3 ms·

One costs $60/year, the other is over $2M/year and not tested and not widely used outside the US

maronato 2y ago
If the doctor prescribed it, it shouldn’t be the insurance company’s decision to deny it. That’s how it works in most countries. Too bad it’s expensive, but that’s why people pay a lot more than $60/yr for insurance.
- mgraczyk 2y ago
  No, that's not how it works. Which countries work that way? Where can a doctor prescribe untested drugs and have it paid for?
  - maronato 2y ago
    I’m not sure about any countries that allow untested drugs or treatments for conditions not covered by the insurance company. I’m saying that in many countries, like Brazil, an insurance company can’t deny a treatment for a covered condition because it’s too expensive. So, for example, if the insurance covers prostate cancer, the doctor can prescribe any medically proven prostate cancer treatment and the insurance company can’t say they’ll only pay for a cheaper treatment.
    - mgraczyk 2y ago
      Right but that's not what happened in this case. In this case it wasn't "medically proven" in the right sense. I'm not an expert on Brazil but from what I just read these specific drugs would not be covered
  - alp1n3_eth 2y ago
    The US, Canada, England, and most of Europe are beginning to embrace the use of dual biologics in Crohns disease. The FDA approved levels of a singular biological may have issues reigning in out-of-control cases of severe Crohns, and there have been tons of trials run in multiple university hospitals over the last 10 years showing that the dual biological combo can help in those instances. That's exactly why his doctor wanted to do it, because it had worked in the past. This wasn't some insane lab experiment done by a fresh grad gastro doctor.
- peitho_pls 2y ago
  I'm genuinely curious, what countries work this way? I've never heard of it, every system has some form of rationing as far as I know.
  - maronato 2y ago
    In Brazil, where I’m from, insurance companies can’t just deny medically proven treatments to covered conditions because they are expensive. For example, my father in-law had prostate cancer. His health insurance covers prostate cancer, so the doctor was able to prescribe any medically proven treatment he had access to. The first treatment they tried was the one with highest percentage of success, and then changed it to other treatments depending on how the cancer responded. Cost was never brought up, and they never heard complaints from the insurance company. Lots of insurances accessible to middle class families also cover in-testing treatments that have shown success in other countries, if the patient matches conditions for the trial and other approved treatments didn’t work.
maxerickson 2y ago
Wouldn't the dual biologic be at least $120k per year? It's at least $60,000, not $60.
- mgraczyk 2y ago
  I meant Prednisone is $60/year. I'm not sure that's quite right but it's very cheap, that's roughly my out of pocket cost in the US Just one of the biologics is 500k/year
  - maxerickson 2y ago
    So you are mischaracterizing the biologics then. They are indicated for UC in the US. It's just that the doctor thought that combined, higher doses would work better (and apparently it did). The prednisone still had him shitting blood 20 times a day. Cheap indeed. How do we even have a conversation if you take drugs that are approved for treating a condition and just hand wave that they are "not tested"? https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/761359s000lbl.pdf https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/76... https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/103772s5359lbl.pdf https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/10...
    - mgraczyk 2y ago
      The combination has not been tested in a way that could show efficacy, as far as I can tell I'm not against experimenting with new drugs, I just don't think we should force insurers to pay since 99% of the time the experiments will not work We should move toward a pay for performance model but not torch the cost controls while we're at it
      - maxerickson 2y ago
        Why not force society (via insurance premiums) to pay for some testing? It's not like combining drugs with different mechanisms is a stupid experiment. The gold standard for testing the combination would be to test it against the standard of care, so it's fairly precious to complain that the doctor and patient here don't have a big enough pool.
alp1n3_eth 2y ago
Remicade and Entyvio have both been heavily tested. Remicade is available in (at least) these countries: - US - Japan - Europe - Turkey - Russia Entyvio: - US - Europe - Canada - Japan - Australia Biologics are the first line of defense for anything over mild IBD. The only effective treatment for above moderate that isn't a combination of other meds is Rinvoq. The small dose items like Azith and Pred are just for flare management, and aren't maintenance medications.
- mgraczyk 2y ago
  They haven't been heavily tested in combination, and they should be! It just shouldn't be required for insurers to pay for exotic multimillion dollar experiments. There are far better places to be spending that money if the goal is improving healthcare

If the doctor prescribed it, it shouldn’t be the insurance company’s decision to deny it. That’s how it works in most countries. Too bad it’s expensive, but that’s why people pay a lot more than $60/yr for insurance.

mgraczyk 2y ago
No, that's not how it works. Which countries work that way? Where can a doctor prescribe untested drugs and have it paid for?
- maronato 2y ago
  I’m not sure about any countries that allow untested drugs or treatments for conditions not covered by the insurance company. I’m saying that in many countries, like Brazil, an insurance company can’t deny a treatment for a covered condition because it’s too expensive. So, for example, if the insurance covers prostate cancer, the doctor can prescribe any medically proven prostate cancer treatment and the insurance company can’t say they’ll only pay for a cheaper treatment.
  - mgraczyk 2y ago
    Right but that's not what happened in this case. In this case it wasn't "medically proven" in the right sense. I'm not an expert on Brazil but from what I just read these specific drugs would not be covered
- alp1n3_eth 2y ago
  The US, Canada, England, and most of Europe are beginning to embrace the use of dual biologics in Crohns disease. The FDA approved levels of a singular biological may have issues reigning in out-of-control cases of severe Crohns, and there have been tons of trials run in multiple university hospitals over the last 10 years showing that the dual biological combo can help in those instances. That's exactly why his doctor wanted to do it, because it had worked in the past. This wasn't some insane lab experiment done by a fresh grad gastro doctor.
peitho_pls 2y ago
I'm genuinely curious, what countries work this way? I've never heard of it, every system has some form of rationing as far as I know.
- maronato 2y ago
  In Brazil, where I’m from, insurance companies can’t just deny medically proven treatments to covered conditions because they are expensive. For example, my father in-law had prostate cancer. His health insurance covers prostate cancer, so the doctor was able to prescribe any medically proven treatment he had access to. The first treatment they tried was the one with highest percentage of success, and then changed it to other treatments depending on how the cancer responded. Cost was never brought up, and they never heard complaints from the insurance company. Lots of insurances accessible to middle class families also cover in-testing treatments that have shown success in other countries, if the patient matches conditions for the trial and other approved treatments didn’t work.

maxerickson 2y ago

Wouldn't the dual biologic be at least $120k per year? It's at least $60,000, not $60.

mgraczyk 2y ago
I meant Prednisone is $60/year. I'm not sure that's quite right but it's very cheap, that's roughly my out of pocket cost in the US Just one of the biologics is 500k/year
- maxerickson 2y ago
  So you are mischaracterizing the biologics then. They are indicated for UC in the US. It's just that the doctor thought that combined, higher doses would work better (and apparently it did). The prednisone still had him shitting blood 20 times a day. Cheap indeed. How do we even have a conversation if you take drugs that are approved for treating a condition and just hand wave that they are "not tested"? https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/761359s000lbl.pdf https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/76... https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/103772s5359lbl.pdf https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/10...
  - mgraczyk 2y ago
    The combination has not been tested in a way that could show efficacy, as far as I can tell I'm not against experimenting with new drugs, I just don't think we should force insurers to pay since 99% of the time the experiments will not work We should move toward a pay for performance model but not torch the cost controls while we're at it
    - maxerickson 2y ago
      Why not force society (via insurance premiums) to pay for some testing? It's not like combining drugs with different mechanisms is a stupid experiment. The gold standard for testing the combination would be to test it against the standard of care, so it's fairly precious to complain that the doctor and patient here don't have a big enough pool.

alp1n3_eth 2y ago

Remicade and Entyvio have both been heavily tested. Remicade is available in (at least) these countries: - US - Japan - Europe - Turkey - Russia Entyvio: - US - Europe - Canada - Japan - Australia Biologics are the first line of defense for anything over mild IBD. The only effective treatment for above moderate that isn't a combination of other meds is Rinvoq. The small dose items like Azith and Pred are just for flare management, and aren't maintenance medications.

mgraczyk 2y ago
They haven't been heavily tested in combination, and they should be! It just shouldn't be required for insurers to pay for exotic multimillion dollar experiments. There are far better places to be spending that money if the goal is improving healthcare