Shock Treatment

mcevoy familyBy Undine McEvoy
HealthEconomics.Com

I am NOT a health economist, I just happen to work for one. Part of my  job as Marketing Manager for HealthEconomics.Com is reading and summarizing the weekly news from around the world as it relates to health economics, market access, pricing and reimbursement (among many other issues). I have learned a great deal in reading all these news items and can now claim knowledge of some the many acronyms used to talk about this stuff – PRO, EBM, PBM, HTA, HEOR, CRO, ACO and on and on….you know them too, right?

Here is the state of affairs: It is February 16, 2013 and my family of five has already spent our entire FSA (you know what that is, right?). This year we put in the max contribution allowed – $2,500 which is less than we contributed in past years due to new limitations on contributions enacted by Obama Care a.k.a. the ACA (yet another acronym).

Is $2,500 all my family will spend this year for out-of-pocket health expenses? Far from it! If I was to make a guess on what we will pay in deductibles, co-pays, prescriptions, orthodontics and what not, I would say we will easily spend another $4,000 out-of-pocket. That is on top of the monthly premium we pay for my husbands’ employer sponsored health insurance, which is $3,900 annually.

My husband has Crohn’s Disease for which he receives an infusion of Remicade every 8 weeks from the Borland Groover Clinic in Jacksonville, Florida. He has been living with this disease for twenty-four years, almost the entire time I have known him. Doctors removed his entire large intestine in 1991(he was 21) and for many years he lived with an ileostomy. He had “reconstructive” surgery sometime in the mid 90’s and now has a “J Pouch”. He has been on Remicade for over a decade with great results after having no success with the other traditional treatments (prednisone, immunosuppressant’s etc.)

Remicade is an orphan drug, and as such costs a pretty penny. Just how much does a treatment of Remicade cost? Well that is the tricky part. Our insurer just received the latest bill from the infusion center. Take a look:

bill

Click to enlarge.

The bill from the infusion center to our health insurer is $10,779. “Plan discounts” account for a “savings” of $4,975.49. So all we have to pay is his annual deductible of $2,500. That seems pretty reasonable right? After all, according to my calculations, if my husband were to receive 6 treatments this year, the total cost to our insurance plan would be $64,674 before those nifty “plan discounts”.  That’s a lot of money, and something we could NEVER afford without insurance.

Coincidentally, Time Magazine just released a special report on this same topic, “Bitter Pill, Why Medical Bills Are Killing Us”. In this article, author Steven Brill makes a great point, “…those who work in the health care industry and those who argue over health care policy seem inured to the shock. When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?”

I am shocked about the high cost of this treatment, so following on Mr. Brill’s questions, here are my own: Just how much does this medication really cost Janssen Pharmaceuticals? (I know that in itself is a very complex question, you have to look at R&D costs and much more.) How much does his treatment really cost the infusion center and what is their profit? Are all insurers charged the same, if not why? I wish someone could just make sense of all this for me.

So here’s is my conclusion: In order to make my life easier I need a maid, a cook, a lawn service, an unlimited supply of tasty wine and a down to earth health economist who can explain this madness to me over a nice glass of cabernet. Thank goodness Dr. Patti Peeples is my friend.

Undine McEvoy is a Marketing Manager at HealthEconomics.com and the mother of three who lives in Atlantic Beach, Florida. Opinions expressed are the author’s, and should not be considered to reflect those of HealthEconomics.Com.