How Do Make Specialized Healthcare Accessible and Affordable?

Frederick G. Banting and Charles Best who discovered Insulin

New Orleans    In this brave new world of medicine involving stem cells and gene therapy, all of which were almost unimaginable in the past, we still are hitting our heads against the wall at the inability to craft a solution to the old problem in the United States of equal access and affordability.  Doctors are estimating the price tags on some of these treatments could hit up to $1 million in our current system.  Lacking universal health care in the United States that spells death and disaster for many families in the 99%.

When the FDA approves a treatment, especially if it is the only one likely to be effective, similar to the sickle-cell disease effecting so many in lower income, minority neighborhoods, government and private health care insurers face an moral obligation to provide the coverage and pay the bill.  We’ve been seeing too many stories of pharmaceutical companies jacking up the bill for rare medicines with limited manufacturing capabilities and forcing insurers to pay or families to do without.  Insurers, drug companies, and even government health officials since the Affordable Care Act fights have danced around so-called “death panels” or anything that might seem to impose price ceilings or the rationing of care, leaving us sucking air for a solution.

Michael Sherman, the chief medical officer of Harvard Pilgrim Health Care in Massachusetts, has made the case in Scientific American that under the existing regime something that might work would be a value-based agreement between institutions, drug companies, and insurers for new drugs.  The essence of the agreement is that if it works, they get paid their demand price, and if it doesn’t work, they are paid a substantially lowered price.  Sherman wonders if such agreements might work for gene therapies as well.

It seems a stretch.  Yes, making the companies prove their mettle is appealing, but it doesn’t deal with the issue that companies are setting exorbitant prices for any and all drugs in the first place in the US, the likes of which we see nowhere else in the world.  For example, the inventors of insulin donated the patent, rather than enriching themselves, but drug makers now charge $200 to $300 a vial for this lifesaver, many decades after its discovery.  It is hard to imagine gene therapies that depend on doctors, drug companies, hospitals, and insurers at this point would be able to come to a reasonable agreement that would make such treatment affordable to all.  I would have more hope for Congress!

Like it or not, it is hard to avoid the root question even as many speculate on how far they can climb out on the branches before falling:  we need universal health care protection for all Americans!  Without it, specialized drugs and path-breaking gene treatments, will make hospitals the new playgrounds of the rich, while the rest of us suffer and die.

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Draining Bloated Drug Prices

Little Rock  Something big is happening among drug companies. They aren’t exactly on the run, but they are at least feeling the heat, so there may be hope for the rest of us.

Let’s look at how the evidence is starting to add up:

  • Turing Pharmaceuticals and its CEO have become the face of exploitation as he testifies before Congress on video screen from jail on stock manipulation charges after having become the picture of greed by upping the price of rare, minimally manufactured drugs for specific diseases by predatory multiples.
  • Valeant, a high flying drug company that assembled its meteoric rise by buying other companies and drugs in recent years has suffered an almost 50% meltdown of its value recently, pushed out its CEO and finance people for suspected earnings misstatements, and shattered the reputation of William Ackerman, a previously highflying private equity mogul who has also lost a fortune and has joined their board to try to stop the bleeding.
  • Anthem, the insurance company, is suing Express Scripts, the prescription drug middleman for $15 billion in damages in a huge pot-calling-the-kettle-black suit alleging that they violated their contract by piling on excessive charges through “unduly high pricing” and “an obscene profit windfall.” This is rich because usually when consumers buy drugs there is already a margin for the benefit manager larded into the price, so we’re really the ones paying. Anthem is charging that there is about $13 billion in such overcharges wrapped into the life of their contract. It’s little mystery that even though Anthem is crying like a stuck pig, the real victim here is the final customer: us!
  • Meanwhile giant drug purveyor, Lilly, is barking up one tree after another complaining about proposals from President Obama under the Affordable Care Act and others from Hillary Clinton and Bernie Sanders that would try to assign the research and development costs from the drug companies to specific drugs in order to rein in pricing. The company’s argument is that, hey, we spent almost $5 billion on R&D about 10% of all R&D spent in the pharmaceutical industry, and it wants us all to shut-up and accept their word rather than coming up with an assessment of drug-by-drug figures on their expenditures. Right, like they don’t do this in-house and already know, huh? They are the cause though that leads to this effect. If they didn’t arbitrarily inflate the costs of drugs against the desperate needs of the sick in their market, this wouldn’t be an issue. What goes around, comes around.

Ok, these are small signs often nestled in the business pages of local and national newspapers, but it’s spring, a season of renewed hope, so let’s take a deep breath and hope that these are real signs that finally a level of rationality may finally be imposed on the predatory pricing schemes of drugs that literally mean the difference between affording life or choosing death.

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