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Re: Another Reason Why Our Drug Prices Stay HIGH - Making It Hard to Negotiate - WHAT'S YOUR DECISIO

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@GailL1 wrote:

I would be interested in your views on this - since it does involve the Medicare Drug Coverage under which many of us participate and the cost of meds- beneficiary, the insurer and Medicare -, specifically in these (5) protected classes of Meds in the Med D program.

 

We all harp about the cost of meds but the case of these (5) protected classes of Meds in the Med D program - What are you willing to accept?

 

IMO, this is a program (Medicare Part D) which we all share in - beneficiary, the insurer and Medicare.  So the questions in the article proposed to the "experts" are actually good for us to answer also -

  1. Should we even have these (5) protected classes in the Medicare Part D program?  These are the classes of meds which Medicare Part D currently requires that “all or substantially all” drugs must be covered by all insurers.  These are some of the MOST expensive meds.  They also may be the ones which could extend life for only a matter of a few months at a tremendously high price.  And as we all know, we don't rate our meds in a good-better-best hiearchy.
  2. Should these protected class drugs be subject to insurers negotiations like the other classes in Med Part D and therefore some insurers will cover those where they get the best price and are listed on their formulary and other do the same with others in these drug classes? 
  3. Should these meds be subject to step therapy as a medically sound reasoning - meaning a beneficiary must use a lower cost treatment med before trying the higher cost treatment.
  4. Should these (Pharma donation subsidized) Patient Advocacy Groups have the right to lobby?
  5. Should some meds in these classes (and maybe others too) just NOT be on any Med D formulary if the price goes over a certain amount?
  6. Should there be a measure for the actual outcome of a Medication?  Meaning if it only extends life a few months without regard to quality of life and is tremendously expensive - should it even have been improved for distribution?
  7.  What do we need to do here with these (5) protected classes of medications in the Med D program where "all or substantially all" meds in these classes have to be covered to make negotiations happen ?  Negotiating from the standpoint that ALL of them have to be covered is NOT a strong place for negotiations.

 

KHN 03/04/2019 - Big Pharma Gave Money To Patient Advocacy Groups Opposing Medicare Changes

 

highlights from the above link ~

 

Dozens of patient advocacy groups . . . . .  recently appeared in national advertisements objecting to a Trump administration proposal that could limit drugs covered by Medicare providers.

 

But a Kaiser Health News analysis found that about half of the groups representing patients have received funding from the pharmaceutical industry. . . . . .

 

. . . . . As patient organizations gain ground lobbying Congress and the administration, experts have begun to question whether their financial ties could push them to put drugmakers’ interests ahead of the patients they represent.

 

The advertisement, which ran in national newspapers, attacked proposed changes to Medicare Part D’s “protected” drug classes, which require that “all or substantially all” drugs must be covered by all insurers. The medicines involved include oral cancer drugs, HIV medicines and antipsychotics.

 

The protection can have the effect of guaranteeing sales to Medicare patients no matter the price tag.

 

The proposed rule

  • would give insurers more opportunities to instead steer patients toward lower-cost therapies and generics using prior authorization or step therapy, in which patients must try cheaper drugs before they can switch to options that are more expensive. 
  • It would also allow protected drugs to be left off Medicare Part D formularies when price hikes exceed inflation or new formulations of drugs don’t offer a “significant innovation” over existing versions.

“It’s wrong and it will put patients’ lives at risk,” reads the ad paid for by the American Cancer Society Cancer Action Network above a list of 56 other patient advocacy groups who presumably agree. Underneath, a link directs readers to an online form to send pre-written emails to members of Congress and the administration.

 

========================

THE CONFLICT

The Government's Position:

The government proposal’s goal, however, isn’t to end coverage for drugs in protected classes, said Rachel Sachs, an associate law professor at Washington University in St. Louis who specializes in health care. Its goal is to give plans more leverage to bargain for better discounts. If there’s a chance an insurance plan won’t cover a drug, the provider has more negotiating power.

 

Pharma and ( many ) Patient Advocacy Groups Position:

It’s important to make sure cancer patients can get “cutting-edge” treatments, said Keysha Brooks-Coley, vice president of federal affairs for the Cancer Action Network. “This is really an access issue,” she said.

 

The lobby for brand-name drugmakers, the Pharmaceutical Research and Manufacturers of America, takes the same stance, according to its submitted comments on the proposal.

 

======================

 

But access to drugs means more than insurance coverage, said Karuna Jaggar, the executive director of Breast Cancer Action, a patient group that was not invited to be listed in the ad and hasn’t accepted corporate funding for two decades to avoid the appearance of bias. “If people can’t afford it, the reality is they cannot access it.”

 

Given the ad’s selective understanding of “access” to exclude cost and the patient groups’ industry ties, she asked, “Can we trust them?”

 

Although there are occasions when what’s best for patients is the same as what’s best for drugmakers, people should consider patient advocacy group statements with a “skeptical eye” if groups have financial ties to the pharmaceutical industry, said Matthew McCoy, a medical ethics and health policy assistant professor at the University of Pennsylvania.

 

Drugmakers and patient advocacy organizations have fundamentally different missions, he said. One wants to make money for shareholders. The other wants to serve patients. Since their goals will inevitably diverge, it’s important that patient groups aren’t swayed by their funders, he said.

 

It can be easy to view a pharmaceutical company as an ally when its contributions help keep the lights on, McCoy said. “I think we have a lot of evidence from research on financial conflicts of interest in other areas of health care to know that the influence often is unconscious to the people who are actually experiencing it.”

 

Still, Sachs said she can understand why patient advocacy groups oppose changes to the six protected classes, even if they lead to lower drug prices.

 

“The question is, what happens if negotiations between pharmaceutical companies and the Part D plans fail?” Sachs said. “In at least some cases, the Part D plan will be able to say simply it’s going to exclude you from coverage because of the price of the drug.”


MONOPOLY

 

DRUG MANUFACTURERS BUY OUT OR USE THEIR POLITICAL CLOUT IN WASHINGTON TO CORRUPT THE US PATENT PROCESS

 

AND AS IN THE CASE WITH PERDUE PHARMA - THE SIMPLY DO THINGS LIKE THREATEN TO CLAIM BANKRUPTCY WHEN THEY ARE HELD TO ACCOUNT - TOO BIG TOO FAIL

 

SOURCE - https://nypost.com/2019/03/04/oxycontin-maker-purdue-weighs-bankruptcy-as-it-battles-opioid-suit/

 

 

 

 

( " China if You're Listening - Get Trumps Tax Returns " )

" )
" - Anonymous

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Re: Another Reason Why Our Drug Prices Stay HIGH - Making It Hard to Negotiate - WHAT'S YOUR DECISIO

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Message 2 of 15

@GailL1 wrote:

john258 wrote

 

This thread is a total waste of time as it is only a small part of the total health care problem. You have to attack all the problems in total not one at a time since the solution will be a total solution.

 

=======================

 

Ok, so let's say, this is part of a whole solution - how would it be handled then ?

 

How would negotiations take place with Pharma if within this total solution, it is determined that in these (6) classes of drugs, ALL drugs or substantiall ALL in these meds have to be covered - just like now.    

 

How does negotiations take place to bring down the cost of these  (6) classification of drugs if ALL drugs in these categories have to be covered?

Where is the strength in the negotiations?  Pharma would just say "go fly a kite" if you want them, this is the price - just like now.

____________________________________________

You can not start with one small part that why this is a waste of time. If you could it would have been done a long time ago.


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Re: Another Reason Why Our Drug Prices Stay HIGH - Making It Hard to Negotiate - WHAT'S YOUR DECISIO

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Message 3 of 15

john258 wrote

 

This thread is a total waste of time as it is only a small part of the total health care problem. You have to attack all the problems in total not one at a time since the solution will be a total solution.

 

=======================

 

Ok, so let's say, this is part of a whole solution - how would it be handled then ?

 

How would negotiations take place with Pharma if within this total solution, it is determined that in these (6) classes of drugs, ALL drugs or substantiall ALL in these meds have to be covered - just like now.    

 

How does negotiations take place to bring down the cost of these  (6) classification of drugs if ALL drugs in these categories have to be covered?

Where is the strength in the negotiations?  Pharma would just say "go fly a kite" if you want them, this is the price - just like now.

 

 

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Another Reason Why Our Drug Prices Stay HIGH - Making It Hard to Negotiate - WHAT'S YOUR DECISIO

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Message 4 of 15

@GailL1 wrote:

The 2003/04 discussion about the Medicare Prescription Drug Program actually is the same one we are having today.

 

Negotiations of price requires a (narrower) formulary built from the meds in the various classification that give the best value and the best price. 

                                          Verses

A formulary that gives a wide choice of medications in the various classifications; letting the insurers negotiate the prices they pay in most all the categories - EXCEPT THESE (6) CLASSIFICATIONS - where every plan has to cover ALL or substantially ALL of them in these classes.  Negotiations in these classifications of meds does not work and these are some of the most expensive drugs.

 

These categories are:

HIV/AIDS treatments,

Antidepressants,

Antipsychotic medications,

Anticonvulsive treatments for seizure disorders,

Immunosuppressant medications,  and

Anticancer drugs (unless covered by Medicare Part B)

 

So - for these classes of drugs - which is the topic of my post -

How would you handle these? (see my initial post in this subject thread)

 

 

 

 


You have to start at the inception of a drug or drugs pricing not after it is priced. There were some good examples on TV last week from the Drug makers on how they arrived at the selling price. What they said made no sense if you use normal pricing  methods taught in business schools, but this has been going on with drugs for years. What other product had a red book on prices where for years no one ever varied from, and no one was ever able to end what they were doing. Other countries end it by govt. action and that is why the US has the highest drug prices in the world. This thread is a total waste of time as it is only a small part of the total health care problem. You have to attack all the problems in total not one at a time since the solution will be a total solution.

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Re: Another Reason Why Our Drug Prices Stay HIGH - Making It Hard to Negotiate - WHAT'S YOUR DECISIO

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Message 5 of 15

The 2003/04 discussion about the Medicare Prescription Drug Program actually is the same one we are having today.

 

Negotiations of price requires a (narrower) formulary built from the meds in the various classification that give the best value and the best price. 

                                          Verses

A formulary that gives a wide choice of medications in the various classifications; letting the insurers negotiate the prices they pay in most all the categories - EXCEPT THESE (6) CLASSIFICATIONS - where every plan has to cover ALL or substantially ALL of them in these classes.  Negotiations in these classifications of meds does not work and these are some of the most expensive drugs.

 

These categories are:

HIV/AIDS treatments,

Antidepressants,

Antipsychotic medications,

Anticonvulsive treatments for seizure disorders,

Immunosuppressant medications,  and

Anticancer drugs (unless covered by Medicare Part B)

 

So - for these classes of drugs - which is the topic of my post -

How would you handle these? (see my initial post in this subject thread)

 

 

 

 

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Another Reason Why Our Drug Prices Stay HIGH - Making It Hard to Negotiate - WHAT'S YOUR DECISIO

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Message 6 of 15

Yep, this is what was said on this forum back in 2003 when Bush needed to gain popularity after his lies got us into an unnecessary war in Iraq.  Many complained about the "no price negotiating" and have ever since. CMS is the largest health insurance provider and Medicare is it's largest plan.  It made no sense back in 2003 and it doesn't make any sense now.  Many have posted the same over the last 15 years.  Welcome to the club.....

 

It was started out of greed.....big pharma, GOP led congress, the lobbiests, etc.  Feel free to continue to deny it.....not getting anywhere with most though.....

 

But....thanks for asking......  


"FAKE 45 #illegitimate" read a sign at the Woman's March in Washington DC, January 21, 2017.
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Re: Another Reason Why Our Drug Prices Stay HIGH - Making It Hard to Negotiate - WHAT'S YOUR DECISIO

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Message 7 of 15

@Centristsin2010 wrote:

The issues are the "greedy pigs" as illustrated.  Big pharma, the lobbyists, Congress and their kickbacks, the entire drug "food chain".  Hope that clarifies "my opinion".  Smiley Wink

Not Really -

This is one big area where the actions of the Medicare Part D Law has created this situation and it is directly related to what is done by law to curtail the cost.

 

If Congress got no kickbacks, if these patient advocacy groups got no kickbacks (donations) from Pharma - If there was no lobbying from these patient advocacy groups - we would still be left with a very low strength in negotiating these drugs in these (5) classes of Med D.

 

It really comes down to basics, to me, should beneficiaries have unfetered access to ALL or substantially all of these drugs in these (5) classes - with no prescribing constraints or protochols - NO MATTER THE PRICE or NO MATTER THE QUALITY OF THE OUTCOME?

 

IOW, should we all pay $ 500,000 for a (cancer or something else in these 5-protected classes) med to treat a beneficiary if it extends their life only for a few months with no regards to their Quality of Life in those few months?  What if something else cheaper could have done the same thing, perhaps for the long term or even a while?

 

 

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Another Reason Why Our Drug Prices Stay HIGH - Making It Hard to Negotiate - WHAT'S YOUR DECISIO

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Message 8 of 15

@Tom5678 wrote:
answer: the health insurance companies!!!

You will have to elaborate . . . . .what do you think they can do without changes to the Medicare Part D Law.

  • Medicare Part D should be changed so that NOT ALL drugs are covered in these (5) classes of meds so that they can negotiate with the pharmaceutical companies for a better price and only have specific ones listed on their formulary like other classes of meds?
  • AND/OR Medicare Part D should be changed to allow the insurers to add a "step therapy" protocol to the use of these drugs in these (5) classes?
  • Which regulator / negotiator should pull the plug on coverage of a medication in these (5) classes if the price goes way up over a specified limit?
* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Another Reason Why Our Drug Prices Stay HIGH - Making It Hard to Negotiate - WHAT'S YOUR DECISIO

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Message 9 of 15

@mandm84 wrote:

I'm sure the fact that Congress , especially the GOP , have refused to stand up against those high prices has just a little to do with those high prices. Who do the Lobbyist's own ?


The Lobbist make donations to Congress members of BOTH PARTIES - especially this one which is NOT a PHARMA group but several patient advocacy groups who get donations from the Pharma companies.

 

Do you not have an opinion on this ?  Do you just leave it up to government to fix this with no input from you?   In this case, I have no idea how Congress (either party)  will decide which pathway to take here.

 

This is an effort to "stand up" against high prices - especially in these (5) classes of drugs which  "ALL or substantially ALL" have to be covered in EVERY Medicare Part D insurer's plan

 

Take a stab at answering the questions the experts are having to answer - your are involved in this, ya know - I assume you are one of the beneficiaries (Medicare) - if you have a Part D plan - you are involved.

 

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Another Reason Why Our Drug Prices Stay HIGH - Making It Hard to Negotiate - WHAT'S YOUR DECISIO

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Message 10 of 15

@GailL1 wrote:

Sorry, @Centristsin2010, don't understand your cartoon's implications - definitely not fake news.  Fake Nws?  LMAO!  Hardly.

 

This is just part of the discussion going on within the Senate and House committees, HHS and the Administration looking into drug cost and how to keep them down - specifically those of Medicare Part D.

 

I guess you have no opinion ?????  You "guessed wrong".  The issues are the "greedy pigs" as illustrated.  Big pharma, the lobbyists, Congress and their kickbacks, the entire drug "food chain".  Hope that clarifies "my opinion".  Smiley Wink



"FAKE 45 #illegitimate" read a sign at the Woman's March in Washington DC, January 21, 2017.
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