lowest possible prices. Negotiated prices are the result of bargaining power the ability of the drug plan to deny business to a firm if their bid isnt favorable. Bargaining power also strengthens the ability of drug plans to demand quality-enhancing safeguards and patient protections.
As you might expect, when a new market segment displaces an old one, stakeholders in the old market understandably dont want to be shut out. As preferred pharmacy networks have become more common, so too have the calls for lawmakers to enact laws that restrict the ability of health plans to partner with exclusive pharmacy networks. The less competitive drug providers lobby CMS, Congress and state legislatures to restrict the ability of drug plans to effectively negotiate for lower prices. This past January the Centers for Medicare and Medicaid Services (CMS) tried to ban preferred pharmacy networks in Medicare drug plans. CMS had been under pressure from pharmacy interests shut out of Medicare Part D drug plans.
Numerous states already have regulations that interfere with negotiations between drug plans, drug makers and pharmacies.So-called, any-willing-provider and freedom-of-choice laws reduce the drug plans power to bargain for lower prices or ensure quality by making it harder to exclude high-cost (or low-quality) pharmacies from their preferred networks. According to the Federal Trade Commission (FTC), such consumer protection laws are actually costly to taxpayers, employers and patients. Not only do such policies boost patients costs, they also compromise safety and invite fraudulent providers who jeopardize the effectiveness of specialty drug therapies.
So whats the problem? Dispensing and administering specialty drugs requires a level of experience and expertise that most traditional pharmacies simply do not possess. A specialty drug pharmacy doesnt resemble the corner drugstore most consumers have come to know. These new drugs represent the latest high-tech therapies, including large-molecule biologics (essentially derived from organic substances or living organisms) most of which may require careful handling. Stocking and dispensing biological agents require sophisticated logistical planning, climate-controlled shipping, meticulous storage with specific protocols and documentation. Patients who receive these therapies require extensive monitoring, risk evaluation, mitigation strategies for side effects and the close support by a physician.
Physicians are in a position to evaluate the expertise and capabilities of the specialty pharmacy providers their patients patronize. In a recent survey, two-thirds of the physicians agreed that some traditional pharmacies are competent to handle and dispense specialty medications, but three-fourths also agreed that most pharmacies do not possess the expertise and capability to manage complex drugs.
After intense lobbying by a diverse group of stakeholders, CMS backed away from its proposed ban on preferred pharmacy networks at least for now. However, the federal agency never officially withdrew its proposed rule change. Unfortunately, this isnt the end of the debate about whether health plans have the right to lower enrollees costs using exclusive networks. When theres money at stake, politicians (both state and federal) are often receptive to constituents pleas for help. Small businesses like community pharmacies often get a sympathetic reception when they descend on the state capitols lobbying for protection against health plans that force them to compete on price. However, Congress and state legislatures should avoid these bogus consumer protections.
I am disgusted by one development. The drive by insurance companies to force people to get their meds via mail pisses me off to no end.
This is just a shout-out to anybody who has any good ideas. What the heck can I do?
Are there any trial research projects you can sign up for
I am curious as to why you feel this way.
I find it to be much cheaper and a lot more convenient than having to go to the pharmacy for refills.
Am I missing something?
The pharmaceutical companies often have discount programs for hardship cases. Also, companies such as Walgreens, Kroger, Walmart, etc. have programs which allow you to buy generics at reduced prices, sometimes as low as $4. There are also Mexican and Canadian companies which sell online.
All good ideas. I’ll check it out. Thanks!
Why does this piss you off?
I have seen lists on the internet, but maybe a doctor or specialist can let you know.
Another issue us proximity. Usually during a trial you have to go in once in a while for a review.
Contact the companies that market the molecule(s) you need and explain your situation. They may provide the item at a discount or no cost.
Try contacting the manufacturers directly and explain your situation. Many have programs for uninsured folk.
I found Meloxicam to be better than Celebrex and a hell of a lot less expensive.
Thank you. These are all good ideas, and I will be exploring the possibilities!
God bless you from me as well!
My general physician had some drug discount cards in his office that were free to his patients. I took one and started using it several years ago. I too have rheumatoid arthritis and take methotrexate. The discount card knocks about $12-15 off the regular cost. I’ve seen other cards, some of them have been received in the mail; they’re from different phara companies.
You might ask your doctor or ask someone down at your local health clinic if they know of any drug discount cards available to people w/o insurance or those, like me, who are not on a lot of medication and do not subscribe to any drug plan.
Sounds like the volume of such programs is going to have pressure put on them, however, by this circus-juggling game that is being played with America’s healthcare plans. In the end, most people still paid for their care; it’s just HOW they did so was the question.
There’s definitely going to be pressure all around. The old fashioned drug stores may become rare birds, if not extinct.
In my relative's case, the following situations would not have occurred with a local pharmacy:
1) Delivery time from placing order unpredictably varies dramatically from 2 days to two weeks.
2) USPS left order on doorstep (too big to fit in mailbox), was stolen, customer out big money and didn't get medication on time. Appeals and complaints to both mail order pharmacy and USPS have failed.
3) So the next time she specified "signature required" and paid extra shipping charge. Sent USPS regular again.
The First Gift!
Sounds like something that Uncle Sam would be on top of eventually, but that would require the Fedzilla to care about what is reasonable.
Is it possible for her to get a bigger mail box or have it sent to a PO box, or someone who is always home, put up a sign asking the mailman to take anything too big for the mailbox back to the post office for pickup, etc.?
You could try a patient assistance program to help you get the medication @ little to no cost. AbbVie does offer one for Humira (I take it for Psoriasis)
There’s a form you can print & fill out and also an 800 number to call. Best of luck...
For the disabled with complications and elderly nothing can really replace the one on one oversight of a good local pharmacist. We use mail order for two Asthma Nebulizer inhalants due to billing issues. The company sending is careful to coordinate shipment with us. Wife's Pulmonary doc writes the script and it stays the same so were reasonably safe.
On the other hand stuff like Thyroid hormone which can vary each visit based on her blood work results gets filled by a local independent owned pharmacy we've been doing business with for about 20 years.
We live in a secluded rural community so theft of stuff isn't an issue in general. Were usually home and the dogs tell me a delivery person is there.
Been using these guys for years. Tried others, but always came back for price and customer service.
They sell Canadian and Brit drugs generic and name brand. Savings range from 20 to 90% over what you pay US.
Legal and fast. Don’t know if they have your needs, but worth a check. Obviously they will not do pain killers, but anti-inflammatory arthritis should pass muster.
I gladly use Expresscripts and get 3 months supply for what a local pharmacy charges for 2 plus it’s free shipping and they arrive within 3 days.
Get a mailbox that locks. I did after a little finagling with the local post master. And I live in the hills...
A lot of the pharmacy companies have patient assistance programs for those like you who cannot afford their medications. Ask your doctor to help or find out if there is a medical social worker or RN case manager available to help you find the programs/file for them.
“I am disgusted by one development. The drive by insurance companies to force people to get their meds via mail pisses me off to no end.”
So I guess you don’t shop on-line for anything else?
They have an 800 number and offices in California.
So I guess you haven't had to try to fix a mistake (meds) made by bureaucratic on-line company?
Thank yuou very much for this information.
I appreciate these ideas. Grateful to your input!
Sounds good -— I’ll look into it.
“So I guess you haven’t had to try to fix a mistake (meds) made by bureaucratic on-line company?”
I only take one BP med and it has never been a problem. But I would rather be able to deal directly with a local pharmacist than some floozie over the phone. It completely destroys your relationship with a key caregiver in the name of saving a buck. It’s just another VA-like government/big business intrusion into what should be a personal decision.