Kevin Dwyer was born with Cystic Fibrosis, a progressive disease that eventually becomes fatal, especially if not properly treated.
Until recently, medications prescribed for Cystic Fibrosis only worked to control the symptoms. However, overtime the symptoms resulting from Cystic Fibrosis become unmanageable.
January 2012, the FDA approved a new medication, Kalydeco™ created by Vertex Pharmaceuticals. Rather than treating the symptoms of Cystic Fibrosis, Kalydeco™ treats the underlying cause, which offers new hope for people suffering with this terrible disease.
The problem with this new life saving drug, the cost is around $25,000 monthly, totaling a whopping $300,000 annually.
On July 16, 2013, Kevin and his sister Martha Weber were both guests on the Today show to talk about Kevin’s failed health insurance battle to obtain the lifesaving medication Kalydeco™.
What’s interesting is the fact that Kevin’s sister, Martha, has the same strain of Cystic Fibrosis. Kevin and Martha also have the same physician, and they both have same health insurance company, United Healthcare.
Their physician wrote the same letter to United Healthcare for both Martha and Kevin, explaining the need for the medication Kalydeco™.
What’s even more interesting and telling, United Healthcare approved Martha for the drug Kalydeco™, but United Healthcare denied this medication for Kevin, claiming it was “not medically necessary”.
This unregulated, unfair occurrence takes place far more often than most Americans are aware. Plus Kevin’s story uncovers numerous problems with America’s health care system.
1 – The health insurance companies are private for-profit corporations. Therefore, their first concern is not paying for their customer’s health care; the company’s first concern is maximizing profit.
2 – The pharmaceutical companies are private for-profit corporations. Therefore, their first concern is not health care; the company’s first concern is maximizing profit.
Most pharmaceutical research and development is conducted by scholastic universities, funded by government grants. Occasionally non-profit groups will also donate money to help fund drug research.
Concerning the new drug Kalydeco™, the Cystic Fibrosis Foundation donated a whopping $75 million to help advance the development of this medication. Therefore the Cystic Fibrosis Foundation will receive royalties on sales of Kalydeco™.
3 – The development of any new drug will cost an average of $105 million.
4 – The new medication Kalydeco™ is projected to bring in billions of dollars annually.
Obviously the cost of developing this drug will be paid for within the first year of Kalydeco™ reaching the market. Thereafter, generally speaking, all sales will be pure profit.
It’s well understood that any company must turn a profit to stay in business. However, at what point does maximizing profit become financial gouging?
If health insurance companies deny payment because of the outrageous cost,
people like Kevin Dwyer die. Kevin is no different from 99 percent of Americans who cannot even start to pay $25,000 every month for such medication.
You’ll be happy to know that the Today show contacted United Healthcare on behalf of Kevin Dwyer to uncover why Kevin was denied payment for Kalydeco™.
Rather than United Healthcare discussing their position on the Today show, United Healthcare suddenly decided to approve payment for Kevin to receive the medication Kalydeco™.
Two years ago, Kevin was healthy. But because Cystic Fibrosis is a progressive disease, his health began to quickly decline. Yet he was denied a life saving medication that his sister obtained under the exact same circumstances.
Kevin battled his health insurance company unsuccessfully for more than a year, but thanks to the Today show, Kevin will receive what he needs to live.
However the question still remains, at what point does maximizing profit become financial gouging?