This $69,600 drug makes your health insurance cost more
You’ve probably seen the ads.
A woman plays with her puppy after taking Humira to relieve pain and prevent joint damage from rheumatoid arthritis.
A man is able to meet his girlfriend’s parents over dinner thanks to the drug easing his ulcerative colitis.
A woman plays in a pool without feeling self-conscious now that her red, scaly psoriasis rash has cleared up.
Humira can change lives, but it also comes with a hefty price tag — $69,600 per year, according to the company’s patient help line.
Humira tops a list of the drugs causing the biggest increase in health insurance plan spending in Oregon.
A new state report lists the top 25 drugs pushing insurance costs up, the top 25 most costly drugs and the top 25 most prescribed drugs in 2018.
Humira is No. 1 for increasing insurance costs and No. 1 on the list of most costly drugs, which is based on total annual spending by insurers.
It tops both lists despite not cracking the top 25 for most frequently prescribed.
Oregon’s Prescription Drug Price Transparency Act, passed by the Legislature in 2018, requires drug manufacturers and health insurance companies to report drug price information to the state.
“These lists highlight the goal of the drug price transparency program,” said Andrew Stolfi, Oregon Division of Financial Regulation administrator and a state insurance commissioner. “They provide a first step to transparency for Oregonians, and help all of us better understand which prescription drugs affect health care costs.”
Rising drug costs are contributing to ever-higher health insurance costs.
Employer-provided family health insurance costs $19,565 per year, on average, in the United States in 2018, according to the Kaiser Family Foundation.
In comparison, mortgage payments on a $250,000 house with no down payment would total about $15,000 per year, according to online mortgage calculators.
Drug prices are notoriously opaque.
In its report, the state did not list the prices insurers actually pay for the drugs.
The amount varies based on rebates and other discounts they negotiate.
For patients, out-of-pocket spending can swing wildly.
Mavyret is No. 2 on the list of drugs that boost health insurance costs.
The drug can cure hepatitis C in 8-16 weeks, costing $26,400 to $52,800 depending on the length of treatment, according to the manufacturer’s website.
People without insurance could face the full cost if they don’t qualify for financial help.
Those with insurance and a co-pay card from the company can pay as little as $5 per month, Medicaid patients can pay $8 or less per month, and Medicare patients pay $650 to $2,542 out-of-pocket per month, according to the company.
People with multiple sclerosis can slow the progression of the disease with Ocrevus — No. 3 on the state list of drugs pushing up insurance costs.
The wholesale cost is $65,000 for one year of treatment, according to the manufacturer’s help line.
Some patients have been hit with bills for twice that amount from a single visit to a clinic or hospital to get Ocrevus, which is delivered as an infusion over several hours.
Last summer, MS patient Laura Kolaczkowski shared screenshots of her $142,546 bill with the media.
The largest part of the bill was $136,257 for the Ocrevus. But she was also billed $5,833 for a four-hour infusion process.
“Sticker shock doesn’t even describe what I felt as I looked at the amount: $142,546.40. That is my entire bill for this twice-yearly treatment,” the Ohio resident wrote in a column for Multiple Sclerosis News Today.
Her insurance picked up most of the bill, but Kolaczkowski said she still had to apply to the company’s patient assistance program to help cover her out-of-pocket balance of $2,126.
Stelara ranked No. 4 on Oregon’s list of drugs that push up insurance costs. The drug treats autoimmune diseases such as Crohn’s disease, psoriatic arthritis and plaque psoriasis.
The annual list price of Stelara is $132,024, according to the company’s website.
Patients can pay as little as $0 per month or the full list price of $11,002 each month depending on their insurance coverage and financial situation, the website said.
Like Humira, Stelara suppresses the immune system and reduces inflammation linked to a variety of disorders.
But the drugs can lower the body’s ability to fight infections, including tuberculosis, and they increase cancer risk, according to patient warnings from manufacturers.
No. 5 on the list of drugs that increase insurance costs is Truvada.
The drug reduces the risk of getting HIV through sex when taken every day and combined with safer sex practices, according to the manufacturer.
The annual cost is $21,095 without insurance and financial aid, according to the company’s patient help line.
Generic versions of Truvada are available in countries such as Australia for $1,560 annually, according to the British newspaper The Guardian.
Truvada maker Gilead announced this year the drug will be available as a generic in the U.S. in September 2020.
Side effects can include kidney failure, liver problems, bone pain and fractures, according to patient warnings.
The new Oregon report on drug prices was a subject of discussion this week during a roundtable talk Sen. Jeff Merkley, D-Ore., held with health and social services providers in Portland.
“Every year, I hold a town hall in every Oregon county. No matter where I am, there is one issue that Oregonians consistently ask me to address: the price of prescription drugs,” Merkley said. “When it comes down to it, the only people in this country who think drug prices aren’t way too high are those getting rich from drug company profits. We need to stand up to Big Pharma, put a stop to pharmaceutical companies’ greed, and provide Americans with much-needed relief.”
In June, Merkley joined a Democrat and a Republican colleague in introducing the End Price Gouging for Medications Act.
The bill would stop drug companies from charging Americans more for prescription drugs than the median price for those drugs in 11 developed countries.
President Donald Trump also has put forward a proposal to bring prices in America more in line with prices paid in other countries.
Americans pay significantly more for medications than residents of developed countries where governments provide most health care for citizens and negotiate over drug prices.
Merkley wants Medicare to be able to negotiate over prices.
Pharmaceutical companies are fighting the moves, saying price controls would stifle innovation and reduce the number of ground-breaking new medicines.
The trade group America’s Biopharmaceutical Companies says 57% of all new medicines come from the United States.
The group said patients in countries with price controls have access to fewer medicines and wait longer to get new drugs.
The companies oppose proposals to allow imports of cheaper medication from other countries, saying that could open the door to unsafe, counterfeit drugs from places such as China.
During the roundtable talk this week, Merkley said American taxpayers help foot the bill for medical research, then Americans are hit again with high prescription costs when pharmaceutical companies bring new drugs to market.
Americans make donations and hold fundraisers to help fund breast cancer research, then face sky-high cancer drug prices that negatively impact patients, said Andrew Asato, director of the Susan G. Komen organization in Oregon and Washington.
In addition, companies are raising prices on old medications, including insulin, health care providers said during the talk.
For people with diabetes, skipping insulin doses or going without can trigger dramatic and horrible consequences, they said.
Complications of uncontrolled diabetes include amputations, kidney failure and blindness.
The Oregon chapter of the American Association of Retired Persons gave Merkley a petition with 16,140 signatures from people calling on Congress to cut drug prices.
“Americans depend on their prescriptions — but from cancer treatments to Epipens, drug companies’ skyrocketing prices are pushing life-saving treatments out of reach for those who need them,” the petition said. “We pay the highest prescription drug prices in the world so drug companies can make billions.”
Humira, the No. 1 drug pushing up insurance costs in Oregon, generated an estimated $20 billion for the drug company AbbVie in 2018, according to industry reports.
The drug’s patent protection expired last year in Europe but remains intact until 2023 in the United States.
AbbVie expects to make up for revenue losses from expiring Humira protections with new drugs, including the plaque psoriasis treatment Skyrizi.
AbbVie set the price for the first year of Skyrizi treatment — which includes starter doses — at $88,500.
Maintenance treatment in subsequent years will be $59,000 annually, which a company spokeswoman touted as “lower than the most widely prescribed biologic treatments for moderate to severe plaque psoriasis.”
New Skyrizi television ads show a man in swim trunks running on a beach and exclaiming, “I feel free to bare my skin.”
A Trump administration move to force drug companies to list prices in television ads was blocked by a federal judge this summer after Merck, Eli Lilly and Amgen sued.
Some companies are voluntarily listing prices.
The Oregon Division of Financial Regulation is encouraging consumers to report increases in the prices of their prescriptions by emailing Rx.email@example.com, calling 833-210-4560 or visiting dfr.oregon.gov/drugtransparency.
Drugs that ranked No. 6-25 on the list of medications pushing up insurance costs were, in order, Cosentyx, Revlimid, Herceptin, Opdivio, Symdeko, Remicade, Enbrel, Neulasta, Keytruda, Dupixent, Basaglar, Tiumeq, Zytiga, Tagrisso, Perjeta, Tecfidera, glatiramer acetate (generic), Rituxan, Eliquis and Genvoya.