America's Insanely High Prescription Drug Prices

As the prior post noted, America continues to have one of the most flawed and expensive health care systems of any developed nation.  Much preventative treatment is not covered and our prescription drug prices are obscenely high compared to drug prices in other developed nations.   Why? Largely, because large pharmaceutical companies have bought and paid for members of Congress, especially Republicans.  The other reason is that programs like Medicaid and Medicare continue to fail to negotiate lower prices, in part because of politicians in the pockets of the pharmaceutical companies.  Imagine if there was a drug that could have a 99% track record of preventing disease but was so expensive - at least in America - that only a tiny percentage of those who would benefit can afford it even if they have "good insurance."  Due to the lack of affordability, many become ill and huge medical costs are incurred - costs that could have been avoided.  The drug exists: Truvada which taken daily and known as PrEP prevents HIV infection.  It cost about $55 to produce a year's supply, yet in America, the cost to patients is $20,000 per year.  I have focused on PrEP, but the same phenomenon applies to countless drugs that drive up medical costs into the stratosphere.  A piece in the New York Times looks at the USA experience versus other developed nations.  Here are highlights:

Last week, the High Court of England and Wales announced a momentous decision: It invalidated the pharmaceutical company Gilead’s patent on Truvada, opening the way to generic competition.

Truvada, a combination of two drugs, is one of the world’s most-used H.I.V. medicines. For treating H.I.V., it’s used along with a third drug. But many H.I.V.-negative people also take Truvada daily as a preventive. That’s called pre-exposure prophylaxis, or PrEP.
In the United States, Truvada is available only as a brand-name drug. It costs $20,000 a year.

Here’s how it will work in Britain’s National Health Service, according to Dr. Andrew Hill, a senior research fellow at Liverpool University who studies the cost of medicines. “The N.H.S. will say to a group of generic companies: ‘We need PrEP for 20,000 people. Give us your best price.’” The cost of making PrEP is $55 per year, Dr. Hill said. He believes that the generic will sell for between $100 and $200.

All over the world, more and more people are taking H.I.V. drugs. These medicines are very good at their job — keeping people healthy and noncontagious — so most patients will take them until they die of something that isn’t H.I.V. Patients are also starting earlier on antiretroviral therapy; the new recommendation is to start immediately upon diagnosis. And now with PrEP, a potentially enormous new group of patients has arisen: H.I.V.-negative people who are at risk for catching the virus.

It’s lucky, then, that Truvada will have generic competition. It should allow the health service to greatly lower costs and offer PrEP to anyone who needs it.

The health service does an admirable job with H.I.V. Around the world, countries measure the percentage of people living with H.I.V. who have no virus detectable in their blood. In the United States, only 49 percent have achieved this. In Britain, the number is 78 percent.

While the National Health Service has a lot of problems, it has some huge advantages over the American system that allow it to provide high-quality H.I.V. care in a cost-efficient manner. So it’s worth looking at what the British health service does right, because some of those strategies could work in America, even though the two systems are structured very differently.

Even when brand-name drugs have no generic equivalents, the medicines in the British system cost a small fraction of what they cost in America. Most brand-name triple therapies cost about $6,500, said Dr. Laura Waters, an H.I.V. physician who is a member of the health service’s H.I.V. Clinical Reference Group, which sets policy. She said that a combination pill that includes some generics would cost between $2,600 and $4,000. Full generics usually cost 70 to 80 percent less than comparable brand names. One completely generic H.I.V. regimen costs $400 per year. If America were to use more generics, much of the savings would stay with insurance companies and pharmacy benefit managers. That doesn’t help people with H.I.V. “The resources saved can and should finance a more aggressive effort to fight AIDS in America,” said Anil Soni, head of global infectious diseases for Mylan.

Could it happen with Medicare or Medicaid? Just a few states — New York, Georgia, Florida, California and Maryland — are responsible for a large share of Medicaid’s spending on H.I.V. drugs. They could lead a drive toward using more generic drugs. These drugs are already available, but doctors don’t prescribe them. Like the National Health Service, Medicaid would have to find ways to encourage (or cajole, entice or force) doctors to prescribe generics. If the generics were more widely used, that would encourage competition that could further drop the price.

Every day, America pays for H.I.V. drugs at higher and higher prices, for more and more people. There is no choice but to reform an unsustainable system.

“I just don’t understand why American payers don’t look up reference prices,” Dr. Hill said. “It’s $150 in England, so why are they spending $10,000? Surely they don’t have unlimited budgets in the U.S. But they behave as if they do.”

 Again, the same phenomenon applies to countless other drugs and is one of the reasons for America's exploding health care costs. 

Hospitals Brace for Nightmare of Obamacare Repeal

Back before many Trump voters cast their votes in what amounted to a possible act of suicide, I noted that many rural hospitals in Southwest Virginia - and a few urban hospitals too - faced possible bankruptcy and closure should Obamacare (as the new Gilded Age advocates in the GOP call the Affordable Health Care Act) be repealed.  Now, once Trump is sworn in and the GOP controls both houses of Congress, what hospital systems feared may be about to happen.  The irony is not only will many of the GOP voting areas see large numbers of residents losing health care coverage, but their local hospitals - typically among the locale's largest employers - closing down. It's as if these regions decided to not only take a fatal drug overdose, but also put a bullet in their own heads simply to satiate their hated of others with different skin colors, religious faiths and/or sexual orientation.   In my view, these voters deserve whatever horrors may befall them.  A piece in the New York Times looks at the self-inflicted threats to hospitals serving these cretins.  Here are excerpts:

PHILADELPHIA — Jason Colston Sr. went to the emergency room at Temple University Hospital last month with his calf swollen to twice its normal size. A bacterial infection had entered his bloodstream, requiring him to spend nine days at Temple, where patients are overwhelmingly poor.

Mr. Colston, 36, had no insurance through his job at a 7-Eleven, but it turned out he was eligible for Medicaid under the Affordable Care Act. Temple helped him enroll as soon as he was admitted, and Medicaid paid for his stay and continuing treatment.

Before the health law, the hospital had to absorb the cost of caring for many uninsured patients like Mr. Colston. Now, with President-elect Donald J. Trump and the Republican-controlled Congress vowing to dismantle the law, Temple and other hospitals serving the poor are bracing for harsh financial consequences that could have a serious effect on the care they provide.

Since the election, hospitals have been among the loudest voices against wholesale repeal of the health law. In a letter to Mr. Trump and congressional leaders this month, the two biggest hospital trade groups warned of “an unprecedented public health crisis” and said hospitals stood to lose $165 billion through 2026 if more than 20 million people lose the insurance they gained under the law. They predicted widespread layoffs, cuts in outpatient care and services for the mentally ill, and even hospital closings.

The stakes are particularly high for safety-net hospitals like Temple, but even more prosperous hospitals face uncertainty after investing in new ways to deliver care under the law.

Temple executives estimate their system could lose as much as $45 million a year if the law were entirely repealed, which would return it to the losses it posted for years before the health law took effect.

“We are the de facto community hospital in one of the poorest neighborhoods in the country,” said Robert Lux, the senior vice president, treasurer and chief financial officer of Temple University Health System, which includes two general hospitals and a cancer center. “Any kind of change like this would not only push Temple University Hospital into financial extremis, it would do the same thing for our entire system.”

Still, even hospitals serving affluent populations have reason to be nervous about a future without the health law. Main Line has invested substantially in response to the law’s push to base hospital pay on patient outcomes instead of the amount of medical services provided. Repealing the law would create uncertainty about the future of this new paradigm, which has forced hospitals to rethink how they deliver care.

Over all, the health law has improved the financial outlook of Pennsylvania hospitals significantly, even though the state was a year late in expanding Medicaid. The former governor, Tom Corbett, a Republican, initially balked, and the program did not expand here until 2015. Still, hospital operating margins statewide increased to about 5.5 percent on average in 2015, from 4.25 percent in 2014, according to the Hospital and Healthsystem Association of Pennsylvania. The amount of care provided to patients who cannot pay dropped by 8.6 percent on average.

Under the health law, hospitals that served a large number of poor and uninsured patients agreed to a series of funding cuts in exchange for getting far more patients with insurance coverage. Temple has lost about $11 million so far in these federal funds, known as disproportionate share payments, Mr. Lux said.

But like other hospitals in the 31 states that expanded Medicaid under the law, it has made up that revenue in part through the Medicaid expansion. It recorded about 13,000 more visits from patients with Medicaid coverage in 2015, the first year Pennsylvania expanded Medicaid eligibility, and at least as many this year. Still, Temple is barely turning a profit: It had operating income of $3.6 million in the fiscal year that ended June 30, despite revenue of $1.7 billion.  “Our current state of stability could be broken pretty quickly.”

So, too, could Temple’s efforts to connect its newly insured patients with preventive care instead of waiting until they show up in the emergency room with advanced, expensive illnesses. Dr. Robert McNamara, chairman of emergency medicine at the Lewis Katz School of Medicine at Temple University, said he had seen more than a few uninsured people arrive in the emergency room with kidney failure, needing costly dialysis for the rest of their lives because they had lived with high blood pressure for so long.

“We were finally in a situation where for most of our patients there was a coverage option,” said Anita Colon, Temple’s director of patient financial services, already speaking about the health law in the past tense. “Now there’s just a total unknown about what will be left.”

What is most troubling is that human excrement like Paul Ryan and many of the 81% of evangelicals who voted for Trump simply do not care about what happens to others.  They go to church each week and act all pious, yet in reality they are worse than the Pharisees of the Bible.  Their version of Christianity is a foul evil.  

Gay West Hollywood Man Brain Dead from Bacterial Meningitis - New York Connection?

As several LGBT blogs are reporting, young, seemingly fit gay West Hollywood attorney, Brett Shaad (pictured at left) is brain dead from bacterial meningitis and for the time being is on life support.  At present, it is not known if he contracted it via someone from New York City where there has been an out break of bacterial meningitis in the gay community.  The purpose of this post is to underscore how critical it is that members of the LGBT community take this situation seriously and preferably get the vaccine against the disease.  This story sends shivers through me and revives old nightmares.  And for good reason.   And to me, it is criminal that the vaccine is not widely recommended.  The CDC in its wisdom believes that the risk is low and, therefore, the cost is not merited.  Stated another way, since the number of individuals who die each year is low, the CDC is willing to write off their lives as a cost control measure.  Anyone who has seen this disease first hand would NEVER be willing to just write off a given amount of lives as an acceptable reaction.

As long time readers likely recall, one of my daughters was stricken with bacterial meningitis almost 14 years ago and very nearly died.   While she had a miracle recovery - she was actually written up in the hospital's magazine after the roughly six month ordeal - many do not.   And what is the most frightening about the disease is the speed with which it strikes.  Often, by the time discernible symptoms are displaying (most noticeably a rash like phenomenon where capillaries in the skin begin to rupture), time is almost out to save the victim from either death or horrible impairment.  In the case of my daughter, another 10 to 15 minutes in getting her to the hospital and she probably would have died.   As it was, the hospital ER staff struggled to stabilize her and thankfully we were at a hospital with top trauma facilities and with staff who immediately recognized what they were dealing with.  I can still hear the doctor telling me to call my former wife and tell her to get to the hospital immediately, no shower, etc., because he did not know if they were going to be able to save my daughter.  Towleroad has some details on this sad situation and the, in my view, irresponsible manner in which the medical authorities are reacting.  Here are highlights:

Brett Shaad was declared brain dead but remained on life support Friday afternoon, said Elizabeth Ashford, a spokeswoman for Shaad’s family. She declined to release further details.

West Hollywood Councilman John Duran incorrectly said he had been taken off life support earlier on Friday, the wire adds:

Duran, who saw Shaad last weekend, described the openly gay man as being “robust and healthy” prior to Monday, when he began to feel sick.

On Wednesday, he went into the emergency room. By Thursday, he was in a coma.

Tests are underway on the strain of meningitis to determine if it is related to the deadly strain in NYC, against which health officials have urged sexually active gay men to be vaccinated.

It has not been determined how Shaad contracted meningitis. Shaad's family cricized Duran after he mentioned that Shaad attended the recent White Party in Palm Springs. Shaad also recently visited an Equinox gym in WeHo, the AP adds.

Symptoms typically develop within three to seven days of exposure and can include stiff neck, fever, headache, nausea, vomiting, increased sensitivity to light and an altered mental state, often confusion.

More info on meningitis and how it is spread here at the CDC.

According to WABC: "Vaccinations are not being widely recommended in Los Angeles County. But community agencies such as the L.A. Gay and Lesbian Center are urging individuals to take precautions."

Added Duran: “We don’t want to panic people. But we learned 30 years ago the consequences of delay in the response to AIDS. We are sounding the alarm that sexually active gay men need to be aware that we have a strain of meningitis that is deadly on our hands."

Our thoughts go out to Shaad's friends and family.

Likewise, my thoughts go out to Brett Shaad's family and friends.  I came withing not too many minutes of facing what they have had overwhelm them seemingly out of the blue.  

As an added note, some individuals are carriers of the disease and never show or develop symptoms themselves.  In my daughter's case, they were never able to tack her infection to anyone in particular, meaning that whoever had the bacteria was a carrier.   If in doubt, go to your doctor and get the vaccine even if you have to pay for it out of pocket.

Romney Still Clueless: "No One Dies Because They Don't Have Insurance"

One of the biggest failings of healthcare in America is the huge number of Americans who do not receive preventive medical care.  As a result, medical treatment is not sought all too often until the situation becomes serious and as a consequence the medical costs of treatment too late are not only catastrophic but often the patient dies from the illness that might have been curable/treatable if addressed earlier.  The other consequence is that because hospitals have to treat so many uninsured patients, the costs for everyone else skyrocket and vastly exceed the cost of similar treatment in virtually every other advanced industrialized nation.  Sadly, through his latest statements it is evident that Mitt Romney - who has never in his life had to forgo medical treatment because of cost worries - does not understand the reality that most Americans face daily.  Even with decent health care insurance many still think twice about seeking preventive or early diagnostic testing because of deductibles and/or copays.  Likewise, he doesn't grasp that its the millions of uninsured who do precisely what Romney describes that cause our medical cost to be so exorbitant.  Think Progress looks at Romney's utterly out of touch  statements as he talks about repealing "Obamacare."  Here are excerpts:

Mitt Romney doubled down on his suggestion that uninsured Americans can find the care they need in emergency rooms, telling The Dispatch that people will always receive the treatment they need, and do not die or suffer because they can not pay for care. He pointed to federal law that requires hospitals to admit emergency patients, repeating his advice that patients rely on the most expensive form of care reserved strictly for emergencies. Romney told the Columbus Dispatch:

“We don’t have a setting across this country where if you don’t have insurance, we just say to you, ‘Tough luck, you’re going to die when you have your heart attack,’  ” he said as he offered more hints as to what he would put in place of “Obamacare,” which he has pledged to repeal.

“No, you go to the hospital, you get treated, you get care, and it’s paid for, either by charity, the government or by the hospital. We don’t have people that become ill, who die in their apartment because they don’t have insurance.”

He pointed out that federal law requires hospitals to treat those without health insurance — although hospital officials frequently say that drives up health-care costs.

Emergency rooms serve as a place of last resort, but 45,000 Americans still die every year because they lack health insurance, or one every 12 minutes. Uninsured adults under age 65 are also at a 40 percent higher death risk. Hospitals may treat patients for emergency medical conditions regardless of legal status or ability to pay, but patients with chronic conditions that don’t require emergency interference are often unable to access needed care.

Romney’s health care proposal would leave 72 million Americans without health insurance and wouldn’t provide all uninsured Americans with a stable source of insurance.

Romney is not only a shameless liar but totally out of touch with the reality that most Americans face ever day of their lives.  Those born to wealth like Romney AND Paul Ryan simply have no clue because neither they nor their families have ever had to worry about how necessary medical care will be paid for.