how would the Drug-price transparency bill impact your own nursing practice. I work in a critical care hospital.
Ans) Insulin has been around for almost a century. The World Health Organization considers it an essential medicine, which means it should be available "at a price the individual and the community can afford."
- In the United States, just three pharmaceutical giants hold patents that allow them to manufacture insulin: Eli Lilly, Sanofi and Novo Nordisk. Put together, the "big three" made more than $12 billion in profits in 2014, with insulin accounting for a large portion.
- The big three have simultaneously hiked their prices. From
2010 to 2015, the price of Lantus (made by Sanofi) went up by 168
percent; the price of Levemir (made by Novo Nordisk) rose by 169
percent; and the price of Humulin R U-500 (made by Eli Lilly)
soared by 325 percent.
- To make insulin affordable, we need more competition. Nothing
would do this faster than a "generic" form of insulin.
(Technically, because insulin is made using bacteria, it should be
referred to as a "biosimilar" instead of a "generic.")
Unfortunately, there isn't one available in the United
States.
- This is true, in no small part, because the big three have
cleverly extended the lives of their patents, making incremental
"improvements" to their insulin. It's not clear whether the newer
insulin products are significantly safer or more effective than
their predecessors, yet the strategy has been effective:
- There is no generic insulin, and over 90 percent of privately
insured patients with Type 2 diabetes who are prescribed insulin
get the newer and more expensive products.
- Something else is most likely contributing to the rising price of
insulin: a very powerful and largely invisible group of middlemen,
known as pharmacy benefit managers, or P.B.M.s.
- Mrs. B has Medicare Part D coverage. She is responsible for
co-payments on her insulin. But every year, by early fall, she
typically reaches a coverage gap (known as the doughnut hole) when
she becomes responsible for paying for insulin out of pocket. So
Mrs. B skimps on her medicine, allowing her blood sugar to rise to
worrisome levels.
- The patent on Lantus (Sanofi's top-selling insulin) recently
expired, allowing other companies to start preparing generic forms.
The first generic competitor usually sets a price that is only
slightly below the branded insulin. Research shows that once there
are two manufacturers of a generic drug, the price typically drops
by about half; with eight, it drops to about a fifth. But because
insulin is a biosimilar, the decline may be more modest. And this
will take time; additional testing is needed to ensure the safety
and effectiveness of each new generic before it is approved.
- Short-term solutions in the hands of patients and doctors.
prescribed an older, slightly cheaper version of insulin — known as
"human" insulin — which worked just as well. In fact, it is more
effective because she is actually taking it.
- Our faith in newer and "better" drugs — coupled with our
unwillingness to police this marketplace — has done little to help
Americans. we need to protect the intellectual capital of
pharmaceutical companies so that they continue to invest in
innovative new drugs. But those drugs should ultimately result in
better health for patients, not just wider profit margins.
- Benefit managers negotiate with drug companies on behalf of insurers, such as employer plans and government programs like Medicaid and Medicare Part D. In theory, their job is to bargain for lower drug prices.
- The hitch is that the biggest P.B.M.s are out to make a buck.
They get "rebates" from drug manufacturers — payments based on
sales or other criteria, which look suspiciously similar to
kickbacks. The rebates are not publicly disclosed, but they are
sizable. Industry analysts estimate that those payments, and other
back-room deals, amount to as much as 50 percent of the list price
of insulin.
- Benefit managers are supposed to be driving down costs, but the
system incentivizes them to choose the products with the largest
rebates. It's not clear whether most of these "savings" are passed
along to consumers or simply pocketed. Last month, a large insurer,
Anthem, complained publicly that its P.B.M., Express Scripts, was
not sharing enough of its savings.
- Together, the three biggest benefit managers — Express Scripts,
CVS Health and OptumRx — bring in more than $200 billion a year in
revenue. They also control over 80 percent of the P.B.M. market,
involving 180 million insured people.
- In much of Europe, insulin costs about a sixth of what it does
here. That's because the governments play the role of pharmacy
benefit managers. They negotiate with the manufacturer directly and
have been very effective at driving down prices. In the United
States, we rely on the private sector and a free market for drug
pricing. But in order for this to work, we need to regulate it
better and demand greater transparency.
- Over the past 10 years, the Federal Trade Commission has brought
only a single enforcement action against benefit managers, over an
issue of patient privacy violations
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