Insurer Investigating After $10,984 Bill For COVID Antibody Test
Read about the biggest pharmaceutical developments and pricing stories from the past week in KHN's Prescription Drug Watch roundup.
A Doctor Went To His Own Employer For A COVID-19 Antibody Test. It Cost $10,984.
When Dr. Zachary Sussman went to Physicians Premier ER in Austin for a COVID-19 antibody test, he assumed he would get a freebie because he was a doctor for the chain. Instead, the free-standing emergency room charged his insurance company an astonishing $10,984 for the visit — and got paid every penny, with no pushback. The bill left him so dismayed he quit his job. And now, after ProPublica’s questions, the parent company of his insurer said the case is being investigated and could lead to repayment or a referral to law enforcement. (Allen, 9/5)
Insurers Bearing The Brunt Of COVID-19 Test Costs. That Might Mean Higher Premiums.
Health insurers say providers are overcharging them for COVID-19 tests and the added costs could mean higher premiums for their plan members in the future. The problem, insurers said, is providers can charge whatever they want for the tests and insurers must cover the full costs — no matter how high — under federal laws passed to address the coronavirus pandemic. One freestanding emergency room charged Blue Cross Blue Shield of Texas $4,800 for a nasal swab test, according to a redacted claim provided by the insurer. (Wu, 9/8)
Drug Price Spikes Still Unchecked, Five Years After Controversy
The current debate over expensive prescription drugs caught fire after a notorious 2015 episode, when the price of a cheap, lifesaving drug was jacked up by more than 5,000 percent and the pharmaceutical executive behind it seemed to revel in the outrage over his decision. The drug was Daraprim, used to treat a parasitic infection, toxoplasmosis, that can be fatal, particularly in immunocompromised patients like those with HIV/AIDS or pregnant women. The manufacturer’s young leader — Martin Shkreli, who earned the moniker "Pharma Bro" because of his brash social media presence — had more experience in investing than in drug development. (Siddons, 9/9)
Trump Assertions Of Lower Drug Costs Mask Truth For Many Consumers
President Donald Trump campaigns on the message that he’s done more to lower drug prices than any other president, but the reality is more complicated. The administration contends that drug prices are rising at a slower pace after years of hikes, while research supports the idea that increases for brand-name drugs have moderated. But that doesn’t tell the full story. The most significant proposals in Congress to drive down prices stalled because of partisan differences and industry opposition. Brand-name drugs are launching at higher prices than in past decades, and their prices continue to increase. (Siddons, 9/9)
Fall Hurdles On Drug Price, Surprise Bills
Lawmakers return to Washington this week with a few outstanding health-care issues to wrap up before the November elections. The House and Senate will look for a path forward on drug pricing and surprise billing measures, while negotiations continue over the next round of coronavirus stimulus legislation and the annual spending bills ahead of the end of the fiscal year on Sept. 30. (Sherwood, 9/8)
US News & World Report:
Medicare Out-Of-Pocket Costs You Should Expect To Pay
Medicare provides valuable health insurance for individuals 65 or older and certain people with disabilities who are under age 65. But it also comes with complex rules and sometimes significant out-of-pocket costs. Here's what you can expect to pay for Medicare out of pocket. (Brandon, 9/8)