JustCare

Tag: Hepatitis C

  • Need a life-saving drug you can’t afford? Consider importing it.

    Need a life-saving drug you can’t afford? Consider importing it.

    Do you or someone you love need a life-saving drug that your insurer won’t cover or you can’t afford? Consider importing it. Outside the U.S., prescription drug costs are far lower than in the U.S.

    Sophie Cousins writes in The New York Times about one 60- year old Tasmanian man with hepatitis C, Greg Jefferys, who wanted the 12-week oral hepatitis C drug called sofosbuvir or Sovaldi, which the Australian authorities had not yet approved. However, it was available in the U.S. for $84,000 and in India for under $1,000. So, he identified a doctor and a licensed pharmaceutical supplier, flew to India, and got the treatment he needed to kill his virus.

    Importing drugs for personal use is legal in Australia, and no one in the U.S. has ever been prosecuted for so doing. Jefferys ended up starting a small business to help people get the hepatitis C vaccine shipped to them in their home countries. He set up buyers’ clubs in different countries to make it as easy as possible for people who needed the vaccine to get it.

    If you need the vaccine or any other costly drug and don’t want to travel to get it, you can often get it shipped to you for personal use. Bull Pharmachem in Mumbai is a licensed wholesale distribution house, shipping hepatitis C drugs, as well as drugs for hepatitis B, cancer and H.I.V. You can get the hepatitis C drug in 10 days from India.

    While you always need to be careful about the source of the drugs you’re buying online, there are no reported patient safety issues if you buy drugs from reputable licensed pharmacies. If you are careful, you should have the same treatment outcomes whether you buy the drug online or not according to a recent study in Australia.

    Importing drugs for personal use is not a wholesale solution to the astronomical prices Congress allows pharmaceutical companies to charge for drugs. But, millions of Americans have no choice but to do it. The House of Representatives has passed a bill that would bring down the cost of scores of drugs to about the same price as other wealthy countries pay. But, the Republican-led Senate is not prepared to take it up. So, for now, importation is often the only option. 

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

    This post was originally published on August 2, 2017 and updated.

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  • NY to pay for drugs based on value

    NY to pay for drugs based on value

    A recent New York State law, designed to rein in drug costs, pays for drugs based on their value. It allows the State to determine the price of certain drugs after assessing their therapeutic value, “value-based pricing.” A JAMA paper by Thomas Hwang, Aaron Kesselheim and Ameet Sarpatwari describes how the law is intended to work and its possible benefits.

    In April of this year, New York enacted a law that permits the State to reduce its costs for select Medicaid prescription drugs. The State can determine the price of any high-cost drug, based on its value–considering efficacy, alternatives and the disease it is treating–and the State can negotiate lower costs for its Medicaid program. Put simply, if the increase in cost of an expensive drug over ten years exceeds inflation by more than five percent, the State can step in to lower the cost for its 6 million residents with Medicaid.

    Given that some high-cost drugs have increased 20-35 percent in the last few years, significantly more than the rate of inflation, it’s more than likely that New York State will try to rein in prices. If it is unable to achieve the value-based price reduction it establishes, the State has the authority to direct Medicaid not to pay for the particular drug.

    Currently, Medicaid must cover all medically necessary drugs in certain classes. Patients will still have the right to appeal a denial of coverage of a particular drug.

    Medicaid programs already get a price discount on high-cost drugs but, especially for newer drugs, the price it pays can still be very high. For example, for hepatitis C, the wholesale price is $84,000, and Medicaid pays about $64,000 for a 12-week treatment. For some older treatments, such as Humira and Enbrel, which treat rheumatoid arthritis, rebates (discounts) deliver value for Medicaid, according to the Institute for Clinical and Economic Review, ICER.

    New York’s decision to calculate rebates based on a drug’s value is a departure from other government attempts to rein in Medicaid drug prices. The Affordable Care Act, for example, simply increased the Medicaid rebate for brand-name drugs an additional 8 percent, from 15.1 percent to 23.1 percent.

    The authors believe that New York’s determination of a drug’s value should be available to the public. This will ensure that other states and the federal government can see and potentially benefit from it. They believe that it could end up being a model for the rest of the country.

    If you believe Congress should rein in the price of drugs for everyone, please sign this petition.

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  • Government’s Section 1498 authority to regulate the price of drugs

    Government’s Section 1498 authority to regulate the price of drugs

    While the federal government should be regulating the price of all drugs, as does every other developed country, Congress has been too much in the thrall of pharmaceutical companies to rein in drug prices and ensure all Americans have access to affordable drugs. Instead, Congress gives drug companies the power to charge what they please for their drugs, even when people’s lives hang in the balance.  In fact, our government refuses to use its authority to limit the prices of some life-saving drugs for the public health under 28 U.S.C. Section 1498, as Alexander Zaitchik writes in his new piece for the American Prospect.

    Right now, in Louisiana, more than 70,000 people have hepatitis C, a blood disease that is extremely contagious and fatal. But, Gilead charges close to $100,000 a person for the medicine that cures it, and Louisiana cannot afford to provide the medicine to the 35,000 Louisianans who need it.

    Hepatitis C is killing more people in the U.S. than every other infectious disease combined. It would cost about $200 billion to treat everyone in the U.S. who needs it. In Kentucky, seven percent of the state’s Medicaid budget went to treating 900 people with hepatitis C, a tiny fraction of the people who need it.

    The cost of producing the hepatitis C treatment is between $62 and $216 and bears no relation to the price of the treatment. Gilead has already reaped tens of billions of dollars in profits from its hepatitis C drug alone.

    Section 1498 gives the U.S. the right to use a company’s patent in the interest of the public health, the national security and commerce. And, according to Zaitchik, back when, the government exercised that right many times. For example, it used Section 1498 to encourage the availability of lower cost generic drugs. But, since the early 1970’s, the government has refused to exercise this right to bring down the cost of prescription drugs.

    Rebekah Gee, the Louisiana Health Secretary is considering asking Secretary of Health and Human Services, Tom Price, to use Section 1498 to spur the production of generic versions of the hepatitis C treatment for which Gilead currently holds the exclusive license. Otherwise, Gilead’s large price tag for its hepatitis C drug likely will lead thousands of people with hepatitis C to die unnecessarily.

    Under Section 1498, the government would have to pay Gilead a “reasonable price” if it infringed on its patent. But, it’s fair to assume that  Secretary Price will not grant Gee’s request. Secretary price has historically placed the rights of corporations to reap profits ahead of people’s lives.

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

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  • Pharma pays academics to justify high drug prices

    Pharma pays academics to justify high drug prices

    A new report from Pro Publica and Consumer Reports reveals how, behind the scenes, pharmaceutical companies are paying academics to justify their high drug prices. While this has always been the case, it is being taken to a whole other level.

    Pharmaceutical companies have spent hundreds of millions of dollars over the last decade to protect their profits, to keep Medicare from negotiating drug prices, and to change the opinion of those who believe that their research and development costs do not justify their exorbitant prices. Historically, they’ve paid doctors to promote their drugs, donated large sums to non-profit disease groups, and contributed to the campaign funds of policy makers to promote their agendas.  Now they are also paying off health economists.

    Over the last three years, drug companies have enlisted academics and other thought leaders across the country to give talks, write articles, address policy makers in Congress to support their new cures for hepatitis C and persuade Medicare, Medicaid and private insurers to cover them. To facilitate the process, companies have sprung up with the express purpose of enlisting support from health economists and other academics, with Pharma’s financial backing.

    Precision Health Economics boasts that it is “Led by professors at elite research universities,” produces “academic publications in the world’s leading research journals” and helps foster “formal public debates in prestigious, closely watched forums.” Among a wide range of work for the pharmaceutical industry, it consults for three manufacturers of a super high-priced hepatitis C vaccine.

    Precision Health’s team of academics from Stanford, USC and Harvard, among other institutions, tends to make the case that high drug prices are justified to enable innovation rather than that high drug prices are undermining access to medically necessary medicines. It also counsels drug companies on how best to price their drugs.

    Dr. Aaron Kesselheim, an associate professor at Harvard Medical School who studies pharmaceutical costs, argues that “There is substantial evidence that the sources of transformative drug innovation arise from publicly funded research in government and academic labs.”  Kesselheim has determined that drugs are priced at as high a level as drug companies believe they can get away with.

    Leonard D. Schaefer Center for Health Policy and Economics at University of Southern California also gets substantial funding from drug companies. And, a CEO of Amgen is on its advisory board.

    Often academics’ conflicts of interest are not disclosed. Publications like Health Affairs do not require disclosure.

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

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  • Pharma pushing states to cover high-cost drugs

    Pharma pushing states to cover high-cost drugs

    When it comes to drug innovations, many would argue that pharmaceutical companies serve the public less well than hoped for. When it comes to marketing innovations or initiatives that drive greater profits, pharmaceutical companies serve themselves far better than one might imagine. Bloomberg News reports on how Pharma is pushing states to cover high-cost drugs.

    Pharmaceutical companies are giving significant financial support, hundreds of thousands of dollars, to advocacy and other non-profit groups. It’s another way to boost drug company profits. The non-profit groups are bringing lawsuits against states that restrict access to high-cost prescription drugs for their Medicaid populations.

    The non-profits’ goal seems worthy–lift restrictions on critical drugs and ensure that everyone has access to them. But, the drug company’s strategy is more than a little concerning.

    First, the strategy makes the non-profits beholden to the pharmaceutical companies that support them. It keeps them from arguing that the federal government should be negotiating and/or setting prescription drug prices. Moreover, if the advocates win their lawsuit against the states, it could threaten state budgets.

    In Washington, the suit is focused on getting the State to pay for Gilead’s hepatitis C cure for all of its Medicaid patients, not only the sickest ones. And, the judge on the case already has ordered the State to provide treatment to all Medicaid hepatitis C patients until there is a ruling. As a result, Washington’s budget for this curative treatment has gone from $24 million in 2015 to $222 million in 2017.

    Stat News reports that Colorado is the latest state to be sued for restricting access to hepatitis C drugs for their Medicaid patients. The suit claims that denying these drugs to Medicaid patients is illegal and violates standard medical care.

    If the plaintiffs prevail, one possible silver lining is that Congress will face even greater pressure to control drug prices. The federal government pays for a large percentage of state Medicaid expenditures. The federal government is projected to spend $174 million  of the $222 million budgeted for the curative treatment by Washington State alone.

    And that’s separate and apart from the Medicare program’s expenses for this drug. In 2014 (the latest available data), Sovaldi, sold by Gilead and used to treat hepatitis C, accounted for less than one percent of all Medicare Part D prescriptions nationwide but ranked number one in terms of total sales among all drugs (>$3.1 billion dollars).

    If the federal government does nothing, Gilead is sure to get the better of all of us. One Morgan Stanley analyst projects Gilead’s revenue could grow by $30 billion over three years if states are required to lift all restrictions on the use of its hepatitis C drug. Shouldn’t the federal government, which spent tens of millions of dollars in funding the research that led to the development of Gilead’s hepatitis C treatments, insist on negotiating its price on behalf of the American taxpayer? That’s what Democrats and Republicans alike are asking for.

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