Peter L. Salgo, MD: All right, here we go. I’m going to pull a pin on this one. Pull the pin, lob the grenade. What do these things cost? Deathly silence, you notice?
Thomas P. Olenginski, MD, FACP, CCD: Everything costs money. I think our role as physicians is that you have to try to do the best for your patient. When I’m seeing somebody with severe osteoporosis, the typical patient I know I can typically get a drug like romosozumab covered is the traditional Medicare patient who has a coinsurance, where it’s 80% covered in the office, and their coinsurance covers that. So I know that typical patient has access. I mean, everybody does preauthorizations. We try to say, “This is probably what your out-of-pocket cost is going to be.” And we have them make that decision. For other insurers, for let’s say Medicare managed care, the costs are going to be different, and they’re going to be set by the individual insurance company. And then for private insurance, it’s going to be different.
Peter L. Salgo, MD: But put me in the ballpark. Are we talking $100,000 a year, $500,000 a year for these new agents if you use them the way they’re prescribed?
Andrea J. Singer, MD, FACP, CCD: Roughly low $20,000s.
Peter L. Salgo, MD: Low-20 thousands.
Andrea J. Singer, MD, FACP, CCD: Yeah.
Peter L. Salgo, MD: So it’s not, as some of these drugs are, insane, although it’s pretty big.
Thomas P. Olenginski, MD, FACP, CCD: That would be in the ballpark for the remarkable drugs for rheumatoid arthritis and similar conditions.
Peter L. Salgo, MD: Sure.
Thomas P. Olenginski, MD, FACP, CCD: And again, different things. If you look at how that’s changed the field of rheumatology in rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, it is tremendous. I hope it translates to something close to that, which would be tremendous. We do the best for our patients. They have to decide sometimes. They’re not going to decide. What I get frustrated with is that cost and/or access is the ultimate barrier, so it remains to be seen.
Peter L. Salgo, MD: By the same token, if I’m an insurance company, and I see a million people want $20,000 a year for this drug, that’s a big number.
Andrea J. Singer, MD, FACP, CCD: And I don’t think anyone is saying that this or another bone-building drug should be the drug that is used for everyone. Again, we need to individualize things, and I think we’re all cost conscious. But you then also have to look at downstream savings. And if you have a drug that, with just a year’s worth of therapy, is going to give you improvements or reduce fracture risk more significantly, maybe over time you can limit total exposure to medications or then move to a drug that might be less expensive. But there are lots of aspects, lots of factors that come into determining cost. It’s not just as simple as saying, “Here’s the price.” I think you need to look at the bigger picture. Because, as we mentioned, this is a chronic disease.