Bill Of The Month: For Toenail Fungus, A $1,500 Prescription
Kaiser Health News
March 16, 2018
During Anne Soloviev’s semiannual visit to Braun Dermatology & Skin Cancer Center in Washington, D.C., in January, the physician assistant diagnosed fungus in two of her toenails. Soloviev is vigilant about getting skin checks, since she is at heightened risk for skin cancer, but she hadn’t complained about her toenails or even noticed a problem.
The assistant noted some unusual discoloration where the nail meets the skin. “They took a toenail clipping and said, yeah, you have a fungus,” Soloviev recalled.
So the PA called a prescription into a specialty pharmacy with mail-order services, which would send medication to Soloviev’s Capitol Hill home.
It seemed like an easy fix to an inconsequential health issue. “I did not ask how much it cost — it never crossed my mind, ever,” said Soloviev, a former French teacher, who still works part time.
Then the bill came.
Patient: Anne Soloviev, 77 on March 18, of Washington, D.C.
The Bill: $1,496.09 for Kerydin, a topical medication that treats toenail fungus. Originally produced by Anacor Pharmaceuticals Inc., it is now a product of Sandoz, a Novartis division.
The Medical Treatment: Shortly after the physician assistant phoned in the prescription to My Express Care Pharmacy, in Maryland, the pharmacy contacted Soloviev for her health insurance information.
Soloviev is covered by Medicare, Parts A and B, and has supplemental insurance through her late husband’s government health benefits that covers prescription drugs. She also has a health reimbursement account (HRA), which contains almost $1,500 pretax dollars each year to pay for uncovered medical expenses. She typically uses that pot of money to cover copays for the other medicines she takes regularly.
Kerydin, the toenail medication, arrived by overnight mail, and an automatic refill came a few weeks later. She began swabbing it on the two toenails, as directed, having been told it would take about 11 months to treat the fungus.
She thought little of it.
But when Soloviev went to her local CVS to pick up another medication — a statin that is usually paid for by her HRA — she discovered her reserve was empty.
Unbeknownst to her, Kerydin, which it turned out costs nearly $1,500 per monthly refill, had wiped out her entire reimbursement account.
What Gives: We’re talking about mild toenail fungus. The price tag is difficult to rationalize, experts said.
“Reality check — this is $1,500 for a medicine to treat [it],” said Wendy Epstein, an associate law professor at DePaul University, who researches health care law. “That’s quite a chunk of change.”
Leslie Pott, Sandoz’s vice president of communications, explained that Kerydin is patent-protected and priced “at parity” with its one market competitor, Jublia. She also pointed out that to secure a place on an insurer’s list of approved drugs — its formulary — the drugmaker often had to offer substantial discounts to insurers and various middlemen. “We have no visibility into the extent to which these discounts are passed onto patients or payers,” she wrote in an email.
There are many prescription treatment options for toenail fungus — both older medicines in pill form and newer topical treatments such as Kerydin, said Dr. Shari Lipner, an assistant professor at Weill Cornell Medicine and director of its nail unit. The patient in this case would have been a candidate for “quite a few” of them.
Patients are likely to pay less for the pills, for which a course of treatment lasts three months, compared with the newer topical treatments, she said, adding that the pills also seem to have greater efficacy.