Prescription Drug Costs
The New York Times's second editorial this morning praises the state of Texas for becoming the first state to require vaccinating girls against HPV. The new drug, Gardasil, boasts being the only drug to guard against the disease that causes cervical cancer in women. Opponents of the mandatory vaccination have nothing more against it than they do against condom distribution in schools, family planning advice, and the birth control pill: that it will promote sexual promiscuity. Of course, we all know that to be false, so there's no point in even trying to debunk that statement. As Governor Perry recently said, the HPV vaccine promotes promiscuity just as much as the Hep B vaccine promotes drug use.
I'm quite impressed that Texas was the first state to pull this off. But other states are not just sitting and doing nothing. Virginia and Colorado are both moving to mandatory vaccinations as well. As is Illinois and probably a bunch of other states as well.
While all of this is good news for the fight against cancer in general, in it's congratulatory editorial, NY Times is overlooking an important issue that is rearing it's ugly head once again: the cost of the drug. A full round of the vaccine (3 doses over an 8-month period) costs $360. While most insurance companies are covering the vaccine, they are reimbursing only $2-$15 for each $120 dose. That leaves the doctor covering at least 85% of the full cost they pay Merck, the makers of the drug. So doctors are either not providing the vaccinations, charging their patients a surcharge, or writing prescriptions for the patients to purchase the vaccine and bring it back. All this does is pass the bloated costs of the drug onto the patients. Meanwhile, Merck is spending it's time lobbying state legislators to pass the mandatory vaccination bills and donating tens of thousands of dollars to their campaigns (see Virgina). What about just lowering the cost of the drug?
What actual good do these laws do if the doctors can't afford to stock the drug and the patients are saddled with the high costs? Will costs naturally come down once the drug becomes mandatory? I'm not an expert in medical economics, and my gut feeling could be wrong, but somehow I doubt it.
I'm quite impressed that Texas was the first state to pull this off. But other states are not just sitting and doing nothing. Virginia and Colorado are both moving to mandatory vaccinations as well. As is Illinois and probably a bunch of other states as well.
While all of this is good news for the fight against cancer in general, in it's congratulatory editorial, NY Times is overlooking an important issue that is rearing it's ugly head once again: the cost of the drug. A full round of the vaccine (3 doses over an 8-month period) costs $360. While most insurance companies are covering the vaccine, they are reimbursing only $2-$15 for each $120 dose. That leaves the doctor covering at least 85% of the full cost they pay Merck, the makers of the drug. So doctors are either not providing the vaccinations, charging their patients a surcharge, or writing prescriptions for the patients to purchase the vaccine and bring it back. All this does is pass the bloated costs of the drug onto the patients. Meanwhile, Merck is spending it's time lobbying state legislators to pass the mandatory vaccination bills and donating tens of thousands of dollars to their campaigns (see Virgina). What about just lowering the cost of the drug?
What actual good do these laws do if the doctors can't afford to stock the drug and the patients are saddled with the high costs? Will costs naturally come down once the drug becomes mandatory? I'm not an expert in medical economics, and my gut feeling could be wrong, but somehow I doubt it.
Labels: prescription drugs
posted by elanit | 9:02 AM
2 Comments:
I'm an opponent of mandatory vaccination for HPV, and it has nothing to do with my feelings about promiscuity etc.
Rather, it has to do with the fact that the vaccine is relatively new, and while it has completed medium-scale clinical trials successfully, and been approved by the FDA, it has not been widely used yet. I think we need about 5 years of real-world data looking for possible adverse events in cases not covered by the testing before making it mandatory.
Also, something worth noting is that the methodology of the clinical trials has gotten some flack (about the undisclosed aluminum content of the placebo), and of course the trials were conducted in adults, while the vaccine is being suggested for pre-adolescents. Due to ethical concerns, it's very hard to use children's data in approval trials.
Therefore, I think that the vaccine should be optional, not mandatory - we should see how effective it is in the real world, and what side effects are caused, before including it as a standard regimen.
I was going to write what David did about the nature of post-market surveillance. The FDA plans to implement a massive post-market effort that will require 18 months of exacting drug monitoring. No clinical trial, no matter how expansive, can compare to the real-world drug experiences of millions of patients.
HPV is an important condition but does not pose the kind of pandemic health risk that diseases like mumps and polio do. HPV does not demand mandatory vaccination yet, especially so soon after its FDA approval.
Now, on to the money: pharma exists to make life-saving products and earn fat profits while it does it. Partly because of corporate greed and partly because their operational costs are astronomical (ask anyone who has seen a drug from R&D to market about the human and capital resources involved.) Merck obviously lobbies legislatures to sell more Gardisil to earn Merck more money. A good sum will be used to defend itself against the bizillion absurd Vioxx suits still pending in all 50 states, but I digress.
I would argue that $360 for this type of brand new vaccine is rather competitive. I'm sure state Medicare/aid disagrees.
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