Breast Cancer For Husbands.com

Cancer Drugs - What's Old Is New, And More Expensive

While talking with an oncologist I was asking about the new drug Reclast being offered to help with bone loss patients. It's being promoted as a once a year treatment alternative to other drugs that are administered monthly or even more frequently. The one I'm familiar with is Zometa, commonly using with cancer that's moved into the bones. He laughed and said he interfaces with Medicare about treatment options and they are not paying for Reclast. The reason? Reclast and Zometa (and Aclasta, btw) are exactly the same drug, Zoledronic acid, just repackaged under a different brand and prescribed once a year for osteoporosis. Oh... and the price for Reclast is much higher too.

So what do you get for the more expensive version of the same drug? Different branding, packaging, different web sites, additional studies, FDA approvals, miles of paperwork, and lots of TV commercials and magazine ads touting a new drug... all so osteoporosis patients can get the exact same drug, less frequently, at a higher price.

It shows you just how utterly ridiculous and out of control our health care and drug company systems are. And we wonder why our health care costs and health insurance premiums are skyrocketing out of site.

Our Health Care System Must Be Fixed

When you or a family member is thrust into any kind of a health battle, you quickly learn the goods and bads of our country's health care system. Breast cancer certainly classifies as a major health battle as probably many of you who read this blog know. My wife and I've had the good fortune, or should I say lucky timing, to have some new drugs emerge just about the time of her first diagnosis, which she responded to very well. It's no doubt that we have the best medical research in this country, but it seems to me there is more to what we can do as citizens besides raising money for cancer through events like Friday night's Stand Up To Cancer TV telethon. I was hoping this event was something more than just a star studded fund raiser, but it turned out to be only that. Raising money for more support, advocacy and research is important but we clearly need more federal support for cancer research and cures. Improving health care, fixing the broken health insurance system and increasing cancer research are top issues for me personally in this election year.

As good as our medical research can be, the health insurance side of the equation is drastically broken in my view. I think I've seen both the good side and (hopefully all I'll see of) the bad side -- at least I hope it doesn't get worse. When we first started down the road to beat breast cancer, our insurance company footed the bill (thanks to payments by me and my employer, plus that good 'ol annual deductible) and presented very little problems for us. They even paid for Avastin which wasn't FDA approved for use in breast cancer patients at the time. We were surprised but of course very pleased.

Fighting a disease like breast cancer changes, or at least heightens, your views about health insurance. Suddenly all those things about deductibles, total out of pocket expenses, covered services, high deductible plans, health savings accounts and plan changes by your employer become much more important topics to you. You also become very concerned about problems like gaps in insurance coverage should you change jobs or go on COBRA in between company health care plans. I'm not sure what people did before our country had COBRA. AARP started an ad campaign that 1.85 million American's go bankrupt due to medical bills in one year. I was shocked when I heard that number on an ad during Democratic National Convention coverage. (There's more information at http://www.aarp.org/issues/dividedwefail)

If working though the battle against breast cancer isn't enough to take on, piling on with insurance company problems only compounds the difficulties. What I've found is that as soon as the insurance companies find an excuse not to pay, they exploit it. Then you are into the chain of phone calls, faxing info, multiple follow ups, etc., to try and get it all straightened out. It's disheartening to realize you are an expense to be managed, and minimized, by the insurance company as your costs directly affect their bottom line. Then there's the whole game of the doctor's overpricing their services to try and get the insurance companies to raise their covered amount for the service. It's just an unending, escalating rate race.

The pharmaceutical side of the equitation is no better. Drug advertising for one has completely screwed things up. If the drug you are prescribed is advertised on TV, you are virtually guaranteed it's over priced at the pharmacy and your portion of the drug cost will be high, sometimes in the hundreds of dollars per month range. Those drugs and others don't always have a generic brand so the consumer is stuck paying the difference. I'm sure there are many who just can't afford to shell out that kind of dough each month and just go without the drugs they need. And we all know the stories about the same drugs being cheaper across the border in Canada or Mexico... for the exact same drug.

It's amazing how oblivious I was to how badly our health insurance system functions until entering the fray with breast cancer. I know none of us wants government waste or a bureaucrat dictating procedures to our doctors, but we clearly need health insurance that isn't limited by who your employer is and patients aren't subject to an accountant's decision (a bureaucrat with a cost ceiling) about paying doctors claims or not. Healthcare is bigger than what market dynamics can manage or will solve. Our health care system must be fixed.