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Drugs, Big Pharma, conflicts of interest, and why U.S. patients pay too much for medication

February 26, 2016

Tags: drug costs, drug prices, step therapy, pharmaceutical industry lobbying

by Pat McNees ( Updated 8-14-17, 8-2-17, 7-19-17, 3-1-17, 10-6-16, 9-26-16, orig. 2-26-16)
Highlights from below:
• "Republican candidates blame skyrocketing drug costs on over-regulation and a few drug companies' 'pure profiteering,' but don't say that Medicare should negotiate drug prices or that the government should limit drug maker’s profits, steps that might dramatically shake up the marketplace....they’re not even making modest suggestions to stem rising costs, focusing instead on hammering a few headline-making companies that they portray as bad actors. "
• "High cancer drug prices are harming patients because either you come up with the money, or you die."
• Polls show high drug costs as "voters' No. 1 health concern," but the candidates are "caught in the box of Republican free market orthodoxy — and also, of long-standing relationships with the pharmaceutical industry, a lobbying powerhouse on the Hill."
• It doesn't matter if a cheaper (often generic) version may be available if doctors don't pay attention to costs and consumers believe the more expensive drug is probably more effective. Moreover, doctors who do pay attention to costs have an incentive to prescribe the more expensive version of a drug, not the generic version. And pharmacies don't always pass along the declining cost of generic drugs to consumers.
• Step therapy ('fail-first" drug policies allow health insurance to practice medicine. Designed to keep insurance costs down, step therapy ("fail first" protocols insist that a patient start with a traditional lower-cost drug and advance to a newer, more expensive drug only if the first drug fails to produce the desired results. For new drugs that are clearly more effective, this means doctors and patients have to jump through hoops to get patient to the more effective drug, in order to get insurance coverage."
• 'It’s sort of embedded in the health care system that the price is never the price, unless you’re a cash-paying customer,' Mr. Fein said. 'And in that case, we soak the poor.'”'
• A Pro Publica investigation shows that many doctors are being paid by the same drug companies whose medicines they prescribe.
• The public ranks the pharmaceutical industry right between the oil industry and insurance companies in overall favorability."
• Why do drug companies charge so much? Because they can.

Here are SOME of the stories about escalating U.S. drug costs that could be fixed, if politicians did what they should:
Middlemen Who Save $$ On Medicines — But Maybe Not For You ( Francis Ying, Julie Appleby, Stephanie Stapleton, Kaiser Health News, 8-2-17) Pharmacy benefit managers — companies that are often unnoticed and even less understood by most consumers — hold an important place in the prescription drug-pricing pipeline. In this video, Kaiser Health News examines the role of PBMs in the drug pricing pipeline -- detailing the emergence of these multimillion-dollar corporations and the impact they have on medication costs and patients’ access to these treatments. The big three PBMs are: CVS Caremark, Optum RX, and Express Scripts. They make money and get rebates, may favor the meds with the biggest rebates (for them, not us), and apparently do not pass savings on to consumers.
Big Pharma Spends on Share Buybacks, but R&D? Not So Much (Gretchen Morgensen, Fair Game, NY Times, 7-14-17) A new academic study reveals that big pharmaceutical companies have spent more on share buybacks and dividends in a recent 10-year period than they did on research and development. Many big pharmaceutical companies are living off patents that are decades-old and have little to show in the way of new blockbuster drugs. But their share buybacks and dividend payments inoculate them against shareholders who might be concerned about lackluster research and development. “The key cause of high drug prices, restricted access to medicines and stifled innovation, we submit, is a social disease called ‘maximizing shareholder value,’” the study’s authors concluded.
Orphan Drugs: The good, the bad, and the greedy. Important pieces (and videos) on the orphan drug machine, on how pharmaceutical companies are gaming the system, on how the patients with rare diseases have become a gold mine for drug manufacturers, who accept a seven-year monopoly to provide drugs for rare diseases and then milk the system for off-label uses at the premium price afforded by the monopoly.
The Senate bill does nothing to fix America's biggest health care problem (Sarah Kliff, Vox, 6-30-17) The biggest problem in American health care -- prices -- is one that the Republican health care plans won’t really try to solve. To be fair, it’s one that Obamacare didn’t touch, either. Health care prices aren’t part of the American health care debate. But they need to be. Other developed countries use price controls in medicine. The government negotiates with drug companies, device makers, and doctors to set lower prices. The United States does set medical prices for the 50 million elderly Americans who rely on Medicare. The Republican plans put the burden of high prices more squarely on patients
The Complex Math Behind Spiraling Prescription Drug Prices (Katie Thomas, NY Times, 8-24-16) "Many people are covered by health plans with large deductibles that require them to pay the full price of their drugs until they hit their limit, which can be thousands of dollars a year. And more plans are requiring patients who need expensive specialty drugs to contribute a percentage of the list price. Drug companies often help cover patients’ out-of-pocket costs through assistance programs, but not always. So patients who are the sickest and require the most expensive drugs are the most vulnerable to soaring drug prices. 'It’s sort of embedded in the health care system that the price is never the price, unless you’re a cash-paying customer,' Mr. Fein said. 'And in that case, we soak the poor.'”'
Tracking Who Makes Money On A Brand-Name Drug (Julie Appleby, Kaiser Health News, 10-6-16)
A new Parkinson’s drug is a long-acting version of a cheap generic. Should it cost $30,000 a year? (Adam Feuerstein, STAT Plus, 8-25-17)
Sounds Like A Good Idea? Regulating Drug Prices (Julie Rovner and Francis Ying, KHN, 7-11-16
The Orphan Drug Machine (KHN video, 6 minutes)
The Prescribers: Inside the Government's Drug Data (major Pro Publica investigation by Charles Ornstein and colleagues). Stories include Medicare’s Failure to Track Doctors Wastes Billions on Name-Brand Drugs (Charles Ornstein, Tracy Weber and Jennifer LaFleur, 11-18-13); How a Simple Fix to Reduce Aberrant Prescribing Became Not So Simple (Charles Ornstein, 2-10-17); ‘Let the Crime Spree Begin’: How Fraud Flourishes in Medicare’s Drug Plan (Weber and Ornstein, 12-19-13); As Opioid Epidemic Continues, Steps to Curb It Multiply (Ornstein, 5-12-16); Brand-Name Drugs Increase Cost But Not Patient Satisfaction (Ornstein, 11-19-15); An Unintended Side Effect of Transparency (Stephen Engelberg, 5-12-16); and more.
To Save On Drug Costs, Insurer Wants To Steer You To ‘Preferred’ Pharmacies (Pauline Bartolone, California Healthline, 3-9-17) "Blue Shield of California wants to create “a tiered pharmacy network” in its 2018 small- and large-group plans, according to preliminary proposals the company submitted to the California Department of Managed Health Care (DMHC)...consumers still would have a broad selection of pharmacies, but they would have to choose a “preferred” pharmacy to maintain this year’s copayment amount. Outside of that network, consumers could pay up to $50 more for the same prescription...Advocates with Consumers Union, which hasn’t taken a position on the most recent Blue Shield proposal, say pharmacy networks could create more complexity for lower-income people in an already complicated health insurance system, one that faces more uncertainty under an Obamacare repeal....Imholz said creating economic incentives to steer patients toward network pharmacies could inconvenience the most vulnerable patients. If the preferred pharmacy is farther away, or in a rural area, lower-income patients dependent on public transit could have a harder time reaching the preferred pharmacy..."
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Behind The EpiPen Monopoly: Lobbying Muscle, Flailing Competition, Tragic Deaths (Pauline Bartolone, Kaiser Health News, 9-8-16) 'Mylan, the company that raked in $1 billion last year for the EpiPen, takes credit for passing “legislation in 48 states” to ensure schools have them. But its political maneuvering is only one reason the company has, in its own words, become “the number one dispensed epinephrine auto-injector.”'...'Indeed, Mylan’s presence in state houses across the country has grown exponentially. The company added lobbyists in 36 states between 2010 and 2014, according to the Center for Public Integrity, outpacing every other U.S. company. And it spent more than $1.3 million lobbying in 16 states since 2012, according to the National Institute on Money in State Politics.' 'The school give-away program brings visibility and credibility to the EpiPen brand, building a consumer base beyond schools. “It’s kind of like the first hit’s for free...”'
The EpiPen, a Case Study in Health System Dysfunction (Aaron E. Carroll, The New Health Care, NY Times, 8-23-16) "Epinephrine isn’t an elective medication. It doesn’t last, so people need to purchase the drug repeatedly. There’s little competition, but there are huge hurdles to enter the market, so a company can raise the price again and again with little pushback. The government encourages the product’s use, but makes no effort to control its cost. Insurance coverage shields some from the expense, allowing higher prices, but leaves those most at-risk most exposed to extreme out-of-pocket outlays. The poor are the most likely to consider going without because they can’t afford it. EpiPens are a perfect example of a health care nightmare. They’re also just a typical example of the dysfunction of the American health care system."
Getting Patients Hooked On An Opioid Overdose Antidote, Then Raising The Price (Shefali Luthra, Kaiser Health News, 1-17-17) First came Martin Shkreli, the brash young pharmaceutical entrepreneur who raised the price for an AIDS treatment by 5,000 percent. Then, Heather Bresch, the CEO of Mylan, who oversaw the price hike for its signature Epi-Pen to more than $600 for a twin-pack, though its active ingredient costs pennies by comparison. Now a small Virginia company called Kaleo is joining their ranks. It makes an injector device that is suddenly in demand because of the nation’s epidemic use of opioids, a class of drugs that includes heavy painkillers and heroin. Called Evzio, it is used to deliver naloxone, a life-saving antidote to overdoses of opioids. Experts say the device’s price surge is way out of step with production costs, and a needless drain on health-care resources. And competition is limited: One of the few consumer-friendly alternatives to Evzio is a nasal spray device for naloxone. (In another Mylan parallel, Kaleo offers coupons to patients with private insurance, so they don’t have any co-pay when they pick up the device.)
The $4,500 injection to stop heroin overdoses (Shefali Luthra, Kaiser Health News, Business, Washington Post, 1-29-17). "Evzio is used to deliver naloxone, a life-saving antidote to overdoses of opioids. As demand for the product has grown, Kaleo has raised its twin-pack price to $4,500, from $690 in 2014....It’s another auto-injector that delivers an inexpensive medicine. One difference, though, is that Evzio talks users through the process as they inject naloxone....Still, experts say the device’s price surge is way out of step with production costs and a needless drain on health-care resources....Kaleo, which is trying to blunt the pricing backlash and turn Evzio into the trusted brand, is dispensing its device for free — to cities, first responders and drug-treatment programs. Such donations were also essential to the EpiPen’s business strategy." The exorbitant price doesn't matter so much when the drug is provided through institutional buyers such as the VA, but in poor areas where poor people are not covered by health insurance, it can mean life or death. "EpiPen happened, and everyone was like, ‘Wow, this is terrible, we shouldn’t allow this to happen,’ ” he said. “And we haven’t done anything about that, and it’s not clear what the solution is. Now, shocker, it’s happening again.”
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E-cigarette critics get research dollars from industry competitors (Kathy Hoekstra, MinnesotaWatchdog.org, 4-10-17) The nicotine patch "is one of four nicotine replacement therapies (NRT) approved by the FDA to help people quit smoking. Three others are prescription-only. Nicotrol NS is a nicotine nasal spray, while Chantix and Zyban are non-nicotine medications. The FDA, however, does not report success rates for these products. And the best Smokefree.gov can do is say they “increase your chances of quitting successfully.” FDA doesn't report success statistics on quitting smoking, and the research criticizing e-cigarettes is funded by pharmaceutical firms.
Why the U.S. Pays More Than Other Countries for Drugs (Jeanne Whalen, WSJ, 11-30-15) Norway, an oil producer with one of the world’s richest economies, is an expensive place to live. A Big Mac costs $5.65. A gallon of gasoline costs $6. But one thing is far cheaper than in the U.S.: prescription drugs. A vial of the cancer drug Rituxan cost Norway’s taxpayer-funded health system $1,527 in the third quarter of 2015, while the U.S. Medicare program paid $3,678. An injection of the asthma drug Xolair cost Norway $463, which was 46% less than Medicare paid for it. (KHN summary)
Sticker Shock Forces Thousands Of Cancer Patients To Skip Drugs, Skimp On Treatment (Liz Szabo, Kaiser Health News, 3-15-17) With new cancer drugs commonly priced at $100,000 a year or more, hundreds of thousands of cancer patients are delaying care, cutting their pills in half, or skipping drug treatment entirely. The jaw-dropping costs of new cancer medications have led to widespread criticism of the pharmaceutical industry, on Capitol Hill and beyond. Six of the 39 cancer drugs on the market in 2010 doubled or tripled in price by 2016; one quadrupled in price; one drug’s price increased eightfold.
$2.6 Billion to Develop a Drug? New Estimate Makes Questionable Assumptions (Aaron E. Carroll, The Upshot, NY Times, 11-18-14) The questionable assumptions: time costs ($1.2 billion), that drug is a "new molecular entity" developed in-house by pharmaceutical firm (few new drugs are), etc., plus which the costs are tax deductible (that is, covered by taxpayers). It "might be more accurate to say that it’s the cost to develop certain new molecular entities for which pharmaceutical companies did all of the research. That’s very few drugs, in the scheme of things."
Climbing Cost Of Decades-Old Drugs Threatens To Break Medicaid Bank (Sydney Lupkin, KHN, 8-14-17) Skyrocketing price tags for new drugs to treat rare diseases have stoked outrage nationwide. But hundreds of old, commonly used drugs cost the Medicaid program billions of extra dollars in 2016 vs. 2015, a Kaiser Health News data analysis shows. Eighty of the drugs — some generic and some still carrying brand names — proved more than two decades old. Even after a medicine has gone generic, the branded version often remains on the market. Medicaid recipients might choose to purchase it because they’re brand loyalists or because state laws prevent pharmacists from automatically substituting generics. Even after a medicine has gone generic, the branded version often remains on the market. Medicaid recipients might choose to purchase it because they’re brand loyalists or because state laws prevent pharmacists from automatically substituting generics.
Wyden-Grassley Sovaldi Investigation Finds Revenue-Driven Pricing Strategy Behind $84,000 Hepatitis Drug (report of Senate Committee on Finance on hearings on the price of Sovaldi (sofosbuvir), a drug that cures most hepatitis C. Those hearings provide a case history in how a company prices a drug, says Norman Bauman (reporting in an email on part of a meeting of the NY chapter of AHCJ 2-15-17). Their pricing was summarized in a Powerpoint slide that was part of a committee report, on page 2 of the document The Pricing of Sovaldi (https://www.finance.senate.gov/imo/media/doc/3%20The%20Pricing%20of%20Sovaldi%20(Section%203).pdf), a PDF of chapter 3 from the government report. "Aside from payer access and physician demands, there are a number of softer issues that could affect Gilead's final pricing decision."
$2.6 Billion to Develop a Drug? New Estimate Makes Questionable Assumptions (Aaron E. Carroll, The Upshot, NY Times, 11-18-14) The questionable assumptions: time costs ($1.2 billion), that drug is a "new molecular entity" developed in-house by pharmaceutical firm (few new drugs are), etc., plus which the costs are tax deductible (that is, covered by taxpayers). It "might be more accurate to say that it’s the cost to develop certain new molecular entities for which pharmaceutical companies did all of the research. That’s very few drugs, in the scheme of things." Major findings include: Gilead justified Sovaldi’s high price point based on price-per-cure. Gilead set a high price for Sovaldi with an eye toward ensuring a future high price for Harvoni. Gilead underestimated the degree of access restrictions that it expected would result from its pricing decision. Despite significant access restrictions, Gilead refused to significantly lower the net price. The burdens on Medicare, Medicaid, and the Bureau of Prisons were significant. Competition entered the market, prices responded, but there are still significant concerns. Among headlines: 18-Month Investigation Reveals a Pricing and Marketing Strategy Designed to Maximize Revenue with Little Concern for Access or Affordability. Report Includes Landmark Release of Medicaid Data: In 2014, More than $1 Billion Spent by Medicaid Programs on Sovaldi Treated Less than 2.4 Percent of Enrolled Patients with Hepatitis C. Medicare Spent More on Gilead Hepatitis C Drugs in the First Half of 2015 than in All of 2014. "These hearings are the best case history of how a company prices a drug."
Medicare Weighing Changes to Doctor Drug Payments, Memo Shows ( Zachary Tracer and Sasha Damouni, Bloomberg Business, 2-9-16). Medicare has been criticized for giving doctors a financial incentive to administer drugs that are most expensive. A memo discussing how Medicare may change the way it reimburses for drugs was released prematurely. The memo suggests that Medicare contractors who process payments set up a system allowing the government to vary by geographic location how much it reimburses doctors for the drugs they administer.
Open Payments (Centers for Medicare & Medicaid Services's new open database of information about doctors' relationships with drug manufacturers and other health care businesses.
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GOP candidates stuck on drug prices (Paul Demko and Sarah Karlin, Politico, 12-1-15) Republican candidates blame skyrocketing drug costs on over-regulation and a few drug companies' "pure profiteering," but don't say that "Medicare should negotiate drug prices or that the government should limit drug maker’s profits, steps that might dramatically shake up the marketplace....they’re not even making modest suggestions to stem rising costs, focusing instead on hammering a few headline-making companies that they portray as bad actors. " Polls show high drug costs as "voters' No. 1 health concern," but the candidates are "caught in the box of Republican free market orthodoxy — and also, of long-standing relationships with the pharmaceutical industry, a lobbying powerhouse on the Hill."
Use Medicare’s Muscle to Lower Drug Prices (NY Times editorial, 9-21-15) One way to reduce drug costs for older patients on Medicare -- who often live on modest incomes, are in poor health, and take four or more prescription drugs -- is to reverse the policy set by the 2003 Medicare Modernization Act, which created Medicare’s prescription drug program. "At Republican insistence, that law barred the federal government from negotiating with drug manufacturers. ...Congressional Republicans would no doubt balk at having the federal government negotiate Medicare drug prices, but the public is clamoring for action, and it’s the right thing to do."
Why We Allow Big Pharma to Rip Us Off (Robert Reich, Moyers & Co., 10-6-14) "...while other nations set wholesale drug prices, the law prohibits the U.S. government from using its considerable bargaining power under Medicare and Medicaid to negotiate lower drug prices. This was part of the deal Big Pharma extracted for its support of the Affordable Care Act of 2010."
Generic Drug Prices Are Declining, But Many Consumers Aren’t Benefiting (Charles Ornstein, ProPublica, and Katie Thomas, New York Times, 8-8-17) Outcry has been building over the rising cost of brand-name medications, but the price of generic drugs has been moving in the opposite direction. The stock prices of generic manufacturers have tumbled, but many consumers aren’t paying less at the pharmacy counter.
Journalists learn about intricacies of prescription drug pricing (Liz Seegert, Covering Health, Association of Health Care Journalists, 2-27-17) Why are drug costs so high in the United States? This and other questions were addressed at a meeting of the New York chapter of AHCJ. What can justify a "$50,000 cancer drug that extended life for an average of 17 days"? A helpful summary of what several experts explained about how we in the U.S. end up with exploitative prices on some drugs. Among points made: (1) "It’s the doctor, not the patient, who decides what to prescribe. Our current system also rewards doctors for prescribing more expensive drugs. Why prescribe the generic when you can make more money prescribing the brand? (2) Doctors are making those decisions, typically, with little information about cost . Now with more patients in high-deductible plans with a coinsurance model, there’s sticker shock and people are asking questions. (3) Nobody knows if we are spending the right amount on drugs, said Peter Bach, MD, director of the Memorial Sloan Kettering’s Center for Health Policy and Outcome. Moreover, we do not know if we are spending it on the right drugs, either.
Healthcare expert for sale (Trudy Lieberman, CJR, 12-6-12) Revolving door between government jobs and lobbying for industry--is it any wonder Medicare is not allowed to negotiate lower drug prices with pharmaceutical industry?
In Cancer Care, Cost Matters (Peter B. Bach, Leonard B. Saltz, and Robert E. Wittes, OpEd, NY Times, 10-14-12). "At Memorial Sloan-Kettering Cancer Center, we recently made a decision that should have been a no-brainer: we are not going to give a phenomenally expensive new cancer drug to our patients. The reasons are simple: The drug, Zaltrap, has proved to be no better than a similar medicine we already have for advanced colorectal cancer, while its price — at $11,063 on average for a month of treatment — is more than twice as high." "This political climate also helps explain why the Affordable Care Act precludes Medicare from changing its coverage or payment amounts based on cost comparisons like the one we have outlined, even when two drugs appear to work equally well. And it is probably why neither presidential candidate has addressed runaway cancer drug prices. But if no one else will act, leading cancer centers and other research hospitals should."
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Pain: A Political History by Keith Wailoo. Read what Rebecca Davis O' Brien wrote about it in this Atlantic review (8-18-14): "The pain of the fetus and the pain of the taxpayer mattered most; the addict’s pain was suspect, the housewife's pain imagined." "The result is gaps in treatment, a glut of pills, and a landscape of addiction—the inevitable consequence of our "unquenchable appetite for relief."
The Cost of Cancer Drugs (Leslie Stahl, 60 Minutes, CBS, 10-5-14--you can listen or read transcript.) Dr. Leonard Saltz: "We're in a situation where a cancer diagnosis is one of the leading causes of personal bankruptcy." "... we as a society have been unwilling to discuss this topic and, as a result, the only people that are setting the line are the people that are selling the drugs." Dr. Peter Bach: "Medicare has to pay exactly what the drug company charges. Whatever that number is." "The challenge, Dr. Saltz at Sloan Kettering says, is knowing where to draw the line between how long a drug extends life and how much it costs." "High cancer drug prices are harming patients because either you come up with the money, or you die." Gleevec as a life-saving drug that makes patients a slave to it and its high cost. Dr. Leonard Saltz: " I don't know where that line is, but we as a society have been unwilling to discuss this topic and, as a result, the only people that are setting the line are the people that are selling the drugs."
Top Prescription Plan to Offer $1 Alternative to $750 Pill (Andrew Pollack, NY Times, Business Day, 12-1-15) "Turing Pharmaceuticals’ effort to charge $750 a pill for a 62-year-old drug is facing a new headwind: The nation’s largest prescription drug manager plans to back an alternative that costs only $1 per pill....Daraprim, known generically as pyrimethamine, is the treatment of choice for toxoplasmosis, a parasitic infection that can be serious for babies and people with AIDS. While there is no patent protection on such an old compound, there are no generic versions approved for sale in the United States, in part because the market is small."
Express Scripts Offers Low-Cost Alternative to Turing Drug (AP, NY Times, 12-1-15) The nation's biggest pharmacy benefits manager is muscling back into the debate over soaring drug costs by promoting a less-expensive alternative to a life-saving medicine with a list price of $750 per pill. Other drugmakers have also recently purchased the rights to old, cheap medicines that are the only treatment for serious diseases and then hiked prices. The practice has triggered government investigations, politicians' proposals to fight "price gouging," and heavy media scrutiny. Express Scripts, which manages prescription drug benefits for about 85 million people, has long been a vocal critic of rising drug prices.

How High Drug Prices Weigh on the Sickest Americans (Drew Altman, Think Tank blog, WSJ, 12-28-15) "The more drugs people take and the sicker they are, the more likely they are to experience problems paying for prescription medicines–or to forego them altogether because of cost....The pattern holds for seniors on Medicare as well. Twenty percent of seniors taking prescription medicine report difficulty paying for their drugs. Among seniors taking four or more medications, the share rises to 29%.
Lawmakers, Candidates Target High Drug Prices (Stephanie Armour, WSJ, 11-15-15) Lawmakers and the Obama administration are ratcheting up efforts to target pharmaceutical companies over high-priced drugs, a sign that legislators are trying to bridge partisan differences to tackle a key driver of rising health care costs.
Prescription Drugs’ Sizable Share of Health Spending (Drew Altman, Think Tank, WSJ, 12-13-15) "As big a problem as rising drug prices have been for consumers and payers, drug spending represents only 10% of national spending on health. Yet ... drug spending represents almost double that share of health spending (19%) in employer health insurance plans. That is not too much less than the 23% employers spend on inpatient hospital care.
Why Higher Drug Costs Are Consumers’ Biggest Cost Worry (Drew Altman, WSJ Think Tank blog, 9-8-15). We "asked which health costs people with health coverage find to be the greatest burden. As the chart shows, deductibles led a closely bunched list, followed by premium payments, drug costs and doctor visits. Deductibles have been rising steadily each year, especially for people who work for smaller employers, as insurance has gradually been moving from more to less comprehensive, with more 'skin in the game' for consumers."...Seventy-six percent of the public blames drug companies for high drug prices – with just 10% blaming insurers. The public ranks the pharmaceutical industry right between the oil industry and insurance companies in overall favorability."

Working to Lower Drug Costs by Challenging Questionable Patents (Gretchen Morgenson, Fair Gae, NY Times, 11-27-15) J. Kyle Bass made a fortune in the financial crisis when his hedge fund, Hayman Capital Management, bet big against subprime mortgages. Now Mr. Bass is wagering against pharmaceutical companies that he says exploit the patent system, keeping drug prices — and their profits — in the stratosphere. He has a formidable colleague in the effort: Erich Spangenberg, a man who became reviled in Silicon Valley for bringing lawsuits against technology companies that he contended had infringed on a patent. By mid-November, the firm had filed 33 requests for patent reviews, targeting 13 drugs from a dozen companies
Pfizer’s Long War on Taxation (Andrew Ross Sorkin, Dealbook, NY Times, 11-30-15) "Long before Pfizer conceived of merging with Allergan in a $150 billion deal to rid itself of what its chief executive called an “an uncompetitive tax rate” in the United States, the company was deploying various tax avoidance strategies dating back to at least 1976....Pfizer has received at least $50 million in federal subsidies over nearly the last 15 years, according to the Corporate Research Project, a nonprofit that tracks corporate subsidies. And, still, it wants to leave the United States and move its headquarters to Ireland....The only way to end the inversion craze, or whatever tax avoidance plan comes next, is to comprehensively reform the corporate tax code."
Doctors Often Receive Payments From Drug Companies (Neal Conan, Talk of the Nation, NPR, 9-13-11) A Pro Publica investigation shows that many doctors are being paid by the same drug companies whose medicines they prescribe. By 2013, all doctors must report any payments from pharmaceutical companies to the federal government, and those records will be available to the public.
Dollars for Doctors: How Industry Money Reaches Physicians (a major Pro Publica investigative series, by by Eric Sagara, Charles Ornstein, Tracy Weber, Ryann Grochowski Jones and Jeremy B. Merrill, 9-24-14) In recent years, drug companies have started releasing details of the payments they make to doctors and other health professionals for promotional talks, research and consulting. As of 2014, 17 companies published the information, most because of legal settlements. Several pieces appeared in this series and are still online. See also We’ve Updated Dollars for Docs. Here’s What’s New. (Ryann Grochowski Jones, Mike Tigas and Charles Ornstein, Pro Publica, 12-13-16) "Companies made about $2 billion in general payments to 618,000 physicians each year, in addition to another $600 million a year to teaching hospitals. General payments cover promotional speaking, consulting, meals, travel, gifts and royalties, but not research. The specific doctors who received payments changed quite a bit from 2014 to 2015; a quarter of doctors who received a payment in 2015 didn’t receive one in 2014, and vice versa. The 10 drugs for which companies spent the most in payments to physicians in 2015 (teaching hospital payments not included) were blood thinner Xarelto ($28.4 million), rheumatoid arthritis drug Humira ($24.9 million), diabetes drug Invokana ($20.9 million), hepatitis C drug Viekira ($19.2 million), blood thinner Eliquis ($18.8 million), diabetes drug Bydureon ($18.5 million), testosterone drug Androgel ($15.3 million), thyroid drug Synthroid ($14.7 million), synthetic hormone Lupron ($14.3 million) and diabetes drug Victoza ($11.9 million)."
MIA In The War On Cancer: Where Are The Low-Cost Treatments? (Jake Bernstein, Pro Publica and The Daily Beast, 4-23-14) Big Pharma’s focus on blockbuster cancer drugs squeezes out research into potential treatments that are more affordable. Says one researcher: “What is scientific and sexy is driven by what can be monetized....Animal studies, in vitro experiments and analysis of patient outcomes suggest that aspirin might help inhibit breast cancer from spreading. Yet even her peers on scientific advisory boards appear uninterested, she says. "For some reason a drug that could be patented would get a randomized trial, but aspirin, which has amazing properties, goes unexplored because it's 99 cents at CVS," says Michelle Holmes.
Pay to Prescribe? Two Dozen Doctors Named in Novartis Kickback Case (Theodoric Meyer, ProPublica, 5-3-13)
Dollars for Docs How Industry Dollars Reach Your Doctors (Eric Sagara, Charles Ornstein, Tracy Weber, Ryann Grochowski Jones and Jeremy B. Merrill, for ProPublica, Updated 3-3-14). See if Your Health Professional Has Received Drug Company Money.
As Full Disclosure Nears, Doctors’ Pay for Drug Talks Plummets (Charles Ornstein, Eric Sagara and Ryann Grochowski Jones, ProPublica, 3-3-14) As transparency increases and blockbuster drugs lose patent protection, drug companies have dramatically scaled back payments to doctors for promotional talks. This fall, all drug and medical device companies will be required to report payments to doctors.
Medicare Drugs Turn Doctors into Millionaires (Walter Russell Mead & Staff, The American Interest, 4-10-14)
Prescribing Under the Influence (E. Haavi Morreim, Markkula Center of Applied Ethics, Santa Clara University)

Why Are Drug Costs So High in the United States? (Roxanne Nelson, Medscape Multispecialty, 11-19-14--registration required).
Patent-Protected Oral Cancer Drugs Are Drivers of High Costs (Roxanne Nelson, Medscape Multispecialty, 10-13-14)
'Parity' Laws for Costly Oral Cancer Drugs Not a Solution (Nick Mulcahy, Medscape Specialty, 10-2-14)
Cancer Drug Costs: Oncologists Must Be 'Part of the Solution' (Zosia Chustecka, Medscape Multispecialty, 9-6-13)
Price of 'Phenomenally Expensive' Cancer Drug Slashed (Nick Mulcahy, Medscape Multispecialty, 11-9-12)
Administration Is Seeking Ways to Keep Prescription Drugs Affordable (Robert Pear, Politics, NY Times, 11-20-15) News about soaring drug costs, such as the decision by Turing Pharmaceuticals to raise the price of a 62-year-old treatment for parasitic infection to $750 a pill from $13.50 overnight, has focused public attention and anger on pharmaceutical costs. Researchers are developing remarkable cures, but they might be out of reach for people who need them most. Opinion polls show that a majority of Americans of both political parties support government action to hold down drug costs. Some proposals have languished in Washington for years, such as allowing the government to negotiate with drug companies to obtain lower prices on medications for Medicare. Others urged reconfiguring health insurance policies so they pay drugmakers more for medicines that are highly effective. Patients might not have any co-payments for “the highest-value drugs,” he suggested, but would face higher co-payments for drugs with fewer proven benefits. "No one expressed the views of the many Republicans in Congress, who oppose any increase in the federal role in setting, regulating or negotiating prices." Federal officials could take administrative actions to help slow the growth of drug spending in federal health programs.
• What's the value of a drug? Norman Bauman: "Suppose you're dying of cancer, and a drug company has a drug which will save your life. How much is your life worth? That's the value of the drug. The company realizes that there's a supply-demand curve. If they price the drug at $1,000, they can sell 1,000 doses, save 1,000 lives, and make $1
million. If they price the drug at $100,000, they might only sell 100 doses, and save only 100 lives, but they make $10 million.
Big Pharma Quietly Enlists Leading Professors to Justify $1,000-Per-Day Drugs (Annie Waldman, ProPublica, 2-23-17) "As it readies for battle with President Trump over drug prices, the pharmaceutical industry is deploying economists and health care experts from the nation’s top universities. In scholarly articles, blogs and conferences, they lend their prestige to the lobbying blitz, without always disclosing their corporate ties."
Customers Sue UnitedHealth Over Prescription Drug Co-Pay Costs (Reuters, 10-5-16) UnitedHealth Group Inc has been sued by three customers who accused the largest U.S. health insurer of charging co-payments for prescription drugs that were higher than their actual cost and pocketing the difference.

Liz Fowler, Top Obama Health Care Aide, To Lobby For Johnson & Johnson (Christina Wilkie, Huff Post, 12-5-12)
Medicare Drug Planners Now Lobbyists, With Billions at Stake (Olga Pierce, ProPublica, 10-20-09) The Guardian follows the saga of Liz Fowler, healthcare lobbyist extraordinaire
AZT's Inhuman Cost (OpEd, NY Times, 8-28-89) "Drug companies deserve high profits on new drugs to encourage invention and risk-taking. What makes the cost of AZT hard to swallow is that all the invention and much of the risk was undertaken by the Federal Government....In 1984, Samuel Broder of the National Cancer Institute encouraged companies to submit possible anti-AIDS drugs for screening by a special test developed in his laboratory. Burroughs Wellcome sent in AZT, a compound it happened to have on its shelves after studying it for another purpose."
Hospitals probed on use of drug discounts (Ames Alexander and Karen Garloch, Charlotte Observer, 9-29-12). U.S. Sen. Chuck Grassley, Congress’ leading critic of nonprofit abuses, has asked three of North Carolina’s largest hospitals to share information about their use of a rapidly growing discount drug program, saying they don’t appear to be passing along the “massive” savings to patients.
After Merger, Two Competing Drugs and Billion-Dollar Questions (Gretchen Morgenson, Fair Game, NY Times, 11-13-15) The investing world is riddled with conflicts of interest that can surprise even the most sophisticated investor. Learning that lesson the hard way are holders of an instrument issued in 2011 when Sanofi, the giant French pharmaceutical company, took over Genzyme, a biotech concern based in Cambridge, Mass. ... The lawsuit charged that Sanofi did not follow the F.D.A.’s clearly stated recommendation that Genzyme conduct a double-blind clinical trial with Lemtrada.... But if Sanofi is found to have slow-walked the Lemtrada approval and marketing process to avoid a payout, the rights holders may not be the only ones hurt in the process. Around the world, some 2.3 million people are affected by multiple sclerosis; among them are patients who might have benefited from Lemtrada.
The Cost of Cancer Drugs (Lesley Stahl 60 Minutes, 10-4-14--both recording and full transcript and MANY comments) The high cost of cancer drugs is driving many cancer patients into bankruptcy ("financial toxicity"). "Another reason drug prices are so expensive is that according to an independent study, the single biggest source of income for private practice oncologists is the commission they make from cancer drugs. They're the ones who buy them wholesale from the pharmaceutical companies, and sell them retail to their patients. The mark-up for Medicare patients is guaranteed by law: the average in the case of Zaltrap was six percent. Dr. Leonard Saltz: What that does is create a very substantial incentive to use a more expensive drug, because if you're getting six percent of $10, that's nothing. If you're getting six percent of $10,000 that starts to add up. So now you have a real conflict of interest. But it all starts with the drug companies setting the price."
The top 10 Medicare billers explain why they charged $121M in one year (Jason Millan, Wonkblog, 4-9-14) "Some doctors said they were just passing through the payment to drug companies. But the Medicare payment system also incentivizes physicians to choose more expensive drugs, since they’re reimbursed for the average price of the drug plus 6 percent."
Behind the Scenes on Those Enormous Medicare Billing Numbers (Kevin Drum, Health Care, Mother Jones, 4-10-14). "Medicare pays doctors a percentage of the cost of the drugs they use" (e.g., 6%) which gives them an incentive to prescribe the most expensive medication they can, even if two alternatives are equally effective and one is twice as costly. The pharmaceutical industry would lobby to keep the 6% fee, but clearly this policy should be changed.
Why Is Insulin So Expensive in the U.S.? (Anders Kelto, Morning Edition, NPR, 3-19-15) Doctors are influenced by marketing, and get caught up in marketing hype, thinking newer is probably better. "But newer drugs aren't always better... That's partly because drug companies don't have to prove that a new drug is better than what is already on the market — they just have to prove that it's not worse." Less expensive forms of insulin that are no longer available in U.S. are available in Canada and elsewhere.
Dollars for Docs: How Industry Dollars Reach Your Doctors (Jeremy B. Merrill, Charles Ornstein, Tracy Weber, Sisi Wei and Dan Nguyen, ProPublica updated 9-29-14)
Dollars for Docs: doctors receive money from drug companies (Tampa Bay, 10 News) Your doctors can't receive promotional products like pens, notepads, or mugs from drug companies because of a perceived conflict of interest. But accepting hundreds of thousands of dollars for speaking engagements is a widely-accepted practice.
A Clinical Drug Study at the University of Minnesota Department of Psychiatry: The Dan Markingson Case (PDF, report from the Minnesota Legislative Auditor about the University of Minnesota's ethical violations in a psychiatric clinical trial, which ended in the suicide of one of the participants.
Human subjects protections under fire at the University of Minnesota (Jennifer Couzin-Frankel, Science, 3-2-150
University of Minnesota Blasted for Deadly Clinical Trial (Carl Elliott, Mother Jones, 4-3-15) A blistering new government report cites "serious ethical issues" and vindicates a Mother Jones investigation.
U of M suspends enrollment in psychiatric drug trials in the wake of scathing report on Markingson case (Susan Perry, MinnPost, 3-20-15). "AstraZeneca, the financial sponsor of the CAFÉ drug study, prorated its payments to the University based on the number of subjects Dr. Olson enrolled in the study and the number of follow-up meetings the subjects completed. Dr. Olson’s goal was to enroll 30 people, and he had difficulty meeting that goal. This created an incentive to enroll and keep Dan Markingson in the CAFÉ drug study in November 2003." Among other things.
Opioid Prescribing for Chronic Pain — Achieving the Right Balance through Education (Daniel P. Alford, N Engl J Med 2016, 1-28-16) "I believe that the medical profession is compassionate enough and bright enough to learn how to prescribe opioids, when they are indicated, in ways that maximize benefit and minimize harm. Though managing chronic pain is complicated and time consuming and carries risk, we owe it to our patients to ensure access to comprehensive pain management, including the medically appropriate use of opioids."
The legal drug epidemic(Charles Lane, Wash Post, Opinion, 3-11-15) "the United States’ massive investment in reducing avoidable deaths from other causes has been undone to a large extent by avoidable deaths stemming from the abuse of opioids, whose trade names include OxyContin, Vicodin and Percocet....the American establishment — corporate, governmental and medical — ...blessed the wider use of modern opioids in the belief that pain was vastly undertreated and that new, extended-release opioid formulations would not be addictive"...America’s deadly prescription opioid epidemic stemmed from a combination of greed, hubris and the best of intentions."
Fix the Medicare ‘doc fix’ with a long-term solution (Editorial, Wash Post, 3-25-15)
Medicare changes must be implemented now (Wash Post editorial, 6-15-15)
CU: Open Payments site will help shine spotlight on potential conflicts of interest between doctors and drug, device makers (Consumers Union)
What Is Your Doctor Getting Paid? (Pew Charitable Trusts, 9-29-14) The Physician Payments Sunshine Act requires that financial relationships between physicians and industry be made public on a government website known as Open Payments
The Physician Payments Sunshine Act (Health Affairs, 10-2-14)
FBI files tell how addicted agent was able to get the drugs (Peter Hermann, Wash Post, 1-15-15) A system of weak checks and balances allowed Matthew Lowry’s thefts and drug use to go undetected for at least 14 months as he worked on a task force focusing on heroin traffickers along the borders of the District, Maryland and Virginia.
Keep Out of Reach of Children: Reye's Syndrome, Aspirin, and the Politics of Public Health by Mark A. Largent. "“A well-researched history of Reye’s syndrome that explores how science, medicine and politics interact. . . . As Largent examines the dispute over whether to require warning labels on bottles of aspirin, he also scrutinizes the actions and interactions—some might say the machinations—of pharmaceutical companies, consumer rights groups, epidemiologists, public health officials, courts and the U.S. Congress. . . . A revealing work.” —Kirkus Reviews
New rules on narcotic painkillers cause grief for veterans and VA (Emily Wax-Thibodeaux, Wash Post, 2-18-15) DEA restrictions adopted to curb opioid abuse mean many vets have to make more appointments with an already overburdened VA.
The Effectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop (Roger Chou, Judith A. Turner, Emily B. Devine, et al., Annals of Internal Medicine, online 1-13-15, doi:10.7326/M14-2559).
Opioids for long-term treatment of noncancer pain (M Noble, JR Treadwell, SJ Tregear, et al., Cochran Review, 11-10-10) "Many patients discontinue long-term opioid therapy (especially oral opioids) due to adverse events or insufficient pain relief; however, weak evidence suggests that patients who are able to continue opioids long-term experience clinically significant pain relief."
Management of chronic pain in older adults (Reid MC, Eccleston C, Pillemer K. BMJ. February 13, 2015. 350:h532 http://dx.doi.org/10.1136/bmj.h532. There are few randomized controlled trials to tell doctors what works or doesn't work, so we have little evidence one way or the other.
Medicare Overbilling Probes Run Into Political Pressure ( Christopher S. Stewart and Christopher Weaver, WSJ). "When investigators suspected that Houston’s Riverside General Hospital had filed Medicare claims for patients who weren’t treated, they moved to block all payments to the facility. Then politics intervened. "
Doctors Cash In on Drug Tests for Seniors (Christopher Weaver, WSJ, reposted on MSN Money, 11-11-14) For dozens of pain doctors, Medicare payments for drug testing have eclipsed their income from treating patients. Some labs encourage doctors to refer more patient specimens for drug testing by giving physicians an ownership stake or a cut of test revenue.
The Slippery Slope: Is a Surrogate Endpoint Evidence of Efficacy? - An analysis of 54 new molecular entities approved by the FDA over the last decade to treat cancer. (John Fauber, Reporter, Milwaukee Journal Sentinel/MedPage Today; Elbert Chu , Staff Writer, MedPage Today, 10-26-14). Many cancer drugs approved on the basis of progression-free survival have failed to show improvements in overall survival in postmarketing surveillance. Requiring studies to address overall survival will increase study size, cost, and time to drug availability--but such outcomes will ensure that the public is paying for efficacious therapies.
The Slippery Slope: Risks and Confusion: An examination of toxicity versus durable benefit. (Fauber and Chu, Part 2, 10-26-14). The FDA has been approving dozens of cancer drugs based on what are known as surrogate measures -- such as the shrinking of a tumor -- rather than based on proof the treatment extends life. Some experts say that the FDA has set up a system that favors technical benefits over proven longevity and quality-of-life improvements although some drugs approved despite serious side effects have proven to be successful.
Surrogate markers may not tell the whole story (HealthNewsReview)
F.D.A. Rejects Use of Drug in Cases of Breast Cancer (Andrew Pollack, NY Times, 12-16-10) Another take on the same story: The Avastin Mugging: The FDA rigs the verdict against a good cancer drug. (Joseph Rago, editorial, Wall Street Journal, 8-18-10). As at least one medical journalist has pointed out, Rago clearly didn't understand the difference between progression-free survival and overall survival and he didn't mention the cardiac toxicity of bevacizumab, and the lowered quality of life.
Detailing Financial Links of Doctors and Drug Makers (Katie Thomas, Agustin Armendariz, and Sarah Cohen, NY Times, 9-30-14)
Persuading the Prescribers: Pharmaceutical Industry Marketing and its Influence on Physicians and Patients (Pew Charitable Trusts, 11-11-13)
Anaphylactic Sticker Shock (Terry J. Allen, In These Times, 8-4-14) Road trip! Or, two middle-aged women go on a Hunter S. Thompson-esque drug-buying spree across an international border. And score. "EpiPens used to be cheap—just $35.59 wholesale in 1986. Harvie now pays $333 for a two-pack—the only option (which, given an 18-month-from-manufacture shelf life, ensures waste and risks reliance on an expired device)."
The Truth About the Drug Companies (Marcia Angell, NY Review of Books, 7-15-04). Bottom line in in this important piece: "Contrary to the [drug] industry’s public relations, [citizens] don’t get what they pay for. The fact is that this industry is taking us for a ride, and there will be no real reform without an aroused and determined public to make it happen." Angell is on the board of Physicians for a National Health Program and advocates a single payer health plan.
The Medication Generation (Katherine Sharpe, The Saturday Essay, WSJ, 6-29-12) Many young people today have now spent most of their lives on antidepressants. Have the drugs made them 'emotionally illiterate'?
[Back to Top]

High-Cost Generic Drugs — Implications for Patients and Policymakers (New England Journal of Medicine, 11-13-14)
The Psychiatric Drug Crisis (Gary Greenberg, Elements blog, New Yorker, 9-3-13) What happened to psychiatry's magic bullets? "Having been discovered by accident, they lacked one important element: a theory that accounted for why they worked (or, in many cases, did not). That didn’t stop drug makers and doctors from claiming that they knew....Bedazzled by the prospect of unraveling the mysteries of psychic suffering, researchers have spent recent decades on a fool’s errand—chasing down chemical imbalances that don’t exist."
Mind Over Misery (Robert L. Strauss, Stanford magazine, September/October 2013) Psychiatrist David Burns wants people to reason their way through anxiety and depression into happiness. A persuasive account of the effectiveness of cognitive behavioral therapy (CBT). " Says Irving Kirsch: "One hundred years from now

Comments

  1. March 2, 2016 4:49 PM EST
    Waste in Cancer Drugs Costs $3 Billion a Year, a Study Says (Gardiner Harris NY Times, 3-1-16) "The federal Medicare program and private health insurers waste nearly $3 billion every year buying cancer medicines that are thrown out because many drug makers distribute the drugs only in vials that hold too much for most patients, a group of cancer researchers has found. Some of these medicines are distributed in smaller vial sizes in Europe, where governments play a more active role than the United States does in drug pricing and distribution.where governments play a more active role than the United States does in drug pricing and distribution....“Drug companies are quietly making billions forcing little old ladies to buy enough medicine to treat football players, and regulators have completely missed it,” said Dr. Peter B. Bach, director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering and a co-author of the study. “If we’re ever going to start saving money in health care, this is an obvious place to cut.”... Pfizer and Merck spend just 17 percent of their revenues finding new drugs.
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  2. March 9, 2016 2:38 PM EST
    U.S. to Test Ways to Cut Drug Prices in Medicare (Robert Pear, NY Times, 3-8-16) The current payment formula provides “weak incentives” for doctors to choose the lowest-cost therapy to treat patients effectively, the administration said. Indeed, it said, the current payment formula “may encourage the use of higher-price drugs when lower-cost drugs of equivalent effectiveness are available.” Various alternatives being considered (and why).

    Medicare considers overhaul of doctors’ payments for drugs (Laurie McGinley, Wash Post, 3-8-16)

    GOP: Obama's Medicare drug plan costly and ineffective (Sarah Ferris, The Hill, 3-9-16) •

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  3. March 12, 2016 12:53 PM EST
    WikiLeaks cables: Pfizer 'used dirty tricks to avoid clinical trial payout' (Sarah Boseley, Guardian UK, 12-9-10). Cables say drug giant hired investigators to find evidence of corruption on Nigerian attorney general to persuade him to drop legal action.
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  4. June 21, 2016 11:40 AM EDT
    How a simple sandwich could be driving up drug prices (Carolyn Y. Johnson, WaPo, 6-20-16). "Doctors who ate a single meal on a drug company's tab had a higher likelihood of writing a prescription for the name-brand drug that was being promoted instead of equivalent drugs that were cheaper, according to a new study. And the more meals — or the more expensive the meals — the greater the rate of prescribing the pitched drug." It's not just extravagant gifts of value that affects doctors' drug-prescribing behavior. Even Cheap Meals Influence Doctors’ Drug Prescriptions, Study Suggests, writes the WSJ, reporting on the same study. Findings published by JAMA Internal Medicine suggest that even a single free meal can boost the likelihood a doctor will prescribe a certain drug
    - Pat McNees,
  5. June 23, 2016 5:59 PM EDT
    Cheaper drug first (Markian Hawryluk, The Bend Bulletin, 8-19-10) Insurance forces patients to try older drugs before getting new ones. "The debate has boiled over in recent years among doctors treating patients with fibromyalgia, a systemic condition marked by chronic pain and a host of difficult-to-treat symptoms. Until recently, there were no drugs specifically tested and approved for the treatment of fibromyalgia. Instead, doctors used a variety of medications approved to treat things like depression, seizures, pain or muscle spasms, a practice known as off-label use. "Then in 2007, Pfizer's Lyrica became the first drug approved by the Food and Drug Administration specifically for the treatment of fibromyalgia. Doctors thought it would be their go-to medication for treating the condition, but insurers thought differently.... "Physicians were stunned that insurance companies would force them to prescribe a drug that wasn't even approved for fibromyalgia before they could use a drug that was."
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  6. July 4, 2016 3:23 PM EDT
    Doctors received $6.5 billion from drug and device companies in 2015 (Carolyn Y. Johnson, WaPo, 6-30-16) "Doctors received $6.5 billion worth of payments — including meals, research grants and charitable contributions from drug and medical device companies in the last year, according to new data released Thursday by the Centers for Medicare and Medicaid Services. They also owned a little over $1 billion in stock in the industry....critics say these payments are powerful marketing tools that can distort the use of health care in ways that drive up spending or lead to medical decisions that follow a company's commercial interests instead of the best medicine."
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  7. July 23, 2016 4:52 PM EDT
    UCSF Medical Center CEO profits from firms doing business with hospital (Nanette Asimov, SF Chronicle, 7-18-16) "UCSF Medical Center CEO Mark Laret has received an average of $556,000 annually in cash fees and equity from two companies that do business with the hospital." He sits on the boards of two companies (Varian Medical Systems of Palo Alto and Nuance Communications, a Massachusetts software company) that together do millions of dollars of business with his hospital and have paid him more than $5 million in stock awards and cash fees since 2007, a review of company filings shows....UC’s policy on “outside professional activities” for senior managers 'permits such arrangements if the executives do the extra work on personal time, and if it presents no conflict of interest or the appearance of one."
    - Pat McNees
  8. August 25, 2016 11:25 AM EDT
    EpiPen’s Price Hikes Draw Intense Scrutiny, Raise Ire Among Lawmakers (KHN Morning Briefings, 8-24-16) News outlets report on how the maker of the emergency allergy medicine came to raise the treatment's price tag by so much, how this move fits into the broader story of U.S. drug pricing policy and how the ensuing controversy will now play out both in the marketplace and on Capitol Hill. Clicking on that link takes you to several stories on the same subject, but with different takes.
    Vox: EpiPen’s 400 Percent Price Hike Tells Us A Lot About What’s Wrong With American Health Care The story of Mylan’s giant EpiPen price increase is, more fundamentally, a story about America's unique drug pricing policies. We are the only developed nation that lets drugmakers set their own prices, maximizing profits the same way sellers of chairs, mugs, shoes, or any other manufactured goods would. In Europe, Canada, and Australia, governments view the market for cures as essentially uncompetitive and set the price as part of a bureaucratic process, similar to how electricity or water are priced in regulated US utility markets. (Sarah Kliff, Vox, 8/23)
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  9. April 10, 2017 10:12 PM EDT
    How U.S. Health Care Became Big Business (on Fresh Air, 4-10-17, Terry Gross interviews Elisabeth Rosenthal, author of An American Sickness: How Healthcare Became Big Business and How You Can Take It Back). "Health care is a trillion-dollar industry in America, but are we getting what we pay for? Dr. Elisabeth Rosenthal, a medical journalist who formerly worked as a medical doctor, warns that the existing system too often focuses on financial incentives over health or science. "We've trusted a lot of our health care to for-profit businesses and it's their job, frankly, to make profit." Rosenthal's new book, An American Sickness, examines the deeply rooted problems of the existing health-care system and also offers suggestions for a way forward. She notes that under the current system, it's far more lucrative to provide a lifetime of treatments than a cure. She talks about what consolidation of hospitals is doing to the price of care, about the ways the health-care industry stands to profit more from lifetime treatment than it does from curing disease, about how prices will rise to whatever the market will bear, about how to decipher coded medical bills, and about why we must learn to initiate conversations early on with doctors about fees and medical bills. She also talks about getting charged for "drive-by doctors" brought in by the hospital or primary doctor.
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  10. June 3, 2017 12:10 PM EDT
    Pfizer has raised prices on nearly 100 drugs by an average of 20 percent (Ed Silverman, STAT, 6-2-17). That is for subscribers only. See also Reuters story, from Financial Times (also 6-2-17) "Drug pricing has become a contentious issue as a wave of new treatments for cancer and other serious conditions reach the market, some costing tens or hundreds of thousands of dollars. But the row is particularly fierce in the United States, where prices are higher than in Europe and where there have been highly publicized price hikes of some older drugs, such as Mylan's EpiPen."
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  11. July 25, 2017 10:28 AM EDT
    Follow The Money: Drugmakers Deploy Political Cash As Prices And Anger Mount (Jay Hancock, Elizabeth Lucas, and Sydney Lupkin, Kaiser Health News, 7-24-17) "Two federal investigations — one examining opioid sales, another about a multiple sclerosis drug whose price had soared to $34,000 a vial — were only part of the troubles Mallinckrodt faced as the year began." The drugmaker's stock was tanking. "Wall Street worried that Medicare might reduce the half-billion dollars it was spending yearly on a Mallinckrodt drug with limited evidence of effectiveness." Mallinckrodt has been spending its money on politicians instead of research. Read the article to see which politicians are collecting big pharma donations and which drugs are ratcheting up prices most outrageously.
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