EDITORIAL NOTE: This is long-ish and gets a bit wonky in places but it is important to know this stuff.
We have all known or have read about elders who don't fill medication prescriptions or cut them in half because the cost forces them to make the choice between life-saving drugs and food.
Just recently, I had a personal encounter with such an issue. A newly prescribed drug I inject twice a day costs me hundreds of out-of-pocket dollars a month which is way beyond my means and at first I told the doctors it was out of the question; find something else to help me that I can afford.
Then someone in the meeting realized they had neglected to note that I need the drug for only three months. I don't like dipping into my emergency fund for that much money, but I suppose that's why I call it an emergency fund. And I can handle three months.
I'm lucky to have that fund. Millions of American adults who can't afford their prescriptions with or without insurance converage just don't fill them, endangering their health and their lives.
Why, do you suppose, are prescription drugs so expensive in the United States, higher than in other countries. Here is an explanation from CNN:
What reporter Christine Romans overlooks in this video is that pharmaceutical companies do not bear the entire of burden of new drug development. A great deal of money and help comes from the U.S. National Institutes of Health (NIH).
In the White House Rose Garden on Friday, President Donald Trump unveiled a proposal he says will lower the prices of prescription drugs for consumers. It tells us something that minutes later, the stock market price of pharmaceutical companies soared:
”The stock prices of Pfizer, Merck, Gilead Sciences, and Amgen all spiked after Trump’s speech,” reported STATnews. “Wall Street analysts said the speech posed few threats to the drug industry on the whole.”
Do you think that outcome could that have anything to do with input from the man accompanying Trump at the podium Friday, the one who will be in charge of implementing Trump's proposed drug plan, Health and Human Services (HHS) secretary Alex Azar?
Until last year, Azar spent a decade employed at pharmaceutical giant, Eli Lilly and Company first as the firm's top lobbyist and later as president of Lilly USA LLC.
So what does Trump's proposal, disingenuously titled American Patients First, include? NBC News reports:
”The plan, presented as a thinly described set of executive actions...focuses on four elements, according to the Health and Human Services Department:
• Increasing competition
• Better negotiation
• Creating incentives to lower list prices
• Reducing patient out-of-pocket spending."
That is a far cry from Trump's campaign promise to
”...allow Medicare to negotiate directly with drug manufacturers... The industry is now having the last laugh,” reports The Atlantic. “In a speech Friday on drug pricing, President Trump completed his 180-degree turn on Candidate Trump’s promises.
“The White House’s new plan, as outlined, does seek to address high prescription-drug costs. 'We will not rest until this job of unfair pricing is a total victory,' Trump said. But it doesn’t directly challenge the pharmaceutical industry and the direct role it plays in setting prices.
“Indeed, the new policy largely meets the goals of big pharma, signaling an ever-tightening bond between Trump and drug manufacturers.”
Trump didn't say much about how his proposals will lower prices and what is conspicuously missing, despite the second item on that list, is any plan to allow Medicare to directly negotiate drug prices with pharmaceutical companies.
Big Pharma won that one when Medicare's prescription drug plan, Part D, was introduced in 2003; the legislation specifically disallows price negotiations between Medicare and the pharmaceutical companies. Trump's proposal does not change that.
During the Rose Garden speech, Trump attacked what he called “global freeloading” by countries where citizens often pay much less than Americans for the same brand-name drugs:
“He directed his trade representative to make fixing this injustice a top priority in negotiations with every trading partner,” reports Robert Pear in The New York Times...
“It is not clear,” continues Pear, “why higher profits in other countries would be passed on to American consumers in the form of lower prices, and officials in those countries pushed back hard.”
The Times also reported on another of the proposal's items:
”Alex M. Azar II, the secretary of health and human services, said the Food and Drug Administration would explore requiring drug companies to disclose list prices in their television advertisements.”
It is equally unclear how that would reduce the cost of advertised drugs. It is worth quoting Robert Reich, Professor of Public Policy at UC Berkeley who served as President Bill Clinton's secretary of labor, at some length on this:
While it’s true that Americans spend far more on medications per person than do citizens in any other rich country – even though Americans are no healthier – that’s not because other nations freeload on American drug companies’ research,” writes Reich in Eurasia Review.
“Big Pharma in America spends more on advertising and marketing than it does on research – often tens of millions to promote a single drug.
“The U.S. government supplies much of the research Big Pharma relies on through the National Institutes of Health. This is a form of corporate welfare. No other industry gets this sort of help.
“Besides flogging their drugs, American drug companies also spend hundreds of millions lobbying the government. Last year alone, their lobbying tab came to $171.5 million, according to the Center for Responsive Politics.
“That’s more than oil and gas, insurance, or any other American industry. It’s more than the formidable lobbying expenditures of America’s military contractors. Big Pharma spends tens of millions more on campaign expenditures.”
And you wonder why your drugs cost so much.
"'This [proposal] is not doing anything to fundamentally change the drug supply chain or the drug pricing system,' said Gerard Anderson, a health policy professor at Johns Hopkins University,” quoted at CNN.
The so-called American Patients First proposal is not a bill and while a small number of the proposals would require Congressional legislation, most can be put into effect with regulations or guidance documents.
So much for lowering the price of prescription pharmaceuticals. Like most everything else in the Trump administration, this proposal is gift to big business.
You can read the full, 44-page proposal here [pdf].