US Healthcare Is So Messed Up


Zack Whittaker is a New York-based freelancer who writes mostly about security for ZDNet and CNET. You can follow him on Twitter

EVERY SIX MONTHS, like clockwork, I fly home to the UK for three days for one reason: to pick up my supply of prescription medication.

I consider myself lucky—drugs are cheap there, where a national health service exists that I can partake of as a UK citizen. The very vast majority of Americans are not as fortunate. John Oliver, fellow Brit, comedian, and host of Last Week Tonight, said Sunday in a skit about Big Pharma that the cost of drug spending in the U.S. last year “works out to be about a thousand dollars per person.”

That’s why my biannual trek is so important. Though it’s nice to see friends and family, they are not the point. The drugs are. Without them, it would be worthless. I wouldn’t be able to enjoy my loved ones anyway. Without my pills I would barely be able to stand, let alone walk. I wouldn’t be able to string a sentence together. Vocal as I would be, it would be mostly groans of agony and then sudden clashes of curse words.

I suffer from severe Tourette’s syndrome. The hallmark “swearing tic,” seen as a common trait of the condition, is by far the least of my troubles. The symptoms can be so bad that my arms flail out and hit walls and people. And when there isn’t anyone else around none other than my own my crotch bears the brunt of my body’s abuse. My legs will shake so intensely that the muscles burn. My head jerks and throws itself back—sideways, frontwards, and any other way it can as though it’s an oversized cantaloupe attached to a Slinky toy.

Tourette’s won’t kill me—at least not directly—but it does affect my ability to function properly. But there is good news. Mercifully, I can be brought back from this jibbering, flubbering, and dribbling mess for a mere $12 every six months—the cost of a large and complicated mug of Starbucks coffee (and a pastry on the side).

But not in America. Here in New York, where I live and work, to fill my prescription at any pharmacy in the city would cost just shy of $720 per month. And that figure is one of the cheapest “quotes” I’ve heard in my quest; the price varies depending on where you go in the city. Some pharmacies further out into Queens and Brooklyn will sometimes charge as low as $548 for a month’s supply of the correct dosage, but the figure can fluctuate wildly.

I’m in my 20s, making ends meet as a writer. Needless to say, I cannot pay those prices. But here’s a fact you may not expect: I have health insurance. It’s just my health insurance won’t help.

 generic vs brand

The root of the problem is this: There is no generic version of my medicine available in America.

And as it turns out, that’s the rub. You see, America’s health insurance system is uniquely bizarre. Here’s a common phenomenon: You are prescribed an expensive, name-brand drug by your doctor, but before your insurance will pay for it, it requires you to try a less costly or generic version first. If those don’t work, your insurance will consider covering the cost of the more expensive drug. This process is called “step therapy”. But you see, if there isn’t a generic version available, you may not be covered at all. The insurance company may simply require you to take a totally different drug that’s cheaper. If you need what’s on the prescription, you might have to pay full price for it. It depends entirely on your insurance.

I arrived in America just as Obamacare was rolling out. Since I couldn’t meet the deadline for insurance, I sought out private health coverage through a company (as a freelance writer, it was my only option). The plan offered good choices for about $400 a month — it even had dental. I could get hit by a car a dozen times over and I would be patched up with great care and minimal costs. I could take a baseball bat to the teeth, and only pay a few bucks for the dentist’s time. But then I learned that it wouldn’t cover the one drug I needed. For that one drug, I would have to pay the full price out of pocket on top of what I was already paying for my coverage.

Is this a unique situation? Do I need a specialist drug that’s sold to just a handful people each year? Not even slightly. The drug I need happens to be the most prescribed (and profitable) in America.


Otsuka Pharmaceutical, which makes Abilify, is said to have made $6.9 billionin sales from the drug last year. Abilify treats bipolar disorder, depression, conditions associated with autistic spectrum disorders, and schizophrenia — illnesses that affect tens of millions of Americans. In a low dose, it also happens to reduce my symptoms by as much 90 percent with no side effects.

For me, Abilify is a wonder drug. And that’s probably why Otsuka can sell it for as much as it does.

For the $720 a month (or $4,320 every six months) my medication costs in America, I may as well fly back to the U.K. in style—a first-class flight, a room in the Ritz London hotel for two nights, and yet still have a few dollars left to pick up my drugs.

The reality is that a coach ticket and a modest hotel for a couple of nights can save thousands of dollars a year on necessary drugs. I pretend it’s a vacation, but, in fact, it’s a laborious and disruptive journey that I should not have to take, and yet am grateful I can afford.

This isn’t a problem just with Abilify. New figures from The Commonwealth Fund’s biennial health insurance survey reported 12 million working-age American adults with insurance who suffer from a chronic illness (like hypertension, diabetes, and asthma) and require medication for it did not fill prescriptions or missed doses because they couldn’t afford the drugs.

Because so many of these life-changing brand-name drugs are not regulated in price, those who need them may have to pay whatever price the drug maker sets. Drug companies regularly patent their inventions, and can drive wild profits annually by being the sole provider. But when those patents expire—typically after 20 years—other drug companies can create cheaper, yet identical generic versions. Otsuka’s patent on Abilify will expire in April, costing it an estimated $65 billion over the next four years. A generic version of the drug could follow soon after, barring any legal spats. My fingers are crossed.

The U.S. government does not regulate the price of branded drugs, but its neighbors do.

For two hours on a plane to Canada, you can pick up Abilify and most other common prescription drugs for a fraction of the cost. One drug store quoted me $78 for a month’s supply. (For me, though, it doesn’t make much sense to fly to Canada instead of the U.K. The overall expense, including doctor’s visits and flight costs, would equal that of a trip to London, where I do get the added bonus of a visit with family.)

For anyone out there in a similar circumstance who would rather not go all the way to Britain, I suggest cashing in a few vacation days, and packing a bag. I hear Toronto is beautiful this time of year. Or you could head south to Mexico, where you can buy Abilify without a prescription for about $65 a month.

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