9NEWS at 4 p.m. 11/18/16. None
(EDITOR’S NOTE: 9Wants to Know investigative reporter Chris Vanderveen spent months tracking the price increases of prescription drugs. His “Side Effects” series aired all week on 9News. This is his summation of the week’s effort)
KUSA - Hopefully, by now, you know it ain’t just the EpiPen. Sure, the plastic injector filled with less than a dollar’s worth of epinephrine made for some fairly rambunctious Congressional hearings.
Its massive price spikes certainly led to a good amount of fist-shaking and finger-pointing.
But it wasn’t THE problem.
Not by a long shot.
FULL INVESTIGATION: Read all of the stories in our Side Effects investigation here
We started this project three months ago convinced those who looked no further than the EpiPen failed to see more than just a small fraction of the problem
Today, we know just how small that fraction is.
That’s it. One stupid percent.
In 2012, the Centers for Medicare and Medicaid Services created the National Average Drug Acquisition Cost database to help the public better understand what was happening to drug prices.
Four years later, 9Wants to Know investigative producer Katie Wilcox used NADAC to track the price increases of hundreds of drugs.
In the end, we settled on 100.
We could have chosen more. She found more than 400 drugs that have increased in price by 50 percent or more since the creation of NADAC.
We may still expand our list because of that.
For now, we’ll settle on 100 drugs. All of which saw price increases of at least 70 percent since 2012.
At a time when more and more of us have high-deductible health care plans, the importance of this list cannot be understated.
In theory, no one is supposed to pay the NADAC price which, by its very definition, sits a shade below what’s known as the list price.
9NEWS WEB EXTRA. 11/14/16. None
There are supposed to be insurance negotiations and rebates.
In the era of copays, that seemed to work out relatively ok. I paid my copay, and insurance picked up the rest.
And much of what insurance had to pick up was softened by those negotiations and rebates.
Today, most of us who receive insurance through work and the vast majority of people who receive insurance through the state’s exchange have deductibles of at least a thousand – deductibles we have to hit before most of our insurance kicks in.
This is where this story will get a little personal. A few years ago, a doctor told me I needed surgery to take out a good chunk of the torn meniscus in my left knee.
It also happened to be the first year of my company’s new insurance policy – a policy that left me with a $1,500 deductible.
Before that surgery, I had very little experiential knowledge of the ramifications of high-deductible health care plans.
After that surgery, once I had seen more than $3,000 in bills sent my way from the various people and entities that performed the surgery, I realized things would never be the same.
High deductibles put patients on the front lines of cost.
And so, when prices go up, we see and feel those price increases in a much more personal way.
Ask a diabetic with a high deductible health care plan what he or she is going through these days.
We introduced you to Brian Novak early on in this series. Seventeen years ago, doctors diagnosed him with type 1 diabetes. It means he needs insulin in order to live.
His deductible is $4,000.
His insulin is Novalog. Novalog has nearly doubled on NADAC.
“So I’m pretty much at the mercy of drug companies at this point,” he told us.
When Novalog goes up in price, Novak’s out of pocket cost goes up at nearly the same rate.
“The drug companies know I have to have it, and they’re banking on that big time,” Novak said.
Not that long ago, drug companies and insurance companies liked to say almost no one paid the list price for drugs.
I tend to think the list of “almost no one” has transformed to “more than we’d like to think.”
Dr. Steve Miller, Express Scripts Chief Medical Officer, told us that when he told us, “Patients that have high deductible health care plans that are now having increasing difficulties.”
Ten years ago, only 10 percent of people who received health insurance through work had a deductible of more than a thousand dollars, according to the Kaiser Family Foundation.
Today, 51 percent do.
Notice a trend?
If you’re still living in a world of co-pays, take heed.
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After all of this, I still can’t say who is definitely to blame. Some drug companies have raised prices simply to make more profit.
Others, however, have raised prices to make sure they can still make newer and better drugs.
Some insurance companies have made it downright impossible for some patients to get the care and drugs they need and prefer.
But others have tried to expand their coverage in an effort to better serve their members.
Congress has taken a ton of money from pharmaceutical companies, but I know there are legislators who fight skyrocketing constantly.
I guess what I’m trying to say is, in this story sometimes the enemies can do good things. And sometimes the good people can act like crooks.
Not long ago, I came to the conclusion the problem lies in the status quo.
Too many people and too many businesses are taking in too much money to want to change things. There’s cash to be made in stagnancy.
If you’ve stuck with us over the course of this series, I believe you’re beginning to learn that.
I also believe you can become part of the solution.
As more and more of us start to see the absurdity of medical pricing, more and more of us will find a reason to disrupt the status quo.
I believe we are the people who stand to lose the most if things don’t change.
And, so, I believe we need to educate ourselves in a way that might not make us feel comfortable.
This is heavy stuff we’re talking about. If you saw our story on PBMs, you know precisely what I’m talking about.
But only when we begin to understand some of the complexities will we be able to offer suggestions for a fix.
Because, as you now know, it ain’t just the EpiPen.
And, to be honest with you, it ain’t just our list of 100 drugs.
There are $441 bags of saline, $6,000 CTs, and $2,000 facility fees.
And far too many of us are a slip on the ice away from learning about just how crazy medical billing has become.
So, thank you for sticking with us on this one. We’ve asked a lot of you, but I hope you’ve learned a little something along the way.
Knowledge is power. And we could all use a little more power when someone decides to bill you $600 for a piece of plastic and a dollar’s worth of epinephrine.