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A drug’s cost and value

A Box of Soap

This morning’s breakfast—an orange, a banana, some cheese spread on a slab of homemade bread, eight or 10 Whopper malted milk balls, a little milk, and one pill worth $133.33.  My doctor suggests that I take 60 of these each month to total $8,000. That will cost America’s health industry $96,000 this year.

I wouldn’t feel comfortable asking all stakeholders collectively if my continued health is worth that much.  If you think of the country’s health expenditures in total as drawing from a shared money-pit you can easily make the case that I have used far more than my share in the last year and a half.

With my usual lack of foresight, I chose a disease that is pretty rare, not attracting research dollars with telethons, marathons, and celebrity support.  As of yet there is no understanding of the causes and, before that gold-plated pill I ate with my breakfast, no effective treatment or cure.

My new pill was just cleared by the FDA for use a couple of months ago.  Not exactly a guinea pig, I am still among the first patients to whom this drug was made available.  If you watch the evening news, you are dulled by a cavalcade of ads shilling new drugs for which you should ask your doctor, invariably followed by a recitation of possible side-effects —high blood pressure, bleeding fingernails, loss of simple math skills, marital failure, and slow painful death followed by depression.  What a curious sales strategy.

The only side effects I was warned against were possible nausea and diarrhea, and those are usually temporary.  So far there’ve been no abdominal eruptions.  I’m also supposed to begin having my liver function checked monthly.  Now I feel duty bound to learn what my liver is doing in there after all these years of blissfully ignoring its existence.

I spent my working life employed by a company that sponsored many good insurance plans.  Now Medicare has also taken me under its wing.  My co-pay on the $8,000 monthly will be about $25.  Does that make any sense? Based on my retirement income, I could only pay full price for a couple dozen pills in a year.

That raises a lot of questions.  There will be some who share the same affliction but have no insurance.  Should they be denied this expensive new treatment?  I can’t make the case that I deserve it more.  Some who suffer the same ailment may never be diagnosed if they cannot afford to see specialists.

This new treatment does not claim to be a cure.  It only slows the progression of this disease.  How much postponement of the inevitable is worth $96,000 a year?   Would that same amount be more ethically spent on exams and wellness care for kids who otherwise can’t afford them?  Their whole life is before them.

This wonderful pill looks like an ordinary gelcap.  How was the price set at $8,000 a month?  Because there is so little demand for it I don’t think we’ll ever see the generic version sold at giant discount stores for $14.95.  Development and research costs must be recouped, I get that, but looking at the half-full little bottle of caps makes you wonder at the cost.  My pedigreed UW specialist seemed astounded that I would even hesitate.  Okay.  Damn the torpedoes, full speed ahead..

(Don Vowell gets on his soapbox regularly in the Keizertimes.)