Review: "States Deny Pricey Hepatitis C Drugs to Most Medicaid Patients" – NPR
December 30, 2015
Here's yet another opportunity to see just how ridiculous our health system is. This was an article written by Jake Harper, published a couple days ago.
Quick summary: a private company uses its money to make a new medication. They get it through a government process to sell to the public. They charge whatever amount they want, which is within their right. The main buyers (insurance companies, Medicaid managed care companies, and the government) then have to figure out how much they want to spend to buy said medication.
The article notes that "states get a discount on the drugs," but because there are neither price controls nor adequate competition in our health care system, the states end up with no leveraging power and in a very awkward situation. Medicaid in particular is this weird and convoluted program wherein the federal government takes money from states in the form of taxes then gives it back to the states in a lump sum with some stipulations.
So how are government-created programs not designed to play hardball with the pharmaceutical companies going to play hardball with the pharmaceutical companies?
They don't and they can't.
In this particular article, they discuss Harvoni (an antiviral medication) that the drug company Gilead Sciences sells for $90,000 for a 12-week regimen. (Wikipedia notes there's an Indian company who has a similar drug for 1 percent of Gilead's price.) The article interviews a patient and some providers who, essentially, make the argument that Medicaid should cover these drugs because that's what Medicaid is mandated to do – and that it's unethical to not pay these outrageous prices since the drug has such a high cure rate for Hepatitis C.
My response: The patients and providers in this story are missing the whole point. They are arguing about managing the crumbs that a terrible system gives them. They neglect to take a step back and recognize that the philosophy behind our system is the culprit.
The details in this story require an overhaul of more than just one health care factor such as pharmaceutical pricing. It requires looking at the situation from a completely different perspective. P.S.Y.C.H. builds the health care system from the ground up. We start with empowered citizens, provide education, and then let people make their own decisions apart from government intervention and any state-federal-state funding scheme.