Wed, Apr

Sick of Spiraling Drug Costs and No Cure in Sight


DRUG POLITICS--For anyone not living in a bubble, or perhaps just so lucky and healthy to have super-duper insurance and/or no health problems, it's pretty obvious that pharmaceutical prices are going up to unsustainable levels.  And if "unsustainable" is the the wrong word, perhaps "infuriating" or "predatory" or "criminal" is a more appropriate description. 

There's a reason or three why Bernie Sanders and Donald Trump have so many followers--they're angry at former President Bush, they're angry at President Obama, and they're angry at how the average American--in particular, the middle class who are trying to play by the rules and who are both stymied and exhausted at how they're being stiff-armed and shoved into decreased economic mobility. 

Part of this is the increasing cost of pharmaceutical medications, including those that are generic and have been around for decades.  We need them for our health and survival, and their astronomical elevations in cost are both unnecessary and infuriating.  And both dangerous and deadly. 

Yet as with the rising cost of health care, it's easy to blame one part of the problem as the solitary monster to be slain...when what we REALLY are fighting is more akin to a Hydra--that mythological creature with multiple heads, and which, if we cut off one head, two will grow in its place. 

In other words, if address only one part of the problem then we risk not fixing the problem at the least, or making the problem greater as the worst result of our efforts.  

If you want to hate on Republicans, Democrats, bureaucrats, health plans, pharmaceutical companies, or anyone else that's fine--but naivete won't fix the problem: 

Rrecognizing that health care is (as with our nation) a combination of pragmatic capitalism and socialism is certainly more helpful in confronting our issues. 

1) Part of our pharmaceutical cost-conundrum is caused by capitalism at its worst, but yet not capitalism at its best.  Somehow pharmaceutical companies have manipulated their way into being virtual monopolies, when they should have so much competition that the price for medications--particularly generics--should be plummeting.  

2) Part of our pharmaceutical cost-conundrum is caused by socialism at its worst, but yet not socialism at its best.  Somehow pharmaceutical companies have been granted too much exclusivity in creating medications--including generics--while not being demanded to keep their prices lower each year as their profits are met and their production prices presumably go down. 

Do you get the picture?  When socialists demand price controls, and when capitalists demand more competition, they're both right, and merit a seat at any table where resolution of this problem will occur. 

And if you're only going to demand on one approach, while ignoring the other approach, you're invariably going to make the problem worse. 

Is the FDA too demanding and cost-driving on pharmaceutical companies to make new products, or are they a necessary quality control agency...or both? 

Arguably, the "fix" should start on generic companies that really do little to nothing to create new products, and are raising their prices simply because they can. 

Martin Shkreli is both a repugnant individual (he doesn't merit the title "human being") who will be heard from in Congress, but he's also done us a service by highlighting this crisis with his outrageous price-gouging: 

1) Shkreli is only the worst of the worst, with Turing and Valeant and Mylan Pharmaceuticals being only slightly less predatory than this contemptible individual in what they have done to the pocketbooks, lives, and health of Americans everywhere. 

2) And where the devil was Congress while doctors were screaming about this over the last few years?  They got dragged to the table in addressing this, and either laziness, fear, or lobbyist contributions are probably to blame.  Unfortunately, THIS current President and Congress will likely do very little until after the fall elections to address this, because the "Affordable Care Act" (cute name, huh?) was politically- and not economically-driven. 

The more money gets thrown into health care, the more we'll see pharmaceutical companies--particularly companies who've either manipulated or been granted governmental exclusivity on certain medications--wanting a piece of that money flow...whether they've earned it or not: 

1) Is the government to blame for not enforcing price controls?  Probably--after all, why should the United States pay thrice the cost that Canadians and Europeans pay for the same medications? 

2) Are health plans to blame for not enforcing price controls?  Probably, although their negotiating power and step-therapy plans are their best weapons in demanding lower medication costs.  In other words, perhaps your health plan is just doing its job when you're denied the medication that you and your doctor want.  Unless you LIKE rising deductibles and premiums. 

And premiums and deductibles ARE going up...for everyone. 

1) I doubt that the Vermont plan of taxing physicians for paying for Medicaid will work (LINK: ), because even if you just think doctors are all mega-rich and getting kickbacks from pharmaceutical companies (I am still waiting for mind after almost 25 years in practice) there's the aforementioned Hydra analogy: 

If we smack around doctors, they will invariably stop seeing all patients, and might just leave to another state. Then we'll see how cheap and easy it is to see doctors who still remain. 

And WHY are we so embracing of Medicaid as the new normal?  Some need that, and they're not getting enough, but if YOU don't have a job that helps cover your health plan YOU have a lousy job.  Deal with that.  

And if you're not getting a second or third job to ensure you can pay for appropriate insurance for you and your family, you're either in an environment where you have no ability to achieve economic independence or you're not doing YOUR job.  Deal with that, too.  (I'm a physician, and I have three jobs, by the way) 

2) I also have major concerns about the November initiative that will require drug companies to allow the same low prices to non-veterans as they do with the U.S. Department of Veterans Affairs.   

I don't doubt for a moment the sincerity, good intentions and righteous anger of those promoting this initiative, but while pharmaceutical companies need a good smackdown this is the wrong one.  If they can't afford this low cost for so many, then these companies will jack up their costs for veterans, too...and that helps us all...how? 

Again, remember that Hydra analogy. 

We want innovation from pharmaceutical companies to create new cancer treatments and new antibiotics, but the $1 billion "moonshot" of President Obama is a joke when considering the $2.6 billion needed to create a single drug. 

To conclude, and in short, we need to: 

1) Demand, require, enable, and encourage generic pharmaceutical companies to keep older medications dirt-cheap.  As in $5-15 per refill for older medications, and perhaps $25 for a few per refill. 

2) Support, encourage, and enable brand-name pharmaceutical companies to create and profit from the development and distribution of new and innovative medications. 

Both government and the private sector will need to do its share.  Any other approach is just self-delusion and a prescription for both higher prices and reduced health for the majority of exhausted, hard-working Americans.


(Ken Alpern, M.D., is a practicing dermatologist with patients and clinics in L.A., Orange and Riverside Counties.  He is also a Westside Village Zone Director and Board member of the Mar Vista Community Council (MVCC), previously co-chaired its Planning and Outreach Committees, and currently is Co-Chair of its MVCC Transportation/Infrastructure Committee.  He is co-chair of the CD11Transportation Advisory Committee and chairs the nonprofit Transit Coalition, and can be reached at  [email protected].   He also co-chairs the grassroots Friends of the Green Line at www.fogl.us. The views expressed in this article are solely those of Mr. Alpern.)


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