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WASHINGTON — Of all his campaign promises, President Trump’s vow to bring down drug prices was perhaps the most popular.

An assortment of interest groups spoke out loudly and passionately on the need for action, from hospitals to doctors to insurers to generic drug makers to patients themselves.

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  • Jim
    When I read your name I immediately knew you from the Genentech days. In fact, you probably know me as well but I can’t use the full name for contract reasons
    Your respected history is well valued and we can simply agree to disagree. I do NOT believe that drugs are a right of passage that anyone with a need should have them dropped on them like popcorn or peanuts
    I have been a surgeon and PharmaCo C-level advising consultant for almost 4 decades working with virtually every company in the industry at one point or another (here is a hint for you privately to maybe recognize me I was responsible for the rebirth of Coumadin after the patent ran out and converted it to the most use anticlotting drug in the world)
    To accomplish successful research we need cash and to in any way stifle that cash process is UNFAIR to the folks who take the risk
    I never hear of working folks who use PharmaCos as their a part of the 401K or retirement funds yet they 100% of the time complain about how much profit they make
    If the risk was so low and profits so high why would ANYONE with an ounce of any brains not invest heavily in them?
    ANYONE can swap positions and instead of being a poor needy and desperate patient can flip the coin and become an actual profit recipient and stockholder
    Funny EVERY time I bring that up in any community setting the audience immediately shifts the focus
    We can’t have it both ways we can’t have state of the art future life-saving drugs and technologies and not pay for them
    Moving the burden to the entire society thru governmental redistributions of taxes is purely WRONG. Why should everyone pay for the needs of the few?
    Why not allow private sector to take on that risk and burden and shift society to being fiscally responsible for their own care needs
    Sure, by all means, use grouped insurance coverage but this focus on social wealth spreading coupled with social expense mitigation has to end
    Looking at the US vs any other nation the US falls WAY short on healthcare OUTCOMES as well as total expenses paid for care. That means that the society OVER spends on services and then refuses to accept the lifestyle changes that are associated with their diseases, to begin with
    NO amount of drugs is going to change obesity tobacco use alcohol consumption and sedentary lifestyles
    We need individual responsibility followed by a forced savings program and insurance that allows when a need actually arises to help in paying for it
    Right now the US has the LOWEST rate of prescription use in the world Less than 40% of all drugs prescribed are ever picked up and of the ones picked up and expected to be refilled long terms less than 30% are refilled as prescribed YET we complain about the high cost of drugs!
    BTW the figures are even the SAME when there is NO copay for the drug so it is NOT about cost it is about motivation and lifestyle alteration
    Dr Dave

    • Dr Dave- I think we’ll have to agree to disagree. The big 3 insulin purveyors have raised their prices in lockstep over the past decade with zero innovation or reason. It would be nice if everyone ate healthy food, exercised and had good health insurance but I’m afraid it’s just not the case and the outlook for these people doesn’t look good. It’s estimated that 40% of Americans are underinsured. That means they pay a disproportionate share of their income for drugs to survive and reports from many physicians to whom I have spoken many have to choose between paying their rent , groceries or their insulin. With insulin that means that at least 8 million Americans are paying these high prices. And for what? So that Lilly, Novo and Sanofi can sell back their shares and enrich their executives? There’s no risk in insulin anymore. Just pure profit.

    • @Dr Dave – “Why should everyone pay for the needs of the few?”

      Because that is what a liberal democracy does in order to keep from degenerating into a banana republic. In the 1970’s the US taxpayers in the bottom 25% of incomes paid more in taxes than they received in benefits (source was my Urban Society professor at CalTech). Given the changes in the tax code since then I am quite sure that statistic is still valid. Rich people benefit a lot from the work of everyone else and if they want to keep reaping the benefits then they need to make sure that others in society are doing well. When you make statements like the one I quoted you come across as believing that your wealth is solely due to your own efforts and you don’t owe anything to anyone. Perhaps you didn’t mean to come across that way so you may want to reconsider.

  • There is a silver bullet! The healthcare supply chain is managed by four Group Purchasing Organizations (GPOs) and three Pharmacy Benefit Managers (PBMs) which write contracts for but in no other way participate in the healthcare supply chain. These “Patronage Agreements” specify prices at every level and kickbacks at every transaction. They are LEGAL because of an Unsafe Safe Harbor for Kickbacks. Get rid of the kickbacks in the Patronage Agreements and the cost of healthcare…including drugs….will plummet. Physicians Against Drug Shortages has a bill written in the House and the Senate. A simple repeal of the kickback safe harbor. Make kickbacks illegal again. How is that for a Silver Bullet. The bill and way more information is available at PhysiciansAgainstDrugShortages.com

    • Bob
      I am VERY well aware of the well-intentioned bill you are talking about. I have worked as one of three independent advisors to the US Senate for a bit over 3 years now. The bill was put into play to quiet down a few very loud groups knowing FULL well that not only will it not get out of committee but it will never be passed on the floor if it does.
      Add to that if it were to pass that prices would actually NOT go down the only thing that would happen is that the rebates would stop so that all the funds would stay in the coffers of the PharmaCos.
      Right now the biggest issue is that as you pointed out only 4 companies do all the negotiations and they are funded by the InsCos. YES, I get it that the US has given over to them all control going back to the Johnson era with the Employee health Benefit Act that allowed employers to instead of giving raises it allowed them to buy insurance without paying taxes on those funds. It was a novel idea but it did a BIG thing; it took the responsibility for the individual care and took it from the employee and gave it to the employer AND the InsCo. At NO place in the discussion is the actual patient. THAT needs to change in order to lower not only drug prices but all medical costs
      If individuals were forced to buy their OWN insurance (maybe with funds from their employer) then they would be contractually involved in each step of the process from premiums to what services cost to what they are willing to have done and or take
      MSA’s are the key allowing if not mandating everyone have their own MSA to pay for everything medical related from premiums to copays from deductibles to toothpaste
      Then and only then will society become in control and will refuse to allow companies to dictate structures
      Obviously, we need to eliminate DTC as well. As only one of two nations on planet earth that allow direct to consumer advertising, we need to get rid of that refocus on educating the professionals as to why they should choose one over another
      DTC only wastes 20% of the typical doc’s time having to answer why the drug is not right for them or their situation
      if a drug was appropriate the doc would have suggested it and NO doc is going to modify the treatment plan because the patient asked for it
      Dr. Dave

    • Dr. Dave seems to be afflicted with the know-it-all disease, apparently a common malady among health policy wonks with MD degrees. The first bipartisan bill to repeal the unsafe 1987 Medicare anti-kickback safe harbor provision was drafted in 2005 by former Senators Herb Kohl (D-WI) and Mike DeWine (R-OH), who presided over four Senate Antitrust Subcommittee hearings on hospital group purchasing (GPO) abuses from 2002 to 2006. They were passionate about this issue. They weren’t trying to placate anyone. They were trying to fix a corrupt, broken “pay-to-play” system that has undermined market competition in our healthcare supply chain; caused artificial shortages and skyrocketing prices of hundreds of prescription drugs, notably sterile saline; harmed and even killed countless patients; and inflated annual health care supply costs by an estimated 30-40%, or about $200 billion. Yes, you read that right. The bill never saw the light of day because of the powerful GPO lobby, which includes the American Hospital Assn and other “allies,” aided by their principal apologist, Sen. Chuck Schumer. We now know that the AHA opposed it because the CEOs of many major GPO member hospitals receive “patronage fees” or “share backs” from the GPOs for enforcing compliance with their exclusionary contracts. Do your homework, Dr. Dave.

  • Jim
    Unfortunately, your data is wrong but so is Anonymous. (if you want ANY credibility in a discussion at least have the decency to put your name or portions of it up for evaluation)
    The NIH does in fact fund about a half a billion dollars a year in drug research. It does so under its division called National Center For Translational Sciences which has a sizable budget for drug development but NOWHERE near a credible number in terms of money spent by the PharmaCos
    https://www.forbes.com/sites/johnlamattina/2012/05/15/the-nih-is-going-to-discover-drugs-really/#1071f5615a57
    Yes there is a TINY bit of Federal money being used for Drug Development especially in areas like vaccines and orphan drugs and things that drastically affect society like Alzheimer’s and the like but honestly, it is like a grain of sand on a beach in comparison
    Dr. Dave

    • Hi Dr Dave
      Well that’s my real name I’m not going by “Dr dave” Anyway that’s beside the point Oharma feeds off of NIH research (read Lazonick’s piece that I cited in an earlier post). Pharma does clinical development mostly using discoveries made elsewhere. As far as my “credibility ” You can check out my background at fairaccessmedicines.org

    • Dr. Dave, how is using Dr. Dave any less anonymous then not putting any name at all? Just because I decided to use Anonymous instead of my real name doesn’t change anything. The fact is that Jim has a very skewed view of the pharma industry. Since when is doing the same thing as any other public company (stock buy backs and stock dividends) to increase stock value wrong? I don’t see you documenting the practices of managed care companies or the salaries that their executives get paid. Huge salaries off the backs of those people that get denied medications every day just so they can save money pushing inferior generics. Managed care companies that charge copays/high deductibles that make some medications unaffordable or that they just completely deny people getting. Yes, there are certainly times that drug prices are raised by greedy companies, but in many cases these increases are to fund future medications and pay for the many failures that happen all the time in the industry. Dr. Dave has already made my point that it is private pharmaceutical companies that fund most of the research. The NIH funding research is a little different, since they aren’t risking anything. If what they fund fails nothing happens to their existence. Giving seed money does not make them responsible for the actual innovation, just as banks that loan money to companies should not be credited for new innovations. The pharmaceutical companies are not innocent but I feel they are always the easy target. There are plenty of industries that make huge margins on their products but nobody complains the same way the do about drug prices.

  • Hello anonymous- just one example is Sovaldi. Gilead bought Pharmaset in 2012 for $11.2B. That’s a lot of money for sure. The NIH paid for most of the development of this drug through SBIR funding and the like. Gilead turned Sovaldi into a goldmine by charging $84k per treatment and paid off their investment in year or so but did they lower the price? No. Check out Merrill Goozner’s editorial in Modern Healthcare Aug 27, 2016 for all the details. Oh and to find out how Pharma spends its money read Bill Lazonick’s paper entitled “The Financialized US Pharmaceutical Industry”. It’s available for free online. It contains the data you’re requesting. You might learn something.

  • Yeah, they’re making glacial progress on drug prices. Meanwhile millions of people are suffering but when you’re making lots of money you don’t let those little things bother you too much.

    • I would rather be accused of making millions of dollars from life saving drugs than making millions of dollars from denying life saving medications like managed care does every day.

    • I love all the pharma fairy tales but as far as the fundamental basis behind their “research ” the NIH (taxpayers) are responsible for most of it and receive high drug prices in return. It is a documented fact that pharma spends >95% of its profits on 2 things. 1. Share buybacks 2. Dividends. Share buybacks enrich pharma executives by juicing their stock prices. Dividends encourage long term investors

    • Mr. Wilkins I have no idea where you are getting your information but it is totally untrue. Please post your source because drugs are paid for and developed by private pharmaceutical companies. Name one major drug that was developed from the NIH and if the NIH is developing all these drugs you speak of why doesn’t the government keep them and market them? Also how does the NIH decide who is going to market all these drugs they are developing? These questions can’t be answered because it is absolutely untrue.

  • Good overall story; however, “to cut to the chase,” just “follow the money” as we learned from prior political fiascos in Washington.

    The uncontrollable abhorrent pricing and excessive profiteering embraced by Big Pharma starts and ends with Congress. As Congress operates on a “pay to play” model, this explains why Big Pharma has the largest army of lobbyists storming Capitol Hill. In evidence of a rare bi-partisan relationship, both parties eagerly, unabashedly grab the lobbyist envelopes for their “campaign funds.” For Congress, it’s like hitting a piñata loaded with cash; a trifecta for Congress to cash in on.

    This explains why both aisles of Congress historically avoided getting behind any meaningful regulations that would conflict with their receiving carpet bags of cash from Big Pharma lobbyists. Not a surprise how this created the Medicare Act of 2002, when Big Pharma spent over $250 Million to lobby and receive Medicare Part D, an open spigot at retail pricing; to prevent Medicare from negotiating drug prices. Indeed, as a reward for pushing this act through, the committee chair, Rep. Billy Tauzin, was paid off by being crowned the head of PhRMA!

    As Congress offers us today its crocodile tears over the opioid crisis, nobody points out how this rests at the feet of Congress. Why has Congress not moved to reverse the FDA’s authorization in 1997 that allowed Big Pharma to push its prescription drugs to the public?

    Why has Congress refused to reign in Big Pharma’s overt dismissal of our anti-trust laws by paying off generic manufacturers to delay release of their generic drug; splitting the profits with Big Pharma producing the costlier brand product? As well, why has Congress not intervened to prevent Big Pharma from releasing coupons to consumers to maintain their branded product at a higher cost for insurance, as Pfizer did with Lipitor?

    Why has Congress allowed Big Pharma to pervert the concept of a free marketplace by creating monopolistic dynasties for their brands; to create needless litigation to delay introduction of generics?

    Why has Congress refused to learn and accept how most other western nations have successfully dealt with Big Pharma? Switzerland, UK, EU, Canada, Australia, etc. tell Big Pharma what their profit percentage will be off of a price determined by these countries. And if Big Pharma threatened if the U.S. did go that route it would drastically cut their research, call their bluff. The U.S. is still their largest market; as well, Big Pharma depends upon at least 80% of research conducted by the tax-financed NIH to identify potential products.

    Just as the Feds stopped the wheeling and dealing of community oncologists negotiating drug purchases based upon AWP; stopping now their picking drugs at the higher ASP; as well as to prevent the overuse of EPO drugs in oncology, so too can Congress move into the mainstream and do the people’s business.

    • “Big Pharma depends upon at least 80% of research conducted by the tax-financed NIH to identify potential products.” This is blatantly untrue, the NIH may support some research but most is paid for by private pharmaceutical companies. Everyone likes to bad mouth “Big Pharma” but never praise it for all the medical advancements that they have made to save lives.

  • This is ridiculous. Why does the NHS get to buy Kymryiah the new cancer drug at 75 cents on the US dollar? Because that’s how much they are prepared to pay for it because that’s how much they think it’s worth. Only a stupid consumer pays whatever the seller asks without considering what the product is worth.

    • The US federal gov is LEGALLY prevented from negotiating prices for its subscribers. The Congress enacted an actual LAW that prevents any negotiation so if Novartis decides to double the price the US Gov will simply write the check for twice the amount while all other nations will as you said negotiate their own lower prices. Yet we wonder why healthcare in the US is so expensive
      Dr. Dave

  • Regarding your statement “And doctors, too, make more money under Medicare rules if they administer a more expensive drug to a given patient.”

    I am in solo practice and see Medicare patients. I do not get any change in my reimbursement based on the medications I prescribe. So from my experience your statement is false.

    Note that I do not participate in the Meaningless Use requirements and so may have excluded myself from scams such as the one your statement describes.

    I would still like to see some evidence for your statement and to whom it applies or else a retraction. Thank you.

    • Joe
      The Meaningless Use sections is exactly what they were suggesting
      if you prescribe “approved drugs” then you do actually get paid more for them as opposed to the drugs YOU chose as best for your patient in their situation
      Dr. Dave

  • Good morning,
    One way I have discovered to be able to not have hospitals charge me for a generic drug that typically doesn’t work as well as a brand name pharmaceutical medication, is when I am admitted to hospital, I bring my own medications and take those, instead of being given medications from the hospital pharmacy. The only way that is able to work is the patient is to give their medications to the nursing staff, and they have them at their station for the patient to receive the medications as prescribed by the pharmacy that originally filled the prescription for the patient.

    Admittedly, in the event of a problem when, for instance the nurse and other staff are busy with other individuals ( especially when there is a code for a patient who is in life threatening condition, and the other patients are not the priority ), I have always kept my own medications in my personal belongings so I have access to my medications on the occasions when I am in need of my medications, during those times when the staff is attending to a code. It is not supposed to be allowed for patients to keep their own medications; when whomever is going to ameliorate the greediness of the offense and intolerable dismissal of a fair amount of money for the necessary medications that individuals require to be as healthy, or not in any danger because they are not able to access the medications as needed, then the patient won’t have to endure this treatment protocol that is not being changed for the patient or the pharmaceutical industry.

    Until then I will continue to do what is necessary for myself, and be discreet about having some of my medications in my personal bags, and provide the hospital with my own medications that I bring with me to hospital; I count the number of pills in the presence of the nurse, and request that s/he please indicate on my chart that I have done this count. The message is quite clear as to why.

    This is one way that I do what I am able, lto try and limit the amount of money that the pharmaceutical companies, and the hospitals charge for medications.

  • you cite patty murray, the senator from the state of washington talking about solving the problem. she is part of the problem. she voted against bernie sanders bill to be able to buy drugs from canada because she was “protecting her constituents from dangerous drugs”. however she says nothing about the more than 50 thousand dollars she received from the pharmaceutical industry the previous year for her campaign money war chest.

    this fox………..says she is guarding the hen house.

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