Enbrel makes the list

by Susan Estrich

The U.S. government last week released the list of the 10 medications that will be the first to be the subject of the new price negotiations under the Medicare reform bill, and my arthritis drug, Enbrel, made the list. To make the cut, you either had to be taken by millions of people, like Eliquis, or cost a fortune. Enbrel costs a fortune.

I’m one of 47,000 Medicare recipients lucky enough to receive a drug that my old rheumatologist, who originally prescribed it for me, described as a miracle. When he was a young doctor, he told me, his waiting room of patients with rheumatoid arthritis was full of crippled people. With the advent of “biologic” drugs like Enbrel, the crutches and wheelchairs are gone. I count myself very lucky to be mostly symptom-free, which, with RA, is saying a lot. As I say, I’m lucky and blessed. And well-insured. And able to cover the out-of-pocket costs. Which are also substantial.

This is the hard part of medical miracles.

One month, when I was switching insurance companies, I ran out of Enbrel. I made the mistake of thinking I could actually pay for my weekly shot out-of-pocket if I couldn’t get the insurance situation straightened out. “How much would it be?” I naively asked the pharmacist. Enbrel is a SureClick pen; it comes in a pack of four. That would be $1,700 for one pen and $7,000 for the pack.

Excuse me? Who can afford that?

I managed to get a sample from the doctor’s office to tide me over and never asked again. Every month when the specialty pharmacy calls me to renew my Medicare prescription, they confirm my $350 co-pay and I don’t so much as murmur a word of complaint, because what can I say? The drug saves my life. But I’m lucky I can afford it. That’s why Enbrel belongs on the list.

Medicines like Enbrel cost billions to develop, and it is only fair that those costs be recouped. But there are limits, and there is no reason that the market should be foreclosed from working freely when it comes to the prices for these prescription drugs. Enbrel costs too much, but there is nothing that I, one consumer, can do about it. We need to stand together, which is to say, we need government to stand up for us and negotiate for us and give voice to our needs.

What is stunning about these negotiations is that it took an act of Congress to authorize the government to use the power of the people on behalf of the people to negotiate fair drug prices. The power of the pharmaceutical industry was so great, so much greater than the power of the American people, that it was literally the law of the land that Medicare could not use its bargaining power on behalf of the American taxpayer. When the bill allowing price negotiation passed last year, the Congressional Budget Office predicted the program would save Medicare more than $100 billion during the next 10 years.

Just stop and consider that for a moment: the biggest purchaser of health services unable to use its bargaining power, on behalf of you and I, leaving the industry’s power to set prices unchecked. And yet this is precisely what government is for, precisely what government is meant to do, to stand up for and give voice to we the people. The pharmaceutical industry continues to fight against negotiations in the courts. “Today is the start of a new deal for patients where Big Pharma doesn’t just get a blank check at your expense and the expense of the American people,” President Joe Biden said in announcing the list.

 It’s about time.

Susan Estrich — politician, professor, lawyer, writer and journalist — tackles legal matters, women’s concerns, national politics and social issues with keen insight and highly intelligent analysis.