by Gabriel Levitt, Vice President, PharmacyChecker.com and Sam Werbalowsky, Pharmacychecker.com | Feb 6, 2015 | Drug Prices, Generic drugs, Medicare Drug Plans
If you were to take a time machine and go back to 2006 and put a hundred bucks in a savings account with 5% annual interest, you’d have $147.50 in 2014. Not bad. But if your interest rate was tied to the annual price increases of brand name drugs you’d end up with…$202. And if for some crazy reason you just wanted to have the same purchasing power 8 years later, and tied your interest rate to inflation, you’d only end up with $125.
Clearly the increase of drug prices are out of line with the prices for everything else, and while the numbers figured above only take in to account brand name prices, generic prices are rising, too. On average, generics cost 5% more in 2014 than they did in 2013. That’s on average – some generic drug prices increased by 2,500 %!
But there’s good news on the way. Senators Sanders and Klobuchar are fighting for more affordable medication. Some more good news, at least for seniors, was released this past week. The Wall Street Journal reports that the Obama administration’s fiscal budget for 2016 calls for the government to negotiate prices for biologic and high-cost drugs for Medicare Part D. While, we’d like to see prices negotiated for all drugs, this can still represent huge savings for the government. Estimates suggest that 9.1% of national health spending could be on specialty drugs. That’s total health spending, not just drug spending.
We’re eager to see if the government will actually able to negotiate prices in 2016 – who knows how the budget will change or if Pharma will push to prevent negotiations. We’ll be keeping an eye on this and will certainly let you know.
Tagged with: Medicare Part D, Senator amy Klobuchar, Senator Bernie Sanders, Specialty Medications
by Gabriel Levitt, President, PharmacyChecker.com and Prescription Justice | Jan 30, 2015 | Drug Prices, Healthcare Reform, Medication non-adherence, Skipping medications
This will not be major headline news anytime soon but it’s true. Last week our friends at RxRights blogged about new data from the Commonwealth Fund showing that the number of Americans ages 19-64 who did not fill prescriptions due to cost decreased to a depressing 35 million in 2014 from the even more depressing figure of 50 million in 2012. Obamacare, lower unemployment, and a stronger economy in which people feel more secure paying for even very expensive medications are largely responsible. Minus the very expensive medications – that’s all good stuff.
And how about international online pharmacies and personal drug importation? Well, just yesterday the U.S. Centers for Disease Control and Prevention (CDC) reported that about 2% of Americans are still buying medication from foreign countries. That’s about 5 million Americans who would potentially go without needed medication if it were not for lower cost foreign medication sold by safe international online pharmacies.
I did not use the word “potentially” loosely. Some of those five million are getting nabbed by rogue online pharmacies, resulting in too many Americans taking substandard, adulterated, or counterfeit medications. If those people are informed properly they will not be victims. PharmacyChecker.com is there for you: if you are one of the 35 million Americans wondering whether you can afford that medication prescribed by your doctor, we’re doing better than ever at empowering you with information that helps you get the medications you need at a price you can afford while steering clear of rogue online pharmacies.
It’s important to remember how dangerous it is to not take the medications you need. One expert at CDC stated: “People who do not take their medication as prescribed have more hospitalizations, emergency room visits and an increased burden of their illness.”
It’s important to note that the CDC report provided lower figures on how many Americans are going without prescribed medications due to cost than the Commonwealth Fund reported: about one in 10. We’re going to look at the data in the coming weeks and provide you some guidance on this discrepancy. But clearly the overall numbers have gotten better in the last two years.
We thrive on these better numbers – more consumers accessing the healthcare they need –but with tens of millions of Americans saying they can’t afford their meds there’s so much more work to be done!
Tagged with: CDC, Commonwealth Fund
by Gabriel Levitt, President, PharmacyChecker.com and Prescription Justice | Jan 23, 2015 | Counterfeit Drugs, Drug Safety
FDA Seized Counterfeit Cialis at International Mail Facility
The FDA issued a warning about counterfeit Cialis, an erectile dysfunction (ED) medication, being sold through the mail, which probably means it was purchased from a rogue online pharmacy. The fake Cialis is some whacky combination of Cialis’s active ingredient, tadalafil, and the active ingredient in Pfizer’s Viagra, called sildenafil. Apparently, the FDA seized the counterfeit product before it reached a consumer in the U.S. by mail.
Fortunately, over 99% of safe, personally imported prescription drugs are not seized at international mail facilities. Still, I’ve given the FDA considerable grief about seizing safe medications, which they usually deem “misbranded” or “unapproved” for intellectual property or labeling reasons – but in this case FDA protected someone from a bad drug and that’s cool.
According to Reuters, FDA “cautioned against purchasing prescription medicines online, noting that some websites may be selling unsafe products.” The FDA also said that there is no indication that the “legitimate supply chain” – meaning the U.S. domestic supply chain – is at risk and that licensed U.S. pharmacies are safe. That’s probably true but there’s no reason to believe that the legitimate supply chains in other countries aren’t safe either. In other words, foreign online pharmacies verified by PharmacyChecker.com continue to sell real Cialis, the one marketed by Eli Lilly, for a lot less than they do here. The lowest cost Cialis (10mg) is $14.25 at a PharmacyChecker.com-approved international online pharmacy. That compares with a whopping $44.92 per pill at a one of the lower cost VIPPS-approved online pharmacies (VIPPS is the online pharmacy verification program of the National Association of Boards of Pharmacy).
The FDA recommends that consumers do not take Cialis supplied in bottles matching one or more of the following descriptions:
- lists “AUSTR81137” on the front of the bottle;
- does not include an NDC number on the front of the bottle, such as “NDC 0002-4462-30” for the 20 mg tablets;
- does not include the tablet strength in a colored box;
- has different patterns and colors; it has yellow and darker green designs on the front label;
- has misspellings; it lists, “CLALIS is a product of: Eli lilly Australia PTY Limited” on the side of the bottle;
- lists the manufacturer location as “112 Wharf Road, WEST RYDE, NSW 2114” on the side of the bottle; and
- lists “Lot: AC 066018, Exp: 01SEP17” on the side of the bottle.
I don’t agree with one of these – the bolded one – and here’s why: safe and real Cialis, or other genuine medications, ordered from online pharmacies won’t necessarily have an NDC number on it. In fact, if you were to travel to another country and purchase meds, real prescription drugs, in a brick-and-mortar pharmacy, they would not have an NDC number. That’s because NDC is unique to drugs packaged for sale in American pharmacies. Other countries use different labeling systems; for example, Canada’s version of NDC is called DIN (drug identification number).
One last important note: the truth is that many people want to get ED meds online, whether it’s Viagra, Cialis, or Levitra, without a prescription. PharmacyChecker.com strongly recommends that you don’t do that. The studies show that online pharmacies that don’t require a valid prescription are more likely to sell fake or otherwise bad medication, especially bogus ED meds!
Tagged with: cialis, Eli Lilly, Pfizer, Viagra
by Gabriel Levitt, President, PharmacyChecker.com and Prescription Justice | Jan 16, 2015 | Drug Prices, New Drugs, Specialty Drugs
(Read Part 1 and Part 2)
Last year we discussed the cost of hepatitis C (“Hep C”) wonder drug Sovaldi for Americans paying in cash or using their health insurance. Notably absent, in both analyses, were how our most economically challenged citizens could afford the $84,000 treatment. According to Governing, “Many of the estimated 3.2 million people living with Hep C in the United States are poor, imprisoned or elderly, which means the cost of Sovaldi falls disproportionately on Medicaid and Medicare.”
To treat every one of the 750,000 Americans with Hep C who receive state-funded treatment through Medicaid or the prison system with Sovaldi would cost $55 billion, according to Express Scripts, and budget realities mean that that simply won’t happen. Public health officials will use prior authorization guidelines in determining who will be covered, similar to the way benefits administrators with private health plans determine eligibility.
Unlike private insurers, drug manufacturers must give Medicaid a 23% discount. The lower price is helpful but does not necessarily make Sovaldi affordable. Current models of drug pricing under Medicaid are not tailored to handle Sovaldi and other specialty medications. According to a letter sent from National Association of Medicaid Directors, “Simply put, the federal Medicaid statute is not designed to allow states to respond to this new pricing approach for pharmaceuticals. Sovaldi is just the first of many such exceptionally high-cost ‘curative’ specialty drugs.”
That letter recommends several federal policies to address Sovaldi and other high priced medications, including the creation of a special federal fund for specialty meds, similar to Ryan White federal funds for AIDS; additional rebates for specialty medications that reach a certain threshold in the percent of the population affected; and, my favorite because of the ludicrousness of international price disparities where U.S. prices are twice the average of other rich countries, “Modify the ‘best price’ policies for breakthrough drugs to include the selling price in other countries.”
There are more suggestions by the NAMD, and they are good future possibilities, but we’ve got to get down to the bottom line here: if you have Medicaid, then under what circumstances will you get Sovaldi? The states are all over the place in terms of coverage policies, but usually a person has to be very sick to get Sovaldi!
The Sovaldi Squeeze, written for Medicaid Health Plans of America (MHPA) by Viohl and Associates, takes a good stab at identifying Medicaid coverage policies. Thirty-five states require prior authorization. Most, if not all, of those states require enrollees to take a liver biopsy; the results of which determine whether or not Sovaldi will be covered. Some states will only cover someone who has not used illicit drugs and alcohol for three years. Other states, including Illinois, Florida, and Louisiana will limit coverage terms to make sure the patient is complying properly with the regiment. For example, Louisiana will only cover Sovaldi for 28 days at a time.
The most extraordinary criterion I saw is referred to as the “once in a lifetime” rule in the MHPA report. As you imagined, if a patient doesn’t adhere to their covered Sovaldi treatment then it won’t be covered again.
Like we discovered with private health insurance and certainly for people who must pay the full price in cash, there are serious obstacles to obtaining Sovaldi even if you’re covered on Medicaid. The costs are just too prohibitive. Yes, Gilead is right that unlike maintenance medications Sovaldi (and other new Hep C meds we’ll discuss below) can cure the patient, which means lower healthcare costs overall. Nonetheless, the market is not established to handle such insane upfront costs.
You might expect that more treatments with the curative-type power of Sovaldi would add competition to bring down prices. Indeed, there are three new Hep C specialty meds on the market. Olysio, marketed by Jansen is cheaper than Sovaldi, but still sells for $840 per pill. Harvoni is actually more expensive than Sovaldi, carrying a price tag of$94,500 for three months, about ten grand more than Sovaldi. Unfortunately, like Sovaldi it is made by Gilead so the competition factor is diluted! Harvoni does have the advantage of being a stand-alone treatment, however, whereas Sovaldi is taken in conjunction with ribavirin.
Viekira Pak, marketed by Abbvie, was approved just last month. Express Scripts wisely decided to make a deal with Abbvie that it would exclude Sovaldi in exchange for lower prices on Viekira Pak! Sure enough, Gilead fought back against Abbvie by making a deal with CVS Health that Harvoni and Sovaldi would be the preferred Hep C medications for CVS’ PBM business.
And which drug is the best? We’re not going to touch on that but the online magazine, Hep Mag, has an excellent summary on all the new Hep C medications discussed above, which could prove helpful.
The market dynamics for Sovaldi and other breakthrough medications like it are highly complex but largely stacked in favor of pharmaceutical company profits against taxpayers and consumers. Neither Medicaid nor private health insurers can afford to treat the millions of people who are infected with Hep C.
To conclude, I’ll leave you with the words of Caroline, who commented on our Part 1 post about paying for Sovaldi in cash, as she sums it all up perfectly:
“Well I’m insured but this medication is not on the formulary for either health care companies offered at my job. They are two well-known companies and according to my GI doctor, none of the insurance companies are approving this drug unless you are at least at stage 3 liver disease. So I’ll have to get a little sicker before I can get it. Thanks Gilead!”
Tagged with: Gildead Sciences, Harvoni, Hepatitis C, medicaid, Sovaldi
by Gabriel Levitt, President, PharmacyChecker.com and Prescription Justice | Jan 8, 2015 | Counterfeit Drugs, Drug Prices, Generic drugs, Personal Drug Importation
I wish I was joking about the racy headline above. The United States is not the only great power in which citizens go without medication because of cost. The cancer drug Gleevec (imatinib), made by Novartis, costs 23,500 yuan, or about U.S. $3,783, per month, in China. Gleevec is not covered by health insurance in China so people there must pay for it out of pocket. Ten years ago, Lu Yong was diagnosed with chronic myelocytic leukemia and was prescribed Gleevec. After facing bankruptcy due to his drug costs, Lu discovered a generic version of Gleevec, called Veenat, and began purchasing it by mail-order from India where it is an approved drug, at a cost of only 3,000 yuan, or about $482, per month — 87% less than the brand name drug.
Lu’s condition improved quickly using the generic version. He began to help people with leukemia who he met online obtain Veenat. Now, according to the English edition of Caixin, an independent Beijing-based media outlet, he is facing criminal charges for credit card fraud and selling counterfeit medication. The same story was covered by official Chinese media under the headline “Leukemia patient prosecuted for buying pills overseas.” Lu has helped 1,000 people with leukemia obtain treatment. Three hundred of them are petitioning the authorities to have his name cleared.
The medications involved are real and clearly life-saving! So why is Lu being prosecuted for counterfeit drugs? Under Chinese law, any drug not specifically licensed for sale in China, even a genuine medication lawfully manufactured by an authorized drug company, is considered counterfeit.
The charge of credit card fraud was based on Lu’s using a foreign credit card to make the purchases. Lu said he did so because using domestic Chinese bank-issued credit cards for international purchases is nearly impossible.
Lu was not charged for procuring his own cancer medication. The charges were for directly facilitating the purchase of the drug for 1000 people, who consequently regard Lu as a hero.
When people can’t afford to obtain life-saving medication locally, the U.S, and all countries, should consider themselves morally obligated to expressly permit their citizens to obtain it internationally.
Tagged with: China, Gleevec, imatinib
by Gabriel Levitt, President, PharmacyChecker.com and Prescription Justice | Dec 30, 2014 | Advocacy, Drug Importation, Personal Drug Importation, Politics
The fight for access to safe and affordable medication will continue in 2015. As 2014 ends we find the price of medication continuing to escalate. AARP’s recent drug price report showed that brand name drug prices had increased by 13% in 2013, eight times the rate of inflation. The costs of generic drugs are going through the roof, some by astronomical amounts – to the tune of thousands of percent. Then of course 2014 brought us Sovaldi at $1000/pill, which is just the tip of the iceberg, as many more outrageously priced “specialty medications” are coming down the pipeline in 2015. New drugs that save lives and help people get better are great…but only if they are affordable.
In the holiday spirit, Senator Amy Klobuchar from Minnesota published a Christmas-themed op-ed last week called “How the Drug Companies Play Scrooge,” as in Ebenezer Scrooge, the greedy miser in Charles Dickens’ famous story A Christmas Carol. Klobuchar’s ghosts of Christmas past, present and future are, respectively, rampant drug price increases; the highest drug prices in the world by far; and the continuing assault on the pocketbooks of Americans by pharmaceutical companies unless Congress acts. Interestingly, Sen. Klobuchar’s metaphor compares Scrooge to Congress (not the pharmaceutical industry). She writes: “if Ebenezer Scrooge can be transformed from a crotchety, thoughtless, “bah humbug” miser to a generous steward of good will to all after only one night of ghostly visits, certainly there is hope for Congress.”
What can Congress do to end its Scrooge-like protection of big pharma? Sen. Klobuchar recommends three legislative solutions. Congress should pass legislation that would allow Medicare to negotiate drug prices with pharmaceutical companies under the same protocols permitted to the Department of Veterans Affairs. Currently, federal law actually bans such negotiations. Under one estimate, due to the VA’s ability to negotiate prices, drug prices are 40% lower when obtained through the VA than through Medicare.
Ending what Sen. Klobuchar calls “illegal pay-to-delay” deals between brand name and generic pharmaceutical companies, which postpone market availability of lower cost generic drugs, is another solution that can be addressed legislatively. Legislation introduced by Klobuchar and Sen. Charles Grassley would give the Federal Trade Commission more authority to stop those deals. Sen. Klobuchar asserts that the savings from ending pay-to-delay could be $4.7 billion for the U.S. budget and $3.5 billion for consumers.
Last but not least, Sen. Klobuchar recommends helping American consumers to personally import lower cost medication by passing The Safe and Affordable Drugs from Canada Act. This legislation, co-sponsored by Sen. John McCain from Arizona, would essentially codify the current practice of Americans buying lower cost medication from Canadian pharmacies. We support this bill but believe it needs to be expanded to include pharmacies in many other countries from which lower cost and safe medication can be and currently are obtained.
Congressional opponents of Klobuchar’s personal drug importation bill, the most vociferous among them surely raking in huge donations from big pharmaceutical companies, will argue that the Act will open the door to counterfeit drugs and rogue online pharmacies. The fact that counterfeit drugs and rogue online pharmacies exist, however, is not an argument against facilitating safe personal drug importation from verified international online pharmacies. Five million Americans already import medication for their own use. Consumers who purchase from safe international online pharmacies, such as those in the PharmacyChecker.com Verification Program, are able to save thousands of dollars a year. For many, personal importation of lower cost medication is the only option for obtaining needed prescription drugs.
While the FDA doesn’t prosecute Americans who import medications for their own use, federal law still holds that, under most circumstances, it is a crime!! It’s understandable that prescription drug importation meant for re-sale in U.S. pharmacies is regulated to that extent that those who violate the laws are subject to penalties. In contrast, people who need to import medication for their own use because they can’t afford the prices at U.S. pharmacies should not be subject to criminal enforcement of any kind, ever. So I hope that Senator Klobuchar and her colleagues, in addition to her recommendations identified above, introduce and pass a bill to amend federal law to decriminalize personal drug importation. By doing so Congress would bring prescription justice to Americans who are haunted by the scary ghosts, past, present and future, of the pharmaceutical industry.
Happy Holidays and New Year from PharmacyChecker.com!!
Tagged with: decriminalization, klobuchar, legislation
