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Will Pharma Defeat the New Medicare Proposal as It Did in 2014?

By       Message Martha Rosenberg       (Page 1 of 1 pages)     Permalink    (# of views)   6 comments

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The Trump administration has proposed that insurance plans providing drug coverage to Medicare beneficiaries will no longer be forced to cover six hitherto "protected" drug classes. The classes----which include drugs for psych conditions, cancer and immune diseases----are among the priciest of all drugs and account for as much as 33 percent of total outpatient drug spending under Part D of Medicare.


Pharma uses Medicare as its ATM
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Under the proposal, Medicare plans could "exclude from their formularies protected class drugs with price increases that are greater than inflation, as well as certain new drug formulations that are not a significant innovation over the original product," says Seema Verma, the administrator of the Centers for Medicare and Medicaid Services.

In 2014, the Obama administration sought the same "price relief" for Medicare but was defeated by Pharma lobbyists. At the time, 100 pills of the "protected" psych drug Abilify cost $1,644, 100 pills of the "protected" psych drug Geodon cost $958, 100 pills of the "protected" psych drug Invega cost $1,789 and 100 pills of the "protected" psych drug Seroquel cost $2,000. Since then, as Pharma makes the taxpayer funded Medicare its ATM, even pricier psych drugs have emerged as well as 6-digit cancer drugs.

The Obama proposal was roundly defeated by Pharma funded front groups like the Depression and Bipolar Support Alliance, Mental Health America, the National Alliance for Research on Schizophrenia and Depression and the National Alliance on Mental Illness (NAMI). NAMI, perhaps the best known group, received $23 million in just two years from Pharma and draws as much as 75 percent of its donations from drug companies.

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The proposal "undermines a key protection for some of the sickest, most vulnerable Medicare beneficiaries," said NAMI lobbyist Andrew Sperling, one of many Pharma voices that defeated the proposal. "You get much better outcomes when a doctor can work with patients to figure out which medications will work best." (As long as the taxpayer pays.)

The six protected drug classes are not the only example of regulations which "protect" nothing more than Pharma profits and its expensive psychiatric drugs, many of which have cheaper alternatives. In T exas, a Medicaid "decision tree" called the Texas Medical Algorithm Project was instituted that literally requires doctors to prescribe the newest psychiatric drugs first. It was--surprise--funded by the Johnson & Johnson linked Robert Wood Johnson Foundation.

Already Pharma and its many phony "patient" groups are bellowing about how the "sickest, most vulnerable Medicare beneficiaries" will be hurt if taxpayers won't fund its 4 and 5 digit priced drugs. Yet few to none of the newer psych drugs show clear improvements over cheaper ones and they all lack the safety profiles of older drugs that are widely in use.

"When insurers balk at reimbursing patients for new prescription medications, these groups typically swing into action, rallying sufferers to appear before public and consumer panels, contact lawmakers, and provide media outlets a human face to attach to a cause," writes Melissa Healy of the Los Angeles Times about this well known Pharma tactic to loot Medicare dollars.

Will the Trump administration cave to Pharma like the Obama administration did?

(Article changed on November 28, 2018 at 15:51)

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Martha Rosenberg is an award-winning investigative public health reporter who covers the food, drug and gun industries. Her first book, Born With A Junk Food Deficiency: How Flaks, Quacks and Hacks Pimp The Public Health, is distributed by Random (more...)
 

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Martha Rosenberg

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  New Content

The newer drugs are only 'better' for Pharma

Submitted on Wednesday, Nov 28, 2018 at 4:30:20 PM

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Reply to Martha Rosenberg:   New Content

In fact, the drive by Pharma to stimulate profits results in the repeated introduction of new drugs with patent protections to replace older drugs that are becoming generic. The new drug may be less effective and have more serious or more common side effects but it is aggressively marketed to doctors because of the higher profit margins. After several generations of this, the latest drugs that are commonly prescribed can be markedly inferior to the ones that doctors commonly prescribed decades earlier.


As a case in point, Probenicid is a drug for gout that was in common use in the 1960's. It had few side effects that were uncommon and the drug remains quite effective though very rarely prescribed at least in the U.S. I've talked to several gout sufferers who take nothing at all to control this condition because of the severe side effects of whatever drug their doctor prescribed.


Why don't doctors prescribe the older generic drug? Because they've never heard of it - they are not that old.

Submitted on Wednesday, Nov 28, 2018 at 9:48:50 PM

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Reply to Paul Cohen:   New Content

Some truth in what you say. Not always.

Submitted on Friday, Nov 30, 2018 at 4:34:50 PM

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Reply to Martha Rosenberg:   New Content

You talk crazy.

Every drug was newer at some point.

Depriving patients of some drugs is no solution.

There are reasonable solutions.

Submitted on Friday, Nov 30, 2018 at 4:33:55 PM

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Pharma has to come out and defend its profits. The industry has the highest gross margins on the planet. Doesn't cost much to make their product (post-development and approval.)

Supporting the higher prices is a pliant Congress that's given pharma everything it's asked for. When will it's number one customer--the federal government--exercise collective bargaining to get lower drug prices? Under the '04 pharma bill, federal law was changed to end bargaining for lower prices!

Even the Congress has to accept that Pharma costs are growing too fast. Except instead of regulating them, the Congress keeps borrowing to pay for ever higher costs. Am I the only one who sees a giant red neon sign flashing--regulate, regulate--over this industry?

Regulate or Americans die. That's clear. The sick already have to cut their overpriced meds into smaller pieces and some have no doubt perished as a direct result. This new policy would make out-of-pocket costs for pharma higher and constrict availability.

Low cost alternatives for cancer treatment like weed make more sense when the government stops paying infinite amounts for drugs with dangerous side effects--though with weed being so strong now, you need to be careful with that too.

Well if you can't afford the now-more-expensive pills, you'll have to seek out cheaper options. Consider now not by choice but because of unaffordability of meds:

Tai chi, exercise, acupuncture, dietary changes like ending consumption of sugar--a substance close in chemical structure to cocaine and a likely culprit in feeding diseases through its lowering of body pH as per Dr. Jeff Tennant. Curcumin and other homeopathic beg study. Turn the Wifi off, shield from 5G, and sleep better. Check your thyroid--get the good halogens. And vitamin D!

Submitted on Wednesday, Nov 28, 2018 at 6:13:50 PM

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Reply to John Peebles:   New Content

Development and approval cost.

Submitted on Monday, Dec 3, 2018 at 2:10:39 PM

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