“A new drug that successfully treats Hepatitis C is being hailed as a breakthrough, but is also stirring fierce debate for it’s $84,000 price tag………Compounding the issue surrounding HCV drugs is the fact that India, Egypt, and Brazil may pay just 1 percent of the U.S. price tag for Sovaldi……………..Iran, Kenya, Burma, and Mozambique have negotiated the price of $900 for a course of Sovaldi,…..“It’s unfortunate that American patients, employers, and taxpayers aren’t currently being offered a more reasonable price for Sovaldi,” he said. “It’s an issue of both public health and public solvency.”
Editor’s Note: Specialty drug costs can “break the bank” of any employer sponsored medical plan. And, specialty drug costs are hitting more and more plan sponsors these days, a growing phenomenon. We have several clients whose drug costs have soared as a direct result of specialty drug pricing. One patient, for example, is incurring specialty drug expenses of over $150,000 per year. One group’s Rx spend now represents almost 40% of the total plan spend per year as a direct result of specialty drugs.
Dumping a patient into a public exchange is one solution to getting rid of the risk which is not illegal under PPACA, as far as we can tell (click on link below):
Business Savior – Self Insurance & Shifting Sick Workers To Exchanges
In the case of Sovaldi, perhaps a stipulation in an employer’s plan document to state that the Plan will cover Sovaldi only in India, Iran, Brazil, Egypt, Kenya or Burma. There is nothing in PPACA that specifies where drugs must be covered, is there? Kind of like an EPO or HMO – your covered but only through specified providers who happen to be located in ……..Or how about Reference Based Pricing – “We will pay $900 towards the cost of a full course of treatment of Sovaldi, you pay the difference if any.”
A plan sponsor may offer to pay for the trip to Brazil, including beach side resort, five star accomodations, for the duration of the treatment. Since Sovaldi is so inexpensive in Brazil, even with air fare, lodgings and meals a plan sponsor can save 70% or more. In fact, the patient could even be given a cash reward too along with free, unlimited number of umbrella drinks while under treatment…………….
Life can be paradise as a patient these days. On the other hand, we don’t want to encourage at risk life styles do we?
“Rather than import the drug, let’s export the patient!” – Homer G. Farnsworth, M.D.