Every three months, Mr. Yeagley, a stock trader, hops into his car and drives seven hours — 390 miles — from his home outside Philadelphia to a Walmart half a mile across the Canadian border. There, he buys Xeljanz to treat his son Jonathan’s alopecia areata, a type of hair loss caused by an immune disorder. He drives back the same day. In 2016, Independence Blue Cross, Mr. Yeagley’s insurer at the time, rejected coverage of the drug because Xeljanz is approved to treat rheumatoid arthritis, not alopecia. Mr. Yeagley appealed and lost his case; an outside reviewer wrote that there’s not enough evidence that the drug is effective against alopecia. In 2017, Mr. Yeagley switched to another insurer that does not cover prescription drugs. There are no approved drug treatments for the condition, and Mr. Yeagley’s son’s doctor at Yale University, Brett King, has found Xeljanz effective at regrowing hair for some patients. (Dr. King is a consultant for the drug’s maker, Pfizer.) Once a year, Mr. Yeagley uses a coupon from Pfizer that covers about three months of the drug, but for the rest of the year he is on his own. In the United States, Xeljanz costs about $50,000 a year (through a drug discount website). That’s after Pfizer raised the price of Xeljanz by nearly 8 percent in January. In Canada, the price tag is $15,000. “I don’t have that kind of money to throw away,” said Mr. Yeagley, who has made five trips so far. Mr. Yeagley’s son spoke on FaceTime with a Canadian doctor who asked for pictures and reviewed laboratory results before writing a prescription so the Yeagleys could legally obtain the drug in Canada. Jonathan, who is 20, worries about shouldering the costs in the future. “I don’t tell him that I think about it a lot but I do think about it a lot,” he said. “I’m so grateful for what he does for me but I don’t know how long it can go on.” THE BACKGROUND: Drug prices are cheaper in Canada, where an independent quasi-judicial body is supposed to ensure that pharmaceutical companies do not charge excessive prices.
The sickest Americans face the biggest burden of high-cost drugs, according to a report by The New York Times and ProPublica. Pharmaceutical firms have raised prices on treatments for chronic or life-threatening conditions like cancer, diabetes and multiple sclerosis and insurers have then passed these costs on to consumers. This means many people are paying thousands of dollars each month just to get by. President Trump and congressional Democrats have vowed action to tackle the problem, but little has yet changed. Among the people whose stories are highlighted in the report is Saundra Johnson, 57, from Minneapolis. On a salary of under $20,000, Abigail Bostwick cannot afford the dozen medications she needs to treat her diabetes, congestive heart failure and other complications. Her 2017 Social Security disability income of $19,560 meant she was above the cutoff for extra government help for her prescriptions despite the vast majority of her income being accounted for – from food to health care fees. Medicare regulations mean she cannot use drug co-pay coupons, which are frequently used by those with private health cover. And Novo Nordisk, which sells her insulin, Novolog, and diabetes drug, Victoza, demands Medicare users first spend $1,000 on drugs each year before they can qualify for free drugs through their scheme. Abigail Bostwick does not have that $1,000 so ends up not taking some drugs for months until she reaches the threshold. “I prioritise the heart stuff over the insulin because the heart stuff is more immediate,” she says. In a statement, Novo Nordisk said it provided some types of insulin at lower cost, adding that Abigail Bostwick’s case was a reminder it needed to “continuously evaluate how we keep our support programs sustainable”. The report also cited multiple sclerosis sufferer Ms Johnson, 37, of Tomahawk, Wisconsin, who said she felt “truly hopeless” when she was diagnosed. Her and her husband drained their savings and sold many of their belongings to cover her medical costs. Diabetes patient Amanda Walker, 34, of Memphis, Tennessee, had to ration her insulin after ending up unemployed. A nearby resident ended up offering her two insulin pens after she put out a plea on Facebook. She now gets subsidized healthcare through the Affordable Care Act, but fears what would happen if it is repealed. It also tells the story of Jonathan Yeagley, 61, of Berwyn, Pennsylvania, who drives 390 miles into Canada each month to buy Xeljanz to treat his son Jonathan’s alopecia areata, hair loss caused by an immune disorder. Medication is cheaper in Canada, where a quasi-judicial body works to make sure drugs makers do not charge inflated prices.