Medicine Is Cheap, but Costly for Patients / The Role of Insurance Coverage in Treatment Costs

Lower drug prices do not necessarily lead to a proportional reduction in patients' out-of-pocket payments, especially when insurance coverage is limited. Comparing the prices of some domestically produced drugs with reference countries once again highlights the need to consider pricing policies, insurance obligations, and the final cost of treatment for the public at the same time.

A decrease in the price of medicine does not necessarily lead to a proportional decrease in the cost paid by the patient; Especially when the insurance coverage is limited. Examining the price of some domestically produced drugs in comparison with reference countries, once again highlights the necessity of simultaneously paying attention to pricing policies, insurance obligations, and the final cost of treatment for people.

A review of the prices of some commonly used domestically produced drugs shows that the prices of these items in Iran are much lower than in the reference countries, but the high share of patients' pocket payments has made the cost of the drug still heavy for the consumer. According to the report of Ambassador Arjan, quoted by Haft Sobah, the high cost of medicine is one of the issues that have been raised many times by patients in recent years. An issue that has become more important with the increase in production and treatment costs. However, comparing the prices of a number of widely used domestically produced drugs with the lowest consumer prices in reference countries shows that the prices of some drugs in Iran are significantly different from foreign prices.

For example, the consumer price of Cefaxim 400 in Iran is about fourteenth of the lowest price recorded in reference countries. Azithromycin 500 is about one-ninth, Rosuvastatin 20 is about one-seventh, and empagliflozin 10 is about one-fifth the lowest compared price.

These figures were obtained while the patient is not only faced with the price of the drug when visiting the pharmacy, and the amount of insurance coverage also plays a role in determining the final cost to be paid.

Examining the mentioned examples shows that the low price of medicine compared to other countries does not necessarily mean that the amount paid by the patient is low.

For example, the price of rosuvastatin in Iran is about 14.5% of the lowest price in reference countries, but its insurance coverage is about 32%; In this way, a significant part of the cost of this medicine is still borne by the patient. In the case of cefixime, despite the significant price gap between Iran and reference countries, the patient pays almost half of the cost of the drug. For empagliflozin 10, about 40% of the cost is paid by the patient.

In other words, a medicine may be offered in Iran at a much lower price than in other countries, but the patient will still pay a significant amount from his pocket at the time of purchase.

What the patient experiences in the pharmacy as the "expensive drug" is not necessarily equal to the real price or the approved price of the drug; Rather, it is the amount that must be paid after applying the insurance contribution. In such a situation, the lower the insurance coverage of a drug, the higher the patient's share will be; Even if the initial price of the drug is lower than in other countries.

For this reason, to check the drug cost situation, the consumer price cannot be used as a criterion, and the amount of insurance coverage and the final share of payment from the patient's pocket should also be taken into consideration.

In a situation where the price of some domestically produced drugs is far from the price of the same drug in reference countries, a further reduction in price does not necessarily reduce the patient's payment by the same amount; Especially if the insurance coverage does not change. On the other hand, the pharmaceutical industry is facing an increase in the cost of raw materials, manpower, energy, packaging and other production costs. Therefore, if drug cost control is followed only by putting pressure on the manufacturer's price, it may be possible to put more pressure on production without reducing the patient's final payment significantly.

Examining these samples shows that in order to analyze the state of the drug market, three issues must be taken into consideration at the same time; The price of the drug, the amount of insurance coverage and the share of payment from the patient's pocket.

In some cases, the drug is cheaper in terms of pricing than in reference countries, but the patient still pays a high share of the cost. Based on this, along with the policies related to drug pricing, the amount of insurance commitment and the method of drug reimbursement can also play a role in reducing people's medical expenses. Finally, a drug may be cheap on paper, but expensive for the patient at the pharmacy; The difference that shows that examining the "drug price" without considering the "patient's out-of-pocket payment" cannot provide a complete picture of the real cost of the drug.

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