Pushing back on costs
In Europe, hemophilia drugs cost less than half what they cost in the United States. That’s because payers – usually governments – request bids and pick products based on cost and quality.
Without pushback from insurers in the United States, “the price of any drug in the U.S. is whatever the market will bear as seen by the manufacturer,” said Dr. Avorn of Harvard.
Recently, a few insurance companies have quietly started to push back on costs. Bayer’s Mr. O’Leary said several insurers have approached the company and demanded rebates in exchange for offering the drug to their customers. Mr. O’Leary would not discuss the details because he said the contracts are confidential.
State Medicaid programs, which provide health insurance to low-income Americans and cover about half of hemophilia patients, already receive significant rebates from hemophilia drug manufacturers.
Michelle Rice, a senior vice president at the National Hemophilia Foundation, said she has been working with several insurers to help them manage costs safely. “We understand the need to control costs, but they can’t impede access to the product a patient needs,” she said.
It is not yet clear whether such efforts will work, let alone spread.