> If you are ever in a situation where you have to pay for drugs out of pocket or your insurance doesn't cover enough of the drug call your doctor and ask for a lower cost alternative. They can call the pharmacy and often times find a lower cost alternative to fit your budget.

I think you hit the nail on the head. Most people just accept what the doctors, insurance companies, and pharmacies tell them, without asking for more affordable alternatives. My pool guy was complaining about how he got one of those "Your insurance is being canceled and your new insurance is 200% the cost" letters from Humana. I got the same exact letter a week ago. I asked him what he was going to do. He said "What can I do? Pay the high cost." I told him I got the same exact letter and I called Humana, talked to an agent for 5 minutes, and they put me on a plan that costs just a few bucks more than my old plan but covers a lot more and with similar deductibles.

It is in the best interest of every corporation to up-sell you the most profitable product. In case of insurance, Humana quoted both of us ACA-compatible plans that sound similar (similar/lower deductible) to the old plans but are actually different (no coinsurance, 100% Rx coverage etc.) and thus cost a lot more.

I also told him to call up BCBS, Aetna, and Cigna if he really wants to shop around because they all have good, competitive plans now. There is no reason to stick with Humana if they don't have a good plan for him. But I don't think he's going to do anything except blame the ACA law. There really needs to be a nationwide education campaign on healthcare. People really have no idea that there are better/cheaper alternatives, regardless of whether you are for/against ACA.

/I don't think they are always out to bilk their patients./

"Genentech also provides rebates to doctors who prescribe large amounts of the drug."

"Rebate"? No, it's a kickback. Unless somehow the doctor is paying for the patient's prescription.

In this case, that is not true at all. I worked for a large retina group for 6 years and now consult for several different retina and general ophthalmology practices, so I'm a little biased, but I've also been lucky enough to see these new drugs through various stages. First of all, Doctors are the ones buying the drug, and they have to keep enough inventory on hand to treat the patients that need it until the next delivery day. The introduction of these higher priced biologics has had a huge affect on the way practices (especially smaller ones) have to manage their inventory. The last practice I worked for was buying between $1.2 and $1.8 millon worth of lucentis, a few hundred grand worth of Eyelea and a boatload Avastin every month. If anything goes wrong during the reimbursement process and the practice isn't paid as expected, it can be devastating. When the use of these drugs started ramping up, there were definitely a few scary payroll periods for us. Putting the right inventory management procedures in place significantly helps this problem, but there's definitely some stress knowing you're on the hook for over 2mil each month. Genentech's rebate and Regeneron's extended payment terms are efforts to alleviate some of this stress on providers while ensuring they are keeping enough stock on hand that they aren't having to bring patients back for a follow up visits just to order the drug. (some practices will see a patient, diagnosis, reschedule for follow up injection, then order the drug. This just wastes everyone's time) Even more importantly though, as said elsewhere in the comments, these drugs are definitely not the same. A lot of us, even the docs, in the industry joked about the high price of Lucentis when it first came out and many doctors (though I'm not sure on the exact number, but I think I remember hearing 80% of anti-vegF injections were Avastin not lucentis) used avastin over lucentis specifically because of the price. In the past few years however, this thinking has changed and it has very little to do with the reimbursement model. In the beginning, these drugs were simply awe inspiring. Before the availability of these drugs, a retina doc's approach to AMD was, "here's an amsler grid.. let me know if anything changes (it will), we'll see you in 6 months to asses how much more blind you've become. There are some vitamins you can take that might slow things down (barely), and oh yeah, there is this cold laser treatment we can try(PDT)that will just shut down that area and maybe prevent the spread. That treatment is going to require us to infuse you with a drug for 15 min, then shoot a laser in your eye for 83 seconds.. oh then after that, we are going to wrap you like a mummy because any form of UV is going to burn the shit out of you.. fun stuf" Now all of a sudden here is a drug (Avastin) that takes half a second to inject, and not only preserves the vision that you have, but if we catch the leakage early, it can even dry it up and improve your vision! I was fortunate enough to work on some of the early trials and honestly the follow up visits were just breathtaking. NVAMD used to be a death sentence to vision.. now it's merely an inconvenience that can be overcome. With that success came Lucentis (Avastin was being used totally off label) an FDA approved drug that was crazy expensive. Patient's couldn't afford it, no one really used it. Then medicare and some other insurances started having issues with off-label use and it actually became easier to get reimbursed for using Lucentis. The CATT trial started and some issues started being raised over whether or not Avastin was actually safe long term. Then there was the scare in Florida were a batch of Avastin from a compound pharmacy was contaminated and a ton of patients lost their sight to infections. So we started using Lucentis a little more frequently, just to see. While the Catt trial shows the two drugs are pretty equivalent.. in everyday practice, it's becoming more apparent that this is not the case. Some forms of AMD respond better to lucentis than Avastin. Diabetics with Macular Edema sometimes respond quicker to Lucentis (and even faster with Eylea!) It becomes more about finding the right drug for the individual patient than just choosing the cheapest option. Most doctors are not trying to screw their patients over, and have protocols in place for finding the best possible drug, and, in my experience at least, most of these protocols do consider the affordability to the patient as well as the effectiveness. (Personally, I think there are genetic variants of these diseases that determine the effectiveness of the drug, we just don't fully understand yet.. once we can more accurately test these variants and build trials around them, this will become more of a non-issue) A few years ago, I would have totally agreed with this article, not anymore. The sad truth is profit drives innovation, it's a bitch developing new drugs, and their has to be enough of an incentive both financially and medically to encourage progress in that field. At the end of the day, the majority of the doctors out there just want was is going to be best for their patients and are continually re-evaluating their strategies to ensure that goal is met.

This has been my experience as well. There's almost always a cheaper, effective alternative. In the one case where there wasn't, the benefit of the medication vs. its cost was so out of balance that we just decided not to use it.