Archive for February, 2018

The Power of PhRMA

Posted by on February 16th, 2018

The pharmaceutical industry, like most industries, has spent a lot of time and money setting up a powerful and influential lobby group. The top 10 lobbyist groups in 2017 were:

  • US Chambers of Commerce
  • National Association of Realtors
  • Business Roundtable
  • Pharmaceutical Research & Manufacturers of America
  • Blue Cross Blue Shield
  • American Hospital Association
  • American Medical Association
  • Alphabet
  • AT&T
  • Boeing

These groups represent economic sectors from aerospace and technology to health care and business. The pharmaceutical industry’s powerful lobby, PhRMA, has been steadily increasing its spending every year in response to the negative public reaction to drug prices. PhRMA is very powerful. Its tentacles are not just limited to Washington DC’s hyper-political atmosphere; they reach to the legislature of every single state as well. Drug transparency ballot measures were defeated in California last year based largely on the campaign that PhRMA ran against them.

PhRMA’s sole responsibility is to protect the profit making power of the pharmaceutical industry. It doesn’t exist to help patients, or to mend the rift in the relationship between big pharma and patients. That’s why the pharmaceutical industry seems so tone deaf.  They do not seem to know that the American people have heard every excuse they have ever provided for outrageously high drug prices; and they don’t seem to realize that Americans have rejected all of them. The millions of people who have used personal importation to supply their prescription drug needs, in spite of big pharma’s cries of danger, is proof of that. Yet instead of acknowledging the situation, big pharma is doubling down. It is not changing its pricing practices, it is, instead, lobbying political leaders more than ever before to maintain the status quo and defeat reform.

PhRMA is likely to remain one of the top lobbying groups in Washington for a long time to come. What it is not likely to do is encourage its members to reform their pricing practices. This is to your detriment. Your only option is push your congressional representatives to change the law to permit personal importation and end the grey area practices of PBMs and insurers and the like.  You should also join the Campaign for Personal Prescription Importation and be part of a grassroots effort to give Americans the freedoms they deserve to get their drugs at affordable prices.

Pharma’s Revolving Door Access to Congress

Posted by on February 12th, 2018

The revolving door of Congress and the private sector lobbying world is still spinning without difficulty. You may have heard that the Senate confirmed Alex Azar as Secretary of Health & Human Services. Azar is a good example of the revolving door. He was an official in the Bush administration, then moved to Eli Lilly where he was made CEO, and now has moved back to the public service as a top mandarin. Azar comes with significant drawbacks for drug price advocates. When he was head of Eli Lilly the drug maker jacked up prices on many medicines, notably insulin, without hesitation. Now as head of HHS his openness to making personal importation available to more people is in question. He certainly stands to benefit from helping keep the status quo for big pharma. They will provide a comfortable fall back for him should he, like his predecessor, need to exit Trump World at some point.

This isn’t limited to Azar, the revolving door is a perennial part of the American system. But it has begged the question, more than once and by more than a few people, as to who exactly do those using the door serve. Congressional and public service is, ideally, an opportunity to serve one’s community and country in a positive way. But far too often, it’s a jumping board to more lucrative and less stressful opportunities in the private sector. Thus frequently people are cynical about congressional staffer and upper echelon public servants who seem to come and go frequently. They seem to be serving their pocket books and political ambitions above the American people. In a way the cynics are right. But when private sector employers are paying 35-40% more for a job just as interesting and less stressful, it’s tough to blame them too.

The pharmaceutical industry is a frequent user of the revolving door. According to a Kaiser Health News report, “Nearly 340 former congressional staffers now work for pharmaceutical companies or their lobbying firms…” There’s a lot of quid pro quo. Staffers on the hill are more likely to take calls and meetings with people they once worked with, they’re also looking out for their future prospects as well. Former colleagues in the private sector are well placed to help them find jobs when they leave the public service as well. Pharmaceutical companies tend to target staffers working in key committees, such as those tied to Health, Education, Labor and Employment and the Energy and Commerce Committee.

It’s mainly beneficial to private sector entities when their staffers move back into government positions. These people have been trained in industry knowledge and biases. They will be less open to changing things without industry agreement. It’s a beneficial thing for the private sector. It gives them an inroad to open and willing government officials.

The revolving door is a feature of American political life that has been at the center of institutional opposition to much reform; in particular opening up personal importation and other cost cutting measures that could force down the price of prescription drugs.

How To Improve Adherence Rates

Posted by on February 9th, 2018

Adherence rates are important. They point to the ability of people to take their medication and improve or maintain their health. As we have seen poor adherence rates are by and large driven by the high cost of prescription drugs. The more drugs cost, the less often or less regularly people are to take them. That’s a major potential health hazard and for the public a potentially large bill, if the person ends up in hospital. Not surprisingly good adherence rates are linked to drug affordability.

Prescription Drugs are priced outrageously in the US. That’s because the US doesn’t impose any limit on them, either through negotiation or regulation. It doesn’t have to be this way. The time has come, and many American consumers would agree, for the present situation to be disrupted in some way. So what can be done to put downward pressure on pharmaceutical prices? Here are some ideas:

  • Permit personal importation from tier 1 countries like Canada, UK, New Zealand, Australia and others.
  • Permit Medicare to use its buying power to negotiate better drug prices.
  • State Medicaid programs could band together to set up large medication buying blocks, using their higher populations to get better deals.
  • Set maximum price levels (unpopular) for similar brand name drugs. There are drugs in some categories that do the same thing but have different prices, why should these brands charge different prices for no different results?
  • Forbid PBMs and Insurers from contractually forbidding pharmacists from telling patients if their drugs can be purchased for less in some way.
  • Force greater transparency in agreements between PBMs and Insurers or abolish PBMs altogether.


Drug Shortages Force Unorthodox Solutions

Posted by on February 7th, 2018

When you’re a hospital and finding it really difficult to source prescription drugs, even generics, what do you do? You start your own pharmaceutical company. At least that’s the strategy being used by a group of health systems to cope with shortages and high costs. It’s a sign of the mounting frustration with the traditional supply system and traditional drug makers. A shortage in a variety of generic drugs has caused major problems across the US drug supply chain. People aren’t able to get the medication they need and hospitals can’t source it. That’s not a reassuring thing. We would expect that when hospitals need a medication it would be available, yet the current situation is it’s not always a guarantee.

Dealing with shortages is one thing. Every industry deals with shortages of products or raw materials at some point, it’s normal. However it’s another thing entirely to take the drastic step of setting up a brand new company to deal with the problem. It shows the problem is very acute. However drastic, this could be the solution that’s needed, a drug company whose mandate is to supply drugs solely to hospitals based on their current needs. Instead of hoping drug companies will continue to make the drugs they need at affordable prices (by no means a guarantee) this group will be able to order drugs, even older and potentially out of production generics; and price will be minimal since they’re not operating as a for-profit corporation.

You and I cannot afford to do this same thing. The resources needed to set up a drug company are immense. The manufacturing facilities alone use a lot of specialized equipment which is very expensive. Big pharma has the retail pharmaceutical market very well locked up. For the average consumer, fighting back is much more difficult. One option still open is ordering from a certified, verified online pharmacy. Canadian online pharmacies have been serving the American market for 20 years and have saved millions of people millions of dollars.

Remember that the reason why prescription drugs are so expensive in the US is that pharmaceutical companies are a heavily protected industry. They sell drugs to the government through Medicare Part D and the government banned itself from being allowed to negotiate prices with them! This is outrageous considering the CBO expects spending on Medicare Part D will cost $92 billion in 2018! That’s nearly pure profit for the pharmaceutical industry. Never mind the spending done by individuals and private plans.

Vermont Latest State to Endorse Personal Importation

Posted by on February 5th, 2018

Proposals are afoot in the Vermont Legislature to allow the state to utilize personal importation to reduce its healthcare costs. Of course this proposal no sooner hit the floor of The Green Mountain State’s Senate than big pharma’s attack dog lobby group, PhRMA, jumped on it like a bone. PhRMA is repeating the mantra that it’s been saying for years, i.e. Canadian pharmaceuticals are unsafe and completely untrustworthy (even though they’re manufactured by PhRMA’s members). You can bet they are prepared to spend tens of millions of dollars to defeat this proposal. They will marshal their resources in Washington D.C. and Vermont to crush this idea. They will lobby the FDA and US Customs to prevent the State and taxpayers of Vermont from saving significant amounts of money.

PhRMA’s winning streak is long. They have left a big pile of bills, amendments, and regulations at federal, state and municipal levels in the trash heap; these pro-importation defeated by their work. Big pharma sees Vermonters and all Americans as captive customers they can squeeze to improve their profit margins. They are very jealous of their captive market and zealous to maintain their privileged position. If the State of Vermont wants to succeed this time it means bringing every ounce of will and determination it possesses to defeat pharma’s vested interests. Vermont is, after all, the state of Bernie Sanders. Senator Sanders is famous for taking busloads of seniors across the border to buy cheaper pharmaceuticals in Canada.

Vermonters, like all Americans, are stuck in a morass that they didn’t create. Their government has given big pharma a privileged position. They can charge whatever price they like for prescription drugs, and not even the government is permitted to negotiate with them. And, officially, you cannot even look for price relief from outside the US. Now the US has never charged an individual for importing a personal supply of medication for their own use. But they come down like a ton of bricks on states, cities and counties who try to do the same thing!

Vermonters should support their politicians in this quest. They should inundate congress and tell them to tell the FDA and PhRMA to back off. It’s time Americans rose as a group against the vested interests and diamond chip lobbyists that force them to pay billions more for prescription drugs than they should.