
US Healthcare Is So Screwed I Fly to Britain for My Medication - AdeptusAquinas
http://www.wired.com/2015/02/us-healthcare-screwed-fly-britain-medication/?mbid=social_fb
======
tsuyoshi
I think a better title might be: I Missed the Obamacare Open-Enrollment
Deadline, So I Fly to Britain for My Medication.

There are exceptions to the open-enrollment deadline. The author is not
completely clear on his situation, but two exceptions may apply: gaining
"status" (i.e. permission to work, or permanent residency) or moving to a new
area. Either will allow you 30 days to apply through the insurance
marketplace. It would be interesting to know if neither of these applied, or
if even Obamacare-subsidized insurance wouldn't cover the drug he needs.

The fact that prescription drugs are more expensive in the US than anywhere
else is not news to me, at least...

------
refurb
You could write the same article in reverse if you had atypical haemolytic
uraemic syndrome (aHUS). Soliris, the only drug available to treat aHUS, was
launched in the US back in 2011 (and all payers cover it), but only just this
year did the NHS decide to fully fund it in the UK.[1]

[1][http://www.pharmaphorum.com/articles/nice-backs-full-nhs-
fun...](http://www.pharmaphorum.com/articles/nice-backs-full-nhs-funding-for-
alexions-soliris)

~~~
koyote
> but only just this year did the NHS decide to fully fund it in the UK

So that means it is covered by the NHS now?

~~~
refurb
Yup, but for 3+ years it wasn't where it was available in the US.

~~~
DanBC
It was available on the NHS. It was available under the "named patient" scheme
which is a bit more complex than just a doctor prescribing it but suggesting
people couldn't get it on the NHS is false.

The cost to the patient would have been exactly the same - about £8 per item
per month with a range of discounts and exemptions.

~~~
refurb
Named patient scheme is different. That allows access to a drug before it
receives market authorization, not before the NHS funds it. Patients in the UK
that could have benefited from Soliris were not able to receive it (without
paying full price).

"Up to 70 patients are in the same position as Dianne Illingworth, 41, who
have been forced to put their lives on hold, and risk their condition
deteriorating, while ministers and officials argue over whether the NHS can
afford the drug, Eculizumab, which costs more than £300,000 per patient per
year."[1]

[1][http://www.independent.co.uk/life-style/health-and-
families/...](http://www.independent.co.uk/life-style/health-and-
families/health-news/at-what-cost-lifesaving-drug-withheld-8632371.html)

~~~
DanBC
"Named patient" does not mean they have to pay full cost for their meds and
I'm not sure where you get that from. It's not in the link you supply. That
link talks about the cost to the NHS, not to the patient.

> In the meantime, NHS England has established an interim scheme under which
> new patients – around 20 a year – will get the drug and existing patients
> already on it will continue to receive it. But patients not currently
> receiving Eculizumab, such as Dianne, will have to wait for Nice's decision.

The newspaper distorts what actually happened. New patients got it, and
existing patients with critical need got it.

Nothing in the link you supplied suggests that patients had to pay more for
the med - the link does say that some people were denied the medication. The
reason for that denial was a lack of communication from the manufacturer.

[http://www.nice.org.uk/news/press-and-media/high-cost-of-
tre...](http://www.nice.org.uk/news/press-and-media/high-cost-of-treatment-
for-rare-blood-disorder-needs-to-be-clarified-says-nice-in-draft-guidance)

"“Eculizumab is an effective treatment for aHUS. The NHS has already
recognised this by making it available on an interim basis, pending the
outcome of NICE's appraisal. However, before we can make a confident
recommendation for routine use, which we estimate would cost the NHS about £58
million in the first year, rising to over £80 million in 5-years, we need more
information."

"Alexion insisted that its information about the overall cost of eculizumab be
kept confidential and so NICE is unable to share these details of the Alexion
submission with stakeholders. We're disappointed about this decision, for
which we have not had an adequate explanation."

But note that people who were critically ill did get the med, for the £8 NHS
prescription charge. From your link

> A spokesperson for NHS England, said: "Patients who are critically ill and
> who need Eculizumab urgently will receive it."

So: people who needed it were getting it. At first they were getting it under
the named patient scheme and they only had to pay the normal NHS prescription
fee; now it's available under an interim commissioning policy from NHS England
- so, again, patients only pay normal NHS prescription fees. For a short time
some people who were ill but not dying did not get it, but that gap in
provision was caused by the manufacturer not communicating with the
regulators.

Since you mention the US: how many people were denied this expensive med by
their insurance companies?

~~~
refurb
My point about paying more is that is the NHS doesn't cover it, it's still
available at full cost.

We'll have to agree to disagree about patients getting it. aHUS is a terrible
disease. To say everyone who needs it got it is untrue. The "critically ill"
got it, but what about people who weren't critically ill, but were sick?

------
pskittle
I studied in the US for a bit, inspite of the university having a decentish
setup for medication. I preferred getting treated by local doctors in my home
country. Studying about the healthcare system in the US makes me sad. It
shouldn't be so painful and expensive

~~~
strictnein
It isn't that bad in the vast majority of cases, and in many ways it's better.
5 year cancer survivability rates for instance are top notch, ability to see
specialists with little to no wait, etc.

Example: My friend's son was diagnosed with leukemia on Monday. They went to
their primary care doctor Monday morning for some gum bleeding that wouldn't
stop, were referred to a specialist Monday afternoon, and is already in a
children's cancer hospital receiving treatment where he will be for the
majority of the next 8-9 months.

~~~
6t6t6
I'm happy for your friend, but this is anecdotal evidence.

Statistics don't agree with your story:

[http://en.wikipedia.org/wiki/List_of_countries_by_life_expec...](http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy)

~~~
ptaipale
While I agree that there are great flaws in the US medical system, I don't
think that life expectancy statistics is a good proof of them.

It gives you an idea where the health care system stands because life
expectancy is low in places where there is no health care system. But life
expectancy is greatly increased just by public sanitation - generally,
education - and vaccinations, but could be lowered by factors that have little
to do with health care.

American life expectancy is surely lowered by how Americans eat (no, I don't
blame McDonalds who often gets the blame as an iconic brand). The kind of
health insurance or lack of it, or how doctors work, cannot really decide how
people eat. They try to impact but they cannot decide. Also, the US has a
homicide rate that is substantially higher than in other developed countries.
I won't bother myself by calculating how much that alone decreases life
expectancy, but it's just an example of these other factors.

------
IvyMike
I don't know exactly what's going on, but I'm on a mediocre Obamacare plan
that costs less than the author's plan. Even though it's in the most expensive
drug tier, as far as I can tell Abilify would cost me $70 a month.

> I arrived in America just as Obamacare was rolling out. Since I couldn’t
> meet the deadline for insurance

Well it's been rolled out for a while now. Can't he switch now?

~~~
maxerickson
Apparently it varies based on the plan:

[http://www.phrma.org/sites/default/files/pdf/exchanges-
menta...](http://www.phrma.org/sites/default/files/pdf/exchanges-mental-
health.pdf)

(In some bronze plans, up to $4300 of deductible applies to medications)

The article is not very careful. It goes from saying the drug is cheaper over
in Queens to the "$720 a month my medication costs in America".

------
wyager
I would like to share my very positive experience with private Mexican health
care.

A family member got in a kayaking accident. They were in severe pain (mostly
from their chest area).

We had a concierge doctor drive out to our remote hotel. He did a basic
checkup, gave us some pain meds, and called ahead to the nearest private
hospital. $100

We drove about an hour and a half to the hospital. A doctor was waiting at the
door for us. She was with us for the whole two hours we were there. We got 2
x-rays and an ultrasound. We also got more pain meds at the pharmacy. $150

It was the best medical service I've ever experienced in my life. I would be
very happy if U.S. medical care was the same as Mexican medical care.

I realize I never checked up on this: how is the Mexican private medical
system regulated? I remember we did very little paperwork, and it seemed like
there was much less red tape than at US hospitals.

~~~
zaroth
"It was the best medical service I've ever experienced in my life. I would be
very happy if U.S. medical care was the same as Mexican medical care."

What you are actually saying is you would be very happy if U.S. medical care
was the same as Mexican medical care _for tourists carrying US dollars_.

The real question is, what is the standard of care for a 50th percentile
Mexican national after their own kayaking accident? What percent of their
annual discretionary spending does this incident cost them? And is the
existing system improving, stable, or on the verge of collapse?

~~~
wyager
Well, yeah. I said "private", didn't I? And it's not like the good hospitals
in Mexico rely on the bad hospitals to exist.

One would expect the average standard of care to be lower because Mexico is
much poorer than the U.S.. If you took whatever the good Mexican hospitals are
doing and brought it to the U.S., it would presumably be roughly as high-
quality and inexpensive.

------
ptaipale
Is the author actually right to live and work in the US, and only fly back to
Britain for getting medication subsidised by British taxpayers? And is the
fact that he can do this just an indication of US healthcare being screwed?

The post doesn't tell too much about facts and I don't know the British rules
for eligibility to NHS, but I think it's possible he could be committing
fraud. If he were doing the same with my country's national system, it
certainly would be fraud (though it would probably not be possible in the
first place, because we have a Big Brother that knows more than the British
one).

~~~
jjoonathan
Well the fact that drugs are twice as expensive (or more) in the US* and the
fact that the US accounts for a huge chunk of government funding into the
relevant sciences are part of the reason why drugs are so cheap overseas.
British taxpayers buying drugs in Britain are effectively getting a subsidy
from US taxpayers even though they don't pay into the pot, so this all seems
like a stroke of cosmic justice where I'm standing. Of course, I doubt the
British tax authorities care much about what I think.

* Why? Remember how bargaining works: the biggest customer gets the best deal. First imagine Kaiser, Wellpoint, and Aetna sitting down at the bargaining table. Now imagine Canada sitting down at the table. Now imagine the European Union sitting down at the table. But at least our insurance companies are more efficient due to competition, right? Spoiler: not even close, and that's _before_ you take into account the costs they offload onto the rest of the system in the form of incompatible claims policies, paperwork, and exploitation of information asymmetry against consumers.

~~~
giarc
I don't know figures, but I imagine Kaiser represents more than 35 million
people (the approx population of Canada). Shouldn't they be able to negotiate
the same price?

~~~
refurb
Bingo! The largest US private insurer (United) cover 40M lives in the US. They
pay higher prices than nearly all European countries (even the ones with
smaller populations).

Drugs aren't cheaper in places like the UK because the gov't negotiates lower
prices. Drugs are cheaper because the gov't _mandates_ lower prices. People
shouldn't confuse the two.

~~~
zaroth
So is the UK not concerned about mandating lower prices and squeezing the R&D
funnel for new drugs... because Americans are making up the difference?

~~~
adwf
Drug companies spend more on marketing drugs to doctors and consumers than
they do on R&D.

In the UK, marketing drugs is illegal and therefore they don't need to go to
that expense. All they have to do is convince an NHS board and then it's on
the list of approved prescribed drugs.

~~~
maxerickson
Do you have a favorite citation for that factoid?

Some similar claims I have looked at have used the "Selling, General,
Administrative" off of an income statement as the marketing expense, but that
category includes salaries and buildings and lots of other things, not just
marketing expenses.

~~~
adwf
Just a quick googling:

[http://www.washingtonpost.com/blogs/wonkblog/wp/2015/02/11/b...](http://www.washingtonpost.com/blogs/wonkblog/wp/2015/02/11/big-
pharmaceutical-companies-are-spending-far-more-on-marketing-than-research/)

[http://www.bbc.co.uk/news/business-28212223](http://www.bbc.co.uk/news/business-28212223)

Reading the BBC article reminded me of all the fines also. People are paying
extra because drug companies push off-label uses on consumers and then get
fined for it. It's not like the company really pays, they just up their prices
a bit and push it onto the consumer. That sort of off-label usage doesn't
happen in the UK so much, because doctors don't have any incentive to
prescribe anything other than the NHS approved drug for a condition.

~~~
ptaipale
"Marketing drugs to doctors" is not exactly the same as "total sales and
marketing budget". I don't even know if "cost of sales" includes the cost of
regulatory approvals in various countries.

Also note that there is not necessarily anything bad about off-label use of
medicines.

Medicines could be off-label simply for the reason that the regulator - out of
pressure from the public health insurer, or more bluntly just the Department
of Treasury in the country - does not approve using a medicine for some
purpose, even though it is known to be efficient and without bad side effects.

In fact, in some cases patients are complaining bitterly because they cannot
get the medicine that their doctor knows would help them, because their
regulators do not approve off-label use.

~~~
DanBC
Off-label use is scary because there is often no evidence base. You have
doctors prescribing meds because they "know it works".

When we look at popular off-label meds and the eventual evidence we often find
that they're not very useful, or even actively harmful.

~~~
ptaipale
A medicine can also be off-label simply because of its price - there is
evidence base, but the regulator says that the health care system shouldn't
pay this much for ailing this medical condition.

Of course that keeps the prices lower. That's the purpose. It also keeps some
medication unavailable for some patients. I don't think it's a huge problem,
but it's there.

------
S_A_P
This article doesn't really make a compelling case. Facts would have been
nice.(I would spend x dollars for the drug I need in the US which is more than
I would spend flying to the UK and getting 6 months worth at a time. Or
something like the drug I need is in short supply in the US so I go to where
it's plentiful in the UK) What is so screwed about it in the authors eyes?

~~~
k-mcgrady
>> "What is so screwed about it in the authors eyes?"

Maybe I missed something but it seems blantantly obvious. In the US he has to
pay for health insurance PLUS $720 a month for drugs he needs. In the UK this
is provided at almost no cost to the patient through taxes. No health
insurance and no huge drug cost.

~~~
refurb
So maybe a more fair comparison would be to compare total costs in the US
(insurance premium and drug cost) to the total costs in the UK (higher taxes
and small Rx cost)?

Of course the end result would all depend on your salary level.

------
6t6t6
So, if I understand well, people with mental disorders cannot access to
medication if they cannot pay for it?

People with mental disorders use to have trouble to find a proper job if they
cannot threat their issue with medication. So maybe they just end up in jail
or living as homeless?

------
stickperson
Is there a way to find out how much drugs cost in other countries? I take a
biologic that runs me $300/mo after insurance.

~~~
DanBC
For England:
[http://www.ppa.org.uk/ppa/edt_intro.htm](http://www.ppa.org.uk/ppa/edt_intro.htm)

------
pacofvf
why not Mexico? it's a big destination for Health Care tourists, it's cheaper
than Canada or Europe and you would only need to go to a doctor once to get a
prescription and re-use that prescription. Also you would get to spend a few
days in places like the mayan riviera.

~~~
IvyMike
He mentions both Canada and Mexico in the article.

------
vonmoltke
> Otsuka’s patent on Abilify will expire in April, costing it an estimated $65
> billion over the next four years.

That statement is false, and demonstrated clearly in the author's source:

> Drug makers face another patent cliff in which _the industry_ will lose
> roughly $65 billion in revenue through the end of 2019, according to a
> research firm’s report.

...

> GlobalData estimates Otsuka will lose $6.2 billion in annual sales due to
> competition from generics by 2019.

Edit:

Continuing on this theme, according to Google finance Otsuka's net profit
margin is 10%, which I think is on the higher end of reasonable. Now, I'm not
saying the price they charge in the US is fair (for some definition of fair),
but one does need to consider how much the ridiculous American drug prices are
subsidizing the $24/year NHS prescriptions. A government can regulate the
price of drugs, but can't force the companies to sell them in the first place.
Not directly, anyway.

~~~
CHY872
> Now, I'm not saying the price they charge in the US is fair (for some
> definition of fair), but one does need to consider how much the ridiculous
> American drug prices are subsidizing the $24/year NHS prescriptions. A
> government can regulate the price of drugs, but can't force the companies to
> sell them in the first place. Not directly, anyway.

Remember that the cost to the NHS is far more than $24 - which refers to the
£8 prescription fee paid in the UK, twice per year. It's actually £220.41 per
patient per month for the NHS - about $335. So whilst it's still somewhat more
expensive in the US, it's not much more expensive - and well within the bounds
of shrewd negotiating (which I'd imagine insurers would normally do).

[1] -
[http://www.awp.nhs.uk/handlers/downloads.ashx?id=9572](http://www.awp.nhs.uk/handlers/downloads.ashx?id=9572)

~~~
vonmoltke
I figured it was costing the NHS much more than that, but I did not know they
were covering so much. Thanks for the information.

The issue of what insurers actually pay versus what the uninsured are expected
to pay is a tangential hot button issue for me, especially since I started
treatment for my sleep disorders.

~~~
CHY872
Any prescription you get on the NHS costs the same amount (and there are many
exemptions, for example they're free if you're a child, unemployed, retired, a
cancer patient etc). There's always some debate about certain very expensive
drugs (generally for cancer) and whether the NHS should pay.

