Drug costs are rising, but in the opaque world of health care pricing, figuring out what’s driving the increase has become difficult — if not impossible.
Nonetheless, pharmacists want Congress to try. Vexed by triple- or quadruple-digit percent increases in drug costs, the National Community Pharmacists Association is asking lawmakers to hold a hearing to find out why.
The problem, the group says, is that pharmacists are getting gouged. Pharmacists trying to get their hands on generic drugs such as Pravastatin, a drug for patients with high cholesterol, or the anitbiotic Doxycycline faced price spikes upwards of 1,000 percent in 2013, according to a survey by the group.
Some 77 percent of pharmacists surveyed by the association said in the last six months of 2013 they experienced 26 or more instances of a large upswing in the acquisition price of a generic drug.
An additional 84 percent said the price fluctuations impeded their ability to provide care and remain in business, as some community pharmacies could not fill prescriptions that would result in losses and some patients declined medication that would have emptied their wallets.
The findings are consistent with reports nationwide that generic-drug prices are experiencing bank-breaking price increases. Health care and pharmaceutical consulting firm Pembroke Consulting, for instance, found that within the last year, more than a dozen drugs hit prices 10 times their standard rate. NCPA wants Congress to hold a hearing to find out what’s driving the price points and whether anything can be done by the feds to stop the trend.
But one primary-care doctor, David Belk, says he’s suspicious that the fault lies with drug companies. The San Francisco-based blogger has observed price jumps in single doses of medication, where one size dosage of a drug was very expensive and the other dosages of that same drug were at a more reasonable cost.
Belk took a clip of the Costco website after he saw the generic drug Irbesartan, a medication for high blood pressure, hit nearly $300 for a 90-day supply of the 150 mg tablet. Yet for the 90-day supply of the 300 mg tablet, consumers paid only $30.
“If you ask the pharmaceutical company, they’ll say ‘Oh, we had a shortage,’ ” Belk said, “which makes no sense because they were making other milligrams. By the time the pharmacy has figured out the price spiked, it’s dropped back down again.”
That trend, Belk said, leaves pharmacies hanging out to dry with the extra cost.
“Most doctors are prescribing on the basis of the last drug rep they went to lunch with,” he said. “I think you would fix a lot of it if everyone had to advertise their price.”
While Belk proposes to turn patients into educated consumers by creating transparency about prescription drug costs at the doctor’s office, the problem remains that pharmacists can’t place their finger on why generic drugs seem to cost more than they used to—or at least, experience extreme price variations throughout the year.
Dan Mendelson, CEO of consulting firm Avalere Health, credits the effectiveness and popularity of generic drugs as one reason pharmaceutical companies are able to charge more.
“I think that as demand for generic drugs has gone up, it’s not surprising to see that price has gone up as well,” Mendelson said. “This is an unregulated market in the sense that no one is telling them what to charge. You’re going to see them cozy up to the price of the brand name product for competition reasons.”
Mendelson said his problem with getting Congress involved in the situation is that it suggests they should step into the market and impose price controls. Sometimes, he said, the spikes are easily explained, such as when Doxycycline experienced a manufacturing problem and had a temporary shortage.
“I think people will continue to use these generic products because they’re cost effective and needed when prescribed,” Mendelson said. “There’s no question in my mind demand is going to go up because of the Affordable Care Act, and these markets respond to demand.”
Even higher prices for generics could be on the horizon, as all health plans offered on the Affordable Care Act exchanges must cover prescription drugs, which could increase use and demand among consumers.
The Affordable Care Act, however, doesn’t include any specific provisions to reduce the overall cost of drugs. But generics are still cheaper than their brand-name counterparts. And with more patents for blockbuster drugs set to expire by 2018, they’ll continue to be a competitive option on the market.
What We're Following See More »
Before we get to the specifics of this exposé about escorts working the Iowa and New Hampshire primary crowds, let’s get three things out of the way: 1.) It’s from Cosmopolitan; 2.) most of the women quoted use fake (if colorful) names; and 3.) again, it’s from Cosmopolitan. That said, here’s what we learned:
- Business was booming: one escort who says she typically gets two inquiries a weekend got 15 requests in the pre-primary weekend.
- Their primary season clientele is a bit older than normal—”40s through mid-60s, compared with mostly twentysomething regulars” and “they’ve clearly done this before.”
- They seemed more nervous than other clients, because “the stakes are higher when you’re working for a possible future president” but “all practiced impeccable manners.”
- One escort “typically enjoy[s] the company of Democrats more, just because I feel like our views line up a lot more.”
No matter where you stand on mandating companies to include a backdoor in encryption technologies, it doesn’t make sense to allow that decision to be made on a state level. “The problem with state-level legislation of this nature is that it manages to be both wildly impractical and entirely unenforceable,” writes Brian Barrett at Wired. There is a solution to this problem. “California Congressman Ted Lieu has introduced the ‘Ensuring National Constitutional Rights for Your Private Telecommunications Act of 2016,’ which we’ll call ENCRYPT. It’s a short, straightforward bill with a simple aim: to preempt states from attempting to implement their own anti-encryption policies at a state level.”
Much has been made of David Brooks’s recent New York Times column, in which confesses to missing already the civility and humanity of Barack Obama, compared to who might take his place. In NewYorker.com, Jeffrey Frank reminds us how critical such attributes are to foreign policy. “It’s hard to imagine Kennedy so casually referring to the leader of Russia as a gangster or a thug. For that matter, it’s hard to imagine any president comparing the Russian leader to Hitler [as] Hillary Clinton did at a private fund-raiser. … Kennedy, who always worried that miscalculation could lead to war, paid close attention to the language of diplomacy.”
The New Covenant. The Third Way. The Democratic Leadership Council style. Call it what you will, but whatever centrist triangulation Bill Clinton embraced in 1992, Hillary Clinton wants no part of it in 2016. Writing for Bloomberg, Sasha Issenberg and Margaret Talev explore how Hillary’s campaign has “diverged pointedly” from what made Bill so successful: “For Hillary to survive, Clintonism had to die.” Bill’s positions in 1992—from capital punishment to free trade—“represented a carefully calibrated diversion from the liberal orthodoxy of the previous decade.” But in New Hampshire, Hillary “worked to juggle nostalgia for past Clinton primary campaigns in the state with the fact that the Bill of 1992 or the Hillary of 2008 would likely be a marginal figure within today’s Democratic politics.”
At first, “it was pleasant” to see Trevor Noah “smiling away and deeply dimpling in the Stewart seat, the seat that had lately grown gray hairs,” writes The Atlantic‘s James Parker in assessing the new host of the once-indispensable Daily Show. But where Jon Stewart was a heavyweight, Noah is “a very able lightweight, [who] needs time too. But he won’t get any. As a culture, we’re not about to nurture this talent, to give it room to grow. Our patience was exhausted long ago, by some other guy. We’re going to pass judgment and move on. There’s a reason Simon Cowell is so rich. Impress us today or get thee hence. So it comes to this: It’s now or never, Trevor.”