Ban direct advertising. It adds a lot to the cost and the consumer has to go through a Dr. anyway.
Go back to enforcing anti trust laws. They buy out the competition and shut them down.
20
From reading these posts it seems there is nothing we can do. Drug companies make higher profit margins than any other business. And their CEOs average 24 million a year. And they don’t make all this money, we wouldn’t have drugs. Yeah sure.
So I guess if you need life saving drugs you either go bankrupt or die.
4
Remove corporation's ability to buy Congress Critters.
Reverse Citizens Divided.
14
Capitalism and free markets are okay … as long as they follow the model, and with reasonable regulation.
But health care does not match the free market model. Health care providers and those who need health care do not have equal bargaining power. The person who is injured or severely ill and enters an emergency room surrenders his/her bargaining power to a system run by for-profit entities. If you're leg is broken, you're in no position to get online and compare prices for surgery, anesthetics, nursing care, a single hospital bed, etc. The health care industry's commitment to making profits will always take precedence over the welfare of patients. And the American people should demand that health care be removed from the for-profit system.
Remember this and make it your mantra: health care for people, not for profit.
11
I would add an additional measure to those listed in the article: Put limits on the subsidization of new drug research costs paid by existing drug sales. Why should people who do not benefit from expensive new drugs be forced to fund that development with sky-high costs of routine drugs, like insulin? Pharma can fund the development of new drugs in many other ways, and then price the new drug relative to what its actual cost of R&D was.
3
Take a look at salaries for executives (millions— why do they need such salaries and do they really need a third home and one more yacht?) and the amount spent on advertising on radio and TV. I don’t watch much TV but when I do, ads for drugs and “ask your doctor” predominate. That is very expensive. Why is this glossed over so blithely? Ever since the airwaves decided it was okay to advertise to the public, we have become more ill and drugs are sometimes prescribed when they shouldn’t because patients ask for them, and doctors are rushed and pressured. There are a multitude of factors and this should be examined holistically.
14
There are pieces of this complex puzzle that The Times Editorial Board HAS IGNORED. The reality is that many important drugs were either first prepared by drug companies (and university laboratories) with significant federal funding and/or exclusively using private corporate (or foundation) dollars.
When companies are doing drug development as part of corporate Research and Development (R&D), what is often FORGOTTEN (or not well understood) is that many of these formulations turn out to be ineffective (for the intended use) and/or toxic to the patient (even at very low doses).
Unless you've not actually been engaged in research, the thought that, "If we knew what all of the answers were before we started, this work wouldn't be fun to do", doesn't cross the lay person's or the politician's mind. Even with new screening software (of new formulations), not all of the new formulations will be blockbusters.
The importance of basic research has historically not been impacted by its inherent inefficiency. Yet, because of the research environment that has existed in this country in the post-War years, most of the innovation in drug discovery and in the manufacture of life saving drugs has been done here in the USA. In order TO MAKE THE SYSTEM WORK, these costs (somehow) have to be covered.
The comparison with other countries is often a non-starter for me, since the R&D costs and research inefficiencies are NOT itemized in with the overall cost to bring a drug to market.
5
NYT should study where Canadian pharmaceuticals come from, i.e., the U. S. which I believe ships north of (so to speak) $4 billion p.a., and from U. S. companies manufacturing both in the U. S. and abroad. I believe these numbers will speak louder than words asto the absurdity of the pricing situation.
5
If the government seizes a patent who is going to then manufacture the drug? The government doesn’t have manufacturing capabilities at hand. They could allow another manufacturer to make the drug but I don’t believe that any company would because it invites retaliation. If the drug in question is a biological there is a good chance that changing the manufacturing site will lead to a protein with different specifications. It is much harder than you think. Maybe a contrarian approach would work better. Rather than seizing patents, how about extending patent life in exchange for real cost controls and also guarantees that the original sponsor will not work to delay generic approvals.
3
There seems to be a strong sentiment here, that we can get someone to take the risks , develop, and produce what we need (prescription drugs ) with either zero profit motive or a sharply curtailed one .
This can happen only if we
1.order companies to do it by gun point , or
2. we can find adequate numbers of altruistic investors , or
3.assign the job of drug discovery to government bureaucrats
Yes medicine is critical and life saving , but it is still subject to rules of supply and demand . You may curtail the financial return to companies but the result would undoubtedly be less supply unless you figure out an alternative motivation .
4
How come the same drugs in other countries is so much less?
6
The United States is unusual in that it allows prescription drugs to be advertised on television. In addition to being a disgusting annoyance, how much does this add to drug prices?
12
There is a long and complex history to how drug prices rose to current levels, but ultimately, the reason they are permitted to stay there is that Congress allows it. Only Congress has the ability to regulate Big Pharma. but it has so far declined to do so, unlike virtually every other advanced nation in the world. Americans die needlessly every day because of inadequate access to medicines like insulin, or inhalers for asthma. The primary reason they allow these companies to charge whatever they wish is ensure that the tide of money flowing into their re-election campaigns continues without interruption. Given the damage and death caused by their greed and inaction, it's hard not see the members of Congress involved as criminals. What else does one call them?
9
The Great Object Lesson of Untrammeled American Capitalism. Like we need it.
The take-away: Pharmaceutical corporations don't care. They do not care if you live or die. There are moments, in dark offices on dark occasions, when they'd just as soon you die.
This is a big threat, no? Take away the biggest-spender client, the one that covers discounts you give the little guys you need to keep the lines rolling between the important business.
They threaten to reduce payments to match the puniest no-account clients you have.
What to do?
What I would do is figure out what the problem is. Make calls. Hold seminars in unusually nice places. Phone up legislators I've accumulating, get them on it. Make a deal. Find a compromise.
Have the PR guys remind everyone about Shkreli.
Point out I am not him. Not close. Ring up a relatable star. Mila Kunis would be nice, she's so good with bourbon.
Haul out "We care. We brave pioneers of drug world. Working together to make the world better, healthier. We care so...much."
Anything, you've noticed, but make drugs reasonable, sustainable, affordable. Anything but that.
Yes, old men in Arizona will be choosing between their dog and their drugs. Some kid will go wanting.
You know what? Business.
You think they do this brilliance for free? Don't they deserve to live (extremely high on extraordinarily fat hogs)?
None of that university research/public funding tripe. We covered that.
Alright. Back to work, those of us with jobs.
4
You made two important observations
1) “So many patients are rationing or outright skipping essential medications that stories of people dying for want of basic drugs — or fleeing the country to avoid that fate — have become commonplace.” even me comes under that category. Next you also wrote that
2) Then, on Friday, Mr. Trump announced that he would soon sign an executive order, creating a “favored-nations clause,” under which the United States would pay no more than the lowest price charged to any other nation for a given drug.
I want add to this second point. Here one pertinent example is India. India is not the best example for various issues, but not for drugs. The government fixes the price of all generic drugs and some brand name prescription drugs ( these latter may be covered by patents from any country).
Ironically most of western pharmaceutical companies that sell in USA sells the same in India too. There they charges substantially less , some times 20 times less.
If you want check the prices you may at the enclosed website , https://www.medplusmart.com/ Here you can check the manufacturing companies and their retail prices. In all cases the direct price is far less than my copay on month to month basis.
However, they will not ship to USA at present. Every one will benefit if that barrier can be broken down.
The Drug/Pharma industry is the second largest Lobbying Industry in Washington. Nothing will change unless money can be taken out of politics which is unlikely. Both sides of congress are bought and sold by these mega-industry lobbyists.
This is corruption that Chicagoans would recognize. The Voters have absolutely no say. We need a " Trust Buster like T.R." to kick corrupt Congress in their collective behind to enforce anti-monopoly statues. For too flong the courts and Congress have looked the other way regarding anti-trust enforcement in lieu of receiving checks.
8
"Here’s how to change that"
Nothing will be changed for the better until we deal with the problem child in the White House.
3
@Chicago Guy Agree--the problem child knows zero zip nada about health care--and his secy of HHS is a drug guy. I love how he goes around saying, "I love pre-existings." The inane leading the corrupt.
1
@Chicago Guy
Because democratic presidents have been so successful?
1
"the president seems increasingly determined to find a solution to the drug cost conundrum."
SEEMS being the operative word. In REALITY, he is doing NOTHING, just the usual "sound and fury".
The FDA, the DHS, and the FTC are all bribed into invisibility by Big Pharma. We have the most expensive "healthcare" system in the world, but the 37th in quality of care. NO ONE is looking to protect the public from this parasitic (vampiric) system. AND we have the greatest opioid crisis in the world.
How did that happen? It was ALLOWED to happen.
Once upon a time, we had a Surgeon General, who, at least publicly, pretended to be looking out for the general health and welfare of U.S. citizens. No more.
Don't look to the WH for any leadership here (or anywhere else). There's big money being given to PACs and "campaigns".
The WH would NEVER interfere with corruption.
4
All of the proposed solutions are excellent ones but require our elected officials to get their snouts out the pharma money trough.
It will only happen if the public refuses to elect people who actually do some of the things proposed in this editorial.
6
but,but, the market knows best ...
Liberty and all,
MAGA?
2
I am on Medicare a supplement and a drug program. I wanted the Shingrax vaccine in order to prevent getting shingles as I had chickenpox as a child. Nothing covered it. So I paid $170 twice in order to get the vaccine. I am fortunate in that I had the money in order to buy the vaccines. However, isn't it imprudent of our government to make a vaccine so expensive. Getting actual shingles would have cost the government so much more.
6
@Jennifer Same--only I didn't have $340 lying around. I had shingles once--I did not get the big pain but it was bad enough. I am taking my chances now.
1
Part of the issue is that to do things like "price drugs based on the benefits they provide", one would have the Department of HHS do an evaluation. Not only is the current head of HHS a former pharma industry lobbyist and executive (concerning but not necessarily damning), but he was appointed by Trump (far worse). Is this who we want as a trusted gatekeeper? In the future will drug companies wait until there is a pharma-friendly administration to get their drugs evaluated?
It might be possible to "piggyback" off the Europeans and take the median result from several countries that do this kind of evaluation, but given the stakes one might have to first convince oneself that the processes and published results in these other countries are strictly objective and stay that way once the stakes are raised.
30
Drug pricing is a reflection of a rigged system. Ex-congress and senate members become lobbyists for the same companies that that influenced them previously through campaign contributions and PAC money.
The FDA does not inspect foreign manufacturers, especially those in India and China where local oversight is also a sick joke. The profits are far too large for any meaningful price controls.
Too many prescriptions are written to treat life-style illnesses. Exercise, lose weight, stop smoking, control and protect your sexual proclivities, eat well and live longer without drugs.
After the Strategic Air Command and the American Medical Association, the Pharmaceutical Manufacturers Association is the third strongest union in this country. Numbers two and three thrive on kick-backs for prescriptions and contribute the above cited elected officials.
Good luck!
1
Why would anyone believe that Trump and his administration, arguably the least interested in the common good of any this country has ever experienced, would be “negotiating like crazy”to bring down drug prices. Trump and his cronies know perfectly well “which side their bread is buttered on” and have shown time and again that they will NOT bite the Big Pharma “hand that feeds them.” (Sorry for the mixed metaphors). Sickening - literally!
4
The cost to bring a drug to market is in the billions.
What seems to be missing from many commentators here is the fact that it is enormously risky . The majority of attempts end in failure and are not approved by the FDA.
In effect the one success needs to also pay for all the failures.
We should all hope that there are some greedy businesses willing to roll the dice for us. They have been and are our best option for a better future.
By and large in a capitalist system , if it can be produced for less then someone will . If you so strongly believe you can produce insulin for less then why don't you ??
1
How come insulin costs my cousin in Europe 54 cents? And in the USA people are dying because the cost of insulin has been jacked up so high.
10
Well in honest to God reality what really really NEEDS to be done is this: Since our country loves loves loves to take the vote away from small time criminals why not take away their "right" to bribe and limit THEIR "freedom of speech"? Uncle Sam does it to kids who get caught with a joint so why not big biz??? While you are at it start fining big biz by a percentage of their gross NOT some arbitrary number that has zero effect but a percentage will demand new leadership on anyone's board of directors.
3
Exellent oped--great recommendations. Let's hope they are realized! Vote Democrat.
2
We have been sold the bill of goods that "the market" will take care of egregious pricing---but it never has.
Where is the quality affordable childcare? Eldercare? Why hasn't "the market" addressed those concerns?
We need to wake up and smell the coffee and stop being suckers for everything politicians and the corporate world tell us.
2
... and still no one talks about doing away with the preposterous Medicare "Donut Hole" ...
5
One answer....close that "donut hole."
OK, so it unto itself will not solve things in the grand scheme; but, it will help.
1
The drug companies already play defense running TV commercials claiming that limiting their profits is socialism, Mr President. If you cannot afford your insulin think of this as the price of not living in Venezuela.
Trump is trying to lower drug prices, I think he will do something big next year before the elections. He knows most Americans will support him on this.
Apparently he is the only one trying. I believed Obama till he let us down, but I do not trust any of the democrat candidates.
Why, you ask? Because of this from Politico:
"Liberals fight their own party over drug prices."
https://www.politico.com/story/2019/06/06/democrats-prescription-drug-prices-1497676
Why does any of this surprise us? We have taken medicine and turned it into a "business". The goal of business is to make as much money as fast as possible, with as little effort or expense as possible. That's what we're doing. That's why premiums keep going up and service keeps going down. Hospitals are run for the benefit of administrators and profits ( even the so called non profits). Doctors, nurses and other care givers are now treated like line workers on an assembly line. If they say anything they get canned. Meds are restricted so the price goes up. This is the "American way" we should just shut up and do as were told.
Or we could take medicine back from the business men and accountants and put it back in the patients and care givers hands ( including personal responsibility) and try to minimize the bloated top heavy administration and regulators that are weighing health care down but providing little in the way of improved care.
I agree with a number of proposals in this editorial, but the inaccuracies and shortsightedness of the piece also need to be addressed.
Although it is correct to say that taxpayer money has in many cases funded the discovery of new drugs, very little taxpayer money has been used to develop drugs – and this is by far the largest investment required to get a drug to market.
It is true that other countries often pay less than US patients, but it is equally true that somebody will have to pay to continue to innovate and create new drugs (not the me-too or slightly modified) whether it’s US or non-US patients or taxpayers. Cost-benefit analysis should be used to determine which medications are truly breakthrough and how they should be priced. But, saying that US consumers will only pay the lowest price charged worldwide no matter the drug will negatively effect innovation. Also – a reality check: in order to do effective cost-benefit analysis many patients need to be evaluated and this again costs money, though we can certainly debate who’s money that should be.
Finally, vilify the corporations, marketers, and spreadsheet guys if you must, but please recognize that this industry wouldn’t exist if there were not many dedicated scientists who spend their lives gaining the education and experience to and devote all their working hours to making a difference in people’s health.
1
I am on Medicare & currently take 5 prescription medications, 4 of which are generic. My copay tripled on my generic drugs since January of this year. The other drug does not have a generic equal, & Medicare does not cover any of the cost, which is $150.00 a month. The cost of my Rx meds amounts to large portion of my income. I know that I am not alone, that thousands of other senior citizens are in the same boat. We are living longer, but will die for being unable to buy our Rx meds. Who is our advocate? We can't march in the streets. We desperately need help.
9
One thing that I became aware of at a very young age, as we lived where our family had lots of doctors, and then later in life, when I had smaller children, is that people ask for drugs, especially antibiotics for colds. Our one doctor in town, who just retired 2 years ago, didn't give them out, unless a strep test came back positive. The advertising that goes on in the media, often drives the drugs people want, and that doctors prescribe. The doctors are often victims of the pharmaceutical system, as they are so busy, they don't have time to follow the latest even news releases in the medical field, let along what new drugs are on the market. Also, if we had a healthcare system, where the either government, or private health care companies could, and would negotiate the prices, then the costs would be lower. We have over 330 million people in this country. That alone with the numbers of most drugs, should drive prices lower.
4
Perhaps instead of importing drugs from Canada the United States should import ideas. Try the idea of single payer for example, which besides providing universal healthcare allows the government to control drug prices.
Then maybe look at the Provincial drug benefit plans, which offer, at a minimum, massive reductions on drugs for seniors. For me, this means I buy a raft of essential medicines for $4.00. There may be an expansion of these programs to further assist all Canadians.
The Canadian dream is never complete, when people are in need there is work to do, and that work is accomplished through responsible government leadership, legislation and regulation.
America, your leaders can and should do better, and your people should demand that which is theirs as a basic human right, which is accessible, affordable drugs and healthcare.
167
@D priest Unfortunately, somebody has to pay. YOU may pay $4 for the drugs, but the company that invented them isn't going to do R&D that costs billions and takes years in order to sell a drug at $4. So the question is: "Who is paying?
6
@D priest All countries are going to have to stop up and pay the Research and Development costs not only the US in the future.
2
@D priest
Just an FYI. The Canadian system does not cover drug costs. That is a separate plan ( which is required) but functions differently than universal coverage for hospital/doctor costs.
1
I’m for a bigger government. Many of these drugs have been around awhile. Cut out the middlemen and produce and provide quality generics. The same for health insurance. A agency with quality personnel (and a pension, I’m a believer), will provide quality health care coverage. Private sector coverage should stay. Can the Federal Government produce insulin? They have gone to the moon, haven’t they.
50
@Cliff R. We have regulations which make it difficult to produce drugs here. Otoh, we get many of our generic drugs from unregulated sources from over seas. One way to improve this would be to force these plants to adhere to all the same regs US companies have to meet. In some cases that happens but it's very difficult to enforce. This mirrors what has happened in the globalism where good U.S. jobs are shipped over seas and then become lousy jobs- the classic race to the bottom. The role of the pharmaceutical lobby on capital hill hasn't helped either. As usual, money in politics rarely helps regular people.
1
This article does not touch on the fact that many doctors are no longer providing vaccines and immunization tests because of the costs of such drugs/testing. Many people have to receive such testing and vaccines in order to work in nursing and other health care professions. I recently had to get vaccinated for varicella (chicken pox) because I never had the disease as a child. The only place I found that provided the vaccine was a so-called travel clinic. I had to pay over $500 out-of-pocket for the pleasure. The nurse who administered the vaccine told me that the same vaccine costs $10 in India.
88
@statuteofliberty
Strange result. If you had an Obamacare compliant policy, either an Obamacare policy or employer provided health insurance that does not require your employer to pay a fine for non-compliance, vaccines are listed as an essential preventative measure that must be provided free of co-pay. Just like if your insurance refused to pay for any female contraceptive available in the market, your insurance is required to cover vaccines for "free."
If you are uninsured, you were trapped between your requirement that you have the inoculation in order to be eligible to work and the massive inflation of drug prices. If you are insured with an Obamacare compliant plan, you have a complaint against your insurer. You will have to decide whether $500 is worth pursuing a claim against your insurer. Call your insurance commissioner.
The California insurance commissioner may not have any interest in helping you. Although the Little Sisters of the Poor have a waiver on contraceptives and abortions from SCOTUS, California is now pursuing them under state law, which would be a higher priority than your insurer stiffing you on a vaccination. You might not want to take up their time on your trivial problem.
3
@ebmem - I could be wrong, but vaccines for childhood diseases that are not commonly given to adults are probably not considered "Essential preventative measures". Health care workers are a special case in needing these vaccines - or a titer that proves immunity.
1
And the irony is that the vaccine you received was probably manufactured in India!!!
3
The pharma industry is made up of companies. The only reason for a company to exist is to make as much money as possible as fast as possible. This is what they are doing. It’s their nature. There is no conscience, no morality, no thought. Just a machine for making money. Treat them as such and tell them where to stop and no further. It’s called a brake pedal.
89
@C. Neville..."The only reason for a company to exist is to make as much money as possible as fast as possible."....The same should also be said for drug insurance companies (which provide no healthcare benefit) and the pharmacies which distribute the drugs. And by the way, the best way for a pharmaceutical company to make a lot of money is to invent and develop a really good drug that people need.
3
@W.A. Spitzer: Ah, the blackmail ploy. Let us do what we want or we won’t invent any new drugs. Every time an industry gets called on this they fold, and then make slightly less money. I genuinely weep!
9
@C. Neville
I have to take a natural form of thyroid because the cheaper synthetics don't work for me and over the past decde the price has gone from $13 per Rx to nearly $100. This is just to get thyroid from a pig--no special research or manufacturing required. Recently I've started to feel like those workers in the 19th century who knew they were being maltreated but had no options. I think the Europeans call it "cruel capitalism" https://www.brusselstimes.com/opinions/americas-cruelty-capitalism/
6
Yes, Big Pharma, certainly.
But our drug costs also come from the fact that we eat, drink, sit around and get fat, and stress out.
And then there’s demand. It’s not just BP’s ads: it’s patients demanding a pill for everything under the sun, and it better be a new pill, too. And no generics, those are for losers. Gimme. No, more.
We absolutely should have HHS bargaining with drug makers. The assessment board that looks at effectiveness vs. cost is also a good idea, though I promise that consumers will scream their heads off when they’re told, “Nope, no evidence that this latest statin is one bit better than what you were taking, so not paying for it.” And the costs for an Epipen or insulin have to be hauled up short.
And two other things that get my goat, the first of which is the new Hep C drugs (about $60-80 grand per patient) are pricey, but they’re cheap compared to having somebody around with Hep C, or a liver transplant. There has to be some clue regarding the bang for the buck.
Last kvetch: can we please do something about the multi-billion patent nostrum industry? You know...”supplements,” probiotics, vitamins, ginkoba, yadayada, and the endless list of quackeries (“balancing the immune system,” I’m looking at you) that accompanies them?
I’ll bet if we sit down and look, GNC or your friendly neighborhood health food store are almost as much a cost prob as Big Pharma. With far less testing for efficacy and purity, too.
1
@Robert Our West. Some pharma company also had to do the R&D required to bring a new drug to market and that costs millions, even before profit is considered. Really expensive people do R&D, eg PhDs and MDs and they’re not going to work for free. Many of the new ideas fail so that’s millions lost The taxpayer doesn’t reimburse Pharma for those losses. The USA does most of the world’s Pharma research so other countries are freeloading. Finally, the litigation risk is significant. There is no immunity for Pharma from real, imagined or exaggerated product defect.
1
Trump has identified the problem. His solution is probably to talk about many 'things' and wait and see what happens.
1
This entire situation is shameful. The most profitable industry in the United States is based on our health care system. Next to the multitude of prisons (and far too many prisoners of color), this is the utmost "wrong" committed here. The sheer greed of both systems makes me sick to my stomach. If I could receive SS benefits and not live here, I would leave.
1
Despite his promise to negotiate like crazy to reduce drug prices, Trump hasn't done jack.
1
All good ideas. But, and this is a big but, as long as pharmas bribe politicians of all stripes all this will result in is sound and fury and ... Drumroll please ... Inaction!
2
Lobbyists, the wealthy and corporations run America, and no one is going to derail the gravy train.
It's just more of the same: to heck with the commoners: Let them eat cake.
1
Great posts here. Get money out of politics. That might right several of our listing ships.
2
50 years ago, drug advertising was not allowed. We should go back to that.
6
Trump is running well behind Biden, even in Trump's favorite polls. I think he also may be running a little scared.
A time-honored tradition among Republicans, is co-opting Democratic positions in the run up to an (2020) election -- things they would have never considered given their sterling "conservative" principles. This prescription drug gambit has that same aroma to it.
Of course it's idiotic that American patients should pay these exorbitant costs -- even Medicare patients whose drugs are being subsidized directly by the government -- just so big pharma can rake in billions in profits.
Trump's drug proposals look logistically flawed (as this opinion piece observes). And it may be just another Trump "look at me" dog-and-pony act.
I think the biggest problem in implementing something like this would be getting it through the Republican senate which is controlled by acres of lobbying money from pharmaceutical companies.
And you know that big pharma is going to fight this one...with a vengeance.
35
@L'Etranger, I might think about beginning to believe that Trump might, maybe, possibly, comes up with a plan and submits it to Congress. Even then I won't give it full credit until there is bipartisan agreement.
1
The solution: make pharmaceutical companies operate as price-controlled public utilities. The reason: medications are a critical necessity required to survive or thrive, which means the capitalist principle of supply and demand does not operated to prevent price gouging. The rationale: water and electricity are also critical necessities required to survive or thrive and companies selling them are required to operate as public utilities for one simple reason - to prevent price gouging. It is the only way to completely solve the problem. The solutions recommended by the article merely make incremental improvements.
59
@Dave
Excellent idea and one I've never heard before.
Now, how do we make that happen? Not in this administration full of posers and sycophants.
Can Trump declare it by wizardry or fiat? ;-)
6
@Dave
Operate as a utility ?
What company is going to risk billions developing a drug ?
The process takes years and has a 1 in 5000 chance of success .
https://www.medicinenet.com/script/main/art.asp?articlekey=9877
2
@Dave
Many people turn to exclusively bottled water for drinking because our public water systems are often toxic and can stay that way for a long time. Even my pet hates tap water. Our public utilities are often propping up many outdated and uneconomic coal plants because the profit motive is often irrelevant.
Even though water and power are necessary services for survival, their public operation has led to some very serious public health consequences. If, for example, Nestle starting shipping bottled water tainted with lead, there would be a massive fine to pay and a big loss in company value. They have enormous incentive to make sure this does not happen.
Your point that markets often do not work in life or death situations is an important one, but that is generally because of a lack of competition on the supply side. One cannot easily price gouge if multiple entities are selling a commodity product, unless barriers to competition are erected through middlemen, shaping consumer preferences for one brand (such as by advertising to doctors or patients) or by outright collusion.
We need to be extremely careful about unplugging markets that might improve dramatically with more competition, especially when dramatic, industry-reshaping technological changes may be just around the corner. Making markets work better and mitigating their worst effects should almost always be the first page of the playbook.
As an indication of just how much money there is is Big Pharma, there is probably not a single show on a single TV channel that is not now sponsored by a drug company. A network that shows reruns from the 1950's and used to advertise nothing more expensive than a garden hose, now runs commercials for niche medications, serving perhaps a handful of people, costing hundreds of thousands of dollars a year. The drug companies are swimming in so much cash they don't even know how to spend it all, though they evidently prefer advertising and lobbying to R&D on anything remotely useful. There is no justification for a drug like insulin, which has been around for almost a century to have become unaffordable.
Our entire healthcare system is one ghoulish, for-profit enterprise, with smartly attired vampires as CEO's and shambling zombies in Congress doing their bidding. Hatred of the drug companies is near universal, cutting across the political spectrum. The first way to begin changing things is to not elect anyone who takes a single cent from Big Pharma. Until that happens, nothing will ever change.
184
@stan continople
Make a list of those drugs instead of ignoring the commercials. Then go to the internet and look up the selling prices for those drugs. The advertised drugs rarely perform enough better than older substitutes to justify the price differential. Once Obama decided everyone had to have drug insurance, there was lots of money floating around from premiums paid by the healthy to allow the drug companies to ramp up the sale of expensive drugs to the few.
Absent the drug insurance purchased by the healthy, the drug companies would have to charge lower prices. Obamacare socialized the cost to the people and directed the excess profits to Obama's friends.
After 2016, there were enough RINOs who joined with the Democrats to prevent any rollback of drug company largesse.
Our high medical costs are not the result of capitalist greed. They are the direct consequence of socialist policies in which the central government, in an effort to increase its power, grants favors to those businesses that support its power grabs.
1
@ebmem
Both partys have had occasions where they controlled both branches of congress and the white house so I don't think this is an idealogical problem. We don't have public financing for political office and legislators go where the money is to keep their job and make some money too. How much money have you given to support your legislator?
6
@stan continople
I am so pleased to read such a clearly worded and accurate comment. You have encapsulated the issue--and one way to begin addressing it--impressively. I salute you, Stan.
4
Several years ago, when the idea of importing drugs from Canada first gained traction, the Canadian Health Minister quickly stepped in to say they would not allow it. Why, you might wonder?
Canada has a smaller population than California. They get cheaper drug prices than we do because they are "the empty airplane seat", the place where companies sell incremental volume. The Canadians know that as soon as the Canadian market begins to look much bigger, because a significant amount of its buying is destined for the US, it will jeopardize their low prices. They will not allow this to happen at any significant scale.
2
Step one-Eliminate political lobbying by the pharmaceutical industry.
5
@Marc A
Not legal. Any company, in fact, any individual in this nation has the right to lobby the government.
2
@JRC
Just because it is so, doesn't mean it should remain so.
Congress can pass a law to make it illegal for lobbying .. if both sides really and truly care about the people they represent.
Corporations are people, too.
Mitt Romney
Drug pricing is just one of scores of problems with our current healthcare system that can be remedied with Medicare for All. Yes, get rid of private insurers. Yes, negotiate drug prices. Yes, cover illegal residents. Yes, permanently bend the healthcare cost curve. Yes, free workers from job lock. Yes, join the rest of the modern world.
2
There is no justification for Americans paying 10x,50x or 100x the price paid by other wealthy nations. Especially when the drugs are developed and manufactured here.
We should treat prescription drugs and therapies like we treats defense equipment. Since Americans are paying for the R&D and profits of these companies and the rest of the world is not, we are effectively subsidizing the drug costs of wealthy French, Swiss, Norwegian and UK citizens. Any pharma company selling its drugs in America should be compelled to sell all of it to the FDA. The FDA would then resell drugs to the rest of the world. If a pharma company refuses, that drug should be prohibited from being sold in the USA with no exceptions. Our market is the largest, pharma cant develop drugs and be profitable without access to the US market. The FDA would give Developing countries free or reduced pricing, but wealthy countries, like Monaco or Japan would pay as much or more than Americans do.
2
@Practical Thoughts: Medicare should be able to contract for or manufacture its own supply of every chronic care drug it covers.
2
The-Art-of-The-Deal President doesn't seem to be able to close a deal to lower drugs prices. Many US residents are leaving the country to stay alive due to exorbitant prices for life saving drugs like Epi Pen, Insulin and many more.
Big Pharma wastes incredible amounts of money on advertising which could be spent on research and development of new drugs.
The FDA needs to not only approve drugs on their safety, but also whether they are superior to a drug already on the market and the cost to consumers. The revolving door between Big Pharma and the FDA is hitting consumers as it swings back and forth.
6
@Jacquie: Nothing Trump has ever done has been totally clean.
1
I fixed the high cost of prescription drugs for myself. I don't buy them. Instead, I have a very healthy lifestyle. I never see doctors. I'm 70 years old and I expect to live until I'm 110 years old without ever spending a penny on health care.
Most people eat garbage food, drink alcohol, and never exercise. The drug companies and the junk food industry love these people.
3
@BobC: Lucky you. My best friend in France, a very clean-living guy, just died of cancer there, aged 60.
2
When Medicare cannot negotiate drug prices, what is the outcome? Tax dollars going into the pockets of private individuals-shareholders and executives. When we have private, for profit prisons, what is the outcome? Tax dollars going into the pockets of private individuals-shareholders and executives. When we have private, for profit education, what is the outcome? Tax dollars going into the pockets of private individuals-shareholders and executives. Tax dollars are supposed to be used for the people and the country. Give me your tax dollar and I will build a road for you to travel on. Oops, changed my mind--the cost of jet fuel for my private jet just went up and I need that money more than you do.
3
@Chris: And all of these beneficiaries spend lavishly on corrupting the entire US political system.
1
@Chris: Every one of these beneficiaries kicks back to the utterly corrupt Congress that cares for nothing but more money to corrupt politics.
Generic Rx are going up as well as brand. I've written to both of my U.S. Senators on this very problem. We both take Rx for controlling high blood pressure. We are both over 74. We DO HAVE Medicare and a decent insurance policy. Last year we paid $6.00 for 90 days of LOSARTAN. We were told to stop that Rx because of a cancer scare. We were told to get VALSARTAN which IS A GENERIC. The cost is now $60.oo per 3 months. Still OK. That said, we saw what it costs without insurance and Medicare. $580.00 per 3 months. That makes over $2000.00. That could "break the bank" if you don't have good insurance. If you make more money per month to get Medicare but DO NOT HAVE ANY INSURANCE and can't get government help, you are going to skip days of VALSARTAN (A GENERIC MADE IN the U.S.) Sadly the BIG PHARMA cartels AND other corporation cartels control the Congress and loved by Trump. All we can do is write, write, write and get a President who really cares for "We the People. . . "
5
Ironically, much of the bad government evident in our failure to control drug costs originated in what was intended to make government more answerable to the citizens: the Legislative Reorganization Act of 1970. This legislation provided that House votes would be recorded on request, and that committee meetings would be open to nonmembers. The Senate followed suit and also opened committee meetings. These rule changes meant that lobbyists could be much more persuasive than had previously been the case. Representatives of special interests were no longer operating in the blind. According to an article in the May/June issue of Foreign Affairs, between 1971 and 1982, the number of firms with registered lobbyists in Washington grew from 175 to 2,445.
And here we are. Transparency is not always a good thing.
2
@'cacalacky: The "Citizens United" Supreme Court ruling legalized rampant political corruption and outright bribery in the US.
1
The pharmaceutical companies are involved in a monopoly. They restrain trade and gauche consumers. They spend tremendous amounts of money on advertising to promote expensive drugs. The system is obviously unfair. And many people suffer the ill effects on their health.
3
@c harris: It is a cartel, not a monopoly. A number of companies divide up the spoils.
1
Indeed something that impacts everyone and something everyone can get behind. No argument. I had a brief period after open enrollment having switched insurers, amd was without an insurance card. I had to purchase prescriptions and pay out of pocket. Not a big deal I thought. A 30 day supply of one prescription was $200! And my insurer considered me to have purchased it "out of network" so they would only reimburse $45.
Surely this is an area where our government can put their differences aside and work on a solution?
1
@Ann: The average person incurs the bulk of health care costs at the start of life, and at the end, when they have no income to pay insurance premiums.
@Steve Bolger: "Socialism" redistributes income from the public's working years to their non-working years.
“Blowing up” drug patents may be “fantastical”, but eliminating patent protection would make all drugs generic and expose their makers to competition, which generally reduces the price.
@Hector Saravia The formulas for generics can vary enormously, legally, for the same drugs. Not long ago, my pharmacy changed manufacturers without informing me (against the law) and I did a swan dive. It was for major depression. Also, 75% of all generics are manufactured in India. The FDA monitors the quality of generics produced in India but admit they don't have a sufficient staff of monitors to do a thorough job of assuring buyers of good quality.
We already have shortages of various drugs in Canada, so I am really hoping that the US can deal with this problem at home and not cause further issues in another country. To lack a medication made in Canada because it was sold to someone in the US would be upsetting to say the least given that there are solutions available for you at home.
3
@Marilyn
"We already have shortages of various drugs in Canada, so I am really hoping that the US can deal with this problem at home and not cause further issues in another country."
Funny, reminds me of something similar ..
.. when many here say, "We already have too many people in the US, hope Mexico does not send us any more."
1
Katie Thomas recently published an interesting article on lowering drug prices.
The article suggests - and I agree - leveraging drug ads to pressure companies to lower their prices, instead of eliminating ads altogether.
https://www.nytimes.com/2019/06/16/health/drug-prices-congress-trump.html?searchResultPosition=11
Why, you ask?
In 2016, the U.S. spent $329 billion on prescription drugs.
The consumer ads budget in 2016 was $6 billion.
That is less than 2%.
(sources: Reenita Das, Forbes; actuary.org)
So you either cut down all ads and save, maybe 2%, on drug prices, or continue with the ads and use them to lower drug prices.
Kudos to Katie Thomas, I hope NYT publishes more such articles.
1
While all the proposals here deserve consideration in various forms, and the I think the real answer is some combination of all of them, I also think this article misses an important point about why these prices are a catastrophe.
The standard concern is that high drug prices mean that people can't afford the medications, usually because of high copays -- themselves a manifestation of a dysfunctional system. But as tragic as that situation is, the concern overlooks the larger issue.
Everyone winds up paying for the astronomical price of pharmaceuticals in the form of higher insurance costs. While in theory in the US one can (once again) forego health insurance, the reality is that most people understand the risks of that and don't. Health insurance dollars go into three types of funds: For profit (e.g. United), not for profit (e.g Blue Cross) and government (Medicare, Medicaid, the VA). All are threatened by insolvency by the "sky is the limit" drug pricing, forcing a rise in insurance premiums or, in the case of government, taxes.
Where does the money come from? From everyone who buys insurance; every employer who provides insurance, which has to be priced into the cost of their products (creating a drag on the whole economy); and everyone who pays taxes, rich or poor.
Where does it go? Mainly to investors of pharmaceutical companies. It is a tragic and unconscionable transfer of wealth from poor to rich, caused by the de facto ransoming of the medicines.
7
First, allow people to purchase their drugs from anywhere they choose, domestic or foreign, and the prices will drop.
Second, insist that getting a new patent on a drug only occurs when there is a significant change to the drug, and allow the old drug to be manufactured as a generic when a new patent is issued.
These two alone will make a significant change in the price levels of many drugs.
3
What is occurring is not the profit system getting worse. It is the profit system following its natural governing principle of greed - get all you can and give as little as you can. It was always a disease that we tolerated because we were convinced by a flood of mainstream propaganda that "free enterprise" existed and that it was really good for us. It was always the wealthy and their servants who were calling the shots, and they always charged as much as the "market will bear," i.e. as much as possible without causing a revolution.
The suffering caused by soaring drug prices is small compared to the fact that in their pursuit of profit, the parasites, that have so much of a say on our lives, are pushing us toward extinction as they try to milk the very last bit of profit out of their oil and gas assets. And their servants who run the mainstream media for them, continue to avoid "alarming the populace." by downplaying climate change. Ever notice how many weather reports on TV will tell of new highs in temperature and rainfall, and so on without mentioning that these events and increasing frequency arise from climate change? How often is it mentioned that we have had the highest recorded global temperatures ever?
We will not be able to stop climate change if we do not get rid of the profit system that is driving it.
4
What would happen if we could muster up enough legislative clout to pass a bill to reverse the action that allowed advertising of prescription drugs? Big Pharma spends a fortune on TV ads alone, but maybe it's just a small fraction of their profits. Still, worth a try. And I could watch TV without getting so angry at the ads that come every few minutes on every channel!!
5
If anybody still believes that Trump doesn't lie about anything, that person should be psychologically examined. He may tell a rare truth about something, but it's necessary to determine if that is only when it fits for him personally. A stopped clock is right twice a day, too. And all those suggestions? I wonder who ultimately, in addition to a president, would have the power lawfully to make those changes? Hmmm... Be wary of corporate-funded candidates; vote progressive candidates. There's a suggestion for you.
5
The primary governing body over pharmaceuticals is broken. Witness the label change made at the request of the pain killer makers to state that oxytocin is safe for longterm use. There were no clinic studies to back up this finding. Just lobbying from the industry. (i.e. Purdue). When the police are corrupt, the criminals run the show. That is the current situation and nothing will change until the FDA is reconfigured to serve the public interest.
6
Just follow the money baby and you can find the root of just about all the ills in the US of A.
@Phillip Agreed. The profit motive across healthcare has been the primary driver for as long as anyone can remember. We are left with millions with no coverage and lagging results compared to other developed countries. Really needs restructuring to at least partially eliminate returns to investors as the primary driver. Better not hold our breath.
Please read "Bottle of Lies" written by a respected author who writes for the NY Times. Big Pharma has managed to produce drugs that are both expensive when under patent and then defective when generic.
It is the worst of all possible worlds.
5
The one thing not mentioned here is the most obvious - allow, indeed force, markets to form for the many drugs that treat essentially the same ailments (e.g., allergy meds). The prescription market is in no way a free market. There is an incredibly cumbersome and inefficient system of middlemen that suck out any efficiencies that a market might generate. That is why you might pay one price at CVS and another very different price at Walgreen for the very same pill.
5
Good old capitalism, inherently immoral as always.
5
@Alan C. - It's crony capitalism and anti-competitive behavior that is at fault here. If allowed to work properly, capitalism would bring in new entrants and suppliers to the generic market if/when the profits become excessive.
@Alan C. I would state "amoral," at least, but it may be a distinction without a difference in this case.
2
Drug pricing, is but one of the problems regarding healthcare. The most fundamental question we must consider is “ Is a just healthcare system compatible even within the framework of unfettered Capitalism.”
The likely answer is that it is not. We are burdened by our history of employer based subsidized insurance AND for-profit pharmaceutical companies. Neither is sustainable or compatible with a healthy society.
It will take politicians of great character to make the changes necessary to achieve the goal of equitable healthcare for all.
While today’s politicians mostly obfuscate the truth of the remedies, Western Europe, Canada, and even small nations like Israel provide examples that work.
The single largest roadblock to change is the “pay for play” nature embedded in our politics.
6
Politicians of great character?
Very few pharmaceuticals are either safe or effective, whatever that actually means. They are drugs, generally highly synthetic chemicals derived from plants. While a few “illegal” drugs - usually so designated for political purposes - are vilified by society, legal ones like nicotine, alcohol and myriad pharms are far more dangerous and often lethal. They are designed to target symptoms rather than promote health. In doing so they expose the innocent systems of our bodies to a host of unintended consequences. Most American doctors would be lost if they could not prescribe these poisons to their patients rather than work on making them healthier by other means. And our public, propagandized by the medical establishment and pharmaceutical industry fall ever deeper into a vicious downward spiral of increased costs and worsening societal health outcomes.
1
I beg to differ. U.S. physicians are highly trained. The propaganda about “bad docs” is far removed from the truth, and quite unfortunate.
The FCC should ban all TV ads for pharmaceutical products.
There is no practical reason to advertise prescription drugs, and the Big Pharma are only using advertising as a huge tax write off. The TV networks are the only ones that profit from this practice.
Just watch broadcast TV from 5 to 7 PM and see what I mean.
Millions of dollars are spent selling junk meds to people that don't really need them.
Why does congress allow people to make millions selling opioids that are killing people. Our whole Medical industry could use a good house cleaning.
83
@USMC1954 I unplugged from TV many years ago. I too was sick of seeing all the pharmaceutical ads - along with ads for foods that were contributing to many of the common diseases of today. I would not be surprised to find out the investors in 'big pharma' are also investors in 'big agra.'
5
@USMC1954
Your comment should be front page. All these expensive ad campaigns hike the price of the end product and has created another useless industry of drug marketing. "May cause serious side effects such as death suicide, blindness, infection" all in a lovely calm voiceover.
5
Thanks for the informative article.
But does anyone really think that this conman Trump has any interest or attention span to do anything positive for healthcare in this country?
Trump couldn’t care less. Vote my friends.
8
@Steven I do vote but nothing changes.
@Steven Wow, you put it a lot more succinctly and better than I did, and I thank you!
despite talk of reform housing prices in New York keep rising. how can we solve this with legislation? idea, more developments like Hudson yards! idea 2, stop developing new drugs, eliminate current drugs, shorten lives like the good old days before those horrible drug companies came along.
2
The changes suggested are weak and piecemeal. Let's get serious and brutal!
First, let's cut the low-hanging fruit from the pharmaceutical racket by reducing or eliminating the $33 billion per year advertising and lobbying expenses that Big Pharma passes on to the consumer. Next, let's address the fundamental issue of overly generous patent protections.
We consumers pay $10 billion a year for the nuisance of Big Pharma's consumer advertising. What, pray, is the sense of advertising controlled substances like prescription drugs that cannot be traded in the open market? The US is the only major country that permits such a travesty.
We pay $20 billion a year for Big Pharma's wooing and bribing of pharmaceutical prescribers. Surely, the mention of a drug in a monthly FDA newsletter would suffice as information and incentive for prescribing the drug.
We spend $3 billion a year for Big Pharma to lobby federal and state legislators and administrators for favorable treatment without regard for the interests of voters and consumers. What fools we are to tolerate such brazen corruption!
Onerous and overly generous patent and copyright protections are a national and worldwide inhibitor to innovation, competition, and progress. Protection should be valid for no more than 5 years. A patent or copyright should be treated as a commodity that can be sold or leased in the open market, but cannot be retained for exclusive use.
8
Don't drink, don't smoke, don't take drugs, keep you weight down, use as few prescription drugs as you can get away with, don't worry about the cost of prescription drugs which you will never have any control over.
3
Am I the only one to find it ironic that the man in the Oval Office who knows no shame, thinks he can succeed in lowering prescription prices by shaming Big Pharma?
3
The problem here is money. Given a choice of negotiating with Big Pharma or taking money from its donors and lobbyists, politicians will always do the latter. Take away that choice and you make a good start toward lowering drug prices. Anything else is so much hype and hot air.
4
This is why the libertarian idea of a free market utopia cannot work. Corporations will never do the right thing.
Let pharma charge whatever they want, and whoever can't afford it will die. When the market for their product shrinks via deaths THEY caused, libertarians will reward them for their smart independent decisions!
1
The government needs to take over bringing some drugs to market. I read about an off-label use of an antibiotic to treat Alzheimers. The drug company wouldn't go through the costly testing needed to evaluate the drug for this disease, so unless the government takes over this drug testing and production, a potential cure for Alzheimers remains locked inside a drug company. This is crazy.
1
Why don’t we just do what the other countries do?
3
The most shocking thing of all the shocking things in this subject is the price of insulin. There is no excuse for price gouging and no excuse of the monumental greed that is literally killing people. The pharmaceutical companies seem to demand respect and accommodation and admiration for all they do. Not in my book.
6
Imagine your reaction if it were oil companies that arbitrarily tripled the price of gasoline in 1 year to cover their cost of mismanagement, greed, and corruption, while maintaining a share price that attracts investors. By granting and gaming patents on new and old drugs the government (the people) give that pharmaceutical company a monopoly. Rights provided by a patent should come with some responsibilities. I don’t think shameless looting should be one of those rights. We will start seeing drug price relief when regulations are passed and CEOs start going to prison.
7
No government interventions are likely to ensue or be effective as long as the pharmaceutical industry continues to wield influence over politics and the media through its vast trove of financial resources. Their pleading for relief is risible in view of the outrageous profits they make, which (it has been well documented) outstrip every other industry in this country. The best solution is for people to wake up to the fact that prescription drugs are neither helpful nor necessary for long term use at least 90% of the time. The direct (through side effects) or indirect (through medication errors) costs of prescription drugs is one of the leading health care costs in our country (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5016741/) and in most cases we need these medications like holes in our heads. Lifestyle changes such as eating better, exercising more, and using a variety of health promoting practices such as yoga, meditation, t'ai chi and economic reforms such as raising the minimum wage and providing more low income housing would probably eliminate up to 50% of the need for pharmaceuticals. Another 30-40% could be eliminated by the use of alternative treatments, including food itself, herbs, certain vitamins and nutraceuticals and many others. See GreenMedInfo.com for an encylopedic source of safe and effective natural treatments, with research citations references for all information provided. Meds wear off, or create new problems, and people need to know this.
1
Conspicuously absent from the list of solutions is to reverse Citizen's United and get money out of politics. Second, you missed the adoption of China's meritocracy system of hiring public officials.
In the US, any slime ball with a good gift of gab and enough looters behind him can ascend to power. The most egregious example might be Trump but there are plenty of other criminals masquerading as public officials.
The problem of Climate Change is much larger than drug prices but neither one will be solved until we require competence, training and experience over Grifter skills.
5
What do you expect in a plutocracy! It comes down to your money or your life and too often - all of your money and then you life. We should change or national motto from "Out of many One," to "What's in it for me."
3
But why did the Times leave out the recent astronomical rise in the price of generic drugs? The cost of my wife's digoxin(digitalis) suddenly went from $9 to over $100.
3
This article is useless. It is clear that the government has the power to regulate drug prices and does not. The Republicans under Bush II pushed through the bill that opened the coffers of Medicaid and Medicare to the pharmaceutical industry. With huge amounts of money flowing into politicans, there is not the collective will of the Congress and the President to change this situation. Having a public health care option would add more potential leverage, but the Federal government has that with Medicaid and Medicare but refuse to use it. Shame on the Congress, the President and both the Republican and Democratic Parties.
3
I’ve always loved the expression “Standing in the shoes of the Fisherman!”
At 80 years old, the simple fact that I’m still alive is pure and simple! It’s because of prescription drugs! I’m not talking about being hooked up to a heart pump, a dialysis machine or IV’s. I’m not even talking about complex drugs. I’m talking about pills and drugs that most older adults take everyday. The Pharmaceutical Industry that invented most of these drugs have made Billions of dollars making them, and for the most part, they have a right to those early profits. That’s how capitalism works.
What doesn’t work is how these same Pharmaceutical companies RAPE patients after they’ve made back their money and a fair profit and then change the formula so that it doesn’t become Generic.
Example: I can purchase Bystolic in the U.S. for approximately $155 for 30 tablets. It’s less than half of that if I go through a Canadian Pharmacy. Once it becomes generic, it, like Lipitor becomes affordable.
If the U.S. Government really wants to help us, force those companies to make their drugs generic as soon as they’ve made a reasonable profit, and they could do that just by looking at the P&L. In the meantime, thank God for Canada!!!
4
@Eric Cosh "At 80 years old, the simple fact that I’m still alive is pure and simple! It’s because of prescription drugs!" Nothing personal, but You, and the millions of others like You, are the reason pharmaceutical companies are raking it in, along with the rest of the Disease Care industry. And it's all been subsidized by taxpayers through Medicare (where the prescriptions are written) and federal government (NIH) funding of research for new drugs and endless trials comparing one drug to another.
1
Don't drink, don't smoke, don't take drugs, keep your weight down, use as few prescription drugs as you can get away with, don't worry about the cost of prescription drugs which you will never have any control over.
2
And while you're at these, try to walk your dog every day in the park.
1
Though not a topic of this article, it should be mentioned that most of our drugs are manufactured in India and China in shockingly unsanitary conditions. We cannot even rely on the purity of the over-priced medicine we're prescribed. Today's pharmaceutical industry is all about money. Another facet of GREED in America.
https://www.nytimes.com/2019/05/13/books/review/bottle-of-lies-katherine-eban.html
4
Rather interesting that the Board completely ignored a major cog in this wheel. The health care providers. They are more than happy to prescribe anything, even if it's useless. Of course the spotlight right now is on opioids so they've had to scale back their pill churning in the segment.
2
Pricing drugs against what other countries pay is basically letting our trading partners do all the hard work for us. Why does this proposal not surprise me. America leads nothing now.
2
"President Trump has indicated that he would support state laws to allow the import of drugs from Canada". How do you think Canadians would feel if suddenly our drug system was open to big private American health companies coming in and buying up our drug supply driving our costs into the stratosphere! How would that solve YOUR problems which are the profit driven basis of your health care system. PLEASE DON'T EXPORT YOUR BROKEN SYSTEM. Or perhaps our only solution will be to build a wall and have America pay for it. And we know how well that solution works. Vote out all that take money from industry, who don't support some move away from for profit health and don't support passing laws to reverse the damage done by Citizens United.
4
Can I write an op-Ed titled, “What Trump WILL do to lower drug prices?” Hint: it will be just one word long.
You are asking ideologues bribed by lobbyists to help solve a problem
they reap riches from
Chances of success? Zero
Chances of a reality show video/sound bite for trump to use in 2020? : excellent
2
We have the best government that money can buy. Why can the former head of the FDA join the Pfizer Board three months after he left office? The stink from Capitol Hill gets stronger every day.
4
Swallow your pride and import ideas from other countries. Some may work, some not, and for gawd's sake don't slap a tariff on those ideas.
Make medical care and drugs to congress the same cost and availability as WE THE PEOPLE.
3
I think there needs to be more discussion on the role of Wall Street in encouraging the insane pricing models of drugs in the United States. Most large and small pharmaceutical companies are publicly traded, and most of that stock is owned by large banks and hedge funds whose only concern are gains in quarterly earnings. These and other activist investor's only concern is making money and making money now. I can't imagine that these majority share holders threatening to short their equity (and therefore lower the wealth of all C-suite shareholders) isn't a motivating factor in their decision making. As long as these big pharmaceutical companies are publicly traded, they are technically bound by a mandate to benefit shareholders, not patients. Consequently, unless the government policy stops them, they'll take any and all opportunities to bilk their US patient base, even if they know such price spikes are transient and unsustainable.
48
@ab
It is a critically important discussion, but the Wall Street component is complicated. They would (and have) argued that they have a fiduciary obligation to their shareholders to get as much value for their products as the market allows. Thus, from Wall Street's point of view, it is actually immoral to charge less for the drugs than "there market," however defined, will support. In addition, they may face shareholder lawsuits if they lower prices simply in the name of being good citizens. A lot of things have changed on Wall Street over the last decades, including the sense of when this fiduciary obligation becomes outright immoral. Whatever the cultural change, it only underscores the need for government regulatory action. Publically traded companies won't change their behavior voluntarily -- they may even perceive that they couldn't even if they wanted to -- and it is unlikely that negotiations will contribute much to changing this behavior.
5
"Britain will cover a new medication only if the benefits it provides are high relative to its price. Germany will pay more money for a new drug, compared with an older one, only if the new drug is better in some way."
These measures would help immensely. American patients need to be educated to understand that a new medication isn't necessarily better--or even as good--as an old medicine. (for example insulin, Metformin, Losartan, amoxicillin, etc). In order to be patented, a medicine only needs to prove that it's a teeny bit better than "no effect." It is NOT compared to the present medicines already available--and the drug companies really don't want to go there, because maybe it isn't. They just want to throw millions into convincing the public that because it's brand new, it must be better--"go ask your doctor". (i.e. pressure him).
Forcing the companies to run trials comparing their new med to the current standard of care, would force excellence and cost effectiveness. It would stop inter-company competition based on whoever has the best advertising wins, instead of who has the best medicine wins. Thwarted in that arena, pharma companies would find it more profitable to search for new meds that address new diseases, or address old diseases in new and better ways.
And another way to save money not mentioned here: ask the providers how much time & energy is lost daily in trying to obtain prior authorizations! This must be costing us millions.
2
Medicare, the largest buyer of drugs, being prohibited from negotiating drug pricing is Exhibit A of how Pharma has both parties in their back pocket.
Full stop.
8
@Henry Possibly they have members of both parties in their pockets but it was the Republican party that agreed to no negotiation of drug prices for Medicare Plan D.
3
I interfaced with the multinational drug manufacturing cartel for decades. It has become a runaway renegade in the last twenty or thirty years. Multiple factors have contributed to this including: It's regulatory capture of the FDA; the ascension of chief financial officers into even greater influence; its ownership of the U.S. government; the consolidation of U.S. hospitals and medical clinics; its intrusion into educational institutions and the National Institute of health; and its being allowed to advertise to the public via television, etc. These are not U.S. companies. They are European and Asian entities that are generally involved in the mass productions of chemicals - some very harmful to humans. All of the "controls" being floated are simply window dressing that will not address the problem. In my experience Australia had the best control system, and some nations are following their lead - not the U.S. Until U.S. citizens become informed and vote about real issues instead those contrived to distract, drug prices and indeed healthcare will never be truly addressed.
2
We are trying to solve the wrong problem. Most drug sales go for illnesses that are completely preventable with nutrition. The research is published and can be found in the Pubmed index. Heart disease, artery disease, ED, type 2 diabetes, GERD, most cancers, many forms of arthritis, autoimmune diseases, high cholesterol, IBS, Crohns, hypertension and more are caused by diet. As a society we wait for an avoidable health issue to occur then we treat it with a drug, we mask it with a drug, which does not improve our health it just makes our lab numbers look better until we die prematurely from the disease. The answer to the problem of high drug process is on our plate, not in a pill bottle or a syringe.
3
New York Times omitted the most obvious, permanent way to control pharmaceutical prices: reduce demand. America is the land of the unhealthy, and our disease care system (now 20+% of our "economy") thrives on the demand for "treating" largely preventable diseases like hypertension, coronary artery disease, diabetes, gout,chronic constipation, lung cancer, colon cancer, emphysema, alcoholism, and on and on. But that would require our unhealthy population to take responsibility for its own health. Like discussing the failed "war on drugs" and how it has destroyed Mexico and Central America and created our "immigration crisis," the subject of sustainable living remains a taboo political point. To raise let alone address the need to dramatically change what people put into their bodies would "offend" the vast majority of our fat, meat- and dairy-eating, cigarette (and now vape)-smoking, alcohol-guzzling, lazy population. It would "upend" the vast "health care" industry, large segments of our "agriculture" industry--ranchers, factory farms, slaughterhouses--and, of course, the health insurance industry and their millions of "jobs" that depend on and support keeping our unhealthy population from not needing their products and services.
5
@JCX
How funny our comments would appear side by side. I completely agree with what you have written. We need to understand and address why we need all of these drugs in the first place, why over half of all Americans take a prescription drug every day, why the incidence of these chronic lifestyle diseases has exploded over the last several decades and why these illnesses are being diagnosed earlier in life every year.
2
@JCX Correction: ...support keeping our unhealthy population from needing their products and services
Good article--critical topic. Perhaps the most important one for all Americans. I don't support the " show the value first" concept because we would lose out on important treatments. England didn't allow Eloxatin to be paid for back in the day; it became a first lime treatment in colon cancer.
Re-importation should be allowed. I know people who have brought back endostatin from China in a suitcase because it was far cheaper than Avastin and more effective in some cases.
Medicare has the legal ability to set pricing without negotiation. If Medicare sets the drug " fee schedule " to an England or Belgium match for example, no one will buy the drug unless the drug companies sell at the re-imbursement price.
Any reform should include in office or hospital drugs delivered by IV as well. It is a shame that we have a critical issue that Bernie Sanders and President Trump agree on and we aren't getting it done. That type of political opportunity does not come around often. Lowering drug prices would also lower insurance premiums as well. The money involved is..simply put... absolutely staggering.
2
@Mark
Places like UK have a fixed pharmacy budget and so a decision to cover any new drug needs to take into consideration its impact on the ability of the system to buy other medications and provide other services. They can't jeopardize the stability of the entire system by knuckling under to pharmaceutical company pricing demands. They have to consider it in the context of competing goals of the health care system and the resources they have to provide it. This is true in varying degrees in most places, but less so in the US, where the assumption is that insurance companies can always raise rates to cover the higher costs and, basically, the cost of insurance is the insurer's (or the government's) problem, not the pharmaceutical company's.
Letting the free market reign and leverage competition is the best approach. Allow individuals to fill their prescriptions from any pharmacy located in countries where there are reasonable safety standards such Canada and the EU countries. The FDA has for too long been a barrier to Americans obtaining safe, cost-effective drugs. Moreover, the regulatory overhead for US drug companies to get approval for new drugs is way too burdensome. Every time an individual takes a drug there is a risk which will never be reduced to zero, but individuals are denied potentially life saving drugs, some approved in Canada and the EU, because the FDA hasn't yet approved them. Insurance companies should be required to cover them and the legal liability of drug companies should be reduced if they made reasonable efforts to ensure the safety of their drugs.
2
This is purely a product of American Capitalism/Democracy, where drug companies use their money and influence to make sure the laws favor them. The result is laws which make no sense, except form the point of view of those that profit from them at the expense of the masses.
4
Idea; use some of the marijuana tax profits to subsidize the costs of Rx drugs? This way, every state could move towards its legalization, as it would be providing a much needed and larger good. Oil states could do the same.
Here's where the real problem lay; "Its use waned in later decades as the drug industry’s influence over government grew." Second half of that sentence in case you missed it.
Isn't this where most of the problems with our public health concerns originates? Be it Rx drug prices or clean water, air, or guns. Any of the obvious and nuanced problems with these concerns all comes back to how much influence Industry has over our Gov't.
No matter what the problem these days, the source of the blockage for doing something meaningful is because our Gov't is acting as advocate and bully for Industrial concerns over the citizenry.
The production of guns outweighs the public health concerns of gun violence. Proper food labeling gets shot down, because it would burden the manufacturers as they attempt to hide less than desirable ingredients in their products, added only to "addict" consumers. Auto emissions standards are deemed anti-competitive, so they are rolled back. (despite contrary evidence) Toxins are allowed into our water and air supplies, their levels permitted to rise so not to cramp production or hinder competition.
US consumers pay the costs of Rx R&D, while cheaper generics are available everywhere else. And its a crime to go get them!
3
The same totalitarian capitalism that gave tax breaks to manufacturers for moving offshore, decimating the industrial states, is also encouraging a for profit health system that costs three times as much as most other developed nations, and for worse outcomes.
A government that runs on money is no more concerned with the public good than a corporation that runs on profits.
We need mandatory public campaign financing so government works for the people and not for the money.
14
Why is there so much general agreement to regulate cost of prescription drugs? Retail prescription drugs make up 10% of health care costs compare larger cost drivers such as physician and clinic services: 20%, and Hospital care 33%. Regulating all cost drivers would make health care affordable to all.
6
@J Stuart
I don't know where you got your numbers, but they sure don't apply to me or any of my acquaintances. Were they provided by BigPharma?
I don't know what is so crazy about the US government making drugs itself. If nothing else, set up facilities to make insulin Diabetes is one of our major health problems, and overcharging for insulin is equivalent to killing people. If the US began making the old-time generic drugs at cost, it would both save all of us money, and it would put the drug companies on notice that we would not tolerate exorbitant price inflation in the US.
6
@Kathleen Supply and demand is what drives insulin prices higher. Diabetes (type 2, in fat adults) is the fastest growing disease in the world. Two thirds of US adults are overweight or obese, and many are on their way to getting diabetes. The Standard American Diet (SAD) they consume is proven to promote obesity and insulin resistance. Though adult-onset diabetes is readily prevented and reversible at its early stages through the right diet (proven through multiple scientific studies), nearly all such people either don't change their diet, or they eat the ineffective diets promoted by government and medical organizations like AHA and ADA. When the vast majority inevitably "fail" these first steps, the next steps are oral diabetes drugs. These don't stop the disease process, they just control the immediate symptoms. "Patients" learn to "live with diabetes." Now they're hooked. As diabetes slowly but inevitably progresses, insulin is soon to follow for many. Tens of millions of adults now consume insulin daily. This requires myriad doctor visits, tests, and medical procedures, and ultimately hospitalizations, dialysis, and other "lifesaving" treatments--the lifeblood of the disease industry. Now imagine the insulin manufacturers receiving all these orders. Should they raise their prices, or lower them, to keep up with the demand? Hence, prices can go in only one logical direction: up.
1
When considering the many the political and self-interest driven factors that keep US drug prices high let's not lose sight of the cultural elements that support the current system. For example, one of the consequences of so many Americans considering healthcare as a privilege and refusing to "pay for other's" medical expenses via taxation (Medicare for all notwithstanding) is that tools widely used elsewhere, like cost-effectiveness assessment, are a non-starter here since they entail a societal perspective. We live in a Country where individual patients expect all assessments and interventions to be made available to them at a time of illness, irrespective of the likelihood of benefit or even appropriateness. Worse, the courts support such expectations as do healthcare providers who benefit financially from overuse of medical resources. Finally, the hysterical over-reactions to safety concerns mean that US manufacturers are able to use scare tactics to limit the uptake of imported medicine. Until the culture changes the structural incentives in the healthcare delivery system will continue to keep prices high.
2
A good deal of drugs costs are due to the cost of TV ads for prescription drugs.These ads use to be forbidden. Return to that practice, and we could lower the costs significantly.
3
@medvedenko
where's the evidence that lowering ad costs would reduce prices? they'd keep the profits.
3
@medvedenko TV ads for prescription medications are a relatively new phenomenon that arose because the government outlawed the longstanding practice of pharmaceutical companies marketing directly to doctors. Your proposal to limit their freedom of speech would do little to alter demand or cause prices to change. Sounds like something a politician would latch onto.
Fascinating discussion.
Obviously, the laws not allowing Medicare/Medicaid? to negotiate drug prices should be rescinded.
And with our current brand of predatory capitalism we all know that the market is the only thing that is real.
Again, Congress has been asleep at the wheel for a long time and maybe it's time to say bye-bye to all the old geezers-- in for more than 20 years. Overall it's not a great record on things in general... Use 1999 as your starting date.
4
As long as healthcare is treated as a business drug prices with subject to the markets
8
@James
Not only is healthcare treated as a business it is truly a very big business. Much monies to be made by all involved, certainly it has nothing to do with health nor care.
Unfortunately, this is a dialogue America resists and too much money flowing into the hands of our Legislatures as well.
3
We are being taken advantage of and being robbed by the drug companies and the high cost of drugs in this country. I do not take drugs for pleasure. I take my drugs to save my life. I am thankful that these drugs are available for me to rely on. But it is a disgrace to our country that people should have to go to Canada to buy a life saving drug such as Insulin because they can't afford to buy it here. Something has to be done about this and it is up to our government to stop this industry from gouging the public.
8
There are three separate issues here: 1) the high cost of patented medications without competition, 2) the high cost of patented medications with (theoretically) lots of competition, and 3) the high cost of generic medications with (theoretically) lots of competition. Patents should not be much of a factor in the latter two situations, because their are equivalent products on the market made by other manufacturers. Clearly, there is a total breakdown of the free market process even for generic medications that could be made be dozens of different companies. I have yet to hear a cogent explanation of why that is. This is what needs to be investigated.
1
@Dermatologist The free market breakdown can be explained by of the lack of transparency in drug pricing, the lobbying power of the pharmaceutical industry, and the balkanization of the insurance industry so that lots of smaller entities are attempting to negotiate prices with a behemoth (the pharmaceutical industry) who spends huge amounts of money paying for politicians' campaigns. No surprise then that our laws are effectively determined by the industry to suit their profit motives.
3
Based on this article, governmental rules relating to drug pricing are a conflicting and incomprehensible mess. The problem would appear to be a second-rate government as much as anything else. Maybe we should just copy the Canadian system. Their drug prices are a fraction of ours.
8
Medication in Canada is free for senior citizens who only receive the federal pension (15,600$ / yr) as well as children under 12 and people on welfare.
All others pay a maximum of 95$ per month (58$ for retirees), this amount is paid only when a prescription is filled and accounts for 50% of medication full price (25% for retirees). Everybody have a credit for what they paid during the year when they fill their income tax.
The medication is bought by the government (at provincial level) to obtain the lowest possible price.
6
@Wentworth Roger No!. That's far too sensible and clever to be adopted here in the USA. Remember we are an exceptional country - somebody has to make a profit and somebody else has to get hosed for a deal on medications to work properly. If we did what you describe we would be just like all of the other countries where people pay sensible prices and live longer. That can't be right can it. Remember America is Great.
2
@Wentworth Roger
Isn't that the same as Soviet communism and will ruin our country forever? The American way would be to double all prices immediately, help drug CEO's make even more for doing nothing, and let the inevitable benefits simply trickle down, as it has for every other part of our economy.
1
“Price drugs based on the benefits they provide.”
All very well and good, but how do you evaluate “benefit?” If a drug helps patients with rare diseases, does that mean there’s little benefit because there’s little need. How do you measure quantity over quality? I ask because large corporations operate on the theory of economies of scale.
What about individual differences? Some patients benefit greatly from some drugs while others have adverse reaction or side effects. Just in today’s paper the article on bipolar II caused a flurry of responses from both doctors and patients indicating that diagnosis is so complex that patients must often try a medicine cabinet of drugs before they find one or more that work.
And then, of course, there are the patients who respond well to drugs prescribed “off-label.”
5
@EAK
Drug prices are based only on profit. Benefits have nothing to do with pricing.
1
We need to revise the incentives of manufacturers without destroying the incentives for drug development which is highly risky. The primary abuse in the system is when a drug is under patent protection which affords market exclusivity to the patent holder allowing that organization to charge notionally any price the market will bear.
1) Stop patent abuses
There are a number of abuses of the patent system that can be stopped at the door including new formularies, new uses, combination with other products.
2) Stop low adoption pricing and then once behaviors are set rapidly raise price - This could be significantly influence by the equivalent of price growth caps. Considering that the vast majority of drug investment is front loaded and the actual production cost is low, then there should not be material reason for price appreciation. Cap drug price increases to an inflation index while under patent
3) too many drugs are patented but provide minimal benefits to existing on and off patent solutions. Force public disclosure of price and efficacy in advertising & doc promotion to alternative solutions e.g. "XYZ provides limited effect on LDL levels except for the following circumstances and costs 3x the average price of on patent competitors and 8x the generic competitors".
3
@Chris
For profit organizations are risk averse and attract the least talented scientists, talented researchers are risk takers with a limited interest in getting rich.
Research and development that really occurs is supported by basic research grants in universities and research centers. Put the money there and keep the patent rights in their hands, rather than handing them over to your corporate supporters.
The Most Favored Nation approach is sound and easy to implement. MFN is required already in most Federal government procurement contracts, but probably needs to be modified for international pricing of medicines. Perhaps an average price of ten developed nations.
1
Ok, this will likely be one of the only times I agree with this administration’s actions.
I don’t agree with all the editorial board’s suggestions though.
I don’t think only covering the most effective drugs is going to be a best practice. For instance, what if only one of the three insulin manufacturers is covered significantly better than the other two. They are all supposed to work the same, but actual patients notice a marked difference in dosing and timing reaction to particular brands. It’s a nightmare when diabetes patients deal with non-medical switching.
Yes, use international pricing indexes. Yes, involve the long delinquent FTC to stop the obvious price fixing schemes between the big manufacturers. Check out the way the 3 insulin’s have increased in price in lockstep several times per year for the last decade. Yes, to seizing patents and yes to the government actually producing generics to be available for live saving meds at cost!
This is a true crisis in the US. No one should die because they can’t afford insulin or an epi-pen or Truvada. Period. We could afford these at retail, out of pocket prices 25 years ago.
3
90% of all prescription drugs taken by Americans are not necessary, do not contribute to quality of life, and do not extend life.
Most that suffer from diabetes are overweight. Most that suffer from high blood pressure are overweight.
5
So the editors agree with what Trump wants to do about drug prices but say that his actions are too slow. I read carefully to learn why no prior Administration has done anything. It seems that Trump, unlike his predecessors, doesn’t have ties to the drug manufacturers and doesn’t receive campaign contributions from those companies. Of course the drug companies didn’t want Trump elected because if he follows through on a promise to control drug prices, their profits will plunge. It will be interesting to see which Democrats support lower drug prices and anger their campaign contributors.
4
@Richard Winchester So if Trump is somehow going to do something, why hasn't he done it? Too busy golfing, right? One problem is, he sees the stock market as a scoreboard for his imagined success with the economy, so he's deeply afraid of breaking the market's momentum. What's likely to end up happening is: very little. But I'm sure Trump will be talking up his accomplishments in this area whether they exist or not.
5
While there is a lot of hand wringing over this question, it's fairly simple; business schools have taught all their MBA students that profit and growth are the only thing to value in a company. Those former students now run all of the large businesses in this country.
Anything that gets in the way of profit and growth is derided and then left out of the conversation - wages, the public good (aside from charitable donations that keep their taxes low), employee satisfaction and even basic integrity have all but disappeared from corporate strategies.
There was a time when corporations felt more responsibility to the environment that allowed them to operate and thrive. That is no longer the case.
16
@Cayce
I would not blame business schools, we have a habit of discussing everything as a financial cost benefit analysis. It is common to read the phrase "voting against their economic interests" in the NYT, as if someone's values are only invoked when they expect their wallet will be unaffected in the short term.
Our most often-cited climate models use a significant positive discount rate to devalue the state of the world in a few decades - because apparently none of us care if the world melts down once we are old or dead.
Traffic fines often come with sky high costs attached to them, because the idea that courts and police have to try to cover their costs outweighs the crushing effect - including resentment of law enforcement - these fines can have on someone with few resources.
2
One thing everyone should have learned from Obamacare is that the health care industry is much more complex than people realize and there are forces at work that are counterintuitive.
One example became clear during a former AETNA executive's interview on NPR. He was asked about Obama's claim that Obamacare would make pharmaceutical companies compete for hospital's business, thereby driving down their prices. The executive pointed out that Obama was wrong about that power dynamic. It was hospitals who were already controlling that relationship via their formularies. Obama just got it wrong. Backwards, in fact.
Obama also believed that having coverage would drive down emergency room visits. Turns out his assumption was wrong. ER use is driven by several factors, including habit. And since Obamacare was essentially an extension of Medicaid coverage, factors in the Medicaid market played an outsized role in ER usage. Many doctors wouldn't take it, so appointments were difficult to get; hence the increase in ER usage by those newly covered.
Chicago tried something novel. Since homeless patients account for an outsized number of visits, they started contributing to their rent. This way their ER's didn't become de facto shelters. Turns out that ER usage is a local issue. One-size-fits-all federal solutions aren't effective.
4
Lately, with the vast amount of advertising of drugs seen in all media, I've wondered what proportion of their revenue the drug companies spend on advertising. Certainly, raising awareness of the treat-ability of some conditions is a good thing. But there has to be a downside w.r.t. increased costs.
I would love to see a requirement for disclosure of the percentage of revenue spent on marketing by the company making the drug being advertised.
9
"In most other developed countries, insurance regulators and national advisory panels apply an extra level of scrutiny in deciding whether they’re willing to cover a new drug, and if so, how much they’re willing to pay for it. "
Every other developed country on the planet does this. The US does not because like the NRA controls Congress in regards to gun safety, like the "defense" industry controls Congress in regards to weapons policy (selling to Saudi Arabia, and our endless wars for examples), so does Big Pharma when it comes to drug pricing and drug approvals.
Corporations are more powerful than our government in more and more ways. Would you rather be controlled by elected officials who can be voted out of office, or by corporations who answer to no one but a handful of ruthlessly greedy executives?
19
Market forces have been stifled for too long in the drug industry. There needs to be transparency and separation of the generic manufacturers from the pharmacy giants as well as transparency of the money trail on the political level resulting in protectionism. We know that you need at least 4 competitors to dent pricing and in this day of big data it should be easy to spot trends indicating collusion in pricing.
Continue innovation by allowing pricing during the patent protection period but stop the games that allow companies to continue protections by developing new medication delivery methods or tying up transition to the generic market in court. While the pricing of the newer medications is stunning, allowing off-patent drugs to be sold at market prices will have the largest effect on the overall health of US patients as well as the cost of healthcare in general.
4
One of the more irritating pieces of balderdash that Big Pharma and foes of so-called "socialized medicine" circulate is that without unfettered pricing, drug and other medical research would dry up due to lack of profit. What they're really wringing their hands over is a future lack of obscene profits. Money will still go to American Big Pharma research labs and to doctors, but they may have to settle for less than the incredible income levels that they've become accustomed to. This has happened to many industries in the past. The medical-industrial complex is among the last that must face this reality.
9
Correct. Pharma spends more on dividends and stock buybacks than on R&D. They spend more on marketing than on R&D.
Fundamental medical innovation is mostly funded through the government (NIH), whereas pharma research focuses mostly on me-too drugs, variants of existing.
Amazing how people (?) keep spreading lies of how lower prices will affect the drug pipeline or how other countries don’t “contribute” to drug R&D through higher prices.
1
It is highest time for USA to join the civilized world in stopping predatory medication pricing. All options listed in this article for normalizing the prices are valid and must be used. However, one issue has not been mentioned. Is the "anti-dumping " law still in power? Many hears ago it was enacted to prevent foreign companies from "dumping" products on USA markets below price they charged outside USA. That was leading to unfair competition with American companies which were this way pushed out of the market. The imported products were priced then at will since there was no competition anymore. Such law could be interpreted also "in reverse": that it forbids companies to charge in USA more than they charge abroad. Of course now most drug companies are multinational, but the principle stays the same: you cannot charged here a different price than you charge elsewhere.
As to Medicare and Medicaid: the law preventing them from negotiating prices and deciding which drug is worth covering, must be eliminated. For those who do not remember: that law was enacted during another disastrous Republican presidency of Bush. Jr and in fact, he let a Big Pharma executive to write it and Republican majority in Congress obediently approved it. It is time for the patients, their families and medical professionals to do something! After all, they are voters!
2
@Stefan I agree that we the voters should do something. But how many people know or care what Citizens United is? Why did we let this happen? We need to get corporate money out of politics. They buy the elections of our politicians and in return, they get to pretty much write the laws. This has to stop. First step is we have to overturn Citizens United. Second is we need a public option moving to Medicare for all.
2
I lived in the US for over a decade. The first thing that shocked me after moving there was the price of prescription drugs compared to Canada. A prescribed and routine drug I was taking was nearly three times the price in the US. The only explanation has to be excessive profit taking by either the pharmacists or the drug companies.
8
One side of the story isn't helpful.
Hepatitis C is cured and HIV is essentially there, etc etc. Would these results have occurred in a regulated environment? How many new drugs are developed across the globe vs what we invent/discover here in the U.S. Has Canada ever developed a life saving drug?
You state that "someone" should manage the cost of a drug against is importance ~~ it's effectiveness. Euthanasia next?
The "sound and fury" you state will be infinitely louder with the controls of which you speak.
Two sides of the story, please ~~ so we can all be better educated.
4
@tobin
Amen. It all sounds great until you consider the unintended consequences. Unfortunately, "for-all" advocates just dismiss consequences as thought they don't matter. But they do. A great deal, in fact.
4
@tobin
New Jersey just passed "Linda's" Law. This requires that the electric company provide power to homes that have electrically operated medical devices for maintaining life. We needed a law, otherwise, you simply die when your bill cannot be paid.
The new law allows the utility to turn-off power after two months of unsettled billing. It is simply a poor man's death in slow motion.
The pharma and utilities can fight it out for their money.
1
@tobi Wasn’t the scientist who developed insulin Canadian? You know, the one who sold the patent for $1?
The cry of "unfettered capitalism" could not be more accurate in pegging the problem. In the case of health insurance and big pharma, we are hip deep in corporations which make life or death decisions purely on how they affect their bottom lines. While there is a deep reflex in America against "g'ment reg'lations," it's clearly time for the only power capable of fettering, the federal government, to get on the case.
7
Conventional wisdom and the press claim that drug companies develop new drugs with federal (taxpayer) dollars. Yet a recent spate of drug company ads suggest that their own profits allow them to invest in new drug development. Probably some truth in both. But the NYT and the investigative press might explore this a little more and shed some public light on what is the truth. Clearly if taxpayer dollars are used to develop a drug, then the government has the right to limit profit on that drug, on the other hand if this drug was developed using a company's internal resources, they get to determine the price.
Which is it?
5
Actual transportation of insulin from Canada could hardly be a problem - it is manufactured in only a few scattered places already and is transported long distances. Maybe what the author is talking about is duplicating tests or other artificial barriers.
3
Let market forces do their thing. Where there are price imbalances, let arbitrage balance those differences. Where large entities have bargaining power, let them bargain. The pharmaceutical industry has largely been protected from competing with anyone but themselves. And of course, if the government has funded research, it’s time to have the government and the people it represents benefit from their investments. Finally, let the FDA, for a fee, certify the supply chain of overseas entities in order to enable them to export medicines back to the States without an counter argument that doing so is unsafe. Plenty of enterprising entrepreneurs would sign up to profit from driving prices in the U.S. down to levels the rest of the world enjoys. Lastly, boot the Republicans out of office. They long ago lost their religion about limited government and letting market forces do their thing. Instead they simply protect the interests of favored companies/industries and the extraordinarily wealthy.
5
@It’s News Here
Market forces in monopoly capitalism?
I know someone who worked for Big Pharma. He said it was not unusual to see $10,000 bar tabs at company functions. I'm just saying.
4
There is no shortage of good ideas, but our elected officials won’t implement them. The problem is not figuring out how to make the system less expensive for consumers, the problem is not daring to make it the least bit less profitable for the owners
11
@Peter Yes and these highly profitable owners of pharma companies give large contributions to politicians. Funny that our system then benefits them more than it does the voters and the people of our country.
The fundamental strategy of Advanced Racket Science is to continuously increase and compound the complexity of essential systems to obscure fraud, theft and failure beyond any probability of a rational analysis or accurate audit.
That enables the end game tactic; When the inevitable crash is imminent, the perpetrators blame the victims as they sneak away by the dark of the moon with all the loot they can manage.
And that's why the usa doesn't work.
6
USA is a corporate scamming operation. It doesn't work for regular humans. It only works for scammer billionaires and their helpers.
2
At age 84 my prescriptions bought with Medicare Part D cost me $5,000/year. Bought from Canada with no insurance at all they cost me $2,500/year. Bought from the VA they cost me $500. Is this a great country or what?
17
The Editorial Board correctly points out some ways in which pharmaceutical prices in the United State are kept unnecessarily high. In fact, the situation is worse than one might expect.
There appear to be an unholy alliance of the healthcare insurance industry and company executives, the pharmaceutical industry and its executives, large hospital systems, highly paid lobbyists in state and federal legislative branches, administrators of Medicare and Medicaid, patent attorneys in the U.S. and elsewhere, appointed federal judges receptive to Big Pharma, and a well-designed plan to guarantee steadily rising profits.
Nowhere do politics play a bigger role than in the case of Israel’s Teva Pharmaceutical Industries, the largest generic drug maker in the world.
All of this causes great expense to governments, potential financial ruin to families and even the unnecessary loss of life to our most vulnerable fellow citizens.
Donald Trump has awakened to how his past disregard of the problem has become political dynamite. Trump’s deprecating anything Barack Obama achieved – combined with Trump’s zeal to curry favor with a large donor class – has driven him to this point.
It is within Donald Trump’s power to cure many of the problems he has spent nearly four years creating, but vague promises are no longer enough. The culpability of Trump and the Republicans has been unmasked. Absent immediate action, they face a bipartisan wrath of American voters in 2020.
2
No matter which way you chose, you have to assert youself against the influence of the drug companies. Lower costs for drugs means less profit for them, and they will fight against everything that could do the trick.
Trump doesn't seem to be the one that is willing to fight against these companies, I wonder if he really allows distributors to import drugs from canada - but I hope that he once keeps his promise.
2
Colleges and graduate students should participate in our economy as R&D laboratories. The colleges enter into licensing agreements with private or semi-private (governmental) companies to market or sell the products to the government because we have migrated to Medicare for All.
I take that back. Marketing and business students can pair up with the R&D to license, sell, and distribute.
Regardless, because of the lucrative licensing agreements, students will be able to eliminate student debt and colleges could make enough money to drastically lower or eliminate tuition for all students.
They would sell at reduced prices to the government (a Medicare for All situation).
Hence everyone wins except the drug manufacturers and private health insurers, who could exist, but they would be out on the fringes, selling exotics or unusual, or extremely expensive healthcare.
It is EASY to eliminate the drug companies. It’s is even EASIER to eliminate the private insurers.
And it is EXTREMELY EASY to reduce or eliminate college debt for our young people.
ALL IT TAKES IS WILL. And the ability to think out-of-the-box.
1
I am a committed believer in the free market system, but that system only works when buyers and sellers have roughly equivalent bargaining power. The American pharmaceutical marketplace is clearly not such a market, and therefore I fervently hope that your suggestions are adopted as soon as possible.
6
@Harry Medications are a "critical necessity" required to survive or thrive, which means the principle of "supply and demand," the mechanism that keeps pricing reasonable in a capitalist system, does not apply. The principle assumes buyers will voluntarily refuse to buy when prices are too high, which a person cannot do when a critical necessity required to survive or thrive is involved. I explain this, and provide the solution, in my book "Repairing America's Democracy."
2
There should be a law that our elected leaders (not career gov. employees) compensation should be exactly what we give the poorest of our society (bottom 25%). The president and congress will get food stamps, medicaid, etc. If they want more they have to give it to the bottom 25% too (and figure out how to pay for all of it, not just their part) Oh and they can NEVER work for any industry that directly lobbies the government after. Basically gov employee for life. But the idea would be that they would get a step up in pay when they transitioned from elected office to career gov employee.
I think this would solve a lot.
2
@zak
Nobody will want to run for public office.
1
I looked for mention of the fact that the United States if the only country that allows advertising of prescription drugs on television. We all know that television advertising is expensive.
Who pays for the advertising? My hunch is that we, the consumers bear the brunt and that that is a strong reason why drugs in this country are so very much more expensive than in other countries. Producers of TV show would probably resist giving up the revenue. It is always more difficult to take away than to never give in the first place.
5
@Arden Drug companies spend more money advertising drugs on TV than they do on R & D, most of which is done by the federal government = to the tune of $36 Billion annually. Drug companies should be required to invest the money they spend advertising on R & D.
3
New Zealand also allows advertising
The combination of artificial government sponsored monopolies (i.e. patents), and the extreme inelasticity of demand for crucial drugs, creates a classic market failure. The solution is for the government to not only sponsor basic research (which it already does to a modest extent, but to also sponsor drug development and testing. Drug companies can do the actual research and testing under contract; but they would have no rights to patents. They would also be free to conduct free lance research in hopes of getting a patent-protected drug. This "government option" would be a perfect complement to "government option" health insurance.
4
Allowing people not yet 65 to buy into Medicare and a national expansion of Medicaid eligibility, combined with giving Medicare and Medicaid authority to negotiate prices with pharmaceutical companies, would require both Pharma and medical insurance companies to compete with public health care in the marketplace. In my judgement, this would be the most effective means to approach health care for all and exert control over the costs of health care in the US.
7
I have come to the conclusion that our Congress is bought and paid for and the pharmaceutical industry is one of those buyers. They will be allowed to charge what they will until we have publicly funded elections which means there will be no relief for the public in the foreseeable future and perhaps never.
13
Sure, there's several things that Trump could do to help rein in drug prices. But you'll have to wait while he checks with his accountants first, to see how it will benefit HIM.
7
Why not have something on drug prices like those being suggested for medical insurance .. public option?
Neither the democrats nor the republicans want to address this, though the public overwhelmingly support lower drug prices.
In fact, I believe our country needs to go to single payer. I think it will eventually, because that is the sensible destination for a first world country, assuming we remain first world.
Even on the insurance side, the democrats and republicans give their lame excuses against single payer.
The democrats promise us public option instead.
This is like my U driver suggesting me, "I cant go where you want to go, but if you can go where I want to go, I can take you there for a triple surge fare."
The republicans do not even want to talk about it.
This is like my U driver suggesting me, "I don't think you should take a ride, because it is always rush hour, and you can't can afford it."
All I am saying is, just take me to where I want to go .. single payer.
6
Price transparency and competition work in a supermarket. Why can't they work with big pharmas? Health regulations apply to supermarkets, not price controls or flow controls. The president is moving in the right direction on this issue and the public ought to support him. Knocking drug imports from Canada or any foreign country is tantamount to disallowing competition.
4
@Gene, the president isn't moving. Please please notice that nothing. has. been. done.
I can't believe he's considering an executive order to import insulin. I also can't believe his cult followers have forgotten their utter outrage at President Obama's 'ruling by fiat'.
Gene, trump is NOT moving anything but his lips. After more than 2 years, after a campaign where he promised YOU instant health care that would be 'beautiful, just beautiful, believe me, believe me.'
What if Canada were to disallow export of insulin? They don't make enough for the U.S.A.
Why should they? If it doesn't work out in the real world, trump will do nothing except hate on Canada.
There are REASONS and FACTS that make importing our insulin a difficult idea. How about some of the ideas Democrats have offered? Is there any way you would consider looking at them? If the behavior of trump supporters is any indication, I'm thinking no.
By the way, grocery stores do not engage in good business practices any more than big pharma. Example: Large chains and their egg suppliers don't want competition from organic/free range small farms, so they actually take a loss to keep THEIR egg brands at $1.99 a dozen, while the competition sits there at $4.99.
3
Is Trump serious or just extorting money from pharma for his campaign?
Remember, he has done nothing for regular people in 2.5 years. Zilch. Nada.
3
Drug prices are high not because the industry is greedy but because private industry always has the goal of maximizing profits. A CEO who was not ruthless about charging as much as possible would be fired instantly by the investors. Patent restrictions are worthless since the drug cartel sets unaffordable prices for many generics as well. The FDA is worthless because most of its budget comes from bribes from the industry it regulates. The only way to reduce drug prices is to control them, as almost every major country already does. Medicare needs the authority to set prices it will pay, and we need Medicare for All.
8
Those CEOs can afford to be egregiously ruthless with pricing as there is no competition. We now have drugmakers with exclusive generic manufacturing agreements, subverting the entire process. How the law even permits this is beyond me, but there it is.
1
@rbyteme The law permits this drug pricing because the drug manufacturers give large campaign contributions to politicians which they are allowed to do under Citizens United. So the politicians essentially allow the drug companies to write our laws.
Patents on drugs give the pharmaceutical companies a long term monopoly that allows them to not only recover their cost of development (for that and other drugs) but then continues beyond that recovery and allows them to reap massive profits from some of the most important drugs.
The idea of using the pricing in other countries is a good way to set the threshold. The penalty for exceeding those thresholds could be an initial loss of the patent extension afforded to drugs. The second penalty could be loss of all patent protection.
6
So long as money equals free speech, so long as politicos must beg funds to run their costly lengthly campaigns, so long as elected reps are beholden to and dependent on major donors, ever at the expense of the voters they only fraudulently if ever represent, there will be no progress on this or any other issue which pits private profit against citizen interests. As all well know.
Sanders / Warren 2020.
9
@vishmael Exactly. The Times suggests a patch to fight the symptom (high drug prices), ignoring the root cause.
Pharma will just find workarounds or other ways to safeguard their profit and politicians will support them... or else no campaign money or worse, campaign money to a challenger. Nice Congress seat you got there, it would be a shame...
3
@vishmael
Railing against a system isn't the same as being able to change it. Neither Sanders or Warren will be able change the system. A plan is meaningless in Congress. Time to differentiate between wishes and action.
3
@AACNY - Was supposed to add that Sanders / Warren would need retake Senate as well else continues McConell's treasonous reign. As all well know.
The politicians support higher drug prices for two reasons. The Pharma companies are part of the ‘donor’ class for the politicians and the politicians support Pharma’s claim that regulation will inhibit drug development. The second claim is a specious argument that is not supported empirically or by any other measure.
8
It seems that any discussion on drug pricing must also include a discussion on the impact of regulation on new drug technologies. Foreign countries’ regulations is a great reason for the disparity in drug cost, but also a leading reason that the US leads the way in drug innovation. It seems that trade deal negotiations are the place to deal with this, essentially getting the free-riding countries to pay-up for new technologies. Agree with the idea that the US government should have a greater say in pricing for drugs developed with federal funds, and with the idea that Section 1498 can and should be invoked in specific circumstances. However, the first place I’d go is negotiating trade terms that diminish other countries use and pricing of new technologies.
4
@James The US does not lead the way in drug innovation, this is a Pharma marketing myth. Many drugs are available in other countries first, and many of our new drugs are developed with tax dollars.
8
So, why the Big pharma is selling these new technologies to other countries for lower prices? They have a patent, why would they charge other countries higher price and just refuse to sell it for less? Isn't because even with lower prices their profit is quite comfortable?
1
@James
Definitely don't want to throw the baby out with the bath water, which is what destroying our pharmaceutical industry will do.
1
It is obvious that single payer (Medicare for all) will lower drug prices. We also need to ban TV advertising of drugs. The US is one of 2 countries that allow this travesty.
We have a corrupt government that prefers to represent the interests of corporations rather than the electorate. We have a Secretary of Health (Alex Azar) former CEO of Eli Lilly who under his tenure the price of insulin tripled!
Hopefully voters will make better decisions in 2020.
12
@Dan
It's far from obvious. When the government gets involved prices also go up. Just look at college tuition. It ballooned after the government got involved in student loans.
2
I believe I read that the drug industry has one of the largest lobbying efforts in the country. Wow, I wonder if that could somehow be connected with the phony patent laws, the fact Medicare can't negotiate prices like in other countries, or that drug makers are allowed to suppress the entry of competing generics without incurring oversight. Those steps all involve Congress, and Congress talks with the lobbyists. Hmm, maybe there is something there. Do ya think?
12
The drug companies are not regulated by design. They are of the ‘donor’ class of GOP favorites.
12
@NOTATE REDMOND I agree unfortunately some Dems are on the take as well. We need more than just Democrats. We need Justice Democrats.
1
@Dan Woodard MD it is our system that puts politicians on the take, not republicans or democrats. Where were we all when Citizens United was approved? We need to get corporate money out of politics! We need publicly financed elections so that politicians don't need to take corporate donations.
I worked for an advertising agency that specialized in working with pharmaceutical companies and I can tell that one of the major factors in high prices (besides knowing that they can get away with it) is the enormous amount of waste within their corporate processes.
They spend huge amounts on unneeded market research testing countless concepts, travel, branding, etc. and they change their minds so often that many projects have to start from scratch. In fact, many entire campaigns get scratched at the last minute after millions of dollars was spent developing them.
The brand managers are all chasing the next promotion and they don't really care about costs. There is a widespread "use it or lose it" mentality about budgets. If they don't spend the whole thing that year, they will get less next year. Ad agencies love this and they make up busy work towards the end of the year to help their pharma clients spend freely.
There are legitimate R&D costs that they deserve to recoup and only 1 in 10 drugs make it to market but they are swimming in cash and spend like drunken sailors.
17
@Gofry
They are flush with cash, which leads to waste. I recall my days as a management consultant with many large pharma clients. They loved to pay consultants.
1
Is not the reduction of drug prices one of our Mystic(obscure thought or speculation) President’s platform promises?
1
@NOTATE REDMOND Yes he has FOUND THE SOLUTION at least three times already.
The Pharma industry is nothing more than a RICO operation in plain sight.
Pharma prices are high because they are suppose too . The FDA and all of Congress who take money from them are in on the game.
Remember before Pharma was in the advertising business? Think the newspapers are going to report on one of their last paying advertising customers?
Should all ads and commercials state that the CEO made $27 million last year, that the drug cost .20 to make and was not invented by the company, that it is $1.50 in Canada BUT it is $2700.00 here in the US. Think that marketing plan would work?
The Congressman who gave the Pharma industry a 2 billion dollar payday and then left and was given a 2 million dollar consulting gig.
That is how things work.
24
You left out dealing with the pharmacy benefit managers (PBMs). They are at least as responsible for the high prices as the drug companies. They decide which drug is on the formulary & demand significant discounts, thereby creating competition to raise prices and then give bigger discounts.
To only blame drug companies without also blaming the entire drug supply chain is naive and does not solve the issue. We may know the drug prices, but we don’t know the true drug costs. And until we do, we cannot make rational policy decisions.
9
@Harry Gewanter In countries with drug price controls pharmacy benefit managers are not needed. They are just there to help the health insurance industry make even bigger profits.
1
@Harry Gewanter You know the true cost of drugs. Just audit the particular drug company's books to get their profits then divide this by the number of drugs sold and you have the true average cost. You can get finer detail by individual drug by looking at the internal costs for that drug.
One area of drug pricing which illustrates the difficulty of controlling prices is biosimilars. These are drugs which are produced, simply stated, by biological processes rather than chemical processes, as other drugs are.
see: https://en.wikipedia.org/wiki/Biosimilar
Biosimilars are used to treat various illnesses, diabetes, particularly. Almost all insulin sold today are biosimilars. And although biosimilar insulins are cheaper than branded insulins, they are not that much cheaper. Indeed, not cheap enough, some would argue, to justify the change. One reason is that the cost of entry into the biosimilar market is high, for various reasons, so the maker dose not have to fear competitors (like chemically produced generic drugs) so they can charge whatever they can get.
In my case I spend thousands of dollars a year on two types of insulin even on Medicare. When my PCP doctor suggested I check out a new FDA approved biosimilar insulin I found that it was not that much cheaper. Anyway my endocronoligist said it was not for me, (for whatever reason, I did not ask).
2
But wouldn't it be true for other countries as well, and yet the other countries managed to have the prices lower?
If you want to understand why drug prices in the US are so high answer one question: Why did the law creating Medicare Part D forbid CMS from negotiating drug prices with pharmaceutical companies?
67
@Jon Tolins - Because these plans were operated by private companies who were thought to be the most effective in negotiating prices.
4
@Jon Tolins Because Pharma spent $100 million lobbying congress to stop them.
16
... and why do those in Congress pretend that it cannot be repealed?
6
Bargain with the drug makers on behalf of everyone (everyone must be charged the same). That's called a monopsony, and it is normally illegal under anti-trust law, but that is how the rest of the world bargains for drugs. There's a British system and a German system, and many others. Any of those will do.
Yes, R&D spending will suffer, but drug makers have been producing fewer and fewer drugs with more and more money for decades.
8
There is no need for R&D to suffer, if Pharma could not advertise it directly to customers, they could decrease spending in advertising and redirect it to R&D.
3
I can't understand why there isn't greater outrage among the general public at the enormous costs of drugs in the US. Shaming drug companies has brought some temporary concessions in pricing but only for the short term before resuming their climb. Our politicians need to be brought into the circle of shame as well. There's money to be made from the drug companies and I'd like to see which politicians are getting what. Who's profiting from Big Pharma needs to be in the limelight constantly. If we treat this atrocity of ripping off the American public by drug companies and the people who allow them to get away with their robbery as we do with the reporting of deplorable migrant conditions at our borders, maybe then we'll see more pressure on the government to act. In the meantime a quick response and an effective one would be to lift all restrictions on the government (medicare, medicare and any related government connected health insurance) to negotiate drug prices with the drug companies.
9
@Dan
One argument is that patients are totally removed from drug prices. Most have no idea what their products actually cost, except in rare cases where their drugs aren't covered and they have huge co-pays.
Being forced to include prices in their advertising is an attempt to close this gap.
3
There is outrage but nobody is listening
1
It is pointless to present these plans when the problem’s root cause is not addressed.
Specifically, our government has ceased to be responsive to the public interest.
It is depressing that the public has become resigned to the distortion of the general good caused by lobbyists, corporations, PACs, etc.
These distortions are never called by their true name, corruption. Instead, it has become institutionalized.
In a rational world there would be a relentless, shrill outcry until it stopped. But it has been normalized.
As a first step, there should actions to reverse the effect of the Citizens United decision.
38
Indeed. Failing to do so will just lead to pharma succeeding over time to deregulate, reverse and renege on their new rules. The system is on their side.
2
@Bongo there was never a travesty worse that the one that john roberts played on the american people than by naming his decision "Citizens United", when clearly it put money in politics to its utmost degree. remember john roberts for this, alone,
2
I vote for blowing up the patent system, and starting over.
Patents create government enforced monopoly power. It is not only the major cause of our ultra high cost of drugs, it is a major reason for the rise of oligopolies in the U.S. which underpin our income and wealth inequality problem.
The current patent system is not based on academic economic studies but on tradition and negotiation. Its structure is arbitrary. Its implementation marred by the revolving door between patent examiners and the law firms whose clients applications they approve.
3
If I can legally buy Canadian beer, maple syrup, cars and virtually every other product that you can think of why should Canadian and other foreign, legitimate prescription drugs be prohibited to me?
26
@MIKEinNYC Unfortunately drug mnufacturers would simply refuse to sell to Canadian pharmacies that export to the US. Drug companies make far more from the US market because of rapacious prices and would drop sales to Canada completely if necessary to keep their US prices.
1
In Canada, Provinces negotiate pre define prices and quantities (statistically you know how many people will have hypertension). By setting these up front, it lowers the manufacturing costs.
Why not allow states and provinces to team up on these negotiations? Michigan and Ontario, or Quebec and NY?
While the federal government is key, why is California doing not anything about this? They are the size of Canada and have a progressive Governor. Heck why is LA and NY not doing this?
It's easy to blame the Republicans, but Democrats need to look in the mirror - single payer systems can be set up at the state level. And California and NY are totally controlled by the Democrats. What's stopping them?
7
@Tom it absolutely does not lower manufacturing costs, and drug manufacturing costs do not contribute significantly to their prices. Quebec's drug plan is monumentally badly designed and wastes billions every year. And Canadian drug prices are at least 30% higher than OECD averages. Canada is NOT a model be followed by anyone.
2
@Sallie ..... Except by the USA !!
Most-favored-nation pricing would be a good place to start - and end up...
PS
There is probably no single arena that more demonstrates to the rest of the world what an institutionally corrupt and predatory governance our government has become...
7
At the heart of this problem is our campaign financing and lobbying laws as well as the swimming door between government and corporations. There is little doubt that that corporations and great wealth have been able to play an inside game with regulations, tax policies, court packing, and antitrust regulations. Both parties are to blame, although the GOP has been most rapacious. But citizen indifference, lack of interest and preoccupation with controlling the life choices of others is at the source of the problems.
15
The whole idea of using "market forces" to drive down the cost of prescription drugs, or medical care generally is foolish and wrong headed thinking. Patients who need medicines, or medical care are not in a position to bargain. I hear politicians and pundit patiently explain that if patients knew the costs of a certain medical procedure or test, and could compare those costs form provider to provider, that patient could choose to go to the less expensive. the same, they say, is true of prescription drugs. Patients can choose to take lesser expensive drugs if they are aware of the cost. These are foolish arguments. Prescribed drugs are chosen for the effectiveness in treating a particular patients with a particular condition. That is why we have doctors. To make choices in drug therapies that work. Patients have little real knowledge or choice. As far as using cost to choose a surgical procedure or test, outcome should be the measure. Not cost, and the outcome , that is the quality of the care provided and likely hood that it will provide a cure should be the main factor in making any medical decision. If hospital A offer a knew replacement at $500.00 but has a 50% failure rate, it is not a good deal compared to hospital B that offers the procedure at $2000.00. We need Federal regulation and management of cost. It is that simple. Medical care should be managed just like a utility with regulatory panels set cost and service.
7
Why don’t we just do what the other countries do?
8
@Independent because every American problem requires a uniquely American solution; because of slavish adherence to the notion of a 'free' market; because of the industry buys the best politicians money can buy; because of your political system which allows members of congress to vote according to who pays them the most instead of according to the party platform and their election commitments (whereas in a parliamentary system they would be thrown out of their party);because the US is incapable of learning anything from any other country and instead of adopting what others have done sets out to destroy their systems using trade 'agreements'; because the USTR threatens countries that take rational approaches to regulating drug prices using the Special 301 process; because Americans are constantly brainwashed into thinking they have a high standard well functioning health system and the rest of the world is freeriding... need i go on. It's time Americans woke up. You want be slaves to a venal industry? Go right ahead but leave the rest of us alone to continue improving our systems and improving our life expectancy, while you continue to go backwards
1
@Sallie
Well said.
Too many Americans are brainwashed.
Or maybe just plain don't know.
Her's another thought: Ban politicians from getting any money from the drug industry.
25
@kennyg Yes but ban politicians from taking any money from any industry. We need to overturn Citizens United for a start.
3
I did not see this editorial when President Obama was in office.
Did he even attempt a change in health care and drug pricing in this country?
5
@Mike
Obama abandoned the experiment to have doctors consider price when prescribing because of pushback from not only pharmaceuticals but also from doctors and patients, who were concerned with doctors trying to cut costs.
4
@Mike Obama was in favor of adding a "public option" ie something voluntary Medicare, in addition to private insurance. The insurance and pharmaceutical industries who give lots of money to politicians, opposed it and stopped it.
Obama was a moderate.
We need progressives in Congress and the WH.
1
As someone with medication-resistant epilepsy and on a Medicare HMO, this really hits home.
My epileptologist has had me on 3 anti-epileptic drugs (AED) for many years and when the medication cocktail becomes ineffective and the dosages cannot be raised any higher she switches one out and ties a new AED - very simple.
Up until several months ago, I rarely had a co-pay for all three more than $15/90-days. The one I was just put on, without the rebate, has a $1000 copay; with the rebate it's $100/30-days.
There are many AEDs on the market ranging in price per month from $10 to >$4300. Here's an example: https://www.goodrx.com/anti-epileptics
That's just flat out wrong.
4
The price you pay for medicines and office visits applies only to you and the others in your health plan, your employers choices, and the deductibles you choose.
There are so many components to going to determine healthcare costs that there is no way to compare the benefits of two policies.
3
@JimH
As someone on SSD and only able to work P/T as a contractor from home, the $100 copay stretches the budget.
Am not on the ACA but a Medicare HMO; I rely on paratransit for appointments and errands; am so loaded up on AEDs 2x/day, taking naps is a must; sleep has been schedule is run amuck for the last 28+ years.
From a NYT article (2012): "Obama Was Pushed by Drug Industry, E-Mails Suggest...Mr. Obama’s staff signaled a willingness to put aside support for the reimportation of prescription medicines at lower prices and by doing so solidified a compact with an industry the president had vilified on the campaign trail. Central to Mr. Obama’s drive to remake the nation’s health care system was an unlikely collaboration with the pharmaceutical industry."
https://www.nytimes.com/2012/06/09/us/politics/e-mails-reveal-extent-of-obamas-deal-with-industry-on-health-care.html
4
@Observer importation will not work. Large scale importation, assuming supply is not throttled by the industry (which it has threatened) would see prices converge or supply dry up. Anyway do we seriously think that the US govt should let the Canadian govt set its drug pricing policy for it? Besides Canadian prices may be lower but they are still way too high
@Sallie It would have been a force pushing down prices. Most of America's junk comes from overseas already. Why not its drugs too?
Big pharma is an international business, racking up 1.2 trillion in annual sales, half of which comes from the US. Because drug companies can charge whatever they want in the US market, they can sell(or dump)the same drugs to the rest of the world market at a huge discount. In effect, by paying so much, we are subsidizing drug prices and drug research for the entire planet. Forget your trade war Mr Trump, make China and Europe pay a little more their RX needs so that we can pay a fair price for ours.
7
No, we subsidize the Big Pharma profit, while other countries refuse to do so.
1
@yulia Yes and we subsidize their obscene profits because we allow Big Pharma to give large amounts of money to politicians who then do the bidding of the industries who give them the big money.
1
The solution to medical price gouging is easy: national health care. Dozens of other nations have shown us the way. They are healthier for a fraction of the cost.
17
@M Davis : You are right. If the VA can do it for thousands of vets like me, why not for all. The answer is conservative politicians don't want it, because they are making too much money from it.
11
@USMC1954
If the VA can do it. The problem is it cannot do it consistently. It has been shown to have very large discrepancies in service quality across the country. There are many problems with the VA because it is, in the end, a large government bureaucracy. We know how they consistently lose the ability to serve Americans over time.
1
@AACNY I don't have experience with the VA but I am willing to bet that the VA could be much more effective if they were funded properly. But that would involve some people and corporations paying more in taxes and we don't want that do we?
2
This problem is an ideal example of why government lobbying should be against the law. The only reason that drug companies keep raising prices is because they know they have Congress in their pocket. Congress has done nothing to mitigate the drug price problem. Congress is on the payroll of the drug companies. It’s that simple folks and it’s why our system of government no longer works for the people.
18
Those are positive steps. Good for Trump.
1
The Federal Drug Administration enforces drug company monopolies by restricting the introduction of new competitive medications into the market. While there are valid safety reasons for FDA testing, the price effects of creating monopolies is a compelling reason for regulation.
5
One step in the right direction would be to pass a law stating that the US government agencies of Medicare & Medicaid will pay no more than the lowest price offered to any other government purchaser.
8
@Tony Medicare does not pay for drugs. Medicare D pays (extra cost) or private secondary insurance. If you are retired and only have Medicare you are up a creek without a paddle.
The argument from drug makers is that they need the high prices on a successful drug to pay for research for failed initiatives and the next success. But they may spend as much advertising and marketing a drug as developing it and piggyback on public funded research.
Developing life saving medications is good; we have tamed the impact of HIV, cured Hep C, found treatments autoimmune diseases, and for nearly 100 years, kept people who would suffer sure death alive with insulin.
But they are not helped if they cannot afford the drug, afford the insurance to pay for the drug; and get laid off for being too expensive on the insurance roll.
1. Companies should trade off long patents and high marketing budgets. They get one or the other.
2. Demand repayment for public investment in drugs that are priced exorbitantly
3. Pull patents and marketing rights from drugs that exploit the market. (Here I am thinking of drugs like Restasis - patented for ocular use, but around as cyclosporine since 1972, yet priced at hundreds per 5ml bottle.)
4. Trade off limited liability - an injury fund - for the first few years a drug is marketed, in return for low pricing and open drug injury database / communication.
5. Fund competitors for drugs in which the company is milking the market - epi-pens, Nar-can,Shkrelian investments - to make competitive products
6. Negotiate Medicare, Medicaid and all Federal, state employee prices
There are things we can do. We just don't.
15
@Cathy Concerning point number 2, it might be more effective to become '"partners" with these drug companies so as to maximize the ability to capture a stream of revenue from these exorbitantly priced drugs rather than a one time repayment.
2
Funding competitors for most of the expensive drugs is a not practical. Years of research and testing cannot be replicated quickly.
1
Very often they could, because the drugs were on market for quite awhile and research is freely available.
1
Apply a windfall profits tax and use the proceeds to fund federal health and medical research.
Ban lobbying and campaign donations by pharmaceutical companies for politicians. A doctor can no longer receive gifts or meals from frog representatives, politicians should mot be able to do so either.
And how did those laws preventing Medicare and Medicaid from negotiating drug prices get passed?
Talk about corruption!
7
The Dems need to grasp this problem and provide a solution that makes sense. Drug companies do not need to make giant profits, but Dems should not attack it from that angle. The focus needs to be on helping consumers. That will be a win with the electorate and accomplish the mission of lowering drug costs. Basically, each state or the federal government as a whole should decide what drugs cost.
4
@Anthony
These measures are consumer oriented. They try to address the concept of consumer awareness and allow for consumers to make informed decisions. While it may seem counter to many's views of how medical decisions are made (ex., on price or cost), there are people for whom price is a factor.
1
The biggest laugh of the day: we can always turn to Congress for the needed protections.
7
Maine just passed a set of 4 bills aimed at controlling prescription drug costs. One of them puts limits on prescription benefit managers, a costly middleman that has flown under the radar for too long. The other bills improve price transparency, address importing meds from neighboring Canada, and set up a state board to monitor/influence pricing of the most common prescription drugs. I’m hoping we can make some progress!
7
@Cathy Breen
Perhaps a good start. But it seems to me that doing things state-by-50-state only adds to the fragmentation of policy & added confusion & exclusion for citizens who live outside those states that are trying to reform the drug industries. I’m for the federal government producing its own!
5
@Patricia
The problem is that our federal bureaucracy is too big to manage. Do you think Europeans would turn over all their health care decisions to the EU?
1
One of the unspoken principles of the Conservative movement has been to tolerate or even support monopolistic behavior. Nothing will change until the voting population recognizes this as a problem.
18
One word can explain why medical costs and drug costs are prohibitively expensive and unlikely to change in our lifetimes:
Lobbying.
68
Lobbying explains most everything that is wrong with government.
5
And greed!
2
Absent from most drug expense discussions are shareholders and politicians. For instance, fellow Americans with large stakes in drug Goliath Gilead cheered the release of Sovaldi, a hepatitis C drug costing $84,000 for a 12-week treatment. Wealthy drug companies and shareholders in Washington lavish money on Congress. Many politicians speak out of both sides of their mouth when it comes to Big Pharm. Shelf prices of drugs and campaign contributions are not easy bedfellows. Just look at banking, insurance and the NRA for instance. Money talks meaning don't look for solutions from the government.
25
@ralph braseth
Good point. Those of us who are shareholders in Wall Street’s monopolized corporations are complicit in all of this. It amounts to “wealth without work,” something that some of the prophets of old have warned against.
5
@ralph braseth yet Gilead spent less than $200m developing Sovaldi and the $11 billion they spent acquiring Pharmasset (to get Sovaldi) is being amortized as an intangible asset. So they are getting a massive tax deduction to boot.
4
@ralph braseth Gilead has saved millions of people's lives. Gilead stock pays a dividend of 3.7%. While that is a nice dividend, it hardly amounts to exceptional corporate greed. Most corporations are not in the business of saving lives.
Does anyone really think Trump will interfere in the profit making ability of pharmaceutical companies? Are any companies giving back to America after their windfall tax cut? Despite Trump's threats to make them, it just does not happen. How about starting with this: the government buys all the insulin at negotated prices and gets the insulin to those that need it. They demand the price be cost plus, say, 10%. The government did something similar with dialysis and that has worked pretty well now for decades. What would be the life expectancy of dialysis patients today if the private sector was the only option? You don't hear Republicans or anyone else screaming the government should get out of the dialysis business. Trump and Republicans told you 'people will not be dying in the street' but dying from a lack of insulin? That is another matter. For once, why doesn't an American company do the right thing instead of finding the loophole in the law and evading responsibility. Hard for a guy who doesn't follow the rules and doesn't pay taxes because he is 'smart' and laughs in your face to tell others they have to follow the rules. They could give away the insulin and still be filthy rich. Trump is trying to find a way for them to not fix the problem, but make it look like they are. You won't hear him say : We are cancelling your tax break and using the money to buy insulin because you are ripping off diabetics. Nope, it's "pretty please with a tax break on top".
20
@Walking Man. Thank you for enlightening me on the dialysis issue. I had no idea!!
1
I observed a situation recently that was jaw dropping. At the pharmacy I use an elderly man in front of me purchased a very small quantity of pills. He pulled four hundred dollar bills out of his pocket and handed it to the pharmacist. I don't know anything of his financials but I was left wondering about the astronomical markup on those pills he purchased.
15
In Canada seniors don’t pay for prescription drugs.
1
The concept of pricing drugs based on the individual and public health benefit that the drug provides has merit. It represents a first step towards aligning drug prices with a borader movement towards value-based payment. This strategy could be enhanced through value-based insurance design meaning that not only the overal drug price is aligned with net health benefit but that the price (if any) is aligned with what people pay. Equity can be built into this strategy by adjusting these payments based on patient/family income making drug more affordable for those with the least means.
7
@Kevin Fiscella, you think it has merit? Wow, imagine that. YOu do realise that dozens of other countries do this already?
And pharma hosts dozens of resort events yearly for our
poor Congressmen, offering free this and that, oh so exclusive.
And so much money for their campaign financing...
While they cut the budgets for our state universities, where so much of the critical research has produced so many key formulas, which were handed off to Pharma to produce and market and sell to us at obscene prices....
It's simply a disaster- for us the impoverished consumers.
And all of this links up to the other ed today advocating public sector options for everything...how nice.
4
Like much of Trump's life, his approach to prescription drug policy has been all talk. I wish him well in this endeavor, as the country would benefit immensely. But, given his record on implementation of anything at all, success seems unlikely.
5
As a retired executive of one of the largest US buyers of pharmaceuticals, this is a very well researched and thought out article describing meaningful options for bringing drug prices out of the stratosphere. Paying for drug efficacy, limiting patent shenanigans, and being willing to use the purchasing power of Medicare are probably the only way to bring our ridiculous drug pricing into the real world. Unfortunately, with the fact that both parties are regularly bought off by pharma manufacturers’ political contributions, and the observation that our current administration seems incapable of strategic thought or operating in the general public’s interest, I have little hope any of it will be acted upon.
76
@Pete -- Let us give credit where it's due -- to John Robert's Supreme Court, who broke one hundred years of precedent in deciding that corporations are indeed people, too (my friend), and that spending unlimited money on politicians is now, in fact, free speech.
If you wanna buy yourself some Lawmakers, your money is now free to do so.
Lord help us.
3
One side effect of the rising cost of prescription drugs and rising health insurance plans, is that it directly depresses wages. If you work for a company that offers quality health insurance or if you work in the public sector, the ever increasing cost of providing health care has led to paltry wage increases. The argument being, well if health care costs are going up faster than inflation, we cannot afford to give you much of a salary increase. It would be interesting to see how much of the impact of rising health care costs across the board has impacted wages and the rising inequality. And if you are part of the gig economy how do you afford health care at all?
13
Having been involved in the design and equipping of large hospital pharmacies for over 40 years, I have watched the major pharma's extract billions of dollars from our citizens. This article pointing out how the major pharma's have done this will hopefully provide enough stimulus to get action on this issue. When a third world country like Egypt provides the exact same medications that are priced very reasonably and our politicians have been bought off by those lobbyists working for the major pharma's of the world, something is very wrong.
THANK YOU NYT, HOPEFULLY THIS WILL GENERATE ACTION!!!!
31
Very few drugs have no substitutes, and prices are hidden at the retail level. Docs are incentivized to push the latest, most expensive brands. The rise in drugs priced coincided with third party pay, prescription plans were added to all healthcare plans in the early ‘90’s since then prices have gone straight up.
There are many generic maintenance type prescriptions on the market that are much cheaper than aspirin and supplements, they should be dropped from healthcare plans driving costs down further
2
The simplest solution is to start by allowing CMS to negotiate with drug companies. Transparency of pricing is a must as well. Unfortunately big pharma has deep pockets. Trump knows this and I suspect he is rattling his saber so that the pharma lobby will cough up for his re-election campaign. The checks are being written as we speak and as usual, only trump will benefit.
6
@TW
Republican voters apparently don't need medications. Ask reporters to interview Republican voters.
There’s another editorial in the NYT about the “public” option for healthcare coverage, however although the writers present a weak argument for this option by giving examples that evoke negative connotations, such as “public defenders”, expanding government investment in the pharmaceutical industry has the potential to benefit all parties, and most of all patients needing medications.
If the government can establish a cost effective partnership with the pharmaceutical companies in which the government funds the majority of research for new and improved medications, yet profits can be established by a formula, which benefits the pharmaceutical companies after the government recoups the costs of the research plus a percentage equal to the rate of inflation.
Pharmaceutical companies will still be able to completely or partially fund research and the formula for profit taking would be adjustable according to the percentage of investment.
Like many other social issues today, the lack of balance has been tipping the scales like a seesaw bouncing up and down to bricks piled on by extremists attempting increase their political weight rather than balance the scale to improve the “needs” to improve the “quality of life” for all of society to benefit.
2
@MDCooks8` Sort of thinly disguised defense of the pharma industry position’s status quo. The idea that very much of the “research” is actually going toward bold mitigation of disease (as opposed to patent extension and market manipulation) is the cudgel the industry hauls out when they feel cornered. It might be that Trump is populist enough and erratic enough to actually do something this time around—it is in his power. But, as others have suggested, all this might be just more money grubbing for the upcoming political season. Over the last 30 years, pharmaceutical manufacturers seem to be getting more and more bold in their ripoff efforts as they discover how cheap it is to buy either political party.
4
@MDCooks8 Research....blah blah blah! Most big pharma companies spend more on marketing than on research. Johnson & Johnson, for instance, spends twice as much on marketing as research. https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-pharmaceutical-companies-are-spending-far-more-on-marketing-than-research/?utm_term=.8f3366b0c053
Perhaps the only thing worse than the sharp divisions we see in our politics and society are when Democrats, Republicans and Trump all appear to agree. Prescription drugs are expensive according to all politicians but they make up only 14% of health care spending. And the large majority of those drugs are already generic (so stealing industry patents, as suggested by the Times, will have little to no impact on costs). And by focusing solely on 14% of the problem means we will have close to zero percent of a solution. I agree with the Times’ Editorial Board that drugs should cost what they are worth (and probably already are) but why limit that analysis to just prescription drugs, shouldn’t we also scrutinize all aspects of health care spending (the other 86%) which is where the problems actually are?
6
@Steve Projan Wouldn't that be the dreaded socialism?"
Drug prices are the epitome of the problem of healthcare delivery in the US writ large. Each of your recommended fixes entails, at core, the simple and powerful prescription to fix the entire US healthcare system. That is, balance the market power of the buyer with that of the suppliers. Currently, the ultimate user, aka: patient, is at a remove from the purchase decision, and in possession of vastly less market knowledge and market power than the suppliers. Add in the fact that the healthcare industry has succeeded in governmental capture and the fix is in. And until we elect politicians who understand the will of the people that they fix this broken system it will be status quo, and our economy will gradually succumb. The facts are clear - the US healthcare system delivers inferior results at nearly twice the cost of those in other developed nations. And the reason is that in the US buyers and suppliers are grossly mismatched, intentionally so. Follow the money.
4
Governmental agencies should be allowed to make their own generic equivalents of drugs when the prices outstrip the ability of a certain percentage of the population to afford them according to a formula based on median income. It’s the humane thing to do. And there’s no reason America can’t produce her own medicines.
4
The issue of transporting drugs from Canada privately or publicly is not necessarily simple. Insulin for example needs to be refridgerated. The interesting deterent used by Big Pharma is that the quality of the drugs are different from Canada.Which is simply false. Just as there is no difference in Coca Cola or Pepsi Cola bought in Canada or anywhere else...similarly there is no difference in drugs from Canada or many other countries.
10
@Abraham Solomon, MD Shipping Insulin is easy. The industry has what's called a 'cold supply chain' and does it successfully all the time. Therefore, this simply can't be the excuse for not shipping Insulin.
7
@Cal Page
It may work successfully but also be more costly, adding to the expense of production.
1
@Abraham Solomon, MD Many goods that need refrigeration are shipped all the time. As soon as there is a good legal mechanism, let the trucks roll!
When I look around the world at citizens demonstrating in the streets against their government including here in France and in Hong Kong, I wonder why we Americans are not clamoring for decent health care?
Why are Americans so reticent and timid when their government is not delivering basic human rights needs like low cost prescription drugs for all drugs and the same for medical care?
The rest of the developed world looks at America and is astounded at how such a wealthy country can rate so poorly in incarceration, gun control, affordable health care, violent citizens, and disagreement on abortion.
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@Michael Kittle
Because millions of Americans don't believe that their government, which has clearly become too big to manage, will do a better job. Not rocket science.
1
@AACNY
Funny, other countries' governments seem quite capable of doing a good job at this. I guess some Americans are so anti-government and anti-regulation they would rather go broke or die early than consider universal "government run" health care. And why stop at that? How about we shut down that evil government program the FDA? Every citizen could simply carry out their own experiments to test the safety and effectiveness of drugs. Keep those great ideas coming, AACNY.
7
What about the several blood pressure medications that have been recalled for contamination with potentially cancer producing ingredients. Alk of the offending medications were produced in INDIA, where a recent article said that the FDA was forced into planned actions to inspect the facilities of drug producers there??? No doubt these and other medications produced there in India are manufactured for pennies a pill but when sold here cost more than $100 for a months amount of these. You can't tell me the bulk of the price increase is due to the shipping fees!!
And no doubt these are medications developed by US companies perhaps at NIH, aminf others. It adds even more costs to the consumer to be worried about getting another health condition for using a medication intended to help!!! I recently received a very standard medication that had not only two other unknown to me pills not my RX but I was shorted on the number of pills. The intact bottle was given to me at my pharmacy, they did not open it. The pharmacy was unable to identify the two other pills (5 each) because neither their markings, shape or color was in the readily identifiable medications they get updates about.
These quality control issues plus costs are on purpose... I am very angry about this.
5
This is sad but I want to share it. The situation would be deadly if I did not move to Ireland with my Irish wife 3 years ago.
I tried to post this some time back on this subject matter but it was passed over or rejected.
I was diagnosed with prostate cancer and bone cancer November last. It was found after six months of the disease taking hold. So far, so good. If I lived in the states I would now have a little time left to live because my main oral chemotherapy treatment alone would cost $10,000 a month. This does not consider the hormone therapy cost. I'm retired and couldn't afford this even for one month. So I would have to depart, sooner or later.
This may not seem right but you can check on it. My drug is called Zytiga.
As a potential citizen of Ireland I am required by law to have Private Medical Insurance. Though on Medicare it has no bearing here. Private Insurance costs about 1,500 Euros a year. Ireland provides a "Payment Scheme" for residents, and immigrants like my self, which decides a monthly cost for drugs for its Citizens and after reaching this ceiling all other medications (per month) are free. My ceiling in this system is 150 Euros per month. This is for Zytiga which as mentioned is $10,000 per month.
You can see why I might be happy to be in Ireland.
There are many, many predators which prey on our American brothers and sister. And sadly, Big Pharma is only one of them.
Thank you for listening.
60
@leo LaBranche There are programs which give patients $10,000 a month prescriptions for free. I don't know how or why this gets done but it is happening.
@Liz
Patient Assistance Programs (PAPs) for under-insured/uninsured people exist for certain drugs, but patients must meet the guidelines. There are also co-pay assistance programs for those who are commercially insured, but when even the monthly co-pay is huge. I know all about this second one; as an MS patient, my selective immunosuppressant treatment costs just over $7,000 a month. My insurance covers 60% of that, but I couldn't possibly afford the rest out of pocket.
6
@Liz But why should some folks have to pay and others have to depend on the pharmaceutical companies for mercy?
19
In my experience there's always a coupon or some other discount dodge on my prescriptions so far. Pharm guy says the meds cost $500 a month and then says but there's a 2 year coupon for $10 a month.
1
Moving to France at retirement provided improvements in many areas including health care and prescription drugs.
Over the counter drugs and eye glasses are exceptions to the rule and are grossly over priced.
I just had a hip replacement covered by the national health plan and the total cost to me was 60 Euros. The surgeon was brilliantly skilled and successful despite extensive bone damage from arthritis.
A visit to the G P is fully covered by our national health insurance and mutual supplemental plan.
These positive aspects of being an expat plus the beauty of living in Provence make for a tremendous boost to quality of life.
37
@Michael Kittle
In the US every interaction with the healthcare industry
is an opportunity for someone to swindle us.
4
I can’t believe that people die because they can’t afford insulin.
In a David Brooks editorial, he claims that rich people are happier. I find that hard to believe as an essential component of happiness is contentment. The upper echelon of the drug corporations, like most corporations, obviously seem to suffer from an intense chronic dissatisfaction with their financial state to the extent that they will engage in deception and duplicity that causes death and suffering to others.
I know that many people profit from stocks in these corporations so they condemn public healthcare for all. So people die because they can’t afford insulin. Peace of mind is another component of happiness. To feel that your future prosperity is so insecure and tenuous that the suffering and death of your fellow citizens is unavoidable suggest a profound stressed mental and emotional attitude.
Experiencing a level of unhappiness because you worry about not eating, getting evicted, not being able to afford lifesaving medication makes sense to me. When I see corporation leaders and managers and stakeholders behave as though they were under the same duress, I shake my head. Not only are they obviously not happy, they clearly lack any capacity for happiness.
13
Perhaps it might get better if so many in your country weren't so scared of universal gov't health care or "big government" meddling in things to make life easier for people. Yeah, yeah, I know, I wouldn't understand freedom because I'm not American.
But I am free to be able to afford medication if I need it and my government keeps the prices down with our Pharmaceuticals Benefit System. I am so repressed.
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@Anthony Burns
Only when you’re rich, freedom isn’t expensive in the U.S.
3
I can see it coming any day now. It must be coming because it’s been promised so often in the past three decades. It must be coming next week or the week after that, or at least really, really soon since the Trump administration, known for its hostility to destructive corporations, has said it’s coming. Any minute now Americans will be paying the kinds of prices Europeans and Canadians pay. Any minute now we won’t have people dying for lack of insulin or paying the cost of a small car for effective delivery of epinephrine for allergic reactions. Really, I know it’s coming. Americans aren’t going to be dying anymore for lack of the pharmaceuticals that save their lives. It’s definitely coming, it’s right around the corner. I just know it. Politicians keep telling us it’s coming so it must be coming. Tomorrow.
27
@ADN I think there's a 12-step program for Hopeholics.
A look at the names of the thirty companies making up the DJI explains all. Government policy affecting pharma profits would confuse some voters into thinking the economy has gone bad.
5
The idea that shame would influence a drug corporation to decent behavior is laughable. Corporations are sociopaths when they are on their best behavior. Worse when they aren't.
Many of the suggestions here are good starts. But the one that should be on the table was the one identified as "fantastical". The number and types of patents granted to private persons whose work is publicly funded is obscene. I believe all researchers should be well rewarded for their work if it is forwarding basic biological science. Regardless of whether or not it is one that "strikes gold". If any of that work is publicly funded or based on publicly funded work, it can't be privately patented. The very idea of private patents based on publicly funded research has Zero daylight from the notion of stealing from the public.
Further, biological patents of any kind are problematic. If anything is part of the commons, it is biology. Patenting aspects of biology is chipping away at patenting life itself. It is an abomination. The ultimate libertarian paradox.
Another irreducible problem is private companies only seek out Profitable drugs. That necessarily Excludes inexpensive effective drugs. How is that Not absurd as a system, when we are aiming to reduce costs? We don't even look for low cost cures and approaches! That is where massive publicly funded research and publicly owned "patents" would work wonders to reduce drug costs.
9
I take five medications for my bipolar condition. I pay nothing for any of them. My two dogs take three anti-inflammatories, one pain-killer and two other medications. The average price is about $25. Eleven medications and none is expensive. Maybe I'm just lucky.
@michjas
Yes, you are. But it is likely that someone will buy the patents for your medicines and raise the price by 8000%. Its be done before and will done again.
3
We forgot how American TV is saturated with drug ads and new diseases that Madison Avenue has a hard time naming until a recent visit.
You will not find one drug ad on French TV; and why should you? Patients don't prescribe medications but I guess the ads drive up "demand". Patients become consumers and Big Pharma rakes in the cash (with more than enough to buy DC).
The best part is the disclaimers at the end of the ads..."could lead to death", etc. Only in America.
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@Rob
I also get advertisements from my local power company - as if I can choose.
2
@Rob
I remember when drugs were not advertised on the TV or in magazines. It was a better world.
5
Biosimilars are therapeutically equivalent medications similar to other biologics. Biologics are molecularly large medications would be impossible to copy like a traditional generics which are chemically identical. These biologics are some of the most expensive medications on the market. So it is ironic that the Trump administration is fixated on revoking the entire Affordable Care Act which has provisions for biosimilars and at the same time cries about high drug prices. So revoking the ACA not only takes away healthcare for millions of Americans but also has the potential for putting this part of the biotech industry in chaos. This provision in the ACA was supposed to provide more competition and bring down prices on these very expensive medications.
https://www.natlawreview.com/article/us-pharmaceutical-and-biologics-industries-could-see-steep-potential-consequences
This just demonstrates the chaos and cruelty of this administration.
2
The time for government measures such as patent overrides is long past due, since it's proven to be fruitless trying to persuade big pharma companies to dial down the greed factor behind the out-of-control drug price increases
Maybe just the threat of invoking these measures will bring pharma to the negotiating table. Unfortunately, I doubt that this administration and its agencies have the interest and fortitude to wage this battle. And even if patent overrides are invoked, the pharma companies will try to tie it up in court for years.
4
Is there a more greedy industry than health care? Health care has led the nation in price inflation for decades now.
35
Indeed, we are living a crisis due to Big Pharma gouging patient's for greed...just because they can. It gets worse when you consider the harm by making us addicted to opioids (remember Purdue?), similar to the tobacco industry cheating on us for so long, denying it's relationship with cancer and cardiovascular disease and premature death (as the high sugar 'soda' industry is doing today, 'promoting obesity, diabetes, hypertension, etc, thus far with impunity). Although I do concur that our government can and must intervene and hold drug makers to account, I doubt very much that Trump is able nor willing to do anything to stop the abuse, he being the abuser in-chief...for personal gain, and complicit in corporate market control.
6
“as the drug industry’s influence over government grew”
As long as Citizens United is allowed to lobby Congress and contribute large sums of money making the politicians beholden to them, I’m afraid no relief in the cost of prescription drug prices is in the near future.
If corporations are people too shouldn’t they pay their fair share in taxes as well?
56
It seems these corporation “people” operate on an entirely different set of rules than most tax payers. I mean they get to “write off” anything and everything while paying their top executives in stock options instead of salaries and on and on and on.
Corporations do not pay nearly at the rate they are supposed to be charged at. And many pay absolutely nothing in corporate taxes neither federal, state and local taxes. They don’t even pay for the roads and infrastructure paid for by the regular tax payers without which they nor their employees could get to work.
Pharmaceutical corps have forgot what should be their primary role in society. Paying zero taxes should be looked upon as cheaters but alas they continue to roll as they have, many over a 100 years and not a dime paid in taxes.
14
As long as Citizens United is *allowing the big corporations*
Perhaps the best idea stated here is the plan to establish an international price index, which Medicare would use to set a ceiling on drug costs. Trump proposed that last October 25, less than two weeks before the midterm election. Since then it has fallen into a black hole of inaction. Certainly Democrats in Congress would support this — they campaigned successfully on healthcare last year — and if Trump is serious about it, he ought to be able to bully representatives of his own party to support it.
But I’m afraid that the reason this has gone nowhere is the huge amounts of Pharma cash sloshing through the halls of Congress and the White House. Immediately after the first Democratic debates, where several candidates voiced support for Medicare-for-All, advertisements started running warning people about the proposals, with outrageous scares that have no basis in reality. The Medical-Pharmaceutical-Industrial Complex is clearly worried about the anger of Americans regarding healthcare costs, and rather than responding with realistic prices, they are using the cash they have accumulated from us to beat back any attempts at reform.
6
The situation in Britain isn't represented entirely correctly here. Yes, we have a medicines assessor, the National Institute of Health and Clinical Excellence. It's not a 'regulator' in the sense of drug licensing or safety approvals, it only assesses health interventions (not confined to medicines) for 'value for money'. Value' in this context is obviously complicated.
NICE operates only for the National Health Service - the state health body. NHS Patients i.e. most of the population, pay a flat rate per prescription (any type or duration) of about $11. The NHS pays the cost difference. A few people pay over the odds but most are getting a fantastically good subsidy on their medication bill, There are also many concessions (age, unemployment etc) so that medications are often entirely free of charge.
NICE can therefore absolutely decide if patients receive any medicine, particularly a new one. You can of course pay for any medicine you wish - but at full cost outside the NHS scheme. Nothing is 'banned', simply unavailable.
NICE and its decision making processes are transparent and published in the public domain. The individual medicines assessments can run to thousands of pages, robustly evidenced and clearly reasoned. Their website is a wonder.
Does NICE work? Absolutely. In my old field of oncology, NICE reviews so ably focussed treatment that survival figures for common cancers improved almost immediately. Is it a 'death panel'? Absolutely not.
37
A genuine consumer friendly outcome of this issue is on how vulnerable Trump feels for 2020.
He is the only politician in a long time that can whack the Republicans and Pharma into submission.
Look at tariffs, foreign policy to allies, who would thought the Republicans in congress would meek as lambs.
This is one issue, Trump can claim credit big time and win handsomely no contest. Question is if he feels the need to do it.
2
I am an engineer, retired from the medical device industry. the issues with drug prices are largely the same as for medical devices. a new drug or device requires investment. new medical investment competes with any other investment and if investors don't see a chance for a good return they will invest in something else like a facebook.
a new device or drug will be patented. the patent laws allow a monopoly for the life of the patent. after that, the product is generic and anyone can get approval to make and sell it. there is a law in economics, called the law of monopoly price. companies set their price to maximize profits country by country while they have a patent monopoly. America regulates prices less than other countries so companies plan to make most of their profits here. other countries regulate more and pay less. but if the total revenue for a new product is cut, investors won't invest in the next product. long term returns from investing in drug companies haven't been that great. these are economic realities.
so what to do? this is much tougher than understanding realities. I think everyone needs access to drugs devices and medical care. the rewards have to be high for breakthrough products and quite low for me too products. Americans need to pay less for devices and drugs. others need to pay more. I have no personal experience with generic products, but it ought to be possible to regulate these like utilities.
2
Nationalize Big Pharma. Years ago, fully tongue-in-cheek we'd begun suggesting that CDC / HSS simply begin production of major medications needed by US, pay top biochem researches 7-figure salaries, and provide the pharmaceutical results to the public - that would be you, voters - at a fraction of the cost now charged by the entire private for-profit vampire industry.
Only recently - and this article almost makes reference thereto - we learn that some advanced democracies are in fact doing this - and a full report here of such national efforts at pharmaceutical manufacture and distribution would be welcomed, timely and useful.
16
One very useful executive order would be to rescind the part of the Medicare law that says the government cannot negotiate with drug companies for lower prices. The VA does, I believe.
This is an old law, one that was a very much reward for the drug industry as we see daily, and is long overdue to be changed.
Where are those who are mouthing support for protecting our citizens and yet fail to come forward with a simple bill. I'm betting it could be one page long, or less. And written at the 5th grade level so there is no misunderstanding it's intentions, and no loopholes.
If anyone voted against it, it would be a clear indicator who's pocket the opposition was in.
32
Any article on the disgraceful way Big Pharma prices drugs should include at least a mention of insulin. The scientists who developed insulin sold it for $1 because they believed doing so would insure that insulin was always affordable to those who need it.
Instead, insulin prices keep going up and up. Big Pharma has, as this article did not, no shame but their shamelessness is most overt when it comes to insulin which never had development costs to Big Pharma.
Insulin is actually kinda cheap to make and it doesn't really need marketing because those who need it are prescribed it.
I am a type one, insulin-dependent (of course) diabetic. My insurance covers my insulin but it costs my insurers around $3,500 a month. This is not just shameful. This is a sin, probably a crime against humanity.
385
The big companies that are almost exclusively manufacturing insulin are those advertising a slew of new drugs on cable news and are obviously trying to create a market for those. Or developing new drugs for the type two diabetic, it is evil for them to abandon the type 1 diabetic by doing so.
20
@Daffodil
I am also a type 1 diabetic, but live in Canada. The cost of an annual supply of insulin for me (30 10ml vials of novorapid) is about $1000 cad or $750 usd. It is outrageous that your government has done nothing to protect you from blatant profiteering off of something essential to life.
The vast majority of drugs here are also paid for by private insurance, with the main difference between our systems being that we have something called the patented medicine prices review board which regulates drug prices at a national level.
"The Patented Medicine Prices Review Board is responsible for ensuring the prices that patentees charge for prescription and non-prescription patented medicines sold in Canada to wholesalers, hospitals, pharmacies or others, for human and veterinary use, are not excessive."
https://www.canada.ca/en/patented-medicine-prices-review.html
The united states is a larger market with greater bargaining power, and if your government were to implement something similar, your drug prices should be even lower than ours are.
70
@Myles Dingle -- Ah, but we absolutely LOVE our Billionaires and would never do anything to limit shameless profiteering because -- one day WE are all gonna be Billionaires, too!
IF we can (somehow) afford to live that long. Pray for us?
16
We all know that the Republicans are corrupt and beyond redemption. However, it is a shame that even Democratic administrations have not seized patents or invoked march in rights to address escalating drug prices. It is time to invoke the nuclear options.
28
@Sam. Really? Democrats don't take Big Pharna money? Making it a partisan issue doesn't help solve the core issue which is Pharna's takeover of government and congress.
10
Certain critical aspects of life are simply not conducive to what we think of as Capitalism. Healthcare—and its related incarnations—is one of them. People should not have to choose between medication, a procedure, rent or food. The overall, and immense, wealth and prosperity this nation—the U.S.—harbors should easily be able cover the costs of basic, essential care, whether it is hospitalization, surgery or pharmaceuticals.
26
Drugs. banking. employment rights. for-profit schools. Telecom. etc. etc. No one is looking out for the American public. But we tell ourselves we live in the greatest country ever and couldn't possibly learn from anyone else or do anything differently. And yes, when my husband went on heart meds that cost $500/month, we flew to Portugal and bought a year's supply for $60/month. The pharmacists all apologized that we had to pay so much. The Portuguese pay $20/month. The NYT can contact me to verify these figures. I have receipts.
202
I purchased my migraine medication at an Italian pharmacy, no prescription needed, and it was far cheaper. I stocked up.
29
@carr kleeb Government by the rich, of the rich, for the rich. Has been that way since the rich Founding Fathers got the common people to fight a war for them over taxes.
6
@carr kleeb Thank you for posting this!
4
One question I would like answered by the experts (I am not one) is how do you control costs without discouraging investment and innovation that is finally occurring in many areas of biotech, as years of research is making its way into the clinics. For example, many companies in the biotech industry are on the path to seriously putting a dent in cancer (a varied and complex disease, despite being grouped under a single word “cancer”) and curing many genetic based diseases. Real cures should over time bend the cost curve down; more targeted drugs will better alleviate suffering and lost production time. So, how do we better control costs and create/maintain incentives for better drug discovery? That seems to be the knot we must untie.
5
There are plenty of incentives to develop drugs without creating super profit. As matter of fact, super profits dull the incentive to create anything except the tactic as to keep your corner of the market. That's why many big companies decrease their R&D departments. Now the big pharma doesn't do discovery. That job is outsourcing to small companies that very often are spin-off from publically funded research. The small companies assumed all risk of. early development, and if they succeeds they will be bought out by the big company that will take drug to the market. The small company will get reward but not even close to the profit of the big companies. That shows for innovation you don't need the high price as incentives
17
@John Use about one third of the military budget to pay decently for medical research, development, & application, with a publicly accountable agency setting realistic prices. Or is Big Payoff the only reason those doctors go into the field in the first place? i don't think so. I don't even think the clinical researchers are the ones getting the wealth under our current system. It's the investors & managers & monopolists, who should simply be informed that the gravy train will be redirected towards patients' benefit.
6
@John In the past, many new drugs and procedures and devices were developed by universities where there were few if any incentives to continue to work on useless dead ends. The schools of medicine were used to doing scientific research, being aware of the developments across the board, and eagerly investigating and applying what has been learned. There was still the idea that basic research without an identified application in a few years would be worth investing in, and knowledge would be advanced.
That is the biggest difference when a drug company sets out on a quest to be the next developer. It is hard to let years of expensive research oriented to one outcome be placed on the shelf. Not useless because there were things learned along the way, but certainly not profitable.
There needs to be a certain degree of altruism and health is one of the areas that needs to be encouraged to work for the good of the people, not the good of the investors.
The shift away from science, knowledge for it's own sake and dedication to making discoveries seems to be the indicator that the center for discovery has left our best and brightest at the Universities.
7
This issue is not new. The pharmaceutical industry targeted the primary care physicians over a decade ago. Simple procedures could take you home with Oxycodone. "Samples". And the cost of blood pressure medication and diabetic medications skyrocketed. Needed medication. Fortunately I have never needed any of the above but have witnessed those that do who worked the whole lives unable to pay for their needed medication.
5
In our attempts to hold on completely to "capitalism" , we hesitate to find a solution to high drug prices ---a solution which smells of socialism. But we already have some socialism mixed into our system --where it is essential for the public. For example, we allow commissions to regulate the rates that public utilities charge. Were we to freely allow such corporation as Con Ed to charge whatever the market would bear for electricity or heating we can imagine that "public shaming" or "negotiations" would have little effect. The appeal of unbounded wealth would override the shame of being called a scoundrel. So for an industry like drugs on which life itself can depend we should set up a government agency ( similar to Public Utility Service Commissions, to regulate and set caps on prices.) You say that this is "socialism"? Correct. But we do have a "mixed economy" and where socialism provides too necessary a benefit (e.g., Social Security, Medicaid, Medicare, the Safety Net) we have embraced it as part of our capitalistic mixed-economy system.
6
Now it is true that drugs are over priced and I certainly support the notion that everyone who need drugs should be able to afford them; but it is also true that the pricing of drugs is poorly understood. I take Xeralto and according to the drug pricing a months supply costs $500. I have drug insurance for which I pay $24 dollars a month and have a copay of $42. So I pay $66 a month for a drug which is price listed at $500. For sure the insurance company is making money, and so is the pharmacy that distributes the drug, so the real price the pharmaceutical company gets paid for the drug is probably about $40, or less than 1/10 of the listed price. I would make two points. First the list price of drugs and the increases in the list price of drugs are meaningless and should not be taken as a serious measure of anything. Second, the drug insurance company contributes nothing to healthcare. They are nothing more than a hand in your pocket and obviously should be eliminated
4
@W.A. Spitzer
Xarelto is a new drug. Have you googled lawsuits about Xarelto -- there are many of them and the plaintiffs (the victims of this drug) prevail. You could be taking coumadin and getting a simple blood test once a month at a far lower cost. I am on a blood thinner and took coumadin for 20 years. I prefer coumadin to the new drugs with lots of side effects (xarelto has no antidote and if you start bleeding and even in an ER no one can stop the bleeding until the drug wears itself out of your system). I prefer coumadin and am just fine with the regular blood tests, required because coumadin can be unstable in the body. I am taking Xarelto just now, against my preference, because I am in a rehab facility and this place just wasn't managing my coumadin properly. Once I go home, it will be coumadin again for me.
3
@Daffodil.....What you say is partially true. At one time there was no antidote for Xeralto, but that is no longer true. The problem with Coumadin is that keeping the clotting time within a safe range is tricky, which is why frequent testing is required You have to be careful of what you eat and there are a lot of issues with drug interference. In most cases Xeralto is more convenient and safer.
Here we are going on 3 years into the Trump term and what do we actually have substantively on pharmaceuticals?
C’mon, get real.
7
@SRP - After 8 yrs of ZIP from Obama admin, 8 earlier yrs of ZIP from GWB admin. etc. See Comment from John below re industry lobbying / bribery expenses.
What makes any think Big Pharma has not for decades controlled pricing through all administrations, and will continue to do so for so long as they wish into the future?
Despite this moment's editorial tirade and its induced welling of impotent rabble outrage. We sheep will soon enough back to sleep, God bless Ambien.
How about no medications instead looking to nutrition and holistic medicine for answers....where you’ll actually find them. Maybe a little more effort to cook from scratch, slightly more cost to go organic, a commitment to exercise, get off the carbs and sugar so the weight flys off and you don’t need these crooks drugs at all. It works.
2
@2mnywhippets
How about this: without insulin, I would die because my body no longer makes insulin. No nutrition and holistic medicine can make up for no insulin.
43
If the pharmaceutical industry takes the hint from Trump and starts to make larger contributions to Trump's reelection campaign, all these initiatives will somehow fail to get out of the Talk-is-Cheap phase that would result in substantive lowering of drug charges. Trying to set drug prices in the U.S. based on what they cost in other countries is not a "deal"; it is a scheme that will fail because pharmaceutical companies will not share those numbers. Why should they? This demand from Trump who will not disclose his tax returns. Ha ha ha.
4
@me
I anticipate that DJ will somehow find a way to inflame the emotions of his 'supporters' as the 2020 campaign fires up, getting them riled up about health insurance without delivering anything and, sadly for all of us, many of his supporters will fall for his con artist manipulation and continue to 'support' him.
And yes indeed, Big Pharma will pony up ever more bucks to DJ to get their obscene profits.
According to Bloomberg the pharmaceutical industry spent $27.5M on lobbying in 2018. That works out to $51K per elected official, if the money was only sent to Congress (House and Senate). Another source says they spent $3.937B over 20 years, meaning big pharma has a larger investment in lobbying than any other industry, second is insurance.
If we think help is coming from Congress we might want to think again. Our representatives are bought and paid for.
169
@John Please add that MOST of the representatives are bought and paid for. I would not argue that, but I do not believe that all should be painted with the same bleak brush.
9
"In recent months, President Trump has indicated that he would support state laws to allow the import of drugs from Canada."
Think about that. Why do places like Canada and England have lower drug prices? Perhaps it's because they have national healthcare systems that actually negotiate. It boggles the mind that so-called "conservatives" in our country want to keep our dysfunctional healthcare system as it is, yet they and their loved ones avail themselves of Medicare and cheap drug prices abroad when they need it.
Like all of President Trump's promises to fix deeply entrenched problems, he'll never do anything about drug prices, certainly not at a national level. Perhaps instead of quick fixes at the state level, we can actually try to solve the bigger problem? All the more reason to vote Democratic in 2020.
20
@jrinsc Drug prices are lower across the board in other countries -- Mexico, Canada, England, Switzerland, India, you name it. This has nothing to do with nationalized healthcare. The answer to lower drug prices is not nationalizing healthcare, but rather opening the US drug market to imports from other countries -- the moment this happens and drug companies realize they can no longer gouge US consumers, prices will drop.
6
@RSSF
The situation in England has EVERYTHING to do with nationalised healthcare. A big market with ONE customer. How often do you think that happens?
Good luck with importing drugs from England. Pharmaceutical manufacturing has been dribbling away to cheaper countries since the 1970s and is now pretty much zero here.
8
@RSSF
England's NHS and Health Canada both use the power of their national health services to negotiate lower drug prices for their entire countries. It has everything to do with nationalized healthcare. What you propose is for the United States to take advantage of their nationalized, reduced drug costs, rather than us actually adopting a similar model and fixing the problem here. By law, Medicare is barred from negotiating drug prices. That's insane.
Here's a CNN article on the subject:
https://www.cnn.com/2015/09/28/health/us-pays-more-for-drugs/index.html
2
Allowing drug importation from Canada is definitely an answer, regardless of what the editorial states. The fundamental issue with drug pricing is that US consumers subsidize these for other countries. Drugs in Canada on average are 30% cheaper than in the US, and the moment large-scale imports are allowed, US prices will drop. Vermont's population is only 600,000 -- just because Vermont is not succeeding in getting more drugs from Canada doesn't mean this will not work if large states like California and New York started doing the same.
4
@RSSF..... Importation of drugs from Canada cannot possibly work. The U.S. has 10 times the population of Canada. The pharmaceutical companies know how much of any given drug is consumed by Canadians and they simply won't supply Canada with a significant amount more of any given drug than Canada needs.
@RSSF....Canada has a population of 35 million. The U.S. has a population of 330 million. The pharmaceutical companies know how much of any given drug that Canada needs. They will not supply Canada with an amount of any drug that greatly exceeds that need. It follows that importing drugs from Canada won't work
I have spent less out-of-pocket on medicines when traveling in France than I would for the same here in the US. Yet clearly pharmacies manage to remain extremely profitable there, while patients can afford their meds (esp with nationalized health insurance).
Here on TV you see where the extra costs go, into fancy ads; at the hospital or doctor’s office, with financial incentives to doctors to prescribe the medication. And so on.
4
@lm Your analysis omitted the fat salaries paid to Big Pharma executives.
It's just a gut feeling, but I'd lay odds Trump is saving addressing this issue in any significant way for some time after Jan. 1, 2020. Not that the timing has anything to do with election posturing, mind you.
6
Truvada is out of patent. There is no need to seize the patent, only for the FDA to change their policy with respect to approvals of generics by reducing the $5-25 million cost and 3-5 years. If they stopped granting an extra 3-5 years of exclusivity to their cronies, the cost of generics would decline, at least in the ones with large demand.
Seventy percent of prescription drug consumption is of generics. Of the 30% name brand consumption more than half are out of patent but most do not have generic competitors because the FDA discourages it with their policies.
Get the dark state to work!
Also, eliminate the anti-trust exemption that allows four group purchasing organizations to purchase 80% of hospital supplies and equipment for deep discounts that are not passed along to the government or consumers. Unless you believe the Tylenol you buy at Walgreens for $0.05 per tablet really costs the $40 the hospital charges you. Even when your insurance discount cuts it to $20.
5
@ebmem
$0.05 for Tylenol? This afternoon I bought 32 generic acetominophen 500mg (the same stuff) for £0.16 at my local corner shop in London. That's $0.004 per tablet (on an exchange rate of $1.30 per £GBP). About 13 times cheaper here. And it wasn't on special offer.
I see what you mean about drug prices..
2
To indulge in fantasy for facing reality, there is no doubt that people are dying brcause they cannot afford the medications they require. A legal charge of extortion causing murder for personal or corporative profit might put a bit more bite into effective effort to cure the problem.
23
"If the plans get serious consideration, they would advance a long overdue dialogue about how the country wants to evaluate medications and what it is and isn’t willing to spend on them — a question that sits at the heart of America’s deeply flawed prescription drug system."
Where I live in Canada the single-payer system *does not* cover prescription drugs, although there are programs for children, seniors and low-income adults. Larger businesses also offer group benefit plans similar to the U.S. that cover prescriptions and other medical services not provided by the provincial medical services plan.
However, the Canadian federal government does cap the prices wholesalers can pay based on a formula tied to the prices paid by the top 10 or 12 other developed countries in the world.
A while back I went to a couple of U.S. pharmacy sites (CVS, Drugs.com) to compare their prices for the six generic Rx drugs I take. Here, I pay $137/month with no insurance, but the same generic Rx drugs in the States cost $750 to $800/month if I ordered by mail.
I don't think the question is whether we need to raise taxes to subsidize consumer drug costs, it's why does Congress allow this kind of rampant vulture capitalism to remain unchecked. Canada has 1/10th the population of the U.S. and it's not like the shelves in my grocery store pharmacy are bare.
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@ExpatTed
The province of Québec does cover prescription drugs through a provincial government insurance program. For a few years now, there has been talk of a similar federal insurance program for Canada, but no new law yet.
4
@ExpatTed - "Where I live in Canada the single-payer system *does not* cover prescription drugs, although there are programs for children, seniors and low-income adults."
Not sure why you telegraphed this to Americans with their fears derived from the talking points of Insurance Co's & their GOP backers regarding any type of Medical & Pharmacare access for all. I too live in BC where I have received complete coverage for px drug costs every year of my adult life, as well as those of my children & grandchildren (I am now 77). The basic deduction of $1,200/yr plus the costs the drugstore charges to fill the prescription is what Canadians pay under the single payer system. This is true whether the particular medication costs $400./mo or $15./mo.
Also, I have never heard of any such special "programs for children, seniors and low-income adults". Since I am a retired Nurse, a senior & I've had grandchildren, I'm sure I would have heard if there were different programs for these select groups. In Canada it is Universal Access to Medical Care & our single payer system works very well. Competing Insurance Co's, hourly TV ads & well heeled lobbyists have no business "dealing" in the human right to equal access to medical care.
3
I feel terrible for my American neighbors. Pharmaceuticals have to be the most rapacious industry in the country, well maybe second to the financial services sector. It's so out of control I don't understand why the government hasn't said enough and just regulate it.
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@Annie
Do you believe that if a drug is available in Canada for $20 that costs $100 in the US that the Canadian pharmacies are going to sell it in the US for $20, or are they going to charge $90?
I need a drug for a chronic infection that costs $200 in the US. The same drug (7.5 ml) I buy in Canada for $48. That’s still expensive.
@ebmem
I order all of my expensive drugs from Canada. You are a sucker if you don't. Here in the US my asthma medication costs $360/mo at Costco (the cheapest place). I get the generic version from Canada, which is unavailable in the US - thanks to our drug industry lobbying, for $40. It is easy to sign up with a Canadian pharmacy and everyone in the US should do it. As I previously said, you are a sucker if you don't...
Thank you Canadian pharmacies!!! I love you guys! You are the best!! You have saved me $1000s of $, and your sales reps, with those nice pleasant Canadian accents, are always soooooo polite when they talk to me on the phone! It is always a pleasure doing business with you...I am more than happy to send my $ to our wonderful northern neighbors.
1
Another problem that "no one knew was so complicated." No way Trump or anyone in his administration is going to do anything to rile Big Pharma. So we have the spectacle, in the third year of his presidency, of Trump signing yet another executive order with no teeth.
Please Democrats, use this charlatan's words against him. The campaign ads write themselves: show the video of him promising a terrific healthcare plan and lower drug prices. And on the debate stage, ask him exactly how many years it'll take him to come up with a plan and implement it. (Answer: "We're working on it, you'll hear something in a couple of weeks.")
I'm not holding my breath.
23
@Elizabeth A
Please, Obama claimed there would be no individual mandate and insurance would be affordable. Even with the mandate, premiums are so high that 80% of the population, up to four times the poverty level, can't afford it.
Obama made things much, much worse and unwinding the damage is hideous. That Obamacare that wasn't going to add one thin dime to the federal debt is at $1.5 trillion and growing. that doesn't include the increases in out of pocket costs for all insured Americans.
Please, Democrats, admit that your scheme is a huge failure relative to doing nothing and stop blaming Republicans for being unable to undo the damage you crammed down on the American people with a House majority and 59 votes in the Senate.
@ebmem The ACA (Obamacare) produced enormously improved coverage for vast numbers of people including required coverage for children up to age 26, coverage for pre-existing conditions, and many others. 20 million people have coverage that had none before ACA, including those who gained Medicaid. Facts are stubborn things. Republicans have stubborn resistance to facts.
12
@ebmem My relative was on Ocare for a while. Said the premiums were reasonable, but the deductibles so high it was like not having a doctor.
A growing factor behind extortionate drug prices, and an easily fixable one, is not mentioned in this article: trial lawyers.
For the most part, drugs are developed, tested, and manufactured by drug companies, sometimes small companies, often “big pharma.” Whatever readers may think of large drug companies, without such companies, there would be few drugs available.
Our legal system is going after two of the world’s largest drug manufacturers: Johnson and Johnson, and the German company Bayer, which purchased a US chemical company, Monsanto. The lawyers have persuaded juries that J&J’s talc-containing baby powder causes ovarian cancer, and that Monsanto’s weed killer Round-up causes lymphoma. Many jury verdicts have favored the companies, but some have gone the other way, and there have been multiple billion-plus dollar verdicts; tens of thousands of additional lawsuits are pending. In both these cases, the “science” behind the suits is likely junk science; but in all cases there are sick, sympathetic patients. It doesn’t take many billion dollar verdicts to bankrupt a company, or to dramatically raise the price of their products.
It’s worth remembering that during the late 1970’s and early 80’s lawsuits nearly shut down US vaccine manufacturing. The threat to vaccination programs was far greater then than the anti-vax movement is today. Only last minute intervention by Congress, which passed a no-fault liability law, saved vaccination.
We desperately need tort reform.
4
@Alex....What we need is an independent panel of trained knowledgeable scientists. Whenever a law suit goes to a jury trial with regard to drugs or chemicals, the conclusion reached by the independent panel should be read to the jury as a part of the legal proceedings.
1
And what is the connection between Round-up and price of drug? So in order to decrease the price of drugs, we should allow big pharma to poison people?
@W.A. Spitzer
What you suggest is how medical malpractice cases (which are different from product liability cases) are tried in Indiana. If a patient files a lawsuit for medical malpractice in Indiana, the state insurance department first assigns the case to a panel of 3 physicians. I believe physicians are obligated to serve on panels if asked, as a condition of licensure.
The panel is supervised by a non-voting attorney, who is paid for his/her time. The physicians vote on the merits of the case.
The findings of the panel are not binding, the case may still go to trial even if the panel finds unanimously is favor of the defendant physicians or hospitals. But the findings of the panel are admissible at trial, and usually carry weight with the jury.
I think most feel the system works reasonably well.
One way to fix this thing is to change the way drugs are approved. As part of the approval process, the trials should include a group treated with natural substances. The drug would then only be approved if its efficacy surpassed the natural substance(s) significantly. Then we also need to change the FDA's rules that any substance for which curative properties can be claimed is a drug and has to go through the ruinously expensive approval process. (If people want to claim that supplements are worthless, then this would be a way for them to put their drugs where their mouth is).
Another thing that has to happen is for the FDA to force drugs off the market when deaths are reported. Vioxx killed 30,000 to 50,000 people and the FDA never forced a recall; the manufacturer took it off because of too many lawsuits).
Next, rescind the liability protection of vaccine manufacturers. Why do they need that if their vaccines were safe and effective. Do these things and the demand for drugs would drop.
1
@Danund
Anyone injured by a vaccine is entitled to a settlement from the vaccine, which is financed by the vaccine manufacturers. the only losers are the trial lawyers who don't get a cut of the proceeds.
It would not be an improvement if the price of vaccines were increased to cover a million lawsuits for autism. the increase in cost would result in reduced vaccinations and an increase in children blinded by scarlet fever and killed by measles.
What "natural substance" would you select to compare a new drug with for testing? Honey? Current trials compare the new drug with an inert substance.
4
@Dan... "Why do they need that if their vaccines were safe and effective."...Juries are not scientifically educated and often give awards completely unrelated to the facts. In most cases vaccines have a low profit margin. The simple answer is that without liability protection the production of vaccines would not be profitable.
1
@ebmem To correct you, many vaccines use another vaccine as a placebo. The HPV vaccine uses the vaccine without the antigen. In answer to your question, the comparison would be determined by naturopaths. The reality is that most drugs are synthetics derived form the active ingredient is plant substances, so coming up with the comparison substance is no big stretch. The idea that using synthetic chemicals as the road to health is nonsensical, except in emergencies.
The question of drug importation keeps coming up. But we already import most of our drugs now. We offshored most of our drug manufacturing capability. Those plants are either owned, or are under contract from the pharma companies. Point being, the capacity for overseas manufacture is already in place.
There is another way to bring down drug prices. Don't use them. Many new drugs are replacements for older drugs that have gone off patent. What's so wrong with using a drug that's 90% as effective that costs 10% as much? We often see studies that show the new wonder drug is something like 20% more effective in 30% of patients, then they charge $50,000 for it.
We also see a few companies that buy up the production of off patent drugs, corner the market and jack the price up 50 times. Why can't we directly import them from India where they already make most of our medications.
This problem seems to be centered around miracle drugs that help to cure rare conditions. The effort should be centered around everyday bread and butter medications that people consume in large quantities. Like those that treat high blood pressure, diabetes, cholesterol, stuff like that.
8
@Bruce Rozenblit
The old drugs, mostly generic, that have been in use for decades, have side effects that are well known and documented. It sometimes takes a few years for side effects to be noticed for the newer drugs. So even if promised a 10% improvement for a drug that costs ten times as much, you need to be aware that there is the potential for an unreported side effect.
Name brand contraceptives have higher adverse effects than the old generic birth control pills.
2
Because drugs from India are not as safe as they should be : four blood pressure meds contaminated with cancer producing substances...
I think there is too much big pharma money coming into both parties to make a change. The people of this country will make the change.
7
"The F.D.A. has approved some 1,600 generic drugs in the past two years ... But many of those drugs still aren’t available in the United States, and experts say that anti-competitive practices are at least partly to blame." Conniving CEO's extorting money from our society using our health care. "The current CEO of Valeant Pharmaceuticals ... recently said that his company’s responsibility is to it’s shareholders, while making no mention of his customers who rely on his drugs to live."
5
Here's a profitable business model: convince doctors to write huge numbers of prescriptions for a drug (statins) to treat an increasingly common condition (high cholesterol). The government will help you by spending decades promoting a "healthy" diet (low fat/high carb) that, in fact, causes the symptom that the drug treats. If the gods are on your side, too, that drug will be found to cause a disease (diabetes), which said diet also contributes to in a big way. Then raise the price of the drug that treats the second disease (insulin) to astronomical levels.
10
I was informed by Express Scripts that my generic medication, Losartan (Cozaar), which comes from China is contaminated with cancer causing agents. Express Scripts recommendation was to continue taking the medication which I have done. Is this where we’re going with imported medications?
18
@Bill
The risk of cancer is low in comparison to the risk of an adverse reaction to your sudden cessation of taking the drug. A better solution would be to transition you promptly to an equivalent. The problem with that is that a large number of the equivalents get their raw materials from the same contaminated suppliers.
Although there are many equivalents or similar drugs your doctor could have prescribed, there aren't enough uncontaminated drugs in the supply chain. Only a few people will actually contract cancer, and there will be lawsuits. And it is possible that your particular bottle is not contaminated.
Good luck.
1
@Bill. Same issue here. Last MD visit he wrote the RX for DAW, for which Express Scripts refused! Told me they followed FDA guidance! Circular firing squad with the patient in the center.
2
Don't wanna kill the goose that keeps laying golden eggs, new prescription drugs to cure or control serious illnesses. Sure, they're expensive, and some drug manufacturers charge far to much for drugs that have been on the market for a substantial period of time, recouping their development costs, and then some. Tread lightly ,say, in the matter of cancelling patents, with an eye to the long term benefits of a happily productive and profitable pharma industry.
1
Does anyone really think the great negotiator will do anything, given the millions Big Pharma invests in his campaign?
Dream on.
131
@Rocky Mtn girl
Big pharma invested in Hillary. No one with any sense would have invested in Trump, who did not have a snowball's chance in heck of being elected. At 7 pm on election day, he had less than a twenty percent chance of winning until the votes started to be counted.
Hillary spent four times as much and had the support of the DNC. The RNC hated Trump and concentrated their efforts on Congressional elections in the hopes they could block actions by Hillary. [Some of the establishment Republicans refused to support the repeal and replace effort.]
The largesse to drug companies is all on Democrats.
Great ideas, I guess but no one has data to prove it. The US might be similar to other countries but there are differences. Guess what, we have 50 states and we can run experiments in them to get some data to help make the decisions needed. We have many cities and even some rural areas where we can run some experiments on the systems best suited for our conditions and needs. What in the world are we waiting for?
3
@Taoshum
If a drug has a controlled price of $20 in Canada and a typical price of $100 in the US, a Canadian pharmacy is going to sell it to an American consumer, not for $20 or $25, but for $80 or $85. there will be administrative costs in having a Canadian MD issue the prescription plus profit for the Canadian pharmacist.
The reason for limited experimentation is that the federal government controls the bulk of the spending. Obamacare defunded SCHIP, subsidies to rural and urban clinics serving a high proportion of the poor in favor of providing free Medicaid to able bodied childless adults. Money was diverted from the most vulnerable to the least needy. [If an able bodied childless woman got pregnant, was seriously injured or sick she was automatically eligible for Medicaid. Same for men if sick or injured.
Obamacare flooded spending on people who didn't need insurance because they had Medicaid as a backstop in order to take credit for 10 million additional insured on their tally sheet.
@ebmem
Or maybe it was because the plan was to place those who needed help the most into the system designed to deliver the most help for the least cost.
You know, you could count on Obama to do some sick thing like that.
1
I’m sure I am not the only senior citizen who is getting prescriptions from Canada for 1/4 the cost of the same drug in the US.
It's so much worse than what the editorial describes!
1. A pharmaceutical company thinks a substance might be profitable and funds a trial. The trial, because of who funds it (the pharma company) is 5 times more likely to find results favorable to the substance.
2. The pharma company pays over $2,500,000 to the F.D.A. for a new drug approval application. More % approved=more applications, and FDA gets more money.
3. Many FDA members have financial ties to Big Pharma. For example, the majority of the expert panel on statins of 2013 had ties to pharma companies with financial interests in the results.
4. Thus we get new drugs that we don't even need--that serve no purpose, or simply replace less expensive drugs already available.
5. We have no sensible or compulsory system for reporting adverse effects. Doctors and pharmacists not required to report and don't. So we don't know the dangers.
6. 80% of the drugs we take are generic. Thanks to Supreme Court decisions of 2011 and 2013, generic drug companies can't be sued for faulty drug design nor for not being current on the warning labels.
7. Other developed nations make it illegal to advertise medications directly to the public.
8. And on and on-to the bottom line: we all know that we pay the most for our healthcare, but don't know that we're 43rd in the world in terms of longevity and dropping.
Yes, some drugs save lives, but overall, but the big cost is that we're medicating ourselves to death for profit
StatinStories.com
241
With regard to the approval process, perhaps we should consider placing at least part of the burden on a trained Artificial Intelligence. Such a machine learning algorithm will/should be far less likely to exhibit bias in favor of passing a questionable drug into widespread use. Not perfect, but a start.
4
@ebmem
If the cost of developing a drug and bringing it to market is even $5 billion, its a bargain. A big one.
A drug store staple like Nexium has annual sales well over $5 billion and is growing at over 10% a year. What corporation wouldn't jump on a guaranteed profit like that?
An old chestnut like Lipitor produces sales in excess of $12 billion a year, and is still growing.
Your plea of poverty is ridiculous.
Besides, according to your team, these people deserve the trillions of profit they rake in, treatment as heroes of commerce and saviors of the nation, and special relief from legal and economic regulation because they nobly take all that horrendous risk upon themselves. What's up with that?
14
@sing75
"7. Other developed nations make it illegal to advertise medications directly to the public."
Just as it was once illegal in America to advertise drugs directly to the public. One of the worst actions for Americans ever made by Congress and the courts was opening up the shilling of drugs.
8
There's a lot of public education and debate to be had about the patent system. People would have some surprises, especially the people who already know a bit.
This editorial's phrase about "the fantastical (blow up the patent system and start over)" is not the way to have a discussion.
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So much has been written about this problem: https://www.vox.com/science-and-health/2016/11/30/12945756/prescription-drug-prices-explained . The difficulties are public and have been around a long time. It is impossible to understand why more cannot be done. It is inescapable that the pharmaceutical lobby has bought itself some degree of protection within our halls of government. That is not a surprise too anyone.
Most of our representatives know that arguments against better regulation are disingenuous, but there is just too much money at stake for personal coffers. This is a bipartisan affair. Just search the industry contributions for your favorite congressmen (it is, for now, mostly men). This is still a smaller dollar amount than what comes from Wall Street.
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@JSK Very little in which politics is involved gets done in the US. Been that way for years.
Drug companies are in business to increase shareholder value. If selling drugs is a business, it has the right to make as much money as it can.
Prices are too high when the number of customers who suffer or even die because they cannot afford the drugs is so great that the high price does not make up for the diminished customer base. Prices are also too high when they make customers so angry that the customers demand abolition or limitation of free enterprise for drugs (and other medical costs). Unless, of course, this anger is countered by the glee of others who like to see moochers get what they deserve.
Those who want limitations on drug prices do not see their demands as equivalent to a critique or limitation on capitalism -- yet. This is what their demands actually amount to, and drug companies will search for a way to accede to these demands while assuring that people remain believers in free enterprise. Bernie seeks to dispel this confusion, advocating strong limits to free enterprise based on an analysis of the common good, so that free enterprise serves the common good instead of the winners whose victory is morphing free enterprise into something else.
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@sdavidc9 Where in the Constitution does it say that businesses have a right to make as much many as they can? No where! No such "right" exists. On the contrary the Constitution establishes the right of the federal government to regulate commerce, which includes drug companies. That means government can legally control prices of drugs.
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@sdavidc9
Businesses have the right to make as much money as they can, and we have the right to get together through government and limit how much money they make. Money and property exist because of government; in a state of nature, something is yours when you make or steal or scam it until somebody steals or scams it from you. So in a state of nature most energy goes into stealing and scamming and defending against stealing and scamming. Drug gangs and Somali warlords exist in a state of nature. To a large extent, so does our financial system -- a gang of scammers scamming each other when they arent busy scamming us.
How much we regulate business is a matter of what promotes the common good, and giving businesses an unlimited right to make as much as they can does not seem to promote the common good. Rights that do not work out well, like the right to dump unlimited CO2 or inadequately-burned auto exhaust into the air, cease to exist.
The federal government can regulate interstate commerce, which meant one thing when economies were overwhelmingly local and something entirely different now that economies are overwhelmingly national and global. Local independence was always a fairy tale for cotton growers who produced for Britain or Massachusetts, but not for farmers who grew to feed themselves until the next harvest.
@sdavidc9: From which of his many homes is Bernie promulgating this?
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The Patient Protection and Affordable Care Act was basically and primarily the conservative Republican Party Heritage Foundation's free market capitalist response to the failed Hillary Clinton healthcare initiative.
Thus there was no credible public option nor any controls on the costs of prescription drugs that would interfere with or limit corrupt crony capitalist corporate plutocrat oligarch welfare pharmaceutical profitable shareholder returns.
Every civilized nation has access to universal affordable quality healthcare as a basic human rlght for the many instead of a privilege for the few. America is not a civilized country.
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@Blackmamba True. Obama received $2.1 million from Big Pharma in 2008 alone. How can we expect change when Democrats elect moderate plutocrats like Hillary or Nancy Pelosi to the top jobs, instead of progressives?
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Drug pricing reform in isolation won't work without occurring in the context of overall healthcare reform. Pricing for any aspect in healthcare is completely opaque. What is the cost of diabetes based on? Supply and demand, or what? Reportedly, treatment costs for hepatitis C is based on the equivalent costs of a liver transplantation. They are not the same. It is really hard to imagine that Trump is serious about any proposal he has made regarding the lowering of medicine costs given the political/economic power of the pharmaceutical industry.
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@Moses
While I agree that the cost of Hep C drugs are too high, the reason they are compared to a liver transplant is because without a cure which these drugs do deliver, the patient will
suffer with the disease for years and then need the transplant or die. Hep C destroys the liver and you cannot live without one.
Before we talk price, let's make sure the drugs work. Go read the books "China Rx" and "Bottle of Lies"--the vast majority of drugs and drug ingredients are made overseas, with not enough inspection by the FDA. The easiest way to improve the drug supply, control quality and ensure that we are not wasting money on Rx drugs in the first place, would be bringing manufacturing back to the U.S. Then we talk both quality and cost--both are essential.
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@Crying in the Wilderness
And we create jobs while doing this.
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with any inspection by the FDA?
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How are we going to regulate prices (all medical prices need to be regulated) when regulation is the ultimate evil to this administration?
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@catlover And to all other administrations too. Notice that we still have this problem after Democrats have been president for 50% of the time. Follow the money. Obama received $2.1 million in contributions from Big Pharma in 2008 alone.
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@catlover I know they're tempting, but price controls have never worked for any extended period of time throughout history. All they end up doing is creating shortages. What works better is restoring normal market forces, such as by permitting payers - private and government - to negotiate as a group. Transparency is another mechanism that would break the power of the shadow brokers who use kickbacks - also known as rebates - to unjustly enrich pharmacy benefit managers and pharma executives alike. Reforming the patent system to prevent patents being inappropriately extended as a result of a minor tweak in formulation as well as outlawing the practice of paying generic manufacturers not to produce a drug would go a long way. But simply applying price controls is a simple, direct and completely wrong approach to this complex problem.
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@catlover And that is why all we will ever get out of this administration is talk. Some people, evidently quite a few, are satisfied with nothing but talk and think it is the same as action. They know their audience and act accordingly. Anyone who is still expecting action cannot expect sympathy for their problems, since it was obvious from the outset that an unqualified person was what they voted for.
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