NYT's "Exhibit A" Piece -- On Why All US Govt. Payers MUST Be Allowed To Negotiate For Better Drug Pricing

The New York Times has a very very cogent, and very long article -- on the front page, center -- this Sunday morning, on "cost" of chronic diseases in the US. And the bulk of the article is about the cost of Medtronic's Type I diabetes pump solution (not Merck's sitagliptin injection for Type II). [And, to be sure, "cost" may be too gentle a word here -- "profiteering" might be more apt -- go read it all.]

The article does a comprehensive job of explaining "what all is broken" (and that is still, post the ACA of 2010, a very long list of things) with the "profiteering" underway in chronic diseases -- here in the US, as compared to the United Kingdom, or the EU -- primarily how the sky-high "costs" of the same are only partially covered in the US system.

Moreover, to reinforce the point that this is not an abberation related only to Medtronic's pump set -- the article makes specific note of the Remicade^®/Simponi^® product line -- to which Merck still holds the US selling rights, post the arbitration settlement, out of the Schering-Plough bust-up faux pas (not that one -- no, the choosing of the wrong structure to avoid triggering a $500 million in an upfront arbitration settlement).

It also mentions the cost of Crohn's disease management -- which is a legacy Schering Plough program (but doesn't mention the name of that treatment). Do go read it all -- but here is a bit:

. . . .For Kristen Bailey, 28, of Colorado Springs, who has Crohn’s disease, an intestinal disorder, that meant not marrying her fiancée so she could continue to qualify for drug company assistance programs that provide, at no cost, two medicines with list prices of more than $16,000 a year in the United States. . . .

For Jeffrey Kivi, 51, a chemistry teacher at Stuyvesant High School in New York, it meant recently giving up an intravenous drug that, as an outpatient, he had had infused every six weeks for years to keep his psoriatic arthritis at bay. Before taking that drug, [Merck's US distributed] Remicade, Dr. Kivi was on high doses of steroids for debilitating joint pain that left him unable to walk at times.

But when his last three-hour infusion at NYU Langone Medical Center’s outpatient clinic generated a bill of $133,000 — and his insurer paid $99,593 — Dr. Kivi was so outraged that he decided to risk switching to another drug that he could inject by himself at home. That is true even though his insurer did not require him to make up the difference.

“I cannot, in good conscience, continue to force my insurance company to pay $100,000 to NYU each time I get a Remicade infusion,” Dr. Kivi, who was a drug company researcher for many years, wrote to the hospital. “That’s insane. . . .”

A good portion of that astronomical Remicade infusion cost above was driven by the place -- the specific out-patient for profit clinic affiliated with a teaching hospital -- at which the patient in question received the Remicade injections -- and even so, I think we all recognize that one hospital's clinic is not 100 times better than another, in the US. Not for simple infusions. Maybe twice as good -- but not 100 times better. . . yet that was the treatment cost differential -- one-hundred fold. Astonishing. And in need of some rather aggressive additional reform, in my mind. Buckle up, Merck adn J&J -- and all you for profit hospital chains.