JustCare

Category: Drugs and technology

  • Some Democrats oppose Biden’s goal of lowering more Medicare drug prices

    Some Democrats oppose Biden’s goal of lowering more Medicare drug prices

    The Lever reports on a cadre of Democratic Congressmen committed to opposing Biden’s goal of lowering more drug prices for people with Medicare. Not surprisingly, these policymakers happen to be the beneficiaries of lots of pharmaceutical industry money. What’s going on?

    The Inflation Reduction Act includes provisions to allow Medicare to pay negotiated drug prices for ten drugs in 2026. It allows Medicare to negotiate drug prices for an additional 150 drugs through 2034. President Biden wants to expand that number to 500 drugs, which would reduce Medicare spending on high-cost drugs and should also reduce people’s copays for those drugs.

    Former President Trump, if reelected, appears interested in weakening Medicare drug-price negotiation. At one point during his presidency he said he supported drug price negotiation, but he has since backed down from that position.

    Democrats Scott Petters of California, Josh Gottheimer of New Jersey, and Wiley Nickel of North Carolina are prepared to go against their president and fight some Medicare drug price negotiation as well. The pharmaceutical industry and other medical industry groups have contributed $300,000 to them in the last year. Gottheimer is considering a run for governor of New Jersey.

    These Democrats are sponsoring legislation that claims to be defending research on orphan drugs, aping the drug industries’ common refrain that negotiated drug prices will compromise investment in research. It is interesting how negotiated drug prices around the world don’t appear to concern them or the fact that Americans are forced to pay three or four times as much as people in other wealthy countries for the same drugs.

    Experts say that pharmaceutical companies will still rake in big profits on orphan drugs with negotiated prices, just not quite as big as they do now. Moreover, the Inflation Reduction Act exempts “orphan drugs” from Medicare price negotiations if they are treating only one rare disease. If Peters, Gottheimer and Nickel get their way, orphan drugs would be excluded from Medicare price negotiations even if they treat multiple rare conditions.

    Here’s more from Just Care:

  • Billions in Medicare savings from Medicare drug price negotiation by 2031

    Billions in Medicare savings from Medicare drug price negotiation by 2031

    A new report from Nicole Rapfogel at the Center for American Progress (CAP) finds that the Inflation Reduction Act’s provision allowing Medicare to negotiate drug prices for its highest cost drugs will reduce drug spending by tens of thousands of dollars a year for millions of people with Medicare and save Medicare millions of dollars a year.

    On September 1, 2024, the Centers for Medicare and Medicaid Services (CMS), which oversees Medicare, will announce the prices it has negotiated with pharmaceutical corporations on ten drugs that treat, among other things, diabetes, kidney disease, blood clots and heart failure. Beginning in January 2026, the cost of these drugs should drop considerably.

    The ten drugs cost Medicare significantly more than other drugs it covers either because they have very high prices or because they are widely used. A total of nine million people currently use their Part D drug benefit to fill prescriptions for these drugs. These ten drugs represent roughly 20 percent of Medicare’s annual drug spending under Part D.

    CAP projects that the price of one insulin product, NovoLog FlexPen will fall $30 a month and the price of one cancer drug, Imbruvica, will fall $6,548 a month. The price of Eliquis, which 3.5 million people with Medicare take, could drop by $123 a month.

    Currently, Americans pay many times more than people in other wealthy nations for several of these drugs. For example, a dose of Stelara, another drug whose price Medicare is negotiating, which treats people with autoimmune conditions, costs $2,900 in the United Kingdom and $16,600 in the US. Moreover, Americans paid $6.5 billion in taxpayer dollars for the development of Stelara.

    While Medicare is only negotiating the price of 10 drugs this year, by 2030 it will have negotiated the price of 80 drugs. CAP estimates that Medicare will save $25 billion as a result of drug price negotiation in the six years between 2026 and 2031.

    Of course, the pharmaceutical corporations are trying to block these price negotiations in the courts, claiming that the government should not be interfering with the prices private corporations set. What they fail to say is that they developed these drugs with $11.7 billion in taxpayer dollars, The Lever reports. And, the pharmaceutical corporations made $70 billion on these drugs in 2022.

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  • How can Pharma defend drug prices in US?

    How can Pharma defend drug prices in US?

    The Biden administration and Congress are concerned about drug prices, they claim. Really? It would be so easy to lower drug prices quickly, simply by opening our borders to drugs from verified pharmacies abroad. Instead, for the first time, the US is negotiating drug prices for ten drugs, and those prices will only be available to Medicare. Noah Weiland and Rebecca Robbins report for The New York Times on a recent Senate HELP Committee hearing.

    The Senate HELP Committee held a hearing on drug prices last week. The heads of three pharmaceutical companies had to defend their prices at the hearing. There was lots of talk and little action about why every other wealthy nation pays less for their prescription drugs than we do.

    CEOs at Johnson & Johnson, Merck and Bristol Myers Squibb admitted that we pay more for our drugs in the US than people in other wealthy countries. In exchange, they claim that we get new drugs sooner. Clearly some spin doctor advised that they praise this “patient choice” in the US. What was left unsaid is that “choice” is only available to the wealthy. Countless Americans cannot afford their drugs even with health insurance because the copays are so high.

    Senator Bernie Sanders, for reasons that I have never understood, is constantly comparing drug prices in the US with those in Canada and sometimes arguing that Americans should be able to import drugs from Canada. Canada has the second highest drug prices in the world. Why not France and England, which have far lower prices?

    Sanders was looking for the CEOs to voluntarily agree to lowering their prices to the same level as Canada. How could they possibly agree to reduce their revenue and profits voluntarily? In fact, they have filed lawsuits against the federal government (which they are so far losing), claiming that negotiated prices for ten drugs through the Inflation Reduction Act is unconstitutional!

    Republicans on the HELP Committee appear to believe that the pharmaceutical market is working. In fact, Congress affords pharmaceutical companies lengthy patent rights and ways to extend them. The pharmaceutical market is fixed to give pharmaceutical companies monopoly pricing power for lengthy periods.

    Senator Romney would like you to believe that the pharmaceutical market works like the automobile market. Not at all. With cars, there’s competition based on lots of known information, including the costs and benefits of the automobile. With drugs, people often don’t know their value. Moreover, the price is rigged by the manufacturers, the pharmacy benefit managers and the health insurers.

    We are paying about three times more than people in other countries for our drugs. Shame on Congress.

    Here’s more from Just Care:

  • Weight-loss drugs are a hot commodity and hard to get

    Weight-loss drugs are a hot commodity and hard to get

    Weight loss drugs are a hot commodity. They can be hard to come by. Getting them can try your patience and your pocketbook. Reed Abelson and Rebecca Robbins offer six reasons why it is so hard for people to get weight-loss drugs in the New York Times.

    1. A lot of people want these drugs. Already nearly four million people are taking weight-loss drugs. Between TikTok and advertisements, more and more people are wanting to take weight-loss drugs.

    2. Production of these drugs is slow. Few factories can manufacture the latest weight-loss drugs. And, they come in five or more strengths. Eli Lilly also needs to make enough of its pens used to inject Zepbound.

    3. Insurance often won’t cover these drugs, making them unaffordable to most. Medicare will only cover these drugs for people with diabetes. It does not cover weight-loss drugs for obesity. However, Medicare covers nutrition and weight-loss counseling.

    Medicaid does not either. The insurers consider them “lifestyle” drugs, rather than medically necessary drugs. As. result about 40 percent of employers also do not offer this coverage to their workers.

    These are injectable drugs that can cost as much as $16,000 a year. With discounts or coupons from Eli Lilly, people can get Zepbound, one of the weight-loss drugs, for $550 a month, if they have insurance. They can get a coupon from Novo Nordisk for Wegovy, another weight-loss drug, and pay $1,000 a month instead of $1,500 a month.

    4. People can’t find these drugs at their pharmacies. While these drugs are often not in stock at pharmacies, they will order them when requested. The drugs cost too much money, literally tens of thousands of dollars for a pharmacy to stock.

    5. Pharmacies sometimes claim that these drugs provide them no profit. In fact, some say that they lose money on weight-loss drugs because the insurers do not reimburse them adequately for the drugs. The insurers’ pharmacy benefit managers or PBMs reimburse the pharmacies below cost in some cases. This seems like a way for the insurers to avoid covering weight-loss drugs.

    6. Most insurers create hurdles in order to cover weight-loss drugs. People need their doctors to verify they qualify for coverage. In some cases, before the insurer will cover these drugs, enrollees must take a six-month nutrition and exercise program. Some insurers require people to try other less expensive drugs before they will cover these drugs.

    Here’s more from Just Care:

  • Drug prices continue to be around three times higher in the US than other wealthy nations

    Drug prices continue to be around three times higher in the US than other wealthy nations

    The Assistant Secretary for Planning and Evaluation or ASPE, a government research agency, released a report showing that US drug prices–brand name and generic–are almost 2.78 times the price in 33 other wealthy countries. Even for people with Medicare Part D prescription drug benefits, drug costs can be high. That will only change when the US negotiates prices for all drugs as every other wealthy nation does for its residents.

    ASPE hired RAND Health Care to conduct the analysis. When RAND compared brand-name drug prices in the US to prices in OECD countries, it found that they were more than 3.20 higher even after adjusting for rebates. It also found that the preponderance of new drugs were first available in the US.

    The US is responsible for a disproportionate and ever larger share of total spending on new drugs as compared with other wealthy nations. The Inflation Reduction Act gave Medicare the ability to negotiate the price of several dozen drugs, beginning with 10 drugs in 2025. But, there are thousands of drugs on the market and working people do not benefit from Medicare’s negotiated prices.

    The price of drugs is rising faster in the US than in other wealthy countries. If you do not factor in rebates, which insurers usually pocket, we pay more than four times the price of people in other wealthy countries for our drugs.

    We pay about two-thirds less for generic drugs than people in other wealthy countries. And, these drugs represent 90 percent of US spending on prescription drugs. These drugs only represent about 41 percent of spending on prescription drugs in other countries.

    Some drugs are particularly expensive in the US. For example, insulin prices are almost ten times higher in the US than in other wealthy countries. We pay more than 10 times what people in France and the UK pay for insulin. We pay six times more than Canadians for insulin. Rebates for people with insurance and people who have met their deductible bring the price of insulin down to 2.33 times what people pay in other wealthy countries.

    While most new drugs launch first in the US, a large number of them launch in other wealthy nations soon after. The researchers found that the drugs that are most beneficial are available in all wealthy countries within a short time.

    Here’s more from Just Care:

  • Biden administration should do more to lower drug costs

    Biden administration should do more to lower drug costs

    In an opinon piece for Scientific American, James Love, Director of Knowledge Ecology International, explains how the Biden administration could do more to lower the cost of prescription drugs in the US. You might not know this but the federal government has the authority to drive competition in the brand-name prescription drug market for brand-name drugs developed with taxpayer support. Many brand-name drugs are developed with your tax dollars.

    Federal agencies can grant licenses to pharmaceutical companies to manufacture drugs that compete with patented drugs with high prices, if the patented drugs were developed with taxpayer dollars. Of course, these are licenses that the pharmaceutical companies that developed the patented drugs do not expect or want to be issued. And, historically, the government has not issued them.

    The federal government has what are called “march-in” rights. It can issue licenses to develop drugs whenever it believes it is necessary to fix a pharmaceutical company’s “abuse or nonuse” of a patented drug. New draft federal guidance clarifies that an excessively high drug price can be considered abusive.

    These “march-in” rights were first established in the Bayh-Dole Act of 1980. Their goal is to ensure that the public benefits from drugs that that are patented, if public dollars contributed to their development. But, over four decades, the federal government has never exercised “march-in” rights, even when pharmaceutical companies set unconscionable prices for their drugs.

    The Biden administration’s new take on the law is significant but still limits the government’s use of its march-in rights and still allows the pharmaceutical companies to set excessively high prices for drugs that were developed with taxpayer dollars. The administration does not suggest that pharmaceutical companies have an obligation to set their drug prices no higher than levels citizens of other wealthy countries pay for the same drugs when US taxpayer dollars funded their development. Right now, we often pay five to ten times more than people in other wealthy countries for the same drugs, developed with our tax money.

    There are not that many new drugs developed with federal funding. And, some of those drugs include patents that were not developed with federal funding. In the administration’s draft, timing, including a patent’s life, could mean that march-in is not a good tack for the federal government to take.

    Moreover, pharmaceutical companies can appeal the federal government’s exercise of march-in rights, which would freeze government action. Essentially, pharmaceutical companies can slow down the march-in process for years, until their drugs lose their patents. And, for obscure reasons, sometimes pharmaceutical companies do not disclose government funding, as in the case of Gleevec, a cancer drug that has generated billions in revenue for Novartis.

    But march-in rights are not the federal government’s only tool for lowering drug prices. Our government has “worldwide royalty-free licenses for a taxpayer-funded invention, and a separate statute allows government use of any patent with compensation—zero for government-funded inventions—set by a judge.” There’s no reason our government should not be using all these rights to ensure Americans can afford the medications they need, especially for Americans in federal programs like Medicare and Medicaid.

    [Editor’s note: I continue to believe that the simplest and swiftest way to pressure the pharmaceutical companies to lower drug prices in the US is to open our borders to prescription drugs from verified pharmacies abroad and require insurers to cover them just as they cover drugs from pharmacies in the US. The Biden administration is now allowing some states to import drugs from Canada, which is another small step in the right direction.]

    Here’s more from Just Care:

  • Biden brought down the price of insulin significantly; a Trump presidency could undo that

    Biden brought down the price of insulin significantly; a Trump presidency could undo that

    Drug prices remain out of control, and there’s a lot that President Biden could still do to bring them down. But, Americans should give President Joe Biden credit for reducing the cost of insulin significantly, a huge achievement for which he has not gotten the credit he is due, writes Jonathan Cohn for Huffington Post. If Trump is reelected, he could undo this.

    In fact, President Biden is responsible for several new laws that are bringing down the cost of health care and making it a little more affordable. [Editor’s note: Not nearly enough, but far more than President Trump.]

    With insulin, which millions of diabetics rely on for their well-being to process sugars in their bodies, the list price can be hundreds of dollars. That price is insane. People in other developed countries pay as little as 10 percent of the amount we pay for their insulin. Their governments negotiate the price of insulin and every other drug on their behalf.

    About 25 percent of Americans with diabetes cannot afford insulin and other basic needs. In some cases, people forego insulin to the detriment of their health. They might not have health insurance and cannot afford the full cost of insulin. Fortunately, thanks to the Affordable Care Act, fewer Americans than ever are uninsured.

    As of 2023, because of the Inflation Reduction Act, older adults and people with disabilities should pay no more than $35 a month for an insulin prescription. If they have two prescriptions, it would cost them $70. Since the government has not yet negotiated the price of insulin, it’s not clear how much more everyone with Part D prescription drug coverage is paying in premiums as a result of the Inflation Reduction Act.

    Unfortunately, reports are that some Part D drug plans have stopped covering insulin in response to the $35 maximum copay. If you have diabetes, make sure that your drug plan covers your insulin prescriptions.

    As of January 1, 2024, people who do not have Medicare should also see lower insulin prices. The three major companies that manufacture insulin have reduced their prices to $35 a month voluntarily. One policy expert explains, however, that the price drop actually helps these companies maximize profits: “They’re lowering prices to avoid paying rebates to Medicaid programs and therefore maximize profits.”

    If President Trump is reelected in November, watch out. His administration would likely undo President’s Biden important legislation on insulin prices. And, many of the 8.4 million Americans who rely on insulin would again be struggling to afford it or, worse still, forced to go without it.

    Here’s more from Just Care:

  • FDA allows Florida to import lower-cost drugs from Canada

    FDA allows Florida to import lower-cost drugs from Canada

    Finally, in some part thanks to former President Trump and Governor Ron DeSantis, as well as to the Biden Administration’s Federal Drug Administration (FDA), the US plans to open its borders to drug importation, reports Christina Jewett and Cheryl Gay Stolberg for the New York Times. While that is not a long-term fix to unconscionably high drug prices in the US, it is a terrific first step–unless the pharmaceutical industry succeeds at blocking these drug imports.

    To be clear, the FDA only has approved drug importation from Canada. And, as of now, only the state of Florida has approval. But, it is the camel’s nose under the tent and could save Florida as much as $150 million in drug costs in its first year.

    Interestingly, while the Biden Administration supports drug importation, it took a lawsuit by the state of Florida against the FDA to get the the needed federal approval.

    Americans already can buy drugs legally directly from Canadian pharmacies for personal use, but insurers are not required to cover those drugs. They still don’t. But Florida has approval to buy drugs for enrollees in its Medicaid program, people using its health clinics, and people in prison.

    It’s also not clear whether drug importation from Canada will work better for states in theory than in practice. Canada might not have enough supply to provide the drugs Florida needs, let alone the drugs other states will also want to purchase once they have FDA approval.

    You can bet your bottom dollar that Pharma is pulling out all stops to keep drug importation from happening. It plans to bring a lawsuit to prevent Florida from importing drugs from Canada. Moreover, some Canadian drug wholesalers have signed contracts with pharmaceutical companies agreeing not to export their drugs. In addition, Canada does not have a bottomless supply of drugs.

    Time will tell how this story unfolds. Drug importation from Canada was a long time coming. The New York Times reports that Congress passed legislation allowing drug importation 20 years ago, but it is only now that the administration is implementing it. Allegedly, there were “safety” concerns. More likely, there were concerns about PhRMA’s wrath.

    To be clear, patient safety concerns abound in the US because people cannot afford the drugs they need. Too often, they die as a result. And, even more often, they become sick or disabled because they cannot afford to fill their prescriptions.

    There are no reports of people harmed from importing drugs from abroad. Nine million Americans import drugs from abroad every year without incident.

    Colorado, Maine, New Hampshire, New Mexico, North Dakota, Texas, Vermont and Wisconsin have passed laws to allow their states to import drugs and likely many more will do so. Canada should not be the only foreign provider. Many drugs taken in the US are manufactured in India, China and elsewhere. Americans should be permitted to import drugs from verified pharmacies in any country.

    Americans support drug importation. Of course, we do. We import food safely from abroad, and automobiles, and electronics and more. There’s no good reason that we cannot import prescription drugs safely. And, anyone who supports competition should support drug importation, especially since drugs in the US often cost four times more than drugs in other developed countries.

    The big problem with drug prices in the US is that PhRMA can charge pretty much what it will for brand-name drugs. There’s little competition. PhRMA also can keep low-cost generic alternatives off the market for years.

    The Inflation Reduction Act allows our government to negotiate drug prices, which is arguably the best way to bring down drug prices in the US. But, it only allows drug price negotiation for 10 high-priced drugs in the first year, and only for people with Medicare. It’s good, but way less than what we need.

    And, while helpful, Medicare Part D drug plans can still cost you a bundle. If you want to keep your drug costs down, you need to compare your drug copays against the full cost of your drugs at Costco and other low-cost pharmacies. In some cases, you’ll pay less through Costco as this JustCare reader does.

    Before it can begin importing drugs from Canada, Florida must specify the drugs it will import to the FDA and explain how it will ensure they are not counterfeit. Florida also must relabel the drugs.

    Meanwhile, the Canadian government is none too happy about exporting drugs to Florida. The Canadian government could step in if it does not liking the consequences of drug exports. There is understandable worry that a country with fewer than 40 million people will find itself without needed drugs if it exports them to a state with 22 million people, let alone to multiple states with tens of millions more people.

    Here’s more from Just Care:

  • Dozens of drug companies owe Medicare rebates from raising prices higher than the inflation rate

    Dozens of drug companies owe Medicare rebates from raising prices higher than the inflation rate

    The Biden Administration just announced that dozens of drug companies owe Medicare rebates from raising prices higher than the rate of inflation. As a result , hundreds of thousands of people with Medicare will save as much as $2,786 per dose of their prescription drugs.

    The Inflation Reduction Act (IRA) prevents drug price gouging–defined as price increases greater than the rate of inflation–by pharmaceutical companies. The IRA also caps out-of-pocket costs for each insulin drug at $35 a month and limits total out-of-pocket drug costs for people with Medicare through Medicare Part D to $2,000 a year beginning in 2025. Yet, Republicans are trying to repeal the IRA.

    In total, the Administration reports that pharmaceutical companies raised prices on 64 drugs more than inflation. For example, the price of Signifor, which treats an endocrine disorder, went up so much that people who use it could see a savings of $311 for a monthly dose of the drug beginning in January.

    President Biden is also heralding his Administration’s decision to allow the government to “March-in” and help bring down the price of drugs developed with federal funding, if the price is unreasonable. This march-in right has always existed but prior administrations have been reluctant to take the position that the government could step in if a pharmaceutical company charged an excessive for the drug.  Of course, the proof of this Administration’s commitment here is in determining that the price of a drug developed with federal money is too high and taking action. Time will tell.

    Meanwhile a story in Becker’s exposes extreme drug price increases for eight drugs, according to ICER.  The story suggests that insurers spent more than $1.3 billion in these drugs in one year. It’s not clear if that means that individuals paid higher premiums to cover the cost of the drugs, but presumably so. The question left unanswered is whether the insurers recouped that money they spent for these drug, through rebates, and left their enrollees’ holding the bag, a likely scenario.

    Herre’s more from Just Care:

  • Insurers overcharge Medicare enrollees for generic drugs

    Insurers overcharge Medicare enrollees for generic drugs

    The biggest health insurers and Pharmacy Benefit Managers (PBMS) offering Part D prescription drug coverage are overcharging Medicare for generic drugs, according to a new JAMA study by researchers at UC San Diego, West Health and the University of Washington. More than 40 million people with Medicare have Part D drug coverage for their outpatient drug needs. As a result of these overcharges, their out-of-pocket coinsurance costs are likely signficantly higher than they should be.

    The researchers find that part of the reason that older adults and people with disabilities face high out-of-pocket drug costs with Medicare Part D is that Rite Aid, Cigna, Centene, CVS Health Humana, and UnitedHealth, which offer Part D coverage, and the Pharmacy Benefit Managers they own or contract with are inflating the costs of some drugs significantly. Pharmacy Benefit Managers or PBMs buy drugs from manufacturers and design the Part D drug formulary–list of covered drugs–that an insurer offers.

    What’s happening? The insurers and/or the PBMs maximize profits by paying pharmacies (often the pharmacies they own and operate) many times the pharmacies’ acquisition cost of a drug. The insurers or the PBMs eventually clawback that overpayment. But, because they pay a high price to the pharmacies, the Part D insurers can charge a much higher copay to their enrollees–based on the inflated price of the generic drugs–driving up enrollees’ costs.

    The researchers found that sometimes, insurers or PBMs pay pharmacies markups of 6,000 percent or 7,000 percent. For example, insurers paid pharmacies $126 for a cancer tablet that costs $4.20 a tablet.

    In 2022, a USC Schaeffer paper also reported generic drug price padding by the PBMs. The authors call for drug pricing transparency. But, that proposal still gives a role to the PBMs and does not fix the system. It would continue to allow PBMs and insurers to keep low-cost generics off their formularies in order to benefit from big rebates they receive from brand-name drug manufacturers for putting their drugs on formulary. And, it would not stop the padding of generic drug prices.

    The simplest way to address inflated drug prices in the US is to open our borders to drugs from verified pharmacies around the world and require insurers to cover them.

    Here’s more from Just Care: