JustCare

Tag: Pharmaceutical companies

  • Get ready for more prescription drug price hikes

    Get ready for more prescription drug price hikes

    We know pharmaceutical companies are greedy. Most, if not all, companies are greedy and will do what they can to maximize profits. But, Congress continues to allow that greed. As long as it does, we will pay increasing amounts for our prescription drugs.

    It’s no surprise that Accountable.us, a government watchdog group reports that the big Pharma companies are prepared to raise prices significantly on more than 350 drugs. However many billions the pharmaceutical companies earned in 2022 is irrelevant if they can make more in 2023.

    For example, Pfizer is raising prices on more than 90 drugs.  Ibrance and Xalkori, cancer drugs, will see 7.9 percent price increases. Why would Pfizer want to put an end to soaring profits in 2021 and 2022 if it does not have to?

    Higher drug prices allow the pharmaceutical companies to say that they can invest more money for research. The truth is that these companies put more money into stock buybacks and dividends than on research. And, when they conduct research, the research generally focuses on drugs that are similar to what’s already on the market, where they know they can find huge demand, rather than drugs for rare conditions that have no treatments available.

    The Republican-controlled House of Representatives is unlikely to pick up where their predecessors left off on drug price negotiation, in the Inflation Reduction Act. Pharma gives oodles of money to them to make sure. So, for now, we have simply the possibility of Medicare negotiating drug prices for 60 drugs over the next several years–if Pharma does not succeed at blocking those negotiations.

    One reform, with some bi-partisan support, that Congress has a small chance of enacting, would allow Americans to import drugs from around the world from verified pharmacies. Ideally, the proposal would also require insurers to cover those drugs, as they would cost a lot less than the same drugs in the US.

    Today, millions of Americans import drugs from abroad for personal use, with no reported safety concerns, although it is not legal for them to do so. At the same time, tens of millions of other Americans can’t afford the drugs they need in the US, compromising their health.

    Here’s more from Just Care:

  • Sen. Bernie Sanders will focus on high health care costs as head of the HELP committee

    Sen. Bernie Sanders will focus on high health care costs as head of the HELP committee

    Next month, Senator Bernie Sanders will become chair of the Senate Health Education Labor and Pensions (HELP) committee. HealthcareDive reports that, in that role, among other things, Sanders will focus on high health care and prescription drug costs as well as elder care.

    In a recent video, Senator Sanders spoke of the huge profits in the pharmaceutical industry at the same time that Americans are going without critical drugs because they are unaffordable; many are dying. The Inflation Reduction Act is a first step towards reining in high drug costs for people with Medicare. It gives the government some power to negotiate drug prices for the 60 most expensive drugs over the next several years, beginning in 2026.

    But, Senator Sanders points out that the government’s prescription drug negotiating power is quite weak and explains that Congress has a lot more to do to rein in drug prices. As I see it, Congress should immediately open its borders to drug importation from verified pharmacies around the world and require insurers to cover imported drugs prescribed by treating physicians.  That is not a long-term solution to high drug prices, but it is a likely way to put downward pressure on drug prices quickly and help ensure that Americans can afford their medicines. Americans usually pay many times what residents of other wealthy countries pay for prescription medicines.

    The Inflation Reduction Act also caps annual out-of-pocket drug costs for people with Medicare at $2,000 beginning in 2025.

    Senator Sanders said the HELP committee would hold many hearings with health care and pharmaceutical company executives. Senator Wyden, as chair of the Finance Committee, has focused on the pharmaceutical industries’ failure to pay corporate taxes through international tax law shenanigans.

    Here’s more from Just Care:

  • Prescription drug middlemen, PBMs, will always drive up drug costs

    Prescription drug middlemen, PBMs, will always drive up drug costs

    There’s a move afoot in Congress to do something about prescription drug middlemen—Pharmacy Benefit Managers (“PBMs”). But, whatever the fix, it won’t bring down drug prices. Here’s a primer as to why:

    What are PBMs? PBMs are large companies, often owned by health insurers and/or large pharmacy chains, that are supposed to negotiate lower drug prices with pharmaceutical companies by securing discounts and “rebates” off of their prices. Based on those negotiations, PBMs design a health insurer’s drug formulary—a list of covered drugs—structuring copay tiers and processing prescription drugs claims, among other things.

    What happens to the discounts and rebates the PBMs secure? PBMs and their clients (generally, insurance companies) often pocket most of those rebates rather than use them to lower drug prices for patients. They claim that their ability to retain some – or all – of that money is what drives them to negotiate for lower prices. That promise appears disingenuous at best when much of that money never reaches patients.

    Why don’t insurers insist on PBMs distributing the rebates? PBMs demand higher administrative fees from insurers when insurers do not allow them to retain the rebates. And, when insurance companies insist on receiving the rebates from PBMs, there is no assurance that the insurance company will pass the savings along to patients. Moreover, if the insurance company itself owns the PBM, as several do, the insurer effectively pockets the rebates.

    What are some of the PBMs’ strategies? 

    • They maximize their own profits by negotiating and retaining the largest rebates possible. When rebates are designed as a percentage of the list price, the higher the price, the larger the rebate opportunity for the PBM. That perverse incentive undermines the PBM promise of lowering the cost of prescription drugs.
    • It is in the PBM’s interest to put the most expensive drugs on their formularies and keep some of the less costly alternatives (e.g. generics) off of their formularies.
    • PBMs often “claw back” money from community pharmacies when a patient’s copay is larger than the drug price the PBM negotiated with a pharmacy. Those patients are paying larger copays than what they would have paid had they purchased the drug without insurance.

    How can Congress address these problems with PBMs?

    • Eliminate the multiple restrictions on federal price negotiations, require the federal government to meaningfully negotiate the prices of all prescription drugs, and make those prices available to all Americans. The value of government drug price negotiations should be made available to everyone – including through Medicare Part D plans and commercial insurers and directly to those Americans without insurance.
    • The federal government, not PBMs, should determine which prescription drugs are on a formulary. The federal government should determine which drugs deliver the most value and construct the appropriate formulary. When formularies are developed based upon negotiations between PBMs and manufacturers, both parties have a business case to inflate drug prices.
    • Build upon the successful model of formulary development at the Veterans Administration and establish one clinically solid formulary for all Americans. The VA has one main formulary, designed by clinicians to meet the clinical needs of veterans and negotiated within parameters established by those clinicians. There are no middlemen; the VA’s only interest is in getting the most clinically appropriate formulary at the best value for all veterans. The same philosophy should be applied everywhere.
    • Allow patients to import prescription drugs from other countries. The United States allows wholesalers to purchase and sell drugs that are manufactured overseas. The federal government should construct a list of nations with drug-approval processes comparable to that in the United States and allow Americans to import prescription drugs from those countries.

    In sum, the most meaningful way to bring down drug prices is through government drug price negotiation. For now, Congress should allow people to import prescription drugs from abroad and require insurers to cover those imported drugs that cost less than they do in the US.

    Here’s more from Just Care:

  • Pharma pours money into telehealth

    Pharma pours money into telehealth

    One upside of the Covid-19 pandemic is that it has become much easier to see a doctor, if you’re willing to go online. Medicare and many insurers will cover your care without an in person visit. With telehealth, it’s also much easier for Pharma to ensure you get the prescriptions they’re marketing, regardless of whether you need them.

    Katie Palmer reports for Stat News on the benefit of telehealth for pharmaceutical companies. They can reach patients directly online and offer access to health care providers who can prescribe their drugs. You don’t need to see your PCP to fill a prescription.

    The one-two punch of pharmaceutical company online ads and telehealth can boost sales for Pharma. So, Pharma is investing a lot in telehealth. In addition to more drug sales, Pharma can collect a lot of data on people. The question becomes are patients getting overprescribed, what are the risks, and who’s paying attention?

    Currently, the federal government, through the FDA, determines what prescription drugs are approved, what goes on their labels and how they can be advertised. States, in turn, oversee the health care providers who prescribe the drugs and the pharmacies that distribute them. With telehealth, ads and distribution go together. It’s not clear whether states or the federal government is in charge.

    Many states do not allow “the corporate practice of medicine.” But, it’s easy enough for pharmaceutical companies to invest in, or otherwise collaborate with, separate entities to do the prescribing and have patients click on a button to reach a virtual doctor on a separate web site. The pharmaceutical companies can then claim that these entities are acting independently when they prescribe their drugs.

    Telehealth enables the pharmaceutical companies to move from “ask your doctor” about this or that prescription drug to “click here to talk to a doctor now.” It enhances the likelihood that patients will fill the prescription drugs advertised. Any doctor can prescribe you a medicine. It doesn’t have to be your PCP.

    Of course, if managed care companies were actually managing your care, they could intervene in the process if you were being prescribed a drug that was not appropriate. But, it’s not as easy as it might appear. They generally should rely on the doctor to determine whether you need a drug.

    Here’s more from Just Care:

  • Drug industry funnels money to Republican candidates who deny legitimacy of Biden’s election

    Drug industry funnels money to Republican candidates who deny legitimacy of Biden’s election

    Ed Silverman reports for Stat News on pharmaceutical companies’ support for Republican candidates who falsely deny the legitimacy of Biden’s election in 2020. In 2022, Pharma, the trade association representing the drug companies, donated more than $1 million to Republicans running for state offices. These campaign contributions buy Pharma political power.

    Elected officials help ensure that Pharma can continue to charge exorbitant prices for prescription drugs. So, one would expect these large campaign contributions. They’re a drop in the bucket relative to the profits pharmaceutical companies generate from having virtually free reign to set prices.

    Pfizer appears to have led the way with its campaign contributions to Republicans, donating $600,000.  GSK, Eli Lilly and Novartis contributed $235,000 or more each. Astellas Pharma, Johnson and Johnson and Merck each donated $125,000 or more.

    The pharmaceutical companies donated directly to either the Republican State Leadership Committee, the Republican Attorneys General Association, and the Republican Governors Association.

    Money from these Republican groups was directed to some individual campaigns, such as Ashley Moody’s re-election campaign for Florida attorney general.  Moody had urged the Supreme Court in 2020 to  rule on a lawsuit designed to invalidate Presidential election results in four states.

    The Republican Governors Association invested more than $5 million in an ad campaign in Arizona opposing Katie Hobbs, the Democrat running for governor against Kari Lake.  Lake claims the 2020 election was stolen, notwithstanding the lack of evidence supporting her claim. The RGA also invested $15 million in Ron DeSantis, who supports Lake. (Notwithstanding these donations, Hobbs was just elected.)

    The contributions by the pharmaceutical companies highlight their lack of concern for the integrity of our democracy and the democratic process. Perhaps their employees, along with Americans, will take note and stand together in support of Congressional action to end monopolistic drug pricing in the US and establish fair drug prices, on a par with what other wealthy countries pay.

    To be fair, the pharmaceutical companies use their campaign contributions to befriend legislators in whatever party. So, it should come as no surprise that they donated to Democratic committees as well, although at somewhat lower levels than Republican committees.

    Pharmaceutical companies claim that their donations are intended purely to support their particular policy goals related to prescription drugs and should not be seen as support for other issues.

    Here’s more from Just Care:

  • Pharmaceutical companies put low-income patients at risk

    Pharmaceutical companies put low-income patients at risk

    If you have been reading Just Care, you likely already know that Medicare only covers about half of a typical person’s health care costs and, unless you also qualify for Medicaid, you might struggle to afford critical health care. Out-of-pocket health care costs present a huge barrier to care for millions of older adults and people with disabilities as well as millions of younger Americans with low incomes. Pew Trusts describes a worsening situation for low-income patients as drug manufacturers fail to participate as much in a federal drug discount program–the 340B program–and, in the process, make it harder for physicians and hospitals to treat low-income patients and for low-income patients to get needed medicines.

    Doctors, clinics and hospitals are at risk of not being able to survive financially with the loss of drug manufacturers providing them with discounts on drugs under the federal 340B discount drug program. Some hospitals are losing millions of dollars a year. They cannot afford to pay staff or treat as many patients without insurance.

    Lots of people are blaming the pharmaceutical companies, which certainly should be blamed for lacking the compassion to provide the drug discounts to people in need. But, they are businesses that are obligated to return as large profits as possible to their shareholders. And, they claim that some hospitals are profiteering off the drug discounts they receive from the 340B program.

    But, pharmaceutical corporations continue to make out like bandits in the US.  And, the real culprit here is Congress and state governments, which give these drug corporations the power to charge whatever they please.

    Just two states, Arkansas and Michigan, have passed laws that require pharmaceutical companies to continue the 340B discounts for prescriptions patients fill at 340B pharmacies.

    Since 2020, 17 pharmaceutical companies have ended or reduced their participation in the 340B program. Sometimes they ended contracts with hospitals. Sometimes they ended contracts with clinics. And, sometimes they ended all contracts.

    They say that they object to the fact that some people with higher incomes, who should not be eligible for the discounts, benefit from the program. If it weren’t terrible that they are pulling back, it would be almost laughable that the reason is that they don’t have claims-level data on who is benefiting from the program. Pharmaceutical companies are notorious for keeping the vast majority of their data proprietary, not open to public scrutiny.

    For their part, the safety net providers say it is administratively burdensome to collect this data, and it could be an infringement of patient privacy. At the same time, without the discounts, many health clinics report that a large portion of their patients will be forced to forgo insulin and other critical medicines.

    The drug companies benefit if they participate in the 340B program because the federal government then covers their drugs in Medicaid. But, that is apparently not enough to keep them in.

    The Health Resources and Services Administration, an arm of the US Department of Health and Human Services, oversees the program. Patients can get discounts at 340B pharmacies as high as 50 percent. The drug manufacturers point to a GAO report finding some violations by safety-net providers, as the reason they are pulling out of the program. But these violations represent only a tiny fraction of the total use.

    The Biden administration says that the drugmakers that have pulled out are violating their government contracts. HHS has referred them to the Office of the Inspector General and plan to impose financial penalties on them. But, it has not suggested that it would take their drugs off of Medicaid formularies.

    The pharmaceutical companies are suing to protect themselves from penalties. About half of all states’ attorneys general are siding with the federal government.

    Here’s more from Just Care:

  • Poll: Prescription drug prices in 2022

    Poll: Prescription drug prices in 2022

    The Kaiser Family Foundation recently polled Americans for their views on prescription drug prices. Here’s what they learned:

    What proportion of the US population takes prescription drugs?

    • Most Americans–62 percent–take at least one prescription drug.
    • One in four Americans take at least four prescription drugs.
    • More than eight in 10 (83 percent) Americans say prescription drug costs are unreasonable.
    • Nearly seven in 10 (69 percent) Americans who take prescription drugs say that they have no trouble affording them.

    Are prescription drugs affordable?

    A recent report in NBER found that thousands of people with Medicare die of stroke, heart attacks and other diagnoses each year because they stop filling their prescriptions when the copays rise as little as $10.40.

    • Affordability of prescription drugs is harder for people who are taking four or more medicines.
    • Nearly one in three people (32 percent) who take four or more medicines struggle to pay for their prescription drugs.
    • Only about 2o percent of people who take up to three prescriptions struggle to pay for them.
    • At least a third of people with yearly incomes under $40,000 (35 percent) and people with chronic conditions (33 percent) also have more difficulty affording their prescription drugs.
    • One in five people over 65 (2o percent) say they struggle to afford their prescription drugs.

    How many people do not fill their prescriptions because of the cost? 

    • Three in ten people did not fill all their prescriptions in the last year, as a result of the cost.
    • One in six (16 percent) did not fill a prescription for a specific drug because of the cost.
    • More than one in five (22 percent) substituted a non-prescription drug for their prescription.
    • More than one in eight (13 percent) cut their pills in half or skipped doses.

    Do people understand that drug company profits are the largest reason for high costs in the US?

    • The overwhelming majority of the public (82 percent) understands that pharmaceutical company profits are the largest reason drug prices are so high.
    • Nearly seven in ten people (68 percent) wrongly believe that research and development costs are responsible for high drug prices.
    • More than half of people (52 percent) mistakenly think that marketing and advertising drive drug prices as high as they are.

    Most Americans would like to see more drug price regulation, including a majority of Democrats, Republicans and Independents.

    What drug price proposals do Americans favor?

    • Nearly nine in ten Americans (88 percent) would like it to be easier for generics to come to market.
    • Nearly nine in ten Americans (88 percent) would like Congress to limit drug price increases to the rate of inflation (which does nothing to keep the launch price of a drug reasonable.)
    • Eighty-five percent would like Medicare to limit out-of-pocket drug costs (which does nothing to lower drug costs, gives drug companies greater freedom to raise prices since people don’t directly feel the increase, and allows insurers to shift drug costs to everyone through higher premiums and other out-of-pocket costs.)
    • More than eight in ten Americans (83 percent) would like the government to regulate drug prices.
    • Nearly eight in ten Americans (78 percent) support legalizing drug imports from Canada (though there is no reason not to open the borders to drugs from verified pharmacies around the world.)

    Here’s more from Just Care:

  • Pfizer continues to hike up drug prices

    Pfizer continues to hike up drug prices

    No one should have any doubt as to whether Pfizer and other pharmaceutical companies will hike up drug prices as often as they can get away with. When it comes to prescription drug prices, pharmaceutical companies have no legal obligation to anyone other than their shareholders. Jake Johnson reports for Common Dreams that Pfizer takes the lead among its peers in hiking up drug prices.

    Pfizer raised prices on 125 drugs so far this year. Pfizer profits are already sky high because of the pandemic and sales of its vaccine. In 2022, it is projected to generate$54.5 billion from vaccine sales.

    Which Pfizer drugs are getting more expensive? To name three, its pneumonia vaccine, a treatment for breast cancer and a treatment for heart disease.  The prices of two of these drugs are going up nearly seven percent. And, the third drug is going up six percent.

    How much money are we talking? For some drugs, we’re talking hundreds and even thousands of dollars. For Ibrance, Pfizer’s breast cancer drug, the increase is $901, to nearly $14,000.

    Americans are seeing price increases on a total of 554 drugs since the beginning of this year. About one in four of these drugs cost more than $5,000.

    Why does Congress continue to let pharmaceutical companies hike up prices? Why won’t the US use its purchasing power to rein in prices on drugs and save lives?

    We need Congress to step in.  Build Back Better Act, if passed, would rein in drug costs for several dozen drugs and prohibit drug price increases more than the rate of inflation. But, Senator Manchin is blocking its passage.

    Here’s more from Just Care:

  • Teva found partly responsible for opioid crisis in New York

    Teva found partly responsible for opioid crisis in New York

    To be sure, multiple actors are responsible for the opioid crisis in the US, some are finally being held to account, others not. Last month, we reported on a federal jury that found three chain pharmacies partly responsible for the opioid crisis in Ohio. More recently, StatNews reports that a jury found Teva Pharmaceuticals partly responsible for the opioid crisis in New York.

    The New York State Attorney General brought the case against Teva and several other pharmaceutical companies.  The other pharmaceutical companies settled. The jury found that Teva misled the public about the real threats of opioids and engaged in a “public nuisance” with deadly results.  Are you surprised? We still don’t know what Teva will be expected to pay in damages, if anything.

    Teva is protesting, unwilling to take responsibility for its acts and saying it will challenge the verdict. It thinks that New York State should have needed to prove a more direct link between the tens of thousands of deaths from opioids and Teva. It must believe that pushing opioids on people and claiming they were neither addictive nor potentially deadly is kosher. It must think that it is OK to instruct doctors to prescribe high level doses of their opioids as a painkiller.

    Of course Teva claims it did nothing wrong. How could its executives and marketing people sleep at night if they deigned to admit that the untold profits they earned for the company from massive opioid sales cost so many thousands of people their lives? In addition, it cost New York State taxpayers millions of dollars in health care treatments for people who became addicted to opioids.

    Make no mistake. Our federal government is also to blame for the opioid crisis, along with the insurers that approved payment on opioid prescriptions when they were unnecessary, knowing that they were addictive and potentially dangerous. With a single public health care plan such as Medicare for All, the government could have restricted coverage of opioids, limiting access to the drug. That’s what Germany did, and it was able to avoid an opioid crisis.

    Here’s more from Just Care:

  • Chain pharmacies found responsible for opioid crisis

    Chain pharmacies found responsible for opioid crisis

    After a six-week trial and five days of deliberation, a federal jury in Ohio recently found that three very large chain pharmacies were responsible in a significant way for the opioid crisis in two Ohio counties. Jan Hoffman reports for The New York Times that CVS Health, Walmart and Walgreens were found accountable for opioid overdoses and deaths. The insurers covering the opioids that were dispensed should also be found accountable.

    Germany never had an opioid crisis. The federal government in Germany controls the drugs that insurers cover and restricted coverage of opioids by health insurers. It’s unfathomable that corporate health insurers in the US, allegedly in business to manage people’s care, approved coverage of opioids in millions of cases where alternative non-addictive pain relievers were available to treat pain.

    Thousands of lawsuits have been filed across the United States against pharmaceutical companies for fueling the opioid public health crisis and creating a “public nuisance.” California and Oklahoma judges have not bought the argument, saying that the opioid manufacturers were not directly linked to the overdoses and deaths.

    Unfortunately, most of these lawsuits are still working their way through the system. And, opioid overdoses and deaths are on the rise. Many of those overdoses were of illegal opioids such as heroin and fentanyl bought on the street. But, those purchases are a bi-product of people becoming addicted to opioids that were legally prescribed.

    Over the summer, Nassau and Suffolk counties in New York State settled an opioid case with Walgreens, Rite Aid, CVS and Walmart for $26 million.

    In the Ohio case, the chain pharmacies claim that they will appeal. As far as they are concerned, they were just doing what they are supposed to do, fill legal prescriptions. In the process, of course, but left unsaid, they were profiting wildly.

    Of note, the lawyers defending the pharmacies in the Ohio lawsuit laid blame with manufacturers and doctors but did not blame the health insurers approving coverage of the opioids. CVS Health, Walmart and Walgreen are also insurers or linked to them.

    Here’s more from Just Care: