Thursday, April 26, 2018

Another $Million Patient

Last year, we reported on a Wellmark insured who was running through $1,000,000 a month in claims. In that case, the patient was a hemophiliac, and his treatment was obviously quite expensive.

It never occurred to me to consider the third party in that scenario: the drug company that made and sold the med(s) used in that treatment.

Flash forward (almost) a year, and FoIB Holly R alerts us to another, similar case:

"Olive-McCoy, 44, has hereditary angioedema (HAE), a life-threatening disease so rare that many doctors have only read about it ... the price of just one of Olive-McCoy�s drugs will be about $600,000 this year ... she has received hospital bills for more than $1 million"

Oy.

So first, we certainly wish Mrs Olive-McCoy well, and hope that her continuing treatments prove successful. But this post isn't really about her: it's about how "Big Pharma" actually engages in a win-win strategy with cases like this.

And yes, there certainly are other such cases:

"Pharmaceutical companies donate to independent charities that cover drug co-pays and, in some cases, health insurance premiums so that financially needy patients such as Olive-McCoy can afford the best health-care plans and get the treatment they need to survive."

Very generous of them, but one wonders "why?" Companies are in business to make money, and are accountable to their stakeholders. So why all this charity?

Well, one reason would be good will: folks like and admire companies that engage in this sort of behavior.

For another, it's good business:

"Patients such as Olive-McCoy are extremely valuable to drug companies. Costs of treating rare diseases averaged $140,000 a year in 2016 ... a pharmaceutical company�s $1 million donation to a charity for patients with rare diseases can generate up to a $21 million return in drug reimbursements."

That's a heck of an ROI, no?

But so what? If the patient gets the treatment they need, at little or no cost, then what difference does it make if the company that provides that treatment makes out, too?

Well, that's a pretty picture, but leaves out a critical detail: none of this is "free;" that is, someone pays that $21 million.

Care to guess whom?

Not saying that's necessarily "a bad thing," but it is something to consider.

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