More Drug Price Insanity

[74-911]

Ran into an old acquaintance recently who is "down on his luck"... most of the bad luck self-induced. Don't know the whole story but he went to the emergency room of Bexar County Hospital (no health insurance) and was admitted then diagnosed with pulmonary hypertension (bad news stuff). Kept him a few days then discharged with a handful of prescriptions which he took to large regional grocery store pharmacy.

One of the prescriptions was for a regimen of 20 mg. of seldinafil (generic viagra) 3 times a day for 45 days IIRC. Pharmacy quoted him a little over $1000 for the prescription cash price... which he choked on. I guess the pharmacist felt for him and told him under his breath: go to COSTCO...

Exact same prescription at COSTCO: $124

no wonder we have the most expensive health care system in the world and health insurance is out of sight price-wise... something is definitely wrong here me thinks.

and no, didn't ask about the effects of that much viagra on a daily basis..

[URY914]

I work at the largest hospital system in the area. At a leadership meeting last week our CFO told us that this year drug prices have gone UP 27% over the projected increase. This situation plus reductions in reimbursements have caused some hospitals to go from a 6% margin to a 1.5% margin. Watch for hospitals to start going out of business thanks to the ACA.

[john70t]

Originally Posted by URY914

Watch for hospitals to start going out of business thanks to the ACA.

I don't believe the ACA is involved.
Rather, it is IntelProp and importation laws which allow these companies to charge whatever they want.
It's all about stock market profits.

State medical system can't source drugs internationally and save taxpayers money:
Judge overturns Maine law allowing prescription drug imports — Health — Bangor Daily News — BDN Maine
The three pharmacy groups argued Maine’s law sidestepped the U.S. Food and Drug Administration’s oversight, designed to protect consumers from unsafe medications.

But most US drugs are still made overseas, with little oversight:
Voters trust drugs made in USA, but few are - USATODAY.com
Yet, unbeknownst to many Americans, an estimated 80% of the substances used to make or package drugs sold here are made in other countries,

And they are not always safe:
Want to Know Which Drugs are Made in China -- Check Out This List
The FDA now says contaminated Heparin is blamed for 81 deaths and almost 800 allergic reactions. After all these recalls, the “Made in China” label is making people wary. A significant amount of the active ingredients for medicines that are sold in the U.S. are made in China. Here in the U.S. the FDA inspects pharmaceutical manufacturing facilities every two years, but the FDA admits that it only inspects about 7% of the overseas plants each year.

[jyl]

Not sure what the ACA has to do with drug pricing or hospitals losing money.

Sildenafil is a generic and as such, a fairly inexpensive drug. Any theory why the grocery store pharmacy was trying to charge so much?

One possibility for what actually happened is the prescription could have been written for the brand drug, Revatio, which is a dosage of sildenafil intended specifically for pulmonary hypertension (PAH). PAH is a very serious and fairly rare disease, the drugs for it tend to be high priced, and if someone actually buys the branded Revatio instead of the generic sidenafil, they will pay a high price. The generic was only approved in March 2016, so possibly the doctor wrote the prescription for Revatio and/or the grocery store pharmacy only had the branded Revatio.

[Neilk]

Should have actually gone to Safeway... if that store is local to him. They offer it for what I presume would be $82.

Check out this site

[NoRush993/951]

These drug price increases are classified as GDP growth by our government friends.

[Arizona_928]

I was able to get a knee MRI with a same day read for 200$ Cash price.
It's not just only big pharm that is gouging the **** out of people.

[motion]

You can get anything you want in Sri Lanka for literally pennies at any pharmacy on the street, without a prescription. Yes, I know its fake. But, when big pharma is off-shoring production anyways, I doubt it makes much of a difference.

[URY914]

Originally Posted by URY914

I work at the largest hospital system in the area. At a leadership meeting last week our CFO told us that this year drug prices have gone UP 27% over the projected increase. This situation plus reductions in reimbursements have caused some hospitals to go from a 6% margin to a 1.5% margin. Watch for hospitals to start going out of business thanks to the ACA.

To clarify the above, ADA is not directly responsible for the increase in drug prices. What I was trying to explain is that the increase of the cost of drugs PLUS the reduced reimbursables as a result of the ADA is causing a huge burden on hospitals in general.

[widebody911]

Originally Posted by NoRush993/951

These drug price increases are classified as GDP growth by our government friends.

Citation needed.

[GWN7]

One of the drugs I now take is Brilinta 90 mg 2X a day. Here they cost me $96 (or $73.21 US$) for 60 tablets. According to https://www.drugs.com/price-guide/brilinta it is $333.56 in the USA (Add 30% for the exchange).

It is interesting to note that the 60 mg and 90 mg are the same price.

[flatbutt]

Originally Posted by john70t

I don't believe the ACA is involved.
Rather, it is IntelProp and importation laws which allow these companies to charge whatever they want.
It's all about stock market profits.

State medical system can't source drugs internationally and save taxpayers money:
Judge overturns Maine law allowing prescription drug imports — Health — Bangor Daily News — BDN Maine
The three pharmacy groups argued Maine’s law sidestepped the U.S. Food and Drug Administration’s oversight, designed to protect consumers from unsafe medications.

But most US drugs are still made overseas, with little oversight:
Voters trust drugs made in USA, but few are - USATODAY.com
Yet, unbeknownst to many Americans, an estimated 80% of the substances used to make or package drugs sold here are made in other countries,

And they are not always safe:
Want to Know Which Drugs are Made in China -- Check Out This List
The FDA now says contaminated Heparin is blamed for 81 deaths and almost 800 allergic reactions. After all these recalls, the “Made in China” label is making people wary. A significant amount of the active ingredients for medicines that are sold in the U.S. are made in China. Here in the U.S. the FDA inspects pharmaceutical manufacturing facilities every two years, but the FDA admits that it only inspects about 7% of the overseas plants each year.

I don't dispute those lists but what needs to be said is large pharma tests the APIs made overseas according to US FDA regulations. I know this firsthand as I spent the last 10 years of my career in Regulatory Affairs and charged with ensuring that very thing. We also inspected those sites ourselves with our own inspectors.

[jyl]

Originally Posted by GWN7

One of the drugs I now take is Brilinta 90 mg 2X a day. Here they cost me $96 (or $73.21 US$) for 60 tablets. According to https://www.drugs.com/price-guide/brilinta it is $333.56 in the USA (Add 30% for the exchange).

It is interesting to note that the 60 mg and 90 mg are the same price.

What drugs "cost" in the US depends on what list you are reading from and what pocket you are paying from.

The list price of Brilinta in the US might be $425 for 60 x 90 mg (don't have actual #, that's just an example). The reported average wholesale price (AWP) is $341 (from http://dsi.com/documents/10710/11035/Effient+Daiichi+Sankyo-Information+For+Vermont+Prescribers+Of+Prescriptio n+Drugs/045fbeca-e1c6-4fb6-b773-0408c6e01da2). But actually large purchasers pay much less than AWP. The pharmacy benefit managers (PBMs) that commercial insurers and hospitals use, and, government programs, might pay more like $275 (again, just an example). The patient with drug insurance who goes to fill a prescription will pay only a co-pay, might be $25 to $40. The patient without insurance who goes to fill a prescription might have to pay the full list price $425.

Drug pricing is a very complex topic. Might read this for starters, talks about how govt programs pay different prices, it is an old article but still relevant. http://www.nhpf.org/library/issue-briefs/IB807_DrugPricing_08-29-05.pdf Private insurers usually pay more than govt programs.

How the situation got so complicated, is another story, but basically:

- one manufacturer has a legal monopoly on the drug for about 10 years post-approval
- the drug is effective, and possibly even vital, to treating a disease
- the government agency that approves the drug for the disease does not know how much the manufacturer will charge for it, and doesn't consider cost anyway (may actually be prevented by law from doing so, I'm not positive)
- the doctor prescribing the drug doesn't have any reason to care what it costs (and may get paid by the manufacturer for prescribing lots of it)
- the patient using the drug doesn't have any reason to care what it costs (because he pays a fixed $20 to $40 co-pay no matter what the cost is)
- the insurer paying for the drug has a mix of legal and business requirements to pay for the drug, no matter what it costs, as long as it is approved for the disease and the doctor has prescribed it
- certain govt programs that also pay for the drug have the same legal obligation, and are also prohibited by law from negotiating for a lower cost; other govt programs don't have these requirements
- the relevant laws were passed by congressmen who receive large sums of money from the manufacturer