According to a story from CNBC, the now former Commissioner of the US Food and Drug Administration (FDA) Scott Gottlieb was recently featured on the news network for a discussion about income inequality and access to new, groundbreaking therapies. With the advent of gene therapy drug developers have the potential to develop a entirely new generation of treatments that could help cure serious, rare diseases like sickle cell disease and hemophilia. However, there needs to be a way to ensure that patients of all social classes will be able to benefit from these treatments.
Most people would probably agree that healthcare in the US is generally just too expensive. Many people live with serious medical debt and one major medical emergency or accident can be bankrupting for many, even with insurance coverage. With major overhauls to the health system making the rounds in politics, such as a single payer system or Medicare for all, it is clear that something needs to change.
However, what can be done under current law to ensure that low income patients can have access to the life-changing therapies that could be coming in the next several years?
Debilitating diseases can easily perpetuate cycles of poverty; after all, being disabled can majorly impact or even prevent someone from working a regular job. A curative treatment could of course change this, but there is little doubt that gene therapy is going to come with an obscene price tag.
Many of the poorest Americans use Medicaid, but history tells us that this system is not prepared to help all of the people that use it get access to the latest and greatest treatments. Take for example the rollout of a curative treatment for hepatitis C in 2014. Medicaid simply didn’t have the funding to cover the treatment for all of the users that needed it in a timely manner. These delays meant months or years of needless suffering for patients whose disease could be cured. Unfortunately it is unclear if coverage from private insurers will be much better.
Gottlieb mentions an approach that could improve the situation: different models for payment. He cites Louisiana as an example, which recently struck a deal with the manufacturer of the hepatitis C cure drug. The deal allows the state to pay a fixed yearly fee for a five year period in exchange for essentially unlimited access to the drug. This could allow the state’s Medicaid system to give low income people access to the treatment and better handle the associated costs.
Perhaps such as proposal could improve the situation, but I’m more in the camp of believing that a larger scale rehaul of the entire system is necessary, like direct regulations that more strictly control drug prices or a system that actually allows everyone to have access to effective coverage for expenses. These are tried and true solutions that have allowed other countries to have better coverage and reduced costs. Regardless, a good number of breakthrough therapies may be on the horizon, and we as a society have to figure out a way to get them to the people that need them.