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Explaining Rep. Pelosi’s F Grade on Drug Prices

Originally published on PrescriptionJustice.org

Prescription Justice has graded all members of Congress in a drug prices report card. Some people are dismayed that Speaker Nancy Pelosi received an F. After all, didn’t she roll-out and shepherd H.R. 3, the Elijah Cummings Lower Drug Costs Now Act, through the House and vociferously called for its passage on the House floor, as read on the Speaker’s website. So, what happened to her grade? A lot of Rep. Pelosi’s F has to do with her role as Speaker and how it differs from all other legislators.

I admire Speaker Pelosi for many – even most – positions she’s taken and advanced throughout her career – including her work to pass H.R. 3. Not surprisingly, I’m a Democrat! But that cannot change the math of our system of grading.  

Due to the methodology and quantitative factors used to create the report card, even a vocal advocate like Rep. Pelosi, can get an F. You see Prescription Justice grades objectively on the following factors: 1) votes; 2) bill sponsorships/co-sponsorships, 3) campaign contributions from drug companies; and 3) policy positions articulated on member’s websites.

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Congress, Not Pharma Execs, Are Accountable to Voters on Drug Prices

Congress is on my mind this week. There’s a lot of talk on PharmacyCheckerBlog about Big Pharma doing this and Big Pharma doing that to keep drug prices high in America. Most often, I aim to expose them for outright lying or exaggerating about the risks of buying cheaper meds from foreign countries using online pharmacies. Criticism of the FDA follows a close second, and in large part due to Big Pharma’s outsized influence on the agency. But who could really enact change? Congress!

This week, we at Prescription Justice announced the new Congressional Report Card on Drug Prices. Our team graded all members of Congress on their action and inaction on drug prices. I’m intensely proud of these efforts. If Congress passed laws that led to lower drug prices in the United States, then Americans would not be forced to obtain medication in other countries – at least not to the extent that they have to now. The lifeline of safe international online pharmacies is important, but it should not be in such great demand.

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When FDA-Approved Generics Fail: Brand Wellbutrin XL Antidepressant is Cheaper from Canada

When you lose count of how many folks have the same suspicion about a prescription medication, action is compulsory. Joe and Teresa Graedon, founders of The People’s Pharmacy, not only have an admirable track record of telling health consumers how it is, but also listening to those in their readership. Years ago, they took on the Food and Drug Administration in regards to Budeprion XL distributed by Teva Pharmaceuticals, the supposed generic equivalent to the popular antidepressant, Wellbutrin XL. Many readers complained that it just wasn’t cutting it compared to the brand name version. In fact, many people reported that when they were switched to the Teva generic Wellbutrin XL, their depression returned. 

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Amazon Pharmacy is going international. Will that lower drug prices?

Amazon Pharmacy recently registered trademarks in Australia, Canada, and the United Kingdom but has not announced its stated plans for these registrations. For those of you who did not know that there is an Amazon Pharmacy, now you do. Amazon acquired online pharmacy PillPack in 2018 as part of its push into pharmaceutical sales. Pillpack specializes in the delivery of prescription drug orders in specially-tailored packages to meet the individual needs of patients. In its own words: “Our claim to fame is delivering medications pre-sorted into packets by time of day. And we’re very good at that.” As of the end of last year, Amazon began branding PillPack-related information with “Amazon Pharmacy.” Also noteworthy is that prior to its acquisition of PillPack, Amazon started to quietly obtain wholesale pharmacy licenses.

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Helping Congress Learn More about Foreign Pharmacy Prices

A few weeks back, I wrote about the House Ways and Means Committee international drug price report, which very competently compared U.S. patented drug prices with 11 other countries. The report found that 79 drugs, ones that account for 60% of Medicare drug spending, are on average priced just under 75% lower internationally vs. the U.S. when looking at ex-factory, meaning wholesale prices.

I half-joked that the Committee was recommending looking abroad for lower drug prices. They were not focusing on drug importation. However, the Committee held a hearing yesterday in which foreign drug prices were central to the debate. The focus of the hearing was a bill, H.R. 3, Lower Drug Costs Now Act, which seeks to lower drug prices in Medicare by empowering Medicare to negotiate with drug companies prices on certain, generally very expensive drugs. There’s a backstop in the bill if the drug companies won’t negotiate in which drugs would be priced at 120% of the average price of six high-income countries. That’s called international reference pricing. The bottom line here is that Congress is now shining a bright light on how much more expensive the “same” drugs are in the U.S. vs. abroad.

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FDA Drafts Guidance to Allow Lower-Cost Foreign Drug Imports From Any Country

The FDA has finished draft guidance on one of two of the Trump administration’s drug importation policy ideas, referred to as Pathway II. The title of this post may seem like a joke for those of you who follow the issue of drug importation in America, but it is real. As a reminder, in August 2019 the administration took its support for drug importation a step further by stating its willingness to support state drug importation programs, Pathway I, and a new idea to give drug companies greater flexibility with their global drug supplies to offer better prices in the U.S, called Pathway II.

Earlier this week, the guidance on Pathway II was sent to the White House Office of Management and Budget (OMB), although I believe it’s not public yet. I found out about the submission to OMB here (BioCentury). It doesn’t relate – at least not directly – to personal drug importation, but it frees the hands of drug companies to sell their own foreign versions of FDA-approved drugs at lower prices in the U.S. market. Its indirect relation to personal drug importation is noted at the end of this post.

Some of this is guesswork. It’s not entirely clear to me what drugs are permissible under Pathway II and it won’t be until the draft guidance is made public.

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