Thursday, June 4, 2015

Of The "Revolution Of Rising Expectations" -- Breakthrough Medical Therapies Edition -- Excellent Long-Form Article

I offer this morning's item not to pick on Gilead, nor the insurer mentioned -- Anthem. Not at all.

I don't even offer it -- in truth -- to highlight the Hep C "cure" pricing tussles.

I offer it for the next level up -- the meta-narrative, as it were, of struggling with how we -- as a nation -- will solve the Rubic's Cube®, of affording these truly revolutionary advances -- and how we'll decide "who is sick enough" to get them.

Consider that in about a year's time, the names in the below story will change, from Gilead to Bristol-Myers Squibb, and Merck -- and the disease will change from Hep C -- to lung cancer (NSCLC). We are talking about an[other] approaching fundamental policy-shifting moment -- allocating a limited pool of dollars for therapies -- even therapies for which the patients whose lives are prolonged -- perhaps by many fruitful, healthy years -- will openly announce: "that is priceless, to me".

So -- if you want to remain current (or relevant!) on these matters, do go read the long ASCO white paper, on cancer therapy cost savings proposals, that I linked on Sunday. The one thing that will be certain -- as it ever has been -- there will be rationing of these therapies (just as we now see, re Harvoni®/Hep C). The question will be -- how best (most equitably) to achieve that rationing? But make no mistake -- there will not be enough money in the insurers' coffers, or federal system -- to give everyone all that they would like to consume. So we face some daunting choices.

The story opens with a California Hep C patient suing Anthem (the plaintiff concedes that her prior street drug habit likely gave her Hep C, for which she now seeks Harvoni) -- but don't let that opening put you off. The article goes on a deep dive, about the competing policies in play, here. In any event, here is the Bloomberg story link -- be sure to read it all:

. . . .Martin makes no apology for excellent financial performance. He notes that he’s received hundreds of personal letters from grateful hepatitis C patients, and "the medical community is very, very supportive of what we’re doing."

No one, in fact, disputes the long-term public health benefits of wiping out hepatitis C—which Gilead’s drugs have the potential to do, if enough patients can get access to them. But the idiosyncratic nature of the U.S. health-care system means that the costs won’t be rationally apportioned.

In an increasingly fluid job market, more workers move from one insurance plan to the next as they shift employers. Medicaid beneficiaries move on and off the public program, depending on their circumstances. At 65, many people leave the commercial insurance market as they become eligible for Medicare. As a result, one insurance payer may face a daunting bill for hepatitis C today, the benefits of which—hospitalizations and surgeries avoided—accrue to society over the patient’s lifetime. . . .

We shall see. [Decidedly more prosaic, here, this morning -- but I personally am facing the choice of moth-balling the blog for Summer/Fall 2015 -- and restarting in November 4, or so. All for happy reasons -- and a chance to go completely off-grid -- but I am weighing the options for truly mobile (hand held) blog reports. On that, we shall see, as well.]

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