High Medication Costs (in the USA but feel free to chime in no matter the country)

[missy]

Opinion | Neurologists Are Actively Working to Reduce High Drug Costs

I've personally witnessed the consequences of medication inaccessibility

www.medpagetoday.com

The cost of lifesaving medications in the U.S. is far too high -- a situation which has become increasingly alarming over time. Nearly one in four Americans has difficulty paying for their prescription drugs, and as a neurologist, I've personally witnessed the consequences of this unfold in my own practice. Nearly all my patients with chronic conditions have stories about their struggles to afford medications, and sadly, some end up abandoning them at their pharmacies due to the cost. Others must endure longstanding battles with their insurers who put up barriers to accessing medications, especially high-cost specialty drugs. At the same time, we also have witnessed new, remarkably effective breakthrough therapies for neurologic conditions such as migraine and spinal muscular atrophy, but each costs tens to hundreds of thousands of dollars, and in one case, millions of dollars.

In the world of neurology, one of the most prominent examples of high prescription drug costs is for disease-modifying therapy for multiple sclerosis (MS) -- the list price often approaches $100,000 per year. Despite having many treatments that compete in this market, including some that have been available for more than 20 years, annual costs for disease-modifying therapies in MS continue to rise. I've also watched as companies buy up therapies that are essential and then raise the price to astronomical levels, as was the case with amifampridine (Firdapse), which went from being widely available for free to costing $375,000 overnight, prompting a rebuke from Sen. Bernie Sanders (I-Vt.). This trend is unsustainable for people who rely on these medications and for the healthcare system overall, which pays more than double compared to other similar nations on average.
It is for these reasons that the American Academy of Neurology (AAN) has made lowering the costs of prescription medications a top priority. In support of this goal, over the last 5 years we have advocated to empower Medicare to directly negotiate drug prices; require transparency in how drugs are priced; and encourage strong oversight by the key committees in Congress. We also have fought arbitrary barriers employed by insurers that restrict patients' access to life-saving therapies -- like fail-first step therapy policies -- that often arbitrarily deny care and create roadblocks to providing the best evidence-based care for our patients.

Thousands of our member neurologists and neuroscience professionals have contacted Congress and the administration over the years in support of these goals, often to share stories about the unique impact of high drug costs on their patients. The AAN has joined coalitions such as the Campaign for Sustainable Rx Pricing, which is dedicated specifically to addressing this issue. We have also collaborated with Patients for Affordable Drugs, which is a leader in shaping the national debate on this issue.
To support these aims, the AAN has advocated for numerous pieces of legislation over the years, offered by both Democrats and Republicans. The most recent and prominent example was endorsing several provisions within the Build Back Better Act (BBBA). Specifically, the AAN supported provisions that would permit Medicare to directly negotiate prescription drug prices for the first time, limit excessive annual increases in drug prices that outpace inflation, and create an out‐of‐pocket spending maximum of $2,000. We believe these provisions would significantly improve patient access to therapies.

The recent opinion piece on MedPage Today by Milton Packer, MD, "Why Are Physicians Silent About Outrageous Drug Prices?" advocated for strong physician involvement in drug pricing. We agree and have been vocal activists in this effort. The AAN's endorsement of the BBBA provisions was only one of many actions we have taken to lower the costs of prescription drug prices. However, Packer implied that the Academy was more focused on avoiding reductions in physician reimbursement related to drugs than on wanting to lower the costs of prescription medications. This assessment misses the bigger picture of the Academy's approach for two reasons. First, the AAN and many of its members individually have a long history of advocacy on reducing drug prices unrelated to physician payments, as outlined in this piece. Second, Packer's perspective discounts the financial realities of a medical practice and the nuances of the AAN's position. The AAN has stated that we are eager to find a way to realign incentives away from higher‐priced physician-administered medications, but we believe this needs to be addressed separately from the larger BBBA negotiations to ensure that access to life‐saving therapies is not disrupted. Two prior attempts, from two different administrations, at reforming the reimbursement system for physician-administered drugs have failed. This is not an easy issue, and in our view, finding a better way requires developing creative solutions through stakeholder collaboration conducted through regular order in Congress.

The time is upon us to lower prescription drug prices. It is essential that Congress act to ensure that Americans have access to critical therapies, and the AAN will continue to work to support these efforts to ensure that our patients have the best care possible.
Orly Avitzur, MD, MBA, is the current president of the American Academy of Neurology (AAN), and the immediate past chair of the AAN Medical Economics and Practice Management committee. She is also the current editor-in-chief of the patient and caregiver magazine, Brain & Life.

 

[missy]

Billionaire Mark Cuban launches online pharmacy aimed at lowering generic drug prices

The pharmacy says it will bypass health care industry "middlemen" and help consumers avoid high drug prices by charging manufacturers' prices plus a flat 15% markup and pharmacist fee.

www.npr.org

Billionaire Mark Cuban launches online pharmacy aimed at lowering generic drug prices​

January 24, 20222:48 PM ET
JOE HERNANDEZ

"
Billionaire investor and Dallas Mavericks owner Mark Cuban has launched an online pharmacy for generic drugs that promises steep discounts over traditional distributors.

The Mark Cuban Cost Plus Drug Company announced the opening of its online pharmacy Wednesday. The pharmacy says it will bypass health care industry "middlemen" and help consumers avoid high drug prices by charging manufacturers' prices plus a flat 15% markup and pharmacist fee.

"All drugs are priced at cost plus 15% ! Sign up and share your thoughts and experiences with us !" Cuban tweeted last week.

POLITICS ​

Biden calls on Congress to pass his Build Back Better bill to lower drug costs​

The launch comes several weeks after the company established its own pharmacy benefit manager. PBMs are companies that work directly with health insurers, drugmakers and pharmacies to manage drug benefits and have a major impact on the prices of prescription medicines.

Sky-high drug costs have long been a problem in the U.S. A Gallup poll released in September found that 18 million Americans reported being unable to afford at least one doctor-prescribed medication in the previous three months. President Biden saidin December that the U.S. had to do something about "outrageously expensive" prescription drugs.



Cuban's pharmacy says it will negotiate drug prices directly with manufacturers to lower costs for consumers. The pharmacy doesn't accept health insurance but says prices will still be lower than what people would typically pay at a pharmacy.

PLANET MONEY ​

This Is Your Brain On Drug Ads​

"The markup on potentially lifesaving drugs that people depend on is a problem that can't be ignored," Alex Oshmyansky, CEO of Cuban's online pharmacy, said in a statement. "It is imperative that we take action and help expand access to these medications for those who need them most."

The website currently offers 100 generic drugs to treat a variety of illnesses, including diabetes, asthma and heart conditions.

One drug for diabetes patients, metformin, sells for $3.90 for a 30-day supply, compared to a retail price of $20, the pharmacy said. A 30-count of imatinib, which is used to treat leukemia and other cancers, goes for as low as $17.10 at Cuban's pharmacy compared with $2,502.60 at other pharmacies."

 

[missy]

The Maddeningly High Price of Prescription Drugs​

Why are prescription drug prices such a consistent source of frustration among patient-consumers? The answer is far more complicated than it appears.




Insulin is a medical marvel, saving the lives of millions of people who would otherwise perish from diabetes. It can also be prohibitively pricey, costing up to $300 a vial for newer versions of the treatment, which diabetes patients need two to three times a month.


For patients with less common ailments, the sticker shock can be much worse. Have a small child with spinal muscular atrophy, a rare genetic disorder that weakens muscle, causes movement problems over time and can be fatal? The good news is that the Food and Drug Administration in 2019 approved a drug, Zolgensma, a one-time curative therapy. The bad news is that it costs more than $2.1 million – and may not be covered by insurance – making it the costliest drug in the world.

Prescription drug prices in America are a consistent source of frustration, anger and bafflement among patient-consumers. Why are some drugs so pricey – and why are some pills dramatically more expensive than the same medication sold overseas? Who decides what prescription drugs cost – and how can they be made affordable without stifling the innovation and research that produced the miracle treatments patients now enjoy?


Congress is grappling with that issue now, mulling provisions in the "Build Back Better" bill that are meant to reduce the burden on consumers by capping co-pays that patients are expected to cover and yearly out-of-pocket costs for certain circumstances. As it is currently written, the measure would allow Medicare to negotiate drug prices – something the government was specifically banned from doing when Medicare Part D, the prescription drug benefit for seniors, was created in 2003.
The new measure would also impose a tax penalty if drug companies increase prices more than inflation, limit insulin co-pays to $35 a month and put a $2,000 cap on out-of-pocket costs for seniors for drugs covered under Medicare.
Many Democrats cast the battle as one between helpless patients and dollar-chasing drug manufacturers. Republicans say efforts to set prices, even in a back-door way, will discourage development of the very treatments that save lives.
"The public really has a love-hate relationship with the pharmaceutical industry. They very much appreciate and value the role of the pharmaceutical industry" in coming up with life-changing and life-saving treatments, Mollyann Brodie, executive vice president of the health research group Kaiser Family Foundation, said in a webinar this week. "On the other hand, they also believe that the industry is too focused on profits and that the profits are too high."

The industry, represented by the powerful Pharmaceutical Research and Manufacturers of America (PhRMA), certainly has its boogeymen. Chief among them is Martin Shkreli, the smirking so-called "pharma bro" who raised ire in 2015 when his company, Turing Pharmaceuticals, hiked the price of a life-saving medication, Daraprim, from $13.50 to $750 per pill. (Shkreli is in prison for security fraud. Turing and its parent company agreed on Wednesday to pay $40 million to settle a case charging that they had fleeced patients).

But drug companies have also developed critical therapies and breakthrough research on ailments ranging from cancer to Alzheimer's disease. They may have saved humanity by the speedy development of vaccines (and a possible new treatment) for the COVID-19 virus.
But why do some medications cost so much? And what can be done to make therapies more affordable?
The answer is far more complicated than it appears, experts say. And the solutions are not as simple as branding manufacturers as the singular source of the problem.
"Everybody loves to find the villains," says Wayne Winegarden, director of the Center for Medical Economics and Innovation at the Pacific Research Institute. Aside from some famously bad actors (like Shkreli), "there's not a villain here. We have a really bad health care system that incentivizes all kinds of crazy behavior," Winegarden says.
Drug prices, experts explain, are determined by a variety of players. A manufacturer sets a "launch price" – which is typically going to be higher if it's new or a breakthrough therapy. A middleman, called a Pharmacy Benefit Manager, then negotiates discounts and rebates with manufacturers for the drug, which they then provide to pharmacies, doctors and hospitals.
But the Pharmacy Benefit Managers don't necessarily pass that discount on to patients, explains Leslie Dach, chairman of the pro-health care reform group Protect Our Care. They also don't reveal how much of a discount they got, so patients don't know what the true cost is.
Insurance may well cover a particular medication, Dach explains. But since the co-pay is based on the original manufacturers' price – and not the lower, negotiated cost paid by the Pharmacy Benefit Manager – the patient ends up paying more.

"Everything about this is a black box," he says.
Pharmacies are in a bind as well, says Douglas Hoey, CEO of the National Community Pharmacists Association. The Pharmacy Benefit Managers – three of which, he says, control 80% of the market – are "incredibly powerful with health care providers." The middleman companies can direct patients to in-network pharmacies, for example, and say to pharmacies, "If you don't take our rates, we will steer this patient somewhere else."
That means that even when the original cost of a drug comes down, a patient might not see the benefit. A report by Milliman, commissioned and released this week by PhRMA, found that the net price of insulin in 2021 was, on average, 84% lower than the list price due to rebates, discounts and other payments. But experts note that a drop in the net, discounted price does not necessarily mean that patients' co-pays will be lower. The study pointed a finger at the Pharmacy Benefit Managers, saying the companies “have been found to favor products with high list prices and large rebates over lower-list price equivalents," having "unintended consequences" for patients whose co-pays are based on the original list prices.

The Pharmaceutical Care Management Association, which represents the Pharmacy Benefit Managers, turned the blame back to manufacturers, noting that the high prices start there.
"Ironically, the industry that controls the list price of prescription drugs has attempted to point the finger at those focused on reducing the cost of prescription drugs for patients and payers," the group said in a statement.
It's true that manufacturers' set the original prices, says Boston University professor Rena Conti, associate research director of biopharma and public policy at the university's Institute for Health System Innovation and Policy. But she says the answer is not to simply penalize the profitable industry.
"There are a lot of very misaligned incentives that create a lot of headaches for real people at the pharmacy counter," says Conti, who is scheduled to testify on the matter before a House committee Friday. "We are also the beneficiaries of a very robust pharmaceutical industry that is actually bringing new products to market, some of which really do transform our lives.”
"The point here is not to punish but instead to really think about how we might have the opportunity to realign incentives," she adds. For patients paying thousands of dollars or more for critical medications, that change cannot come soon enough.

"

 

[missy]

Prescription Drug Prices in the U.S. Are Twice as High: Here’s Why​

"

• A new survey indicates that prescription drug prices in the United States are more than twice as high as in other countries.
• Experts say brand-name drugs are the main driver of higher prices.
• They note that the actual out-of-pocket cost to consumers for a prescription is difficult to gauge due to consumer rebates and price adjustments to insurers.

Most people in the United States know that prescription drugs can be expensive.

How expensive?

Prescription drugs in the United States on average cost around 2.5 times more than those same drugs do in other Western countries, according to a new report from the nonprofit, nonpartisan research organization, RAND Corporation.

Those prices, in fact, have been steadily increasing for a while.

The RAND study found that spending on prescription drugs in the United States rose 76 percent between 2000 and 2017.

According to the RAND report, brand-name drugs appear to be the primary driver of price disparities in the United States compared to the 32 other nations analyzed in the study.

For example, brand-name depression drug Abilify costs $34 per pill in the United States compared to less than $5 per pill in Canada, according to a PharmacyChecker analysis.

Likewise, asthma drug Flovent costs $781 in the United States compared to $152 in the United Kingdom, Australia, and New Zealand.

All told, countries in the study spend nearly $800 billion on prescription drugs per year, with the United States accounting for 58 percent of the total but only 24 percent of the consumption.

Generic drugs, which account for 84 percent of all drugs sold in the United States, are actually slightly cheaper here than in other countries, on average. But the RAND study shows that they make up only 12 percent of total pharmaceutical drug spending,

“For the generic drugs that make up a large majority of the prescriptions written in the United States, our costs are lower,” Andrew Mulcahy, PhD, lead author of the study and a senior health policy researcher at RAND, said in a press statement. “It’s just for the brand name drugs that we pay through the nose.”

Why prices are hard to determine​

The true cost of prescription drugs in the United States is difficult to determine.
That’s because they’re enmeshed in a web of pricing adjustments and middle managers from the manufacturer’s list price (the gross price) to the actual price a person pays.
“Since gross prices have been growing much faster than net prices — in fact, over the past 3 years, net prices have been declining — there has been an inequitable cost shifting that has been occurring,” said Wayne Winegarden, PhD, an economist with the Pacific Research Institute (PRI) and the director of PRI’s Center for Medical Economics and Innovation.
“Patients out-of-pocket costs have been growing while net costs to insurers have been going down. This means that insured patients are now bearing a disproportionate share of the costs relative to the terms of their insurance agreements (spirit of the agreements, not the letter).”
“The health insurance system in the U.S. is so entirely different than in any other developed nation,” Thomas Miller, senior counsel and FDA and Life Science Lead, at Nixon Gwilt Law in Washington, D.C., told Healthline.
“There are three reasons that prescription drug costs are higher in the U.S. than in other countries. One, we have a multi-payer insurance system with several intervening entities each taking a margin; two, the government does not set ceiling prices in the U.S. like they do in other countries; and three, marketing exclusivity periods for patented innovator drugs.”
The other party unique to the United States’ healthcare system are a group of middlemen known as pharmacy benefit managers (PBMs), who negotiate prices with pharmaceutical companies for inclusion in health insurance coverage lists, also known as formularies.
“PBMs and insurance companies usually demand sweet deals from pharma manufacturers in exchange for inclusion on their coverage lists. These come in two forms: direct discounts or rebates,” Timothy Faust, a health care reform advocate, public speaker, and author of Health Justice Now: Single Payer and What Comes Next, told Healthline.
“Direct discounts are what they sound like — lowered list prices — and rebates are more nefarious. The PBM, upon purchase of the drug, receives a rebate from the manufacturer. This rebate is usually split between the insurer and the PBM but rarely passed on to the patient, whose copay is based on the drug’s list price regardless.”
But some rebates go directly to the consumer as well, another factor that makes it difficult to assess the actual costs of prescriptions.
“To counteract this tendency and encourage insurers to reconsider, manufacturers will sometimes offer direct-to-patient rebates, the likes of which are collected by products like GoodRX,” Faust said.
The end result is a war of internal pricing, where manufacturers are incentivized to increase list prices while simultaneously increasing discounts to keep PBMs happy.
“So what’s the ‘true’ cost of a drug?” Faust asked. “It depends on who’s paying, and everyone involved is pushing costs up, up, up.”

What can be done​

Challenging this trend would require a large push against a powerful alliance of financial interests.
“As one of the largest industries in the U.S., drug manufacturing is using its vast resources to protect the industry from regulatory changes that might negatively decrease the market size, which in turn keeps pressure on the cost of the prescription to remain higher than other countries,” said Brandon Newman, CEO and co-founder of Xevant, a drug analytics company.
“The conclusion from this reality should encourage fundamental rebate reforms to both fix the cost-shifting problems in the U.S. and to develop a more open and reliable net price,” Winegarden added.
There are other levers as well.
For instance, Medicare, which currently accounts for nearly a third of all retail pharmaceutical spending, is currently prevented from negotiating drug prices. Some experts say that giving Medicare the ability to negotiate pricing would help drive costs down.
Another possibility includes making sure everyone has health coverage, since uninsured people don’t benefit from negotiated pricing (though they can use direct-to-consumer rebates).
“An insurer typically structures its formulary such that drugs that are cheaper for the insurer are cheaper for the consumer, to encourage patients to request cheaper drugs like generics,” Faust said. “Uninsured people exist at the whim of the market.”

"

 

[missy]

https://www.commonwealthfund.org/sites/default/files/documents/___media_files_multimedia_podcasts_cmwf_podcast_transcript_rxdrugs.pdf

"
Why Are U.S. Prescription Drug Prices So High?
Producer: Sandy Hausman

This is New Directions in Healthcare, the Commonwealth Fund’s podcast. In this edition we look at why prices for some prescription drugs are so high in the United States.
One patient advocate who is working to bring prices down is 67-year-old David Mitchell of the nonprofit organization, Patients for Affordable Drugs. Since 2010 he’s been taking medication to manage a dangerous blood cancer called multiple myeloma.
“The drugs I take right now, I will receive 22 times over the course of a year. Every time they give me these drugs, the retail price is $20,000, so it’s about $450,000 worth of drugs that are keeping me alive right now.”

Mitchell is not alone. One out of four Americans says they have difficulty affording the medicines they take, and the Commonwealth Fund’s Shawn Bishop says we spend more on medication than any other country.

“The U.S. pays the highest prices for drugs in the world, and we put more of our health care costs toward prescription drugs than any other country. Seventeen percent of total national healthcare spending goes for prescription drugs. Analysts who advise Congress expect the share + to rise over the next ten years, because drug costs are expected to outpace those of all other services like doctor visits and hospital care.”

Even people with good health insurance are concerned. The cost of prescription drugs is driving premiums for policies up, and some people can’t afford the co-pays and deductibles for their medications.

“Health insurance in the U.S. includes prescription drugs, but patients are charged cost-sharing, and cost-sharing can be unaffordable, because the underlying prices of drugs are quite high in the U.S.”

Bishop, who is Vice President of Advancing Medicare and Controlling Healthcare Costs at the Commonwealth Fund, adds that while some medications cost less, bills can add up for treatment of chronic disease.

“Conditions like multiple sclerosis and rheumatoid arthritis and cancer which are treated with what are called specialty drugs and biologics – they have the highest-priced medicine – often $50,000-$100,000 per year, and some drugs for these conditions are priced in the $300,000- $400,000 range for an annual treatment. But even drugs for common conditions like diabetes have been increasing astronomically and creating affordability issues for patients, because patients who are being treated for diabetes take those medicines every day, so year over year increases are having an impact on their pocketbooks as well.”

A recent poll found one in four adults in this country is worried about the high cost of prescription drugs, and David Mitchell notes some are not taking medications as prescribed.

“We see patients who can’t take the full dose. They cut their pills in half. They skip doses. People with diabetes who don’t take the required amount of insulin to manage their Type 1 diabetes let their blood sugars spike dangerously before they take an injection, because they can’t afford it.

People with rheumatoid arthritis who have terrible pain because they can’t take the full dose required to manage that disease. People are angry, and they’re hurting, and they don’t understand how this could be happening to them in the United States of America.”

One reason, he says, is the fact that drug companies that develop new drugs are given the exclusive right to sell them for a period of years.
“The idea is you made an investment. You deserve a return on that investment. For a small molecule drug, a period of exclusivity is five years. For an orphan drug for a small population, the period of exclusivity is seven years. For biologics it’s 12 years. During that period of exclusivity, you are able to exercise monopoly pricing power. The short outcome of that is that drug companies are able pretty much to charge whatever they want, and we have no way to stop them.”

Former Congressman Henry Waxman, who co-sponsored the 1984 Hatch-Waxman Act that reformed the system for drug approval and patenting, offers a related explanation. He says companies defend high prices by claiming they need money for research and development.
“PHRMA, the trade association for the pharmaceutical industry, is quite powerful. They’ve increased their lobbying budget. They’ve increased their advertising budget. They have a sympathetic case to make when they suggest to people who are suffering from diseases for which there are no cures that there may not be cures if their incentives are taken away.”

David Mitchell points out that much of the research leading to new medications is done through the National Institutes of Health using tax dollars. He says drug companies spend more on sales and marketing than on research and development, but Waxman says many on Capitol Hill believe high prices for existing drugs help fund new ones.
“The consensus in the Congress has consistently been that they did not want to enact price controls. The alternative to that was to have competition with a generic drug. We have saved at least a billion dollars if not more by providing a less expensive alternative to the brand name drug.”

But lately, David Mitchell says, some generics are pretty pricy.
“People equate generics with cheaper, and it’s true, but the reason it’s cheaper is because of competition. If there is one generic the price goes down only modestly.”
And Waxman says brand name drug makers have found ways to stop generics from coming to market at all. One approach is known as Pay to Delay.

“A manufacturer of a brand name product can go to a generic manufacturer who’s ready to go into competition and pay that manufacturer not to go into competition. They both come out with more money — the brand and the generic, but it means that the consumer and insurance companies and government pay a higher price because of that lack of competition.”

Or the maker of a profitable drug may simply refuse to share samples of the medication with generic manufacturers.
“And unless you get the original drug, you can’t quite know how to manufacture the competitor drug.”

Mitchell says some companies also make small changes to drugs to delay the manufacture and sale of generics — a tactic known as evergreening.
“Instead of being administered twice a day we’ve formulated it so it’s administered once a day. We get a whole new patent.”

And pharmaceutical firms aren’t the only ones to benefit from the current system of patents and pricing.
“For example, the pharmacy benefit managers who run prescription drug insurance programs can make more off a higher priced drug, because they negotiate percentage rebates. Say they negotiate a 20% rebate on a $1,000 drug. They’re able to take half of that amount, put it in their pocket. Maybe they give the other half to the insurance company. We don’t know because pharmacy benefit managers conduct their business in secrecy. On top of that, doctors and hospitals are frequently paid based on a percentage of the price, and so they can make more off of high priced drugs. Ironically, it’s the patients who get hurt the most by high priced drugs, because patients in Medicare and in the private sector insurance plans pay their co-payments and deductibles based on the retail price, not the discounted price that the insurance company or the doctor or hospital may pay.”


For all of these reasons, former Congressman Waxman says voters are ready for reform.
“There’s no doubt in my mind that there’s enormous public pressure to do something about the high price of drugs.”

So, too, are insurance companies. And there’s one more force lining up to battle high drug prices.
“President Trump has indicated that he wants to do something in this area, and when a president wants to get something done that can be an enormous pressure on the Congress, as well as all the others.”

Lawmakers are considering a bill to govern drug company practices that delay the arrival of generics, according to David Mitchell at Patients for Affordable Drugs:
“There is a bill that could make a meaningful difference in speeding generics to market called the CREATES Act which will stop this gaming of the system by certain drug makers, that’s interfering with generics coming to market. The CREATES Act enjoys bi-partisan support.”
And, he adds, there is growing support for allowing one of the nation’s leading customers to bargain with pharmaceutical companies for better prices.

“Right now, by law, the U.S. government Medicare cannot use its bargaining power to get better prices for us. Medicare should be able to bargain over the prices of drugs directly with the manufacturers.”

Congress could make that happen – but that’s not the only legislative body concerned about the high cost of drugs. Again, the Commonwealth Fund’s Shawn Bishop.

“Federal policymakers haven’t taken any action, so states are taking it upon themselves to try to make some headway here for folks who live in their states. Some states have passed laws that prohibit price gouging, which is when price spikes are higher than really can be justified. Other states have passed laws that require more transparency about higher prices. Some states are seeking to require manufacturers to give notice of price hikes when those price hikes go over a certain threshold, and some states are requiring manufacturers to explain why their prices have increased. Other states are taking more drastic action. They’re trying to pass laws that would enable them to import drugs from other countries that have lower prices, and there’s really a range of proposals that are sitting in state legislatures that are being looked at right now.”


Former Congressman Henry Waxman’s consulting firm has a grant from the Commonwealth Fund to report on all the reasons why prescription drug prices in this country are so high and possible paths forward.

This report is available to you on the Commonwealth Fund’s website. I’m Sandy Hausman. Thanks for listening.

 

[dk168]

I am sorry, however, my own personal opinions and sentiments about health economics do not gel well with my day job as a HCP, therefore, I shall keep quiet.

DK

 

[missy]

We should not remain quiet. What is happening (USA, I cannot speak to other countries) is a huge injustice. Only those who are rich can afford meds without thought to cost. IMO competent healthcare and necessary meds are a right, not a privilege.

"Article 25 of the United Nations Universal Declaration of Human Rights lists medical care as a basic human right"

“If you have your health, you have everything”

Special Rapporteur on the right to health

www.ohchr.org

About the right to health and human rights

Defining the right to physical and mental health The right to health is an inclusive right, extending not only to timely and appropriate health care, but also to the underlying determinants of health. These include:

www.ohchr.org

And, this pandemic, has proved the opposite as far as I see it. That healthcare is a privilege instead of a basic human right. This must change.

We need to demand quality care for ALL.

"We are, in fact, the only developed country in the world who does not provide universal healthcare to its citizens"

"Because health-related costs are so high, medical bills are by far the single most common cause of personal bankruptcy in the nation"

“Are we as a society willing to make the right choices and continue to achieve those goals moving forward, or we are simply going to standby and watch our rights becoming more and more inaccessible to us?”

 

[autumngems]

We should not remain quiet. What is happening (USA, I cannot speak to other countries) is a huge injustice. Only those who are rich can afford meds without thought to cost. IMO competent healthcare and necessary meds are a right, not a privilege.

"Article 25 of the United Nations Universal Declaration of Human Rights lists medical care as a basic human right"

“If you have your health, you have everything”

Special Rapporteur on the right to health

www.ohchr.org

About the right to health and human rights

Defining the right to physical and mental health The right to health is an inclusive right, extending not only to timely and appropriate health care, but also to the underlying determinants of health. These include:

www.ohchr.org

And, this pandemic, has proved the opposite as far as I see it. That healthcare is a privilege instead of a basic human right. This must change.

We need to demand quality care for ALL.

"We are, in fact, the only developed country in the world who does not provide universal healthcare to its citizens"

"Because health-related costs are so high, medical bills are by far the single most common cause of personal bankruptcy in the nation"

“Are we as a society willing to make the right choices and continue to achieve those goals moving forward, or we are simply going to standby and watch our rights becoming more and more inaccessible to us?”

Missy,

I agree, luckily my daughter is still on our insurance (military Tricare) until she marries or is 26 so it reasonable. But just 1 of her medications is a teir 3 and cost 408.00 a month (she has tried 6 different meds and this is the only one that works for her) I don't know what they will do when she gets married.

They wonder why mental health is getting worse.

 

[missy]

Missy,

I agree, luckily my daughter is still on our insurance (military Tricare) until she marries or is 26 so it reasonable. But 1 of her medication is is a teir 3 and cost 408.00 a month (she has tried 6 different meds and this is the only one that works for her) I don't know what they will do when she gets married.

It is a grave injustice to most people. The USA is ranked 37th in healthcare but #1 in cost. What a travesty. IMO our country should be ashamed of itself with the way healthcare is here. How can any country be truly great without taking care of the health of the people who live there? One's income should not determine quality of care. Poor, middle class, rich doesn't matter. We all deserve equal and good healthcare and that includes medications.

I could give examples but we can afford it despite the high cost. is that right? NO.
What about those who cannot afford 8K a month? Which is the cost of one of the meds I might need. Not covered by our health insurance. What about those who don't have that money?
It makes me angry. We are talking about real people. Flesh and blood. Everyone deserves good healthcare. Everyone. It should be a RIGHT. A basic human RIGHT.

 

[ItsMainelyYou]

How can any country be truly great without taking care of the health of the people who live there?

Simply put, it can't

 

[missy]

I’m struggling with this thread too @missy. Struggling to comment without turning political - I agree that healthcare should be a human right. That we don’t treat it that way is egregious. What human being could possibly disagree with that? But we had a presidential candidate with a track record of keeping his word who promised to do exactly that and… The DNC walked him out the door in favour of pandering milquetoast. And then we wound up with a lunatic.

Yes there are really no words to do justice to how I feel about this. But how we feel doesn't matter. What matters are actions that work. There is much that can be done but they have to work together. Instead they behave like children. Ill behaved children at that. We cannot make political comments but I agree with you. It is egregious on all levels. And unacceptable.

 

[missy]

Simply put, it can't

I completely agree with you.

 

[AprilBaby]

I would love to get monthly migraine shots but insurance won’t pay and it’s $1200/ mo for one shot.

 

[telephone89]

As a canadian I am always aghast at the prices of meds in the US. I did hear about Mark Cuban's site and I think it's amazing. He still gets richer (15% is still a good ROI, and billionaires still gotta billionaire), and it makes many more drugs accessible. Unfortunately the selection is quite slim for now, but I'd expect it to grow quickly.

 

[missy]

As a canadian I am always aghast at the prices of meds in the US. I did hear about Mark Cuban's site and I think it's amazing. He still gets richer (15% is still a good ROI, and billionaires still gotta billionaire), and it makes many more drugs accessible. Unfortunately the selection is quite slim for now, but I'd expect it to grow quickly.

Yeah I am looking into getting some meds from Canada if I can. Big pharma is in bed with the fda here and it’s disgusting.

 

[DutchJackie]

Waarom sommige ziekenhuizen zelf medicijnen maken | Gezondheid | NU.nl

De kosten van medicijnen zijn soms zo hoog, dat ze te duur worden om te vergoeden. Daarom besloten twee Nederlandse ziekenhuizen al om zelf een medicijn te gaan maken. Waarom is dit nodig en zal dit de komende jaren vaker gaan gebeuren?

www.nu.nl

This article is in Dutch. It’s about why some hospital apothecaries have started producing small batches of expensive medication after price hikes. The article is from some time ago, but the situation was again in the press last summer.

 

[Karl_K]

Anyone that has a Walmart near by can get the same generic medications Mark Cuban's company will offer for the same price or cheaper and they have been doing it for a long time. I dont like Walmart much but I would have not been able to get my meds at times without them in the past.

The biggest issue is getting anything modern from the last 20 years or that is old but a crook has managed to lock up.
No where is that more apparent to me than antibiotics, even with insurance I am never able to get the one the doctor prescribed.

 

[lala646]

I take a medication called Cambia for my migraines. It is the quick-dissolve powdered form of a generic painkiller called Diclofenac, which is one of the most common OTC painkillers in the world, outside of the US. It's an NSAID, and in pill form costs pennies per pill. My insurance refused to pay for it in the powder form, and direct pay was going to be something like $75 per dose (you only take it when experiencing a migraine episode, but sometimes I need more than 1 dose). I truly thought about just buying the pills and crushing them myself. Luckily the manufacturer had a program for people whose insurance wouldn't pay, and I was able to get 4 doses per month for $20. But I had to "apply" to the program, provide financial information, and wait to hear if they would "accept" me.

 

[TooPatient]

However flawed the system is, I am truly grateful it is not what they have in other places. I have several friends who had more than one family member each die while waiting for care. It sounds great in theory, but the best solution would be more looking at the causes and addressing multiple small/large things that contribute. I think we need to approach it like a tangled chain. Rather than grabbing one end and yanking, loosen here and there or slowly jiggle a bit out then look again and see what is next.

 

[Rockdiamond]

We pay $3000 a month for health insurance. It's obscene.
And even then, we can't choose our doctors....we're screwed, badly. All of us....

We did have our dental work done in Mexico this past summer- great dentist, all the latest equipment, and 20% of what it costs in NYC. Not 20% less, 20% of the cost.
And it seems to me that virtually no insurance covers dental....who needs teeth anyway

 

[smitcompton]

Hi,

I, of course agree with everything written here. My famiiy doctor has told me that he uses a pharmacy in Canada for his patients to access their drugs at less cost. Sometimes he has samples that he gives me, but would order for me if I wanted him to from Canada.

Each year my costs go up a lot. One asthma medication was discontinued and replaced with a 400.00 a month med. I love my pharmacist and don't wish to get my meds elsewhere. So I pay the large deductible and cry in my beer. I really feel for those that cannot afford these drugs. We do need regulation here.

Annette

 

[missy]

"

Americans Have No Right to Healthcare​

— It's high time we change that​

by Cedric Dark, MD, MPH, and Kyle Fischer, MD, MPH January 31, 2022

The United Nations' Universal Declaration of Human Rights, signed in 1948, set up the framework that healthcare is a human right. Article 25 of the document stated that, "everyone has a right to standard of living adequate for the health and well-being of himself and his family including...medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control."

President Franklin D. Roosevelt previewed these sentiments in his State of the Union Address where he described the four freedoms. The first two, freedom of speech and freedom of religion, are codified in our First Amendment. But the third and fourth, freedom from fear and freedom from want, remain nebulous in our view. And nowhere in our nation's founding documents does it explicitly state that Americans are entitled to have access to a physician or any form of medical treatment.
Some people might interpret the values espoused in the Declaration of Independence, with its notion of inalienable rights to "Life, Liberty, and the pursuit of happiness," as denoting that "life" equals an explicit right to healthcare. This is simply not a reality in America.
The preamble to the Constitution mentions providing for the "general welfare." Could this be recognition enough that healthcare is a right for the individual? No, for one's individual welfare does not necessarily equate to the general welfare. Although there have been Constitutional Amendments proposed in the past -- most recently by Rep. Betty McCollum (D.-Minn.) -- as yet, there is no enumerated U.S. right to healthcare.

But, you may ask, doesn't a pregnant woman have the right to choose whether or not to have an abortion? Isn't that a right to healthcare? Yes, the Roe v. Wadedecision determined that this form of healthcare is legal. However, the Supreme Court based their decision on an individual's right to privacy in their medical decision making. It did not stem from a right to healthcare.
But, others may say, the emergency department is open to all -- doesn't that mean Americans have a right to healthcare? Unfortunately, the 1986 Emergency Medical Treatment and Labor Act (EMTALA), which made access to emergency care a right for all Americans, is exceedingly limited in scope. It only guarantees treatment for life and limb threatening conditions and treatment of women in labor. It does not guarantee treatment for chronic conditions such as high blood pressure or heart disease. It does not cover cancer care. Moreover, one must ask if a single, limited law could be construed as a right.

Senior citizens have a right to healthcare once they age into the Medicare program. More recently, Americans with specific diseases, such as end stage renal disease and Lou Gehrig's disease have this right to healthcare extended to them. But as simple laws, the right to emergency care, to care for seniors, and for those with certain deadly conditions could easily be ripped away. A future Congress could repeal these laws if it chose to do so.
It wouldn't be the first time. We have seen that health laws, such as the Medicare Catastrophic Coverage Act of the late 1980s, can easily be repealed. Other laws, like the Affordable Care Act, show that a single law can be sabotaged whenever a political party has control of both Congress and the White House. And the will of the people can be ignored by dithering politicians who intransigently refuse to implement lawful extensions of healthcare. As just one example, this occurred in Maine in 2018, when the former Governor failed to execute a Medicaid expansion ballot initiative approved by the state's citizens.

All our patients desire is a chance to be healthy and to keep their families healthy. Should they not be allowed to do this without squandering their life's savings or risking bankruptcy? Since the 1940s, following the defeat of Nazi Germany, our country has made bold steps towards securing this human right to healthcare and making Americans free from want.
If nothing else, this last year showed us that moving toward the right to healthcare for all is possible. With the federal government ensuring access to COVID-19 testing and vaccinations, everyone in this country had a right to the most aggressively developed medical care the world has ever seen. The pandemic has shown us what we can do when we recognize that an individual's welfare actually is dependent upon the general welfare. So, although an explicit right to healthcare does not formally exist in the U.S. for all people regardless of age or medical condition, the past 2 years have revealed why every American should be assured of that right.

America must make the healthcare of its citizens a protected right. As difficult as it may be in these polarized times, the U.S. needs a Constitutional Amendment to guarantee healthcare as a right. Anything less would fall short of the needs of everyday Americans. Until then, in America, healthcare is not a right. But its high time we change that.
Cedric Dark, MD, MPH, is an assistant professor in the Henry J. N. Taub Department of Emergency Medicine at Baylor College of Medicine. Kyle Fischer, MD, MPH, is a clinical assistant professor of emergency medicine and fellowship director in health policy at the University of Maryland School of Medicine."

 

[MrsBlue]

We pay $3000 a month for health insurance. It's obscene.
And even then, we can't choose our doctors....we're screwed, badly. All of us....

We did have our dental work done in Mexico this past summer- great dentist, all the latest equipment, and 20% of what it costs in NYC. Not 20% less, 20% of the cost.
And it seems to me that virtually no insurance covers dental....who needs teeth anyway

I once cracked a tooth during a holiday weekend and had to get an emergency root canal and crown. That was basically a 1 carat problem. Now I need about 2 carats of additional work (by NYC prices) so I'm seriously considering some dental tourism of my own.

 

[Rockdiamond]

so I'm seriously considering some dental tourism of my own.

If you need our Mexican dentist, he's in an amazing city in the Yucatan called Merida.......

 

[MrsBlue]

If you need our Mexican dentist, he's in an amazing city in the Yucatan called Merida.......

Thank you!! Will definitely look into it!

 

[Bron357]

Here in Australia prescription costs are subsided. The max price, per script, is $40 odd dollars, however if you are a concession card holder (unemployed, aged pension, sick benefits) the max price is $6 a script. On top of that there is a annual $$$ ceiling at which further scripts are free.
So people managing chronic conditions are protected from overwhelming financial costs.
Not all medicines are on the Subsidy list, however nearly all of the commonly used one are. If your medicine isn’t subsided it can be very expensive.
So here in Australia we can go and see a General Practioner for free (normally, some choose to charge above the schedule fee so you might have to make up the difference) and get a prescription and then take it to a Chemist and 10 minutes later after paying the script cost, walk out.
Like if I need a blood test or an X-ray, my doctor gives me an authorization and I go to the appropriate centre and have blood taken or an x ray done, for free, and then go back to my doctor for the results / follow up.

 

[SparklieBug]

I'm in Canada, where we moved to a different province. Moved from having a GP to a province where there's on average, a three-year waiting list for the privilege of having a doctor. Unbelievable! The system here, so proudly touted by many, actually sucks. Yes, meds are less expensive, on average, but if you can't get in to see someone to prescribe them, it doesn't matter the cost.

Heaven forbid you need a specialist. My DH needs to be in the care of a rheumatologist due to a chronic disease. As a newbie to the province, he found a rheumatologist that's a 2.5 hour drive (one way), and was relieved. The wait to get in was five months.

Incredibly, his former rheumatologist contacted someone in our city—she was no longer taking new clients, but on the request of DH's former doc, agreed to see DH. After a four-month wait, he just had his first appointment, and it's a great fit, very fortunately!

My brother and SIL went to HI for six weeks (they're still there), and were absolutely amazed to be able to call a doctor's office, get an appointment, pay a small fee ($75), get a prescription, fill it, and be done inside of an hour. Here? Would have taken a wait (could be minutes to hours/a day) to access a walk-in clinic, then more waiting to see a physician, then hopefully have the right advice/ meds.

Filling a prescription is generally pretty quick, here. One easy thing, at least.

/rant

 

[GeliL]

I'm in Canada, where we moved to a different province. Moved from having a GP to a province where there's on average, a three-year waiting list for the privilege of having a doctor. Unbelievable! The system here, so proudly touted by many, actually sucks. Yes, meds are less expensive, on average, but if you can't get in to see someone to prescribe them, it doesn't matter the cost.

Heaven forbid you need a specialist. My DH needs to be in the care of a rheumatologist due to a chronic disease. As a newbie to the province, he found a rheumatologist that's a 2.5 hour drive (one way), and was relieved. The wait to get in was five months.

Incredibly, his former rheumatologist contacted someone in our city—she was no longer taking new clients, but on the request of DH's former doc, agreed to see DH. After a four-month wait, he just had his first appointment, and it's a great fit, very fortunately!

My brother and SIL went to HI for six weeks (they're still there), and were absolutely amazed to be able to call a doctor's office, get an appointment, pay a small fee ($75), get a prescription, fill it, and be done inside of an hour. Here? Would have taken a wait (could be minutes to hours/a day) to access a walk-in clinic, then more waiting to see a physician, then hopefully have the right advice/ meds.

Filling a prescription is generally pretty quick, here. One easy thing, at least.

/rant

My mother is in Canada as well. What you don't pay in money, you pay with time. There is a 3 month wait with just getting a mammogram where she is, and they don't even know when they will release the new appointment slots. Getting an appointment with the doctor is also impossible, and by average a 3 week wait. Sometimes it makes you wish you can resolve things with money...because you cannot in Canada. There are lots of patients who need help but it's hard to determine what is and is not an emergency, so you end up waiting for years for a surgery, and by the time you finally receive the surgery your condition could already have gotten much worse.

 

[telephone89]

I can't speak to all provinces, having only lived in 2, but I can say that has not been my experience at all.
I actually called today to book a dr appt for friday with my GP. I hadn't had a family doctor in yeeeaarrs but LY decided to take a look around and found one 5 mins away that fit all my criteria. No wait or anything to get in.
Now surgeries have been a bit difficult. I've been waiting on an elective surgery since May 2021. It has been cancelled twice due to the hospitals being overfilled with covid patients. I'm extremely lucky that this isn't a serious surgery, but even during covid, my FIL fell ill and turned out to have cancer. He was treated right away and definitely did not have to wait for anything. The worst part was not being able to visit because of covid protocols.

 

[SparklieBug]

@telephone89 The province we moved from was much better than where we are now, for medical access. It sounds similar to your experience with finding a GP, getting appointments, etc. We thought that the situation was likely exaggerated here, but nooooope.

Where we are now, it's been tough for patients (and doctors!) for quite a few years, and this is throughout the province, not just in certain areas. Several years ago, my SIL wasn't able to get in to a rheumatologist here, so she flew to another province where a doc was readily available. Wild!

I suspect I'm more aware of the medical situation now because of my DH's condition. I'm very healthy as far as I'm aware (for which I'm deeply grateful), and the only time I need a prescription is if I have dental work done where I need an antibiotic, which isn't very often.