Human health is incompatible with a for-profit model of healthcare. Sick people need healthcare and maybe medicine. It really is that simple. Just like the country needs federal interstates and highways, it needs to take care of the health of the people. Simply because sick people cannot take care of themselves. Is there something difficult to understand about that?
41
I am so sick of the greed in this country, from the top down, and the rampant corruption that comes along with it. It is incredibly disheartening and they just seem to keep winning. It is exhausting and it feels like nothing we can say or do (aside from buying votes) would make any difference. We've got to get corporations out of politics. Period.
43
The incentives under ACA are all wrong, proving we need single payer. We have no idea whether the drug companies are paying rebates to the insurers, whether those rebates are counted in calculating the year end refunds to patients, or whether the drug companies are paying bribes or kickbacks to individuals at the insurance firms. These practices could easily be fixed by small amendments to the ACA, but the GOP prefers to eliminate the ACA rather than reform it. Its no wonder that the entire system favors big providers and insurers.
Also, all my friends in medicine report that the insurers just treat the system as "cost plus" so have no incentive to cut costs. Once an insurer agrees to pay providers a specific amount, there is no help given to referring patients to a low cost provider who is willing to undercut the negotiated price, even if that would save the patient big bucks in deductibles and copays, and lower costs of insurance. Since there is no competition in medicine today, its easy to understand why single payers saves other nations at least 50% of the money we pay here in the US for our "free market" medicine.
Finally, Congress could hold hearings on fraud and abuse and prevailing practices in healthcare, but the GOP prefers to use their subpoena power for Bengazi and other useless investigations.
Also, all my friends in medicine report that the insurers just treat the system as "cost plus" so have no incentive to cut costs. Once an insurer agrees to pay providers a specific amount, there is no help given to referring patients to a low cost provider who is willing to undercut the negotiated price, even if that would save the patient big bucks in deductibles and copays, and lower costs of insurance. Since there is no competition in medicine today, its easy to understand why single payers saves other nations at least 50% of the money we pay here in the US for our "free market" medicine.
Finally, Congress could hold hearings on fraud and abuse and prevailing practices in healthcare, but the GOP prefers to use their subpoena power for Bengazi and other useless investigations.
24
I don't know if this happens in the US or not, but here in Japan I discovered that for some medications, pharmacies were charging me the same price for the generic as for the original -- all the while encouraging me to get the generic.
I only discovered this when I directly asked the price difference. My conclusion was that the generics were cheaper for the pharmacy, but they were pocketing the difference, since for minor medications most customers just assume they are getting a savings.
Now I always ask prices, and tell them if the generic is the same price, I'd rather have the original and have some of the profits go to the company that did the R&D in the first place.
I only discovered this when I directly asked the price difference. My conclusion was that the generics were cheaper for the pharmacy, but they were pocketing the difference, since for minor medications most customers just assume they are getting a savings.
Now I always ask prices, and tell them if the generic is the same price, I'd rather have the original and have some of the profits go to the company that did the R&D in the first place.
16
I live in Montreal, Quebec. The provincial (like your state) government is responsible for health care. On 2 different occasions I was prescribed a drug but the pharmacy gave me the generic. In Quebec, a doctor has to sign off that the patient needs the name-brand drug, otherwise the government won't pay.
Both generics gave me irregular heartbeats. In the first case it took me 18 months and all kinds of tests to figure out what the problem was. Eventually, my doctor specifically asked for the name-brand. When I started to get an irregular heart beat with the second drug, I knew immediately what the problem was.
A generic may have the identical chemical structure to the name-brand drug, but the ingredients (colour, binder, coating and other chemicals are different). What my heart reacted to was any of the above additives!
Both generics gave me irregular heartbeats. In the first case it took me 18 months and all kinds of tests to figure out what the problem was. Eventually, my doctor specifically asked for the name-brand. When I started to get an irregular heart beat with the second drug, I knew immediately what the problem was.
A generic may have the identical chemical structure to the name-brand drug, but the ingredients (colour, binder, coating and other chemicals are different). What my heart reacted to was any of the above additives!
16
"That did not mean lowering the list price of the drug, but rather negotiating rebates that were paid not to the patients but to insurers and middlemen such as CVS Caremark."
That should be illegal.
~~~~~~~~~~~
Americans pay the highest cost for the least results in the world.
Just another of the many reasons there are better countries to raise children.
Fortunately, in order to preserve their quality of life it is difficult for Americans to move there. Readers of this column can see why other countries take care not to let in people who sit by while politicians eat away at what the people work to obtain.
That should be illegal.
~~~~~~~~~~~
Americans pay the highest cost for the least results in the world.
Just another of the many reasons there are better countries to raise children.
Fortunately, in order to preserve their quality of life it is difficult for Americans to move there. Readers of this column can see why other countries take care not to let in people who sit by while politicians eat away at what the people work to obtain.
22
Unfortunately, the drug and insurance companies got to help write the Affordable Care Act when it came to crunch time and President Obama needed to get it passed. We are seeing the results in many ways, including this one. They had more power than Obama thought they would bring to the table. Single-payer is the only way out of this. On the flip side, as long as Big Food is allowed to continue to poison our population with their fake food, the vast majority of disease which Big Pharma lives off of providing relief from and sometimes curing will continue to inflict us. And demand for medications will continue and escalate. Eating safe, healthy food will prevent majority of the sickness that inflicts us. You'd almost think Big Fake Food is in cahoots with the drug and health insurance companies.
13
I notice one of the people you quote is in Walnut Creek in California. . My pharmacist told me that California has passed a law that all pharmacies 'must' provide a generic when a brand has been prescribed. The prescriptions have a spot where the doctor has to check that a brand 'must' be provided or the pharmacy must give the customer a generic.
Sounds like California is ahead of the rest of the country.
Sounds like California is ahead of the rest of the country.
6
Drugs only treat symptoms and don't necessarily help you overcome your issues. By being dependent on physical drugs that scientists spend so much time to research and actually takes more than $10 to produce, you are signing up for more expense than you can handle. I would prescribe lifestyle changes than any generic drugs. It will be hard and may be expensive, but if you have issues that needs drugs constantly, you're like a slave to drug companies. You won't be free until you overcome it yourself or die before bankrupting your health care providers.
4
Generics are not always the same quality, therefore not always better.
11
Looks like the pharamaceutical sales industry has done a better job of training you than your chemistry teachers have.
"Generic drugs are required to have the same active ingredient, strength, dosage form, and route of administration as the brand name product."
- FDA
Generic drugs in the USA are regulated by the FDA. In a nutshell, they ARE exactly the same from a functional perspective. Suggest you google the FDA website "Understanding Generic Drugs" to cure yourself of your lack of knowledge.
"Generic drugs are required to have the same active ingredient, strength, dosage form, and route of administration as the brand name product."
- FDA
Generic drugs in the USA are regulated by the FDA. In a nutshell, they ARE exactly the same from a functional perspective. Suggest you google the FDA website "Understanding Generic Drugs" to cure yourself of your lack of knowledge.
15
i have a Medicare Advantage plan through United Healthcare.
Their drug tier chart has changed many times ovrr the years.
First with having to use a generic over a brand name drug if one exists.
Then on brand name drugs that cover the same health condition - healthcare companies came up with their "Preferred Brand Names so you were stuck with their brand name choice.
A couple of year's ago they came up with another scam by creating Preferred brand name 'generic' drugs !
And it used to be when a Brand drug patent ended - the FDA allowed generic drug companies to make copies and sell at much lower prices once they came on the market.
Not so anymore. Case in point for many years since it first came on the market - I went on "Crestor" a new statin drug and it worked wonders with my bad cholesterol and still does. Put it was a 'Tier 3, brand name drug that I had to pay a co-pay of around $45 for a 30-day supply.
Just last year they came out with a generic to Crestor - but I had to pay the same copay amount as I did for Crestor. (generics on my plan usually cost $2 up to $8 for a 90 day supply.).
I asked why and they could not give me an answer but did tell me in 2017 that I would still have to pay the same co-pay for the Generic as Crestor. ($154 for 90 day supply) snd may continue into 2018! This is crazy!
Then when you are taking a generic for months and renew - you get a different pill made by another generic drug company approved by the FDA. Sometimes a different size.
Their drug tier chart has changed many times ovrr the years.
First with having to use a generic over a brand name drug if one exists.
Then on brand name drugs that cover the same health condition - healthcare companies came up with their "Preferred Brand Names so you were stuck with their brand name choice.
A couple of year's ago they came up with another scam by creating Preferred brand name 'generic' drugs !
And it used to be when a Brand drug patent ended - the FDA allowed generic drug companies to make copies and sell at much lower prices once they came on the market.
Not so anymore. Case in point for many years since it first came on the market - I went on "Crestor" a new statin drug and it worked wonders with my bad cholesterol and still does. Put it was a 'Tier 3, brand name drug that I had to pay a co-pay of around $45 for a 30-day supply.
Just last year they came out with a generic to Crestor - but I had to pay the same copay amount as I did for Crestor. (generics on my plan usually cost $2 up to $8 for a 90 day supply.).
I asked why and they could not give me an answer but did tell me in 2017 that I would still have to pay the same co-pay for the Generic as Crestor. ($154 for 90 day supply) snd may continue into 2018! This is crazy!
Then when you are taking a generic for months and renew - you get a different pill made by another generic drug company approved by the FDA. Sometimes a different size.
7
This happened to me with Adderall too. I was on a health plan with a now defunct insurance comoany. When I was prescribed Adderall I got the generic version.
When then switched insurance and "all of the sudden" I had to get the brand prescription for $220. No word why from the insurance (Cigna).
Now, I'm with another insurance and I can get the generic one again. We just moved to. New state and a new insurance. Not looking forward to get the next prescription....
When then switched insurance and "all of the sudden" I had to get the brand prescription for $220. No word why from the insurance (Cigna).
Now, I'm with another insurance and I can get the generic one again. We just moved to. New state and a new insurance. Not looking forward to get the next prescription....
3
Welcome to the world of for-profit medicine. It will only get worse. The system is broken beyond repair. Of course single payer would be better but it ain't going to happen. Too many hands in the cookie jar. Let it break, get the greed out of medicine. But then greed is what makes the US proper. Oh well, more money for the 'job creators'.
12
It makes my blood boil reading this. Ornstein and Thomas don't come right out and say it, but I think the situation is this: sometimes insurers can cut a deal with a drug company so that it costs the insurer LESS to pay for some particular drug even though it costs the patient MORE. Then the insurer makes that drug the only version they will cover.
As infuriating as this would be for anyone to deal with, imagine what it would feel like if you were dealing with this sort of baloney on top of, say, a life-threatening illness.
Developing drugs to cure disease and alleviate suffering should be a noble pursuit. How is it that the pharmaceutical industry, or at least some of it, has turned into scammers using quirks of the marketplace to basically steal from sick people. E.g. Turing Pharmaceuticals' Daraprim debacle, Marathon's deflazacort story, AMAG Pharmaceuticals and Makena, the EpiPen story, and now insurers taking kickbacks to act against the best interests of their patients. If the pharmaceutical industry wanted to make a case for stricter government oversight, they couldn't have done much better than this.
Despicable.
As infuriating as this would be for anyone to deal with, imagine what it would feel like if you were dealing with this sort of baloney on top of, say, a life-threatening illness.
Developing drugs to cure disease and alleviate suffering should be a noble pursuit. How is it that the pharmaceutical industry, or at least some of it, has turned into scammers using quirks of the marketplace to basically steal from sick people. E.g. Turing Pharmaceuticals' Daraprim debacle, Marathon's deflazacort story, AMAG Pharmaceuticals and Makena, the EpiPen story, and now insurers taking kickbacks to act against the best interests of their patients. If the pharmaceutical industry wanted to make a case for stricter government oversight, they couldn't have done much better than this.
Despicable.
20
Wow. If only I were "forced" to accept Adderall instead of the generic I've been stuck with the last ten years. Even with that drug's help this piece was wildly confusing. Here is what it was supposed to say:
To protect the market for its overpriced brand-name drugs, Pharma buys/pays off/colludes with generics makers and major pharmacy chains. They also give freely available discount cards to doctors to give patients who complain, or patients who sign on to their web sites. Anyone who wants a discount for, say, Lunesta, can get one.
Why the charade? Because by maintaining the fictional "list price" the one entity that cannot, by law, get a discount is the US government, which has to pay bust-out (outrageous) retail. That was the deal for Medicare Part D, by far the largest drug purchaser on the scene.
How could a free-market Republican (Bush) get a social-welfare plan through Congress? By promising the industry that profits were assured. Take it from there, Pharma! This corner of the world is your oyster. Do with us what you will, but please be gentle.
To protect the market for its overpriced brand-name drugs, Pharma buys/pays off/colludes with generics makers and major pharmacy chains. They also give freely available discount cards to doctors to give patients who complain, or patients who sign on to their web sites. Anyone who wants a discount for, say, Lunesta, can get one.
Why the charade? Because by maintaining the fictional "list price" the one entity that cannot, by law, get a discount is the US government, which has to pay bust-out (outrageous) retail. That was the deal for Medicare Part D, by far the largest drug purchaser on the scene.
How could a free-market Republican (Bush) get a social-welfare plan through Congress? By promising the industry that profits were assured. Take it from there, Pharma! This corner of the world is your oyster. Do with us what you will, but please be gentle.
14
The inactive ingredients of generic drugs can have negative effects. Generics are often not the equivalent of brand name drugs whatsoever.
“There’s only one reason why they’re requiring you to use a more expensive product,” Mr. Frankil said. “Because somewhere down the road, somebody is earning more money.”
Someone is also making a boatload selling the generic, too.
“There’s only one reason why they’re requiring you to use a more expensive product,” Mr. Frankil said. “Because somewhere down the road, somebody is earning more money.”
Someone is also making a boatload selling the generic, too.
6
'The inactive ingredients of generic drugs can have negative effects. Generics are often not the equivalent of brand name drugs whatsoever. '
Wow that's misleading.
First, let's get something out of the way: the active ingredients in generic drugs are identical to those of 'brand name' drugs. They are medically identical and regulated by the FDA to ensure this.
The inactive ingredients in drugs - generic or not - are basically food or at most very mild drugs such as aspartame. Normally it's food - sugar or sugar substitutes, starches, oils, and the like. You might have an adverse reaction to some particular food -for example, your body might not like aspartame. But there's no reason to link this to generic drugs per se - the 'brand name' drugs also have similar or identical inactive ingredients and it is equally likely that you could have an an adverse reaction to those!
In short, your claim is very, very highly misleading. You are attempting to paint generic drugs as having some issue which actually affects all drugs equally. And then you compounds this by a slam on the profits that you suspect that generic drug makers are making.
The only question left i guess is to ask is which brand name pharmaceutical company do you work for?
Wow that's misleading.
First, let's get something out of the way: the active ingredients in generic drugs are identical to those of 'brand name' drugs. They are medically identical and regulated by the FDA to ensure this.
The inactive ingredients in drugs - generic or not - are basically food or at most very mild drugs such as aspartame. Normally it's food - sugar or sugar substitutes, starches, oils, and the like. You might have an adverse reaction to some particular food -for example, your body might not like aspartame. But there's no reason to link this to generic drugs per se - the 'brand name' drugs also have similar or identical inactive ingredients and it is equally likely that you could have an an adverse reaction to those!
In short, your claim is very, very highly misleading. You are attempting to paint generic drugs as having some issue which actually affects all drugs equally. And then you compounds this by a slam on the profits that you suspect that generic drug makers are making.
The only question left i guess is to ask is which brand name pharmaceutical company do you work for?
12
The American Health Care system is broken, and we need a single payer plan where the government negotiates the prices for drugs. What this articles demonstrates is the current health care system is not primarily about treating patients, it is about making money. The GOP insists they want to let the "free" market work and this will lower health care costs. This article demonstrates that the market is corrupted by profiteers at the expense of the consumer, who does not have the information or ability to force competition. If the GOP is sincere about reforming the health care system so it works for the consumer, the first thing on the agenda should be to address the corruption in the drug markets. However, do not expect this to happen because our elected representatives are captives of the donations made by Big Pharma.
15
Whenever politicians preach the free market system, you can be relatively certain they are indeed working to eliminate competition.
9
My spouse has a seizure disorder. The original brand name drug works for her - it is truly a life-saver. Our various health insurance companies over the years have nearly universally complained and demanded a generic be used instead.
We were talking with some family friends who work in "big pharma" and learned that generic drugs are not exactly identical to the original. The formulations can supposedly vary several percent for an ingredient in any direction.
For an anti-seizure drug (or anti-depressants, etc.) that take time to quantify optimal dosing, it is rather scary to demand a drug whose contents are variable. Drugs like ibuprofen may not be adversely impacted. Something else, may.
I am amazed at the accepted variability to claim a drug is generic. With today's science and manufacturing exactness, there is no excuse. To maintain our lifestyle, I am willing to pay a great deal more to make sure we don't experience a seizure (and thankfully we can, at least today). The consequences are too costly. But neither should we be forced into that position because the two formulations are not exact.
We were talking with some family friends who work in "big pharma" and learned that generic drugs are not exactly identical to the original. The formulations can supposedly vary several percent for an ingredient in any direction.
For an anti-seizure drug (or anti-depressants, etc.) that take time to quantify optimal dosing, it is rather scary to demand a drug whose contents are variable. Drugs like ibuprofen may not be adversely impacted. Something else, may.
I am amazed at the accepted variability to claim a drug is generic. With today's science and manufacturing exactness, there is no excuse. To maintain our lifestyle, I am willing to pay a great deal more to make sure we don't experience a seizure (and thankfully we can, at least today). The consequences are too costly. But neither should we be forced into that position because the two formulations are not exact.
14
My first job in high school was working in a dispensary. The pharmacist made it very clear that there was NO DIFFERENCE between generic and name brand except price. The drug companies have patents for years and can rake in all the profits. Once generics can be made, they have the choice of lowering their prices or playing on people's fears that generics are inferior products. Well, big surprise what they pick to do. I always ensure I get the generic - even though I have a drug plan. Because I don't want my insurance paying one penny more than they have to. If they are paying these high prices - the highest in the world - then insurance premiums go up. The only people who win are the drug companies and the politicians who get money from those companies.
8
Shire manufactures the generic - it all comes off the same assembly line.
http://www.reuters.com/article/shire-adderall-xr-idUSWLB0062Z20131202
One could postulate that Shire is purposely manufacturing an inferior product but the standard for FDA generic approval, is to verify non-inferiority.
This is clearly a scam and only further bolsters the sense that many of us have developed - health care is not about patients but about profits.
http://www.reuters.com/article/shire-adderall-xr-idUSWLB0062Z20131202
One could postulate that Shire is purposely manufacturing an inferior product but the standard for FDA generic approval, is to verify non-inferiority.
This is clearly a scam and only further bolsters the sense that many of us have developed - health care is not about patients but about profits.
18
Isn't this a substance over form kickback? Where is the FTC in enforcing what is clearly anti-competitive practices. Fair competition and transparency is about protecting the consumer. This is outrageous. I am happy to see my stocks and dividends devalue to zero for the sake of my fellow humans, whose life and health is far more valuable than a brand name.
19
The NY Insurance Law generally requires insurance companies to allow you to fill a 90 day prescription at a local pharmacy if the pharmacy will charge a similar price to their mail order pharmacy. Costco jumped through hoops to qualify yet United Healthcare REFUSES to follow the law.
Also, some drugs cost MORE if purchased with their insurance than if the customer pays the price without insurance!
I think that United Healthcare should be put out of business. Other, hopefully more honest, companies will then pick up the slack.
Also, some drugs cost MORE if purchased with their insurance than if the customer pays the price without insurance!
I think that United Healthcare should be put out of business. Other, hopefully more honest, companies will then pick up the slack.
17
This is one of the best arguments yet for single payer Medicare for All, to negfor legislatively requiring MEDICAID to negotiate prescription drug prices.
Also makes the case for permitting importation of prescription drugs from Canada.
If we had a Justice Department instead of an AG interested in restoring Plessey v. Ferguson, the feds would be suing Big Insure and Big Pharma for multiple (one count for each pill) anti-trust violations.
Also makes the case for permitting importation of prescription drugs from Canada.
If we had a Justice Department instead of an AG interested in restoring Plessey v. Ferguson, the feds would be suing Big Insure and Big Pharma for multiple (one count for each pill) anti-trust violations.
23
We really do need more investigative articles on this topic of bait and switch tactics carried out in unison, not only by the covert collusion of BigPharma and the Insurers at the life and death expense of paying consumers, but also of corporate pharmacies which too often will choose to order their generic supplies from the lowest of the low generic makers who have quite a sordid manufacturing history in which the quality of their final products have been questioned as 'inferior'. (The ones that don't quite work the way the brand-name does).
Sunshine is the best (and the only) disinfectant that these operators need. Full on exposure is needed of how easily they've rigged our once functional American medical system that now caters, not to the patients or the public, but to the CEO's and their greedy self-centered shareholders. Don't wait for the government to do anything. Remember, the swamp is currently being 'drained'. There is no help from Uncle Sam right now. Time to change that.
Sunshine is the best (and the only) disinfectant that these operators need. Full on exposure is needed of how easily they've rigged our once functional American medical system that now caters, not to the patients or the public, but to the CEO's and their greedy self-centered shareholders. Don't wait for the government to do anything. Remember, the swamp is currently being 'drained'. There is no help from Uncle Sam right now. Time to change that.
15
Is it time for a single payer system for pharmaceuticals?
15
And for Congress to rescind their bill passed years ago as a $$ gift to Big Pharma which states the government's Medicare system cannot negotiate prices with the drug manufacturers. like in all countries with socialized healthcare can. Why patients in those countries pay less than half or less for the same drugs supplied in the USA.
YET our government can negotiate prices of drugs supplied by Medicaid.
Makes no sense whats so ever ??
Both are huge government programs that cover millions of Americans.
Big Pharma owns Congress - period !
American drug companies selling drugs cheaper to other countries than America sounds and is treasonous !
YET our government can negotiate prices of drugs supplied by Medicaid.
Makes no sense whats so ever ??
Both are huge government programs that cover millions of Americans.
Big Pharma owns Congress - period !
American drug companies selling drugs cheaper to other countries than America sounds and is treasonous !
7
So let me see if I have this right: When I am treated to lunch by a pharmaceutical rep while listening to a presentation about a new drug, my name and the value of that lunch is reported to a national database under the Sunshine Act--because I might be convinced to use a new, more expensive drug, and cost the payer--the insurance company--more money. That I can be bought by a turkey sandwich to place the drug company' profits above the needs of my patients is just flat out insulting.
But when the pharmaceutical companies pay millions of dollars in kickbacks to pharmacy benefit managers (PBMs), and those dollars benefit the insurers' bottom lines at the expense of my patients, there is no sunlight shining on those possibly legal but clearly immoral activities.
Drug prices, like all healthcare costs, are higher in the US than anyplace else in the world, without a commensurate increase in results. Who benefits from all this extra spending? Not patients, with ever increasing costs for insurance and copayments, and not doctors, who are taking salaried positions in increasing numbers. Must be the insurers, again reporting record profits. And as long as they are allowed to share those profits (which would be illegal fee-splitting if a physician did it) with Congress, they are both happy and nothing is ever going to change.
What a country!
But when the pharmaceutical companies pay millions of dollars in kickbacks to pharmacy benefit managers (PBMs), and those dollars benefit the insurers' bottom lines at the expense of my patients, there is no sunlight shining on those possibly legal but clearly immoral activities.
Drug prices, like all healthcare costs, are higher in the US than anyplace else in the world, without a commensurate increase in results. Who benefits from all this extra spending? Not patients, with ever increasing costs for insurance and copayments, and not doctors, who are taking salaried positions in increasing numbers. Must be the insurers, again reporting record profits. And as long as they are allowed to share those profits (which would be illegal fee-splitting if a physician did it) with Congress, they are both happy and nothing is ever going to change.
What a country!
35
Hey man, totally with you. The gun is pointed in the wrong direction. In my business, which was journalism, for thirty-plus years, the biggest source of corruption I found was not the free turkey lunches and "press trips" showered on us by the business community. It was the editors and their bosses, who pushed, pushed, pushed, for headline stories, warranted or not. Those same corrupting influences are the ones who demand that everyone (else) be held accountable. Look deep into this article and you can see the wheels in motion.
4
Sadly, many studies have shown that pharma sales reps tactics DO influence physician prescribing practices, hence the need for oversight.
5
Stories like this are why America is spending roughly twice as much on healthcare as other advanced industrial nations.
And yet the Republican solution to this spending is high deductible plans, and health care rationing, not allowing government to aggressively negotiate drug prices with pharmaceutical companies.
And yet the Republican solution to this spending is high deductible plans, and health care rationing, not allowing government to aggressively negotiate drug prices with pharmaceutical companies.
17
“There’s only one reason why they’re requiring you to use a more expensive product,” Mr. Frankil said. “Because somewhere down the road, somebody is earning more money.”
Another reason could be to prevent many patients from taking any version of the drug at all.
Another reason could be to prevent many patients from taking any version of the drug at all.
11
Corruption in the US healthcare system? Who would have expected that?
13
Why aren't such deals considered illegal restraint of trade under the anti-trust laws?
13
About two years ago my neurologist wrote a prescription for a stimulant for my daytime fatigue. When I tried to fill the prescription, the cost was $2,000!!! I called my doctor and she gave me another prescription that cost $16.00. No news, the health care system is out of control.
JD
JD
19
How about collusion* between the big insurers and Big Pharma?
*"secret or illegal cooperation or conspiracy, especially in order to cheat or deceive others."
Silly me, I thought my doctor made the decision about which would be the most cost-effective and best drug for my condition.
Here is a fundamental question we need to address: Is medicine a business or a profession?
Hint: the main objective of business is to earn profits; the main objective of a profession is to render services.
A profession requires education, highly specialized training, demonstrated expertise, and adherence to ethical codes of conduct;
there are no standard minimum qualifications for business and no standard ethical codes of conduct
You decide
How did doctors in this country lose control of their profession?
*"secret or illegal cooperation or conspiracy, especially in order to cheat or deceive others."
Silly me, I thought my doctor made the decision about which would be the most cost-effective and best drug for my condition.
Here is a fundamental question we need to address: Is medicine a business or a profession?
Hint: the main objective of business is to earn profits; the main objective of a profession is to render services.
A profession requires education, highly specialized training, demonstrated expertise, and adherence to ethical codes of conduct;
there are no standard minimum qualifications for business and no standard ethical codes of conduct
You decide
How did doctors in this country lose control of their profession?
15
They let the god "mammon" take over their lives. And they still think that they are good people, wear white hats, cream of the crop.
1
SHIRE is already under a US GOVT Compliance Agreement for "over marketing Adderal RX (https://www.justice.gov/opa/pr/shire-pharmaceuticals-llc-pay-565-million... so new strategy force patients to purchase by entering into Strategic Alliancex with downstream medication wholesalers for kickbacks and free stuff (well hidden insider language in Feb 2017 10k) to RETAIN the ever critical market share. Seriously unless cost of medication are fairly dealt with by a Congress woe to the patient.
10
Is the illness/malady being better treated with the generic or brand name?Docs write the prescription but when doing so they should explain to the patient the risks and benefits of both options. The patient should make the decision of drug choice after being informed of the risk to benefits and a cost analysis during the purchase. Behind closed doors shenanigans needs to stop. Maybe a computer analysis print out of all pertinent facts should be available to the patient. It's the patients body and his/her choice matters a lot.
10
This is simply criminal... period. Trouble is, it may in fact be legal, in the completely profit-driven, amoral (ie, without moral or ethical considerations at all) world of drugs in the USA. When i hear of insane atrocities such as these, i am doubly happy to be living in Canada: yes our public medical system doesn't cover drug costs but at least the government successfully regulates these prices so the pirate-led pharaceutical companies can't make huge profits off of people who are often in no position to fight back. Making the most money one possibly can, off of sick people is about as low as it gets.
16
We have no option for the generic here.
3
Well, this answers a question my husband and I have been asking for over a year: Why on earth has our insurance company stopped covering the perfectly good generics we were using (mine for ADHD, his for cholesterol) and insisting that we use brand name? Not only has it raised our costs by several hundred dollars, but it's a pain because the pharmacy doesn't always have them in stock, so we have to order them specially and wait. I'd pay for the generics myself, but without the insurance coverage, they're even more expensive than the higher co-pay. :(
14
I will never take a generic again.
Two years ago I took one dose of Levaquin, a popular antibiotic - just a single pill. Within an hour my knees were numb. I immediately stopped that medicine and switched to another antibiotic, but the damage was done. I still have not regained feeling in my knees.
Turns out, the fluoroquinolones of which Levaquin is one, have serious side effects which include permanent nerve damage. There are 'black box' warnings on them and the FDA has issued strong warnings against them with recommendations to physicians against using them except in cases of antibiotic resistance to other drugs. Serious stuff. [By the way, local doctors are still prescribing them like candy for minor infections here in Iowa.]
There are also class action lawsuits against the makers of this drug, but due to our beloved lawmakers, generic makers of drugs are exempt from lawsuits in all but Alabama, California, Illinois, and Vermont.
I was prescribed a generic version of the drug, manufactured somewhere in India. There was no black box warning in the materials given me by the pharmacy, and no warning by either the physician or pharmacist. Guess since they are exempt from legal action, they feel under no obligation to warn or care for their customers.
Despicable.
Two years ago I took one dose of Levaquin, a popular antibiotic - just a single pill. Within an hour my knees were numb. I immediately stopped that medicine and switched to another antibiotic, but the damage was done. I still have not regained feeling in my knees.
Turns out, the fluoroquinolones of which Levaquin is one, have serious side effects which include permanent nerve damage. There are 'black box' warnings on them and the FDA has issued strong warnings against them with recommendations to physicians against using them except in cases of antibiotic resistance to other drugs. Serious stuff. [By the way, local doctors are still prescribing them like candy for minor infections here in Iowa.]
There are also class action lawsuits against the makers of this drug, but due to our beloved lawmakers, generic makers of drugs are exempt from lawsuits in all but Alabama, California, Illinois, and Vermont.
I was prescribed a generic version of the drug, manufactured somewhere in India. There was no black box warning in the materials given me by the pharmacy, and no warning by either the physician or pharmacist. Guess since they are exempt from legal action, they feel under no obligation to warn or care for their customers.
Despicable.
12
Lets assume that the deductible is the same as the max out of pocket expense.
The basic problem is who gets the max out of pocket expense on a health insurance policy. The way it works now is that there is a free for all among doctors/hospitals/pharmacy's to grab as much of the deductible as they can. The losers get stuck with the insurance company negotiated price.
In the case of drugs, it's the same. In the worst case scenario, the worst pharmacy can do is be paid the insurance company price, but it can grab as much as possible until the maximum out of pocket costs are met.
The basic problem is who gets the max out of pocket expense on a health insurance policy. The way it works now is that there is a free for all among doctors/hospitals/pharmacy's to grab as much of the deductible as they can. The losers get stuck with the insurance company negotiated price.
In the case of drugs, it's the same. In the worst case scenario, the worst pharmacy can do is be paid the insurance company price, but it can grab as much as possible until the maximum out of pocket costs are met.
6
1. Single payer option to negotiate better prices 2. Change insurance to non profit entities
12
Joe Sixpack versus Marty Kickback. Time for some Affirmative Action.
4
So if the generic is still cheaper just get a prescription for it and pay cash. The big name folks are reducing their prices to keep volume, now they should send the cost reductions to the customers.
3
As the article stated, if you buy the generic and pay cash it doesn't count toward your deductible, so it's "lost" money.
10
I think we can count on more stories of health insurance companies using strategic tactics against a good sized group of people with high deductibles. The reason I feel so sure of it, Congress will never be able to fairly and appropriately legislate protections for people ( voters ). Proof is demonstrated daily for the past 7 years.
9
The only difference between lobbyist-led BigPharma and street drug dealers is the latter go to jail.
22
There seems to be no end to the greed of the drug companies.
16
This corrupt behavior of insurance and drug companies is equivalent to racketeering and should be prosecuted (doubt it will happen) by the government. This is another reason why we have the most expensive health "care" and worst outcomes, access and quality compared to civilized countries that have single payer. This would not happen if we had single-payer government funded health care. It will only happen when we elect a Congress that is not beholden to the lobbyists and their corporate donors.
19
Pharmaceutical companies are evil. It's time for price controls !
Thank you to the reporters for this article. More articles like this, please. This is extremely important journalism. Keep digging and digging on medical, insurance, and pharmaceutical stories.
Thank you to the reporters for this article. More articles like this, please. This is extremely important journalism. Keep digging and digging on medical, insurance, and pharmaceutical stories.
15
If you really want to make your blood boil google The American Pharmacist Association building > images. One of the most grand buildings in DC.
3
So are you saying that the American Pharmacists Association is to blame for high drug costs because they have a nice building? It is the insurance companies and drug manufacturers that benefit most from high costs, not pharmacists.
3
"Lucrative Deals By Drug Firms Stifle Generics" is the headline of the hard copy story.
"Take the Generic, Patients Are Told. Until They Are Not." is the online headline.
I think the hard copy readers got a better deal. It's both more succinct, and easier to understand. Are your online headlines for millennials, perhaps?
"Take the Generic, Patients Are Told. Until They Are Not." is the online headline.
I think the hard copy readers got a better deal. It's both more succinct, and easier to understand. Are your online headlines for millennials, perhaps?
10
I would change the final quote in the article from "somebody is earning more money" to "somebody is making more money off the backs of patients."
14
When physicians accept kickbacks from pharmacies, laboratories and other healthcare providers they go to jail. Why do we allow insurance companies and pharmacy benefit managers to profit at our patients expense? This practice harms patients and should be illegal. Walter Wynkoop, M.D.,
22
Sadly Melinda is more than a little off Main Street. Who does she think is running her government besides Pig Pharma and the Insurance companies?
3
Pls Mr. Taylor, restrain your diet and get some exersize and you may not need any medications.
It's called the "agency problem" as discussed here:
https://en.wikipedia.org/wiki/Principal%E2%80%93agent_problem
It has been with us a long, long time:
https://en.wikipedia.org/wiki/Parable_of_the_Unjust_Steward
This is why the constitution contains the "emoluments clause". I don't expect any Federal policing of this corrupt behavior for several years. But that's called the "fox in charge of the hen-house" problem.
https://en.wikipedia.org/wiki/Principal%E2%80%93agent_problem
It has been with us a long, long time:
https://en.wikipedia.org/wiki/Parable_of_the_Unjust_Steward
This is why the constitution contains the "emoluments clause". I don't expect any Federal policing of this corrupt behavior for several years. But that's called the "fox in charge of the hen-house" problem.
4
I wish this was the case for the medication I take. The generic is definitely not equivalent for me. CVS and Blue shield are giving me hell trying to get continuous approval for a brand formulation medication that I have to take. It feels like between BlueShield of California and CVS that the tactic is to drive me to frustration thru long hold times and multiple conversation about the situation that end in no progress until eventually I'll give upand take the generic.
6
Suggestion: 1) Medicare option for anyone that wants it, 2) relaxed regulations, such as an opt-in universal EHR, 3) real-time public bidding on drugs and medical services, 4) a required single universal bill that allows for comparison shopping.
Some argue that competition will drive down costs. Maybe so. But, that only works when there is more than one competitor, and the customer know what he or she is paying for.
We have US Postal Service, as well as UPS, Fedex, and others competing to deliver packages. Let's do the same for health care.
Some argue that competition will drive down costs. Maybe so. But, that only works when there is more than one competitor, and the customer know what he or she is paying for.
We have US Postal Service, as well as UPS, Fedex, and others competing to deliver packages. Let's do the same for health care.
7
Thank you for this article. It is an excellent illustration of the confusion that exists in this unregulated marketplace. There is a lack of transparency in how manufacturers, insurers, and particularly pharmacy benefit managers do business. Many states, including New York, have failed in the legislative process to require transparency. As a result the traditional generic medication market is upside down. Adderal XR is a splendid example. Thank you for this piece.
12
I don't see why this surprises anyone. Health insurance companies can basically do whatever they want to, and consumers have almost no recourse. Some regulations were imposed upon them with the advent of Obamacare, but not many. Something is obviously wrong when a CEO's bonus alone is worth more than than the annual wages of hundreds of middle-class working folks.
It will get worse until the public has had enough, and that does not appear to be anytime soon. Single payer is the only way to go if we want these abuses to stop.
It will get worse until the public has had enough, and that does not appear to be anytime soon. Single payer is the only way to go if we want these abuses to stop.
21
The bottom line is that insurance companies and drug companies are engaged in one underhanded nefarious scheme after another to deceive consumers and bilk them out of more money. Often the drug companies and insurance companies conspire, both withholding information about the real pricing of drugs in order to extract more money out of insured patients.
Both industries are despicable in their tactics. There is a simple answer that would resolve 99% of the problem but the government refuses to require it. All drug companies and pharmacies should be required to set a single price on each of their drugs. That is the price at which they must be sell it to everyone, whether sold to Americans or whether sold to foreigners, whether the patient is paying cash or is insured, and if insured then regardless who the insurer is. And every drug company and pharmacy must publish their drug prices to the public. Severe penalties should be imposed upon any drug company or pharmacy for deviating from the single price they set. Severe penalties should be imposed upon any insurance company or clinic or hospital that purchases drugs at a price different that the published price;
Both industries are despicable in their tactics. There is a simple answer that would resolve 99% of the problem but the government refuses to require it. All drug companies and pharmacies should be required to set a single price on each of their drugs. That is the price at which they must be sell it to everyone, whether sold to Americans or whether sold to foreigners, whether the patient is paying cash or is insured, and if insured then regardless who the insurer is. And every drug company and pharmacy must publish their drug prices to the public. Severe penalties should be imposed upon any drug company or pharmacy for deviating from the single price they set. Severe penalties should be imposed upon any insurance company or clinic or hospital that purchases drugs at a price different that the published price;
13
It should also be prohibited for insurance companies to use flat rate deductibles or flat rate co-pays for drugs. All drug insurance should be required to be written as a percentage co-pay which is the same percentage for all covered drugs.
3
It's becoming more clear every day - we have two classes in the USA now - Politicians /C-level executives and everyone else. Disgusting.
15
Developing new drugs can be expensive and extremely risky, with more losers than winners. It's the prospect of generous profit that motivates the investment that moves us forward. So profit is important.
But the profit should be honestly won. Drug companies and benefit managers should be rewarded for helping society, not finding clever ways to cheat it.
"Regulation" has a bad name among Republicans, but without regulation all but the rich and powerful are screwed.
But the profit should be honestly won. Drug companies and benefit managers should be rewarded for helping society, not finding clever ways to cheat it.
"Regulation" has a bad name among Republicans, but without regulation all but the rich and powerful are screwed.
18
Peter:
It is not true that Republicans oppose regulation per se. Both Democrats and Republicans actually very much favor regulation which benefits their constituencies. And they both oppose regulation which does not serve their constituencies. The difference is that the 2 parties have different constituencies, not their attitude toward regulation.
It is not true that Republicans oppose regulation per se. Both Democrats and Republicans actually very much favor regulation which benefits their constituencies. And they both oppose regulation which does not serve their constituencies. The difference is that the 2 parties have different constituencies, not their attitude toward regulation.
1
Sickness knows no political affiliation.
3
Errol:
Both parties embrace certain kinds of regulation. Democrats tend to try to protect consumers and workers, and conservative Republicans tend to embrace regulation that shelters favored businesses or industries. The prohibition against the government negotiating drug prices is an example of a regulation that conservatives tend to favor. They see the law as a way to keep government from getting in the way of private profit.
It is Trump and other Republicans, not Democrats, who rail incessantly against regulation. Republican opposition to regulation is why net neutrality is likely to vanish--enriching Comcast and Verizon and turning the Internet into something akin to cable television.
Both parties embrace certain kinds of regulation. Democrats tend to try to protect consumers and workers, and conservative Republicans tend to embrace regulation that shelters favored businesses or industries. The prohibition against the government negotiating drug prices is an example of a regulation that conservatives tend to favor. They see the law as a way to keep government from getting in the way of private profit.
It is Trump and other Republicans, not Democrats, who rail incessantly against regulation. Republican opposition to regulation is why net neutrality is likely to vanish--enriching Comcast and Verizon and turning the Internet into something akin to cable television.
3
'By law, Medicare cannot negotiate directly with drug manufacturers and instead gets a share of any rebates collected by insurers and benefit managers, like CVS Caremark, which operate Medicare’s drug plans.
[...] “There’s only one reason why they’re requiring you to use a more expensive product,” Mr. Frankil said. “Because somewhere down the road, somebody is earning more money.”'
America needs a pill for "Big Government" anxiety.
[...] “There’s only one reason why they’re requiring you to use a more expensive product,” Mr. Frankil said. “Because somewhere down the road, somebody is earning more money.”'
America needs a pill for "Big Government" anxiety.
13
I think you're confusing "Big Government" anxiety with "Corporate Anxiety". We NEED Medicare (ie., big government) to be able to negotiate directly with drug manufacturers and thereby reduce prices. The only way to fight the highway robbery going on in healthcare is to give government a bigger role! The side that's fleecing the consumers is the insurance and pharmecutical industry, i.e. Big Corporations.
9
Read "An American Sickness", by Elisabeth Rosenthal. It's a 330-page expose of how Big Pharma, Big Medicine and Little Government are methodically ripping us off. Americans pay more for less effective healthcare than any other advanced nation. And the notion that we can "price-shop"? A fantasy.
15
I have to ask - are any of the politicians who have platinum healthcare policies forced to purchase brank-name only drugs too or do they get a break with the generics? In the end, I guess it really doesn't matter since we, the taxpayers, pay for it all anyway.
11
Why quote drug company reps if they're just going to spit out self-interested double speak?
10
Wouldn't it be simpler if the drug companies just cooked us and ate us?
24
single payer...the only answer...
19
Sadly, many drugs I take have no generic option. If I don't use medicare (I'm past 65) or the VA (I'm a veteran) I can get a coupon from the pharma and get 7 of them for free. If my doctor prescribed double dose's on generic's and I fill a 15 pill quantity the insurer fill's them for free. Then arbitrarily 'Express Scripts' decided on June 1st to stop, after many years of doing it. This rotten insurer was forcing me to buy a 90 day supply from them at astronomical amount. Pharma coupons can only be used on 30 day supplies. Five of my brand name med's that have a retail price of $1199, $599 x2, and $499 x2. I told my doctor that I stopped a bunch on my med's. So, he hooked me up with a new special consultant at the hospital. She broke down my drug costs and my retirement pension and SS, and told me they currently have a program that will supply all my med's for free. Two I'm waiting on the pharma to OK. I was told for a year, they would supply me with free med's. Who know's how long it will last? It's not medicaid and all privately funded! It's the nicest thing that's happened to me in a very long time. Our healthcare delivery system is the biggest joke worldwide and 1 party wants to deprive more people of access to life saving care. They're a disgrace and I'll never understand how they get elected!
16
Drugmakers price their products to maximize profitability - period. Insurers, plan managers are simply passing costs to patients and dividing that money between their pockets and the drugmaker's pocket with this type of formulary trickery. Shame, shame, shame. The reason we cannot reform healthcare delivery in the US into a sane, efficient system: Healthcare's high profit margins.
11
Remind me again why mixing healthcare with capitalism is a good thing?
21
It the magic of the invisible hand of the market. Donchaknow??
2
Invisible --- as in "it's never been seen to operate"
2
Politicians are the ultimate beneficiaries of pharmaceutical gouging. Industry contributions to political campaigns assure favorable legislation to promote and maintain the advantage of big pharma over the welfare of the consumer. Find out who pays for the loyalty of your state and federal representatives and senators and then vote the despicable rascals out!
5
Solutions "remain elusive"? Scoff.
2
Take a trip to Dubai, where name-brand drugs such as Inderal (the beta blocker propranolol) and Seroquel (the antidepressant quetiapine that works well for insomnia) are not only subsidized but also available over the counter. Antibiotics are also available over the counter. Seriously. Buy enough for a year and return to the U.S. and you may find that the coach air fare and a couple of nights in a hotel are worth it. Four-star hotels can be had for under $100 a night in the summer months; perfectly good three-star ones for $75 or less. Inderal 40 mg tablets come in 50-count bottles for $12, last I checked. The bottles are about two-thirds empty so you can buy ten of them and consolidate them into three or four bottles. When I worked in a remote part of Saudi Arabia, they often ran out of Inderal. Luckily I lived right on a regional airport. Instead of making the miserable trip to Riyadh, I'd board a plane for the 90-minute flight to Dubai and pick up supplies using the bottle-consolidation method. Of course, a Dubai weekend was always extremely welcome coming from Saudi Arabia. (The Saudi authorities only care about the super-controlled meds like Xanax). If you prefer a trans-Pacific route, I found similar prices and over-the-counter availability in Thailand. Hotels are even cheaper.
9
After reading this article and the many informative comments, I fully understand the dilemma many seniors face and the painful choices they are forced to make on a daily basis - do I eat or forgo my medication today? How does anyone sustain or maintain their health with such price gouging practices?
15
I tried multiple generics for an ailment after using a brand-name drug. The brand-name works. The generics simply did not work. So I am stuck paying hundreds of dollars out of pocket until I reach my deductible, which for some reason is always met on my last refill at the end of the year. Amazing how that always happens! We'd be better off buying these drugs on street corners. At least we would get better customer service.
10
I keep reading "It doesn't make sense". It makes all the sense in the world, someone is making money off of this.
13
Several years ago, a psychiatrist prescribed me the brand name drug Wellbutrin for depression after my mother died, explaining that his patients did a lot better on the brand name version than the generic. That took me by surprise, as I assumed, as we all do, that generic drugs are the equivalent of the originals. Wellbutrin was several hundred dollars a month extra as opposed to the nominal amount my insurance would pay for the generic. I stopped going to him, eventually, because I couldn't afford the prescription. It's a problem either way — if generics don't work as well as brand names, that's a big problem. If they do and my doctor was getting a kickback or some other incentive to prescribe Wellbutrin, then that's a big problem, too. Either way, as a patient I lost.
12
There are often significant differences in how generics work for people. These differences can manifest as increased side effects or diminished effectiveness. I've experienced a significant decrease in effectiveness of a medication when the generic version of a drug i had taken became available. After being switched to the generic my symptoms worsened. I thought it was a progression of my disease at first, but on a hunch I requested the brand from my doctor. After going back on brand my symptoms improved. I've witnessed the situation of increased side effects between medications made by different generic drug manufacturers when my family member's prescription was changed from mylan to another.
6
Your doctor was correct in prescribing the brand Wellbutrin: there was a multitude of patient complaints regarding the generic's proven inefficacy within the past several years.
2
Developmental costs aside, there is only a tangential relationship between a drug's production cost and its retail price.
9
I've run into a similar problem with Medi-Cal, California's version of Medicaid. I take Abilify to help me with a mood disorder. Kaiser's pharmacy only stocks the generic, while Medi-Cal will only pay for the name brand. As a result, I have to go through hoops with Kaiser to get my prescriptions filled. No change in co-pay, however. I find it odd that a government program MAY be involved in playing a variation of this sordid game.
6
The article states: "Then, a few years ago, Shire tried a new tactic: giving ever-larger discounts to pharmacy benefit managers and insurers for preferential treatment over the generics. That did not mean lowering the list price of the drug, but rather negotiating rebates that were paid not to the patients but to insurers and middlemen such as CVS Caremark."
Huh? Isn't this the definition of a kickback? "For-profit healthcare" is an oxymoron. We should more fully nationalize health R&D, including drug development. People don't realize how much for-profit drug companies actually rely on publicly funded research. We haven't been getting our "public health money's worth" when allowing these companies to profit from public investment. Many critical public health issues aren't of interest to the for-profit sector. For example, they want drugs for chronic conditions that people have to take for a life time, not drugs that cure. Antibiotics fall in the latter category. And they aren't interested in the kind of pure science NIH and grant-funded academic centers pursue, which have led to most of the important breakthroughs in our understanding of health and disease processes. So, gov should directly invest in HEALTH research and let the public own and benefit from the treatments (and cures) that result. The for-profit sector can "own" other things...like anti-wrinkle drugs, treatments to grow longer eyelashes, etc.
Huh? Isn't this the definition of a kickback? "For-profit healthcare" is an oxymoron. We should more fully nationalize health R&D, including drug development. People don't realize how much for-profit drug companies actually rely on publicly funded research. We haven't been getting our "public health money's worth" when allowing these companies to profit from public investment. Many critical public health issues aren't of interest to the for-profit sector. For example, they want drugs for chronic conditions that people have to take for a life time, not drugs that cure. Antibiotics fall in the latter category. And they aren't interested in the kind of pure science NIH and grant-funded academic centers pursue, which have led to most of the important breakthroughs in our understanding of health and disease processes. So, gov should directly invest in HEALTH research and let the public own and benefit from the treatments (and cures) that result. The for-profit sector can "own" other things...like anti-wrinkle drugs, treatments to grow longer eyelashes, etc.
23
This seems like a no-brainer: The pharmaceutical companies have been paying the insurance companies for a long time.
8
Ah yes, the industry that spends billions on research, market research not biological research manages to find another way to pick patients pockets bare. It's not as if they are coming out with new breakthrough drugs that are extending or improving our lives any longer. There's a dearth of new antibiotics. Vital vaccines are often manufactured by just one company. Drug companies don't accept responsibility for or disclose some of the most serious side effects of their medications. Savings that they or the middlemen negotiate aren't passed down to patients. And then there are people like Shrekli (and he's not the first and won't be the last) who raise prices just because they can.
Considering that some drugs, or most drugs or medical devices, can become a necessary part of life (Lithium for bipolar patients or insulin for type 1 diabetics) drug prices do need to be regulated. Taking less than what's needed if one is diabetic can product long lasting complications. Being unable to afford a heart or asthma medication (my issue) can cause other issues. Yes, pharmaceutical companies need to make money. But they don't need to charge the equivalent of an expensive house for one pill or a series of pills. That's not health care, that's greed.
Considering that some drugs, or most drugs or medical devices, can become a necessary part of life (Lithium for bipolar patients or insulin for type 1 diabetics) drug prices do need to be regulated. Taking less than what's needed if one is diabetic can product long lasting complications. Being unable to afford a heart or asthma medication (my issue) can cause other issues. Yes, pharmaceutical companies need to make money. But they don't need to charge the equivalent of an expensive house for one pill or a series of pills. That's not health care, that's greed.
21
Yes! And notice, too, that there's more profit in managing disease than in curing it.
10
Absolutely. Let's say you have a peptic ulcer which can be fixed quickly and easily with a specific antibiotic. But if you call the ulcer "acid reflux," then you can string the patient along for the rest of his or her life by prescribing anti-acid reflux medication which do not cure, but treat the hole that the ulcer is creating in your stomach. It's quite a racket that the pharmaceutical companies, doctors and insurance companies have got going there.
5
Although medication can be a lifesaver, there have been so many failures and rip-offs that what we need is greater transparency and oversight of an industry pretty much out of control.
We, as consumers, need to not go blindly into the night when it comes to prescription and non-prescription drugs and supplements. Do your homework because it is one of the few things that can help reshape an industry in this age of "lobbyism."
We, as consumers, need to not go blindly into the night when it comes to prescription and non-prescription drugs and supplements. Do your homework because it is one of the few things that can help reshape an industry in this age of "lobbyism."
9
Reduce drug costs by 30%, "How" you ask?
Simply ban marketing of drugs. SG&A (sales expenses) costs at big pharma range from 27% (Merck) to 33% (Pfizer). Without the opportunity to waste that money (if actual healthcare is your goal rather than sales vs a competitor) drug costs plummet.
Over the past 20 years the amount of healthcare costs attributed to drugs has risen from 7% to 17%. That should cause a pause for thought!
Simply ban marketing of drugs. SG&A (sales expenses) costs at big pharma range from 27% (Merck) to 33% (Pfizer). Without the opportunity to waste that money (if actual healthcare is your goal rather than sales vs a competitor) drug costs plummet.
Over the past 20 years the amount of healthcare costs attributed to drugs has risen from 7% to 17%. That should cause a pause for thought!
17
If you watch broadcast TV for any length of time, you see that most advertising is now monopolized by drug companies, car companies and telecoms. Only a small fraction of the population is looking to buy a new car at a particular moment; only a small fraction of the population remotely has a condition requiring one the these questionable medications and only a small fraction would consider switching their telecom provider for the same lousy deal elsewhere in an endless game of music chairs. The only conclusion must be that the ROI on this advertising must be spectacular and that the actual value of the products being sold is minimal compared to their price.
7
It is a shame the article didn't mention the option of buying drugs from Canada. My meds are all covered by my insurance, but a friend gets all her meds from Canada. It is the same product at a fraction of the cost.
6
There are several issues this article doesn't address that are key to the heart of the issue.
1. I get the same US medication at a twentieth that it is available in the US and there is still the cost of getting it shipped over here. Without the government subsidy portion, the medication cost is still one ninth the cost for US manufactured medication here (but again there is no ability to court the doctors directly like in the US as the purchasing is centralised, no advertising to consumers on TV, no huge profit motive for middle men between the manufacturer and consumer).
2. Generics are not the same as the original non-generics. Take for example citalopram. There are several different generics all with different side effects and yet supposedly the same active ingredient. One generic was so bad it caused aggression in my severely autistic daughter who has acute anxiety. Her mode of dealing went from flight to fight and it was a serious problem that doctors failed to catch for 26 months because doctors only ask which medication you are on, not which manufacturer. Doctors need to not only look when there are changes in medication, but also when there are changes in manufacturers for the same medication. We switched back to the non-generic which does have a higher cost, but again we don't have the same aggression any more.
1. I get the same US medication at a twentieth that it is available in the US and there is still the cost of getting it shipped over here. Without the government subsidy portion, the medication cost is still one ninth the cost for US manufactured medication here (but again there is no ability to court the doctors directly like in the US as the purchasing is centralised, no advertising to consumers on TV, no huge profit motive for middle men between the manufacturer and consumer).
2. Generics are not the same as the original non-generics. Take for example citalopram. There are several different generics all with different side effects and yet supposedly the same active ingredient. One generic was so bad it caused aggression in my severely autistic daughter who has acute anxiety. Her mode of dealing went from flight to fight and it was a serious problem that doctors failed to catch for 26 months because doctors only ask which medication you are on, not which manufacturer. Doctors need to not only look when there are changes in medication, but also when there are changes in manufacturers for the same medication. We switched back to the non-generic which does have a higher cost, but again we don't have the same aggression any more.
16
@James Wallis Martin
We can confirm your 2nd point with regard to citalopram. When Celexa was used to good effect, the later generic versions did not have the same positive effectiveness. The pharmacy supplied different generics when the prescriptions were refilled. No continuity. Benefits from the generics were never achieved.
We can confirm your 2nd point with regard to citalopram. When Celexa was used to good effect, the later generic versions did not have the same positive effectiveness. The pharmacy supplied different generics when the prescriptions were refilled. No continuity. Benefits from the generics were never achieved.
2
For some drugs, you may be able to buy what you want more cheaply if you pay cash and use a Good Rx coupon. Anyone can use these -- do a web search to learn about it, then search for the drug that you want. For some drugs the cost may still be high, but for others you may be able to save money.
5
Working in pharma I can certainly vouch for the confusion that surrounds what can and cannot be done with pricing. For patients who use any form of federal healthcare (Medicare, Medicaid, TriCare, etc.), there are laws that prohibit companies from providing financial assistance to patients for drugs. The basic idea is that giving discounts will incentivize use of drugs that cost more over generics. On paper that proposition makes sense - but I've encountered a number of instances where these patients are the ones that are harmed the most, often times in the very circumstances described in this article. I've never quite bought into the rationale of why a person on Medicare shouldn't be able to get the same discount as a person with private insurance - but then again, not much makes sense in the US healthcare system.
56
Thank you for your thoughtful insight. I think the healthcare system adopted my mother's old philosophy of "do what I say, not what I do." It is painfully clear that various factions of the federal healthcare system do not want recipients of Medicare to benefit twice (receiving Medicare aid AND a discount even though they need the financial break more than most). The added perk of "rebates" is designed for the various pharmacy benefit managers. Any and all extra monies is apparently earmarked for that special group. Talk about a rigged deck. WOW!
7
In Response to nictsiz:
One thing is well established in our current health care system: the Big Pharma is all about their profits, and not about the best interest of patients. They have a very powerful lobby within Congress, and Congress is more interested in what increases their best financial interests, rather than what benefits the rest of the country's medical/prescription needs and services. Congress is paid a significant salary, and have wonderful healthcare. They also line their pockets by colluding with Big Pharma. I worked in community health for all of my professional positions as a physician. About 20 yrs ago, I was able to get some free samples of meds for my patients who were too poor and had no coverage for meds. Eventually, I received greater pressure from Big Pharma reps who came to my office. When I refused the bagels, the clock, etc they offered me, I began to get more pressure. I was able to show them data/papers that showed the benefits of these meds to my patients. In addition to the data I presented, I also reminded them that the samples they provided for our community clinic could be written off in their taxes. Eventually, they decided to try "sugar" to bring me to their side: they came to my office and "invited" me to speak to groups about the efficacy of their medication for a financial reimbursement to me. I turned them down. The poorest, sickest among us pay the price for the pay-outs to Big Pharma, and the Congress that colludes with them.
One thing is well established in our current health care system: the Big Pharma is all about their profits, and not about the best interest of patients. They have a very powerful lobby within Congress, and Congress is more interested in what increases their best financial interests, rather than what benefits the rest of the country's medical/prescription needs and services. Congress is paid a significant salary, and have wonderful healthcare. They also line their pockets by colluding with Big Pharma. I worked in community health for all of my professional positions as a physician. About 20 yrs ago, I was able to get some free samples of meds for my patients who were too poor and had no coverage for meds. Eventually, I received greater pressure from Big Pharma reps who came to my office. When I refused the bagels, the clock, etc they offered me, I began to get more pressure. I was able to show them data/papers that showed the benefits of these meds to my patients. In addition to the data I presented, I also reminded them that the samples they provided for our community clinic could be written off in their taxes. Eventually, they decided to try "sugar" to bring me to their side: they came to my office and "invited" me to speak to groups about the efficacy of their medication for a financial reimbursement to me. I turned them down. The poorest, sickest among us pay the price for the pay-outs to Big Pharma, and the Congress that colludes with them.
3
Discounts would not be necessary if drug pricing was rational to begin with. Discounts are just another tool used by pharma to obfuscate prices.
1
The big pharma cartel in this country gets away with their unending greed year after year because both parties have been been so bought off and corrupted by big pharma's money that they can't and won't enact price control legislation to protect it's citizens from being swindled on a daily basis. Again, the US is the only western democracy that has allowed this price gouging to continue....because campaign contributions is much more important to protect than people's lives.
28
Hard to believe that even the generic version of Adderall, a lousy amphetamine, should be so expensive. This class of drugs has been around over a hundred years and could not present such a difficulty to manufacture. It is only because the psychiatric industry, through reckless prescribing, has created a captive market for their friends in the pharmaceutical industry. As George Carlin said "It's a big club and you aint in it".
4
It is harder to make any drug time release. It also makes it worth less on the black market. No excuse for what companies like this do. But, it is worth noting that a 100 year old drug that has been reformulated into time release that is better for patients, is really a different drug.
Soon a good drug company, that plays fair, works for the good of the patient will be considered as bad as the worst of these mentioned here. They push that so the good companies can't 'steal' market share by being honest. So, don't let Big Pharma do that. Do your own research, take your script to Walmart, see what it will cost YOU there.
We (hubby & I) have transferred all ours from CVS/Caremark Our Medicare HMO Insurance prescription plan. One cost $400 for 90 days, now at Walmart $111 for 90 days. Others were over $100 for 90 days, at Walmart under $10 or one is $2.94 for 90 days. Not mailed to you. Not a fancy web site. Large deductible they chop up & add some to every script. So Walmart doesn't do that. They say the HMO is paying a portion, but, not showing on the monthly reports they send us. Either way we are saving a bundle. My husband thought we HAD to use CVS/Caremark. By law. Nope. Even though he hasn't retired (can't afford it), it was pushing it to pay those high prices. Retired? We'd have had to stop taking them. A new one his Doctor suggested turned out to need preapproval from HMO, through doctor, & would have cost 300. Hubby decided to tell doctor, no thanks.
Soon a good drug company, that plays fair, works for the good of the patient will be considered as bad as the worst of these mentioned here. They push that so the good companies can't 'steal' market share by being honest. So, don't let Big Pharma do that. Do your own research, take your script to Walmart, see what it will cost YOU there.
We (hubby & I) have transferred all ours from CVS/Caremark Our Medicare HMO Insurance prescription plan. One cost $400 for 90 days, now at Walmart $111 for 90 days. Others were over $100 for 90 days, at Walmart under $10 or one is $2.94 for 90 days. Not mailed to you. Not a fancy web site. Large deductible they chop up & add some to every script. So Walmart doesn't do that. They say the HMO is paying a portion, but, not showing on the monthly reports they send us. Either way we are saving a bundle. My husband thought we HAD to use CVS/Caremark. By law. Nope. Even though he hasn't retired (can't afford it), it was pushing it to pay those high prices. Retired? We'd have had to stop taking them. A new one his Doctor suggested turned out to need preapproval from HMO, through doctor, & would have cost 300. Hubby decided to tell doctor, no thanks.
16
Health care in this country is a racket. Its that simple, and its a racket protected by both major political parties at staggering cost to Americans, who aren't feeding at the trough. Faux progressives such as Paul Krugman shill regularly for the beast.
5
As a related concern, I don't understand why CVS does not list the country of origin on their over the counter products. For example I buy the brand name Lactaid for dairy intolerance rather than the CVS brand because Lactaid is made in Canada, a country I trust for manufacturing standards. Curiously CVS seems to include the country of origin their products made in the USA. Why? I try to buy OTC products made in the USA and Germany for the same reason.
14
I agree. Though sometimes they are labeled - I was having an issue with generic Zyrtec bought under CVS label and happened to notice label said "made in India," not a good sign to me. So I switched to real Zyrtec (made somewhere in western Europe I think) and got better results. More and more I am switching from house generics to original brands on OTC medications because of that issue. Have also found OTC medications at CVS that were beyond their expiration date.
However, I have not seen generic Rxs labled by country of origin at CVS and would definitely like to see that.
However, I have not seen generic Rxs labled by country of origin at CVS and would definitely like to see that.
3
I learned several years ago that CVS was notorious for buying cheap generics from India, etc. What they were giving me caused side effects that the brand name, no longer covered by my insurance, had not. I moved to a pharmacy that was less convenient after confirming that the ones they carried were made in the USA.
3
Unfortunately collusion is rampant and Congress will not interfere as they are the direct beneficiaries of Big Pharma support.
Medicare is not allowed to negotiate with Big Pharma, thanks to Congress for protecting their funding sources
A simple Google search will show the prices of brand name drugs in the world, the differences are staggering and as high as 90%
Next time you travel, ask your doctor for a paper Px, in a lot of countries these will be honored (personal experience, prices are even lower than the co-pay).
Medicare is not allowed to negotiate with Big Pharma, thanks to Congress for protecting their funding sources
A simple Google search will show the prices of brand name drugs in the world, the differences are staggering and as high as 90%
Next time you travel, ask your doctor for a paper Px, in a lot of countries these will be honored (personal experience, prices are even lower than the co-pay).
67
I really don't understand why the practice whereby insurers are given substantial rebates when the insured is required to pay a copay based on the list price of the drug isn't prosecuted as fraud, for it certainly is a fraud on the insured's expectations. Of course, this is only aggravated when the insured won't count a generic toward the deductible.
What are health care system needs to hold down costs is more transparency in pricing not less. If Obamacare was worth anything it would have expressly outlawed this practice.
What are health care system needs to hold down costs is more transparency in pricing not less. If Obamacare was worth anything it would have expressly outlawed this practice.
6
No, what really ought to be done is to put on display what CEOs of these companies have done and do to earn enough money or get enough perks and stock options to run a small country. Most of them, unless they've founded the company, are caretakers, not former doctors or researchers. They're MBAs with no experience in real life except running a company for their own benefit.
9
The republicans wouldn't let that through. They wouldn't let a lot through that President Obama begged congress to work on the program when it got passed. Nothing is perfect. The ACA isn't perfect. But, it's the republicans who sat on it for 8 years. Letting there be NO discussions even of things that needed fixing, upgrading, changing. So, it's not the ACA (aka ObamaCare) that is the problem, it's sitting there waiting for the work to start, it's the republicans. So, yell at them. Protest them. Call them what they are. Destroy them. Look at the garbage they have come up with so far this year. Not one Health Care bill. ALL Death Bills. They want more 'useless' people to die. That means their base is first up. They (you?) don't pay enough taxes to make you worth keeping. So, the older you are, the more change whatever you need to live will be pulled away from you. The young men will be kept, until the repugs decide not to start another war, their favorite hobby every time they are in control. Because the young men will be drafted (already registered, or should be). *He* doesn't trust any of the 'others'. So no military training, no handing weapons to them. Gotta get dumb soldiers somewhere, the base will do. Used to draft those of color more, just to kill them off. Now scared to train them. Women have been thrown out too. So the 230lb 5'0" base will be drafted & after next to no time sent over seas to the front lines. They don't care. Not about war, not about meds.
30
Oh please Mac, let's not get desperate and start blaming the Affordable Care Act. Granted, there is a lot of room for improvements with the ACA, but blaming this insanely, greedy concept of denying Medicare recipients as well as other individuals a generic version of their medication solely so some drug companies and pharmacy chains can make a big profit on to the ACA is not a fare statement and in fact, is basically incorrect. This practice is just one more example of corporate greed that is allowed to occur with no push back from anyone in a position to do something about it. For all of President Trump's yapping about "fixing" a broken healthcare system, neither he or any members of his "dream team" have lifted one finger in helping correct or corral these out of control prescription drug costs. Wherever his priorities are, they certainly are not with the senior population who are battling staying afloat financially. I apologize if I have offended anyone.
8
The difference with biosimilars is that there are legitimate reasons to believe that the biosimilar versions are qualitatively and quantitatively different from the branded originator medication. This is because producing biologic drugs is a complex process that involves using living cells and requires many steps, each of which can introduce variations from the originator medication.
Thus the generic/branded argument for small-molecule drugs doesn't really apply for biologics/biosimilars. Also note that the price differences between generic and branded small molecule drugs are relatively much larger than between biologics and biosimilars.
Thus the generic/branded argument for small-molecule drugs doesn't really apply for biologics/biosimilars. Also note that the price differences between generic and branded small molecule drugs are relatively much larger than between biologics and biosimilars.
5
I left organized medicine because I couldn't stand all the games being played by the big money players. But there's a link on this article to a prior article written June 16, 2015 where the generic version of Adderall XR didn't have the same time release mechanism and the medication was only in the bloodstream for 7 hours. Technically by law generics of extended release formulations don't have to use the same technology to get the desired pharmacokinetics, it just has to be the same drug achieving the same results. In this particular case, it didn't, defeating the whole purpose of XR as the product is designed to be taken just once a day. Lawsuits followed, the FDA acts like they're mired in quicksand. No other links on what the outcome was more than two years later.
I think it's slightly shoddy journalism not to mention the issue from two years ago in this particular case, given that the NYT provides the link to that article. But I generally wouldn't trust Big Pharma at all. They're beholden to their stockholders and share prices, they couldn't give a damn about the patients who rely on their products, whom they refer to as customers or consumers.
I think it's slightly shoddy journalism not to mention the issue from two years ago in this particular case, given that the NYT provides the link to that article. But I generally wouldn't trust Big Pharma at all. They're beholden to their stockholders and share prices, they couldn't give a damn about the patients who rely on their products, whom they refer to as customers or consumers.
11
The creativity of big companies in finding ways to rip off their customers is astounding, yet we are told that government regulation is the problem?
38
Well lack of government regulation is a problem with government regulation isn't it? O.o
14
If a physician offered an insurance company a payment if the company would exempt the physician from its price limitations, and require the patient to pay him more, I suspect the physician would be disciplined. Here, insurers should refuse to do business with companies like Shire, that seek to bribe them to sell its pills to patients at higher rates. And Shire should either be prosecuted for fraud or dissolved. Period.
3
Some comments here calling for Medicare for all, but it doesn't get any better, folks. In my case circumstances have pushed me to Medicare advantage policies as ultimately more beneficial. Then I ran into the same nonsense of restricted PCPs, constantly cutting back my choice of Drs. - mine dropped off their list because he referred patients to other off list specialists - and I'm paying out of network to stay with him. Tried to revert to plain medicare with a medigap policy, but no go there because of pre-existing conditions. Just had a 15 minute cardiology diagnostic procedure, billed 5000 to insurance company, paid with a prenegotiated 700 payment plus 100 to me. It is all crazy, wasteful, intractable, greedy, ultimately damaging to all of us. Talked to state insurance commission, though they can regulate some regular health insurance they can't touch medicare advantage policies because they are essentially federal programs. We are truly screwed.
17
Let's say it like it is. I tired by getting screwed by Big Pharma, the Congress and the White House. Just like health care...it could be done if the people aforementioned would go to work for the people in this country instead of themselves, their power trips, their bottom line and their paychecks which we pay for along with the outrageous drug prices. Their egos and power trips are on them.
12
This is not new. The "co-pay" for the brand name drug is more than the cost of that brand name drug and the insurance companies use the extra money to improve their drug benefit balance sheets.
"Next Stop, Single Payer Station. ALL ABOARD!!!!"
"Next Stop, Single Payer Station. ALL ABOARD!!!!"
20
Since Bush Jr. capitulated to the drug companies and agreed not to negotiate with them, the Republicans have been in their pocket. Businessmen and Republicans love monopolies - they're good for making money.
14
people let themselves look like the fellow in the picture and then think pills and doctors can magically make them healthy...
8
And your point being?????
3
Right Derek, and did you ever think that he might be on other medications or that he has other problems and he doesn't expect the pills to make him magically healthy? No, you have make a statement that has nothing to do with the article. And while you're saying that about Nathan Taylor, what unhealthy things do you do? Do you text while walking or driving or biking? Do you eat fast food? Do you drive everywhere instead of walking once in awhile? Do you make sure to eat at least 3 servings of vegetables each day? Do you put on sunscreen any time you're in the sun? Do you exercise regularly or do you just sit around and make comments about how other people expect too much when that wasn't the topic?
6
People fall down stairs onto their heads (not on purpose, though you probably feel otherwise), leaving themselves with memory problems, & ending up disabled, not getting disability, ever & then you say we should be tossed to the curb, then put in the local incinerator. Right?
May it happen to your daughter at 15-16. Better start saving. She might never find some idiot to marry her & take the burden like my Navy Vet hubby did 45 years ago. Been wondering if they will find CTE when I die?
Oh, even if all the bloody wounds heal pretty much without scars, be warned, as you age some can come back. Believe them it's true.
Yes I'm overweight. Hard to stay thin when pretty much immobile. But, am losing. Lost 41 so far. Each pound is giving me more wrinkles as older skin isn't as elastic. Isn't that nice. Another thing for your kid to look forward to. Started out, on wedding day under 100 lbs, 5'6" too thin. I hope before I die I get below 200. Exercise really isn't an option. Just makes things worse, I've tried. Better wrap her up in cotton & make her spend her life eating starvation rations & locked in a closet with a treadmill. Only way she will stay starvation thin. Body thinks your starving. It demands food. Almost impossible to not give in. Willpower doesn't equal shit. A nice broken leg would teach you that. Oh, watch out for the pain pills they give you. They are horribly addictive. Of course you won't sleep for about a week without them. But, better safe than sorry. Right?
May it happen to your daughter at 15-16. Better start saving. She might never find some idiot to marry her & take the burden like my Navy Vet hubby did 45 years ago. Been wondering if they will find CTE when I die?
Oh, even if all the bloody wounds heal pretty much without scars, be warned, as you age some can come back. Believe them it's true.
Yes I'm overweight. Hard to stay thin when pretty much immobile. But, am losing. Lost 41 so far. Each pound is giving me more wrinkles as older skin isn't as elastic. Isn't that nice. Another thing for your kid to look forward to. Started out, on wedding day under 100 lbs, 5'6" too thin. I hope before I die I get below 200. Exercise really isn't an option. Just makes things worse, I've tried. Better wrap her up in cotton & make her spend her life eating starvation rations & locked in a closet with a treadmill. Only way she will stay starvation thin. Body thinks your starving. It demands food. Almost impossible to not give in. Willpower doesn't equal shit. A nice broken leg would teach you that. Oh, watch out for the pain pills they give you. They are horribly addictive. Of course you won't sleep for about a week without them. But, better safe than sorry. Right?
1
Two words: Drug - Regulation
Oh wait... "regulation" is now a BAD word in the US now, right?
Oh wait... "regulation" is now a BAD word in the US now, right?
15
And I can buy a tube of Voltaren gel at the Mexican airport for less than $20 Us dollars. As a physician I am sickened by the corporate greed that runs our US healthcare system. Our people are dying so that insurance companies and big pharma CEOs can sail the seas in their yachts. Disgraceful.
37
I have a bottle from Rite Aid that reads, "Amphetamine Salts, generic for Aderall, 10mg,. There were 30 in the bottle, if I remember right it cost $20 or less.
2
I have exactly the same thing, from an independent pharmacy. Except that mine costs $148 a month. (For the Teva generic!) Insurance won't touch it because they claim it is a drug meant 'only for children'.
3
I"m confused. Can you not have it filled at Rite Aid for the same $20? The system is crazy.
A suggestion for Mr. Taylor and others in his position. Do not run your Rx for Adderall xr through your insurance when you go to the pharmacy. Fill it with the generic and use a coupon from goodrx.com, which is accepted by most major drugstore chains. That is what I do, and my cost is $67. It's still not cheap, but better than $90.
6
"Shire tried a new tactic: giving ever-larger discounts to pharmacy benefit managers and insurers for preferential treatment over the generics. That did not mean lowering the list price of the drug, but rather negotiating rebates that were paid not to the patients but to insurers and middlemen such as CVS Caremark."
I always had a stinking suspicion that there was a degree of an unholy alliance between various insurance companies and pharmacy benefit managers. This article just confirmed my suspicion. What this article really demonstrated for me is to carefully read the prescription drug section of my new insurance plan come 2018. If there is ANY clause that reads the plan will fill ONLY brand-name drugs, I will continue to shop around.
Once again, it is articles such as this that keeps me coming back as a paid subscriber, year after year. I would like to thank the NYT and ProPublica for enlightening readers like myself.
15
Real name for those discounts is kickbacks. In some middlemen companies & insurance companies the companies don't see a dime of it. Goes right into the manager's pocket who cuts the deal. No one checks. Shareholders aren't told. Lets the companies pay their 'negotiators' less too.
3
Funny, the AG of New York isn't on top of this. Of couse, being from NY, he is on the pad.
1
Not surprising at all, the AG of Texas isn't on top of this. Of course, being from Texas, he is on the take. And also not surprising at all is that it was a Republican president and supposed Texan who cut that sweetheart gift to Big Pharma to shut down price negotiation and regulation.
I'm glad I live in New York.
I'm glad I live in New York.
4
The only drug I take is now dispensed by Mylan. When my prescription runs out I am going to switch to another drug or just do without. I will not buy anything from this company ever again. Greedy Big Pharma cares about nothing but money. NOTHING else.
We Americans need to speak with our pocketbooks. It is the ONLY thing Big Pharma understands.
We Americans need to speak with our pocketbooks. It is the ONLY thing Big Pharma understands.
9
I've done that with my asthma and allergy meds. I've also stopped seeing the allergist and I haven't been for a checkup in years. Why? Because of the confusing mess our so called health care system has become. It's impossible to know if you're going to get cheated or treated.
5
These insurance companies and pharmaceutical corporations make Martin Shkreli into an honorable scoundrarl who at lest teaches the public how the game is played- What happened to laws about restraint of trade and price fixing....These practices are not coming even from the Trump FDA or Interstate Commerce commission.
3
Martin was prosecuted to distract us from all the big players who are as bad as he is but are too smart to be caught.
Same reason they went after Martha Stewart.
Same reason they went after Martha Stewart.
1
Why are citizens held hostage by drug companies? Easy..follow the money. Big Pharma donates about $30 million annually to both political parties, with a somewhat greater share going to Republicans. Additionally, about $14 million is spent on lobbying. Few candidates can afford to turn down that kind of money which buys silence on their corrupt practice.
https://www.opensecrets.org/industries/background.php?cycle=2016&ind...
https://www.opensecrets.org/industries/background.php?cycle=2016&ind...
16
By saying few candidates can't afford to turn it down, you are saying few candidates are willing to be honest. When did honesty become a liability? Time to make dishonesty a ginormous fine decades in non country club prisons. Don't cha think?
Freedom Warriors, time to march!!!
Freedom Warriors, time to march!!!
Of course the health insurance companies don't return phone calls. What are they going to say, "we've got the Congress in our pockets and we gladly accept kickbacks from the drug companies"?
13
One way to "fight back" is to drastically decrease demand for drugs. Switch your diet from animal based to plant based. Watch the Documentary "What The Health" (2017) if you need further inspiration.
3
This is the Collusion that is harming Americans more than the Russians---our politicians’ dependence on big money to run for office. Most blatant in drug costs.
CNN: “…. despite all the drama and talk of standing up to the pharmaceutical industry, these companies continue to be big spenders, donating $951,018 to candidates in the 2016 presidential election, per the Center for Responsive Politics and the Federal Election Commission.”
We the People have no way of competing to influence lawmaking. This is proveed by Princeton professor Martin Gilens --- congress passes laws and regulations per the wishes of the corporate elites, not the majority of citizens. Yes, we vote, but we have little way to translate our preferences and needs into political action.
US drug prices and health care is the most expensive in the world ---it’s the obvious inevitable result of our election system.
This should be a the top of the TV cable news shows and NY Times columns--- of the so called ‘liberal ‘ media.
CNN: “…. despite all the drama and talk of standing up to the pharmaceutical industry, these companies continue to be big spenders, donating $951,018 to candidates in the 2016 presidential election, per the Center for Responsive Politics and the Federal Election Commission.”
We the People have no way of competing to influence lawmaking. This is proveed by Princeton professor Martin Gilens --- congress passes laws and regulations per the wishes of the corporate elites, not the majority of citizens. Yes, we vote, but we have little way to translate our preferences and needs into political action.
US drug prices and health care is the most expensive in the world ---it’s the obvious inevitable result of our election system.
This should be a the top of the TV cable news shows and NY Times columns--- of the so called ‘liberal ‘ media.
4
Thank you for this information. Finally I understand what I did not before – – why suddenly my insurer refused to cover generic Adderall XR, forcing me to get my child's pediatrician to specify the brand-name. I should've figured out that payola was involved somewhere up the line. Absolutely disgusting.
65
Proof that the free market won't solve our healthcare overspending.
14
We don't have a free market in health care. Insurance is the primary problem in concealing prices. Free markets require price disclosure. Government regulation and insurance companies have worked to obscure prices and impair market operation.
consumers can't make intelligent decisions about costs when they don't know what they are and can't make choices of providers based on costs.
consumers can't make intelligent decisions about costs when they don't know what they are and can't make choices of providers based on costs.
11
I take exception to the antepenultimate word of this article. "Making more money" doesn't mean "earning more money".
3
Somehow this situation stinks of anti-trust. Good and creative lawyers might be able to attack through that avenue.
5
Excellent reporting. You should send Katie Thomas to Washington and let her do her investigative journalism there!
3
And that's why we subscribed support; because the Times is one of the few "outlets" doing investigative and comprehensive reporting. Please note that Th Times gives credit at the head of the story to the work of ProPublica, a nonprofit newsroom that also deserves our support. Thank you. Getting the information out is the first step. However, I doubt that a nation that has sunk as low as we currently have, can remedy the ills of the pharmaceutical industry in today's climate. But someday, maybe.
6
Let me see… I had been insured by Humana until they drop me like a hot potato after a year; I am now insured by United Health, with its corresponding pharmacy company; and had been picking up my medication prescriptions at a CVS. That gives me three names and unfortunately bragging rights about three companies mentioned in this article… Let me finish the article and get back to you!
Last summer my generic migraine nasal spray was impossible to get for over 4 months. Although I had medication on hand, I was running out and beginning to get anxious. When I called the distributor myself, I was told there was nothing they could do, but it would be available "soon". So, instead of paying $84 for my usual month's supply (6 doses) of the generic migraine nasal spray, when I needed a refill, I got a script for the brand name spray covered under my plan and paid $160 for a month's supply (6 doses) of it. Luckily, the generic came back in stock the next month.
In fact, this happened the year before with this same generic migraine nasal spray. Alternate meds like pills don't help my migraines, so I depend on this nasal spray. This "out of stock" dance is curious at best. Certainly this big Pharmacy company can anticipate when they will be running low on inventory?????? What gives?????
In fact, this happened the year before with this same generic migraine nasal spray. Alternate meds like pills don't help my migraines, so I depend on this nasal spray. This "out of stock" dance is curious at best. Certainly this big Pharmacy company can anticipate when they will be running low on inventory?????? What gives?????
3
More profit for the ultra-wealthy at the expense of the rest of us. There is nothing some people won't do to turn a buck.
10
This is a complex problem without a simple solution. I observe that insurance interferes with consumer's ability to shop directly for drugs.
1
The generic of this medication is probably cheaper than the name brand. He should pay out of pocket for generic which would much less than the copay he now pays.
1
Sounds to me like these payment are in effect bribes. Hmmm....something that usually is not legal. Why are these payments (which take forms like marketing rebates, etc) legal when their impact is just as if they were an out-and-out bribe? A bribe is what they accomplish: pay to cause something that benefits the bribe-payer but has the opposite impact on the consumer. In many consumer-consumer products we can shun a company that does such things but with drugs we are absolutely stuck.
4
How much evidence will we need to convince the power-that-be that we must have single payer? How much frustration and outrage must consumers endure?
2
I've had the opposite problem--my insurance company always tries to stick me with generics. I have to take thyroid medication (no choice, my organs will shut down and I will die, otherwise) the rest of my life.
After thyroid surgery, the first pill I received in the hospital was generic levothyroixine. Since I had never taken it, I didn't know it would cause a severe allergic reaction in me. My doctor pooh-poohed the idea that the generic was to blame until I ended up in the ER. Then, they switched me to Tirosint (expensive but no fillers, dyes, etc.). My insurance company refused to cover it even though I did well on it. After an appeal, they decided to cover me--but only for six months. Really insulting because I have to take a thyroid supplement for the rest of my life and even synthroid caused problems.
After the Tyrosint became unaffordable for me, my doctor switched me to brand name Synthroid. The same old unbelievable nonsense happened when I caught my pharmacy automatically switching my Rx to the Levothyroxine. Despite the Rx specifically stating "Name brand Synthroid" my insurance company tried to sneak in a generic again. I was furious--had I not paid attention, I would have ended up in the ER again by taking this generic.
After thyroid surgery, the first pill I received in the hospital was generic levothyroixine. Since I had never taken it, I didn't know it would cause a severe allergic reaction in me. My doctor pooh-poohed the idea that the generic was to blame until I ended up in the ER. Then, they switched me to Tirosint (expensive but no fillers, dyes, etc.). My insurance company refused to cover it even though I did well on it. After an appeal, they decided to cover me--but only for six months. Really insulting because I have to take a thyroid supplement for the rest of my life and even synthroid caused problems.
After the Tyrosint became unaffordable for me, my doctor switched me to brand name Synthroid. The same old unbelievable nonsense happened when I caught my pharmacy automatically switching my Rx to the Levothyroxine. Despite the Rx specifically stating "Name brand Synthroid" my insurance company tried to sneak in a generic again. I was furious--had I not paid attention, I would have ended up in the ER again by taking this generic.
53
I have the same problem with Zyprexa, the generic won't work for me, the brand name does. But I've had to clamp down hard on Express Scripts to make sure they don't perscribe the generic, a frustrating experience for both me and my psychiatrist. Glad to know i'm not the only one in this position.
4
Generics are the exactly the same chemical composition. You seem to have some psychological hangup about it, but it's the same thing (without the marketing scams). If it wasn't, it wouldn't be certified for use.
This is ridiculous. My insurance Anthem Blue Cross does not do this. However, if the doctor does write a prescription that says brand only, they will pay for it...my co-pay is $5 for generic and $15 for name brand. (Not all generics are =). I am apparently very lucky. I also save even more money if I purchase the prescription via mail order.... Clearly this an issue that Congress could address. Too bad they don't want to do their job and actually govern FOR the people.
2
Are you covered under an employer plan?
1
People's lives are at stake, but in the U.S. it's all about the money.
4
One of the dangers of repealing the ACA requirement for essential coverage such as pharmacy is that "Full sticker price" is NOT the same as "negotiated price to your insurance company." The statement " because they often have to pick up the full sticker price of medications " is not accurate because of this. The patient pays "full negotiated price to your insurance company." That is almost always much cheaper than the out of network or price to the uninsured.
Before the ACA as self employed, individual market insured person I had a plan with no maternity, preventative, or prescription benefits. That meant that I had to pay Full sticker price. One prescription cost me $300 a month, all out of pocket. Now the same prescription is still all out of pocket as part of my huge deductible, but the insurance negotiated amount is only $60. The drug company mark up for those without insurance coverage is excessive.
Before the ACA as self employed, individual market insured person I had a plan with no maternity, preventative, or prescription benefits. That meant that I had to pay Full sticker price. One prescription cost me $300 a month, all out of pocket. Now the same prescription is still all out of pocket as part of my huge deductible, but the insurance negotiated amount is only $60. The drug company mark up for those without insurance coverage is excessive.
3
See the related articles at the bottom of this one for one reason that "brand" may be preferable to generics. Not all extended release mechanisms deliver the same dose rate: Generic A.D.H.D. Drug, Not Equivalent to the Brand, Is in Use Anyway https://nyti.ms/1elsu30
3
Good article.
2
Funny, but the opposite was true for years - thanks to those oh-so-caring "pharmacy benefit managers." They are usually algorithms (not people) who calculate the highest profit margin for the pharmacy - not the best drug for the consumer. Walgreens is particularly horrible on this one. I can not take many generics because I'm allergic to their fillers - and walgreens would constantly give me generics. I had to shout down a pharma tech to get them to *stop* giving me generics, even when my dr. wrote "dispense as written" on the scrip.
It's all about the money - and how the corporations can make the most. They don't care what's best for the patient.
It's all about the money - and how the corporations can make the most. They don't care what's best for the patient.
2
A number of people are expressing support for "Medicare for All", which is certainly a step in the right direction. But if I understand correctly from this article, Medicare cannot, by law, negotiate drug prices (I don't understand why that should be law), in which case this problem still won't be solved. In countries with socialized medicine, like where I live, the health plans with the health ministry does negotiate drug prices, to get the best deal on whatever drugs are included in the "health basket", as it is called here. The result is that most prescription drugs are far less expensive than they are in the US, and pharmacies don't make their living from prescription drugs at all but from over-the-counter (which are more expensive here) and from the toothpaste, shampoo, diapers, throat lozenges and other stuff you'll buy when you come in to get your anti-biotic. So, what you need to demand of your law-makers is "Medicare for All" (i.e., a non-profit insurance system) together with Medicare-negotiated drug prices.
1
Join a union. My union dues are forty nine dollars a month, I have no annual deductible, and my drug co-pays are never over twenty dollars. If I choose to use the union pharmacy, there are no co-pays for any drugs.
4
1. The suits or countersuits between brand and generic drug manufacturers to protect turf, intellectual property and access to markets after patents have expired sound like normal business practices and a fair contest between market players with substantial resources to pursue their rights and objectives.
2. But the practice of forcing an end consumer to buy a higher "list cost" drug (for which the health plan is paying much less, by virtue of manufacturer discounts and rebates) and denying claims for generics that would be at much lower out of pocket cost for the consumer ... that sounds like a very lucrative class action lawsuit in the making.
Sympathetic plaintiff - the chronically ill and often poor and elderly patient (because those are the classes of patients who rack up the really big total drug charges, not youngsters who need an occasional antibiotic). For the poor, ill, elderly, the out of pocket cost is material and the ability to understand what is happening to them and fight back, INDIVIDUALLY, against the goliaths is almost nil.
Unsympathetic defendants - Big Pharma and big health insurers.
2. But the practice of forcing an end consumer to buy a higher "list cost" drug (for which the health plan is paying much less, by virtue of manufacturer discounts and rebates) and denying claims for generics that would be at much lower out of pocket cost for the consumer ... that sounds like a very lucrative class action lawsuit in the making.
Sympathetic plaintiff - the chronically ill and often poor and elderly patient (because those are the classes of patients who rack up the really big total drug charges, not youngsters who need an occasional antibiotic). For the poor, ill, elderly, the out of pocket cost is material and the ability to understand what is happening to them and fight back, INDIVIDUALLY, against the goliaths is almost nil.
Unsympathetic defendants - Big Pharma and big health insurers.
5
Voltaren Gel cost about $75 when i bought it through my plan about two years ago. On the other hand Voltaren Emulgel, Same company, different, in my experience, transport agent to get it into skin &muscles, cost $14 for a tube containing 50% more, from Canada $9 shipping. Do the math., the research and politics accordingly.
6
Voltaren, at twice the strength (2.3%), is not only available in Canada but over the counter in pharmacies in Mexico and all over Europe. Clearly the company has figured how to maximize profits in the US by limiting the strength (so you use more) and keeping it prescription-only at $70 per tube.
3
The greed of Big Pharma and insurance companies knows no bounds.
Sadly, the only solution is for the government is to closely regulate prices of both brand name and generics.
Sadly, the only solution is for the government is to closely regulate prices of both brand name and generics.
12
I have been working for both sides of the pharma industry for over 25 years, and here's my take.
A generic is generally not exactly the same as the brand (unless the brand company is selling its own brand as a generic). Also, the generic does not have to prove that it's product is therapeutically equivalent in a cross-over study. It has to follow certain manufacturing and formulation guidelines, and in some cases, do studies to show that the active drug gets into the blood stream at the same rate and in the same amount.
So here's my advice: start with the brand, and then after a while, switch to the generic. If you are getting the same therapeutic benefit, go with the generic. If the brand is better or has fewer side effects (in your body) stick with the brand.
A generic is generally not exactly the same as the brand (unless the brand company is selling its own brand as a generic). Also, the generic does not have to prove that it's product is therapeutically equivalent in a cross-over study. It has to follow certain manufacturing and formulation guidelines, and in some cases, do studies to show that the active drug gets into the blood stream at the same rate and in the same amount.
So here's my advice: start with the brand, and then after a while, switch to the generic. If you are getting the same therapeutic benefit, go with the generic. If the brand is better or has fewer side effects (in your body) stick with the brand.
9
i have personally experienced the same thing with OTC drugs -- that is, the CVS version not being the same as the branded version of the same med.
2
it's worth noting that for drugs affecting brain chemistry, such as antidepressants and mood stabilizers, the generic drugs are often not as effective. Generics are only required to get at least 80 percent of an effective dose of the original into the patient's system within a specified time period, and thus, generics often use cheaper binding agents. for most medications, that's good enough, but the effective dosing range of brain meds needs to be titrated much more closely.
Many psychiatrists specify brand name only when prescribing because there is so much variation between generics even within the same medication.
Many psychiatrists specify brand name only when prescribing because there is so much variation between generics even within the same medication.
6
I came here to the comments section to also point out the issue of different binders/excipients. In many cases, a generic drug is just as effective as the name brand, but in others, the non-active ingredients can actually affect the drug's pharmacology and subsequently how well it treats the disease.
These pill binding agents can also cause issues for patients with allergies and other problems (did you know lactose is a common ingredient to medicines? did you also know that some include dyes that are banned from manufacture but makers are allowed to use existing supplies?).
Anyway, the decision on which drug to prescribe is not as simple as cost + active ingredient.
These pill binding agents can also cause issues for patients with allergies and other problems (did you know lactose is a common ingredient to medicines? did you also know that some include dyes that are banned from manufacture but makers are allowed to use existing supplies?).
Anyway, the decision on which drug to prescribe is not as simple as cost + active ingredient.
3
And many insurance companies will then refuse to pay or force us to pay the higher fee. Like it's out fault our bodies need the name brand. The other thing that always bothers me is that I'm prone to headaches with certain food coloring and guess what, many of them are used in both name brand and generic drugs. I found it particularly ironic that there were certain food colorings in allergy meds.
7
One of the prescription items mentioned is Voltaren gel. I too was prescibed this and found it to be incredibly expensive. However, after speaking to friends and relatives in the U.K. And Canada, I found out that it is sold over the counter in both places, without a prescription, at a fairly low price. I now stock up on Voltaren anytime I visit these places.
5
The Hippocratic oath has morphed into the hypocritical oath. First do no harm has become first make more money. The practices outlined here for forcing patients to expensive branded medicine is on the same level as over charging for out-of-network ER doctors working in in-network hospitals. We should throw out the current system and replace it with medical coops that serve the members. The current profit driven system is entirely broken. Health outcomes have become less important than profit margins.
6
Remember drug manufacturers, pharmacy (middle man) benefit companies, health insurers, and healthcare staffing companies don't take the Hippocratic Oath. They only take the Wall Street Oath which is make as much money as possible.
7
This article is helpful in elucidating a real problem, however in a somewhat simplistic and at times inaccurate manner. For example, Shire didn't just sue generic drug companies. The drug companies filed Para IVs (alleging that their product either doesn't infringe on Shire's IP or that Shire's IP is not enforceable), and Shire filing suit as a response is next step in this process. There is nothing nefarious about this.
The real issue is that there is very little transparency around pricing. Pharma companies get significantly less than the WAC price quoted. The big wholesalers (70%+ of US drugs go through only 3 buying groups) and their associated PBMs have created a system lacking in transparency and mostly benefiting themselves.
I understand that there is only so much that can be achieved in a single article, however it would be worthwhile shedding some more light around the interplay between manufacturers, wholesales, retailers, PBMs and insurers.
The real issue is that there is very little transparency around pricing. Pharma companies get significantly less than the WAC price quoted. The big wholesalers (70%+ of US drugs go through only 3 buying groups) and their associated PBMs have created a system lacking in transparency and mostly benefiting themselves.
I understand that there is only so much that can be achieved in a single article, however it would be worthwhile shedding some more light around the interplay between manufacturers, wholesales, retailers, PBMs and insurers.
9
I have used GoodRX.com many times to find a lower cost alternative than what is offered by my insurance under part D Medicare, Humana. What I pay though GoodRX is not counted toward my deductible, but instead of paying over $100 through my insurance for a recent eye medicine, I paid $43 using a GoodRX code at the Walmart pharmacy. GoodRX lists all of the pharmacies near me and what I would have to pay. Walmart is always the cheapest (for non pharmacy purchases, I am able to refrain from patronizing Walmart because of their labor practices). I use my Humana plan at a local pharmacy when the price is reasonable. If not, I have my prescription transferred to Walmart pharmacy and use GoodRX, or I ask my Dr. to give me a paper prescription and decide after figuring out my alternatives. This process takes a lot of my time I would rather not spend, but such is retirement for me.
9
I have had the same experience with an outfit called "Blink" in the New York area. I also have a Humana Part D Rx plan (the cheapest one, about $18 a month). Although I never reach my annual deductibe of a couple humdred dollars because I take very few meds, I thought Humana was nonetheless giving me some sort of discounted rate on what I DO take. Then I learn about Blink and find out the monthly cost for the same meds is about the same as under Humana, but with no annual enrollment and no monthly premiums. Plus Blink sends me a $5 or $10 coupon every one in a while, making some fills free. I know there are other groups like this and people ought to consider them, if not as alternatives to Rx plans, then as complements to them. When I want something filled under Blink instead of Humana, I just place the order with Blink and tell CVS not to use Humana this time.
2
What does GoodRx get out of this? Ever wonder?
If Trump ever wants to score any points with the American public, he should start by focusing on this. After all, it was one of his campaign promises.
9
Taxpayers took a hit in 94 when Bill Clinton caved to Republican demands to reduce research dollars for new prescriptions and give pharma whatever they wanted and let the market dictate what's produced. That was a fatal mistake and why we have zillions of high profit boutique and Viagra type drugs and no research for critically needed new antibiotics.
Not only do we need a single payer, Medicare for All healthcare plan, we need federal pharma research dollars redirected to public institutions allowing taxpayer to benefit from the new discoveries a reasonable prices.
When are we going to learn there is a legitimate role for government to play. The unbridled greedy business culture caused the economic great recession ten years ago and we still haven't learned a thing!
Not only do we need a single payer, Medicare for All healthcare plan, we need federal pharma research dollars redirected to public institutions allowing taxpayer to benefit from the new discoveries a reasonable prices.
When are we going to learn there is a legitimate role for government to play. The unbridled greedy business culture caused the economic great recession ten years ago and we still haven't learned a thing!
33
Drug Prices keep going sky high. I'm on medicare and fortuante to only be on two eye drop medications. Those who take a number of medications are left with a choice. Which prescription do I fill. To many people it's a mater of life and death. As our Elected officials in Washington argue over health care, I sure wish they were in the same boat as the rest of the population. then we would see Action.
10
Has anybody noticed that the folks we elect every election to the Senate and Congress have not been mentioned in this report?
Some comments noted the stream of folks going to Canada to buy drugs. Do the lawmakers in Canada know how to make better laws?
May be we should trade Canadian lawmakers for ours.
Some comments noted the stream of folks going to Canada to buy drugs. Do the lawmakers in Canada know how to make better laws?
May be we should trade Canadian lawmakers for ours.
5
Just remember that most "American" drugs are made in India and China with chemicals manufactured in India and China. Buyer beware at any price, whether generic or brand name.
12
Teva, one of the largest generic manufacturers, is an Israeli company. The majority of its generics are manufactured in Israel or North America.
2
Counterfeit pills have made it into mainstream drugstore supplies such as CVS but this fact has been quietly covered up by the big pharmas and drug stores.
3
Why do we continually act surprised when pharmaceutical manufacturers and health insurance providers, as publicly held companies, put the interests of shareholders (profit) first when they find themselves with leverage over the consumer?
12
If one were to look at the required generics by benefit managers, I've heard that the drug makers have a whole host of items that they are willing to package and offer at a reduced fee to the company if they take the whole package including some otherwise expensive meds but then require all their other drugs, therefore capturing a large group of conditions.
As another observation was made, the ONLY reason for this is someone (the drug company) is making more money than they otherwise would be pulling in.
As another observation was made, the ONLY reason for this is someone (the drug company) is making more money than they otherwise would be pulling in.
7
It seems to me an obvious way of combatting this problem is for the United States to set up its own medicine manufacturing facilities to produce medication that is vital to the health and security of its people. Every pharma CEO is obligated to maximize profit for their companies. That means every pharma CEO has a little Martin Shkreli or Mylan (overpriced Epipen) CEO Heather Bresch in them. The only way to keep the pharma industry from overcharging is the possibility that another player may come in and make available the same medication at a substantially lower cost. The manufacturing facilities must be built and running to make the threat a credible one.
7
That is just increasing the bureaucracy. Instead, just let Medicare negotiate the price of drugs for use by Medicare and Medicaid users. The prices for all will fall automatically.
6
The problem is that the big pharmas don't have to negotiate or at least not very much because many of them have a monopoly or close to one with respect to the expensive drugs. This is why I cited Epipen. Negotiation also does not help with drug shortages routinely faced by hospitals. Sometimes the supply simply isn't there.
1
Now we know where the street dealers hone their trade. Collusion with insurers pharmacies, the medical profession, Kickback at the consumer's expense. looks like we need more regulations not fewer Donald Trump and y friends in the Republican Party.
5
If only there was a mechanism to ensure fair pricing, for everyone, every time. Medicare FOR ALL-2020- the Time is NOW.
11
Medicare does not cover prescription drugs, and it does not negotiate prescription drug prices. One can purchase a private sector prescription drug policy once they are on Medicare. These are deceptively referred to as Medicare Part D, but as I stated, they are offered through private, for-profit insurers. In my estimation, most of these policies are rip-offs. I found that if I had enrolled in one of these policies, the drugs I take would actually cost me more than paying the full retail price! That's in addition to Part D monthly premiums and deductibles. How Medicare can "recommend" these insurance policies is beyond me.
3
Yes, WITH prescription drug coverage. If we can go to the Moon, and fight never ending Wars, WHY can't we all have Healthcare?????
3
I'm guessing that if you use the standard investigative practice of "follow the money" you will discover a connection between the insurers and the drug manufacturers. How often has it happened that those entities that already make huge profits find ways to make obscene ones at the cost of people under their control?
6
Generic drugs are not the panacea they are made out to be. In certain classes of drugs (i.e. thyroid replacement or psychiatric drugs), small differences in bioequivalence can cause major differences in control of symptoms.
So why not just switch from brand name to the generic, experience some uncomfortable "tweaking" of dosage for a few months and go on from there? Because your pharmacy can switch generic drug manufacturers on you every month. Take a drug this month and maybe get used to it, come in next month and start all over again.
I pay a high price to stay on brand name medications, but I'd be paying a higher price in terms of loss of functionality if I played the "guess which generic you're getting this month" game.
So why not just switch from brand name to the generic, experience some uncomfortable "tweaking" of dosage for a few months and go on from there? Because your pharmacy can switch generic drug manufacturers on you every month. Take a drug this month and maybe get used to it, come in next month and start all over again.
I pay a high price to stay on brand name medications, but I'd be paying a higher price in terms of loss of functionality if I played the "guess which generic you're getting this month" game.
13
This may be a figment of your individual imagination. Broad-based, high-quality studies have demonstrated the clinical equivalence of generic medications.
An anecdote is not science, nor is it a sound basis for policy.
An anecdote is not science, nor is it a sound basis for policy.
1
A generic or bioidentical can have the same average effect on a sample population, within statistical error, without having the exact same effect on every individual who might ever take it. I am a scientist, and I have had the same experience with generics as Sharon Joseph. So has my companion. So now you have three such anecdotes. Might they be figments of our individual physiologies and genetic makeups, rather than our imaginations?
A real scientist would respond to such a report by investigating further, not by belittling the reporter.
A real scientist would respond to such a report by investigating further, not by belittling the reporter.
3
Linda, it's no figment. Many psychiatrists specify brand name only specifically for this reason. It's well-documented with peer-reviewed published research. You owe an apology to the person who posted the original comment.
3
Drugs don't have a price. Pharmas charge every big customer (plan, chain store, hospital) a DIFFERENT price that is negotiated including quantity discount, bundled products, minimum purchases, and side payments (aka kickbacks). All legal now. Here they found a new way to shift cost to the patients.
7
This is another reason to vote out the GOP. They will never champion cutting drug prices. The Democrats will however.
11
Democrats no longer wear the white hat--if they ever did. Your allegiance is misplaced.
1
This happened to all three of us - adding insult to injury, along with job loss we had the added burden of paying exorbitant rates for healthcare - $1500 per month premiums and three Card Monty drug coverage. What an unpleasant surprise to get the news at the druggists counter that generics were not covered. Came to thousands of dollars.
14
The very last paragraph says it: someone is making more money. Pharma companies charge each customer a different price!, and there are complex rebates (kickbacks) and discounts including bundling products. In this case the producers and plans have conspired to make the insured pay the difference.
16
After many changes in insurance companies over the last few years due to insurance company increases and employer cost cutting measures, it appears that all generics are not created equal and, in fact, some seem to provide little benefit. One wonders if the quality of generics is overseen, if some generics are being imported from foreign countries with less than reliable standards in the interest of cost- cutting, and if it might be better if we all demand the name brand drugs. At least, that way, we know what we are getting.
10
The reverse is also true for some of us; for me a generic Synthroid works far better than the band-name one. This has been proven over decades of use.
1
Generic drugs are not identical to brand and are not required by law to be identical .They may have different binders and are not necessarily delivered into the system in the same way . There also can be a legally allowed variation in the
active portion of the drug. No matter what they say about the supposed costs of brand name drugs they are cheaper in other countries ,including Canada ,where
there is a significant cost difference. Americans are charged ridiculously high prices by greedy companies because they can get away with it.
active portion of the drug. No matter what they say about the supposed costs of brand name drugs they are cheaper in other countries ,including Canada ,where
there is a significant cost difference. Americans are charged ridiculously high prices by greedy companies because they can get away with it.
30
Is anyone aware that there are medical prescription bus tours for senior citizens of the US to Canada? What's wrong with this picture?
15
"That means that when her (Ms. Hopkins) drugs cost a lot, taxpayers pay the bill. By law, Medicare cannot negotiate directly with drug manufacturers and instead gets a share of any rebates collected by insurers and benefit managers, like CVS Caremark, which operate Medicare’s drug plans."
And we wonder why our national health care organizations can't keep costs down. Let Medicare, Medicaid and the ACA negotiate directly with drug companies and we'd have much cheaper health care. Lets drain that swamp.
And we wonder why our national health care organizations can't keep costs down. Let Medicare, Medicaid and the ACA negotiate directly with drug companies and we'd have much cheaper health care. Lets drain that swamp.
25
How are you going to do that, when our own congressmen are involved in this racket?
2
There are plenty of readily-available, safe, natural alternatives for common drugs used to treat common health conditions. But using them requires a person to do a little simple research and make a commitment to one's own health.
Do a little Googling, and read only the articles from reputable scientific journals and studies.
Vitamin C is a blood-thinner and artery-cleaner. It dissolves plaque. Ginger is a potent blood thinner--people on Warfarin must avoid ginger because it's as strong as the prescription drug.
B-complex vitamins are useful in dealing with mild anxiety and attention-deficit disorders.
In the use of supplements, as with any drug, correct dosage is essential for safety and efficacy. If you consume a sub-therapeutic level of anything, it won't help you.
For pain? Aspirin at the right dosage works quite well and is a better anti-inflammatory than the alternatives. Worried about stomach bleeding? Take your aspirin with a vitamin C capsule. You can Google that too. And--don't take one, or even two, aspirins at one time. Take three at once, and you probably won't need another dose for another 24 hours, though you haven't yet reached your maximum.
Sure--plenty of you will dismiss this as quackery. I go only by my own lifetime experiences. I come from a family full of heart disease on both sides, with plenty of early deaths in the earlier generations. My mother was on statins and other medications for decades. I'm on nothing--except supplements.
Do a little Googling, and read only the articles from reputable scientific journals and studies.
Vitamin C is a blood-thinner and artery-cleaner. It dissolves plaque. Ginger is a potent blood thinner--people on Warfarin must avoid ginger because it's as strong as the prescription drug.
B-complex vitamins are useful in dealing with mild anxiety and attention-deficit disorders.
In the use of supplements, as with any drug, correct dosage is essential for safety and efficacy. If you consume a sub-therapeutic level of anything, it won't help you.
For pain? Aspirin at the right dosage works quite well and is a better anti-inflammatory than the alternatives. Worried about stomach bleeding? Take your aspirin with a vitamin C capsule. You can Google that too. And--don't take one, or even two, aspirins at one time. Take three at once, and you probably won't need another dose for another 24 hours, though you haven't yet reached your maximum.
Sure--plenty of you will dismiss this as quackery. I go only by my own lifetime experiences. I come from a family full of heart disease on both sides, with plenty of early deaths in the earlier generations. My mother was on statins and other medications for decades. I'm on nothing--except supplements.
7
The advice given here is extremely dangerous, and please please discuss this with your doctor before following any of it, including the information on aspirin and vitamin C, or aspirin at all especially if you are older. Google only finds comments, and does not evaluate the quality of the information in any way.
I don't dismiss this as quackery, I dismiss it as life threatening information given by someone with no idea of scientific study or dangers even if small number can be life threatening.
I don't dismiss this as quackery, I dismiss it as life threatening information given by someone with no idea of scientific study or dangers even if small number can be life threatening.
9
Dale: Considering the ultimately fatal harm my mother experienced from a lifetime of obediently following her various doctors' advice--trust me. I'll take my chances on and shall continue to do as I've recommended above. I am 67; take no prescription drugs; have perfectly clear arteries. Am a decade older than my maternal grandfather at his death and a year older than my maternal grandmother at hers; she suffered all her life from heart disease. Her sister died at 41.
My mom had arthritis. When my knees hurt, I increase my vitamin intake, and my use of ginger tea, and the pain goes away. Last year I fractured five bones in my right foot and sprained that ankle. Following doctor's instructions played havoc with my left leg. Took me ages to get back to pre-injury condition. But I did it--my way. This is a free country (still). Do as you choose...
My mom had arthritis. When my knees hurt, I increase my vitamin intake, and my use of ginger tea, and the pain goes away. Last year I fractured five bones in my right foot and sprained that ankle. Following doctor's instructions played havoc with my left leg. Took me ages to get back to pre-injury condition. But I did it--my way. This is a free country (still). Do as you choose...
3
Practicing medicine without a license?
1
It's time for the fossils in the United States Senate, both Republicans and Democrats, to take on both big pharmaceuticals and big insurance. The one hundred individuals in the U.S. Senate do not have to worry about their health needs; they are very well taken care of, even in retirement. It is the rest of the citizens that have much more concern about these two issues.
It is time to move to a single payer health care system. Europeans have higher quality of care at half the cost. Americans are of the same species.
It is time to move to a single payer health care system. Europeans have higher quality of care at half the cost. Americans are of the same species.
24
Why do these higher drug prices only seem to happen in the US when everyone else on the planet apparently gets the sweet deal? It's not so much about scrapping our healthcare system as it is about sharing the cost of medications across the entire worldwide population that uses them. Duh, of course nationalized healthcare is cheaper everywhere else when we get stuck with R&D bill. The US needs to enforce the same sort of drug price restrictions that Europe and Canada do. If this mega-conglomerate of drug manufacturers wants to play the tax-break game, they need to pony up by shifting their development costs elsewhere. The other markets would get a rude awakening once they found out what quality healthcare really costs.
7
But Dave T, you misunderstand where pharma spends its money.
"Under fire for skyrocketing drug prices, pharmaceutical companies often offer this response: The high costs of their products are justified because the proceeds generate money for crucial research on new cures and treatments.
It’s a compelling argument, but only partly true. As a revealing new academic study shows, big pharmaceutical companies have spent more on share buybacks and dividends in a recent 10-year period than they did on research and development. The working paper, published on Thursday by the Institute for New Economic Thinking, is entitled “U.S. Pharma’s Financialized Business Model.”"
https://www.nytimes.com/2017/07/14/business/big-pharma-spends-on-share-b...
"Under fire for skyrocketing drug prices, pharmaceutical companies often offer this response: The high costs of their products are justified because the proceeds generate money for crucial research on new cures and treatments.
It’s a compelling argument, but only partly true. As a revealing new academic study shows, big pharmaceutical companies have spent more on share buybacks and dividends in a recent 10-year period than they did on research and development. The working paper, published on Thursday by the Institute for New Economic Thinking, is entitled “U.S. Pharma’s Financialized Business Model.”"
https://www.nytimes.com/2017/07/14/business/big-pharma-spends-on-share-b...
1
Maybe stop taking so many drugs.Improve your lifestyles and you won't need so many drugs.
1
I'll mention that to my cousin with MS.
5
This is what we get when 83 people control the wealth of America - particularly stocks. The same people control them all and only want more profit. They have no social conscience. They trade between "their" companies for greater profit.
Unfortunately, many in the medical profession have decided they like the easy money these 83 people provide so they go along with simply pushing the priciest medicines and using drugs instead of hand-on medical care. They simply do what their "computers" say. Problem is the same 83 people control computer content.
WE THE PEOPLE are the only ones who can change it by dusting off our social consciences and stepping up to fight like hell to preserve the one thing we value most about democracy. OUR lives are at the top of the list and the health of them are endangered by the greediest, most socially corrupt human beings ever to inhabit the planet in modern times.
Unfortunately, many in the medical profession have decided they like the easy money these 83 people provide so they go along with simply pushing the priciest medicines and using drugs instead of hand-on medical care. They simply do what their "computers" say. Problem is the same 83 people control computer content.
WE THE PEOPLE are the only ones who can change it by dusting off our social consciences and stepping up to fight like hell to preserve the one thing we value most about democracy. OUR lives are at the top of the list and the health of them are endangered by the greediest, most socially corrupt human beings ever to inhabit the planet in modern times.
12
Thanks to the New York Times and ProPublica for this excellent article. Information is power and WE must use the information to create the kind of America the world WE want to live in.
9
In 2012 the Supreme Court ruled that name brand drugs reverse payments to generic companies to keep the generic drug off the market violated antitrust (See FTC v. Actavis). While this should have put an end to name brand companies blocking generics from market entry it did not. The FTC still allowed to name brand drugs to delay generic's entry onto the market by licensing, and other such agreements. This seems to be another repercussion from that ruling. The name brand drugs needed to find other methods to stop the competition. Going directly to the insurance companies is a clever way to avoid FTC scrutiny and get around the 2012 Actavis holding.
With the SCOTUS holding essentially nullified by clever tactics, it is time for regulatory action. Law makers need to sanction and create regulations that allow the generics onto the market and stop negotiations that result in blocking generic drug coverage.
However, with many republican and democratic senators accepting campaign money from pharma companies this does not look like it will likely happen anytime soon. Maybe this is another compelling reason for severe campaign reform in the U.S.
With the SCOTUS holding essentially nullified by clever tactics, it is time for regulatory action. Law makers need to sanction and create regulations that allow the generics onto the market and stop negotiations that result in blocking generic drug coverage.
However, with many republican and democratic senators accepting campaign money from pharma companies this does not look like it will likely happen anytime soon. Maybe this is another compelling reason for severe campaign reform in the U.S.
6
Every year for the last four years I have had to visit my endrocronologist for a new thyroid medication as the insurance companies keep changing what they will accept. This is after years of taking the same med successfully. It ends up costing the insurance company more as they have to pay for blood tests and specialist visits! Totally pointless as thyroid meds are among the more affordable medications.
My husband can only take the brand medication he needs as the generic is not as effective. So every year he has to go through lots of red tape and doctor paperwork needs to be submitted so that he can get his correct medication. In the end also costing the insurance company more in staff processing and specialist appointments.
The whole ordeal for both of us is pointless. Insurance companies need to respect the decision of the qualified physician!
My husband can only take the brand medication he needs as the generic is not as effective. So every year he has to go through lots of red tape and doctor paperwork needs to be submitted so that he can get his correct medication. In the end also costing the insurance company more in staff processing and specialist appointments.
The whole ordeal for both of us is pointless. Insurance companies need to respect the decision of the qualified physician!
7
I have been taking Synthroid for a long, long time. After I had been on it for about a year or so, the pharmacy (accidently?) gave me the generic version. I didn't really think much about it, having heard the same old "generic is the same, just cheaper" mantra we all have heard. The second day on the generic, I started experiencing fibrillation. Called my doctor, who said to stop taking it. She told me she had a few other patients that had a bad reaction to the generic. She called in a script for the brand name with NO SUBSTITUTION which I have been taking ever since.
Just to confuse things: I take the generics, with no problem, for Ambien, Xanax, Tofranil, and Levsin.
Just to confuse things: I take the generics, with no problem, for Ambien, Xanax, Tofranil, and Levsin.
6
Is there a pill for corporate moral anaemia?
10
"...somewhere down the road, somebody is earning more money.” That is the short form of the American Dream. We all want to be rich, like movie stars and pro athletes, and the landed gentry. The money can come from the well or the sick, we don't particularly care.
5
Yet another example of the bold-faced corruption that is enveloping this country. Unfortunately, our politicians won't put a stop to it because they get their share of the boodle.
This disgusting practice would go away in a heartbeat with a single-payer system. Let the insurance companies make their gezillions on auto and home policies and get them out of our healthcare!
This disgusting practice would go away in a heartbeat with a single-payer system. Let the insurance companies make their gezillions on auto and home policies and get them out of our healthcare!
13
FYI, Shire is not an American company. But I don't think it would get away with this strategy anywhere else, so I suppose it may as well be an American company. Single payer can't come soon enough.
3
A most important reminder, that Big Pharma is gouging us consumers, with no choice nor say in the matter. That "W" Bush signed Medicare part D with them with no recourse in bargaining, to lower the sometimes outrageous cost of prescription medication is an ongoing abuse. As long as we continue to have political prostitutes, able and willing to sell themselves to the highest bidder, no salutary results can be expected. And that is a shame and an insult to Pharma's promise to help those in need. Greed ought not be the driver for 'business as usual'.
7
News Flash: Greed *is* the driver for business as usual, in every business.
2
There is all kinds of weird things going on with drugs - and I will bet you they are all designed to stiff us. Recently a friend gave me some Voltaren (pain relief gel for joint pain) he had brought back from Europe (OTC in Europe Prescription here) and it worked well. I went to my Orthopedist who then prescribed me the same drug but the generic which is called "Diflucenac." I looked at both tubes and both were manufactured by Glaxo. I thought that was strange that he brand name and the generic were both manufactured by the same company. In any event, not long after my prescription was filled my insurance company sent me a letter telling me it would no longer cover the drug unless I tried a bunch of other meds first. I sent them a letter telling them that I had tried all the drugs on their list and none of them worked. Never got a reply.
6
Verify the correct address and then send that letter again and copy the state insurance commissioner, your physician and your senator and congressman. Improve your odds of response.
6
Thanks for the advice.
1
Pharma Bro and now this. What was that argument against single payer?
7
A few years ago, I went to order Voltaren gel and was stunned to discover it was something like $80 a tube. I ordered it from Canada for about $10 a tube. The problem with that route, of course, is it then doesn't count towards your deductible. When is SOMEONE going to fix this fiasco? We scream, the politicians allegedly scream and...nothing is done.
7
Citizens of American unite against this tyranny. This is sheer piracy.
Perhaps some NON-PROFIT, non-stockholder pharmaceutical company can enter the scene to really fight these greedy monsters and really create the darling "free market"?
Perhaps some NON-PROFIT, non-stockholder pharmaceutical company can enter the scene to really fight these greedy monsters and really create the darling "free market"?
3
Of course certain life long medications are good and necessary, but it's also up to consumers to resist efforts by profit-motivated pharmaceuticals to colonize their bodies. That requires paying close attention to test results and making the appropriate lifestyle and diet changes. Doctors are not nutritionists; they are obligated to recommend treatment according to the numbers before them. Therefore the patient may need to manage not only their diet and lifestyle choices but also their doctors and the larger medical industry if they want both to be healthy and live a life without being tethered to pharmaceuticals.
1
The benefit managers are requiring the more expensive brand name because the manufacturer is kicking back some of the resulting profits. How is this not a felony?
9
The republicans are in charge of everything. That is why.
3
ACA was a great idea ruined by the collusion of four quasi-criminal enterprises: the insurance industry, the pharmaceutical industry, the hospital industry, and our Congress. The rules and regulations that frame the health insurance marketplace were written primarily by lobbyists and special interests. They quietly and shrewdly rigged the system to enrich themselves while throwing the public under the bus. The primary mechanism for this is the use of high deductible policies and fine-tuning of fine print rules that pass major financial burdens onto consumers, guarantee ever exploding profits for insurers and pharma companies, and tons of cash for politicians. Its a sick, sick system and the devil is definitely in the details. When will honest government finally come to our aid?
2
All that stands between consumers and the solution to this problem is our own government, a statement increasingly true of nearly all that ails this country.
There is a long tradition in this country of thinking and acting on the premise that the business of government is business. Businesses have long used the government to act in their favor, and Republicans are their enablers. Read Mark Twain's "The Gilded Age."
1
A friend on Medicare takes a prescription drug - one a day and its filled for 90 days at a time. The generic co-pay $0. The mail order pharmacy under United Health Care insists on filling it as a brand name drug, same quantity, and "bills" Medicare something like $270 thereby forcing her into the donut hole faster.
5
Another piece of evidence of just how pervasive & invasive Big Pharma is the daily, continual advertising on TV, across all channels & most programs. Shameful that kids are exposed to such a heavy inundation of drug marketing.
Perhaps Jeff Sessions could turn his obsession with drug use, drug dealers & users to some understanding of the part Big Pharma plays in the normalization of drug use in everyday life in our culture.
Perhaps Jeff Sessions could turn his obsession with drug use, drug dealers & users to some understanding of the part Big Pharma plays in the normalization of drug use in everyday life in our culture.
129
This is why we need a single payer, well regulated health industry. When the bottom line - stock prices and profits - take precedence over citizen's health - we need action! This is common sense, but somehow Americans have come to believe that "choice" of doctors and medicines, etc. is best. It is not real "choice" when the system is opaque and forces beyond the control of individuals leave us with nothing.
The government is our ally in this process. There is no other mechanism for individuals to band together and stand up to these corporations. Health reform and more regulation of the pharmaceutical and insurance industries is required.
I state this as a resident of New Jersey, a state that benefits most from the pharmaceutical industry. While these companies profits might be reduced, be sure, they will not cease to exist. Profits will remain. We still have utility companies, don't we?
The government is our ally in this process. There is no other mechanism for individuals to band together and stand up to these corporations. Health reform and more regulation of the pharmaceutical and insurance industries is required.
I state this as a resident of New Jersey, a state that benefits most from the pharmaceutical industry. While these companies profits might be reduced, be sure, they will not cease to exist. Profits will remain. We still have utility companies, don't we?
3
A large part of the problem is the consolidation that occurred in the drug market. Powerful generic companies were merged with brand name companies. So instead of pure generic companies fighting for market share, we now have an oligopoly of a few companies that control a huge percentage of the generic drug market that also have large segments of branded drugs. The oligopoly colludes with insurance companies and divides the market to protect their products, both generic and branded. Insurers benefit by massive deals across product lines. The result is that the USA is the most profitable drug market in the World. That benefits stockholders of the oligopolistic companies on the backs of Americans. There is no dispute that we pay the most for drugs. Unless the Antitrust Laws are enforced rigorously by the Attorney Generals of the States, there is no cure.
5
before retired from managing a doctor's office, i spent lots of time fighting insurance companies on getting patients' meds. medicines were mostly divided into: preferred generic, preferred brand, non-preferred generic, non-preferred brand. many times, generic meds given to patients were not covered and told to get brand, which cost higher deductible, and for Medicare patients, sooner to fall into the "donut hole". we sometimes advised patients to get generic out of pockets, which cost the least, but these payments won't count into their deductibles. patient discharged from hospital 2 wks but couldn't get his med approved--insurance company used delayed tactic: asking for forms after forms for review first . local pharmacist was amazed how much time i spent with insurance. when i gave him the "approval number" to dispense med, he told me patient could only get it through "mail order". i called the insurance back: insurance company would be held accountable for jeopardizing patient's health for denying timely treatment. only then, insurance company agreed to provide "short term" treatment from local pharmacy. another case: insurance insisted patient's policy required "step therapy" even though the med they suggested (1st step) had "black warning on box--adversely affected his health for his situation), but the insurance insisted patient would not be covered for the "2nd step" med until "1st step" was tried . so we are not talking only $ here. it could be LIFE & DEATH.
24
Thank you to the New York Times for reporting on this. I hope there will be more exposes on the tricks used to gouge consumers.
Even if you, as a consumer, aren't paying more, you might feel outraged by the system because you know it's being used to generate excessive profits for middle men, which increases costs and makes it hard for many people to get affordable health care.
Throwing up our hands and saying, "Nothing can be done" is unacceptable. Let's keep informing our representatives about what's happening so they can fashion legislation to prevent price gouging. I sent this article to my senators.
Even if you, as a consumer, aren't paying more, you might feel outraged by the system because you know it's being used to generate excessive profits for middle men, which increases costs and makes it hard for many people to get affordable health care.
Throwing up our hands and saying, "Nothing can be done" is unacceptable. Let's keep informing our representatives about what's happening so they can fashion legislation to prevent price gouging. I sent this article to my senators.
15
I agree completely, but these kind of abuses have been going on so long that our representatives cannot be unaware of them. Millions of Americans have no insurance or access to affordable health care at all -- a fact long known to every politician -- yet our representatives regard this as something like an administrative error and not the national disgrace it is.
4
N. Peske
Well said!
Well said!
2
This article exemplifies the importance of a free and open Press. Thank you The New York Times once again for your fine reporting!
40
Pharmaceutical companies would have you believe that Canadian drugs should not be an option, because they are not reliable. In fact, there are some online Canadian pharmacies that are perfectly reliable. For several years I used an inhaler called Advair for my asthma. The co-pay for my Part D insurance was around $250. I discovered I could buy it at an online pharmacy for closer to $75. The name on the inhaler is different, but the drug is made by the same manufacturer, the packaging is the same. I was told by the pharmacy that it is made in the same factory in India as the brand. The two are virtually indistinguishable. The difference? Medicare's prohibition on negotiating with drug companies and the generally higher prices in the US. This is unconscionable price gouging. It is especially egregious for families with asthmatic children, a category of patients that has increased because of environmental pollution. There are so many things wrong with this, it makes my head explode.
56
Remember about 10 years or more ago, when busloads of elderly Americans came up here to Canada? The reason for their coming up here was that drugs were less-costly and the Canadian dollar was also lower than the American dollar.
Big Pharma closed down the operation very fast, and the elderly got bilked in the USA!
"Concerned by the threat to their profits, some drug companies are striking back. In March 2003, GlaxoSmithKline, a UK-based pharmaceutical giant that manufactures blockbuster drugs such as Paxil for depression, the antibiotic Augmentin, and the ulcer medicine Zantac, cut sales to Canadian pharmacies shipping to America. Soon after, AstraZeneca, another major supplier, did the same. If more companies follow suit, the supply of drugs available could dry up."**
**Citation: http://www.pbs.org/wgbh/pages/frontline/shows/other/etc/so.html
Big Pharma closed down the operation very fast, and the elderly got bilked in the USA!
"Concerned by the threat to their profits, some drug companies are striking back. In March 2003, GlaxoSmithKline, a UK-based pharmaceutical giant that manufactures blockbuster drugs such as Paxil for depression, the antibiotic Augmentin, and the ulcer medicine Zantac, cut sales to Canadian pharmacies shipping to America. Soon after, AstraZeneca, another major supplier, did the same. If more companies follow suit, the supply of drugs available could dry up."**
**Citation: http://www.pbs.org/wgbh/pages/frontline/shows/other/etc/so.html
2
The article mentions that buying generics out-of-pocket is problematic because it doesn't count toward deductible. My ACA plan has begun setting "co-pays" equal to 100% of the negotiated "price" of each service. I essentially pay the entire cost and never reach the deductible. Last year I paid around $2k, and satisfied $0 of my deductible. The only value of the insurance is to qualify for the sane price of any service, vs. the ten-times-greater original billed price. My point is that satisfying some unachievable deductible has ceased to be a consideration for me.
5
Does this not somehow violate anti-trust, unfair competition or consumer protection laws? This is simply more evidence of a broken for-profit health care "system" in which profits, shareholder value and CEO compensation Trump delivery of care to patients.
2
None of these costly games would be possible if the government (Medicare) were required - rather than prohibited - to negotiate drug prices directly with the manufacturers. Of course the PhARMA lobby has spent hundreds of millions buying off congress to make sure that that does not happen.
9
Generics are only required to have 70% efficacy of the brand name drug. Not all do and reach higher percentages, but this is why those drugs are cheaper.
2
This is not true. The FDA requires equal efficacy
https://www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicines...
https://www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicines...
1
Lisads, Believe what you want in government documents and websites. I have worked with life science patents - both generic and brand - for nearly 20 years and there is a different. Youre link states -
FACT: FDA does not allow a 45 percent difference in the effectiveness of the generic drug product. -
Does it state that the FDA does not allow for a zero or five percent difference in effectiveness? No. It states 45 - 15 percent more than 30.
FACT: FDA does not allow a 45 percent difference in the effectiveness of the generic drug product. -
Does it state that the FDA does not allow for a zero or five percent difference in effectiveness? No. It states 45 - 15 percent more than 30.
2
Siciliana, the comment about 45% is worded that way because it is debunking a myth. Read the entire paragraph. I'm not saying there's no difference. I'm merely saying that the notion that there's an official requirement that generics need only have 70% efficacy is false.
So, drug companies conspire with insurers against patients -- and the patients simply reward them. Such is the logic of our cherished American health care system.
8
Let us not forget it was the Republicans who just before the passage of medicare part D insisted on adding to the legislation a prohibition on medicare negotiating drug prices. When the democrats controlled both houses of Congress and the Presidency long enough to pass the ACA, they refused to remove this prohibition. If anything shows the contempt of our congress and the drug companies for the public, this is it. While it might not affect everybody, it certainly affects those of us who have to rely on medicare part D along with the asinine hole in the middle of coverage. And one wonders why Americans pay 3 times the price for the same drugs as Canadians made in the same factories. Solution to the problem of asinine high drug prices, make a trip to Canada and pick up your drugs there.
16
Recently my eye doctor prescribed a new medication called Avenova for my dry eyes. After years of pain the spray brought welcome relief, but my Medicare plan didn't pay for it and local pharmacies didn't carry it. I didn't understand how I was getting it for $35 at far less than the list price, but apparently the company was providing rebates to selected pharmacies. The last time I bought it, the company had halved the contents and nearly doubled the price to $60. I started to research the product online and quickly discovered there is an OTC product with the same active ingredient in a slightly different formulation. Customer reviews raved about the effectiveness and cost of the product--$10. I was nervous about using it, because the active ingredient was 2% instead of 1.5%, but at that price I wouldn't be out much, and I thought the difference probably wouldn't cause much of a problem if any. I love the OTC product. Not only has that difference not caused a problem, but it is far more effective. Further, the brand product deteriorates after opening while the OTC product does not. I can't help wonder why this drug even needed to be prescription. What a racket.
19
The problem is even much broader than this article allude to. In many cases the physicians who get kickback from drug companies change the medication as soon as it becomes generic to a new one for no apparent reason. It happened to me with Herat burn medication and glaucoma drops. I did my own research and fought it, but I bet that many less sophisticated consumers don't fight it.
4
The wonders of the free market! Of course "regulations" must never be allowed to interfere.
3
A little known secret is that some pharmaceutical companies own generic companies making exactly the same drug as their own brand and selling same as their brand at far lower price.
Purchasing generics from Canada quite reliable.NOT Mexico!
That insurance companies are often in cahoots with pharmaceutical companies should come as little surprise.
It did not take long in practice to become very cynical about both and pity for patients. Especially those with lower incomes.
As a physician the only drug I ever recommended as a brand named drug instead of generics was Bayers aspirin.Chemically both are the same;however, Bayers is easily absorbed whereas many generics are not and are embedded in stomach wall causing painful gastritis.
Purchasing generics from Canada quite reliable.NOT Mexico!
That insurance companies are often in cahoots with pharmaceutical companies should come as little surprise.
It did not take long in practice to become very cynical about both and pity for patients. Especially those with lower incomes.
As a physician the only drug I ever recommended as a brand named drug instead of generics was Bayers aspirin.Chemically both are the same;however, Bayers is easily absorbed whereas many generics are not and are embedded in stomach wall causing painful gastritis.
1
"He began receiving faxes from pharmacies telling him that he had to specify that patients required brand-name versions of the drugs."
This should read "...required GENERIC versions..." Doctors have always had to specify brand only if the generic is available.
This should read "...required GENERIC versions..." Doctors have always had to specify brand only if the generic is available.
re-read the article.
@idnar Re-read that sentence. The doctor writes a prescription for a drug and writes down the brand name or the generic name. Unless the doctor writes "dispense as written" on the prescription, it makes no difference to the pharmacists which of the two names the doctor writes; they will fill typically fill the generic, if one exists, because this is what insurance plans and Medicaid will reimburse. The article describes pharmacists filling the brand version in this scenario which is a recent phenomenon. For many yearz it has been standard practice for pharmacists to tell doctors or patients that a prescription needed to include "dispense as written" if the doctor or patient required the brand version. This wouldn't surprise a doctor. The doctor in the article is describing the opposite: a pharmacist telling him he had to specifically request the GENERIC version to avoid getting the brand version.
1
Required reading: the archived New Yorker article on Ranbaxy or the N Y Times coverage of the case. Some generics are just fine...and others are just awful.
3
ALWAYS check Costco generics even if you have a drug plan. The generic Avapro costs me $30 via Caremark (the insured rate, mind you) and $11, without insurance, via Costco. Call Costco online pharmacy if you don't see your drug on their site-for example, you won't see many psychoactive drugs, but Costco still sells them, they just aren't on the Costco pharmacy site.
3
One point: I understand you don't even need a Costco membership to use their pharmacy.
3
Stop clutching your pearls. We live in an oligarchy now in which corporations buy and sell "our" democratically elected officials like so many... pills. You are nothing but a target to exploit. You are being stripped bare. To act as if this is news when it is quite clear these corporations will stop at nothing to fleece you is to act a child.
Two choices:
1. Make a pile of money and buy your way through the system.
2. Leave.
It will not change. In fact, it will only increase.
Two choices:
1. Make a pile of money and buy your way through the system.
2. Leave.
It will not change. In fact, it will only increase.
10
Remember that study that showed that older white males were dying off at an alarming rate? This is partially why.
3
UnitedHealthcare charges the same amount for Zetia and its generic. Shameful waste of my money ($138.00) and theirs ($784.69) for a three month supply when I could order the same 90 unit supply of the generic from Canada for $50. This type of greed on the part of insurance and drug companies needs to be addressed in any improvements to the ACA. Thank you for this great article.
8
If insurance companies are going to receive kickbacks from the drug companies at the patient's expense, isn't that a conflict of interest? I know, profit motive in health care is a conflict of interest, but this is just yet another way to gouge patients and tax payers.
Don't forget the drug pusher tactics to get one hooked - with free promos, coupons and first month trial periods frequently advertised on TV.
Don't forget the drug pusher tactics to get one hooked - with free promos, coupons and first month trial periods frequently advertised on TV.
5
it's all about 'kickbacks' which in the Pharmacy Benefits Management world is called a 'rebate program'. the name brand manufacturer pays $$$ to the PBM to cover their medication exclusively, even when cheaper versions are available to the patient.
8
I have a problem in that the medication I take,Prandimet, is only available as a generic, and the Indian company Lupin, has the patent run out in 2018. They stopped making the medication in March 2017, and started shipping the medication in June 2017. The only change appears to be new language on the package insert. I was told that CA would have Prandimet shipped to Ca, and would be in Walgren's =by 07/25/17. I checked with Walgren's they claim they will not have it until 08/25/17 and are offering the 2 drugs separately, with double the copay.
1
There is a big problem with generics. Generic manufacturers cannot be sued by individuals about their warning labels or lack thereof. Even if a generic company discovers unknown dangerous side effects, they cannot change the warning label or formula unless the brand name does so first and cannot be sued for such side effect not being listed.
The pharm industry, with deep pockets for legislators and high costs for Medicare and Medicaid, needs to be regulated.
The pharm industry, with deep pockets for legislators and high costs for Medicare and Medicaid, needs to be regulated.
6
"a few years ago, Shire tried a new tactic: giving ever-larger discounts to pharmacy benefit managers and insurers for preferential treatment over the generics. That did not mean lowering the list price of the drug, but rather negotiating rebates that were paid not to the patients but to insurers and middlemen such as CVS Caremark." Oh wait, now i recall what this is called. It's a bribe. And because "Medicare cannot negotiate directly with drug manufacturers" (the other Bush-Cheney gift to America after the Iraq war), the drug co's have figured out how to transfer greater wealth from the have-nots to the haves, because Medicare is prohibited by law from complaining about the bribes that lead to higher prices whose burden falls on the taxpayers. Republicans talk about "freedom to choose" with their fingers crossed behind their backs, because the last thing they want is to allow Medicare to negotiate drug prices, or allow people to choose cheaper generics over more expensive brand-name drugs.
23
Can we all agree this is not a "free market"? The prices for these drugs more resemble a racket or a mafia. The cost of a drug is hammered out behind closed doors and the advantage goes to the company and not the American citizen. When I go buy a car or gas or get my car fixed, I am given a price and I can shop around. With healthcare, I have to pay a mystery price after the fact. This is not capitalism by definition. We are the "mark" in "market".
284
I've been saying the same for years. "Health care in America" is to my knowledge the only product on the planet that you have to purchase without knowing the price. If you ask, as I've done so many times, they won't tell you. You're told you can call back next week and the supervisor or somebody will be able to tell you, but it's never up front and when "call back next week" I wouldn't advise it when you are having a busy day.
A physician wrote an article a few years back entitled, "The Health Care Mafia."
A physician wrote an article a few years back entitled, "The Health Care Mafia."
2
I would argue that this system is indeed capitalism. You might call it vulture capitalism, but really all capitalism cares about is the bottom line: the more profit, the better. It's an effective, but amoral system. Capitalism has no built-in ethics like socialism: to each, according to his need; from each, according to his ability. Thus, capitalism needs to be properly regulated, i.e., watched like a hawk. People are greedy.
2
As a consumer with a high deductible health care plan, it made financial sense for me to circumvent my insurance company on the prescription front. Blink Health actually lowers my monthly out-of-pocket (versus the insurance co-pays), and I still have my scripts filled at my local CVS. The only downside is the payments to Blink don't count towards my massive $6,000 deductible (I can stomach this risk since I'm fairly healthy).
https://www.cnbc.com/2016/08/05/blink-health-looks-to-disrupt-relentless...
https://www.cnbc.com/2016/08/05/blink-health-looks-to-disrupt-relentless...
2
One thing a consumer can do is to check with their pharmacy as to the cost of a generic WITHOUT using insurance. You might be surprised at the lower cost (though it may not be cheaper in all cases) - in one case for me $1.15 generic without versus $15 generic with insurance. Could work too for those cases where only the brand is covered by insurance: buy the generic without insurance. At these lower costs I don't have any problem buying without insurance and foregoing the additional of these costs to my deductible. Of course, this is not workable for those super-expensive generics.
There is a very informative chart I think published by Consumer Reports and republished elsewhere that shows all the players in the pill chain and who pays whom. Very interesting. You'd think it's you pay your pharmacy for your insurance cost, the pharmacy obtains the difference between what you pay and the cost of the drug from your insurance and pays the drug company. Not so at all. Many more back and forth payments.
This article is pointing to some of these cross payments between a drug company and an insurer but that's but one of many. More public exposure of this process would help consumers and put pressure on the cosy relationships between the many players that sit between you and your prescription. And add to the costs.
There is a very informative chart I think published by Consumer Reports and republished elsewhere that shows all the players in the pill chain and who pays whom. Very interesting. You'd think it's you pay your pharmacy for your insurance cost, the pharmacy obtains the difference between what you pay and the cost of the drug from your insurance and pays the drug company. Not so at all. Many more back and forth payments.
This article is pointing to some of these cross payments between a drug company and an insurer but that's but one of many. More public exposure of this process would help consumers and put pressure on the cosy relationships between the many players that sit between you and your prescription. And add to the costs.
13
The American free market again shows how it does not work to improve our health. It is not "free" in any sense of the word, nor is it efficient or logical. And this is exactly what the Republicans are attempting to foist on all of us, including, eventually, those on Medicare.
23
The flip side of this issue is the prior authorization process required for even routine medications that have already been prescribed for years. Slight medication adjustments are subject to review and often denial. Many hours of physician time are used trying to advocate for good care. Again, it is the collusion between drug manufacturers and insurance pharmacy programs interfering with good medical care.
20
Via nefarious "rebates" and strict control of formularies, brand name drug makers, insurance companies and PBMs are colluding to force end consumers to pay more for branded medicines. Notice that this process could not have happened without the shift to much higher deductibles as a reslult of Obamacare. Health insurers should never be allowed to acquire PBMs, as United Healthcare has done with Optum and Catamaran, as it puts all three parties (drug maker, insurer, PBM) on the opposite side of the table from the consumer.
3
Rebates. I came here to mention the dirty little secret. C Smith is right.
1
Also, those third party companies Caremark,Express Scripts,etc. are now setting up groups to try to shape public opinion against single-payer, and to defend their practices on prescription drugs. They are trying to sign up unions and the public employee pension groups for their dog and pony show.
7
It’s a protection racket, pure and simple. The PBMs come to the branded drug makers and offer to protect them from the generics for a “piece of the action”. Consumers are only becoming wise to it because the deductibles and copays have been expanded so much under Obamacare.
3
"In an email, a spokeswoman for CVS Caremark, Christine Cramer, said consumers never pay more in the rare instances in which the company favors a brand-name drug over a generic."
So it appears that CVS is taking cues from the Trump administration. They've invented their own alternative accounting system. I don't think it quite adds up.
So it appears that CVS is taking cues from the Trump administration. They've invented their own alternative accounting system. I don't think it quite adds up.
21
Please.
As others have noted, this is an unintended result of ACA changes to the market. Not something that has only occurred in the past seven months.
As others have noted, this is an unintended result of ACA changes to the market. Not something that has only occurred in the past seven months.
3
"As others have noted, this is an unintended result of ACA changes to the market."
The pricing may be a result of the ACA. The lying surely is not. Your comment negligently (or cunningly) confuses the two, using the pronoun "this".
The pricing may be a result of the ACA. The lying surely is not. Your comment negligently (or cunningly) confuses the two, using the pronoun "this".
2
John, you're saying CVS is lying because of the current administration in Washington?
Isn't that a kickback to the insurers and pharmacies? Isn't that illegal?
61
By "rebranding" kickbacks as rebaits, incentives, etc. the drug companies and insurers are playing a game that lets them win at the expense of consumers. It has to be surfaced and stopped.
1
Sure, but why call it a kickback if using that word will get you prosecuted? Let's call it something else.
3
These kinds of shenanigans are one more reason why I will never vote Republican again.
13
The Republican Party unabashedly advocates for thieving corporations that engage in shenanigans of this sort. Like yourself, I greatly prefer the Democrats, who likewise advocate but are, at least, abashed.
4
This is why I'll never vote again. Both parties are dirty.
2
Jane, sorry to say it but you must keep voting. And call, fax and email your representatives in Washington and in your state government.
Don't let PAC propaganda be the only thing they hear. Make sure they hear your concerns when situations like this arise.
Don't let PAC propaganda be the only thing they hear. Make sure they hear your concerns when situations like this arise.
2
The cost of generic nitrofurantion tripled this year. I bought a 3 month supply at Costco not using my insurance and saved $15. I buy 3 months of zolpidem(ambien) at Costco for $12 without using insurance. One month at CVS costs $50 and at my local pharmacy $15. I am on Medicare and my part D plan in Humana.
I always check at Costco to see if their"no insurance plan" is better than my part D Humana.
I always check at Costco to see if their"no insurance plan" is better than my part D Humana.
34
Margaret, if you tell Costco you're "not using" insurance, you do get a cheaper price, but Costco's pharmacy told me that if I actually DO have insurance and I say I don't, my physician could lose his license! Be careful!
1
I think I told them I had insurance but was not using it. Thanks for the reply. I certainly will check again the next time. I really don't think the physician has any connection to my insurance.
3
And we vilify Martin Shkreli! These guys are just as bad. It has gotten to the point where I expect to get hosed every time I go to a doctor. Now when I go to a doctor, I not only get a doctor's bill but I get a "hospital facilities charge" even if I visit the doctor at some suburban office park that is NOT a hospital. I have given up fighting this and just pay.
8
'...I expect to get hosed every time I go to a doctor.' Well, at least you're not delusional!
2
United Health Care and AARP collude with Medicare to "set" prices on in-office doctor visit tests, enforcing on patients high co-payments.
Recently I went to see a ENT specialist who took a laparoscopic view of nasal passages. It took less than 3 minutes and cost $496, $60 of which was my co-payment after United Health Care's supplemental contribution.
When I complained to the doctor, I was told that they were "forced" to charge that fee because Medicare "set" the price.
Outrageous. Government, Corporate, and patient advocates colluding to fleece people on Medicare. I am fortunate to be able to pay these "forced" charges, but most aren't. This hits the most vulnerable among us.
Recently I went to see a ENT specialist who took a laparoscopic view of nasal passages. It took less than 3 minutes and cost $496, $60 of which was my co-payment after United Health Care's supplemental contribution.
When I complained to the doctor, I was told that they were "forced" to charge that fee because Medicare "set" the price.
Outrageous. Government, Corporate, and patient advocates colluding to fleece people on Medicare. I am fortunate to be able to pay these "forced" charges, but most aren't. This hits the most vulnerable among us.
17
You can always switch to a doctor who doesn't take Medicare patients. They are not subject to Medicare fee schedules. There are many of them in New York, especially in Manhattan, and their numbers are growing.
2
Medical insurance is a typical American scam—supported by the government for which it exists in a symbiosis— whose goal is to bleed the American proletariat. Violent overthrow of the government is not a solution and is punishable under state and federal laws, so all you can do is pray.
2
I am an atheist, so I don't pray. I am an old lady, so I am ready to try the overthrow method, and I don't care at all about the consequences. I can only die once.
2
It's hard to explain...no one can understand it...it makes no sense...and on and on. It makes perfect sense if you are the one profiting from human misery. Until we stop telling ourselves silly stories about the sanctity of free enterprise and make this kind of piracy illegal (like price-fixing, protection rackets, usury, and a thousand other unendurable things that would otherwise be sanctimoniously justified by the same "logic", legal medical robbery will continue. It is no no longer an "honest profit" the minute we make it against the law. Entirely up to us.
9
Exactly. When a situation "makes no sense" it's only because you haven't yet figured out who is profiting.
2
Keep exploring this story to figure out who is making money here. I'll bet there's a lot more there.
3
Setting aside the obvious kickbacks and the intent of this article, people forced to take name brand drugs should check the company's websites for coupons. These coupons are for people with private insurance and often wipe out the co-pays, or limit them to a small amount IF you fall under their income guidelines (which are more generous than government #s). I have coupons for two medications that I take which reduce my co-pays from $100 a month to zero. I have a full time job and no dependents and I still met the income guidelines.
3
Pharmaceutical company CEO Martin Shkrell and Mylan's EpiPen have been doing a great job of getting the general public to accept that BIG pharmaceutical companies can do what they want when they want to make money - a lot of money. They have lost in the courts.
So --- here comes kickback!
So --- here comes kickback!
5
why would you pay $7/pill for adderall? It's essentially no different from meth, which is much cheaper. Oh I forgot - it's legal. 10 cents for the drug, and $6.90 to all the people who profit from a rigged system.
And pot is as dangerous as heroin. And Donald Trump is president.
Which of the above is the most absurd statement?
And pot is as dangerous as heroin. And Donald Trump is president.
Which of the above is the most absurd statement?
10
So to give an analogy to your claims - you say that Adderall (let's equate that to a cupcake from the local bakery subject to health inspections) is the same as meth (equate that to a pie baked with human waste in a rat-infested kitchen and then coated with urine crystals) - no, not seeing the equivalence. One will not cause serious side effects, the other is guaranteed to cause trouble. You also say that pot (equate that to a bottle of antifreeze) is the same as heroin (equate that to a bottle of drain cleaner) - both very dangerous, both can kill depending on the dose and use pattern. The absurdity is making up stuff to sell stuff - once the truth is noted, the absurdity is the motive for making up the sales pitch to sell dangerous chemicals to the gullible, the depressed and the bored. PS the local cops on Long Island all carry naloxone now in their squad cars to revive opioid overdoses, and sometimes this works. But there is no antidote to marijuana overdoses yet, they die due to jumping off bridges due to psychosis or kill their families due to psychosis or drive while impaired and die/kill others, or collapse and die when they inhale their own vomit. No antidote. Chronic marijuana use kills the part of the brain involved in making decisions, impairing judgement. But hey, why tell the truth about marijuana when there are trillions of dollars to be made - same as big pharma, just better at claiming pot is "not dangerous" when law enforcement and ER doctors know better.
There is no such thing as a marijuana overdose, and marijuana does not cause psychosis unless it was treated with PCP, known as Angel Dust on the street. If it did, millions of cancer patients undergoing chemotherapy would be overwhelming mental hospitals and prisons in sheer numbers.
Marijuana does not cause psychosis.
Marijuana does not cause psychosis.
2
Get rid of the profit motive and have Uncle Sam negotiate drug prices like the rest of the world and you see the insurance companies bow out of health care. We don't call blue cross blue double cross for no reason!
24
Do we have a drug for that, to decrease our addiction to the profit motive?
This reads like obvious collusion between big pharma and big insurance to squeeze every drop of blood out of each of we turnips. But forget about that, get back to the Russian kind because that's what's really vital to me.
4
Here's anoher example of the crazy world of prescription drugs. I recently had ear surgery and needed ear drops. Medicare advantage plan cost: $85. After 3 days the tiny bottle got lost but the Doctor allowed for 1 refill. Since it was too early to be covered by Medicare I had to pay out of pocket. Pharmacy charge: $260. Searching online I found a discount coupon for $190. I took it to the pharmacy and asked if they could perhaps find a better discount. I returned an hour later and they found a discount that cost me only $35!! They also said they could not use discount cards in conjunction with Medicare advantage plans. So they could not use it for the initial purchase. What a racket!
98
You just ain't gonna outsmart the Big Dogs.
They didn't get rich by being fair and balanced.
And unregulated capitalism allows it: you can charge what the market will bear, or, as in your case, forced to bear.
They didn't get rich by being fair and balanced.
And unregulated capitalism allows it: you can charge what the market will bear, or, as in your case, forced to bear.
2
To rgfrw:
Please do not disparage the mafia. Big Pharma does't need any assistance . They've got a powerful "Mob" of their own.
Please do not disparage the mafia. Big Pharma does't need any assistance . They've got a powerful "Mob" of their own.
1
A similar situation exists with medical devices. Those of us with a high-deductible insurance plan find that our copay for a device obtained through the insurance-friendly channels is about the same cost as buying the same device on Amazon (analogous to generic drugs).
As the article's last paragraph implies, there is obviously collusion between insurance companies, benefit managers, and the pharma companies. Perhaps someone in the industry could leak a rebate and discount information to the NYT so we could see just how egregious the behavior is.
As the article's last paragraph implies, there is obviously collusion between insurance companies, benefit managers, and the pharma companies. Perhaps someone in the industry could leak a rebate and discount information to the NYT so we could see just how egregious the behavior is.
14
For decades now drug companies have held on to profits not through drug development, but through patent shenanigans. Only a few actually new drugs now hit the market, while the remainder are either newly-patented biosimilars to older formulations, or admixtures of two older drugs (with a new higher price). It sounds now as if the drug industry is now co-opting benefit managers to collude in lifting their profit margins at the expense of consumers. This mirrors the business history of medical providers and medical insurance.
As a result of grossly lax anti-trust oversight and the continued concentration of corporate power, there are now but a few benefit managers. As well, the rate of mergers among drug companies has been pace-breaking. So too has it been with providers and insurance. This kind of concentration has also been allowed at the hospital level, so that there are now vastly fewer choices for medical providers anywhere you live. Similarly, insurance companies are pushing arguments to merge as well, to maintain competitive balance against medical providers.
The losers of this battle? Consumers, who get stuck with the excessive billing from multiple monopolies squeezing them from both ends. There needs to be another great trust breakup, (Teddy) Roosevelt style, in the medical industry, because the market concentration that has been allowed is *nothing* like what exists in a competitive marketplace.
As a result of grossly lax anti-trust oversight and the continued concentration of corporate power, there are now but a few benefit managers. As well, the rate of mergers among drug companies has been pace-breaking. So too has it been with providers and insurance. This kind of concentration has also been allowed at the hospital level, so that there are now vastly fewer choices for medical providers anywhere you live. Similarly, insurance companies are pushing arguments to merge as well, to maintain competitive balance against medical providers.
The losers of this battle? Consumers, who get stuck with the excessive billing from multiple monopolies squeezing them from both ends. There needs to be another great trust breakup, (Teddy) Roosevelt style, in the medical industry, because the market concentration that has been allowed is *nothing* like what exists in a competitive marketplace.
9
Start my making it illegal for a pharmaceutical company to play in the stock market. That would take care of one level of profiting from the misery of others.
Second, make it illegal to advertise on TV--another huge reduction in unnecessary costs, thereby reducing the costs to the patient (stop using the word consumer!).
Third, place a ceiling on executive compensation---thereby further reducing the costs to the patient.
Fourth, regard any form of marketing to doctors (i.e,. expensive maui golfing trips, fancy lunches, etc) as a form of illegal activity.
Second, make it illegal to advertise on TV--another huge reduction in unnecessary costs, thereby reducing the costs to the patient (stop using the word consumer!).
Third, place a ceiling on executive compensation---thereby further reducing the costs to the patient.
Fourth, regard any form of marketing to doctors (i.e,. expensive maui golfing trips, fancy lunches, etc) as a form of illegal activity.
3
These kinds of shenanigans are one more reason why we need single-payer health care. When bean counters get involved in the prescription drug decision making process, not only does it cheat the end users, it could be medically dangerous. Doctors and pharmacists are trained to know the differences. Bean counters are not.
13
Several years ago, my husband was having problems with the generics of Adderall. His doctor said his other patients were having problems, too. The one generic that did work for most of his patients disappeared from the market. The other generics caused all sorts of problems and side effects. The doctor had no choice but to prescribe brand to treat his patients. The problem was with the manufacturers of the Adderall generics. Was there collusion between manufacturers disguised as "market" pressure? Probably. But generics are not always better than brand, and sometimes they are worse.
The greater problem is the "free-market" pricing of drugs in the USA. Pharmaceutical companies say they must pay for the high cost of research, but research costs are tax-deductible, and the Federal government funds many research projects. High profits, high executive compensation, shareholder dividends, advertising and marketing do nothing for drug quality and patient affordability. It's the worst example of our for-profit medical industry where patients are disposable and replaceable.
The greater problem is the "free-market" pricing of drugs in the USA. Pharmaceutical companies say they must pay for the high cost of research, but research costs are tax-deductible, and the Federal government funds many research projects. High profits, high executive compensation, shareholder dividends, advertising and marketing do nothing for drug quality and patient affordability. It's the worst example of our for-profit medical industry where patients are disposable and replaceable.
26
The last time I dug into the issue, the "source and application of funds" analyses of drug companies showed the first application to be for profits, the second to advertising (including direct to health care providers) and only third to research. Much of the basic research is done by government entities or by private entities under contract with the gov't. The whole "we have to charge a lot to cover research" is a sham.
3
I'm a transplant recipient, and my medical team refused to allow the pharmacy to fill two of my prescriptions with generics on the basis of short cuts and lower quality. This has got to be a major concern as well; in my case, there was no cost shifting to me to get the higher quality brand name, but it has to be of concern that insurance companies are doing this to patients. Quality controls on generics have to be of concern as well.
5
When is this country going to realize that keeping health care under the umbrella of capitalism causes social harm, rather than social benefit?
This has become a self-perpetuating debacle, comprising a big slice of our economy and providing huge contributions to politicians.
Every year that this continues makes it more difficult to wind back to humane sensibility.
This has become a self-perpetuating debacle, comprising a big slice of our economy and providing huge contributions to politicians.
Every year that this continues makes it more difficult to wind back to humane sensibility.
73
Countries (including 'this country') do not make realizations. People do. Some people have realized ways to enrich themselves tremendously. Other people have realized they cannot afford their medications. There is no 'we' in this country, there are power structures and those that hold a position somewhere within it.
2
FREE MARKET IN MEDICAL SERCES - Ha!
Whether it is a doctor bill, an ambulance ride, a hospital stay, or a wheel chair. Prices or charges have no relationship to costs, and have little relation to what any insurance pays; are impossible to ascertain in advance; and it usually impossible to choose an alternative item. The whole medical industry does nothing but profit from this confusion.
Whether it is a doctor bill, an ambulance ride, a hospital stay, or a wheel chair. Prices or charges have no relationship to costs, and have little relation to what any insurance pays; are impossible to ascertain in advance; and it usually impossible to choose an alternative item. The whole medical industry does nothing but profit from this confusion.
13
Oh, UnitedHealthcare, my Medicare insurer, and their "advice" that one can ask for a manufacturer's 'exception' to get the brand name for less than an arm and a leg. And guess how easily and well THAT tends to go! (Answer: It goes not at all.)
For half the year, I take Lialda for ulcerative colitis; the copay is something like $45, but the copay for the generic would be $100. Crazy.
Upon making my deductible and hitting the infamous "donut hole," aka coverage gap, in Medicare, the generic balsalazide becomes the lesser of two expenses: About $65 a month instead of over $100.
Twice a year, I have to call my gastroenterologist's office and also coordinate with my pharmacy, and ask to be switched from one to the other... then back again a half year later.
This never made sense to me or anyone at the doctor's office - including the doctor - but now I get it perfectly: IT'S JUST ANOTHER INSURANCE COMPANY RACKET!
Single payer health care for all is the answer. Let the insurance companies STARVE - they deserve nothing more.
For half the year, I take Lialda for ulcerative colitis; the copay is something like $45, but the copay for the generic would be $100. Crazy.
Upon making my deductible and hitting the infamous "donut hole," aka coverage gap, in Medicare, the generic balsalazide becomes the lesser of two expenses: About $65 a month instead of over $100.
Twice a year, I have to call my gastroenterologist's office and also coordinate with my pharmacy, and ask to be switched from one to the other... then back again a half year later.
This never made sense to me or anyone at the doctor's office - including the doctor - but now I get it perfectly: IT'S JUST ANOTHER INSURANCE COMPANY RACKET!
Single payer health care for all is the answer. Let the insurance companies STARVE - they deserve nothing more.
108
Insurance companies never lose.
They did well through our Great Depression even.
They did well through our Great Depression even.
The bottom line is the profit margin no matter what the insurance company says. That is what determines what you get. Whatever difference there may be in efficacy does not justify the cost difference.
11
Let me get this straight....
The price of Adderall XL has remained steady at roughly $7/pill since 2012 yet the amount of money Shire is keeping has dwindled to $1.73.
While we don't know how much of that is distributor costs and how much is incentives paid to those who are in a position to demand that only the non-generic be covered, why not just reduce the cost of the drug to the consumer?
If you're losing $5 per pill, what's the difference except the consumer gets a break. Given the choice between a generic or a name brand at comparable costs, I'd go for the original every time.
Market share protected without the shadow games.
The price of Adderall XL has remained steady at roughly $7/pill since 2012 yet the amount of money Shire is keeping has dwindled to $1.73.
While we don't know how much of that is distributor costs and how much is incentives paid to those who are in a position to demand that only the non-generic be covered, why not just reduce the cost of the drug to the consumer?
If you're losing $5 per pill, what's the difference except the consumer gets a break. Given the choice between a generic or a name brand at comparable costs, I'd go for the original every time.
Market share protected without the shadow games.
4
Which medication is used should be a decision between the patient and his/her doctor. The decision should not involve the pharmaceutical companies whose agenda is profits and not the well being of patients.
28
UHC had been after me changing to a brand name drug. they did it on their own. when I asked the doctor if he had okayed the change his response was, "What is that?" he had not heard of the drug! Why? the med I was supposed to be on had the word "potassium" in it as did the one I had been taking. there are different types of potassium. he was unfamiliar with the brand name. UHC had changed even the generic over 2 years before! I was on the wrong med that had no effect. as a matter of fact, the one I was on is the last drug used in lethal injection executions! they want to change 3 other meds. my doctor had to ask for a waiver (or whatever they call it) and they now cost me more.
1
The last paragraph sums up the entire article and is all you need to know. Could there be a better way where one single powerful payer had the ability to negotiate and stand up to tactics such as this -- nah, probably never work. Let's just keep tinkering around the edges with what we've got.
3
If this had ANYTHING to do with what's best for even some patients that would be one thing...but as Mr. Frankil says at the article's end, this can only be about improving multiple someones' bottom lines- and not the consumers'. I don't often resort to this line of thinking, but isn't there some attorney/law firm interested in taking this into class-action territory?
13
More laws to increase hedge funds and investors profits while the average consumers pockets are picked.
11
Beware.....generics can not be trusted to contain the same ingredients and proportions as original prescriptions. This is particularly true of sensitive issues like the thyroid gland.
Resist pressure to use generics. Your health is at stake!
Resist pressure to use generics. Your health is at stake!
8
“Beware.....generics can not be trusted to contain the same ingredients and proportions as original prescriptions. This is particularly true of sensitive issues like the thyroid gland.
Resist pressure to use generics. Your health is at stake!”
Right! We are not trying to scare you but God only knows what will happen to you If you if you take a generic rather than our expensive original version of our drug! We can’t have you take the risk of trying the generic, even though the FDA has accepted it as equivalent to ours, so we have a deal with insurers and pharmacies to make our original the only one covered by your health insurance. It’s a win-win both for your health and financially for our stockholders, your insurer, and for our CEO. Can’t afford the original? Get a different disease that requires less expensive drugs!
Resist pressure to use generics. Your health is at stake!”
Right! We are not trying to scare you but God only knows what will happen to you If you if you take a generic rather than our expensive original version of our drug! We can’t have you take the risk of trying the generic, even though the FDA has accepted it as equivalent to ours, so we have a deal with insurers and pharmacies to make our original the only one covered by your health insurance. It’s a win-win both for your health and financially for our stockholders, your insurer, and for our CEO. Can’t afford the original? Get a different disease that requires less expensive drugs!
6
Manufacturers make more money.
Middlemen make more money.
Retailers make more money.
Customers pay more than they should have to pay.
The American Corporate dream is alive and well.
Middlemen make more money.
Retailers make more money.
Customers pay more than they should have to pay.
The American Corporate dream is alive and well.
77
In response to Umar:
The American Corporate dream IS alive and well. Unfortunately the patients are not!
The American Corporate dream IS alive and well. Unfortunately the patients are not!
1
Jeez Louise. Medicare For All, and let Medicare negotiate supply prices for drugs. How long will we allow the insurance industry and their minions and henchmen in Congress to torture us with substandard third-world healthcare?
120
Yeah, it's almost as if they didn't care. Hmph!
1
The most galling thing about this is that when patients mention how crazy this is both their insurer and doctor essentially tell them "not our problem". PhARMA, PCBMs, and insurers need to be trust busted yesterday. we all suffer with an unaffordable healthcare and they churn out consistent profits. "not our problem"
3
I pay $85 / month for a generic. Wonder what's behind that.
6
So the drug company is bribing the insurance company to stick it to the customers. This is why health care cannot be left to the whims of predatory capitalism. Single payer and be done with it !!!!
323
That common conception that the generics are always exactly the same is actually false, and it's an uphill battle I've had to fight for years now. The Times even covered it:
https://www.nytimes.com/2015/06/17/business/generic-ritalin-drug-not-equ...
To sum up, Concerta is an ADD medication with an extended release mechanism. The generics for it *do not include* the extended release feature, and are instead a single huge dump of the drug all at once. Instead of having a full day of a normal and consistent level of focus, I'd have a huge stimulant spike in the morning, start to plateau around noon, and completely crash by the late afternoon. Ignoring that important difference, insurance companies began to drop coverage for brand name Concerta in favor of the generics, and in turn, pharmacies stopped carrying brand name Concerta altogether. To avoid a significant hit to my quality of life, I currently have to have my doctor write a letter to my insurance company to get pre-approval for the brand name, have her write "brand medically necessary" on every prescription, and since there are literally no pharmacies in my area that even carry brand name Concerta, I have to mail the prescriptions to my mother so that she can fill them at a local pharmacy that's carrying the brand name as a favor to me.
The fact is, not covering generics that aren't actually equivalent is a big victory for us. It's upsetting to see the Times trying to undo it.
https://www.nytimes.com/2015/06/17/business/generic-ritalin-drug-not-equ...
To sum up, Concerta is an ADD medication with an extended release mechanism. The generics for it *do not include* the extended release feature, and are instead a single huge dump of the drug all at once. Instead of having a full day of a normal and consistent level of focus, I'd have a huge stimulant spike in the morning, start to plateau around noon, and completely crash by the late afternoon. Ignoring that important difference, insurance companies began to drop coverage for brand name Concerta in favor of the generics, and in turn, pharmacies stopped carrying brand name Concerta altogether. To avoid a significant hit to my quality of life, I currently have to have my doctor write a letter to my insurance company to get pre-approval for the brand name, have her write "brand medically necessary" on every prescription, and since there are literally no pharmacies in my area that even carry brand name Concerta, I have to mail the prescriptions to my mother so that she can fill them at a local pharmacy that's carrying the brand name as a favor to me.
The fact is, not covering generics that aren't actually equivalent is a big victory for us. It's upsetting to see the Times trying to undo it.
13
An interesting point, but I suggest it's the exception to the rule. Most generics ARE the same as their brand name equivalent.
1
The Times is reporting what is happening. The choice, to use generic or brand name, should remain with the consumer with doctor's advice. But as we are all aware the big money has the scales heavily tipped against the individual.
5
This article was about the opposite problem, though: the doctor prescribes the generic, or at leadt is OK with it, but the insurer only pays for the brand-name.
3
Doc prescribed generic albuterol asthma inhaler, insurance has a generic in the list of tier 1-2-3 drugs, but could only get the brand name ProAir HFA at $150.00 for 90 days. Needless to say, I don't use it as often as I should. Apparently, I am not alone within my company as the HR department issued a memo saying the list of generics was expanded... I'll not be holding my breath for any improvement.
As another writer said: Medicare for all... after big pharma is reined in.
As another writer said: Medicare for all... after big pharma is reined in.
7
I have four -- count 'em, four -- pre-existing conditions; the primary drug, an anti-seizure med that I take twice a day, costs $24 per generic pill, RIGHT NOW. Take that away and my risk of life-threatening seizures escalates immediately. Add on my age, 56, and my back is not big enough to hold the target on it.
Didn't Shkreli say something to the efffect of, "if they really need it they'll find a way to pay for it"?
It's a standard cliche that "Life itself is priceless": Really? It seems to me that life definitely has a price, and here is the indisputable proof.
Didn't Shkreli say something to the efffect of, "if they really need it they'll find a way to pay for it"?
It's a standard cliche that "Life itself is priceless": Really? It seems to me that life definitely has a price, and here is the indisputable proof.
54
I just experienced this confusion last week -- I went to pick up my monthly birth control prescription from my pharmacy, asked for the generic, and was told that 1) I would now have to pay a co-pay on it even though the pill was previously covered entirely by the ACA; 2) that the generic would cost me $20 MORE than the brand-name, and 3) any generic brands that were covered by the ACA were unavailable for the specific pill i'm taking. It's completely unfair, and there's no explanation from anyone to anyone until you're at the pharmacy picking up your next refill.
12
This is a message to those who would seek a compromise by permitting private insurers to participate in any government health plan.
Keep out the insurers. They are thieves, plain and simple.
Keep out the insurers. They are thieves, plain and simple.
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The insurers and the pharmaceutical companies are thieves, plain and simple. Medicare Part D is a great case in point. It was written to the benefit of the pharmaceutical companies.
So far as I know, my pharmaceutical plan has not embarked on this latest outrage. That may be because my plan, a Medicare Part D plan that my former employer requires me to use, administered by ExpressScripts, includes a self-insured component. In other words, my employer pays not only the premium, but that part normally paid by the insurance company. In this case, the insurance company is in effect my employer, The University of Texas. Perhaps in looking out for its own interests, it unavoidably looks out for its employees' and retirees' interests.
That doesn't make ExpressScripts a saint in handling our prescriptions. I must take Cialis daily for enlarged prostate. Because of other uses of the drug, the company and the plan require additional documentation, called "prior authorization." Each time I have to get a refill, I have to spend my time, my doctor's office's time, the pharmacy's time to get this done. And each time, the pharmacy (that is, ExpressScripts) bungles the communication, and we each end up redoing the process multiple times. All this costs money, of course.
So far as I know, my pharmaceutical plan has not embarked on this latest outrage. That may be because my plan, a Medicare Part D plan that my former employer requires me to use, administered by ExpressScripts, includes a self-insured component. In other words, my employer pays not only the premium, but that part normally paid by the insurance company. In this case, the insurance company is in effect my employer, The University of Texas. Perhaps in looking out for its own interests, it unavoidably looks out for its employees' and retirees' interests.
That doesn't make ExpressScripts a saint in handling our prescriptions. I must take Cialis daily for enlarged prostate. Because of other uses of the drug, the company and the plan require additional documentation, called "prior authorization." Each time I have to get a refill, I have to spend my time, my doctor's office's time, the pharmacy's time to get this done. And each time, the pharmacy (that is, ExpressScripts) bungles the communication, and we each end up redoing the process multiple times. All this costs money, of course.
5
Well, it's legal, so let's just say that they are greedy. It's capitalism, man: survival of the fittest.
If all drugs were sold only in their lower-cost generic version, the innovative pharmaceutical manufacturers would be deprived of income necessary for research that develops new drugs that benefit people’s health. I do not work for a pharmaceutical company, but did years ago. There I saw how these companies used their profits not only for research to develop new drugs, but also had a staff of physicians to answer queries from both consumers and practicing physicians who had questions or needed expert advice about the company’s drugs. Do any of the generic drug manufacturers offer such services? Look at a list of the largest selling pharmaceutical products today compared to 10 years ago. Nearly all of these groundbreaking new drugs were introduced in recent years, and exist only because these innovative manufacturers made enough money to fund expensive pharmaceutical research and development.
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From what I've seen, many, if not most, new drugs are developed in government funded institutions, such as universities and teaching hospitals, with some small participation by the pharmaceutical companies. It seems to me that if the public is actually paying for most of the research, the public should benefit.
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I worked for a group of medical doctors, and I saw how the well dressed drug reps wined and dined the docs and the office staff all the time. One of the docs was even treated to an all expense, paid vacation at the Atlantis in the Bahamas! As far as developing "new drugs that benefit people's health," several the reps aggressively promoted during all those free, catered lunches were eventually withdrawn from the market because they didn't benefit people's health -- they harmed peoples health. Moreover, many new drugs are simply repackaged versions of old drugs, identical in every way except the price.
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Much of the money for pharmaceutical research comes from government sources, not from the companies selling the drugs. In fact, several recent cases have been made public where a company was paid by government to develop a drug, yet marketed the drug as if it had borne all the costs itself.
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And this leads to why it's so hard to get Medicare for all in this country. The single payer system would provide transparency, revealing these scams more quickly. The drumbeat response is always that we can't afford to provide healthcare to everybody but the real reason is that too many greedsters would lose their cover.
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This story is journalism at its best. My thanks to the writers who tackled a tough-to-understand, tough-to-explain issue and brought this problem to light. We (slowly) become a better society thanks to reporting like this.
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Thank you for saying this. Now if only the Editorial Board and its columnists would wake up.
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Excellent reporting by the Times. I am reminded of the laws in financial matters that the adviser must exercise the best interest of the client. In medicine, we have always included that concept. Next step for legislation might well be indicated to bar the "rebates that were paid not to the patients but to insurers and middlemen as CVS Caremark." I concur with Pete from Boston. These are kickbacks by any other name. The patient is unable to defend themselves.
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The rich and powerful always win.
How could they not?
How could they not?
@kefcon: Financial advisors are not required by law to act in the best interest of the client. That is a regulation (good word!) from the Department of Labor that was cancelled by the Trump Administration in February. See
"Trump Signs Memorandum Shelving Fiduciary Standard For Financial Advisors", Forbes.com; Jamie Hopkins, Contributor.
"Trump Signs Memorandum Shelving Fiduciary Standard For Financial Advisors", Forbes.com; Jamie Hopkins, Contributor.
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Once again, the differences between Europe and the US are striking. In Italy, where I lived for 6 1/2 years until a few months ago, name brand drug prescriptions are provided, in most cases, with no out-of-pocket, or only 2 euro co-pay. Generics are the ones that get expensive.
Obviously, someone must pay for the cost, but it becomes part of the healthcare system. The price of drugs is regulated, and you don't see commercials on TV every four minutes, advertising the latest miracal cure.
I think once again the US has fallen victim to the theory that profit must lie at the base of every decision made. It is inconceivable to most in congress that perhaps government is there to serve a greater good.
Obviously, someone must pay for the cost, but it becomes part of the healthcare system. The price of drugs is regulated, and you don't see commercials on TV every four minutes, advertising the latest miracal cure.
I think once again the US has fallen victim to the theory that profit must lie at the base of every decision made. It is inconceivable to most in congress that perhaps government is there to serve a greater good.
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Duh, I meant "miracle"...
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Well, the greater good is your local Big Pharma corporation.
America! Capitalism!
America! Capitalism!
Some years ago my doctor prescribed Zetia, a combination of two statins, for me. It required an exception to have it covered by my insurance, Medicare Part D. The insurer wanted me to take two generics which were cheaper. Two - three years ago this same insurer, and others, refused to pay for Zetia at alll. Ergo I had to take the two generics. Now, according to this article, Zetia is the preferred medication! The medical insurance market is broken. The major insurers go to great lengths to skew the market to their advantage. Hidden rebates, minor changes in formulation to gain patent extensions, payments to generic manufactures to keep their product off the market. It appears there is no free market as far as drug manufacturers are concerned. Manipulalting the market is more profitable. Time for corrective government action to prevent this manipulation! Probably will never happen under a Republican administration.
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Zetia is not a statin, nor is it a combination of two drugs. You are thinking of vytorin, which is zetia plus simvistatin (a statin - one of the more dangerous ones). Even though it lowers cholesterol and LDL, both of my cardiologists (current and retired) recommended against Zetia, because it hasn't been shown to actually reduce heart attacks.
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My doctor prescribed Zetia with an "OK" to use a generic. My Part D with Humana only paid for the brand name, and my pharmacist said he didn't even have a generic. I don't know if he was considering my Rx plan or just making a general statement. I called Humana, who assured me there was no generic available. Anyway, the Zetia was about $900 for a 3 mos. supply. After doing some research, I am now paying $35 cash out of my pocket for a 90 day supply of generic through Universal Drug Store in Canada. The generic Zetia is MADE in Canada, so it's really cheap. My sister-in-law buys Synthroid, which is also made in Canada, at about $20 for 3 months at UDS, a ridiculous price saving over buy Synthroid in this country. I have used UDS off and on for years and they are very friendly and helpful. Call their 800 number and see if you are equally shocked.
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Just don't take drugs like zetia. People take drugs they really don't need 90% of the time. Just because the dr recommends some obscure drug that doesn't cure anything, doesn't mean you have to take it. Just say no thanks.
Oh yes - my personal experience was with good old Epi-Pens. My Medicare Part D plan would ONLY cover Epi-Pens (for a several hundred dollar copay), even though the same manufacturer had come out with a lower cost alternative. I ended up doing some online research and buying, with my doctor's blessing, Adrena-click with no insurance coverage but with a $100 manufacturer coupon: net cost $9.99. Insurance companies had better wake up. We are coming for them.
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This lower cost alternative pen was a cynical play by the manufacturer (Mylan), which had greatly increased the cost of Epi-Pens to the insurer, and sometimes the patient. They wanted to own both ends of the market, the insured, low-copay market where patients were often totally unaware that the Epi-Pen was costing the insurer $1600.00 (which is my actual case), and a patient who needs to buy this emergency drug and has a prohibitive copay or has no insurance. The insurers in this circumstance was the victim, not the fiend.
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I have long wondered why pharmaceutical rebates to insurers is not legally considered a kickback. It hurts the consumer, limiting choice and increasing out of pocket cost, and enriches the insurer and pharmceutical company. Enough.
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I am in complete agreement with your comment. For me, the only thing worse than what you described is the blatant arrogance and transparency of these "rebates". Good God, their open greediness to harder to swollen than the numerous over paid pills I need to take on a daily basis.
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Behold: unregulated capitalism.
Not the little guy's friend.
Not the little guy's friend.
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Secret "rebates" paid to middlemen or insurers? Sounds a lot like a kickback.
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Obviously, Sir, you must hate Capitalism! Profit before life and the Devil take the hindmost! :)
Sounds like a duck ... Walks like a duck
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When is congress going to intervene and stop this senseless abuse by BigPharm?
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When it turns Democratic.
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When pigs fly. The congress members are on the take. Look what they did with the creation of Medicare Part D.
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When their personal drug costs are higher than their stock dividends in Drug Companies.
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All brand-name and generics are not the same. Prescribed generic thyroid med until not working so well, doc changed me to Synthroid, costs much more. But works better, for me. (I have Medicare with no drug coverage, all out of my pocket.)
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The same thing happened with me, now also on synthroid.
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Thank you for your post.
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Granted that is the case in some circumstances - my wife has that issue with one drug. However, that is not the issue in the circumstances discussed in the article. In those cases, there is just collusion going on to benefit everyone other than the patient.
8
can you say collusion ?
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When a patent runs out on a drug it goes generic. If the generic is identical to the original what is the problem with taking less expensive generics?
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Generic drugs are not exactly the same. The chemical composition is different and patients may react differently.
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Actually, it is my understanding that the actual generic drug is identical to the patented drug -- but the formulation, the compounds the drug is mixed with for delivery into a patient -- may vary. The manufacturing process may also vary, though the final generic drug product should be identical to the originally patented product.
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Mike's comment has little or nothing to do with the subject of this article, which is about drug companies bribing insurance companies to force patients into buying brand-name prescription drugs instead of cheaper generics.
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The Anti-Trust Division of the Federal Department of Justice should investigate this price fixing.
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Under Trump, things are only going to get worse!
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As usual these days, even the insured are being bilked by an opaque system of health insurers, PBMs and the drug companies. In their twisted logic, paying more for a brand name that counts against your deductible, is preferable to you paying far less for a generic, even if you pay for it yourself and not use your insurance... I speak from experience with a major insurer and ExpressScripts,. As a result, I've taken all of my generics away from insurance and pay for them myself, versus being overcharged for generics simply to satisfy my deductible. These days, it's truly 'buyer beware' in all things related to healthcare, especially prescription drugs because the insured are being gamed at every turn in order to maximize drug profits. I'd love to see a detailed analysis required with each drug dispensed by any pharmacy, outlining the initial cost and the ancillary, pocket-lining add-ons being kicked back to everyone else in the chain. I think if we all had that transparency, riots would ensue...
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If one does not require a prescription to buy cigarettes or alcohol or marijuana, it should make sense to sell non-addictive drugs over the counter. Why should so many drugs require a prescription?
Not just Rx, there's a systematic lack of transpearsncy at most levels of healthcare. Try getting charge sheets/prices from hospitals!
Tell me where to sign up for RESIST version of the healthcare boondoggle, so we can enhance the ACA, or bring in Medicare of ALL!
(Now there,s a good idea for an article: a summary of all the leading healthcare advocavy groups. Inquiring minds want to know.)
Tell me where to sign up for RESIST version of the healthcare boondoggle, so we can enhance the ACA, or bring in Medicare of ALL!
(Now there,s a good idea for an article: a summary of all the leading healthcare advocavy groups. Inquiring minds want to know.)
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Medicare for all.
It is time.
It is time.
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It's been time for the last... 100 years?
This is USA, it will never happen. Progress is not welcome here. The only thing that really matters is profit.
This is USA, it will never happen. Progress is not welcome here. The only thing that really matters is profit.
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Remember, by law, Medicare is prohibited from negotiating prices for pharmaceuticals.
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Just started Medicare but you still have to pay for Plan B and Plan D. Recently I needed an inhaler but my supplemental plan would only cover one brand name and it was expensive. We need to keep an eye on Medicare too.
4