US: Why Medicare pays so much for psychiatric drugs

Published on Intrepid Report, by Martha Rosenberg, May 23, 2014.

“Never mind” said the Obama administration in March after its proposal to limit automatic Medicare coverage of pricey depression and psychiatric drugs was met with a Pharma funded backlash. It apparently wasn’t worth it as “patients” on the Hill yelled “You’re going to limit WHAT?” and won.  

As private insurers balk at paying as much a month as $830 for Abilify, $250 for Seroquel, $450 for Geodon and $760 for Invega, Pharma increasingly relies on government programs to subsidize its expensive psychiatric drug habit. At least 16 states pursued legal action in 2008 against similar profiteering in Medicaid programs (which included Texas Medicaid paying $557,256 for two months of pediatric Geodon which was not even approved for children.)

That is no doubt why in February the Obama administration sought to limit the “protected status” of expensive categories of brand name pills which account for as much as 33 percent of total outpatient drug spending under Part D of Medicare.

Siphoning expensive psychiatric drugs, many of which are unnecessary or have cheaper alternatives, through government programs has been Big Pharma’s marketing plan for over a decade. In Texas, a Medicaid “decision tree” called the Texas Medical Algorithm Project was instituted that literally requires doctors to prescribe the newest psychiatric drugs first. Ka-ching. It was—surprise—funded by the Johnson & Johnson linked Robert Wood Johnson Foundation.

Big Pharma also uses patient front groups to scream about the need for expensive drugs when alternative drugs exist. “When insurers balk at reimbursing patients for new prescription medications, these groups typically swing into action, rallying sufferers to appear before public and consumer panels, contact lawmakers, and provide media outlets a human face to attach to a cause,” writes Melissa Healy of the Los Angeles Times about their tactics … //

… (full text with many hyper-links).


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