Iron-poor "tired blood" and the marketing of iron supplements The example of iron infusions, she adds, suggests "a clear financial incentive to prescribe more expensive drugs." that might move the physician away from the choice the patient would optimally make, we might be concerned," says Aditi Sen, a health economist at Johns Hopkins Bloomberg School of Public Health, who is researching how doctors prescribe and are paid for intravenous iron treatments. Physicians argue that they simply prescribe the most effective medication for patients, regardless of what the payment system would suggest.īut the government's own Medicare claims data, research and stories like Rothenberg's paint a different picture. This plan has generated sharp backlash from conservative lawmakers and the medical and pharmaceutical industries. The administration would tie Medicare reimbursements for some IV drugs to the price paid in countries that set drug prices at a national level - prices that are partly based on an estimate of each drug's comparative value. Situations like these, which drive up Medicare spending, are why the Trump administration has suggested changing how Medicare pays for intravenous drugs. Cheaper, older formulations - which can go for as little as a tenth the cost - have seen their share of Medicare claims fall dramatically. Indeed, a Kaiser Health News analysis of Medicare claims found that Injectafer and Feraheme - the two newest (and priciest) infusions on the American market - made up more than half of IV iron infusions in 2017, up from less than a third in 2014.
IRON CAD COST SKIN
That creates a financial incentive to favor the most expensive infused treatments, rather than pills or simple skin injections that patients can use readily at home. In Great Britain, for example, "it would be extremely unlikely that IV iron would be administered," says Richard Pollock, a health economist at London-based Covalence Research, who studies the use of iron products. In other countries, doctors usually would not be so quick to resort to iron infusions for anemia - especially in healthy patients like Rothenberg, who have no underlying disease and no obvious symptoms. That's almost one infusion for every five Medicare recipients. Since 2013, the first year for which data are available, about 9 million Americans in the federal government's health plan for people 65 and above have gotten iron infusions each year. People with certain medical conditions, including a history of heavy menstrual periods, inflammatory bowel disease and kidney failure, among others, are prone to low iron levels and anemia, which can be severe.Īlthough Rothenberg had private health insurance, a close look at Medicare data suggests her experience with pricey iron infusions is pretty common. "I don't have $2,700 sitting around."Īnemia, the principal outgrowth of low iron levels, can cause headache, fatigue and an irregular heartbeat. I'm already a bit freaked out about upcoming expenses," she says. "I have twins who are going to college next year.