Today, as the Obama administration hosted a “public” forum (think invitation only) about pharmaceutical innovation, access and affordability, I announced the formation of a non-profit organization dedicated to helping Americans get justice when it comes to prescription drug prices: Prescription Justice Action Group (PJAG). Whereas the administration’s public forum ignored personal drug importation, PJAG is providing guidance to Americans on what to do if their prescription drug orders are refused import by the FDA so they can try to have their medications released.

For about fifteen years, tens of millions of Americans have purchased medication from outside the U.S. –usually ordering it online. They do it because they want to save money or they really cannot afford the medication here at local pharmacies. The fact is that it has become a lifeline of lower cost medications for Americans.

But a new law – Section 708 of the Food and Drug Administration Safety and Innovation Act – gives the FDA expanded powers to destroy your personally imported medications, whether bought from a Canadian, Indian, Turkish or U.K. pharmacy. That doesn’t mean they will. It just means that they can. That law became effective over a month ago, and we haven’t heard of increased FDA seizures and destructions of international prescription orders.

The FDA has stated, and we have re-affirmed on our blog and main website, that under most circumstances it’s technically illegal to import prescription medication for personal use. But is it really? Is it always?

Section 708 allows the FDA to detain and potentially destroy your prescription order if it appears to be misbranded, unapproved, counterfeit or adulterated. If they take your adulterated or counterfeit drugs then the FDA has done their job. Misbranded or unapproved drugs, in contrast, could be entirely safe and effective medications, the same or foreign versions of the ones you buy in the U.S., but much less expensive. Under Section 708, you must be notified by the FDA if they take your prescription drug import, and you have 20 days to challenge them on their action. PJAG, in consultation with legal advisers, believes that you can make a good case that FDA should not destroy the medication but instead send it to you.

There are many dangerous online pharmacies out there from which you don’t want to buy or import medication. We call them rogue online pharmacies. But if you import a genuine, safe and effective medication, one that was purchased from a PharmacyChecker.com-approved online pharmacy and you get a notification from the FDA telling you that your prescription drug order is subject to destruction…PJAG!


Do Medicare Part D Plans Engage in Bait and Switch Practices? What Consumers are saying…

In this post, we’ll give you some snapshots of consumer frustration, pulled from www.MedicareDrugPlans.com (a website operated by PharmacyChecker.com), about the problem of medications getting dropped from Part D Plans and tell you what is and is not actually permissible. I believe this practice is well characterized by the phrase “bait and switch.” Just listen to Riley from California talk about Blue Shield Medicare Enhanced Plan:

“Keep changing the drugs in the formulary. Just get stabilized on a drug and they drop it from the formulary or charge high tier prices. Then you start on a different drug fine one that works then it is no long covered in next formulary. There is no concern for the patient doesn’t matter to them if you wind in the emergency room at a cost of many thousands of dollars and patient’s pain and discomfort. It is not their problem the medical coverage has to pay for it and the drug coverage have saved themselves some money at the cost of medical coverage, medicare and the patient.”

Before choosing a plan, most experts encourage people to research plan premium and deductible costs, pharmacy networks, gap coverage, and – most importantly – which drugs are covered in a plan’s formulary. The beauty of the government’s Medicare Plan Finder is that you get to actually type in your medications and find plans that cover those drugs. So imagine doing just that: you look on the government’s site and find a plan that covers the three medications you take. You’ve taken THE BAIT and enroll in that plan. Come January all is well, your costs are manageable and you pat yourself on the back for a research job well done. Then in March – THE SWITCH – you find out that the brand name drug prescribed by your doctor, which has worked well for you for years, will no longer be covered and you either have to take an alternative drug that is covered or pay for the drug as an out-of-pocket cost.

Is this type of bait and switch legal? Yes. After reviewing the regulation, 42 CFR 423.120, the law is clear that Part D plan sponsors can take a covered drug off its formulary. There are some caveats but I don’t believe they compensate for how unfair these formulary changes are. The plan must either give you 60 days notification before the formulary change goes into effect or if you go to the pharmacy for a refill the plan must cover the drug with a 60-day supply. In other words, they need to warn you about the bait and switch to give you time to figure out your next move.

Some enrollees seem to have had good experiences with a plan and then everything just tanks. We learn from one Michigan resident about an experience using the Cigna-HealthSpring Rx Secure plan

“After 5 years in plan they dropped coverage on 3 of my 5 scripts, no value now, cheaper to buy all on my own”

Some consumers gave greater details about the costs incurred due to these bait and switch practices. Here’s what one Floridian said about AARP MedicareRx Saver Plus:

“They dropped an important Blood Pressure medication (Micardis) for 2015 as well as others. Out of pocket cost went from 2013 -$60.00, then in 2014  $120.00 now in 2015 over $545.00 for 90 day supplies of Micardis through Optum RX their online med source. Too late for me, will look for a better Part D source come next year.”

Our friend from Florida could look for a new plan for 2016 but what guarantees to they have that the same bait and switch won’t occur?

Is there an upshot here? You do receive notification with 60 days to figure out what to do. The notification that you’ll receive about your drug being dropped must contain, to quote from the federal regulation, “alternative drugs in the same therapeutic category.” It might seem like small consolation if the medication you’ve been using works but do not rule out a pharmaceutical alternative, probably a lesser expensive generic, IF your prescriber believes it will work just as well.

If you and your healthcare provider decide you should take the drug that was dropped and not a pharmaceutical alternative, and the costs are too high domestically, then you might consider an international online pharmacy verified by PharmacyChecker.com. Brand name drugs are often 90% lower outside the U.S. when purchased from a verified online pharmacy.

Finally, there is an appeal process that you and your healthcare provider can use if you believe your plan isn’t covering the medications you need – including ones that they drop! I’ve read that this process can be a serious nightmare. But this is a blog post unto itself and I plan on covering this topic in the weeks to come.


On The Newly Formed Congressional Task Force on Prescription Drug Prices…

Affordable Drug Pricing Task Force Press Conference November 4, 2015
Americans should know about the heat coming down against the pharmaceutical industry from certain members of Congress in an effort to combat the public health crisis of high drug prices. This week, nine lawmakers from the House of Representatives announced the formation of a new group called the Affordable Drug Pricing Task Force. Its goals are clear, to lower cost barriers to life saving medication and to demand greater transparency about drug cost decisions made by the pharmaceutical industry.

Two pertinent facts were continually raised. One, high drug prices are the No. 1 healthcare issue in America. Two, medication prices are much lower in other countries, about 50% lower in the UK.

To announce the task force, a press conference was led by Congressman Lloyd Doggett (D-TX) and included speeches by Rep. Sander Levin (D-MI), Rep. Jan Schakowsky (D-MI), Rep. Jim McDermott (D-WA), Rep. Rosa DeLauro (D-CT), Rep. Peter Welch (D-VT), Rep. Marcy Kaptur (D-OH), Rep. David Cicilline (D-RI), and Congressman Elijah Cummings (D-MD). We wrote about Rep. Cummings’ efforts a couple of weeks back as Congressman Cummings noted PharmacyChecker.com as a supporter of the Prescription Drug Affordability Act of 2015. I also want to note  thank Congresswoman DeLauro for recently becoming a co-sponsor of the Personal Drug Importation Fairness Act of 2015.

The speakers have supported a variety of solutions to lowering drug prices, including allowing Medicare to negotiate drug prices with pharmaceutical companies; ending “pay-for-delay,” a practice sometimes described as payoffs by brand drug patent holders to generic drug companies to that the latter will postpone launching a lower cost generic; reforming prescription drug importation laws to make it easier to access lower cost medications from other countries; and greater oversight into pharmaceutical industry pricing practices.

Some highlighted quotes or phrases:

  • “If the people are not able to afford their prescriptions that means they suffer and in some instances they die.” Rep. Cummings.
  • McDermott’s take: “The pharmaceutical companies have got the Congress in the palm of their hand and they will not let us go.”
  • The problem of high drug prices was referred to as an “emergency situation” by Rep. Sander Levin.

It’s no secret that I support much of this agenda. But what is needed is bipartisanship, and I’m waiting for these leaders, as part of their noble effort, to consider looking critically at the Obama administration’s record on personal drug importation and online pharmacies. Candidate Obama in 2007 supported reforming the law to make it easier for Americans to import lower cost medication. Unfortunately, in its efforts to pass the Affordable Care Act, which I supported, the Obama administration made a deal with big pharma to change course and dump drug importation legal reform in exchange for pharma’s support for Obamacare and agreement to new discounts on Medicare Part D medications through the coverage gap (the “Donut hole”).

On that final note, the Obama administration, though the Department of Health and Human Services (HHS), has announced a forum on drug prices to be held on November 20th. Maybe we’ll learn that the Obama administration’s position on prescription drug importation has returned to one more in line with most Americans. We’ll keep our fingers crossed.

(You can view the complete press conference below)

Affordable Drug Pricing Task Force Press Conference

Members of the newly formed Affordable Drug Pricing Task Force will hold a press conference announcing meaningful action to combat the skyrocketing costs of pharmaceuticals. Who: Reps. Cummings, Doggett, McDermott, DeLauro, Schakowsky, and Welch.

Affordable Drug Pricing Task Force Press Conference – Nov 4, 2015


Part D Medicare Drug Plans 2016 – Know the Basics, Then Get Down to Work

Photograph of Pills and Money
We’re two weeks into the open enrollment period of Part D Medicare Drug Plans and it is my deepest hope that if you are a Medicare enrollee then you are taking time to find the best plan. It’s not easy. Finding the right plan, however, could mean getting the medications you need to stay healthy, saving money, and avoiding lots of headaches throughout the year. Our website, MedicareDrugPlans.com, gives you basic information, such as premiums, deductibles and coverage levels, but also ratings and reviews about Part D plans that can inform you about the experiences of your peers in using the different plans. Your final search should be with the government’s website – Medicare Plan Finder – where you can find the plans that cover the medications you are already taking now and specific costs related to those plans. Below are key points about costs and coverage.

Part D Plan Costs

Plan costs have gone up this year. The deductible cap increased by 12.5%, from $320 to $360. Fifty-three percent of the plans are charging the full deductible, while the other 47% charge less. Average premiums have increased from $36.68 in 2015 to $41.46 in 2016. The lowest monthly premium is $6.80, that’s if you live in Puerto Rico and choose the Humana Preferred Rx Plan. The highest premium is $174.70, that’s if you live in Florida and choose Blue MedicareRx Option 2.

Part D Plan Choices

The overall trend of having fewer Part D plans to choose from continues this enrollment season, down to 886 this year compared to 1001 last year. Looked at historically, the declines are even more striking, as there were 1,875 plans in 2007. These numbers are the totals available in all states and U.S. territories but options are really state-based. Alaskans had only 19 plans to choose from, compared to a high of 29 in West Virginia and Pennsylvania.

Part D Plan Coverages Phases

There are four coverage phases for Part D plans: deductible, initial coverage period, the coverage gap, often referred to as the “donut hole,” and catastrophic coverage. The deductible is pretty straightforward–you pay the full cost of your medications up until that dollar amount, which can be as high as $360. During the initial coverage period, you usually pay about 25% of drug costs and the plan picks up 75% until total costs have reached $3,310. At that point you’re in the coverage gap, but you’re paying discounted prices, 45% and 58% of brand and generic drug costs, respectively. Once total costs have exceeded $7,515, you are in catastrophic coverage territory, and only have to pay 5% of your total drug costs until the next year begins.

Understanding these generalities about Part D plans is important, but the devil is in the details, which can only be understood through research. It’s not enough to just stick with the plan you have. Nine out of 10 Medicare enrollees do not change plans, and many end up with higher drug costs because they don’t. The landscape of plans changes every year; so do your research, shop around, and get the best plan for your health and wallet!

For a thorough plan analysis see Kaiser Family Foundation.

For ratings and reviews, check out www.medicaredrugplans.com.

To finalize your decision go to Medicare Plan Finder.


Elijah_CummingsCropIn his article for AFRO – “A Growing National Outcry for Lower Prescription Drug Prices” – we were pleased to be noted by Congressman Elijah Cummings (D-MD) as a supporter of the Prescription Drug Affordability Act of 2015, and one of several organizations, including Public Citizen, Families USA, and Knowledge Ecology International that “speak of millions of Americans.” The bill was also introduced in the Senate by Senator Bernie Sanders (I-VT), who is a candidate for the Democratic Primary.

Rep. Cummings highlights the fact that American public opinion is overwhelmingly in favor of legal and regulatory reform to bring down drug prices. His legislation calls for Medicare to negotiate drug prices with drug companies, ending “pay-to-delay” deals, which are often characterized as payoffs from brand to generic drug companies to postpone introducing a lower cost generic, and reforming drug importation laws to expand our access to lower cost medications in other countries.

PharmacyChecker.com is not taking sides in a partisan fashion. Republicans, Democrats, and independents agree on the urgency of tackling drug prices in America. Sen. John McCain (R-AZ), Charles Grassley (R-IW), and David Vitter (R-LA) have all introduced and sponsored drug importation reform legislation over the past few years that we support. Another example is Republican presidential candidate Mike Huckabee, who wrote an op-ed strongly in favor of legal reform of drug importation to help Americans buy lower cost medications from Canada.

The most critical factor is that we move in the right direction towards expanding access to affordable medication, and we salute Congressman Cummings for doing so.


Woman with Migraine
Migraine” by Sasha Wolff from Grand Rapids – Can’t Concentrate: 14/365. Licensed under CC BY 2.0 via Wikimedia Commons.

Dr. David Belk, a practicing physician in California, healthcare cost research guru and Huffington Post blogger, recently wrote a story about the huge difference in price faced by one of his patients when trying to fill a prescription for the migraine medication called Maxalt (rizatriptan). Since my daughter suffers from migraines, I know how debilitating migraine headache can be and how important it is to have the medication when you need it.

Essentially, Dr. Belk discovered that Walgreens, a big chain pharmacy, was charging much more money than another pharmacy – in this case Costco. The price for the generic at Walgreens without insurance was $1,490 for 40 pills, or $37 a pill, and even with insurance the price was almost $17 dollars a pill. But Dr. Belk’s patient ended up getting the medication at Costco for $1.03 per pill!!

Now ordinarily here’s where we’d write about how you might consider PharmacyChecker- verified international online pharmacies to purchase Maxalt or rizatriptin if you don’t have insurance – but you would not need to. According to Dr. Belk’s post, Costco’s price was the cash price! None of the online pharmacies in our program sell it for just over a buck a pill. It’s the cheapest in the U.S.A.!

A few months back, Tod Cooperman, MD, founder of PharmacyChecker.com was on Fox and Friends talking about another big chain pharmacy, one accused of overcharging consumers for generic medications. It seems that the problem is not just Big Pharma but Big Pharmacy.

Drug prices these days seem to be all over the place. The moral of this story: shop around as much as possible and don’t trust your friendly neighborhood chain pharmacy or assume that international online pharmacies are cheapest. I know it’s enough to give you a headache, even a migraine, but finding the lowest drug prices will help lessen the pain.


"Abstract pills" by Robson# - Flickr: Pills here. Licensed under CC BY 2.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Abstract_pills.jpg#/media/File:Abstract_pills.jpg

“Abstract pills” by Robson – Flickr

We issued a press release yesterday about our new drug price savings analysis, which shows that consumers can save 84% on average among a basket of 10 popular branded maintenance medications if purchased from verified international online pharmacies instead of local U.S. pharmacies. Many of the savings are over 90%! The greatest savings is 94% for the acid-blocking drug Nexium ($946.50 in the U.S. vs. $53.09 online for a three month supply of 40 mg pills) and the cholesterol-lowering drug Crestor ($803.89 vs. $51.40 – 20 mg pills). The greatest dollar savings is for the antipsychotic drug Abilify ($3,178.99 vs. $237.05 – 10 mg pills). The average annual savings per drug is $3,479. Despite this, last month, the U.S. FDA announced a “new rule” regarding its expanded authority to destroy personally imported medicine under Section 708 of the Food and Drug Administration Safety Act of 2012. Several members of congress have raised concern that FDA’s rules may impede access to affordable medication. [1]

The FDA says that its new regulation is meant to protect patients from unsafe medications and counterfeit drugs but the agency doesn’t seem to say how they will distinguish safe from potentially unsafe personal drug imports.

For the full press release, click here.

Prices for a 3-month supply of top-selling brand name medications
Drug Local U.S. Pharmacy Price International Online Pharmacy Price* International Online Savings Annual Savings
Nexium 40mg $946.50 $53.09 94% $3,573.64
Crestor 20mg $803.89 $51.40 94% $3,009.96
Abilify 10mg $3,178.99 $237.05 93% $11,767.75
Advair Diskus 250/50mcg (180 doses) $1,203.00 $99.99 92% $4,412.04
Spiriva Handihaler 18mcg $1,221.00 $113.99 91% $4,428.04
Diovan 80mg $611.99 $57.85 91% $2,216.56
Synthroid 100mcg $137.99 $26.99 80% $444.00
Jardiance 10mg $1,150.00 $287.99 75% $3,448.04
Ventolin HFA 100mcg $192.00 $68.82 64% $492.72
Lantus Solostar 15ml $397.89 $148.94 63% $995.80
Average $984.33 $114.62 84% $3,478.85

Sources: Local pharmacy prices based on prices at chain drugstores in New York City; International online pharmacy prices based on lowest prices listed on PharmacyChecker.com. All prices obtained on September 30, 2015.

*Medications dispensed by licensed pharmacies, verified by PharmacyChecker.com, in one of the following countries Australia, Barbados, Canada, India, Mauritius, New Zealand, Turkey, Singapore, or United Kingdom.

[1] U.S. Senator David Vitter, “Vitter Fights to Keep Prescription Drug Prices Affordable Through Reimportation,” July 9, 2014 [press release], see [www] vitter.senate.gov/newsroom/press/vitter-fights-to-keep-prescription-drug-prices-affordablethrough-reimportation [Last accessed 9/20/14]. 38 Representative JoAnn Emerson (MO), “Food and Drug Administration Reform Act.” May 30th 2012. See [www] votesmart.org/public-statement/702416/food-and-drug-administration-reform-act-of-2012#.UxVJN-co4s9 [Last accessed 9/22/14]. Letter to the U.S. Food and Drug Administration by Congressman Keith Ellison dated July 1st, 2014. See See [www] regulations.gov/#!documentDetail;D=FDA-2014-N-0504-0022.


The Daraprim Drama: Prices Keep Going Up in the U.S. AND at Foreign Online Pharmacies

Contrary to the belief of the pharmaceutical industry and their minions, PharmacyChecker.com is not a champion of foreign online pharmacies, even the safest ones.  They just charge a lot less for medication, which helps American consumers stay healthy and avoid bankruptcy. But they are, like their U.S. pharmacy counterparts, just businesses.

Drug prices up up up

And that brings us back to our blog topic from last week, which was Daraprim, the parasite-fighting drug that, in the blink of an eye, went from $13.50/pill to $750/pill in the U.S. a few weeks back. We wrote what seemed impossible: a 99.8% international pharmacy savings on a medication. When we published that post, the price of Daraprim, manufactured and marketed by GlaxoSmithKline in Europe, was $1.53 a pill at the lowest cost international online pharmacy in the PharmacyChecker Verification Program. Well, those international online pharmacies jacked their prices, too…kind of.

As PharmacyChecker founder Tod Cooperman, MD, was writing an article for the Huffington Post about Daraprim, prescription drug importation and overall drug affordability problems, we discovered that the online price of Daraprim 25mg jumped from $1.53 a pill to $6 bucks! An increase of 292%.

It was reported that the villain of this whole story, the head of Turing Pharmaceuticals, the company that owns Daraprim in the U.S., was planning on lowering the price of Daraprim, which appeared to be an almost necessary public relations move. I called chain pharmacy giant Walgreens today expecting that the price would be less than $750 but found out that the price was actually $796/pill.

So the potential international drug price savings on Daraprim has plummeted from 99.8% to 99.25% A little Rx irony to end our week here at PharmacyChecker.com.


Tagged with:
Martin Shkreli trying to look cool

Martin Shkreli, founder and chief executive of Turing Pharmaceuticals. Not that cool.

It’s no secret that Americans are unhappy with Big Pharma. Pharmaceutical companies regularly rank as one of the least loved industries, right up there (or down there) with Big Oil and Big Government. And while this has usually been expressed as contempt towards the industry as a whole, recently the negative spotlight is shining brightly on one man: Martin Shkreli, hedge fund investor and drug company entrepreneur.

Soon after his company Turing Pharmaceuticals purchased the marketing rights to the drug Daraprim, Shkreli raised the price of Daraprim from $13.50 per pill to $750.00 per pill in the U.S. market where Turing has exclusive marketing rights. But that only affects America! Thankfully, consumers can purchase Daraprim, marketed by GlaxoSmithKline in the UK, from a verified international online pharmacy for as low as only $1.53 per pill. A mere savings of 99.8%.

Daraprim is used to treat toxoplasmosis, a disease that results from infection with the Toxoplasma gondii parasite. This parasite is very common (in fact it’s been estimated that 22% of U.S. population have been exposed to it and it usually infects people who have eaten undercooked meat, raw vegetables, or have handled cat feces. In healthy people it usually only causes flu-like systems. However this disease can cause severe complications in people with compromised immune systems, such as those with HIV or cancer, including brain lesions and seizures. The disease can also be very harmful to women who are pregnant, leading to a stillborn child or a child born with birth defects.

It’s not rare for medications that treat a rare disease or a small patient population to be expensive. Moreover, it’s understandable that pharmaceutical companies want to recoup the extensive costs of developing a drug and make a profit, although Big Pharma’s lust for profits appears insatiable. But let’s take a deep breath…Daraprim is not some new wonder drug. It was originally developed and marketed by Burroughs Wellcome and patented back in 1953 (the patent expired in the 70s). A relatively inexpensive drug, it was long manufactured by GlaxoSmithKline, until that company sold the U.S. marketing rights to CorePharma in 2010. Impax Laboratories later bought CorePharma, and turned around and sold the rights to the drug to Turing.

At that point Mr. Shkreli and our friends at Turing decided to change how Daraprim was distributed. Hospitals, instead of going to a wholesaler, now had to order from Turing’s “Daraprim Direct” program. Patients, instead of going to their neighborhood pharmacy had to order from Walgreen’s Specialty Pharmacy. And since there is no approved generic in the United States, patients who need Daraprim face monopoly pricing, with no competition to Turing on the horizon.  Many people of all political stripes seem to be enraged over price gouging like this, because it seems like they’re getting the worst of corporate monopoly and government protectionism.

In order to get this medication, American consumers may need to look across the pond. As mentioned above, GlaxoSmithKline may have sold their U.S. marketing rights to Daraprim in 2010 but not in many countries around the world, such as England, where it’s sold for pennies to the pill!

It only seems fair, not to mention in the interest of public health, that an important drug like this, that’s listed on the World Health Organization’s List of Essential Medicines, should not be one subject to the twisted reality and bizarre rationalizing of hedge fund managers.


Dollar Symbol

Image by Svilen.milev

As reported today in The New York Times, a new study shows that the diabetes drug Jardiance (empagliflozin) can reduce the risk of dying from cardiovascular disease by 38%. The drug not only reduces blood sugar levels, but also blood pressure and arterial stiffness leading to a reduced risk of heart failure.

The cost of Jardiance in the U.S. is about $350 to $400 for just 30 pills. It would be a shame if people could not get this medication due to its high cost. Fortunately, this drug is available from licensed pharmacies in other countries (where the price is controlled or negotiated) at prices which are about 70% lower than in the U.S. As shown on PharmacyChecker.com, the 10 mg dose is available from several verified international online pharmacies for about $110 a month or, better, if purchasing a 3 month supply, it’s under $300. The 25 mg dose is only a few dollars more.

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