MONEY Health Care

Here Are the Top-Selling Drugs in the US

Picture taken on January 15, 2012 in Lil
Philippe Huguen—Getty Images

The top-earning prescription drug brought in nearly $8 billion in 2014.

Prescription drugs are a vital part of American health, helping millions every year with their health conditions. About half of all Americans take a prescription drug regularly, and about 1 in 5 U.S. adults takes three or more regular prescription drugs, according to the Centers for Disease Control and Prevention.

But these medications are also a vital part of our economy, for better or worse. Collectively, we spent nearly $374 billion on prescriptions in 2014, according to the latest report by IMS Health Informatics, a company that tracks health care spending. That amount is about equal to Walmart’s profits in 2008 or the entire gross domestic product of Austria in 2009.

We’ve already shared with you the most widely prescribed drugs, but none of those makes the most money. So which drugs were the top earners in 2014?

  1. Sovaldi, $7.9 billion
  2. Abilify, $7.8 billion
  3. Humira, $7.2 billion
  4. Nexium, $5.9 billion
  5. Crestor, $5.8 billion

Uses for the top-selling drugs

The top-selling drugs treat different ailments, and all are brand-name drugs, meaning there were no generic options for them in 2014. That may be why they top the list in sales; generic drugs are typically much cheaper than branded drugs. Here’s what the top-selling prescriptions are used for.

  • Sovaldi was first approved for most types of hepatitis C in 2013 and quickly skyrocketed to the top earnings spot in 2014. There are six genotypes of hepatitis C, and Sovaldi can cure four of them in one or two treatment courses; the other two genotypes account for about 3% of hepatitis C patients. Manufacturer Gilead boasts an 84% to 96% cure rate of hepatitis C, depending on which genotype is being treated, leading many to call Sovaldi a miracle drug.
  • Abilify is a medication for depression, bipolar disorder, and schizophrenia. Officially classified as an antipsychotic, Abilify also treats irritability associated with autism. In April 2015, the first generic for Abilify, aripiprazole, became commercially available.
  • Humira is a biologic drug, which means it’s synthesized from animal tissues or cells instead of from chemicals. It’s indicated for eight conditions, including Crohn’s disease, plaque psoriasis and several types of arthritis.
  • Nexium is approved to treat frequent acid reflux, stomach ulcers, damaged esophagus and gastroesophageal reflux disorder (GERD). In January 2015, the Food and Drug Administration approved the first generic Nexium drug, esomeprazole, so it may not make this list next year.
  • Crestor is the only statin on our list, approved to treat high cholesterol and triglyceride levels. It also may reduce the risk of heart attack and stroke in some high-risk patients.

Cost of the top-selling drugs

These five drugs aren’t among the most widely prescribed, so their high prices explain why they made so much money for their manufacturers last year. Drug prices also vary depending on which pharmacy and dose you use, your health insurance policy and how much you purchase at once, among other factors.

Here are some cash price estimates for one month of common doses of each of the five drugs based on GoodRx searches in San Francisco. For comparison, we’ve also included the prices of the two generics that are now available for the same doses and time frame. Keep in mind that your price will depend on on your insurance formulary, or list of approved medications for coverage, and out-of-pocket costs outlined in your policy.

  • Sovaldi: $30,700 – $31,900
  • Abilify: $921 – $954
    • Generic Abilify, aripiprazole: $371-$682
  • Humira: $3,305 – $3,408
  • Nexium: $252 – $273
    • Generic Nexium, esomeprazole: $103 – $199
  • Crestor: $219 – $225

Bear in mind that the first drug, Sovaldi, is not intended for chronic use, but rather only for three to six months in one lifetime. Sovaldi costs about $84,000 for an average 12-week course of treatment, and some patients require two courses, for a whopping price tag of $168,000. Humira also has a caveat: It requires a larger dose to start before going to maintenance dosage, which will cost more. Only maintenance doses are quoted above.

Saving on the drugs

All this price variation can be a big problem if you’re using one of these drugs. If you’re paying cash for your medications, consider looking into coupons on a site like RxRevu or the manufacturer’s website, which also may have longer-term discount programs. The price ranges are based on different pharmacies, so where you choose to fill your script can make a difference of hundreds or thousands of dollars.

You can also save on your medications by going through an online pharmacy. By allowing you to purchase a larger supply, online pharmacies can offer substantial discounts. If you need more help, you can check out the U.S. Department of Health and Human Service’s listing of prescription assistance programs.

Lastly, if you take a drug such as Abilify or Nexium for which a generic is available, talk to your doctor about switching to the less expensive option. Generics are required to be just as safe and effective as branded drugs, and they must meet the same quality standards. According to the FDA, generics cost about 80% to 85% less, on average, than their pricey brand-name counterparts.

Don’t be afraid to ask your doctor questions about any cost issues. It is always OK to ask about generics, or any other cost-saving options you might find.Whether it’s for drugs, medical procedures, or finding the right doctor, doing your homework and shopping around is a great way to start saving money.

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MONEY Health Care

What Americans Hate Most About Prescription Drugs

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Chris Ryan—Getty Images

Half of us take them and most of us can afford them, but we still have one major complaint.

Nearly three in four Americans say the costs of prescription drugs are “unreasonable” — and most blame drugmakers for those prices, according to a poll released Tuesday.

The survey by the Kaiser Family Foundation found 74% of those taking prescription drugs find the costs unreasonable, as do 72% of those not taking such drugs. (KHN is an editorially independent program of the foundation.)

The poll builds on the results of an earlier Kaiser survey in April that identified high drug costs as the public’s top health care priority for Congress and the president. Drug costs have gained attention in the past year in part as a result of controversies surrounding Sovaldi and other new hepatitis C drugs, which can cure most cases of the deadly liver disease but at a price of $84,000 for a 12-week treatment. The high cost has strained Medicaid and Medicare budgets and left private insurers scrambling.

Half the public say they take prescription drugs. More than three quarters of those say they are easy to afford, with only one in five saying they have difficulty paying for them. But about a quarter of respondents said they or a family member have not filled a prescription in the past year, while 18% have cut pills in half or skipped doses to save money, the poll found.

More than three-quarters of the public cited drug company profits as the No. 1 reason for the high costs, followed by the expense of medical research (64%), the cost of marketing (54%) and the cost of lawsuits against pharmaceutical companies (49%).

About 10 percent of respondents also blame insurance companies, saying they require enrollees to shoulder too great a share of drug costs.

The survey also found most Americans are still not paying attention to the latest challenge to the Affordable Care Act in a case called King v. Burwell. The Supreme Court is expected to decide this month whether to cut off government subsidies to millions of people in about three dozen states that rely on a federal insurance marketplace, rather than a state-based marketplace. About 72 percent of respondents say they have heard little or nothing about the case.

However, the survey found more than half of respondents were “very” or fairly closely” following news about the 2016 presidential campaign. About 39 percent of respondents said they were closely following news about the House of Representatives banning abortions after 20 weeks of pregnancy — the most closely followed health policy issue.

The poll of 1,200 adults, conducted from June 2 to June 9, had a margin of error of plus or minus 3 percentage points.


Kaiser Health Tracking Poll: June 2015

Kaiser Health News (KHN) is a nonprofit national health policy news service.

TIME Crime

How Stolen Prescription Drugs Might Be Fueling Baltimore’s Crime Surge

baltimore police shooting maryland
Colin Campbell—Baltimore Sun/Getty Images Police pick up a pair of tennis shoes after a double shooting in the 2300 block of E. Preston Street in Broadway East on May 24, 2015 in Baltimore, Md.

At least 175,000 prescription drugs looted during April's riots now on the street

Hundreds of thousands of prescription drugs looted during deadly riots in Baltimore over the death of Freddie Gray may be to blame for a recent surge in violence in the city.

Baltimore Police Commissioner Anthony Batts on Wednesday said that at least 175,000 doses of prescription drugs stolen from 27 pharmacies and two methadone clinics during April’s riots have flooded Baltimore, leading to turf wars and violence over their illegal resale.

Officials are also concerned that private information like names and addresses found on drug labels could be subject to misuse and potentially lead to identity fraud.

Since protests broke out on April 27 following the death of Freddie Gray, who died in police custody from a severe spinal injury, violent crime has spiked in Baltimore. Last month, there were 43 homicides in the city, the most in a single month since 1978.

Many criminal justice experts, and the city’s police union, say that some criminals now feel emboldened following the riots. Arrests, meanwhile, have decreased significantly over concerns by some officers that they’ll be charged for improper use of force. Six officers have been indicted in Gray’s death.

Peter Moskos, a John Jay College of Criminal Justice professor, says the stolen drugs could be leading to elevated crime levels but questions whether that’s truly behind the elevated crime levels.

“It could create more robberies,” Moskos says. “That’s certainly possible, but my guess is it doesn’t really matter.” Moskos says he believes that the recent spike in violent crime is due more to a reluctance by police to make arrests.

MONEY Health Care

The Hidden Risks of Short-Term Health Plans

The low-cost plans have huge limitations -- plus a tax penalty.

Worried about going without health coverage, musician Tom Miller bought a nine-month insurance policy in January to tide himself over while he rebuilt his business after a divorce and moved from Maryland to North Carolina.

At $90 a month, it fit his budget, even though it does not offer the broad benefits required by the federal health care law.

Long seen as a stopgap for people between jobs, short-term policies that focus on catastrophic coverage can fill a niche for people like Miller looking for protection against unforeseen accidents, say some insurance brokers. In exchange for their lower premiums, the plans come with sharp limits, including no coverage for pre-existing medical conditions. Many consumer advocates hoped interest in such plans would decline after the Affordable Care Act made broader coverage widely available, but short-term policies appear to be enjoying a resurgence, brokers say.

“We’re writing more short-term now than before the ACA,” although not as much as in the boom years of the early 1990s, said Lynda Sussman, owner of C.O.B. brokerage, which sells insurance policies through its office in Pikesville, a suburb of Baltimore.

The plans attract not only those between jobs, but also people who missed the deadline to sign up for an ACA policy and those who say they can’t afford a more comprehensive plan, she said.

One of the nation’s biggest online brokers — eHealth — has also seen a surge in consumer demand. The website reports that applications for the policies on its website rose 130 percent, to more than 140,000, between 2013 and last year, when the ACA’s requirement that most Americans carry insurance went into effect. The eHealth website may not necessarily reflect national trends, but little data exists from government or industry sources on the sales of short-term policies.When he bought his plan online from eHealth, Miller said he didn’t know that it would not protect him from a tax penalty of at least $325 imposed by the federal health law for failing to have coverage that meets the law’s minimum standards.

“That bothers me,” said Miller, 36, a self-employed sound engineer and drummer in Raleigh, who formerly had coverage through his wife and now may face at least a $325 penalty for not having coverage this year. “I should still qualify.”

On the eHealth website, consumers can see disclaimers for the short-term plans, warning, “even if you enroll in and maintain short-term coverage, you may still be subject to the tax penalty.” Short-term policies, which can be bought in increments of 30 days to 12 months, generally have lower premiums than other health insurance. While that is attractive to many consumers, the premium price reflects their limits: They are exempt from most provisions of the health law.

Applicants, for example, can be rejected for coverage if they take prescription medications or have a health condition, which the federal law prohibits for other types of insurance. EHealth reports that insurers turned down 18,000 short-term policy applicants using its website last year, up from 5,500 in 2013. The plans usually ask applicants a few simple questions about their health, but could seek more information from a policyholder’s medical records.

In addition, short-term policies rarely cover maternity care, some cap the dollar amount of care they will cover, they can’t be renewed and any medical conditions policyholders develop during the course of the policy can be excluded from coverage if they do re-apply.

“People are really taking a chance,” said Karen Pollitz, who studies the insurance market as a senior fellow at the Kaiser Family Foundation. “They have to hope they stay healthy until the next open enrollment.” (KHN is an editorially independent program of the foundation.)

For Miller and others, the draw is the price. He could have stayed on his wife’s policy for a time while going through his divorce, but it would have cost $300 a month.

“That’s a car payment,” he said. “I didn’t want to put myself in a financial situation with more stress.”

EHealth reports the average premium nationally for a short-term policy is about $110 a month for an individual, and carries an average annual deductible of $3,589. They’re less expensive for younger people, averaging $89 a month for those between the ages of 25 and 34, the biggest group applying for coverage through eHealth. No subsidies are available to help people purchase them because they don’t qualify as ACA plans.

Premiums are generally higher for coverage that meets the requirements of the federal health law. A Kaiser Heath News analysis of 2015 rates found the average monthly premium for a 40-year-old buying the lowest cost silver-level coverage through the federal online market nationally was $273, before subsidies. Still, federal data show that 87 percent of those enrolling through the federal website received subsidies of varying amounts to help offset the premium cost.

Brokers say that some of those purchasing coverage are doing so because they fall into the “coverage gap,” earning too much to qualify for Medicaid coverage in states that did not expand eligibility, but too little to get a subsidy.

Ruth Dunlap, a 36-year-old office assistant in Ann Arbor, Mich., said she bought a policy this spring, hoping it would protect her until she can get a full-time job with benefits. She works temporary jobs, earning between $10,000 and $20,000 a year. She signed up for the short-term policy after she was told she earned too little to qualify for a subsidy in her state, and her state did not expand Medicaid eligibility under the health law until April.

Not long after getting her policy, Dunlap went to the emergency room with a gall bladder attack. The hospital sent a bill for $1,500 — marked down from $2,000 because she had insurance – but she hasn’t yet submitted the paperwork to the insurer to see how much of the bill will be covered by her $75-a-month plan. She’s likely to have to pay a deductible first, but isn’t sure of the amount. She may also face questions from the insurer about whether she had any past gall bladder problems and might get no help if she did.

Last week, Dunlap learned she may now qualify for Medicaid since the state expanded eligibility to those earning up to 133 percent of the federal poverty level, about $16,000 for a single person. She applied and is waiting to hear if she’s been accepted, but will hang on to her short-term policy in the meantime.

Many people won’t qualify for a short-term policy, particularly if they have had a recent illness or are taking certain medications. Broker Sussman said she does not recommend short-term plans for older customers, or those with health conditions. Still, for some clients, particularly younger adults being pushed to have coverage or those who missed the open enrollment deadline for the ACA and just want something in place until the next enrollment period in the fall, “it’s better than going without and it’s a helluva lot cheaper” than other types of insurance, she said.

Not every broker agrees the policies are worth having.

“I refuse to sell it to someone in lieu of Obamacare,” said Susan Lundy of Benefits by Design, a brokerage in Larkspur, California. She said the main reason customers ask about the plans is their price, but she warns them that the policies won’t cover any existing medical conditions. And if something happens during their term, “if you break your leg and you get a new policy six months later, they have an exclusion on the break,” she said.

Lundy said even people who fear they’ve missed the ACA signup enrollment period, which this year ran from mid-November until the end of April, may not be out of luck.

Many people can qualify to buy a plan now through a number of exceptions, which include losing other ACA-qualified coverage, moving, getting married or having a baby.

Because he recently moved and lost his coverage when he divorced, Miller might qualify. For now, though, he’s hanging onto his short-term policy while looking around do see what else is available.

“I know I need health insurance,” Miller said. “I travel a lot. I’m active. The policy is good while I go through a transition. I just needed something until I get my feet back on the ground.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

MONEY Health Care

Here’s How Much We Spent on Prescription Drugs Last Year

prescription pill containers
David Smart—Shutterstock

Costs for the top 5 most popular drugs can vary widely.

We remain a prescription nation. Nearly 70% of Americans are taking at least one prescription drug, and more than half take two, according to researchers at the Mayo Clinic and Olmsted Medical Center. What’s more, about 20% of Americans use at least five prescription medications. That same research shows that prescription drug use has been increasing steadily in the U.S. for the past decade.

And sales are high, too. According to an April 2015 study by the IMS Institute for Healthcare Informatics, a company that tracks sales at the pharmacy level for drug companies, total drug spending in 2014 was $374 billion, up 13.1% from the prior year.

So which drugs are the most widely prescribed? That same IMS report shows that the top five medicines prescribed in the U.S. in 2014 were:

  1. Levothyroxine
  2. Hydrocodone/acetaminophen
  3. Lisinopril
  4. Metoprolol
  5. Atorvastatin

These drugs are being prescribed in the millions, according to the IMS Institute. There were about 120 million prescriptions dispensed for levothyroxine, 119 million for hydrocodone/acetaminophen, 104 million for lisinopril, 85 million for metoprolol, and 81 million for atorvastatin.

Uses for the most commonly prescribed drugs

The top drugs are used to treat a variety of ailments — from pain to high blood pressure and high cholesterol. Here’s a breakdown of the use of each drug:

  • Levothyroxine is used to treat hypothyroidism, a condition in which the thyroid gland doesn’t produce enough thyroid hormone. This drug also is used to treat thyroid cancer and to help shrink an enlarged thyroid gland.
  • Hydrocodone/acetaminophen is the nation’s most popular painkiller used to treat moderate to severe pain. Hydrocodone, a narcotic analgesic, relieves pain through the central nervous system, and it also is used to stop or prevent coughing. This drug’s reputation precedes it, as it can become habit-forming when used over an extended period of time.
  • Lisinopril (which used to be sold under the brand names Zestril and Prinivil) is a high blood pressure medication. Its main function is to block chemicals in the body that trigger the tightening of blood vessels. Lisinopril also is used to treat heart failure.
  • Metoprolol, the generic version of Lopressor, is used to treat high blood pressure and also helps reduce the risk of repeated heart attack. Metoprolol also treats heart failure and heart pain, or angina.
  • Atorvastatin, the generic of Lipitor, is prescribed to treat high cholesterol and is typically recommended in conjunction with diet changes. This drug is believed to have a variety of benefits, including helping prevent heart attacks and strokes.

Cost of the drugs

The cost of these drugs is a slippery subject, as the price varies depending on where you buy them and on your insurance coverage. Factors that influence the cost of a prescription include how many doses are in a prescription and how many milligrams are in each dose. If you are prescribed a brand-name drug, be sure to ask the pharmacist if there is a generic version, since brand names tend to be 80% to 85% more expensive than generics, which legally cannot differ in efficacy, potency, quality or safety.

Here are cash price estimates for the five drugs based on GoodRx searches in San Francisco for both 30- and 90-day prescriptions. Keep in mind that your costs will differ based on your insurance status and drug co-pays associated with your plan. Where you get your prescription filled can also affect the price you pay, so be sure to shop around.

  • Levothyroxine: $4-$16
  • Hydrocodone/acetaminophen: $12-$20
  • Lisinopril: $4-$12
  • Metoprolol: $4-$13
  • Atorvastatin: $15-$41

Discount programs

There are a variety of ways to save money on prescription drugs. If you’re paying cash for your prescription medications, look into drug coupons — from a website like RxRevu — or in weekly discount fliers and direct mailings from major pharmacies.

Another way to save money on prescriptions is to shop through an online pharmacy, which can shave 35% or more off the cost of your medication. If you go this route, your doctor can fax or mail the prescription to the online pharmacy, then the medicine is mailed to you.

Some states, such as Washington and Kentucky, also offer drug discount cards for those who meet age and income requirements. Another resource is the nonprofit NeedyMeds, an organization that maintains a website about programs that can help people who can’t afford medication. In addition, the U.S. Department of Health and Human Services has a website to connect people with prescription discount programs. Many pharmaceutical companies offer patient assistance programs for individuals who cannot afford their medications, so look into your options before making a purchase — especially if it’s for a pricey brand-name drug.

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MONEY Health Care

How to Survive This Awful Allergy Season

pollen written on windshield covered in pollen
Joseph De Sciose—Getty Images/Aurora Creative

Lingering winter cold means pollen levels could rise quickly—and so could your medical costs.

Grab your tissue box. We’re in for a terrible spring allergy season. Experts say that the long winter may cause early-blooming trees to pollinate late this year, which means more trees pollinating at the same time.

About one in five Americans suffer from some kind of allergy, with seasonal allergies the most common, according to the Asthma and Allergy Foundation of America. While not as severe as food and insect allergies, hay fever can put a real damper on your life—seasonal allergies are responsible for some 4 million missed or lost workdays every year, the National Academy on an Aging Society estimates.

The upside is that if you take your allergies seriously this year, you might feel better and save money. True story: My entire childhood, I had “seasonal” allergies that lasted almost year-round. (For some reason, no one thought this was weird.) As an adult, I finally got tested. I was allergic to my cat. Part of me wishes I didn’t know that, but I don’t have to buy as much Claritin now.

Here’s what allergies could cost you—and how you can save.

Over-the-counter antihistamines: 10¢ to 67¢ a pill

With hay fever, you can burn money on boxes upon boxes of over-the-counter allergy relief like Claritin, Allegra, and Zyrtec. But you can save a ton if you just compare prices online, says Elizabeth Davis, editor-in-chief of GoodRx blog, a prescription savings blog.

“One thing that tends to be worthwhile is going for the non-name brand version,” Davis says. “It looks like you can get [generic Claritin] for as low as $10 for 100 tablets, but I’m generally seeing about $20 or so for a regular box of brand-name Claritin, which has 30 tablets.”

So shop online, save 85%.

Another medication to consider: nasal spray. Nasacort and Flonase were both recently approved for over-the-counter sale, where they cost between $17 and $25 a bottle, Davis says.

Prescription antihistamines: 50¢ to $1.60 a pill

Sometimes, over-the-counter medications won’t be enough to alleviate your symptoms. If you’re still suffering, or if you find yourself relying on Benadryl on a daily basis, it’s time to see an allergist.

While prescription allergy meds are usually more expensive—as low as $15 but as much as $40 or $50 for 30 tablets, Davis estimates—what you pay will depend on your health plan. Doctor visits, tests, and prescriptions are typically covered by health insurance, with a co-payment or co-insurance, after you meet your deductible.

The higher dosages in prescription meds might be what you need to kick your symptoms. A doctor might double, triple, or even quadruple your dose, or advise you to take a combination of antihistamines and decongestants, says Neil Kao, an allergist in Greenville-Spartanburg, S.C.

“When you go the doctor, you might say, ‘Well, I took Claritin, and it didn’t work,'” Kao says. “The doctor might say you need two—one in the morning, one at night. You might say, ‘The box says one.’ Well, that’s why I went to medical school!”

Also, while prescription generic Nasacort nasal spray costs more—typically $50 to $75 a bottle—and prescription generic Flonase costs less—usually $12 to $17—the prescription versions could be a better deal than over-the-counter versions if you have a low co-pay, Davis says. Talk to your doctor and check your plan.

Allergy testing: $30 to $275

Once you’ve spent serious money on allergy medicine, you may want to know if you’re on the right track, Kao says. Are you sneezing because there’s pollen in the air, or because you have a cold, or because your cat is shedding his winter coat? With a simple skin test, an allergist can determine what, if anything, you are allergic to.

According to HealthSparq, a health costs transparency firm, an office visit with an allergist typically runs $200 to $300 before insurance. Those estimates are based on insurer-negotiated prices on claims filed in Oregon, Washington, Utah, and Idaho.

From there, the cost of the allergy tests can vary from $30 to $275, and even as high as $4,000, depending on the type and number of tests given, according to HealthSparq. Pro tip: 77% of large employers offer a price transparency tool, according to Mercer, so you can get your own individualized price estimate.

Immunotherapy: $15 to $20 a session

After you know what you’re allergic to, allergy shots are another treatment option. Here’s how it works: Your allergist uses a skin test to decide which allergens to put in your shots, which slowly expose you to your allergens to get your immune tolerance back up to normal, Kao explains.

Kao recommends shots for sufferers with moderate to severe allergies who either do not get enough relief from medications or who do not want to take medications any longer. “Statistically, [shots] help about 90% of well-selected people,” Kao says.

HealthSparq estimates that it typically costs $15 to $20 a visit before insurance kicks in, but could be as high as $170 a visit, depending on your course of treatment.

However, Kao says that in the long term, allergy shots pay for themselves. Think of the money you won’t be spending on over-the-counter medications, prescriptions, antibiotics for sinus infections, and doctor’s visits. “That’s all money saved,” Kao says.

EpiPens: $450 to $500 for a two-pack

Pollen means something else for people with bee sting allergies: It’s time to carry an EpiPen again. EpiPens—or epipnephrine auto-injectors—provide immediate relief to anyone suffering from anaphylaxis, a potentially fatal allergic reaction. The pen is inserted into the middle of the thigh while a patient awaits professional medical attention.

Unfortunately, the price of EpiPens have increased significantly in the past several years. Davis of GoodRX Blog estimates a two-pack could run about $450 to $500 before insurance.

Coupons can help. At EpiPen.com you can apply for discounted epinephrine pens. Many patients with private health insurance can get the EpiPen two-pack for free, and everyone else can get $100 off, says Davis.

Alternately, you can get a generic epinephrine pen for $250 to $300, but you’ll need to ask your doctor to write a prescription specifically for the generic, Davis says.

Update: This article was updated to indicate the correct use of an EpiPen.

MONEY health

We’re Spending Much, Much More on Prescription Drugs

Americans spent nearly $374 billion on prescription drugs in 2014, thanks in part to some shockingly expensive new medicines.

MONEY Health Care

The Scariest Health Care Statistic of 2014

Express Scripts reports that spending on medicine surged by 13.1% in 2014.

Healthcare has no shortage of frightening statistics, but a recent review of U.S. spending on medicine last year by the pharmacy benefit manager Express Scripts EXPRESS SCRIPTS HOLDING COMPANY ESRX -1.29% contained a particularly scary revelation: Last year, Americans shelled out 13.1% more for medicine than they did in 2013. That surge in spending could put our healthcare system on a perilous path, especially given that healthcare utilization is climbing on the tailwind from aging baby boomers and healthcare reform.

Better drugs equals pricier medicine

Thanks to innovative new therapies, people are living longer, but they’re doing so at a steep cost.

A decade ago, medicines were primarily small molecule drugs that were easy to manufacture and duplicate. As a result, these drugs were less costly to prescribe and were more quickly challenged by generic alternatives once their patent protection ended.

Today, medicines are increasingly complex biologics. These biologic drugs are medicines that are developed inside living systems such as plant or animal cells. Most biologics are complicated molecules or combination molecules that aren’t easily replicated. The complexity of biologics often translates into increased efficacy over prior generation drugs, but it also makes them much more expensive to develop and manufacture. It also makes it incredibly difficult for generic drugmakers to duplicate them once their patents expire.

The ongoing shift toward these increasingly complex — and correspondingly more expensive medicines — has resulted in them accounting for an increasingly larger share of our healthcare dollars.

According to Express Scripts, despite specialty drugs like biologics representing just 1% of all annual prescriptions, they accounted for a whopping 31.8% of drug spending last year.

Unsustainable spending?

Across the tens of millions of health insurance members covered by Express Scripts pharmacy plans, spending on the average member climbed to $668.75 per year for traditional drugs and $311.11 for specialty medicines.

As you can see in the following table, annual spending per member increased by 6.4% year over year for traditional drugs and by 30.9% for specialty drugs. In both instances, higher drug prices were overwhelmingly behind the increases.

If left unchecked, drug spending growth of this magnitude could be unsustainable. In 2013, IMS Health reported that U.S. spending on medicine clocked in at about $329 billion.

If spending increases by 13.1% per year over the next 20 years, the amount spent annually on prescription medicine would surpass $3.8 trillion (yes, with a “t”).

Taking matters into hand

Such a surge in drug spending would undeniably put patients at risk. Medical costs are the biggest reason for personal bankruptcy, particularly among patients with diseases like HIV and cancer.

In an attempt to blunt the risk to the system posed by runaway drug costs, pharmacy benefit managers, or PBMs, like Express Scripts and CVS Health CVS HEALTH CORPORATION CVS -0.65% — the two largest PBMs — are rethinking how they pay for drugs.

In December, Express Scripts negotiated a steep discount to AbbVie’s ABBVIE INC. ABBV 1.85% new hepatitis C drug Viekira Pak by offering exclusivity. In January, CVS Health similarly orchestrated a discount for Gilead Sciences’ GILEAD SCIENCES INC. GILD -0.76% competing hepatitis C drugs, also in exchange for exclusivity. Express Scripts estimates that its deal with AbbVie will save its clients $1 billion annually.

In addition to more aggressive price contracts with drugmakers, healthcare payers are also developing programs that can increase patient adherence to medicine to lower the risk of costly future healthcare events, as well as programs to increase the use of generic alternatives.

PBM programs that increase the use of lower cost generics could prove to be critical. Despite biologics’ difficult-to-copy nature, technology advances are helping generic drugmakers develop biosimilars. While not exact copies, these biosimilars deliver similar efficacy to their brand name counterparts. So far, biosimilars have been a bigger story in Europe than in the U.S.; however, the FDA approved its first biosimilar this month when it gave Novartis’ Sandoz unit the go-ahead to begin marketing its biosimilar of the top-selling cancer drug Neupogen. That approval is likely to be the first of many over the coming years.

Looking ahead

The financial stakes are high for patients and drugmakers. If prices are too low, it could force drug developers to focus only on diseases that offer the biggest payoff. That could derail advances in a range of orphan diseases. However, if prices for medicine continue to grow at this rate, it’s unlikely that the system will be able to afford it. Clearly, a middle ground is not only necessary, but in the best interest of everyone. Finding that middle ground, however, may remain difficult.

MONEY Health Care

Why You Could Have to Foot the Full Bill for a Weight-Loss Drug

The government has approved more drugs that suppress your appetite, but not all insurers will pick up the tab for the prescription.

In December, the Food and Drug Administration approved a new anti-obesity drug, Saxenda, the fourth prescription drug the agency has given the green light to fight obesity since 2012. But even though two-thirds of adults are overweight or obese—and many may need help sticking to New Year’s weight-loss resolutions—there’s a good chance their insurer won’t cover Saxenda or other anti-obesity drugs.

The health benefits of using anti-obesity drugs to lose weight—improvements in blood sugar and risk factors for heart disease, among other things—may not be immediately apparent. “For things that are preventive in the long term, it makes plan sponsors think about their strategy,” says Dr. Steve Miller, the chief medical officer at Express Scripts, which manages the prescription drug benefits for thousands of companies. Companies with high turnover, for example, are less likely to cover the drugs, he says.

“Most health plans will cover things that have an immediate impact in that plan year,” Miller says.

Miller estimates that about a third of companies don’t cover anti-obesity drugs at all, a third cover all FDA-approved weight-loss drugs, and a third cover approved drugs, but with restrictions to limit their use. The Medicare prescription drug program specifically excludes coverage of anti-obesity drugs.

Part of the reluctance by Medicare and private insurers to cover weight-loss drugs stems from serious safety problems with diet drugs in the past, including the withdrawal in 1997 of fenfluramine, part of the fen-phen diet drug combination that was found to damage heart valves.

Back then, weight-loss drugs were often dismissed as cosmetic treatments. But as the link between obesity and increased risk for type 2 diabetes, heart disease, cancer and other serious medical problems has become clearer, prescription drugs are seen as having a role to play in addressing the obesity epidemic. Obesity accounts for 21% of annual medical costs in the United States, or $190 billion, according to a 2012 study published in the Journal of Health Economics.

The new approved drugs—Belviq, Qsymia, Contrave and Saxenda—work by suppressing appetite, among other things. Saxenda is a subcutaneous injection, the other three drugs are in pill form. They’re generally safer and have fewer side effects than older drugs. In conjunction with diet and exercise, people typically lose between 5% and 10% of their body weight, research shows, modest weight loss but sufficient to meaningfully improve health.

The drugs are generally recommended for people with a body mass index of 30 or higher, the threshold for obesity. They may also be appropriate for overweight people with BMIs in the high 20s if they have heart disease, diabetes or other conditions.

In 2013, the American Medical Association officially recognized obesity as a disease.

Nevertheless, “people still assume that obesity is simply a matter of bad choices,” says Ted Kyle, advocacy adviser for the Obesity Society, a research and education organization. “At least half of the risk of obesity is inherited,” he says.

Many people who take an anti-obesity drug will remain on it for the rest of their lives. That gives insurers pause, says Miller.

The potential cost to insurers could be enormous, he says.

Susan Pisano, a spokesperson for America’s Health Insurance Plans, a trade group, says the variability of insurer coverage of anti-obesity drugs “relates to issues of evidence of effectiveness and evidence of safety.”

In 2012, the U.S Preventive Services Task Force, a non-partisan group of medical experts who make recommendations about preventive care, declined to recommend prescription drugs for weight loss, noting a lack of long-term safety data, among other things. But its analysis was based on the older drugs orlistat, which is sold over the counter as Alli or in prescription form as Xenical, and metformin, a diabetes drug that has not been approved for weight loss but is sometimes prescribed for that by doctors.

The task force did recommend obesity screening for all adults and children over age 6, however, and recommended patients be referred to intensive diet and behavioral modification interventions.

Under the health law, nearly all health plans must cover preventive care recommended by the task force without cost sharing by patients. Implementation of the obesity screening and counseling recommendations remains a work in progress, say experts.

Dr. Caroline Apovian, director of the Nutrition and Weight Management Research Center at Boston University, says many of the patients she treats can’t afford to pay up to $200 a month out of pocket for anti-obesity drugs.

“Coverage has to happen in order for the obesity problem to be taken care of,” says Apovian. “Insurance companies need to realize it’s not a matter of willpower, it’s a disease.”

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

MONEY Health Care

Why a Serious Medical Condition Could Cost You Even More Next Year

Pill container spilling out money
Last Resort—Getty Images

Health insurance plans are hitting you with higher out-of-pocket costs for the specialty drugs you may need, a new study finds.

Americans with health coverage–including those who buy it through government insurance exchanges and Medicare beneficiaries–are likely to pay more out-of-pocket next year for so-called “specialty drugs,” which treat complex conditions, according to two studies from consulting firm Avalere Health.

More than half of the “bronze” plans now being sold to individuals through federal and state marketplaces for coverage that begins in January, for example, require payments of 30% or more of the cost of such drugs, Avalere said in a report out Tuesday. That’s up from 38% of bronze plans this year.

In “silver” level plans, the most commonly purchased exchange plans, 41% will require payments of 30% or more for specialty drugs, up from 27% in 2014.

As the cost of prescription medications rise, insurers are responding by requiring patients to pay a percentage of specialty drug costs, rather than a flat dollar amount, which is often far less. Insurers say the move helps slow premium increases.

But “in some cases this could make it difficult for patients to afford and stay on medications,” Avalere CEO Dan Mendelson said in a written statement.

While there is no standard definition of such drugs outside of the Medicare program, they are often expensive medications used to treat serious, chronic illnesses, such as multiple sclerosis, rheumatoid arthritis, hemophilia, some cancers and hepatitis C. While lists of specialty drugs can differ by insurer and by policy type, drugs can include arthritis treatments Enbrel and Humira, cancer drugs Gleevec and Tarceva, hepatitis C treatment Sovaldi, and MS drugs, Betaseron and Copaxone.

While they add up to only about 1% of all prescriptions written, specialty drugs account for 25% of spending on all drugs—an amount expected to rise rapidly, according to various studies.

An earlier Avalere analysis found that for the first time since Medicare’s drug program began in 2006, all of the stand-alone drug insurance plans place some drugs into specialty “tiers.” Two thirds of those plans require patients to pay a percentage of the costs of drugs in those tiers, rather than a flat dollar payment. Medicare plans can place a product into a specialty category only if the price negotiated with the drugmaker exceeds $600 a month.

Increasingly, health plans –including those offered to people with job-based coverage – require hefty payments, sometimes 20% to 40% or more of the total cost of medications that insurers classify as specialty drugs. That’s a change from the flat dollar payments of $10 to $30 or $50 that many patients have become accustomed to for other types of drugs.

Source: Avalere

There is a limit to how much patients must pay, but it’s often high: Most policies have an annual out of pocket maximum, which is often several thousand dollars.

The new Avalere study looked at plans sold in the federal exchange and in New York and California, which run their own marketplaces.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. This article was produced by Kaiser Health News with support from The SCAN Foundation.

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