Saturday, November 01, 2014

Sticker Shock

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In the event of a scorpion sting, Anascorp can save your child’s life. And bankrupt you.

Dr. Leslie V. Boyer isn’t afraid of scorpions – not even Arizona’s own bark scorpion, the most venomous variety in North America. Her ease with the arachnids is a byproduct of the 12-year study she conducted at the University of Arizona that helped perfect an intravenous scorpion “envenomation” cure called Anascorp.

“[The drug] is a slam dunk,” the Tucson native says. “It is 98-plus percent effective within four hours of being administered, and can turn what could otherwise be a nightmare in the intensive care unit into a drive home from the emergency department with a happy kid.”


Nowhere is Anascorp more needed than in Arizona, which accounts for roughly 11,000 of the estimated 17,000 scorpion stings reported annually in the U.S. (including 200 cases of the dread bark scorpion). About 250 Anascorp doses have been administered in Arizona since Tennessee pharmaceutical company Rare Disease Therapeutics started marketing the drug in August 2011.

 Only one thing daunts Boyer: the price. The drug’s original Mexican formulation costs only $100 a dose. But in the U.S., it wholesales at $3,800.

Patients sometimes pay more – a lot more. Marcie Edmonds, 52, of Ahwatukee was stung by a bark scorpion in June. Two vials of Anascorp at Chandler Regional Medical Center cured her pain, dizziness, and short breath. Her highly newsworthy ER bill: $83,056. (Her insurer picked up most of the tab, leaving Edmonds owing a mere $25,537.) Other local cases include Matt Garner of Anthem, who was billed $51,000 by John C. Lincoln after his 3-year-old son was treated for a scorpion sting last May, according to The Arizona Republic. Blue Cross Blue Shield paid $38,000, while the hospital waived the rest.

So how is it that two injections of anti-venom cost as much as open-heart surgery? Research costs account for part of it. Originally, RDT wanted to import the $100 Mexican product straight to the U.S., but the U.S. Food & Drug Administration demanded new trials and manufacturing processes, company medical liaison Jude McNally says. Liability premiums and middle-man markup by the drug’s distributor,  Medco, drive the per vial wholesale cost to $3,800, and individual hospital markup accounts for the rest.

According to experts, out-of-proportion costs are common with so-called “orphan drugs”  – i.e., drugs designed to treat rare or small-scale maladies. “If you had to blame [the price] on any one thing, it’s just the really small patient population that has to absorb everything that it takes to get a drug to market,” McNally says. An anti-venom that treats the rare but deadly bite of the coral snake, which frequents some southern states, was $1,500 a vial before the manufacturer stopped making it in 2010; new owner Pfizer says it will restart production.

Chandler Regional spokesperson Julie Graham “can’t emphasize enough” that nobody should delay needed care because of money problems. Similarly, Phoenix Children’s Hospital – which absorbs $65 million a year in unpaid bills – counsels immediate medical attention in the event of a sting. Spokespersons at both hospitals note that Anascorp is cheaper than weeks in intensive care.

Citing laws encouraging the production of orphan drugs, Boyer and others say Anascorp shouldn’t be “the highest-priced antivenom ever to be sold in the U.S.” She adds: “My greatest dream is that somebody somewhere is going to take note of the situation and say, wow, scorpion antivenom is the tip of the iceberg of what is wrong with the U.S. drug-pricing structure.”

PRICEY PANACEA
What Phoenix hospitals charge for a vial of Anascorp:
Phoenix Children’s Hospital: $21,875
John C. Lincoln: $12,467
Maricopa Medical Center: $9,077
Mercy Gilbert Medical Center: $8,000
Chandler Regional: $8,000
Banner Good Samaritan: $7,950
Mayo Clinic: $7,701.75
SOURCE: ADHS, October

 

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