"Advances in science and immense investments by the federal government and drug companies have completely altered prospects for people with conditions that seemed untreatable in almost every area of medicine — cancers, allergies, skin diseases, genetic afflictions, neurological disorders, obesity," says The New York Times.
But for many people with private insurance, innovative medicines are unaffordable, says the Times. And Medicare has a $10,000 co-pay (the Inflation Reduction Act limited the co-pay to $2,000, but not until 2025). Medicaid doesn’t always pay for expensive drugs.
Researchers for Brigham and Women’s Hospital in Massachusetts found that the median price of a new drug was about $180,000 in 2021, up from $2,100 in 2008.
The new era in treating previously intractable diseases began with major scientific leaps after the turn of the century, enabling researchers to find genes they could target to treat cancers and other diseases, says the Times. Scientists could harness the immune system or suppress it and even alter patients’ DNA with gene therapy.
“Today’s drugs are more effective because they target the biology of disease,” says Dr. Daniel Skovronsky, chief scientific and medical officer of drugmaker Eli Lilly, which has new treatments for obesity, mantle cell lymphoma and Alzheimer’s.
Skovronsky calls previous drugs to treat diseases like psoriasis or rheumatoid arthritis “blunt instruments” that shut down the immune system but had serious side effects.
“Yesterday’s drugs were moderately effective in treating a
broader population,” he says.
But the new drugs often are extremely expensive to produce. At Lilly, Skovronsky says, the company will spend more than $8 billion in 2023 on drug research and development.
Not only are the new drugs expensive to research and develop, but some treatments are for just a few patients with very rare diseases. Some, like gene therapy, are used just once, rather than over a person’s lifetime.
One sign that a treatment is working, experts say, is a widening gap in outcomes between wealthy patients and everybody else, says the Times. This is in part because when the prices for miracle drugs reach hundreds of thousands or even millions of dollars, many people don't fill prescriptions because they can't afford them.
Dr. Otis Brawley, a professor of oncology and epidemiology at Johns Hopkins University, points to cancer, with a death rate among Americans who have college educations (a proxy for wealth) at 90.9 per 100,000 per year. For people with a high school education or less, the rate is 247.3.
Ultraexpensive drugs include not just new medications but also older medications that drug companies have hiked the prices of in the last few decades, says the Times. For example, the price for Revlimid, which treats blood cancers, now is three times its cost when it first was introduced in 2005.
Often, even people who can afford commercial health coverage or get it through their employer may face insurers that refuse to pay. Other times, the insurer pays part of the cost, but high co-pays, deductibles and cost sharing put treatments out of reach.
“The idea that the care you deliver could bankrupt somebody and hurt an entire family is devastating,” says Dr. Benjamin Breyer, a reconstructive urologist at the University of California, San Francisco who's studied the issue.
The PAN Foundation helps people with an annual income about 4 to 5 times the federal poverty level with high medical bills for about 70 illnesses. But a foundation official says the need is so great that "we are just scratching the surface.”
A ProPublica article says: "More than 200 million Americans are covered by private health insurance. But data from state and federal regulators shows that insurers reject about 1 in 7 claims for treatment. Many people, faced with fighting insurance companies, simply give up: One study found that Americans file formal appeals on only 0.1 percent of claims denied by insurers under the Affordable Care Act."