Below the Fold - drowning in high drug prices

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WELLNESS CHECK
This edition leans...

Hey Below the Fold fam,

Some of you may have heard about Medicare premium hikes announced last week. It’s largely thanks to a controversial Alzheimer’s drug priced at $56,000 annually. Although efficacy of the drug remains unproven and experts on the FDA advisory panel have resigned in protest of its approval, Medicare premiums will increase almost 15% next year to account for the pricey prescription — for example, Medicare Part B’s monthly fee will go from $148.50 to $170.10.

This major increase has more lawmakers pushing the importance of legislation in improving affordability of prescription drugs. Many have been advocating for years, and progress is now being made. Here’s the latest.

TODAY'S STORY

Legislation for lowering drug prices is finally here
Thu Nov 11

Lawmakers have reached a deal on legislation lowering the price of prescription drugs. Included in President Biden’s social spending package, the legislation is set to:

Allow medicare to negotiate (some) drug prices. While progressive Democrats pushed for the ability to negotiate up to 250 expensive drugs each year, the updated policy allows the negotiation of ten starting in 2025 and increases to 20 by 2028.
Prevent drug companies from raising prices faster than inflation — last year, retail prices for 260+ brand-name drugs increased at more than double the general rate of inflation.
Cap seniors’ out-of-pocket costs at $2,000 per year. For context, in 2019 more than 1.2 million older Americans incurred drug costs exceeding $2,000.

Of course, not everyone is celebrating. Progressive Democrats are upset over the compromises made to appeal to conservatives and pharmaceutical companies, who argue the deal too steeply caps potential reward and thus will hinder innovation and the development of new treatments.

Question is, who does that innovation truly serve? Many Americans argue that even the well insured can’t afford the innovative drugs the FDA approves. For example, Tafamidis was granted expedited approval to treat a rare disease that affects the heart and kidneys. It costs $225,000 a year to make and, at best, delays death by ~2 years. Other innovative drugs recently approved cost up to $1 million per patient — all of which raises premiums across insurance companies.

Pfizer’s CEO argues drug prices have been decreasing but patients aren’t seeing those savings because they’re eaten up by insurers and a “black hole of the federal budget to do other things.” While we don’t have data on his claims, a 2017 study showed that drug companies used 66% of their $116 billion in profit on research and innovation. As such, industry analysts recommend reducing spend on marketing, which would allow R&D investment to remain unaltered.

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Want to better understand the issues plaguing the American healthcare system? You can find an extensive list here, as well as (some) solutions in the works.

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RESOURCE CENTER

The Hill:
(Where we found this story)
17 days old | 5 minutes long

Politico (Opinion):

Cost of innovative drugs
1 month old | 9 minutes long

Yahoo News:
Pfizer CEO reacts
3 weeks old | 6 minutes long

Washington Post:

2017 study and concerns
16 days old | 10 minutes long

ICYMI: RELATED HEALTH NEWS

A historic opioid trial began in May arguing that big pharma companies brushed off growing concerns to maintain profits. Read more >>
The U.S. healthcare system ranks dead last among 11 high income countries — despite spending the most on it. R ead more >>
“Junk” healthcare is costing Americans thousands of dollars. These short-term, low cost plans are stuffed with fine print that excludes common treatments. Read more >>

ASCII-ING ABOUT THE NEWS

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I tried playing hide-and-seek from my insurance provider, but they found me in the ICU.

Art Credit: Joan G. Stark

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Below the Fold - drowning in high drug prices

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