A new drug clears the FDA. Now the health plan has to decide whether to cover it, and that decision sets off a scramble: six or seven specialists, working mostly in sequence, two to three months, and somewhere around $100,000 by the time it’s done. Meanwhile, the patients wait.
For some drugs, the wait is an annoyance. For a schizophrenia drug, it’s something worse. When treatment gets interrupted, people end up hospitalized, and each of those admissions costs a plan somewhere between $8,000 and $15,000. A few hundred of them across one large plan and you’re looking at four to seven million dollars in costs that didn’t need to happen. All from one slow decision about one drug.
