#so he has to pay out of pocket for insulin and prozac

[limewatt]

jesus fucking christ learning anything about american healthcare makes me so sad and angry. what a fundamental failure to provide a vital service to a populace.

[dinafbrownil]

California’s New Transparency Law Reveals Steep Rise In Wholesale Drug Prices

Drugmakers fought hard against California’s groundbreaking drug price transparency law, passed in 2017. Now, state health officials have released their first report on the price hikes those drug companies sought to shield.

Pharmaceutical companies raised the “wholesale acquisition cost” of their drugs — the list price for wholesalers without discounts or rebates — by a median of 25.8% from 2017 through the first quarter of 2019, according to the Office of Statewide Health Planning and Development. (The median is a value at the midpoint of data distribution.)

Generic drugs saw the largest median increase of 37.6% during that time. By comparison, the annual inflation rate during the period was 2%.

Several drugs stood out for far heftier price increases: The cost of a generic liquid version of Prozac, for example, rose from $9 to $69 in just the first quarter of 2019, an increase of 667%. Guanfacine, a generic medication for attention deficit hyperactivity disorder (ADHD), on the market since 2010, rose more than 200% in the first quarter of 2019 to $87 for 100 2-milligram pills. Amneal Pharmaceuticals, which makes Guanfacine, cited “manufacturing costs” and “market conditions” as reasons for the price hike.

“Even at a time when there is a microscope on this industry, they’re going ahead with drug price increases for hundreds of drugs well above the rate of inflation,” said Anthony Wright, executive director of the California advocacy group Health Access.

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The national debate over exorbitant prescription drug prices — and how to relieve them — was supposed to take center stage in recent weeks, as House Speaker Nancy Pelosi released a plan to negotiate prices for as many as 250 name-brand drugs, including high-priced insulin, for Medicare beneficiaries. Another plan under consideration in the Senate would set a maximum out-of-pocket cost for prescription drugs for Medicare patients and penalize drug companies if prices rose faster than inflation.

President Donald Trump has highlighted drug prices as an issue in his reelection campaign. But lawmakers’ efforts to hammer out legislation are likely to be overshadowed, for now, by presidential impeachment proceedings. In Nevada, health officials in early October fined companies $17 million for failing to comply with the state’s two-year-old transparency law requiring diabetes drug manufacturers to disclose detailed financial and pricing information.

California’s new drug law requires companies to report drug price increases quarterly. Only companies that met certain standards — they raised the price of a drug within the first quarter and the price had risen by at least 16% since January 2017 — had to submit data. The companies that met the standards were required to provide pricing data for the previous five years. In its initial report, the state focused its analysis on drug-pricing trends for about 1,000 products from January 2017 through March 2019.

California’s transparency law also requires drugmakers to state why they are raising prices. Over time, that information, in addition to cost disclosures, could create “one of the more comprehensive and official drug databases on prices that we have nationwide,” Wright said. “That, in itself, is progress, so that we can get better information on the rationale for drug price increases.”

But the data does not reflect discounts and rebates for insurers and pharmacy benefit managers and bears little resemblance to what consumers actually pay, said Priscilla VanderVeer, a spokeswoman for the trade group Pharmaceutical Research and Manufacturers of America. The group filed a lawsuit seeking to overturn the California legislation that has not yet been resolved.

“If transparency legislation only looks at one part of the pharmaceutical supply chain, without getting into the various middlemen like insurers and pharmacy benefit managers that ultimately determine what patients have to pay at the pharmacy counter, it won’t help patients access or afford their medicines,” VanderVeer said in an email.

State Sen. Richard Pan (D-Sacramento), a pediatrician who chairs the Senate health committee, agrees — up to a point.

“Transparency always has value,” Pan said. But policymakers need more data on how much insurers and consumers are spending on prescription drugs, he said.

And he wonders why the price of generic drugs, including those with plenty of competition, rose at higher rates.

His concerns were echoed by University of Southern California policy researchers, who recently published a study that concluded most state-level drug-transparency laws are “insufficient” to reveal the true transaction prices for prescription drugs, or where in the distribution system excessive profits lie.

“The question is, why are these prices going up? Typically, there are competing stories for that,” said Neeraj Sood, vice dean of the University of Southern California’s School of Public Policy and an author of the study. “Maybe cost of production is going up,” he said. “Maybe there’s a drug shortage, or some competitors got eliminated. This reporting of [wholesale acquisition cost] data doesn’t really tell us which of these stories is true.”

For now, California’s new data is not likely to be of much help to consumers, Pan said. But he said it might help state officials in their bid to overhaul the way the state purchases drugs for 13 million people served by Medi-Cal, the state’s Medicaid program for low-income residents. Gov. Gavin Newsom’s controversial plan to have the state, rather than individual Medi-Cal managed-care plans, negotiate directly with drugmakers would save the state an estimated $393 million a year by 2023, according to the administration.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

from Updates By Dina https://khn.org/news/californias-new-transparency-law-reveals-steep-rise-in-wholesale-drug-prices/

[takebackthedream]

Trump's HHS Pick Alex Azar Is the Worst Pharma Bro of All by Richard Eskow

Nominating Alexander Azar for Health and Human Services Secretary is worse than a fox guarding the henhouse. It’s like pinning a sheriff’s badge on Billy the Kid. For all his polish and small-town charm, when it comes to pharmaceutical predation, the mild-mannered Azar puts blowhard “pharma bros” like Martin Shkreli to shame.

Shkreli is the pharmaceutical exec people love to hate. That’s understandable. He sought out rights to drugs for rare diseases so he could extort outrageous prices from those whose lives depended on these treatments.

Shkreli became wealthy through his shameful strategy for extortion, but was convicted of defrauding investors in August. His smug narcissism and openly corrupt bullying made him an easy target, and a poster boy for pharmaceutical industry greed.The guy’s face tells the whole story. He even reportedly paid $2 million for the only copy of a Wu-Tang Clan album just so that the group’s millions of fans could never hear it.

Photos of Azar, on the hand, usually display a warm and open smile. “Trust me,” it seems to say. This smalltown graduate of Dartmouth and Yale, who clerked for Supreme Court Justice Antonin Scalia, Azar doesn’t look or sound like a bare-knuckled capitalist. He might even make a fine dinner companion, capable of navigating both idle chit-chat and philosophical reflection with ease. He almost certainly orders the right wine, knows which fork to use, and never ever commits a faux pas over dessert and coffee.

He was a lobbyist, after all.

But when it comes to public harm, Azar puts Shkreli to shame. As horrible as Shkreli’s misdeeds were, some will dismiss them as the rogue acts of a bit player. Azar, on the other hand, is the ultimate pharmaceutical industry insider: he has gone through the revolving door from government to lobbying several times to ascend to the helm of pharmaceutical giant Lilly USA.

Azar’s face is the industry’s face, not just that of one corrupt fraudster. And his shame is the industry’s shame. And now the date has been set for his Senate nomination hearing: November 29.

Bad Company

Azar is the son of an opthamologist, and grandson of an immigrant from Lebanon. He ascended to partnership at a white-shoe DC law firm after working for Independent Counsel Kenneth W. Starr on the Whitewater investigation of President Bill Clinton. He then became General Counsel of HHS under President George W. Bush, where he supervised the agency’s $1 trillion operations.

In 2007, he went directly from government service to become the top lobbyist for Lilly,  where he could mine his government contacts for the Indianapolis-based drug manufacturer.

Lilly certainly needed friends in Washington at the time. As the Corporate Research Project’s Phillip Mattera reports, Lilly has paid more than a billion dollars in criminal fines and settlements to the federal government and the states, as well as hundreds of millions to settle private lawsuits.

For decades, Eli Lilly has repeatedly been accused of concealing dangerous and even deadly side effects of some drugs and illegally marketing others for unapproved purposes.

In a foreshadowing of today’s opioid crisis, Lilly’s Darvon proved to be seriously addictive, and was eventually pulled from the market. As the New York Times reported in 1983, Lilly knew of at least 29 deaths in Europe caused by its arthritis medication Oraflex before it was approved for use in the United States. But it did not report those fatalities because, it claimed, “federal regulations did not require reporting of foreign deaths.” Lilly eventually pleaded guilty to criminal charges in that case. its former chief medical officer pleaded no contest.

Lilly was also compelled to pay $1.42 billion to settle a raft of lawsuits over misleading marketing of the anti-psychotic drug Zyprexa as an anti-dementia drug, a use for which it was not approved. This happened less than a month after it agreed to pay $62 million to settle similar charges regarding its marketing of the medication for pediatric uses. It was apparently equally willing to prey on the young and the elderly.

Under Par

A Lilly sales rep even once placed golf bets with doctors to put patients on Zyprexa, according to documentation in a South Carolina suit. ““I got four pars out of nine holes,” the Lilly rep wrote. “I said I wanted my four new patients.”

Lilly’s greatest marketing triumph may have come with Prozac, the antidepressant that arrived with a massive social impact and the sheen of proven science regarding serotonin, only years later was it revealed that that pharmacological effects of these drugs were “clinically negligible.”

2007, the year Azar joined Lilly, was the same year the drug manufacturer was accused of misleading consumers about its canine version of Prozac. It looks like the company was willing to overhype a cure for depressed dogs, too.

Deadly Greed

Did Azar help Lilly clean up its act, of just sweep its misdeeds under the carpet?

Azar became the head of Lilly’s U.S. division in 2012, and under his leadership — if “leadership” is the right word – the company stands accused of illegally conspiring with other manufacturers of insulin to keep prices high, a practice that reportedly began in 2002 and continued at least until 2013.

As the New York Times reports, prices for insulin have risen in “near lock step” for years, without any apparent increase in costs. The consumer group Patients for Affordable Drugs (P4AD) said in a statement that “Eli Lilly is one-third of an insulin cartel that has driven up prices by more than 300 percent.” A major class action suit accuses the three companies of racketeering, and probes of insulin pricing by attorneys general in multiple states remain underway.

And this isn’t just a case of financial fraud or malfeasance. Lives are stake.  Websites like this one offer advice to desperate diabetics struggling to stay alive in the face of sky-high insulin costs. Sometimes diabetics are forced to choose: insulin or food.

As the Times reports, one lawsuit recounted horror stories of diabetics who can’t afford up to $900 per month for insulin and have instead injected expired insulin, or starved themselves in an attempt to control their blood sugar levels. The lawsuit said that other patients allowed themselves to develop a potentially fatal condition in order to obtain insulin in the hospital emergency room.

Lilly has also been accused of making billions by avoiding its tax responsibilities through offshore profits. Lilly reportedly had $21 billion parked offshore in 2013. Lilly reportedly paid an effective U.S. corporate income tax rate of only 14.8 percent from 2008 to 2012. Like other drug manufacturers, it has also been accused of dodging taxes in Australia and Lithuania.

Azar’s Phony Claims

Donald Trump has accused drug companies of “getting away with murder” – an assertion that is, sadly, more than a metaphor – and promises that Azar will be a “star” in reducing drug costs, despite his track record leading a pharma industry giant that has been sanctioned for its price-gouging practcies.

How likely is that?

Not very. Azar is a right-wing ideologue with close ties to Vice President and longtime corporate minion Mike Pence. His public comments about drug prices have blended misdirection and bullshit in roughly equal measure.

“The issue shouldn’t be just to focus on drug prices,”Azar said on the Fox Business show. “The issue is what are people paying when they go to the pharmacy to get their drugs.”

Actually, it’s both. Insurance companies and pharmacy benefit managers have sometimes conspired to overcharge customers for medications, as David Dayen reported last March. But Azar’s line is standard drug-company spin. Big Pharma wants Americans to think about the prices they see when they fill prescriptions. That’s why they often offer programs that waive copayments for certain high-priced medications.

But the costs we don’t see are just as important. Overpriced medications are taxing the entire health care economy, and Americans pay for them in a number of less visible ways: in higher insurance premiums, less covered services, and higher copays and deductibles. Azar wants us to forget about those costs, even as the insurance companies pocket undeserved billions.

The High Cost of Low Innovation

Azar also spewed standard-issue Big Pharma doubletalk in 2014 when he said, “The narrow focus of costs of medicine to the exclusion of innovation would be self-defeating in the long run.”

Drug companies love to claim that we need to pay exorbitant drug prices because research and innovation are so expensive. But a recent study of new cancer drugs in the Journal of the American Medical Association showed that drug companies have been wildly exaggerating those costs and enjoying huge margins on new drugs.

Nor does the cost of research and development explain Eli Lilly’s excessive charges for insulin, an “innovation” which first came to market in 1922.

Azar also said this last year, at a panel hosted by the right-wing Manhattan Institute:

“When the government gets involved it is more likely than not to create perverse incentives and unintended consequences than when the market players can work together to figure that out.”

This claim has been disproven by every other developed country in the Western world, where government-directed health insurance is the norm and drug costs are substantially lower.

The Player

Azar is a catastrophically bad choice for the government’s top health care job. It’s true that he never bought a Wu-Tang Clan album just so no one besides him could ever hear it. But then again, we now know the album Martin Shkreli bought may not have been the real thing after all. The would-be player may have been played.

Nobody’s played Alexander Azar. Thus far, he’s played the system with cold-eyed ease on a scale Shkreli could only dream of, regardless of the financial or human costs.

And now, unless his nomination is blocked, this unrepentant fox is about to be handed the keys to the nation’s henhouse.