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

by Pat McNees (Updated 9-16-19--further updates posted in Comments)
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. "
Price of Snakebite Drug Is Sky High, But New Competitor Unlikely to Lower Costs (Carmen Heredia Rodriguez, KHN, 8-8-19) In a case reported by Kaiser Health News and NPR (a 9-year-old hiker snakebitten at dusk on a nature trail), an Indiana hospital last summer charged nearly $68,000 for four vials of CroFab. CroFab faces competition from a snake antivenin called Anavip. But few experts who study drug laws and drug prices expect this competition to reduce the cost for patients. Legal wrangling, the advantageous use of the patent system and the regulatory hurdles in creating cheaper alternative drugs stymie any serious price competition. Indeed, the antivenin is a case study of why drug prices are so high. Head-to-head competition between brand-name medicines may not meaningfully reduce prices. “When we allow a system of perverse incentives to flourish, this is the result we get,” said Robin Feldman, a professor at the UC Hastings College of the Law in San Francisco who specializes in pharmacy law.
• "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."
• In response to legislation requiring pharmaceutical sales reps promoting medicines at doctors’ offices simply to reveal a price, pharma lobbyists were brought in to fight legislation requiring price transparency.
• 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.
• Provide "greater transparency in how drugs are priced, and how the money flows through the system. Pharmacy benefit managers have outsized power and take too much money from the system."
• 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. Because they've got the politicians wrapped around their little fingers. Read More 

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