The Indicator from Planet Money - One Drug, Two Prices

Faced with the prospect of paying for an expensive drug to treat his daughter, this dad found a nearly identical product for thousands of dollars less. But the insurance company wouldn't let him.

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everyone is Cardiff. This is the indicator from Planet Money how much pharmaceutical drugs cost how they get priced can be an incredibly confusing issue and it's also an issue that we suspect a lot of people thinking about now given the different drugs that are being studied for use against coronavirus silver Today Show. We're going to play an episode about drug pricing from our friends over shortwave, which is NPR's daily science podcast, by the way, you should absolutely subscribe to shortwave. If you have not already. It's great. You're this good correspondent. Hey, there you have this outrageous story to share about drug pricing. Yes. It is part of our bill of the month Series in partnership with Kaiser health news and it's about one family, but it tells a bigger story about how difficult it is to navigate our Healthcare System.

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I went out with my producer Jane green house to visit City tech salary in Oregon about 2 years ago from India who we're not going to name for the sake of protecting her medical privacy. You adopted her when she was howl when we got her and she's 8 years old now, but that she was starting to show more puberty like changes like her parents noticed. She was getting really tall for her age taller than their twelve-year-old son over the course of these years. We've noticed that she's grown tremendously. Like I'm I think she is like maybe 7 in taller the condition that she was eventually diagnosed with is called Central precocious puberty together with her doctors. They decided she didn't need one more obstacle in her life going through puberty with all of

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Friends your friends is hard and awkward enough right sided to use a pharmaceutical implant to basically hit the pause button on her puberty or two options. They're both made by the same company and chemically they're the same drug both cost thousands of dollars. But as too deep no doubt one was over eight times more expensive than the other but the frustrating part for the text Ali's is that their insurance UnitedHealthcare would only cover the more expensive one how much more expensive are we talking with the hospital's markup? It would be $95,000 that is verifying number city of Saint orthopedic surgeon. So he's used to hospitals adding markups to pay for their own operation emergency care for people who can't afford to pay Etc sure, but he couldn't shake this knowledge that there was a near-identical option out there. That was so much cheaper, but

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Just Out Of Reach, it feels abusive when it really feels abusive to drugs that are virtually the same ended up being so wildly difference in price.

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Sydney so you mentioned that sudeep taksali basically has two options to treat his daughter's condition of central precocious puberty. What is that treatment look like you can basically put a pause on puberty with just a little implant that goes under the skin in your arm. That would effectively is just putting her puberty on hold and as we said there two versions of the same plant made by the same company Endo pharmaceuticals Allen LA which the FDA has approved to treat Central precocious puberty, and that's the one that's two beeps insurance covers that has a list price of $37,000 and then the hospital marks it up to $95,000. Right and the cheaper drug is called Vantas. It has a list price of a round $4,000. Okay. So it's the deeps insurance will only cover the more expensive one the one listed at $37,000 versus $4,000. Yes, and that needs to be really mad the same drug made by the same pharmaceutical company with a

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Very trivial difference in dosing I reached out to both of you ask them why they price them so differently and they didn't really explain it. They just said it was approved as two different products to treat two different patient populations when I followed up with Endo to ask whether maybe one was somehow more expensive to manufacture. They didn't answer. They just stress that they're not identical. So what is the difference? Well, there is a tiny dosing difference 15 micrograms. That is about the weight of an eyelash. Yeah. That's anybody there's an incredible amount of vulnerability you have as a parent that was not happy with Endo pharmaceuticals to know that there's a predation on parents who had that sense of vulnerability who will do anything within their means to help their children. I feel like they're exploiting. So, why does the text Ali's insurance?

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Cover the more expensive version if they're so similar, their policy is not to cover Vantas for Central precocious puberty patients because it wasn't approved by the FDA for that sentence was only approved to treat prostate cancer. So I asked me if he gave why didn't they just push for the one drug to be approved for multiple different conditions One Drug multiple diseases and the short answer is that it's up to the company how they want to submit their drugs for approval. So even though the FDA is the regulatory Agency for all these drugs. They don't have the power to point out. They're basically the same and then say you have to charge it to the FDA actually can't say anything about price. I see so for City of Stillwater the doctors at the hospital offered an off-label use and he said great let's do the cheaper one. That's Vantas. So the hospital requested it but his insurance UnitedHealthcare said no UnitedHealthcare says it typically does stick with what the FDA says. Okay. So deep was really at this point stuck between a rock and

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Replace yeah, I mean he sent the next month assuming that he was going to have to pay for this expensive drug plus the hospitals Mark and at that point he reached out to reporters to talk about this outrageous medical bill that he was facing by the time I got involved sudeep had already been talking to jonelle. Alicia are reporting partner at Kaiser health news and what city was on the phone with the hospital's billing department Journal called until I had this, you know, nice way of kind of breaking the conversation saying sorry. I've got to go to reporters on the phone again and this time it works. It works. Yeah United Healthcare approved this request in this one case the health insurance company changed its mind why we don't a hundred percent know why do you think it's because of the reporting? So the timing is interesting but we we really don't know for sure. What we do know is that when the hospital request advantis for a second time it end.

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Size that it was because Vantas cost less basically and what's really important is that at the end of this entire process to deep daughter finally got the implant which lasts about a year and it should slow down her early puberty the doctor wanted to talk to her about the implant and the procedure in puberty. She brought up. And she's like, do you know what a. Is and she's like, yeah, it goes at the end of the sentence.

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A little one like it's hard when you're that young got to say so how much will sue deep in his family be billed for this implant. We don't exactly know yet. He's gotten the kind of pre bill called an explanation of benefits or an EOB. These are basically an estimate of What patients might be on the hook for and they can change the total charge for the Vantas implant with that Mark up that we were talking about was going to be more than Twelve Grand and it looks like he'll be personally responsible after insurance for about $4,700. So was it worth it in the end to fight for this cheaper implant like did he save a ton of money from this? Well, the ironic part is that after all this work that he put in he thinks he'll mostly wind up saving his insurance company a bunch of money to me. One of the most mind blowing things about this whole story UnitedHealthcare saved approximately $45,000 from all these f

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That was his back-of-the-envelope calculation for how much she was going to have to pee and I'm a save a couple hundred bucks. Wow, Sydney Lufkin queen of our hearts and Garrus Fearless pharmaceutical correspondent. Thank you so much for dropping by thanks for having me. That was an episode of NPR's wonderful shortwave podcast that originally aired in March of this year, So does produced by Rebecca Ramirez with engineering help from Stacy Abbott. It was edited by Viet Lai and fact check by Burley McCoy. The host was Emily Kwong. I'm Cardiff Garcia is in PR. Thanks for listening.

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