As a diabetes doctor in Baltimore, Sally Pinkstaff saw her patients struggle to pay for insulin. They told her they would take half the normal amount, delay doses, even skip entire months. She would try to help them by adjusting their prescriptions — and sometimes by giving them cash.Then, after she received a diagnosis of smoldering multiple myeloma, she began to see firsthand what it meant to depend on a costly drug.Her disease, a type of blood cancer, is often treated with an oral medication, Revlimid, that can keep the disease at bay for years. At first, the insurance from her medical practice charged her a $50 co-payment a month. But when she retired and went on Medicare, the first bill was nearly $4,000, and she became the patient who stopped taking her medicine for a month.“It’s a prohibitive cost,” Dr. Pinkstaff said. “You have to have a lot of retirement money to pay for it.”Many Democrats in Congress ran on a promise to lower prescription drug prices, and their big social policy bill may offer their best chance to do it. As they struggle toward an overall agreement this week, lawmakers are sparring over policies that would lower the prices drug companies could charge for drugs like Revlimid; that would reduce how much they could increase those prices each year; and that would, for the first time, impose a cap on how much Medicare patients can be asked to pay for their medications.The legislation could allow Medicare to demand price cuts on dozens of expensive drugs, including treatments for cancer, diabetes and multiple sclerosis. The proposal could also save Medicare hundreds of millions of dollars — which the Democrats could then use to finance other priorities in the bill, such as expanding health coverage to the uninsured and offering new vision, hearing and dental benefits to those with Medicare.But the details of drug regulation are still unclear, and passage will require assent from every Democrat in the Senate and almost all those in the House. Several Democratic lawmakers remain skeptical of policies that might hurt the drug companies or stymie future drug development. And the pharmaceutical industry, along with allies, has spent more than $26 million on advertising this year to defeat the measure, according to Patients for Affordable Drugs, an influential patient group advocating price negotiations.Insurance companies and patients in the United States pay the highest prices for prescription drugs in the world. On average, drugs in the U.S. cost about 250 percent of the average for the 38 advanced nations in the Organization for Economic Cooperation and Development, according to the RAND Corporation. The United States is unusual in declining to negotiate directly for drug prices with manufacturers.Revlimid has become so identified with high drug prices that the House Oversight Committee last year called in Mark Alles, the C.E.O. of Celgene, which developed the drug. He was grilled over just how innovative it was — it’s a modification of the old sedative thalidomide — and how the drug’s steep annual price increases had helped the company hit earning targets and allowed him to collect a bonus.Bristol Myers Squibb, the company that has sold the drug since 2019, charges $16,744.24 for each 28-day course, a price that has more than tripledsince 2005, when it was first approved. Revlimid costs Medicare and its patients more than $4.7 billion a year — the second-highest cost of any drug in the program.There is not always a straight line between the list price a drugmaker charges and the price patients pay. The price at the pharmacy counter has usually been filtered through a complicated and opaque system of rebates, formularies and cost-sharing policies.For a drug as expensive as Revlimid, the relationship is simpler. Like Dr. Pinkstaff, nearly all beneficiaries blow through their deductibles, their normal cost sharing and a coverage period limit that leaves them in a gap of higher payments, in one very expensive first month.Then they graduate to what Medicare calls its “catastrophic benefit.” Once that happens, patients are responsible for 5 percent of the drug’s price until the end of the year. Any reduction in the price of Revlimid would also lower the price Medicare beneficiaries pay each month. A generic version of Revlimid is scheduled to hit the market next year in a limited fashion, but that may lower costs for only a fraction of the patients who currently take it.“The reason I’ve been doing this for five years is because of Revlimid,” said David Mitchell, a former communications executive who founded Patients for Affordable Drugs. He’s a myeloma patient who was staggered by the high and rising costs of the drug. He now takes a similar myeloma drug called Pomalyst, for which he pays moreBy: Margot Sanger-Katz
Title: This May Be Democrats’ Best Chance to Lower Drug Prices
Sourced From: www.nytimes.com/2021/10/27/upshot/drug-prices-democrats.html
Published Date: Wed, 27 Oct 2021 09:00:24 +0000
Read More
Did you miss our previous article...
https://badpoliticians.com/us-politics/early-voting-in-virginia-has-an-impact-its-also-a-longterm-investment
UK PoliticsWorld PoliticsVideosPrivacy PolicyTerms And Conditions
