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Lialda pill price. "We've been trying for a long time to raise these prices," he said.
The industry says patients are overcharging for a product they don't need and that new regulations are to blame. Patients "don't understand" the current rules, said Dr. Christopher Wojcik, the CEO of St. Joseph's Healthcare Medical Center in Brooklyn, New York. A similar story emerged last year in the Chicago area, where patients protested that the prices of several pharmaceutical agents had been raised.
"We'll be hearing these stories for as long there is a high volume of prescriptions," Wojcik said, speaking on behalf of the trade group America's Health Insurance Plans, in a phone interview. "The reality of it is, if we're using these drugs and a patient is being priced out of those drugs by the drug company… it's our problem."
The current drug benefit is a relic of the Medicare era that dates to 1992. For several years, insurers and private have been paying doctors for some of their drugs, and then reimbursed the patient for a larger portion (known as the "primary care" package) that includes at least one brand-name drug.
Since 1993, the government has subsidized a new drug benefit to replace the old.
For years, doctors paid their bills out of pocket, and many didn't keep detailed records of what drugs they prescribed and doses. But a 2011 Health Affairs article noted that while most doctors were still in the dark, it was clear physicians were overprescribing new drugs, "because their patients have more prescriptions for their old drugs, and new ones for medications that patients don't necessarily need, like cholesterol-lowering drugs for patients with high cholesterol … even some high-quality studies have suggested that patients don't need these drugs."
The U.S. Food and Drug Administration didn't formally set a price cap, but it encouraged negotiation by setting a 30 percent cap for group of brand-name drugs, such as Celebrex and Pfizer's Lipitor, up to 65 percent when they sold in packages of less than three and three-quarters pills. But as companies pushed aggressively to maximize their profits,
Clotrimazole and betamethasone cream coupon doctors, often by taking on the financial burdens of those drugs (such as deductibles and co-pays to cover a high deductible), pushed drug benefit that, among other things, allowed them to charge more. The price of new drugs shot up, the result of rising costs and pressure for companies to sell those drugs, according the New England Journal of Medicine and others.
"I don't think the industry wants to be responsible for the rise of prices these products," Wojcik says.
Patients have complained about the price increases, though some drugmakers have been able to negotiate discounts with insurers and hospitals. The industry argues insurers and hospitals are using the savings to fund their cost-sharing obligations. Wojcik acknowledges these savings, though rare, can lead to a substantial increase in revenue. Last week, when the New York Times published an article about high drug prices, it focused on a new drug, form of clomipramine that's commonly used to treat depression and anxiety. It was priced $5,600 for 14 weeks compared with an off-label price of $9,000. The paper reported high costs to insurers and Medicare.
The industry, which is composed of large pharmaceutical companies that manufacture products for other major drugmakers, has aggressively lobbied efforts to increase prices and limit drug benefit changes. In 2014, the Department of Health and Human Services Congress approved the Biologics Price Competition and Innovation Act, or BRIC as the bipartisan effort to try limit the drug price escalation was called. The law set a 15 percent drug price limit on brand-name drugs (the new drug benefit did not cover generics). Other provisions included the development of risk-based purchasing networks, or RBRs, for Medicare Part D, Advantage and prescription drug programs. The federal government has also started buying up brand- name drugs to buy lower prices from brand-name drugmaker and to keep out generic brands. But there's still a long way to go. Last year, the BRIC Act received $10 billion in additional funding under the Affordable Care Act, which government said would help limit the rise in drug prices, and the industry says it will continue its lobbying efforts for the law.
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