WICHITA — The numbers seem fake, said Philadelphia journalist Brian Howard.
In April, Philadelphia Magazine carried a story written by Howard, its features editor, that described his first-hand experience with the rising costs of health insurance at the workplace and the unpredictable pricing of drugs prescribed for chronic conditions.
When he called pharmaceutical manufacturer Mylan to see if it had an assistance plan for his prescription drug costs, he learned it would cover $9,000 of his costs annually.
“This made me wonder: If it’s worth it to Mylan to cover $9,000 of my medication, how much money are they making on me?” Howard wrote.
Howard, 45, currently on paternity leave for the birth of a second daughter, was asked to be the featured speaker at the Sunflower Fair, to be held from 8 a.m. to 4 p.m. Tuesday, Sept. 17, at Tony’s Pizza Events Center in Salina. Howard is slated to speak about 9:10 a.m. on “Why Prescription Drugs Cost So Much in the United States.”
North Central-Flint Hills Area Agency on Aging Inc. sponsors the annual event that executive director Julie Govert Walter calls an “information extravaganza” for seniors and caregivers.
Multiple sclerosis risk
In 2003, Howard was working a day job plus taking on freelance work. Sight problems sent him to the doctor. Lesions found on the optic nerve led to a diagnosis of optic neuritis. He had a 50/50 chance of developing multiple sclerosis.
To increase the amount of time between incidents, he was put on medicine. ‘If you can tolerate the medicine, you should stay on it,” is his doctor’s opinion, Howard said in an interview Monday in Wichita.
He said his wife also does not want to increase risks by discontinuing the medicine. Currently, he is on a generic version of Copaxone, injected three times a week.
Learning in late 2018 that his employer’s insurance plan offered through the insurer United Healthcare would leave him with the equivalent of a $3,180 annual pay cut because of an individual's maximum out-of-pocket cost of $6,650 a year, Howard delved into the subject of drug costs.
“The pricing methods of drug companies in this country — largely unregulated by an innovation-obsessed, lobbyist-beset government and buttressed by taxpayer-funded research — are a big mystery,” Howard wrote for Philadelphia Magazine.
It seems entirely possible, he wrote, “that no two people in the country pay the same price for the same drug.”
The list price for a manufacturer’s drug can appear “unfathomably high,” he wrote.
The four different name-brand drugs he’s been prescribed since his diagnosis, for example, have annual list prices currently ranging from nearly $76,000 to $99,000.
Pharmacy benefits managers negotiate with pharmacies and drug companies. The difference between the high list price and the negotiated lower prices may stay with the pharmacy benefits manager or may be passed along to insurers or patients, Howard wrote. In some cases, a pharmacy benefits manager may be affiliated with an insurer or with another player in the chain.
There’s a lot of money to be made, Howard said, and the system was described to him as essentially monopoly sellers selling a product that its users cannot walk away from.
Tweaking a medicine can enable a drug manufacturer to re-patent it, he said. That’s another way for a manufacturer to make money from the drug.
Underpinning the drug manufacturers’ work and products is all the taxpayer-funded research that they rely on, Howard pointed out.
“They are all starting with research that we have paid for,” Howard said in the interview.
“One could reasonably think as this is becoming a bigger and bigger issue, the gravy train might be coming to a close,” Howard said of escalating drug prices. “Nothing about this seems rational or to be adhering to what we think of to be market principles, where there's supply and demand."
Elected officials as separated on the political spectrum as President Donald Trump and Democratic presidential hopeful Sen. Bernie Sanders have voiced concern about drug pricing, he said.
Removing the ban on Medicare’s ability to negotiate drug prices would be one way to change a system that in Howard's view is “tilted entirely” to the supply chain.
The more pressure people put on their elected officials regarding drug prices, he said, would increase the likelihood of change, in his opinion.