This week the CDC recommended that baby boomers be screened for Hepatitis C. The motivation behind this recommendation is the development of a new class of Hepatitis C treatments that are in pill form and not injected.
Simplicity of treatment makes screening more successful. Yet people who are identified with the disease may have to pay more out of pocket for more effective and convenient care than they do for less effective and time consuming infusions.
That's because most health plans, following Medicare Part D, pay 100 percent of the cost of injectble drugs while paying only 70-80 percent of new oral medications. Since these drugs are expensive -- though relative to dying, permanent disability or the cost of repeated hospitalizations, organ transplants -- they are bargain patients wind up forking over tens of thousands of dollars for treatments do less. Moreover, because you can take a pill at home the cost of infusion goes away.
Our system of health care reimbursement is out of whack with the value of new, simpler treatments. It covers what is cheapest and then only covers in part technologies that work and are less instrusive if the cheap approach fails. That, not over use of tests ot treatments, is the biggest source of waste in health care, a source that could be eliminated if we did things right the first time,
Similarly, all new cancer drugs are in pill form. They make staying alive and healthier, simpler to do. They generate value for consumers who can go back to work, eliminate costly procedures such as blood transfusions, stem cell replacements and help avoid the side effects of chemo, which are tantamount to being shoved into a microwave while seasick.
Maybe Medicare and health plans think they are saving money by forcing people to pay a penalty for better treatments that are more convenient. They are wrong. There is mounds of data demonstrating that every dollar spent on new cancer and HIV drugs offset $7 spent other services. And the combination of longer life, improved health and increased productivity is not even accounted. My colleague John Vernon and I have shown that social value of increased health and longevity runs into the trillions. Advances in cancer alone have allowed people to live longer with fewer disabilities. If I were in control of my premium dollars, that's where I would want my money to go.
Instead, people -- particularly those with life threatening illnesses that are not caused by poor health habits -- have to pay more for these advances than any other health care service. Does it make sense to subsidize massage therapy or birthing pools at a higher level than pills that prevent cancer .
We don't need lots of legislation to change the paradigm. All the employers investing millions in 'wellness programs' could tell insurance plans the game has to change. States can introduce legislation making parity a requirement. Some will say this will add to the cost of premiums. So what? Studies have shown people are willing to pay more to be protected from catastrophic costs or give up the frills that are covered but never used. I bet a health plan that covered pills to treat hepatitis C and cancer could keep premiums where they are if they stopped covering the extras like acupuncture, chiropractors, massage therapy, gym memberships.
Our way of paying for health insurance and covering benefits is still pre-industrial. As I had mentioned in a previous post, you have to bribe doctors to use health IT even as thousands of health professionals are paying for iPads and using them in practice. Simplicity empowers. Medications are a highly efficient way of treating disease. I don't mind paying a portion of the cost of these treatments out of pocket. But it makes neither clinical or economic sense to force consumers to pay a higher percentage of the cost relative to less transformational care.
If somone running for public office wants an issue to campaign on, the tax on access to innovation that these co-pays impose is a great one. In the meantime, companies have to do a better job of showing it's innovative products enhances value by increasing clinical utility for patients and reducing the complexity of care. No doubt certain interests will oppose paying for progress that could eliminate their jobs or income. But the last time I checked, the typewriter and bank teller lobbies didh't have much success. On a related matter, why are we using clincal trial methodologies from the 19th century? From recruitment to treatment to followup, we can use digital technologies, biomarkers, remote sensors to cut the time and cost of evaluating new products in more than half.
Digital and personalized health technologies will creatively destroy the existing approach to medicine. Only regulation and political inertia stand in the way.
Change can be accelerated by we the patients. As Eric Topol has written: "the change will come from the truly empowered, beyond informed, consumer who has access to all the relevant data and is now fully participatory. This transcends the era of internet access to health information that started in the late1990’s, since now each individual should be able to access all of their biologic, physiologic, and anatomical data that was largely unobtainable before. And the earlier in life the better, in order to foster the critically needed emphasis on prevention of diseases—which
has been essentially ignored until now."
It's time to stop sticking it to patients when there are more empowering and powerful pills out there.