Vivian Bykerk, MD: Cost and Patient Access to Biologics

Vivian Bykerk, MD, associate attending rheumatologist at the Hospital for Special Surgery, associate professor of medicine at Weill Cornell Medical College, discusses how cost affects patient access to biologic therapies.


Do you see cost playing a role in patient access to biologics?

Cost and access to biologics is an issue, but it’s maybe not an issue that the patient sees themselves because there are always ways to cover some of the copays. So yes, there’s a small cost, and there is a cost to using biologics. The payers have figured out how to fund them, and they figured out formulas that work for them on how to fund what, so each insurance company might fund different ones. In a way, access for patients to any given biologic is dictated by their particular insurance company. The cost is either being taken out by insurance companies, or it’s taken out by government, and that is becoming a challenge for payers, and I’m calling them all payers because they are costly. I think it’s important to note that the cost that’s advertised as the so-called, “real price,” is not what the payers are paying. So, it’s a little bit misleading to say that they are as expensive as they are because there’s no way that’s what people are paying for them.

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