On March 10th, I received the news that the drug Makena™ (hydroxyprogesterone caproate) had been FDA approved for the prevention of preterm birth. It is given from 16 weeks of pregnancy through the 36th week as a weekly injection. A large trial was completed in 2003 which revealed that this drug actually worked to prevent preterm delivery in women with a history of preterm birth.This was the first time we actually had a drug like this and it was outstanding news. So what’s my beef, you ask? How does this relate to marking the first year of the historic passage of the health care law, the Affordable Care Act?
Well, I’ve been using this drug, successfully, since 2003 with my patients and my local compounding pharmacy could get it into my patients’ hands for about $10 per dose. But now, Ther-Rx (the pharmaceutical company producing Makena™) has the list price set at $1500 per dose. As far as I’m concerned, this is price gouging, pure and simple. Ther-Rx is a subsidiary of KV pharmaceuticals and I’m sure they will justify this price based on quality control and the cost of obtaining FDA approval but it’s about making money. Never let a little thing like preterm birth get in the way of capitalism, right?
What’s worse is that my local compounding pharmacist received a “cease and desist” letter in the mail letting him know that he had better not make anymore of the “cheap” stuff because the FDA would come after him.
Even though this drug will prevent thousands of preterm births annually, if insurance companies have to cover the cost of the drug, it will cause everyone’s premiums to rise. The cost of this drug per pregnancy to prevent one preterm birth is $30,000, which is a small price to pay when you consider that the cost of caring for a preterm baby in the first year of life is more than $50,000 but when we have been preventing preterm birth for about $200 per pregnancy, it seems a bit ridiculous, doesn’t it?
After I said a few choice words and had time to think for awhile, I decided that there must be a silver lining to this cloud somewhere. Then I remembered that the first anniversary of the Affordable Care Act is coming up on today, March 23. Looking at the law and what it does reminds me that even though we have some huge issues with our health care system that remain, the Affordable Care Act is helping to make sure that some of the women who need this drug will get it and some of the rest of us will be protected from the insurance companies.
I’ve made a list of some of the provisions in the law that allow for this but I recommend that you look at http://www.healthcare.gov/ to see a timeline for implementation of the various provisions within health care law for yourself. Maybe it will help you stay sane, too…
- States can now cover more families under Medicaid.
- A national program was instituted to provide access to insurance for the uninsured with a pre-existing condition.
- Young adults under the age of 26 can stay on their parents insurance plan.
- Rescission of coverage is prohibited (this is when insurance companies would end your coverage when you got sick, that can not happen anymore).
- Lifetime limits on coverage is also prohibited.
- On January 1, 2014, annual limits on insurance coverage and denial based on pre-existing conditions will be eliminated for everyone. This is a big issue for women since pregnancies and C-sections often bump us into the “pre-existing” condition category.
I fought hard to ensure the health care law was passed. My grandfather fought hard while in Congress to ensure Nebraskans had access to care through Medicaid and Medicare. I know today on radio, TV and in newspapers across our state that we will hear opponents against the health care law.
The truth is, they have no real alternative.
It is time for us all to move forward, protect the law, fix things that may not work, but most of all protect our families and babies.
We can do that by keeping our elected officials accountable and by staying up-to-date on the truth behind the health care law. When you hear elected officials call it “Obamacare” or tell lies about the law, send them an email with the facts, call them out on Twitter and Facebook.
We have to move forward together, it’s how we built our country and how we will build a health care system that protects us all.