Save Billions or Stick With Humira? Drug Brokers Engage in Blatant Price Gouging as FTC Investigates and Some Health Plans Rebel

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Yves here. The article below describes in gory detail blatant cases of price fixing with pharmacy benefit managers either refusing to provide, or refusing to give price breaks for so-called biosimilars, which are the analogue to generics for biologics, for expensive treatments like Humira.

Insurers, including health insurers, are state regulated. And on the state level, letters to legislators can make a difference. Reader letters in the big state of California led its then Treasurer to sponsor legislation on private equity fees, a much more esoteric and niche topic than drug price gouging.

For readers in retirement (as in you hopefully have some time in your schedule and are exposed to the risk of needing to find a way to pay for outrageously-priced treatments) as well as anyone who is currently taking biologics, send this KFF Health News article to your state assemblyman and senator and to members of the state insurance committee, and demand hearings. If all insurers in a state are not allowed to pay for biologics from pharmacy benefit managers who do not allow them to buy biosimilars at the discounted prices offered by their manufacturers, the PBMs will fall into line, One moderately big state threatening to go this way would mean others would follow. If they were to unite to try to fight back, that would be a per se case of cartelization and set them up for Federal and state anti-trust suits.

Towards the end, the article also cites doctor resistance as a factor, so please talk to your MD if you are on a pricey biologic where a biosimilar is available. No less than Harvard Medical School recommended a decade ago: Generic drugs: don’t ask, just tell.

By Arthur Allen, KFF Health News Senior Correspondent, who previously worked for Politico and before that was a freelance writer for publications such as The New York Times, The Washington Post, Smithsonian, Lingua Franca magazine, The New Republic, Slate, and Salon. He is the author of the books “Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver,” “Ripe: The Search for the Perfect Tomato,” and “The Fantastic Laboratory of Dr. Weigl.” Originally published at KFF Health News

Tennessee last year spent $48 million on a single drug, Humira — about $62,000 for each of the 775 patients who were covered by its employee health insurance program and receiving the treatment. So when nine Humira knockoffs, known as biosimilars, hit the market for as little as $995 a month, the opportunity for savings appeared ample and immediate.