Drug costs skyrocketing since Obamacare began

February 03, 2016

The ACA law, affectionately referred to as "Obamacare" by many, has done a lot to control and regulate health insurance - Insurance carriers must pay out 80% of every dollar they collect on claims or refund the money to insureds (85% for large employer groups with over 100 employees); a long list of preventative benefits for adults, women, and children must be covered at No Cost to insureds; there is a true out of pocket maximum for insureds, and thereafter insurance companies must pay 100% of costs for the 10 essential benefits with No Limits, annually or lifetime.

What the law has failed to do is control costs for healthcare, and specifically for prescription drugs. Everyone heard about the CEO that raised the cost of Daraprim 5000%. Well, he is not alone. A survey of about 3,000 brand-name prescription drugs found that prices more than doubled for 60 drugs and at least quadrupled for 20 drugs since December 2014. The price of Lantus insulin rose 34% in a year. A widely used antibiotic called doxycycline jumped from $20 to $1,849 in six months. And a heart-rhythm drug called Isuprel costs six times what it used to: $1,300 a vial.

Meanwhile, you cannot watch a single show on television without being inundated with commercials for drugs; open a People magazine - every other page is a 2-3 page drug ad. And why is it that they are allowed to advertise to consumers? Aren't the Dr.'s supposed to be the ones who know about drugs? Some say you can't impose price controls on the drug companies. Here is the one problem with the basic economics of healthcare: after the maximum out of pocket costs, consumers are not on the hook for paying any additional costs, and drugs MUST be covered by law. So insurance companies are on the hook, and currently losing money - paying out more than they are collecting in premiums; so they raise the health insurance premiums 40-50% to consumers. See the problem?

There is no such thing as a free lunch, and with more and more Americans on more and more medications for serious conditions, something must be done. In a true 'free economic environment', you have the laws of supply and demand that control costs and consumption. We have seen this with the cost of laser eye surgery, which is not covered by insurance and paid for by consumers. People were willing to pay, and as competition and demand increased, prices came down. Unfortunately, you don't have that with traditional healthcare - hospitalizations, surgeries, drugs. Consumers don't know that one hospital is charging 10 times more for a surgery than the one down the block; they are only on the hook for their maximum out of pocket costs ($6850 for 2016). Since they are going to hit this, why not go to the BEST? And in the case of prescriptions, the latest and greatest new drug that costs $60k, $90k, or $132k a year (I had a client in my office last week who is on a med for 2 yrs following a stem cell transplant that costs $11,000/month), that didn't exist a decade ago is now the thing that you MUST HAVE to beat whatever diseases you have.

I don't have the answers and don't claim to know how to fix this; however we are seeing the unintended consequences of a law that said "no annual limits on drugs" and "true out of pocket maximums" on the 10 essential health benefits, including prescription drugs. In the past, once you hit the out of pocket maximums, you still had co-pays on things like Dr. visits and co-pays on prescriptions. If you had to continue to pay 25% of the cost of $11,000/month, would you do it? And if the big bad insurance companies are forced to pay these costs, what then happens to premiums when they start LOSING money every year? Unfortunately, the answers are tough and people don't want to be told "you can't have that drug" or "that's not covered". However, ask anyone that is on Medicare (the government's healthcare for seniors and the disabled) how their drug plan works: there is a list of medications that the government approves. if a drug is not on the list, it is not covered and you must get an exception or find an alternative. Unfortunately, I think this might be where we are heading.