Monday, June 18, 2012

Third Party Central

Third Party Central: that's what health care has become in the US.  Third party here, third party there, third party absolutely everywhere! 

In the business of medicine, I am constantly amazed at the number of third parties that have sprung up to assist patients and doctors through the maze of insurance coverages, co-pays, benefits, non-benefits, and pharmaceutical programs - just to name one example.  It's gotten so confusing that pharmaceutical comapnies are now getting into the act. 

What people don't realize is how this adds to the costs of goods in medicine.

The latest example of this fiasco are the new anticoagulant agents.   Since they're new, they're expensive.  Since they're expensive, insurers don't want to pay for them.  Yet because they innovated, researched, and developed a novel drug through a incredibly expensive regulatory process, pharmaceutical companies want to make as much money as possible to reward their stockholders, board members, and employees.  The end result?  Patients can't afford the price.  Not even close.  But no matter: a GROUP of people can pay for it for you - this is called i.n.s.u.r.a.n.c.e.  (Hence the collusion inherent to the new health care law, but I digress)  But there's a myriad of policies out there for i.n.s.u.r.a.n.c.e. with a myriad of co-pays and deductibles.  This makes it virtually impossible for a doctor (or even the pharmaceutical company itself) to know how much a patient should expect to pay for their drug each month.  Added to all of this, doctors really don't want to have to spend all day dealing with the multitude of "barriers to entry" constructed by the  insurers.   But if doctors don't deal with the insurers and their pharmacy customers, the patients won't get the drug.
So what's a drug company to do? 

Why, the drug company turns to another third party!

I learned that this is excactly what Janssen Pharmaceuticals has done for its drug Xarelto (rivaroxaban).

Janssen promotes this "value added feature under the name "Care Path" that is managed (according to their "Benefit Investigation Form" by TheraCom, LLC.

What's TheraCom's entire job?

To sit on the phone and find the best price based on the patient's particular insurance coverage for patients so doctors don't have to.

Now there's innovation!

But they've forgotten something.

They've forgotten that doctors no longer receive pens from the pharmaceutical industry.   As a result, filling out Benefit Investigation Forms becomes a hassle as doctors have to leave their examination rooms to ask: "Does anyone have a pen?"

Yep, it's just another important addition to health care of tomorrow, courtesy of Janssen Pharamceuticals, TheraCom, LLC and your $8.22-a-day rivaroxaban pill.


1 comment:

Anonymous said...

The law of unintended consequences. Since Obama promised Pharma to close the donut hole in exchange for their support of ACA, expect the pharmaceutical prices to skyrocket since there is no longer any connection between producer and consumer with the loss of market signals (i.e. prices).
Cardiology doesn't have a large biologic drug selection. This is mostly limited to oncology. If you think that Xarelto is expensive, check out some of the biologics for $250K/yr. Don't worry about the price since the government will be paying for it.
The politicians keep making promises that the doctors will be forced to keep in the way of lowered reimbursement and additional oversight.