Formulary guidance and transparency from P&T to point of care

Planes, Wi-Fi and Medication

Posted by Wade Carter on Mar 1, 2016

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As I sit on the plane reading this article, I cannot help relate back to the “gouging” I just felt while paying $30 for horrible and intermittent Wi-Fi access for the duration of my flight. Like I said in a prior post, a lot of frustration and ridicule comes from not fully understanding something, so I did some digging and found this that explains in terms I can understand why I may be paying so much. Now I am not trying to say I feel the same pain or even saying I NEED this internet like some patients NEED certain therapy, but I do draw some correlations between the two.

  • Much like my likelihood of purchasing inflight Wi-Fi is highly tied to the fact I am a business traveler and my company is going to reimbursement for it, more than likely, the patient has insurance in which the payer will foot the bill for the medication. I know there are many nuances for this - deductibles, donut holes, on/off formulary, rebating…but these are the nuances that all feed into the pricing and “business model.”
  • Much like I am part of a fairly small percentage of the plane’s passengers that will actually access the Wi-Fi, certain medications have very small patient populations that will ultimately be prescribed, pick up and adhere to the therapy, therefore the “business model” is set so that it makes sense to keep that product alive and available in the market place. If it were priced such that they lost money, I doubt anyone would continue to offer it. Therefore, it would be withdrawn from the market and NOBODY would have access to the needed medication.

I know my last couple posts have sounded like I am defending the actions of certain pharmaceutical manufacturers. I am really not, some things sound egregious and I do not know enough to even make that argument, but I do get the sense that there has been this blanket thrown over an entire industry, punishing many for the deeds of a few. We should all think (and worry) about what future impacts may occur if we dictate their “business models” and do not allow for adjustments based on current market conditions. We could be back to days before advanced medicine and inflight Wi-Fi and have to watch the overhead 10-inch screen 4-seats away and actually get away from work for the next 4 hours of this flight, or maybe we can just sic our politicians on the internet industry as well.

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Topics: Specialty, Industry Trends, Payer