Posted on 09/06/2018 10:13:18 AM PDT by Kaslin
Before entering public service at the federal level, I spent most of my life serving my community in a different way. As a pharmacist for more than 30 years, I saw firsthand the impact that prescription drug prices have on everyday citizens and families.
As a result of research and development I have seen improvements in medications that save lives. Illnesses that were once a death sentence are now treatable with a prescription. While this is nothing short of a miracle, these advances are worthless if they are not affordable.
I have seen elderly couples forced to choose between their medications and groceries. I’ve seen mothers struggle to afford their children’s prescriptions. That is what drives me to utilize my background as the only pharmacist in Congress to tackle rising drug prices in America.
To lower costs, there must be transparency, choice, competition and accountability in the health care supply chain. Unfortunately, instead, big business has wedged itself between patients and their health care in a dangerously opaque manner. The most egregious example of this is the middle man in the chain – the Pharmacy Benefit Managers.
Today, the three largest PBMs manage drug benefits for approximately 95% of Americans with prescription drug coverage.
The intent of Pharmacy Benefit Managers has evolved from negotiating prescription prices to a multi-billion dollar revenue machine that relies on a complicated system of rebates, formularies with no basis in health outcomes, and preferred networks. The result is fewer choices and less control for patients.
The largest Pharmacy Benefit Manager makes more than McDonalds, Pfizer, and Ford combined. At the same time, as they continue to advocate that they reduce expenses for patients, data from the Centers for Medicare and Medicaid Services shows out-of-pocket costs for patients increased 169% from 1987 to 2014.
The complex system of rebates and fees developed by Pharmacy Benefit Managers has eliminated any incentive to reduce costs. Even worse, it has created perverse incentives to drive costs up.
For example, pharmaceutical companies are often instructed to set a higher list price to deliver a rebate to the Pharmacy Benefit Manager. If they refuse, the Pharmacy Benefit Manager simply excludes the medication from their formulary. This is the definition of putting profit over patient as it cuts off access to new treatments. Additionally, those rebates, which were intended to drive down costs for patients, can actually add to them, creating an incentive for a higher list price.
As Health and Human Services Secretary Alex Azar said, “everybody is wetting their beak on a percent of a high list price, and we’ve got to change those dynamics.”
The other end of the drug chain is also trapped under the Pharmacy Benefit Manager’s web and I have experienced it firsthand. When a pharmacist attempts to negotiate contracts to provide the best for their patients, Pharmacy Benefit Managers often say contracts are non-negotiable. Pharmacists are left to either accept the Pharmacy Benefit Manager’s terms or be kicked out of network.
Even more shocking, pharmacists are many times contractually prohibited by Pharmacy Benefit Managers from telling their patients when it would be cheaper to pay with cash instead of insurance. I have experienced this and I am grateful President Trump has made eliminating this unfair practice a priority in his quest to lower prices.
Another concern is the alarming amount of consolidation in the market. As the discussion of consolidation continues, it has been abundantly clear that this message is resonating as people grapple with drivers of health care costs. On July 27th, the Energy & Commerce Committee sent a letter to the Federal Trade Commission outlining concerns with the potential effects on the consumer market. The goal is to ensure that mergers are in the best interests of patients and proper diligence is afforded to the review process.
An opinion piece recently published by this outlet falsely claimed that campaign donations from PhRMA is what is driving my work. Unfortunately for the author, if you simply follow the link provided by them, it clearly lays out that neither PhRMA nor any of their members are in my top 25 contributors. Community pharmacists who have dedicated their lives to serving patients across the country take that spot. They are the people who have seen Americans struggle and sacrifice across the country to afford their medications firsthand, just as I have.
I believe every part of the chain has a role to play in lowering prices and has a responsibility to do so. As part of this, we must demand transparency from Pharmacy Benefit Managers and shed light on anti-competitive practices that are not in the best interest of patients. This will have a direct and significant impact to lower costs for patients who need it the most. It is unfortunate that the author has attacked me for this mission and fails to see its necessity while claiming to be working against “abusive, monopolistic behavior.”
I look forward to continued work with my colleagues in Congress, President Trump and his administration to make this happen. Secretary Azar said we need to “fundamentally examine and re-examine the role of Pharmacy Benefit Managers.” We will work together to do just that.
Get it out of insurance plans and watch the prices plummet.
I’m all about diet and medical marijuana products. At 64 the only thing my wife and I take besides aspirin is Claritin for her allergies.
they continue to advocate that they reduce expenses for patients, data from the Centers for Medicare and Medicaid Services shows out-of-pocket costs for patients increased 169% from 1987 to 2014.
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That sounds like a savings to me ,, most things have gone up at least that much in that timeframe.
Another concern is the alarming amount of consolidation in the market.
A $2,500 tube of cold-sore cream?
I last bought some in Australia where it's available OTC for less than $10. (£4.85 on the UK from Amazon -- no they won't deliver it to the US)
I was running low -- that's how I found out about the silly pricing.
They wake up each day, shower, have their coffee, and go to work. There they devise ways of gaming the system through complex Kafkaesque rules whose purpose is to cheat the patient, a patient with no other recourse or court of appeal.
The word shameful doesn't even begin to describe this behavior.
Instead of asking why prices are so high here, a better question might be why are they so low there?
The system stinks. However it costs nearly 1/2 billion bucks to get a new drug on the market.if drug is used and there is a side effect which was barely detected in limited human trials, the damages will be in the multibillions paid out. Or if a competitor comes out with a superior version of the first drug...the originator loses big time.Greed, fear of competitors and protection from damages are 3 very large reasons for rapacious pricing. Also...our bloated government guarantees health payments....gee whiz...what could go wrong?
Finally....if obesity, overuse of alcohol, so called recreational drugs and smoking (all combustibles) and STDs was way lower...our health costs could be drastically lowered also.
Being a pharmacist this guy actually seems to have some insight into what the structural problems are.
They all lead back to Big Pharma + K Street.
Last studies I’ve read is that prescribtion drugs are killing more people than ever. Don’t know why anyone would want to create a larger mass market with cheaper prices given the statistics. None of them are designed to CURE ANYTHING anyways.
I will throw this in the mix: The hate for anything related with Marijuana is there because it really does cure a host of ills that normally are the domain of extremely expensive drugs and treatments. I’m speaking from the personal experiences of friends with serious health conditions cured or mitigated with it.
But onto the liability issue, we were given an ehtics question in high school back in 1970 and it went something like this: Imagine a vaccine being developed that could cure a serious disease like Polio, but every one millionth person that took the treatment actually got polio from the vaccine?
My personal, and my groups, solution was to charge an extra dollar for every use of the drug and that dollar was put into escrow to be handed over to the person that actually caught the disease from the treatment. And everyone that took the vaccine would sign an affidavit agreeing that if they were that unlucky person, that payment would be their full compensation for damages, or they will not be allowed to get the shot.
I don’t think that is really the best solution since treatment could be far more expensive than that payout, but something like that would be a solid solution to mitigate risk without it costing the GNP and still making the drug affordable to those that it would truly help.
It's comments like these, that make posters like you, lose all credibility in this conversation.
Last studies I’ve read is that prescribtion drugs are killing more people than ever. Don’t know why anyone would want to create a larger mass market with cheaper prices given the statistics. None of them are designed to CURE ANYTHING anyways.
My firm belief is that diet kills more americans than smoking. If we would just get minimal exercise and ingest fast food, soda, etc. in moderation, a lot of people would get their lives back.
Heck, I cut my meth use down to once a month and my dentist immediately noticed the improvement. :-D
They are doubling down on bad behavior. It’s like they are trying to force the government to take them over. Well, if they don’t straighten up, they are going to get their wish.
Overseas pharmacies are definitely one way to fight this battle.
“pharmacists are many times contractually prohibited by Pharmacy Benefit Managers from telling their patients when it would be cheaper to pay with cash instead of insurance.”
That’s why I use 2 pharmacies: one has my insurance, the other thinks I am uninsured. Many times, the cash price is less than your out of pocket.
Vaccine idea not bad in perfect world. However if vaccine doesnt work...not all do 100%...so lots of liability is assumed for no purpose..also how many lawsuits would there be for people who get disease similar to.polio...as far as hate for marijuana...so many use it and it can have many effects...there are whole journals associated with discoveries of so called natural remedies...we will find out more from other plants and animals...pharmacognosy is a very interesting topic...
Yeah, it is ironic that the ban on re-importation is still in effect. American consumers are essentailly subsidizing the R&D costs (as well as big Pharma greed) by protecting artifically low prices in small markets such as Canada and Australia while socking it to consumers here in what is essentially a de facto monopoly market. That arrangement needs to end yesterday.
Express Scripts is PBM,and a HUGE company.
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Express Scripts can do it only because they've greased the right palms to allow the trade which costs, of course, must be passed on to the consumer while still saving them money and allowing our glorious government to claim that reverse importation is legal.
When Bernie Saunders was still just a mere Senator from Vermont, he led a bus excursion loaded with Vermont seniors over the border to Canada to fill some scripts which they were legally allowed to bring back as personal use.
The purpose of this excercise was, of course, to show how socialized medicine in Canada was superior to the U.S. model.
How practical is such a day trip to Canada for most of Americans?
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