Each week I try to come up with a new and compelling blog post to discuss issues involving drug prices and problems Americans are having affording medications. I often find myself resoundingly critical of the pharmaceutical industry and this week I was intrigued but curiously put off to be joined by a pharmacy corporation that made over $100 billion last year.
Express Scripts, the nation’s largest pharmacy benefit manager, reported that brand name drugs in the U.S. cost 98.2% (about twice) more on average today than they did in 2011. Last year, brand name drug prices were up 16%. As I read in the Chicago Tribune, Express Scripts used hostile, downright anti-big pharma (and pharmacy) language blaming “opportunistic manufacturers” and “scheming pharmacies.” Rising drug prices of this magnitude are no laughing matter as cash-strapped Americans bear the brunt of these increases, either in higher insurance premiums, co-payments, co-insurance and full cash prices for uninsured (still almost 30 million Americans), or when plans don’t cover certain drugs.
But it is a little funny to hear Express Scripts go after Big Pharma using the rhetoric of greed. After all, PBMs, particularly Express Scripts, are often criticized for their lack of drug pricing transparency and profit-seeking practices, kind of like drug companies and big pharmacies, such as Walgreens and CVS.
While the focus of Express Scripts’ ire is on brand name drug prices, most of the prescription sales it administers and profits from are generics. On that note, buying generic medication without using your insurance’s PBM is often less expensive than your co-payments. But don’t expect Express Scripts to tell you that.
So that Express Scripts doesn’t feel singled out, we’ve reported on the antics of Big Pharmacy before, including Express Scripts’ biggest competitor. PharmacyChecker CEO Tod Cooperman, MD, was on Fox and Friends not so long ago discussing an investigation of CVS Caremark in which the company was accused of price gouging. The allegation: by not informing its customers that the cash price using CVS’ own discount card program would be lower than co-payments using PBMs, such as CVS Caremark or Express Scripts, hundreds of thousands of customers were overcharged.
On that note: the nuts and bolts message is DON’T BE SHY and ask for the lowest possible price at your local pharmacy.
In defense of Express Scripts, and even CVS Caremark, PBMs and large pharmacy corporations do not yield profit margins even close to those of the biggest drug companies. Furthermore, the pharmacy corporate giant, Express Scripts, is right: the blame for ever increasing drug prices falls on opportunistic manufacturers and scheming pharmacies.
An article in the Washington Post yesterday covered the steep rise in the cost of a cancer medication called Gleevec, drug company Novartis’ brand name for imatinib, which is incredibly successful in treating people with chronic myeloid leukemia (CML). Despite its concern with public perception over price at the time, Novartis charged $26,400/year when the drug hit the market in 2001. With today’s price for Gleevec now $126,000/year it seems any concerns by Novartis have gone by the wayside (or did they really exist at all?). One would think and hope that new, similar products would bring down – or at least slow increases of – the price of Gleevec. After all, competition is supposed to drive down prices.
Not in the pharmaceutical industry, at least not until a drug goes off patent. The launch of therapeutically equivalent brand medications to treat CML actually coincided with Gleevec’s steepest price increases. Bristol-Myers Squibb launched Sprycel (dasatinib) in 2006 and Novartis launched a second generation drug called Tasinga (nilotinib) in 2007, both at much higher prices than Gleevec. In 2007, the monthly prices for Gleevec, Sprycel and Tasinga were $3,757, $5,477 and $6,929, respectively. The details can be found in the Post’s article but essentially Gleevec started to play “catch up” to its competitors.
In 2007, the price of Gleevec was 46% less than Tasinga. By 2014, the discount had shrunk to 12% with Gleevec’s price at $8,156/month compared to Tasinga’s price of $9,300/month. Let’s keep in mind that the newer drugs were shown to treat people that Gleevec could not treat, which would soften the argument that these are truly competing products. But soon after their introduction, Sprycel and Tasinga were found to successfully treat people with newly diagnosed cases of CML, to more directly compete with Gleevec, yet the latter’s price soared!
Source: Graph below from the Washington Post.
One source cited in the post’s article summed it up perfectly. A hematologist from the University of Chicago, Richard Larson, stated: “Ordinarily, you might think with three equally effective drugs on the market, the price should go down through competition, but it’s been a failure of the competitive pricing process.”
While the Washington Post’s article delved into the problem of out of pocket costs for Gleevec, it didn’t hammer home that the suffering in America is extreme when it comes to Gleevec’s drug price (and other medication prices as well). Gleevec is not a new topic on these blog pages, which has solicited comments from people and families crushed by drug costs. Yes, the irony is glaring: cancer medications that alleviate suffering also create suffering, too, in the form of cancer patients facing bankruptcy, feeling guilt, and causing anxiety.
It’s not just market failure – it is greed, too. I’ll let one American, Penny Kincaid, a commenter on this blog, bring it home:
“I guess I am luckier than many on Gleevec. I am paying 5% of the cost each month but the cost keeps going up. Our lives depend on this drug but still the cost is obscene. They praise themselves for creating [these] drugs for patients with [CML] but still we are forced to pay and many go broke. It is the cancer patient who has to pay up or die and they keep raising the cost. This is just wrong in so many ways and here we have the creators wanting to deny us the generic because they want that big money to keep rolling in. They should be ashamed of themselves.”
Yesterday, our CEO, Tod Cooperman, MD, applauded leading presidential candidates for supporting legal reforms to make it easier for Americans to buy lower cost medications from other countries.
“With millions of Americans doing this safely for more than a dozen years, it’s time for our government to stop threatening and scaring consumers and simply do what’s right: Make personal drug importation fully legal. Every presidential candidate should support this,” says Dr. Cooperman.
According to a new AARP drug price report, in 2006 the average cost of prescription medication increased by 3.6%, just a little higher than the rate of inflation in the U.S. which was 3.2% that year. In 2013, in stark contrast, drug costs were up 9.4% above 2012 with a corresponding rate of inflation of 1.5%. In fact, the average annual cost of popular medications for chronic conditions used by seniors went from $4,140 in 2005 to $11,341 in 2013.
Many of these brand drugs are covered by private and public pharmacy benefit plans, including Part D – but too often they are not, which leaves Americans having to foot the bill out of pocket. Even covered brand name drugs often mean very high co-payments or co-insurance. If you’re paying out of pocket and can’t afford your brand name drug, international online pharmacies have much lower prices – an average of 84% less on a basket of popular medications.
In the past, AARP has been criticized, not surprisingly by the pharmaceutical industry, for just looking at brand name drug prices in its drug price reports and not generics, which help moderate increases. But this latest report measured 622 drugs, a large basket that included brand, specialty and generic drugs. Brand and specialty drug prices were up an average of 12.9% and 10.6%, respectively, compared to a decrease in average generic drug prices of 4%.
AARP’s report concludes that it’s possible, “we can no longer rely on lower priced generics to counterbalance the price trends seen in the brand name and specialty prescription drug markets.” And things appear to be getting worse.
After reading the report, which looked at prices up to 2013, I was curious to find out how much brand name prices increased last year. In 2015, brand name drugs still under patent were up almost 15%, and generics, which tend to get cheaper, had even increased by almost 3% on average [Source]. These drug price increases corresponded with an inflation rate increase of .1%!
With about 30 million Americans still uninsured, many more millions of underinsured with inadequate pharmacy benefits, and drug prices continuing their ascent, tens of millions of Americans will continue to forgo prescribed medication entirely. Fewer will have to make this choice by comparing drug prices among safe international online pharmacies and local pharmacies using prescription discount cards at www.pharmacychecker.com.
Too many Americans are being kept in the dark by the very governing authorities and companies that are meant to protect their health. The FDA goes too far in telling Americans not to buy lower cost medication from outside the country, and Big Pharma spends big money on media relations to generate stories about rogue online pharmacies that wrongly conflate them with safe international online pharmacies.
It’s nice when some light gets in. Money Talks News published a straightforward story and video that tells the truth about saving money on prescription drugs online. It asks the question: Are Overseas Pharmacies Unsafe and Illegal?
It takes time, but the truth often prevails because, after all, it’s the truth.
With its gift of $7.2 million to fund various research projects, the John and Laura Arnold Foundation gave a boost this week to the cause of lowering drug prices in America. According to the Foundation’s press release: “The research projects will focus on analyzing how regulatory policies and programs impact drug pricing, drug development, and patients’ access to medication.”
The lion’s share of the funds will go to the Memorial Sloane Kettering Cancer Center’s Evidence Driven Drug Pricing Project. Led by Dr. Peter Bach, the effort pursues strategies to evaluate the relative effectiveness of medications. The goal of Dr. Bach’s project is to make sure that medications are priced according to how well they actually work. Sounds like common sense, but too often medications that often don’t work are widely prescribed, and very expensive!
The money will also go toward various evidence-based studies looking into the workings of the drug development pipeline, state and federal regulations that affect Medicaid drug purchasing, and alternative Medicaid purchasing models that tie reimbursement to patient health outcomes.
One smaller project caught my eye, because it looks at pharmaceutical regulations and law that affect innovation. The Brigham and Woman’s Hospital’s Program on Regulations, Therapeutics, and Law will receive $748,445 to analyze existing regulations enacted to incentivize pharmaceutical innovation. The press release reads: “Researchers will analyze programs and incentives such as tax breaks, market exclusivity protections, and the Food and Drug Administration’s (FDA) fast-track approval pathways.”
In looking at regulations and law, the cause of lower drug prices would be well served by a research project dedicated to evaluating the effects of federal restrictions on prescription drug importation. Ostensibly, drug importation restrictions are in place to prevent unsafe and counterfeit medications from reaching patients, but we know that they also curtail access to lower cost, safe and effective medication as well. That’s why millions of Americans buy foreign medication online despite the prohibiting regulations.
New research would help determine a more suitable regulatory framework to protect patient health, but also expand access to more affordable medication through safe personal drug importation. This recent grant by the John and Laura Arnold Foundation is its second in the area of prescription drug prices. Three’s a charm!
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