Consider this post my opening salvo in what will become an ongoing effort to expose the boondoggle that health insurers and certain pharmacy benefit managers are foisting upon employees and employers in the US.
If you’re not interested, stop reading here. But you should be interested; in fact, you should be passionate about it, because there isn’t one person in this country who isn’t impacted by the ongoing cronyism and preferential treatment that directly impacts the quality of health care on people in this country. If you have parents who are entering the Medicare system or if you are employed and have health insurance or if you have kids who are reaching that magic age of 19 or are done with college, you will be affected. If you need to fill a prescription at the pharmacy there is an impact.
I am writing about this because for the last 2 years I have been fighting this system with results that are just…well, nil. If I’m going to fight it and lose, I’m at least going to talk about what the structure is that is punishing individuals and employers who are in need of health care and in particular, pharmacy benefits and I’m going to shout about it until someone hears me and takes it seriously. Maybe if enough of us do, there will be a way to reform a system that is bloated, out of control and arrogant.
I began this blog to sort out the issues surrounding ADHD. One of the central ADHD issues is always whether to medicate or not, and if medications are the answer, which med is best. This question was settled for us fairly early on — the response to the medications was so incredible right from the get-go that it was the way to go. Of course, the fact that a kid responds to Ritalin doesn’t mean that he’s ‘cured’ — just that there’s a pathway toward improving those areas that ADHD disables so well. The same is true for adults.
Without going into a lot of detail here about the medication decision matrix, I do need to establish that we started with the ‘first-line’ preferred meds (Ritalin, Dexedrine, etc) and have since moved on to the more expensive and newer lines. AdderallXR is without question the most effective medication that either one of us have taken. It is literally the difference between night and day. AdderallXR is Adderall delivered in time-release fashion and is effective for about 10 hours or so. When it wears off, it does so in a much slower fashion than Ritalin or its counterparts, so that rebound is minimized (rebound can be a real pain to manage, so that’s a HUGE plus).
Issue #1: Pharmas Pricing Structures are out of control
AdderallXR has no generic equivalent. The delivery system for the time-release is the patent owned by Shire and they’re not going to release it to the generic arena until they have to, ostensibly to recover their R&D costs. That’s the first problem. While I’m sure that there are enormous R&D costs associated with many drugs that Shire manufactures, I’m having difficulty believing that the container for a medication they already have recovered their development on was that expensive. However, that’s something that really does have to be undertaken by the Feds — no one person is going to change pharma pricing.
With a system that is seriously broken, what could make it worse? Answer: Political cronyism, payoffs and rebates. That comes in the next post.
