More Americans Will Take Drugs by Injection or Infusion

As we age, we’re more likely to develop chronic conditions. And the pricey category of “specialty medications” is growing fast to treat them.

After a week of swollen, stiff hands, one morning you wake up from a dream about a great aunt. You recall trying hard not to stare at her gnarly hands. As a child, you didn’t even ask — you knew she was a witch.

When you hear your diagnosis, rheumatoid arthritis, you’ll also hear that treatment is much more successful than in your aunt’s day. The autoimmune illness, which destroys the joints, affects more than a million Americans. In the 1990s, about one in five people newly diagnosed with rheumatoid arthritis ended up retiring within two years. Now, a new class of drugs called “biologics” can keep your fingers from gnarling up. The copays are substantial, and you’ll need infusions by IV. But patients seize the chance to keep their hands useful. As you go off to the clinic for your infusion each month, you’ll joke to your husband that it’s worth it so you don’t scare the grandkids.

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Some 10,000 Americans turn 65 every day, and they can expect to survive another two decades. As we age, we’re more likely to develop chronic, often painful, diseases like rheumatoid arthritis and cancer. The drug industry has responded with a flood of new products that tend to require injections or infusions by IV — from 20 to 40 new drugs considered “specialty medications” are approved by the U.S. Food and Drug Administration (FDA) each year, accounting for about half of all new approvals. Remicade, Enbrel, and Humira, the top sellers, treat rheumatoid arthritis and other autoimmune diseases like psoriasis.

Specialty medications can be life-savers — and a huge burden. You might have to endure two-hour sessions hooked up to an IV, or weekly injections. If you travel, you might need to carry your medication in a cooler. But the biggest burden is financial: More than half a million Americans now incur yearly medication costs of more than $50,000, facing co-pays of up to 33 percent, though, on newer drugs, manufacturers may provide assistance.

More Americans will be facing those choices in the near future, as specialty medications arrive for increasingly common conditions like heart disease and obesity. About a third of American adults have elevated cholesterol levels. In 2015, the first injectable drug to lower cholesterol, alirocumab (Praulent), won FDA approval to treat people with a history of heart disease or stroke or an inherited kind of high cholesterol. The injection is intended to boost statins for people whose cholesterol levels don’t fall enough with the statin alone. It’s common for drugs to first win approval for a relatively small group, and then win approval for ever-bigger populations.

About two thirds of Americans are overweight or obese.  This year, a diabetes drug became available as a double-powered daily injection called liraglutide (Saxenda), for weight problems. To be specific, the FDA approved it for adults with a body mass index (BMI) of 30 or greater or adults with a BMI of 27 or greater who have at least one weight-related condition, such as hypertension, type 2 diabetes, or high cholesterol.

We’re also now seeing clinics offering infusions by IV with ketamine, prescribed off-label for suicidal thinking. Suicide is the tenth leading cause of death in the United States.

So far, about half of the current spending on specialty medications goes to inflammatory illnesses (like rheumatoid arthritis and psoriasis), multiple sclerosis, and cancer. The other half goes to treatments for hepatitis C, HIV, growth deficiency in children, cystic fibrosis, pulmonary hypertension, and sleep disorders.

In the debate over who will pay for these pricy medications, remember that no one would go to all this trouble if the drug didn’t meet a significant need. HIV drugs extend the life expectancy of someone with an HIV infection by 40 years.  And drugs for rheumatoid arthritis are allowing people to drive and use keyboards. How much is that worth?

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