A version of this story first appeared in D.C. Diagnosis, STAT’s weekly newsletter about the politics and policy of health and medicine. Sign up here to receive it in your inbox.
WASHINGTON — “Most* patients pay between $0 and $5 per month” for Janssen’s drug Stelara, the chart proclaims.
But, boy, does that asterisk contain quite the caveat. Way down at the other end of the graphic, any patient paying the list price is shelling out a whopping $11,002 every month for the same drug.
The jarring figure comes from a new Janssen website launched recently as part of the broader pharmaceutical industry’s push to disclose some pricing information in its television ads. A broad swath of companies voluntarily agreed to include mention of a website with pricing information in the spots as a response to a far more stringent Trump administration proposal that would have required them to actually include a drug’s sticker price. The final version of that proposal is still pending regulatory review.
The websites offer a new and rare window into the exceptionally opaque drug pricing world. For the first time ever, consumers eager to ask their physician about the latest and greatest drug will have some sense of how much that drug is going to cost them before they trek over to their doctors’ office for a prescription.
They also underscore just how hard it is to calculate something like “the price of a drug.” A myriad of factors — many of which are outside of drug makers’ control — go into determining what exactly a patient pays out of pocket. The drug companies, in many cases, went to great lengths to explain that to consumers on their new websites, and to list out the options available to anyone who can’t afford a medication.
But no good deed goes unpunished. STAT dug into each company’s new website to compile the highlights, and of course, the lowlights.
And with that: The First Annual WACkies. (Yes, we made a joke about wholesale acquisition cost.)
The ‘Oh, my God, I can buy a small sedan for that price’ award
Janssen wins this unenviable accolade. It tried its best to assure would-be customers that most people pay less than $5 dollars a month for its Crohn’s disease drug Stelara (it even made a sleek periwinkle graphic to drive the point home!). But you can’t help but lose your breath when you see the list price for the drug is more than $11,000 per month. No amount of Photoshop and pastel tones is going to make that one sting any less.
Janssen, it is worth noting, is the lone company on this list to include actual pricing information — rather than just a link to its website — in the TV spots, a voluntary policy it announced in February.
The ‘Best fine print’ award
Pfizer wins this one for its rheumatoid arthritis drug, Xeljanz. Pfizer’s website (which is quite user-friendly) says 52% of commercially insured patients pay less than $20. But when you scroll down, you can see that 14% of patients pay more than $200. Scroll down even farther and you find this: “People who paid $200+ paid $1,167.47 on average.” Always pays to read the fine print.
The ‘Most blatant attempt to play down a sticker price’ award
Astellas deserves this honor for its quixotic attempt at disguising the list price of its overactive bladder drug, Myrbetriq. You won’t actually find a list price on Astellas’ site — instead, patients are told they’ll pay $12.81 per day. A little basic arithmetic and you see why Astellas may not have wanted to put the monthly cost (or, yikes, the annual cost) on its site. We’re happy to, though: $12.81 per day means a $4,675 annual cost.
AstraZeneca is a close runner-up for this title. To the company’s credit, the list price is prominently displayed at the top of each of their drugs’ respective websites. But its attempt to downplay who pays that price is something to marvel at. The company won’t even admit patients without insurance pay list price. Instead, the website states: “If you do not have insurance coverage … you can expect to pay the amount determined by your pharmacy, which will vary.”
The ‘Best explanation of why insurance is confusing’ award
No snark here, GlaxoSmithKline wins the award for most thoughtful explanation of why determining what Medicare patients pay is so confusing. While most of its PhRMA brethren resorted to just providing an average for what patients pay, GSK went to great lengths to explain the four phases of Medicare drug coverage and how those stages impact patient out-of-pocket cost.
Second place goes to Celgene, which had a nice succinct explanation of the difference between copays and coinsurance.
The ‘It’s not that simple’ award
If GSK was the best at explaining the nuances of insurance coverage, Takeda and Lundbeck were the worst. You won’t find a thoughtful explanation of Medicare drug coverage on the pricing website for the antidepressant Trintellix, which they market together — in fact, you’d be hard-pressed to even find the word “Medicare.” Unlike many of their pharma industry colleagues, Takeda and Lundbeck don’t even try to explain on the website what Medicare patients would pay. Instead, there’s one graphic assuring patients “You can pay as little as $10.” The fine print, of course, is that Medicare patients can’t use the copay coupon Takeda is pushing.
The ‘Pushiest copay card advocate’ award
The competition was fierce for this one. So much so that we’ll call it a tie between Amgen and Takeda. If you’re insured by your employer and seeking a clear answer — or rather, any answer — on what you’ll pay out of pocket for these companies’ drugs, you’re out of luck. If you tell any of these companies you have commercial insurance you’ll only be able to see what a patient using a copay card pays. Those websites are here and here.
The ‘You missed the point’ award
This one goes to Gilead, which seems to have omitted list prices from the websites for its drugs Truvada and Epclusa entirely. The omission was so glaring, we thought it could be a mistake. We even watched their TV ads to see if we were looking at the wrong website. When asked to identify where prices are posted on Gilead’s websites, a spokesperson directed STAT to a statement from earlier this month that said the company would begin publicizing pricing information “this quarter.” (PhRMA, the drug makers’ trade association, originally set a deadline for the websites of April 15.) Perhaps it’s already buried somewhere, but if we can’t find it, consumers probably can’t either.