Drug companies and insurance companies aren’t getting along lately, and patients as well as their doctors are caught in the crossfire.
Certain drug therapies have changed the way we fight and live with serious diseases such as rheumatoid arthritis, Crohn’s disease, multiple sclerosis and many forms of cancer. As a result, for one thing, cancer is no longer a death sentence. But limitations on insurance coverage can often stand in the way of patients getting the treatment they need. Now, thanks to the Affordable Care Act, everyone must purchase insurance, expanding the marketplace while simultaneously turning the insurance industry into a runaway train with unchecked power to deny care in an effort to increase profits.
Here’s where it gets even more complicated: Insurance companies and drug companies negotiate the price of drugs and coverage plans for drugs in total secrecy. No two plans pay the same amount for a drug because drugmakers and insurers – as well as pharmacy benefit managers, another arm of insurance companies focused entirely on drugs – have made deals that include negotiated rates for certain drugs. So when you hear about escalating drug prices, it’s not a totally accurate representation of cost; almost always, the manufacturer provides hefty discounts or rebates to the insurer.
About the Author:
Seth D. Ginsberg began his 20-year career as a health advocate at age 13 when he was diagnosed with a form of arthritis called Spondyloarthritis. Since then, Seth has evolved into a passionate thought leader and social entrepreneur in the global health care conversation. He believes that all patients with chronic disease deserve the best access to care, and that it is everyone’s responsibility to participate in patient-centered research to unlock the clues needed for better health outcomes in the future. Seth spends his energy engineering that future. At 18, Seth helped pioneer the online patient community for others like himself who were suffering with arthritis, co-founding CreakyJoints. The CreakyJoints platform today is a highly customized, interactive delivery channel of relevant patient education, emotional and personal support services, advocacy initiatives and patient-centered research efforts. The Global Healthy Living Foundation is the non-profit parent organization of CreakyJoints, which Seth and CreakyJoints co-founder social entrepreneur Louis Tharp, created in 2004.