Posts Tagged rosenthal

Insulin pumps for diabetes — the cost of health

insulinpumpElisabeth Rosenthal of the New York Times published her article “Even Small Medical Advances Can Mean Big Jumps in Bills” on April 6, 2014.  Type 1 diabetes is a rapidly fatal illness without insulin treatment.  The discovery of insulin in the 1920’s changed the disease from fatal to treatable and with improved insulin and improved devices to deliver the drug people with the disease now can look forward to a long life.

The article by Ms. Rosenthal points up the cost of current insulin pump therapy.  She lists the yearly cost of insulin treatment for one woman as $26,470 (a large part paid by the woman’s insurance).

Surely, big pharma would not take advantage patients with life threatening illness like diabetes.  Surely, they would not pad the bill with unnecessary equipment or lock-in patients to their brand of insulin with a device linked to that brand.  Surely, US big pharma would not disadvantage US citizens and favor drug plans in other countries.  WRONG, WRONG AND WRONG AGAIN.  It’s the modus operaindi of such organizations and a lack of regulation that allows it to happen.

  • Ms. Rosenthal comments on the fluff added to the bill:  talking pumps with multiple colors and new models every year.
  • The linking of insulin pumps to only one type of insulin (made by the insulin maker).
  • The withdrawal of less expensive insulin from the market.
  • The 70% profit on insulin.
  • The limited number of companies that now make insulin.
  • The sweet deals for countries that drive hard bargains (acquisition cost for a bottle of insulin in the UK $30 but in the US $200).

It seems there is a line to be drawn.  On one side is the unquestionable benefit of research and development that brings fantastic life saving benefit to many patients.  On another side is a business formula for fantastic profit to a few people.  Fortunately, one need not choose either extreme — it is possible to have adequate research and reasonable profit as demonstrated in other parts of the world.

So, what can and should be done?

  1. Break up drug companies to separate the manufacture of insulin and the manufacture of insulin pumps.  The competition in the pump market should not be limited by the drug maker.
  2. Limit drug patents with a strict end point and encourage smaller companies to make generics that may not be an exact copy but simply be similar (bio-similar).
  3. Set prices for drugs and devices based on realistic economic considerations (like limiting profit to 5%).
  4. Allow government sponsored research to compare various types of similar therapy to allow a reasonable choice by patients and providers.
  5. And, allow the government to negotiate prices since the government now pays a big part of health care costs.

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Prescription Medications — sky high price

pillsnbills

Elisabeth Rosenthal wrote the lead story for The New York Times today (10/13/13) “The Soaring Cost of a Simple Breath“.  This is another blockbuster exposé of drug costs that are crippling US health care.  Sadly, not a story about what is being done to correct the problem.

Here are some of her key points:

  • The average brand name prescription has risen from 1995 at $40 to 2013 at $170
  • The average generic prescription has risen from 1995 at $20 to 2013 at $45.
  • A common asthma medication Pulmicort costs $175 in the US but only $20 in the UK and $25 in France.
  • Drugs account for 10% of the $2.7 trillion annual health bill.
  • Americans take more generic medications than people in other countries (they just can’t afford branded or new medications)
  • Other countries set the wholesale price of drugs to make drugs affordable.
  • US pharmaceutical companies have used the FDA to restrict manufacturing rules to favor large companies and have used the judicial system to bankrupt competitors.
  • US pharmaceutical companies have paid generic companies not to sell their products in the US.
  • Medicaid, paid for by taxes, pays millions of dollars to drug companies for high priced medications.
  • Asthma medications have been the target of profiteering drug companies.  Not a single inhaler is available as a generic.  Despite the fact that inhaled medications have been available for over 30 years.  The effect on people with this condition is a tremendous burden.
  • Drug companies spend about 50% of funds on marketing and only about 20% on drug research.  Other advanced countries prohibit marketing prescription medications directly  to consumers.
  • Medicare is prohibited from negotiating prices.
  • Drug prescribing guidelines published by the government are prohibited from considering cost.

Rather than just be angry about the sorry state of drug costs, what can be done?  Just take a lesson from other countries, this is not rocket science:

  • The US government should set the prices for all drugs
  • The FDA needs to loosen the rules for generic manufacturing — for goodness sake, an inhaler is an inhaler, not the space shuttle.
  • Comparative effectiveness research should be required, and the results published for doctors as in the UK.  Drug cost is important to all US citizens, so restricting the government from considering cost  borders on insanity (perhaps giving psychiatric medications to Congress is currently too expensive).
  • Finally, there is no excuse for the current drug cost problem — other countries have solved the problem, the US needs to do the same.

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