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Honored Social Butterfly

Your Thoughts on Medicare Negotiating the Price of Drugs as a Health care cost containment method

An old (but new again) piece of legislation has been re-introduced in the House of Representatives on allowing Medicare to negotiate the price of medication - at least some of them.
 
The President supports Medicare negotiating the price of drugs to bring down the cost of drugs - although there maybe some unintended consequences -
 
Would you support allowing Medicare to negotiate the price of medication - at least some of them?
 
What if your particular (expensive) drug is not included - would you switch to another one that is included or pay a higher price for the same one?
 
Would you be OK with taking a generic instead of a brand name drug if available?
Would you be OK with taking a generic of a type that gives the best price to Medicare and which may change from one generic manufacturer to another periodically depending upon who gives the lowest price to Medicare?
 
This is now in discussion at the (House) legislative level so I am just wondering what the actual medication users think about such a proposal.
 
It's Always Something . . . . Roseanna Roseannadanna
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@GailL1 got this in my mailbox. Looks like something up your alley.

 

I am a subscriber and downloaded the eBook. Glanced through but not in depth yet.

https://www.statnews.com/debate-over-drug-pricing/


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Honored Social Butterfly

If you really want to learn about Drug Pricing go watch Cong. Katie Porter question the head of a Drug Mfg on pricing, and why his Co., raised the price of a drug. What she proved is pricing is not based on recovering total costs and profit, but to get as much as possible from the American people to enrich the drug co. It clearly spells out why the Govt. should set prices of drugs, and not  allow the Cos. to set prices, as they do what Insurance Carriers did in the old days which lead to State control, and then the ACA.  Katie was on MSNBC this evening and covered all of this with facts. 

Super Contributor

@john258 I got a chance to see Congressperson Porter on video. It was an interesting presentation. I agree that certain drug prices need to reduce especially after years and years of patent extensions. What is a reasonable cap on prices? If you leave it for the government to determine, you may see price increases rather than reductions. Remember the Federal government paying about $35.00 for a screw or the $640 toilet seats. Whether real or a myth, the Feds have been known to overpay when they need something immediately.  The Humira drug that Ms. Porter addressed is probably the largest selling drug on Earth. And, the private sector where I worked, always negotiated price. If an organization was not large, using Pharmacy Benefit Managers (PBM) helped; and, that may be the approach the Feds may want to try first. I believe some Part D Plans and Medicare Advantage Plans are already using PBMs. In my opinion, Ms. Porter's approach to try to correlate increased Humira prices with stock buybacks was inept. First, the Board does not set prices for individual drugs. However, the Board does approve or disapprove stock buybacks which is decided based on many factors. What was missing from her presentation was the fact that stock buybacks support stock prices if not increase prices which all Americans benefit. The largest shareholders of Abbvie (who sells Humira) are institutions such as Vanguard, Blackrock, State Street and Fidelity. That appears to me to be significant retirement plans as well as IRAs are benefiting from stock buybacks. Moreover, why doesn't Ms. Porter target Apple who has bought back approx. $282 Billion of their stock versus Abbvie's approx.$22 Billion. Stock buybacks from all corporations have supported the stock market over the last 5 years and retirees who elect to participate in equity ownership. I believe Ms. Porter should focus her energy on addressing the issues which our Social Security systems (both OASDI and Medicare) face. If she participates in the Government Thrift Plan, she benefits from all stock buybacks. For the last 5 years, the stock market (using S&P 500) has provided average annual returns of 11.96%, 21.82%, -4.38%, 31.49% and 18.4% (during the pandemic). The nominal GDP for the same periods grew at 1.64%, 2.37%, 2.93%, 2.16% and -2.3%. . 

Honored Social Butterfly

Tonster:

 Could not disagree with you more. Having been involved with this industry when the Red Book was the vehicle they used to set prices for all I have seen it loosen some but not much, and you have to treat it as one not parts in setting prices. If you do not they just make their money in other sectors as the Congresswomen proved.

The Govt. paid those high prices because it is a bureaucracy with a lot of rules to follow. That is how Trump got the ok from NYC to do the ice rink.

Every Insurance Carrier now negotiates drug prices and has been. They were doing that when I worked for a Carrier. If Medicare could negotiate prices it would get the biggest discount and that is why the drug Cos. made sure that would not happen. They saw the Medicare discounts with health providers were steep and wanted none of that.

You can be sure if a drug was not sold for as much as possible the board would become part of that area quickly. As I said before you look at all parts of a Co. to see if they are stealing from people, and the drug Cos. have been stealing from all of us for years and the Congresswomen proved that period. What you tell me is right out of the Drug Co playbook, and one reason their stealing is allowed to go on.

Drug Cos. return should be limited to a small profit because of the type of business they are in and how it effects all of us. If you want to make a quick buck the Drug Mfg. should be the last place one looks other wise you are making your money off of another persons misery, or death.

The Congresswomen is correct in what she said and if the American People care about others will back her 100% and drug prices will come down.

Super Contributor

@john258 I suggest you take a look at operating margins and profit margins of any business before drawing conclusions such as Ms. Porter did with Abbvie. I believe presenting a more positive approach to the high cost of Humira would accomplish more rather than "putting on boxing gloves".  If she or her staff would have performed basic college entry level financial analysis, it would be abundantly clear that Abbvie is not the most profitable company in the World, USA, or drug industry. In fact, you do not even need to study 10Qs, 10Ks, Income Statements, P&L Statements, or Annual Reports. It is done for us on websites such as Yahoo Finance, etc. FYI, Abbvie has an Operating Margin of 32.67% and a Profit Margin of 10.28%. Using Apple, the company with the largest amount of stock buybacks at about $282 Billion, has an Operating Margin of 27.32% and a Profit Margin of 23.45%. Although I did not find any statistics regarding the number of people who have I-Phones or who take Humira, I would conclude just by the above profit margins that Apple is significantly overcharging and getting away with it. Perhaps Ms. Porter should target Apple inasmuch as phones are a necessary utility that should be governed just like any other utility. I hope you get the point.

With regard to the government setting prices, you will be creating another large politically staffed agency that will be a waste of money. The staff will change based on which party wins the election. In my opinion, the government would be more efficient simply paying a discounted cost for the folks who cannot afford certain medications. Using the Dept. of Energy as an example, they could not affect the price of oil as compared to the Saudi's.

At any rate, I believe there are discounts happening currently with the Medicare folks. In my own case, I am using the mail order option rather than the local pharmacy that I could walk to. My last EOB informs me that my Plan paid $7.65 for a 90 day supply; and, I do not need to pay a copay. I believe the copay is waived for certain generic drugs purchased via mail order. There has to be a dispensing cost as well as postage. I am guessing the cost of the pills may be $5.00 or $0.055 per pill and dispensing and postage $1.65. How much more can the government discount?  I suspect the distributor (i.e., McKesson, Cardinal, etc.), the PBM, or insurer reduce the cost to capture the business. Sort of the way General Motors reduces the cost of a Chevy and increases the cost of a Cadillac.There may be more bells and whistles on the Cadillac, but is it worth $25,000 to $35,000 more? Lastly, it is estimated by the Employee Benefit Research Institute that approx. 132 million folks are covered by employer sponsored self insured plans governed by ERISA, the federal law. So, State insurance laws are not applicable. The ACA was suppose the tax the Cadillac Plans which the majority are Union negotiated benefits. The Unions used their influence to get the Obama Administration to back down on that tax. Do you think the Biden Administration will initiate such tax; and, possibly lose the Union vote? I agree with price reductions on certain medications. However, in my opinion, the government could simply support price reductions thru company tax credits, financial incentives, and/or outright payments to the innovative drug companies rather than create another bureaucracy. 

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Honored Social Butterfly

The good congresswomen presented the truth about the drug industry. Sadly we have a lot of people who do not understand what is going on in an industry, or how it works reading articles on economics and trying to apply them to where they can not be applied. What we end up with is a lot of useless information that has no bearing on the subject and leads anyone who follows it down the wrong path so the problem is never solved just made worse. The good Congresswomen does not fit into the group, and smart people will follow her as she could solve the problem.

Honored Social Butterfly

These are the top-selling drugs in 2020 - some of them are widely used in Medicare as well as the rest of the population.   Many have no generic alternative at present.  They are each mildly to extremely expensive.

So if we negotiate the price of some or all of them - what will happen if the 

drug companies say NO or say they will only negotiate down to a certain price?  

 

If we negotiate the price of say, Humira, down in the Medicare coverage, the way I understand it, the price will go UP for Medicaid beneficiaries because the drug rebate which Medicaid gets will not be as great.

 

There are other suggestions being contemplated too at the legislative level like -

  • the price we pay in the US can't be higher that 100% + (some %) of what some other defined countries pay.
  • we limit the amount of what Medicare beneficiaries pay out of pocket

Capture.PNG

 

 

 

 

It's Always Something . . . . Roseanna Roseannadanna
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@GailL1  Thanks for posting the list of top selling drugs. The prescription drug industry is complicated as you pointed out. Negotiated discounts may affect negotiated rebates.

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Honored Social Butterfly

Easy answer. We have govt set the prices. Lets take Humira and its price. Well if you are being treated by IHS you get it free. I have a friend who used it for about 2 years for a very rare problem. He had to see the Dr. at IHS a few times a month and was given a supply to carry to the next visit. That was about 4 or 5 needles each visit. The drug did its job and he is well and has no after effects. I call it the $100,000 disease but it is in the past. Without that drug he would have been on medical treatment the rest of his life, and it would have cost the medical system even more so money was saved. Better yet lets revise the drug pricing system so there is a lot less profit for the drug cos. and save even more money for the system. Great part of drug research is not done by the drug Cos. but by Govt., Univ., Foundations etc. By the way the Dr. overseeing the treatment was located at one of the large medical intuitions in the US.  They oversaw what the local Dr. and staff did. You saw how a medical system should work to cure, and save all people. That should be our National model to try for.

Honored Social Butterfly

@john258 

The US Government cannot set the prices - they can use the price in authorizing the use of the medication, they can negotiate the price, if such a plan is put into effect, but they cannot set the pharma suggested retail price.  They are the patented right of the creator.

 

You do not get Rx free under the IHS - they work their program similar to Medicaid so government pays, that's not FREE- the Medicaid rebate on meds is shared with the IHS very similar to the way the Fed gov. shares the rebates with the states.  In most cases, an IHS beneficiary gets this med or any other medication at someplace other than an IHS pharmacy, they have to shoulder the price of it.  

Indian Health Services.gov - FAQ 

from the link ~

Q: Am I required to get my prescriptions filled through an IHS pharmacy?

A: Patients are not required to get their medications filled through the IHS pharmacy. If you wish to purchase the medication at an external pharmacy, you can request a prescription or request that the prescription be electronically transferred to the requested pharmacy.

Your prescriber will enter the medication in your medical record even if the medication is filled at another pharmacy. This keeps the your medication list up to date and prevents medication related errors. Please note that unless there are special circumstances, the patient will be expected to cover the costs of the medication filled by a non-IHS pharmacy.

 

IHS beneficiaries like any other people can request special access to Humira through the Abbvie Patient Assist Foundation or some illness specific foundations.  Depending upon the situation and income the med is given either free of cost to the patient or at a very low cost.

 

When a pharma company gets research for a particular med they want to pursue from a university - the university is paid for this research AND if the drug makes it to fruition (many don't, you know) and the med is patented - the university, if they have been smart about their contract, also share in the profits of the drug by being made part of the patent filing.  But not all meds begin with outside research from universities.  

 

Sometimes the NIH helps to bolster the development of a new drug for a specific disease - again this is a joint effort -   They do the same for other types of treatments.

 

 

 

 

 

It's Always Something . . . . Roseanna Roseannadanna
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Gail:

By the numbers:

1. If you change the law and the Govt. could set the price, and that is what should happen if the Drug Cos. push it to that point.

2. Do not try and tell me what happended with the Indian Health Service. I lived it and saw it with my own eyes. The pharmacy is at the facility and you  pick up all drugs prescribed by the Dr. before you leave, and there is no cost. Period and fact. THERE WAS NO COST FOR HUMIRA AND IT WAS GIVEN OUT EVERY TIME I TOOK HIM FOR A DR. APPOINTMENT FREE. Every drug they dispense is free to the user. Period and fact. Looks like your ref. article is not complete, and that is what happens when you rely on what you read rather than what takes place in the real world. In all the time I have known him he has never paid for a drug at the facility, nor has anyone else.

3. I will say it again. A lot of drug research is done by other than the Drug Cos. No one should be allowed to make a large profit on drugs as that is making money on peoples misery and death. This country is better than that.

 

The information I gave in my previous post and this one is what has happended period, and no article one has read can  change that period.

Honored Social Butterfly

UPDATE 05/11/2021

Legislative movement is not going too well in the House - 

POLITICO - 05/11/2021 - Pelosi drug price plan threatened by centrist defections 

A group of Democratic moderates have raised concerns over a drug price negotiation bill, enough to potentially doom the effort.

 

The legislation seems to have hit some troubled waters in the House.

 

At least 10 caucus moderates are signaling opposition to Democrats’ drug pricing negotiation bill — more than enough to potentially force House Speaker Nancy Pelosi into dropping the reforms from infrastructure legislation Democrats hope to pass along party lines. Pelosi can only spare two Democratic defections on partisan legislation because of the party’s slim House majority.

 

. . . . Eight of the 10 Democratic moderates now raising concerns over H.R. 3 voted for the bill in the previous Congress. 

 

[ Several are ] pushing more incremental alternatives that have garnered some Republican support, like capping Medicare enrollees’ out-of-pocket drug costs — a policy included in Democrats’ broader negotiation bill.

 

whole article is at the POLITICO link ~

Stay tuned . . . .

 

It's Always Something . . . . Roseanna Roseannadanna
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the federal government is a not for profit organization unlike the pharmacuticle companies. goverment is involved in our daily lives and if they can get prices lower that helps the consumer. look at the prices of some of that medicine out there its ridiculas to have to pay thousands of dollars of income for these drugs and it only coves 30 day.  i am not a big government fan but in this case its ok                          

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.

To those that believe our government shouldn’t be involved in our healthcare, are you sure you never depended on the U.S. federal governments expertise in public healthcare?

 

We’d still have small pox, polio and an out-of-control Covid19 pandemic in our neighborhoods if the federal government hadn’t gotten involve in health care.

 

And about Obamacare, I wish Obama was a socialist then we would have gotten real socialized health care, but instead only in the US can an insurance middle man stand between you and your health care professional and be allowed to profit exceedingly.

 

Since others have mentioned their favorite Ronald Reagan quote, here’s mine.

“I never drink coffee at lunch. I find it keeps me awake for the afternoon.” Ronald Reagan

Honored Social Butterfly

Never been able to understand as to how come a nation that has over 300 M people think that it can be governed by dealing with the differences that every Stated wands and needs. It makes me think of a nation that has 50 different nations  and they all try to work together.
Medicare is a Federal program. therefore it needs to function as a Federal program. If each and every Stated wants to have their own rule and regulations it will become a mess. for all.

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Honored Social Butterfly

@Roxanna35 

Medicare is a federal program but when private industry is involved - be that some type of providers or insurance companies - there is only so much they can do to get them to participate.  States have more latitude in getting these private companies to participate in certain ways.

 

Like:  Not all states and localities have Medicare Advantage plans because it is not feasible - the area may not have enough providers or even senior population that want to be apart of that part of Medicare.  OR states may want to extend coverage of Medigap coverage [ private coverage] to more of the disabled population under Medicare or not.  

 

Healthcare for the most part is local and is provided by private entities, as opposed to government owned & operated, like the VA Healthcare System.  That is why states play a very important part.  States also know the needs of their own populations better -

 

I think more can and should be done at the state level.  I think this will become more apparent when and IF some type of national plan is ever seriously considered.  

 

 

 

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@GailL1 wrote:

@Roxanna35 

Medicare is a federal program but when private industry is involved - be that some type of providers or insurance companies - there is only so much they can do to get them to participate.  States have more latitude in getting these private companies to participate in certain ways.

 

Like:  Not all states and localities have Medicare Advantage plans because it is not feasible - the area may not have enough providers or even senior population that want to be apart of that part of Medicare.  OR states may want to extend coverage of Medigap coverage [ private coverage] to more of the disabled population under Medicare or not.  

 

Healthcare for the most part is local and is provided by private entities, as opposed to government owned & operated, like the VA Healthcare System.  That is why states play a very important part.  States also know the needs of their own populations better -

 

I think more can and should be done at the state level.  I think this will become more apparent when and IF some type of national plan is ever seriously considered.  

 

 

 


Lets go be the numbers.

1. It is feasible to have Medicare Advantage in every area of the country. Fact is we had that when the program was first started. I was in one. The Carrier provided just what Medicare did. Nothing more nothing less. Claims were submitted to the Carrier for payment. Providers did not have to accept this type of Advantage plan and people were turned down. Hot spots where this happended were in N. FL, and GA. The Carrier was paid 15% more by Medicare for providing this coverage.  Medicare some time ago ended these type of plans and said Carriers had to add programs to the basic Medicare ones. Many Carriers dropped out.

The real reason we do not have Advantage programs in every area is the Carriers can not make a profit.

2. Health Care is provided to all mainly  by local private or govt. supported private entities, and States should know what is needed better than any party.

Many States provide money to cover some of the costs by these entities, and provide oversight of them.

3. Health Care is a National issue and can only be solved at the National level on a broad basis with States allowed to add or subtract things not needed in their State, and this is something the Feds must agree to so it is a State and Fed. Partnership. We have seen this with the virus. We need a base National plan as a Starting point.

4. The Carriers are in this to make a profit as big as they can. If they can not make a profit they drop out or get one of the parties to support changes to existing laws so that happens.  Part D Drug in Medicare is an example of that by the Drug Mfg.

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@john258 

1.  It is feasible to have Medicare Advantage in every area of the country.

RESPONSE:  The number of counties with no Medicare Advantage plans for 2021 is 82, similar to 2020. As in prior years, there are no Medicare Advantage plans offered in Alaska. Additionally, no Medicare Advantage plans are available in territories other than Puerto Rico.

KFF: Medicare Advantage 2021 Spotlight 

The real reason we do not have Advantage programs in every area is the Carriers can not make a profit.

In a way, that is true but it originates because the insurers have little way of developing their networks in areas where [all types] of providers are scarce.

2. . . . States should know what is needed better than any party.

Many States provide money to cover some of the costs by these entities, and provide oversight of them.

That is why I said "

States also know the needs of their own populations better -

 

I think more can and should be done at the state level.  I think this will become more apparent when and IF some type of national plan is ever seriously considered.  "

States are also the ones that provide charters to hospitals to either open new ones or expand their bed capacity with reason.  To control health care cost, as other countries do, this sort of managed medical infrastructure is carried into other areas of supply like where & how many imaging facilities are placed. It does us no good to have them all piled into one area and none in another - same with other types of medical infrastructure - and these can only be controlled at the state level unless a system like the NHS is developed but I don't think we would ever go that far.

4.  Part D Drug in Medicare is an example of that by the Drug Mfg.  

Part D was designed the way it was because seniors wanted access to the widest range of drugs.  Negotiating drug prices also means that we are gonna negotiate which drugs are covered - there is NO negotiation strategy that can support the number of drugs that seniors have access to today under the Part D program - if we go this route, only some drugs will be on this negotiated formulary.  I am not saying that is bad - just a reality.

 

It's Always Something . . . . Roseanna Roseannadanna
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Gail.

By the numbers again.:

1. You are correct there are now parts of the country that have no advantage programs. The area I live in is one of them. The reason is that no Carrier wants to have one in that area because they can not make money. PERIOD.

There was Advantage plans in my area when the program started and I explained it to you. That program was in every State, and county in the USA. The Carrier made money by the extra 15% paid to it by Medicare. Medicare ended that and the Carrier ended the plan everywhere.

 

Carriers can develop networks in just about everywhere in the country they want to have one. There are networks developed by outside groups which sell access to the network to Carriers. How do I know that. I was involved in using those networks in programs I had a hand in developing. I am in such a network now for Dental Insurance which is used by a large Carrier.

2. Glad we basically agree on the States. There are States which do some of this now. One Eastern State some years ago got in to the heart transplant area. When it was new just about every Hospital was trying to have one. The State stepped in and ended any new Hospital having such a unit with out State approval. The State then only allowed what was needed.

4. Part D was created by the drug mfg. and crafted to end the problem of Seniors being forced into bankruptcy by having to take a high cost drug off long periods of time. Medicare picked up the cost after a certain level. They threw in the starter coverage to supply something for all so they would get support of most members. The far right Rep signed on to that idea and saw it as a starter to turn Medicare back to Carriers. What they actually did was lay the groundwork for total drug coverage, and you see this as the coverage gap is shortened each year.

You can include all drugs in the program you set prices for, so  you leave none out, and you can be sure drug mfg. want all their drugs in. I have no problem in requiring that generic be used where there is one unless the DR. has a reason to use Brand name.  Have you ever been to a drug mfg operation? If not visit one. Have them explain the red book to you and how it used to work. Go look at the production line on over the counter drugs and see the pills going into different bottles on the line and then learn the difference in prices the bottles of the same pills will be sold for. This area has been controlled pricing for years.

 

 

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I know that you know about these things more than the general public. so what is your position ?  Mine is as follows. we al know that we pay in the US for medicines more than the rest of the world. so if Medicare can alleviate any of this more power to them. Personally, yes I think is a good idea. and I already accept generics in most of my prescription. If there was one that was not included I would have to make the decision depending of my need as to whether I would pay or whether I would  get a generic if that generic was as efficient as the brand one then yes I would take that generic.

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Honored Social Butterfly


@Roxanna35 wrote:

I know that you know about these things more than the general public. so what is your position ?  Mine is as follows. we al know that we pay in the US for medicines more than the rest of the world. so if Medicare can alleviate any of this more power to them. Personally, yes I think is a good idea. and I already accept generics in most of my prescription. If there was one that was not included I would have to make the decision depending of my need as to whether I would pay or whether I would  get a generic if that generic was as efficient as the brand one then yes I would take that generic.


The  answer to your question is easy. Yes the prices would come down if Medicare could bargain with the drug Cos. on prices. That is why the drug Cos. had it made unlawful for Medicare to do that. You will hear a lot from some on the free market and all the usual cries when their ability to control what you and I do that can reduce what they make in profit. There is no free market in health care and has not been for years. The States control most of what the Insurance Carriers do. Everything from what they must cover, to rates, reserves, and definitions. This came about due to the Carriers misuse of what they were doing. If you ask a number of Carriers to rate a policy based on loss ratio all would give you the same rate as they all use the same base table.

 I always say never listen or follow anyone who says the free market will fix this. It has proved it will not, and has not in the last 100 years.

Honored Social Butterfly

@Roxanna35 

I feel pretty much like @somarco does.  If the government would stay out of it ( not just this but other stuff too, like the cost of higher ed.), private institutions - be that a pharmaceutical company, a college or even a doctor, hospital or other medical business - then those who want to sell something would have to compete for just our dollars and between themselves.  That, in and of itself, would make the price of [whatever] more reasonable for our dollars.  There is only a finite number of rich people who could afford something with price being of no concern.  

 

Government creates a lot of this problem with the way they approve medications and even therapies, surgeries, treatments, etc. even down to the way they allow the creating pharmaceutical manufacturer to manipulate their patent protections.  Governments roll should be only to evaluate the efficacy (including price) of any medication and then if approved as the good-better-best, set limits on how long they can continue to hold its formula captive without a MAJOR re-invent.  They also should not be able to hold such medication ransom for other uses - IOW, a med should be approved, rated by its efficacy (including price), for only the patented use - outside of that patented use, either they or another drug company / manufacturer has the ability to seek approval in the same way for other uses - treatment for AMD involving Avastin, Lucentis or Eylea is a great example.

 

We do need government to determine the efficacy of all drugs - they should always include price in this measurer of approval.  Further more, they should rate it for approval (including price) as to whether or not it is good-better-best of the current market treatments.  Meaning they rate it (including price) not only that it works but that it works better than whatever is now on the market in comparison (including price and quality of life).

 

As the Commonwealth Fund links in my post show, there will be some draw backs to this current plan.  That's why it is still in the works -

When government says, it is gonna save money - many times, it is not talking about a persons' money - they are talking about the money that government spends which does affect people's pocketbook - IF they pay taxes.

 

So downfalls in the current plan as written are:

  • scope would be limited to the most expensive, most widely used meds in the beginning and most likely just a few.
  • might cut down on manufacturers development of new drugs somewhat
  • will reduce the size of the Medicaid drug rebates, increasing the price for government (feds share with the states)

There are a lot of IF's in your answers - and that is always the problem - the unknown, unintended consequences and how those changes would affect real people.

 

It's Always Something . . . . Roseanna Roseannadanna
Honored Social Butterfly

Gail, I believe that you want perfection in politics and government? LOL LOL

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Bronze Conversationalist

@GailL1 the most feared words in the English language are, "I am from the government and I am here to help you".

 

Almost every time the DC critters try to help they make it worse and more expensive. Promises to "fix" or "save" Medicare and SS in particular translates into "DC will pay/contribute less and the beneficiaries will pay more".

 

Part D was supposed to make Rx more affordable but instead caused prices to rise. Consumers lost access to most of the PAP's once they enrolled in a PDP.

 

Medicare beneficiaries, for the most part, are better off without Part D than with it. That is a general observation and, as always, there are exceptions. Most of my clients, including those with a PDP, pay cash and use GoodRx vs their drug plan for all but brand names.

 

In some cases they may qualify for a PAP even with Part D but many of the PAP's won't give you a discount card if you have a Medicare drug plan.


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Social Butterfly

Drug companies should not be allowed to extend their patents for minor changes to a brand drug such as a tablet versus a capsule, one pill a day instead of two, a blue color instead of green, or even some changes to molecules of a drug are questionable as whether they are safer or more effective.

.

All drug companies are doing is unfairly preventing another company from manufacturing a cheaper generic version of the drug.

.

And yes, I think Health and Human services should be permitted to negotiate Medicare prescription drug prices.

.

Congress needs to pass the Elijah E. Cummings Lower Drug Cost Now Act that will help older Americans afford their medications.

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Honored Social Butterfly

@ReTiReD51 

Yes, it is the Elijah Cummings Bill that has been introduced HR 3 but they seem to be tweaking it slightly because of some of the unintended consequences brought out by some studies/research last year.

Commonwealth Fund - 04/29/2020 - The Elijah E. Cummings Lower Drug Costs Now Act: How It Would Work,... 

 

It still depends on what we all (including other nations) can live with - it is not the "fix-all" for everybody.  That's why I asked the questions that I did in my initial post.

 

It is a very complicated topic - U.S. drug pricing and patents.

It's Always Something . . . . Roseanna Roseannadanna
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Bronze Conversationalist

@GailL1 most of the folks in DC lack real world experience. All they know is collecting a paycheck from the taxpayers as long as they promise lot's of free stuff.

 

Almost every time they try to bring companies "in line" and make them behave the consequences are enormous.

 

Obamacare is a good example. The promise was to prevent the insurance carriers from "discriminating against those with health problems", make health care and health insurance more affordable and accessible to everyone by creating more competition and letting the market dictate pricing.

 

What a joke.

 

What we got instead was over 90% of the carriers in the individual health insurance bailed within the first 2 years after the law was implemented. Most never even stuck around for the 2014 inauguration year.

 

Premiums nearly doubled almost overnight and are still rising. PPO plans, once the norm, gave way to HMO's with smaller networks and LESS access to care, not more as promised. Deductibles and OOP limits increased from $1500 - $2500 pre-2014 to the current $7,000 levels.

 

"Junk" plans that were not true major med were supposed to be eliminated. Now we have more than before.

 

The promise to "tax the rich" to pay for these pipe dreams never works out as planned. The 1991 luxury tax was supposed to create a windfall for the Treasury. What it did was collapse the luxury boating industry and almost sink the private aircraft industry as the wealthy found ways around the tax.

 

The luxury tax was a complete failure and was repealed 2 years later due to the crushing impact on jobs.

 

The DC crowd always assumes behaviors are static, that everyone and every company will simply roll over and comply with new rules, taxes, etc.

 

Instead, the companies take their jobs elsewhere, ship their products out of the country and the wealthy pay advisors a lot of money to find ways to legally avoid compliance.

 

So pardon me if I don't jump on the wagon and expect lower Rx prices. History says this will fail like most other government great ideas.

 

 


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Honored Social Butterfly

Lets look at what we got from the ACA. Carriers were forced to have a loss ratio of 80%, and that will go higher. They used to be come concerned at 60% loss ratio. Everyone was required to have coverage so base table rates could be used, and that also gave us coverage for all as the pre ex was ended. Kids were allowed to stay on parents policy till age 26 reducing need for high cost Indv. coverage. There was to be a public option offered, but that was killed by Joe L. who would not vote for the bill. They offered a non profit approach by state and gave the start ups a grant for funding. After a short period of time the grant was changed to a loan forcing most of theses new carriers out of business to to State Insurance laws on reserves since now it was a loan or liability. (The Carriers, and agents were behind this along with the far right.) There was expanded Medicaid which was changed to an opt out at the State level. Joe L work again. The ACA was working to cut costs, and increase number insured till Trump gutted it by executive orders.

 

Yes at first a lot of Carriers got out since they could not make the large profit, and most woke up and came back in. There were no pipe dreams but the first step to what would become a medicare for all approach to pay for our medical coverage for all system we have had for years. HMO and networks were invented to cut costs mainly by the Carriers and all started to use them because they could make more money the ACA  had little to do with this area. Just look at the Dental Insurance area and just about every Carrier uses them.

The DC Crowd is a lot smarter than the people who opposed the ACA since they now work under the new rules. The Insurance Agents have been the biggest losers since the commissions are much smaller.

Where does this end. When we have a medicare for all under 65. That will give us Medicaid and Medicare supplying coverage for all and hopefully from a trust fund which can take money from the sources that cause a lot of our illness.

 

Bronze Conversationalist

@john258 interesting observations but a few miss the mark IMO.

 

I have worked the health insurance market for a long time. The only time I have seen 60% MLR is for ancillary business (dental, cancer, HI, etc). I have never seen 60% for primary payers. More common (pre-Obamacare) was in the 78 to 85% range.

 

All the MLR rules did was make the cost of administering these plans more expensive . . . and that cost is passed along to the end user . . . along with the incredible cost of eliminating underwriting and pre-ex.

 

Mandating coverage accomplished almost nothing. There are still millions who go bare or rely on overpriced indemnity plans and health care sharing (which are not insurance). Both of those approaches have a lot of holes. In addition, the sharing plans are not regulated by the DOI since they are not insurance.

 

MEWA's were essentially banned except for TH plans and some association plans. Now MEWA's for individuals are coming back and some of them have already crashed and burned.

 

Other insanely stupid ideas by those who crafted Obamacare include the "public option" (which is really Medicaid for all) , and the health care co-ops which soaked up a lot of taxpayer money. Most of the $$$ went to the folks who started the co-ops (many were Obama cronies) and the 30+ co-ops that did make it out of the starting gate were all gone in 3 years or less.

 

Obamacare was a pipe dream designed to draw in votes  . . . "relying on the stupidity of the American voter" (thank you Jonathon Gruber for pulling back the curtain). The real purpose of Obamacare was a Trojan Horse to disguise the Medicaid expansion (another taxpayer boondoggle).

 

Affordable Care never materialized and never will. Most aspects of Obamacare not only increased premiums but also significantly added to the cost of health CARE.

 

at first a lot of Carriers got out since they could not make the large profit, and most woke up and came back in.

 

I don't know where your world exists but I haven't seen that happen in any state.

 

I know agents in just about every state (all 57 of them . . .) and they all tell the same tale. Pre-2014 they had 20, 30 carriers or more now they are reduced to usually 3 or less.

 

PPO plans were once prevalent  now they are nowhere to be found, replaced by HMO's.

 

You say "insurance agents were the biggest losers" and again, I disagree. Weak agents who were peddlers left the market in droves or moved to non-compliant plans (including STM).

 

Some, like me, moved to the senior (Medicare) market and never looked back.

 

The REAL losers in the Obamacare game were the consumers.

 

Fewer choices, if you like your plan too bad it's gone, if you like your doctor get over it, if you want advice and help in picking out a plan go to hc.gov or the carrier.

 

Medicare for all will become Medicaid for all with limited access to care.

 

"Trust funds" in DC are really promissory notes (IOU's) that are nothing more than a slush fund for politico's to raid when they run out of real money.


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