A friend just got a prescription of the diabetes medicine, Ozempic® (semaglutide) injection. 3 syringes: $2200. Fully insured, so out of pocket only $150.
Here the problem:
1/ High price means new medicines like this are only for well off people with good insurance
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Here the problem:
1/ High price means new medicines like this are only for well off people with good insurance
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2/ And secondly, don't think for a minute that the insurance company is paying the remaining $2050. Due to rebates they may pay $1000 or less.
So the only people who pay the full list price will be unsuspecting uninsured paying cash, who think the list price is the real price.
So the only people who pay the full list price will be unsuspecting uninsured paying cash, who think the list price is the real price.
3/ The exact same thing happens with insulin. One vial of analog insulin costs >$300. Insured people will probably get it with a copay of <$30. The insurance company has to pay only $100 or less due to rebates.
Only people paying $300 are vulnerable diabetics without insurance.
Only people paying $300 are vulnerable diabetics without insurance.
4/ So all these great new medicines we get, whether it is for cancer or for diabetes or anything else, are mainly for the well insured. Underinsured and uninsured will either not get access, or will face severe financial difficulty or go broke trying to buy them.
5/ We can do simple reforms to make the system more fair and simultaneously incentivize true innovation. I have listed some in this article on insulin. It applies to other drugs too. mayoclinicproceedings.org/article/S0025-…
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