Seven years ago, Ed Levitt received what he considered a death sentence.
He was diagnosed with Stage 4 lung cancer. For a nonsmoker who had seemed “fit as a fiddle,’’ the diagnosis came as a shock.
He had worked for a Fortune 500 company, and he believes the chemicals involved in his work led to his lung cancer.
Levitt, of Acworth, began taking a drug called Iressa, a so-called “biologic’’ drug. Biologics are complex mixtures made from living organisms. Unlike other drugs, they are not chemically synthesized.
The good news for Levitt was that the drug therapy shrank the tumors in his body, so that his lung cancer is under control for now.
The bad news was the price. Iressa cost him about $500 a month under his former company’s retiree health plan. The drug, he said, “is like a Ferrari – a beautiful car, but out of my reach” financially.
Levitt, 69, recently testified before a Georgia House health committee about the cost of such medications.
Biologics can cost $100,000 or more a year. But many of these drugs have sustained and vastly improved life for patients with multiple sclerosis, rheumatoid arthritis, cancer and other health conditions.
The drugs have a 12-year exclusivity period from “generic” competition. (For scientific reasons, copies of biologic drugs are not officially defined as generics.) The industry argues that exemption is necessary to protect companies’ large investment in producing these innovative medications. AARP, among others, supports a reduction in the exclusivity period.
Meanwhile, the number of prescription biologics is expected to grow in coming years.
The drug industry notes that prescription drugs save money in other areas of the health care system, such as hospitalization, and that manufacturers have financial assistance programs for people with low incomes.
For patients with insurance, biologic medications are often classified as “specialty’’ or Tier 4 or Tier 5, which in a drug plan often makes the consumer pay a percentage of the medication’s cost, perhaps 20 percent to 33 percent.
For years, while he was getting insurance through his former employer, Levitt had total out-of-pocket medical costs that ran up to $15,000 a year, with the cancer drug contributing a large chunk of that tab. (He also was diagnosed with bladder cancer.)
It was enough to make him and his wife, Linda, worry that their money would run out.
“How many average people can afford $15,000 out of pocket?” he asks.
Yet he feels he’s lucky even to get Iressa. Since 2005, the FDA has limited use of the drug to cancer patients who in the opinion of their treating physician are currently benefiting, or have previously benefited, from its use.
Now Levitt has Medicare’s Part D prescription drug plan, after his former employer dropped retiree coverage. He is paying $400 a month for all his prescriptions.
He credits the health care reform law’s easing of payments for seniors in the Medicare drug “doughnut hole,” plus a Medicare supplement policy.
Still, the costs have squeezed the couple financially. “Now we really push it to make ends meet,’’ he says.
After Ed got sick, the Levitts formed a Georgia chapter of the national Lung Cancer Alliance.
Recently they have focused on the cost of cancer drugs. “I don’t want to see people dying with nowhere to turn to,’’ he says. “We’re not talking about people getting these drugs for free. We’re saying they should be affordable.’’
Linda says, “We get more and more calls about people trying to pay for’’ the expensive cancer drugs.
“They are miracle drugs,’’ she says. “People need access to these drugs at an affordable amount of money.’’
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