Hidden costs

I went down a rabbit hole of research to understand the skyrocketing costs of insulin after reading this op-ed in the New York Times. Written by Dr. Danielle Ofri, a practicing physician at Bellevue Hospital in New York, she begins the piece by walking through the dizzying experience of managing her patient’s insulin for Type-1 diabetes: near-constant changes on what is covered, and how much is covered. As a result, her patient’s out-of-pockets expenses changed month to month, making it difficult for the patient to budget on a fixed income. This doctor was willing to go above and beyond to work with the pharmacist to figure out what was going on. Sadly, they had little success, and it struck me how few patients have advocates like Dr. Ofri on their end.

In my research, I felt the same dizzying experience as I navigated the pharma value chain, generics, drug patents, and the system of rebates and coupons that pharma manufacturers, distributors, PBMs and insurers play with to get drugs covered and drive up costs. All of this, at the devastating expense of their patients: people unable to pay the $1,000+ a month for their medication, people missing doses, people rationing their doses, and the black market, from people donating their doses once a loved one has passed away to people seeking alternative providers beyond our borders.

This research also led me to reflect on a company I recently reviewed. The company wanted to help low-income consumers access drugs at a more affordable cost, and a big piece of its model was using this system of rebates and coupons. That sounds promising at first glance, right? Lowering the cost of drugs means it’s more accessible, and then improved adherence, then improved health outcomes. But maybe not: the story behind insulin was a reminder of how some fixes can cover up the underlying dynamics that created these unjust systems in the first place. And exploiting a loophole (or something broken) here may mean something else must break down in another part of the system. Someone always pays. Sadly, it seems like it’s usually the consumer that has the least power in the system.

Also, related, I’m currently reading Elizabeth Rosenthal’s amazing An American Sickness. I don’t know why it took me so long to pick the book up, but I highly recommend if you’re interested in or working in healthcare.

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