That's the title of my latest HND piece. "RSV" stands for Respiratory Syncytial Virus, and this common pathogen can be devastating to preemies. The good news is that there is a drug called Synagis® that prevents infections in this high-risk group.
The bad news is that as part of a ludicrous (and brown-nosing) cost-cutting measure from December 2009, the American Academy of Pediatrics (AAP) thought that it was throwing a bone to its insurance company paymasters, by severely restricting the eligibility requirements for third party coverage of the drug. Notably, their recommendations are long on eyewash, and short on actual data.
In fact, a study has just been released which shows that Synagis®, used in accordance with the original (pre-December 2009) guidelines is cost-effective, if not cost-saving. After all, you can burn through the supposed cost savings on the drug within a day or two in intensive care.
Maybe that's why the trade associations of doctors who actually care about preemies opposed the AAP action. Make no mistake, untold billions of dollars are spent each year on expensive pharmaceuticals—especially for the elderly—in cases where cheaper and just as effective drugs really do exist. The massive over-prescribing of proprietary psychotropics is but one example.
Tragically, the current situation typifies our badly broken American health care system. Medicaid or private insurance can be billed hundreds of thousands or more to keep a preemie alive in the NICU, but helping them make it through their first two years at home is apparently a big problem.
To those (including the moronic policy wonks behind Obamacare) who still don't get it, lack of insurance is surely NOT the biggest problem with our system. Just ask the parent of a preemie who has insurance.
Maybe you don't care about preemies, and maybe you don't care about other affected groups that lack political clout. My question is: Who will be your protector, when the bell tolls for you?
Read the complete article.