As a person with Devic's Syndrome, a rare illness similar to Multiple Sclerosis, there are numerous difficulties that plague my life. First and foremost there is the physical repercussions that I endure from having this disease. The second is the financial strain it puts on my family. I lost count of the number of times we had to re-modify our mortgage so we wouldn't lose our home. Borrowing money from our relatives left a sour feeling of shame and worthlessness. The unrelenting struggle to keep afloat wears on us emotionally and sometimes the stress is heavy enough that we buckle from the sheer weight of it. Which brings me to my next topic.
I recently came across an article regarding the gross escalation of drug prices here in the United States. I'm sure you all have heard about Mylan's swelling Epipen costs and Martin Shkreli's deplorable attempt to make a life saving HIV drug treatment basically unattainable due to the drastic price increases. The mention of 3 top treatments for Multiple Sclerosis is what made me take notice of this piece yet after reading it I have to admit I was completely ignorant when it came Pharmacy Benefit Managers.
Most of us, including myself, put the blame on Big Pharma but PBMs have a bigger hand in the cookie jar than they do. Surprisingly, most firms aren't making a profit from the rising costs that they themselves are setting. PBMs are responsible for deciding which medicines are covered, what it'll cost insurance companies, and set the price for pharmacies as well as patients. They do this with over 210 million American's plans and it's all done for profit, not necessarily for the patient's best interest. This supplies them with tremendous bargaining power for purchasing medicines in bulk. Express Scripts, which is my own prescription company, is one of 3 pharmacy benefit managers that commandeer at least 70% of the market. This puts Big Pharma in quite the conundrum considering that they aren't capable of reaching the millions of patients unless they play ball with the PBMs.
Now, by PBMs negotiating lower prices with the drug companies you would think this helps patients by having to pay less for life saving medications that they rely on. Wrong! Sad to say that's rarely the case since greed's a bigger epidemic than any other disease on earth. PBMs don't pass those savings onto pharmacies, insurers, and definitely not the patients. Instead they keep the cash and for Express Scripts that translates to an increased profit margin of 500% since 2003. What's even worse, PBMs continue to increase their profits by refusing to cover hundreds of medicines, approximately 239 to be exact, so they can attain even more bargaining power and as a result patients are suffering due to their inability to afford life saving treatments. CVSHealth purposely excludes 3 top MS drugs so they can pressure makers of other treatments into giving larger discounts. This deplorable game they play has dire consequences for MS sufferers who doctors prescribe those specific excluded drugs. As someone who battles MS daily I can say for certainty that we only respond to specific medicines that are tailored to our individually unique symptoms.Developing a tolerance can also happen so our treatments would require adjustments or possibly even a new therapy altogether. This tailoring of medications doesn't happen overnight and mostly is done through trial and error if certain drugs are cut from our plan then our options are extremely limited. Instead of filing an appeal for exemption, which I honestly had no idea you could do, patients just end up not taking their meds. I, myself, have done this on occasion and the results are undesirable. My flare-ups increased and hospitalizations ensued. You might very well be aware that increased emergency room visits drives up the overall cost of health insurance. It doesn't take an economist to notice this disastrous domino effect and it's us, the patients, who suffer the most.
So, who's the real culprit, pharmaceutical companies or pharmacy benefit managers?
If you're having trouble affording your medication I've listed some links that might be able to help. Also, if you have a quick moment please answer the survey below. Thank you.
Resources for medication aid: