Wrong. This is unbelievably wrong. Please stop spreading false information. Also, check your sources. A "brought to you by big pharma" article, from a website about big pharma news, let alone about an isolated case, is likely to be extremely biased.

First, these medications are absolutely never reimbursed the day after approval in the United States.

If you get a prescription for a medication the day after approval from your doctor, the insurance company will almost certainly (practically a 99% chance) call the medication "experimental" and "not medically necessary", and deny all coverage of the medication. You will have to appeal the denial, and you will be extremely lucky if you do get approval to take this medicine. To do so, you have to write an extremely detailed letter, very cohesive and without any sort of mistakes that give it any uncertainty. You basically have to tell them that you will either cost more to them than the cost of the drug, if it is not approved by them, or die.

If you are "extremely lucky" your insurance is (almost) guaranteed to send your doctor a prior authorization request. This takes weeks to resolve, if not months. This is basically a request so that a a bureaucrat from an insurance company can "give you permission" to take this medicine. If you are "lucky" it gets approved. There are people who are denied approval just because they have another condition (that is off-label) in addition to the FDA-approved condition that the drug was approved for, just because this was affirmed in a check box in the prior authorization. It is straight up incompetency. Also, doctors reviewing any sort of appeal or prior authorization are practically guaranteed to be practicing medicine in a board-certified field that is completely irrelevant to the condition you have.

They can also deny you the recently approved medicine because they require you to do step-therapy first, and sequestering this medication as not being an option for a very long time. This means that you must try a cheaper and less-effective medicine first, putting you at risk of having your condition worsen in potentially devastating and irreversible ways, before being able to try more effective medicines. So, patients with devastating conditions like multiple sclerosis will often have to go through a series of trials of less effective medications, often with their conditions worsening in an irreversible way, just because their insurance says so. There is no way to legally get around this in the United States as a patient.

To top this off, more than likely, the medication will not be put on the formulary. Pretty much all insurance companies in the US subject their subscribers to a formulary. A formulary means that you cannot take certain medications under any conditions, and the health insurance company will not cover the medication under any conditions whatsoever. It will absolutely be denied, no matter what. There are tons of medications that have legitimate medical uses, that are excluded from insurance plan coverage, even in the case when there is no alternative for it.

Between automatic denials, prior authorizations, step therapy, and formulary exclusions, which are standard practice in the United States, it is guaranteed that one will not get the needed, recently FDA-approved medication, for months at best, but in reality, it could be several years, or even never. They do let people die in life or death situations all the time.

Regarding Germany: By the way, orphan drugs (rare disease drugs) dominate current regulatory approvals, being the vast majority of current drug approvals.

These medications typically cost hundreds of thousands of dollars per year, if not millions per year, now in the United States. This is not the list price of the medication or the amount that was billed to insurance either. This is the reimbursement rate by insurance, that is paid under contract.

Countries like Germany have no issue paying for them, and they are reimbursed much quickly than you claim.

https://www.sciencedirect.com/science/article/pii/S109830151...