Random medication pricing question

[Ladybugs]

Just wondering if anyone knows where I can get historical pricing trends for DMDs? I want to know at what intervals and at what percentage the drug price increases. Like does the drug increase at X% every 3, 6, 12, etc. months?

I've been on Gilenya for four months. In that time the cost of the medication has gone up about $400. Although my insurance picks up the tab, I have to worry about my meeting my insurance yearly maximum. From a cost effective analysis staying on the medication may not be worthwhile. I also currently do not know how the Supreme Court's recent ACA decision will effect my insurance coverage.

I've been diagnosed for 5 years now. I've yet to have a relapse. Point being, I can't honestly attribute being relapse free due to the medication. I guess the argument is 'stay on the drug to continue to be relapse free.' Response would be 'if first 5 years after diagnosis help determine future disease course, then I might just take the risk and not go on expensive medication.'

I am a Kaiser member. So unless Novartis has increased the price of the med, I don't see why the pharmacy would increase the price of the med without any external price increase.

Please let me know if any clarification is needed.

[22cyclist]

Researching their records is something I am not all that familiar with, but I am familiar with the ACA.

Your coverage should not change at all with the ACA other than you will now get some things like mammograms, paps, for free, and birth control paid for.

You will not be kicked off of your insurance because of the ACA, on the contrary, you will be insured that you get to keep insurance with no lifetime limits.

Suggestions on your study:
1. Ask people on the board under each med section. They can research their particular drug under their insurance.
2. You can call the company and ask them.
3. There are probably other ways... some others will comment.

BTW: My Tysabri is outrageous! I pay for my health insurance, it has a lifetime limit, which has been lifted thanks to the ACA, otherwise I would have hit it. My premiums do rise, but believe it or not have not been as bad the last 2, even with the Ty and many many MRIs.

Good luck!

[Redwings]

I am a Kaiser member. So unless Novartis has increased the price of the med, I don't see why the pharmacy would increase the price of the med without any external price increase.

Volume purchasers usually have their own contracts with drug manufacturers (or their distributors) that are independent of external, "general purchaser" pricing. What Kaiser pays for Gilenya, and subsequently what they charge their members, is determined by their negotiated contract price, which can be different (lower) than Novartis' declared/external price. And when the pricing changes occur is a private business matter determined by the terms of the contract, not by when Novartis makes an external price change.

Another factor that can contribute to what Kaiser members are charged -- and the amount that's contributed toward the yearly maximum -- is Kaiser's own cost of doing business. If Kaiser's cost of acquiring and distributing Gilenya goes up, then the price of the drug to the members can go up accordingly. Those internal price increases are independent of Novartis' prices.

And one more factor that can contribute to drug pricing (and thereby yearly benefit totals) is the type of medical plan. Medicare and private plans operate under different rules.

As a side note. Is Gilenya even on Kaisers formulary?

[Ladybugs]

Thank you everyone for your feedback.

Gilenya is not on Kaiser's formulary (I get the insurance through MRMIP.) My neuro had to put in some kind of request.

[onlyairfare]

You might ask you friendly neighborhood pharmacist about price trends.

I can tell you that when I began on Copaxone in 2002 the list price was $985 per month and I had a flat co-pay of maybe $50. I quit taking Copaxone around 2008 when the list price had increased to $3,200 and my insurance had changed and required 25% co-pay, or $800 per month.

The drug tripled in price in less than 6 years. No explanation given.

[Special Kay]

The stated cost of my Avonex has more than doubled in the 5 years I've been taking it. I pay a fixed co-pay so the cost to me hasn't changed, but nevertheless, I find it alarming.

In 2007, it was $1,536 for a four-week supply. Last month, it was $3,717. That's a 140% increase!

[onlyairfare]

I am guessing that the pharmas charge as much as they can get away with, keeping in mind they must balance how many customers they lose due to price increases vs how many don't care because they have a flat co-pay and their insurance company (or its PBM) negotiates a low price. Also in the mix - how generous to be with the assistance programs.

Between assistance programs and insurance coverage, very few people pay the "list price." Even a high co-pay, let alone having to pay list price, causes many people to drop their DMD. I have read that only one-third of MS patients get DMD therapy, and I suspect high cost is one reason.

[Thomas Jackson]

My Betaseron costs $3,600.00 a month. No copay-good thing because insurance, other meds, and doctor copays take half my disability check. Interesting to me is the profits the pharmas make.

[onlyairfare]

The pharmas will make a legitimate argument that the pharmaceutical business is high risk (it costs $1 billion to bring a new drug to market), therefore they deserve a high reward (profit or return on investment).

My question is: presumably they made a nice profit when they sold Copaxone at a list price of $985 per month, so why do they need to triple the price to earn a profit now?

Another question - What else should we expect when our pharmaceuticals are developed and sold by publicly traded companies who are in business solely to make a profit?