Quote:
Originally Posted by GWN7
One of the drugs I now take is Brilinta 90 mg 2X a day. Here they cost me $96 (or $73.21 US$) for 60 tablets. According to https://www.drugs.com/price-guide/brilinta it is $333.56 in the USA (Add 30% for the exchange).
It is interesting to note that the 60 mg and 90 mg are the same price. |
What drugs "cost" in the US depends on what list you are reading from and what pocket you are paying from.
The list price of Brilinta in the US might be $425 for 60 x 90 mg (don't have actual #, that's just an example). The reported average wholesale price (AWP) is $341 (from
http://dsi.com/documents/10710/11035/Effient+Daiichi+Sankyo-Information+For+Vermont+Prescribers+Of+Prescriptio n+Drugs/045fbeca-e1c6-4fb6-b773-0408c6e01da2). But actually large purchasers pay much less than AWP. The pharmacy benefit managers (PBMs) that commercial insurers and hospitals use, and, government programs, might pay more like $275 (again, just an example). The patient with drug insurance who goes to fill a prescription will pay only a co-pay, might be $25 to $40. The patient without insurance who goes to fill a prescription might have to pay the full list price $425.
Drug pricing is a very complex topic. Might read this for starters, talks about how govt programs pay different prices, it is an old article but still relevant.
http://www.nhpf.org/library/issue-briefs/IB807_DrugPricing_08-29-05.pdf Private insurers usually pay more than govt programs.
How the situation got so complicated, is another story, but basically:
- one manufacturer has a legal monopoly on the drug for about 10 years post-approval
- the drug is effective, and possibly even vital, to treating a disease
- the government agency that approves the drug for the disease does not know how much the manufacturer will charge for it, and doesn't consider cost anyway (may actually be prevented by law from doing so, I'm not positive)
- the doctor prescribing the drug doesn't have any reason to care what it costs (and may get paid by the manufacturer for prescribing lots of it)
- the patient using the drug doesn't have any reason to care what it costs (because he pays a fixed $20 to $40 co-pay no matter what the cost is)
- the insurer paying for the drug has a mix of legal and business requirements to pay for the drug, no matter what it costs, as long as it is approved for the disease and the doctor has prescribed it
- certain govt programs that also pay for the drug have the same legal obligation, and are also prohibited by law from negotiating for a lower cost; other govt programs don't have these requirements
- the relevant laws were passed by congressmen who receive large sums of money from the manufacturer