JustCare

Tag: Cost

  • Maryland law protects people from prescription drug price-gouging

    Maryland law protects people from prescription drug price-gouging

    With more than one in five Americans today not filling their prescriptions because of the cost, it’s time to bring down drug prices. While we wait for Congress to act, even generic drug manufacturers are hiking up some drug prices astronomically because they can. And, some states are fighting back. Maryland just passed the first of its kind bi-partisan prescription drug anti-price-gouging legislation to protect its residents from huge generic drug price increases.

    Under Maryland’s new law, its attorney general can sue generic pharmaceutical companies for hiking up prices too high and return the money they win to people taking these drugs and other payers. The attorney general’s authority only extends to non-competitive markets, where three or fewer manufacturers are producing a drug. For meaningful competition, there needs to be four or more drug manufacturers.

    To make the case, the attorney general must show that the price hike is legally “unconscionable” as well as unjustified, as Jeremy A. Greene and William V. Padula explain in this New England Journal of Medicine piece. The legislation, supported almost unanimously by Democrats and Republicans in the Maryland State legislature, addresses one of the public’s top policy priorities.

    Generic drug corporations increasingly have been taking advantage of their ability to drive up generic drug prices enormously when the market for a drug is not competitive, simply because they can. Many of the generic drugs seeing huge price increases have been on the market for decades, such as insulin and albuterol, at a fraction of their current cost.  The Maryland Attorney General’s office is also suing six generic drug manufacturers for price-fixing in violation of anti-trust laws.

    While Maryland’s legislation is a strong step forward, we need federal legislation to ensure fair drug prices. Maryland does not begin to have the resources to take on the drug companies in each instance that they gouge consumers. Reining in drug prices is a bi-partisan issue across the country, but we will need to see change in Washington D.C. before Congress is likely to pass any meaningful drug pricing legislation.

    Of note, drug transparency legislation in Maryland, which would have given people notice of drug price increases, did not get passed.

    If you want Congress to rein in drug prices, please sign this petition.

    Here’s more from Just Care:

  • Low-cost hearing aids coming to pharmacies

    Low-cost hearing aids coming to pharmacies

    There’s some good news for people struggling to afford hearing aids. The Food and Drug Administration has issued a guidance document that permits the sale of hearing aids without a prescription. Experts predict that, soon, buying low-cost hearing aids at the pharmacy over the counter should become the norm, much like buying reading glasses.

    Today, 30 million people in the U.S., mostly older adults, experience hearing loss. Hearing aids typically cost close to $5,000 a pair, $2,300 apiece on average, according to the White House blog. And, because Medicare does not cover hearing aids, most people have to pay the full cost of hearing aids if they want them.

    Fortunately, Medicaid covers hearing aids in 34 states and territories, according to the Kaiser Family Foundation. Unfortunately, more than 80 percent of people who would benefit from hearing aids today do not have them because of their cost and the cost of getting a medical evaluation.

    As a result of the FDA’s new guidance, you will no longer need to get examined before you can get a hearing aid. While the FDA regulation that people get a medical evaluation or sign a waiver in order to get a hearing aid remains in place, the FDA has said that it will not enforce the requirement.

    Once hearing aids can be bought without a prescription, many new manufacturers should surface and the price of hearing aids should come down significantly. Today, there is very little competition in the marketplace. Only six companies–one U.S. and five foreign–sell hearing aids in the United States.

    Here’s more from Just Care:

  • Drug prices likely to rise in Trump administration

    Drug prices likely to rise in Trump administration

    The price of drugs remains out of control, and President-elect Trump has vowed to address high drug prices. But, the Republican Congress is set to repeal the Affordable Care Act, which means that the drug companies will lose millions of customers with drug coverage who will no longer be able to afford their drugs. Because drug companies have the power to set drug prices and will want to make up for their lost revenue, drug prices are likely to rise in a Trump administration.

    Since passage of the ACA, the drug industry has seen enormous profits. Regardless, according to StatNews, Pharma is claiming that the ACA didn’t help drug companies as much as pharmaceutical executives expected. Drug makers had to pay billions in fees under the ACA. They also were required to give drug discounts and rebates to people with Medicare through the Part D drug benefit.

    Still, the ACA gave drug companies 22 million more customers with insurance to cover their drugs. And, the Republican Congress has no plans to replace the ACA with equally robust insurance. Consequently, drug companies should be prepared to lose substantial revenue after the ACA is repealed and Congress imposes fewer requirements on the coverage health insurers offer.

    Unfortunately, drugmakers can raise drug prices further to compensate for their loss of business. Indeed, they are likely to raise prices on many drugs significantly. And, notwithstanding Trump’s recent claim to Time Magazine that he is going to bring down drug prices, it is hard to imagine that the Republican Congress will do what it would take to change this likely scenario.

    Speaker Ryan and his Republican allies do not support legislation regulating drug prices. And, they have always supported laws that give drug companies monopoly power over prices for many drugs. The only reason drug companies would not raise drug prices significantly is fear that, if they do, Congress would take some extreme action against them. That seems unrealistic.

    Drug companies will also want to make up for the probable loss of sales stemming from the Republican leadership’s plan to deregulate the health insurance industry. Laws that require insurers to provide more generous drug benefits are not on Speaker Ryan’s or his Republican allies’ agendas. So, it seems inevitable that insurers will further restrict access to costly drugs.

    Health insurers would prefer to deter people with costly conditions who tend to use high-cost drugs from enrolling in their plans through a limited formulary or high cost-sharing. Indeed, they have many ways to cherry pick healthier enrollees. To keep premiums down and profits up, they will no doubt revert to using them as much as possible.

    So long as the Republican leadership opts not to privatize Medicare–a long shot–older adults and people with disabilities may be in slightly better shape than younger people with insurance. Some believe that even if the ACA is repealed, Congress will keep elements of the law that fill the gap in coverage under the Medicare Part D prescription drug benefit, known as the “donut hole.”  If drug costs continue to rise, however, it’s a good bet that Pharma will benefit far more than people with Medicare.

    If you want Congress to keep its hands off Medicare, please sign this petition. Yesterday, more than one million petitions were delivered to Congress, and Congressional Democrats vowed to fight Medicare cuts.

    Here’s more from Just Care:

  • Three reasons why a faith-based movement can help fix our broken medicines system

    Three reasons why a faith-based movement can help fix our broken medicines system

    When it comes to our medicines system, it is hard to overstate how profoundly broken it is.

    Here in the U.S., many of our neighbors, especially seniors, are forced to choose between paying for medicine or food.  Hundreds of cancer physicians recently wrote an angry public letter protesting the fact that one in five of their patients can’t afford to fill their prescriptions—not surprising, with the cost of cancer medicines now averaging over $100,000.

    Hepatitis C and prostate cancer drugs are so expensive that even insured patients go without the drugs they need. Insurance companies and government programs balk at paying pharmaceutical corporation mark-ups that can make a pill manufactured for $1 carry a $1,000 price tag.

    Meanwhile, the corporations that own the rights to those medicines are rolling in money. Some enjoy breathtaking corporate profits as high as 42 percent annually, with the industry’s average return on assets more than double that of the rest of the Fortune 500. Pharma CEO pay exceeds even the swollen average of other big corporations.

    No wonder, given the gold-plated business model of the pharmaceutical industry. These corporations grab government-granted monopolies on government-developed medicines, then sell the medicines—often back to governments, their biggest customers—at prices set at hundreds of times over manufacturing costs. When you hold a monopoly on a life-saving product, you can force the desperately ill to pay any price you name.

    As bad as we have it in the U.S., the crisis is even worse in many other parts of the world. I recently spoke with a South African mother who faces an early and unnecessary death. Neither she nor her government’s healthcare program can come close to affording the monopoly-protected breast cancer medicine that may save her. United Nations health officials estimate that 10 million people die each year because they don’t receive medicines that exist, but are unaffordable.

    Ten million people is more people dying each year than the entire population of New York City. Many of those who die are children whose families and communities couldn’t afford basic vaccine protection.  Many more suffer in unrelenting pain and misery, all because medicines cost too much.

    We can fix this system, and we can fix it soon.  Here are three reasons why a faith-based movement can help:

    1. The Time is Ripe. The medicines problem is no secret. People across the U.S. are well aware that the cost of prescription drugs is bankrupting families in their own communities, and putting a huge strain on state and federal budgets. Outrageous EpiPen price hikes and the greed of “Pharma Bro” Martin Shkreli are the high-profile symptoms of a diseased medicines system that features routine double-digit annual price increases on many necessary drugs.

    And people are angry. With huge majorities demanding a change in our medicines system. An ambitious California ballot initiative is aimed directly at lowering medicine prices. Patients and media are seeing through the corporate damage-control smokescreen of promised discounts and limited donations.

    The inability of the pharmaceutical industry to curb its own gluttony suggests that the corporate monopoly on life-saving goods carries within itself the seeds of its own destruction. Social movement history tells us that profound and widespread frustration with the status quo is a prerequisite for systemic change. With medicines reform, that first ingredient is already in place.

    2. The Solution is at Hand.  There are many social justice problems that can and must be fixed, but will take significant reallocation of resources to do so. Think of the refugee crisis, climate change, affordable housing. Comparatively, the medicines crisis offers an easy solution. There are already more than enough taxpayer dollars flowing into the system now to make essential medicines available to all, and still fund more and better research for new medicines.

    The U.S. government alone puts tens of billions of dollars annually into medicine research, and then pays billions more in monopoly markups on medicines—many of which were actually developed by that same government funding. For now, suffice it to say that current law allows the U.S. government to bypass the huge corporate markups, and save more than enough money in medicine prices to exceed pharma corporations’ claimed research investments.

    And that research can be far better targeted to discovering medicines we need. When we stop funding pharma’s eternal quest for the 7th copy-cat version of an erectile dysfunction drug destined for a billion-dollar marketing campaign, we will find the resources are available to do better—much better.

    3. Faith-Based Advocacy Can Put the Movement Over the Top.   There are already many wonderful access to medicines advocates and organizations, including the inspiring people behind Knowledge Ecology International, Médecins Sans Frontières’ Access Campaign, Public Citizen, Universities Allied for Essential Medicines, HealthGAP,  Treatment Action Campaign, and others.

    But all involved agree that a successful medicines reform movement needs to be strong within the U.S., since our government is the chief sponsor of toxic medicines policies both domestically and internationally. And all agree that the movement is not yet strong at the grassroots level in the U.S.

    That is where the faith community comes in. In the U.S. and beyond, our communities and politics are still significantly influenced by faith-based organizations and activists. History’s iconic social movements, including the U.S. civil rights movement, the labor movement, the anti-apartheid movement, et al., relied on faith-based organizations for grassroots organizing, outreach to new allies, and morally-resonant messaging.

    For our current faith-based organizations, access to medicines should be a natural priority issue. Virtually every congregation and creed embraces two principles that are at core of the access to medicines challenge: basic equity among all people rich and poor, and access to health care. Roman Catholic institutions alone provide one-quarter of the world’s healthcare services.

    So, at PFAM, our mission is to push access to medicines up to a priority spot on the faith-based agenda. Join us!

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    To urge Congress to put an end to allowing drug companies to set prices for medically necessary drugs and to put people at risk of going without needed medications, sign here.

    Click here for six tips for keep your drug costs down.

  • Should drug companies be allowed to advertise on TV?

    Should drug companies be allowed to advertise on TV?

    On November 17, 2015, the American Medical Association voted to support a ban on drug and medical device company advertising on TV. The AMA sees a negative impact from these ads and also says these ads lead to an increase in drug and device prices. Moreover, they say these ads lead individuals to ask for drugs which they don’t need, are more expensive than other treatment options, and can be harmful to them.

    In the last two years, there has been a 30 percent increase in the amount that drugs and device companies are spending on direct-to-consumer advertising, now at $4.5 billion annually. The AMA is particularly concerned with the cost of drugs, which rose almost five percent last year. They are often unaffordable to patients, even those with insurance, keeping them from getting needed care.

    Drug and device companies could only conduct extremely limited direct-to-consumer advertising until 1997 when the FDA loosened restrictions. For almost 20 years they have been advertising heavily to consumers, Yet, most people do not have the scientific or technical knowledge to understand whether a particular drug or device is right for them based on an ad.

    That notwithstanding, the ads do lead nearly three in ten people to talk to their doctor about a drug. And, two out of three of these people ask their doctors for the prescription.

    A recent Kaiser Family Foundation poll shows that about half the population thinks the drug company advertising is generally good. But, almost 90 percent of the public, Democrats, Republicans and Independents alike, supports FDA review of the ads for accuracy and clarity before they are aired.

    Given that prescription drug advertising drives up drug costs, the risk of harmful side effects from many drugs, along with FDA drug and device approvals that are sometimes not based on clinical evidence of safety and efficacy, do you think drug and device companies should be allowed to market directly to consumers? Please post your comment.

  • Majority of cancer drugs that FDA has recently approved don’t work

    Majority of cancer drugs that FDA has recently approved don’t work

    According to a new study in JAMA, there is no evidence that the majority of the U.S. Food and Drug Administration (FDA) approved cancer drugs over the last five years work. The FDA used substitute measures, laboratory measures rather than clinical evidence, to approve two out of three cancer drugs, without any indication that the drugs either improve health or prolong life.  Indeed, in follow-up studies, 86 percent of drugs approved through substitute measures showed no clinical benefits.

    In the case of bevacizumab, a breast cancer drug treatment, the FDA allowed the drug to go to market based on substitute measures that showed “progression-free survival” or PFS. But, a later study showed substantial toxicity and no improvement in life expectancy. And, the FDA ended up removing authorization to market it.

    In 2009, the U.S. Government Accountability Office took the FDA to task for failing to do postmarketing studies on all drugs that are approved using substitute measures. The GAO reported that the FDA had plans to improve oversight, but it was not prepared to say whether those initiatives would be effective. According to the GAO, there are no specific conditions that require the FDA to speed up the withdrawal of a drug from the market if a drug company does not conduct a follow-up study in a timely manner or if a drug is shown not to be beneficial in a follow-up study.

    The drug companies prefer getting drug approvals using substitute measures that do not focus on efficacy or health outcomes. Substitute measures allow drug companies to bring drugs to market faster and at less cost. When the drug companies use clinical measures that look at health outcomes, they must spend more time and money on their trials.

    The problem is that substitute measures may show good performance when in fact health outcomes are not any better.  Health complications may also not be evident through the substitute measures. So, drugs approved using substitute measures may actually hurt patients.

    The price of a new cancer drug can easily be $10,000 a month, regardless of either the drug’s worth or its cost of development.  The cost of cancer drugs can literally bankrupt a person with cancer.  In 2014, the least expensive new cancer drug approved cost more than $120,000 a year.

    Today, the drug industry helps cover the cost of the FDA’s work. And, we are left to wonder whether the FDA’s independence has been compromised at the expense of patient safety. At the same time, the public may wrongly assume that FDA approval means the drugs are safe.

    Here’s a short post on how Congress leaves insured Americans at the mercy of the drug industry. Top 20-selling drugs in the U.S. are now three times more than the in the U.K. And, here are six tips for keeping your drug costs down, along with five programs that could lower your costs if you have Medicare. And, for other free and low-cost assistance programs, click here.

  • Health plans must cover preventive care services in full

    Health plans must cover preventive care services in full

    It’s always wise to question your health plan if it denies coverage for your care or covers less than you expected. Improper denials or inadequate coverage appear all too common. The latest evidence comes after a report by the National Woman’s Law Center finding that health plans had been refusing to cover all types of women’s contraceptives in full in violation of the Affordable Care Act. Last week, the Department of Health and Human Services made clear that health plans must cover preventive care services in full.

    Health plans cannot pick and choose among the preventive care contraceptive services they cover. They must cover the full range of FDA-approved contraceptive services. They must also cover well-woman visits at no charge to the patient.

    The National Woman’s Law Center surveyed 100 insurance companies in seven states and found that 15 health plans failed to cover all forms of FDA-approved birth control, including Cigna, Aetna and Anthem Blue Cross Blue Shield. The Kaiser Family Foundation conducted a similar study of 20 insurers in five states and found, among other things, that some insurers do not cover birth control patches, four insurers did not cover the contraceptive implant Implanon, and one insurer did not cover the NuvaRing.

    The Department of Health and Human Services clarified that the health plans must offer for free at least one of the 18 contraceptive drugs available, but they can cover the generic drug in full and charge a copay for the brand name drug. The ruling will take effect in January 2016.

    For answers to a range of questions on the Affordable Care Act, visit the Center for Consumer Information and Insurance Oversight. And, remember, if your health plan denies coverage, fight back.  Here’s how.