"What I say to the
companies is if you think the cost of your drug will scare people from buying
your drugs, then lower your prices."
Terrific quote from the
not-always-terrific Health and Human Services Secretary, Alex Azar. The
Department of HHS will require TV ads for drugs to disclose the list price for
the drugs they advertise. Sure, they will be at the end in the small print along
with the side effects (‘nausea, vomiting, headache, baldness, serious
infections, death, etc.’), and thus far there are no plans to require it in
print ads, but it is a big step forward. There is so much evil being done by
the Trump Administration that it is nice, every once in a (long) while to be
able to point out something that is good. The #Trumpenik himself tweeted
something very similar to Azar’s quote.
This has been one effort
by the Administration to try and control drug prices by a very indirect route
that, tellingly, does not include actually controlling drug prices. It does not
even include allowing Medicare (the nation’s biggest drug purchaser) to
negotiate drug prices with pharmaceutical manufacturers (that ban was built
into the GW Bush era legislation that created the Medicare drug requirement, Medicare
“Part D”). Still, it is something and something that is not insignificant. You
can tell this from the reaction of the drug manufacturers, represented by PhRMA
(the Pharmaceutical Research and Manufacturers of America), which said “We are concerned that the administration's
rule requiring list prices in direct-to-consumer television advertising could
be confusing for patients and may discourage them from seeking needed medical
care." It takes some chutzpah to say such a thing; what PhRMA wants is
for patients to demand these drugs (some of which cost upwards of $30,000 a
year. Or, for some, a month!) from
their doctors, and then the doctors to put pressure on insurers to cover them.
Yes, often the price
paid by the insurance company will be much less than the list price that the
new regulations will require them to put on their TV ads. But there will still
be those, the poorly insured and uninsured, the most needy, who will have to go
without, who, even if they are not discouraged from seeking needed medical care will find out that it is not really
available to them. While PhRMA is the trade group for the most profitable
industry in the US, their objection to posting list prices is mirrored by
health providers, especially health systems, who argue that posting their
prices from their “chargemaster” is deceptive because insurance companies often
(usually) pay less. Yeah, so? Why not charge less and let them pay the charge?
This is how it is in most other industries, and in healthcare in most other
countries.
The pharmaceutical
industry has a well-deserved reputation as an evil cabal, and it is not only the
“outliers”. Yes, we have the fantastic extremes of Heather Bresch’s Mylan and
its Epi-Pen®, and Martin Shkreli and colchicine, but we also have the “mainstream”
pharmaceutical companies who have unconscionably raised their predatory pricing
on key life-saving drugs, like insulin. NBC
reports a doubling of the price of insulin from 2012-2016, and stories on
people who are affected abound. In 2017, the pharmaceutical companies were
accused of fixing
the price of insulin. They deny it, but their actions belie that denial; in
March, Eli
Lilly agreed to sell a “generic” version of its Humalog® for half price and
ExpressScripts,
a pharmacy benefit manager (PBM, read either facilitator or middleman, but
however you read it, it is “moneymaker”) said it would offer to cap insulin
costs at $25/month. Interesting for a drug whose discoverers refused to
patent it because they wanted it freely available to the public. (And,
interestingly, insulin still does not require a prescription, although the
needles and syringes do…) The NY Times recently
reported that “Lawmakers
in Both Parties Vow to Rein In Insulin Costs”, but we shall see.
Of course, while its
reputation as evil is well-deserved, the pharmaceutical industry is not alone
in making rapacious profits from our health needs. The entire “industry” is not
about making people healthier, or even curing the sick, but on making money.
This includes, of course, insurers, but also health providers, hospitals,
health systems, nursing homes, doctors, etc. Ever try to get a price on any
health care you need, besides drugs? Ever try to figure out a bill? Two stories
from my own life I have written about before but will re-tell here:
Some years ago I had outpatient hernia surgery. I arrived about
6:30am and was back home in my bed by noon. Later I got the bill from the
hospital for its charges (not including the doctors’): $10,000. Then my
insurance company told me that I would pay $400, they would pay $1,600, and the
hospital would write off the other $8,000 as a contractual adjustment.
Of course, if I had been
uninsured, I would have not been billed for the $2,000 the hospital actually
received, but for the whole $10,000! This is why they don’t want to list their
charges. This obfuscation is motivated by insurance companies looking to show
what a good deal they provide their customers (look! We saved you $8,000!). Of course, this is baloney; since the
hospital was willing to settle for $2,000, that is what they should have
charged, everyone.
And price lists? Time
for the other story.
I live an hour from the border, and, with Medicare but no dental
coverage, I go to Mexico to get my teeth cleaned. It costs $35; a lot less that
in the US and is done quickly and thoroughly by a dentist. It costs everyone
$35. If you have dental insurance (they take it), it costs $35. But say you
need more – a filling, a crown, implants. Not only is it a lot cheaper than in
the US but they can tell you exactly how much it is going to
cost! A friend had several implants, and
this cost thousands (but a fraction of the US cost); the point is they told her
exactly what the cost would be up front. This, it turns out, is actually possible!
The article I cited at
the beginning, from the Associated Press (and read by me in the Arizona Star,
shout-out), quotes
‘Leigh Purvis, a pharma
expert with AARP's research division, [who] said disclosure will help dispel a
"cloak of darkness" around prices and encourage more informed
discussions between patients and their doctors. But she cautioned against
expecting too much.
‘"The overall idea
of reducing drug prices is something for which there is no silver bullet,"
said Purvis. "This is just one step, one tool in what will have to be a
very big arsenal."’]
She is right. I said it
was a good step, worthy of praise, but it will not alone be enough to bring
down drug prices. Or the cost of any of the health care we are regularly ripped
off for. While the burden will continue, as always, to fall heaviest on those
who can least afford it and have the greatest need, it is impacting everyone.
Let’s start with letting Medicare negotiate drug prices. Let’s regulate
insurance company profits. Let’s make everyone in the health industry post
their prices.
Indeed, let’s have a
universal, single-payer health system. #MedicareforAll!
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