Civil War: healthcare edition

The formula for rising healthcare costs in the US is filled with a bunch of pointed fingers lately. One finger is being pointed at drug maker Kaléo (no, not that Kaleo) by pharmacy benefit manager Express Scripts. They’re suing Kaléo over its price hikes on a heroin/painkiller overdose treatment. According to Express Scripts, these hikes triggered price protection rebates owed to Express Scripts, which total around $14 million—most of the lawsuit. The PBM has successfully sued larger drug companies like Horizon, so Kaléo may be at a bit of a disadvantage here. Especially since Express Scripts could use the extra cash to deal with the fingers pointed at it, including one $15B lawsuit by its (soon-to-be former) largest customer, the insurance provider Anthem.

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I’m just a bill

Drug pricing is hot. Want proof? According to The New York Times, there are six major drug pricing bills under consideration. For those who require it, here’s a refresher on the U.S. legislative process. Two of the proposed bills focus on the approval of generic medications. One would require pharma companies to give notice before price increases. Another would allow U.S. citizens to import cheaper drugs from other countries. Two others would require PBMs to disclose rebate levels and increase transparency. Additionally, President Trump is asking why the government does not negotiate prices it pays for Medicare. Net-net: there are lots of spaghetti strands being thrown at the drug pricing refrigerator, let’s see what sticks.

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Healthcare is complicated

A recent NY Times op-ed piece and a corresponding Letter to the Editor talk about how importing generic drugs might lower healthcare costs in the US and stop what the op-ed writer perceives as price gouging. The op-ed position: just do it. The letter to the editor position: not so fast. Relationship status: it’s complicated. There are obvious concerns about drug safety and the US is making strides in protecting the drug supply with its track and trace efforts. That said, the letter to the editor proposed an interesting idea: “…speedily approve any sound generic drug application from a nonprofit entity for a drug whose price has risen sharply.” That’s one idea, but why just from nonprofits? Come on, people. More ideas required! Have an opinion on this? Participate in this week’s FastPoll™ below.

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5. Robin Hood of drugs

Give a man a drug and you can treat him for a day; teach a man to make his own drugs and you can treat him for a lifetime. At least that’s the goal for the pharmaceutical hacker attempting to create open-source drugs for the public. To fight drug makers, who some believe gouge patients for lifesaving drugs (i.e. EpiPen, Daraprim), mathematician Dr. Mixael Laufer launched the Four Thieves Vinegar collective – a group determined to reverse engineer critical pharmaceuticals so that they can provide to the general public instructions for making those drugs at home. While using home-made pharmaceuticals may seem unthinkable for most of us, those without the means to pay for the real deal may find it worth the risk. Yikes. Some of us can’t even make a grilled cheese sandwich.

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4. The cheap drug club

Takeda has joined the ranks of increasingly price-conscious pharmaceutical companies that have pledged to keep their drug price hikes to “reasonable” levels in the coming year (see: Allergan, AbbVie, Novo Nordisk).The Japanese-based company recently announced it would maintain single-digit price increases, and added that its pricing model has been fair for years. However, it’s probably safe to assume that the announcement has something to do with Trump’s not-so-subtle cease and desist alarms to pharma about their rising drug prices. Certainly a push for drastic measures, but consider: in the wake of a sudden call for price lowering also comes a federal push to decrease pharma regulations, cut taxes, and speed up approval timelines for drug products. Looks like industry gods taketh away, then giveth right back.

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2. Hope Santa brought cash for Christmas

Happen to have a spare $750,000 USD in your bank account? If so, you could afford the initial year of treatment on Biogen’s new spinal muscular atrophy drug, Spinraza. After the first year, you’d need another $375,000 per year for subsequent treatment. Our collective wallets shuddered just thinking about that. Keep in mind—this is a drug for an ultra-orphan disease so companies typically set high price points given the small patient populations. Nonetheless, the price tag is turning heads in the media. Patients and their families will be waiting with bated breath to gauge payers’ reactions. So far into 2017, it looks like there is no end in sight for drug pricing controversies.

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