The Cost of Treatment

By: Marcus Hopkins, Blogger

One of our primary concerns, here at HEAL Blog, is the availability of effective HCV treatments to patients not only in America, but also around the globe. With this availability comes the unfortunate reality that treatments are expensive – so expensive, in fact, that Medicaid Health Plans of America has begun a public push to voice their concerns over the price points of the new HCV medications (most notably, Olysio and Sovaldi).

The sticker shock that comes with new HCV medications is not just shocking to Medicaid (which stands to see the largest increase in HCV treatment costs), but also to UnitedHealth Group, the nation’s largest insurer. UnitedHealth, by itself, spent $100 million on HCV medications during the first quarter of the year, alone, setting a potentially devastating forecast for the rest of their year.

As we’ve stated in previous posts, the price tag for Sovaldi is $84,000 for 12 weeks of treatment; Olysio is $66,000 for 12 weeks. These prices place treatment well out of the range of the uninsured or underinsured, but even for those who have insurance, how long will it be before providers begin refusing to cover the costs associated with these treatments?

Pills spilling out of the bottle onto money.

Source: BioNews TX

As it stands, these prices were clearly not taken into account when determining 2014 insurance premiums, which could spell trouble for the bottom lines of major private insurers, as well as for both Medicaid and Medicare budgets.

The latter issues are, for me, of greater concern – these are programs created for those in our society who most need assistance; if their budgets are broken by the cost of HCV treatments, who will step in to pick up the slack? Beyond non-profit organizations, whose budgets are already in dire straits, there really are no fallback organizations who can step in to help those most likely to suffer from HCV.

Demographically speaking, those most at risk for contracting HCV fall into one of two categories – the elderly and the poor (with or without incidence of intravenous drug use) – the very two categories Medicaid and Medicare were designed to serve.

It will be interesting to see whether or not the “Free Market” will actually dictate how these treatments are priced. If it’s an issue of Supply and Demand, logic (and economic theory) dictates that, if the need for treatment increases as expected, Demand will rise, and as such, the costs will increase as the Supply shrinks.

However, if patients (via their insurers) are unwilling to pay the prices set, while manufacturers be forced by market forces to lower their price points? History tells us that, yes – insurer price fixing for certain treatments has in the past lowered the cost; this is not, however, assured.

As we move forward, a serious discussion must be had if we intend to treat and cure illness – “Which is more important? Profit or people?” Clearly, the lines do not have to be so firmly delineated; there is always room for a grey area. How that grey area is defined, however, is up to the consumer.

Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates.

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