BURLINGTON, Vt. (WCAX) – The end of patent protections last year was expected to bring the price down for the drug Humira, one of the world’s top-selling prescription drugs for rheumatoid arthritis. But as Reporter Laura Ullman found out, the laws of the marketplace don’t always apply when it comes to some specialized high-cost drugs.
“Like a lot of things in health care, there have been huge advances, and it’s good for all of our health — and those things are expensive. And it might be one of those things that we kind of have to pay for,” said Sara Solnick, an economics professor at the University of Vermont.
For Burlington resident Zephryn Hammond, that’s absolutely been the case. Hammond had been battling painful flares of Crohn’s disease until being prescribed the right medication. “It was hard at first but I was able to live my life as I had before. It didn’t really affect me,” Hammond said.
Breakthrough innovations in anti-inflammatory drugs make Hammond’s story possible. Plus, Hammond’s previous job — and now Medicaid — made the co-pay next to nothing.
But for doctors and insurance companies the process isn’t so simple. Doctor Corey Siegel, a gastroenterologist at Dartmouth Hitchcock Medical Center, says medication prices for his patients are so high that insurance companies often won’t approve coverage for them until they fail on less expensive medications first.
“They seem to have been progressively increasing over time, and more challenging to get approved with insurance companies,” Siegel said. “It’s rarely cost to the individual, the cost comes to somebody else. But the health detriment is at the individual level.”
Insurance companies — the state and federal government — pick up the bill for medications like the one Siegel prescribes and Hammond takes. “Our colleagues in other countries are paying a fraction of the cost of the same drugs,” Siegel said.
The original list price for the anti-inflammatory drug Humira in the U.S. was a little over $500 a month. Their patent expired last year and biosimilar or copycat drugs have entered the market. But even with the competition, Humira’s price per month is up to $7,000 according to GoodRX.
Solnick says that’s because the amount and cost of pharmaceutical firms’ competition don’t really exist in the field. “The market for building airplanes, car manufacturers… like these companies are so big and they’re so complex that you’re not really going to be able to get a competitive market,” Solnick said.
Solnick says generics entering the market — shortening patent exclusivity deadlines — and policy changes could slightly change drug prices but overall won’t change much. “I’m not sure that there’s some brilliant idea that’s gonna solve the prescription drug cost issue,” she said.