This week in Medicine October 11, 2014

Topping the news this week is greed from Pharmaceutical companies:
1. A 60 minute report (October 5th) describes a cost of a cancer drug going from $33,000 for a treatment course to $98,000, because a competitor came out with a similar drug for $100,000 per treatment course, see the link to watch the 14 minute video. 60 minutes
2. There is a dramatic increase in generic drug prices resulting in decreased access for patients. “77% of pharmacists reported 26 or more instances over the past 6 months of a large upswing in a generic drug’s acquisition price”. “A recent analysis found that half of all generics sold through retailers became more expensive over the past 12 months. And prices paid by pharmacies more than doubled for one out of 11 generics”. (the Wall Street Journal, Oct 2,2014 Silverman) Here are four such medication prices increased since April 2014:
a. Blood pressure medication Benazepril/hydrochlorothiazide was $34 for 100 tablets now $149 up 420%
b. Antiseizure medication Divalproex Sodium ER was $43 for 100 tablets now $351, up 667%
c. Antibiotic medication Doxycycline Hyclate was $20 for 500 tablets now $1,849, up 8281%
d. Cholesterol medication Pravastatin sodium was $9 for 90 tablets now $51, up 473%
Now why should the price of a generic medication that is being made by multiple drug companies (to induce competition – “free market” – not) go up in price instead of down? Any other industry which has a true free market will drop the price, look at the iphone, x-box, and others. This is truly a wealth transfer of hard earned savings from the general populous to a overfed pharmaceutical industry.
3. This one has a twist to it (Bloomberg Business week, Oct 6, 2014, Tozzi) How drug discounts for the poor have become a windfall for Hospitals. There is this program where hospitals (in rural settings) can buy medications from drug companies at steep discounts so hospitals can take care of people who could not afford the drugs or had no insurance to pay for them. But hospitals are using these drugs on patients covered by insurance companies or medicare, billing at a higher rate and keeping the profits. Something is not right here. Who ends up paying for this? Yep, your right the taxpayer.
4. Yesterday Oct 10, 2014, I reviewed a report out of Washington that “Federal health officials (FDA) have approved a daily pill that can cure the most common form of hepatitis C” (honestly a great advancement). But the drug’s price (Harvoni) is $1,125 per pill, costing $94,000 for a 12 week supply, though 40% of patients can get by with 8 weeks at $63,000. (By the way this is the same company, Gilead, who makes Sovaldi discussed in the 60 minute report). It is expected that Harvoni will be used on 150,000 to 200,000 patients a year (by my calculation is $15-16.3 billion dollars a year, while Sovaldi racked up $5.8 billion dollars in sales in the first 6 months of 2014). food for thought: About 1/3 of all AID’s patients have hepatitis C, and most people with hepatitis C today are either on medicaid or medicare. Once again who ends up footing the bill? – evidence of the wealth transfer going on in America.
5. Here is one comment to the 60 minutes broadcast above that is representative of the pressures on healthcare.
JRICH6041 October 6, 2014 1:1PM
I am a health care and insurance company investor and unlike doctors and health care workers who care for people I care only for profit, as do the CEOs of the companies in which I invest.

Our goal is to make as much money as we can from human illness and suffering, while providing service in a manner that keeps us in business and within the law as our attorneys interpret it. Profit drives our policies and practice, not what is best for patients, or the nation and we like the current system so much that we contribute huge sums to politicians in order to maintain the status quo.

Old time highway robbers used the threat “Your money or your life”, and many were caught and hung, but we can take all of your money and sometimes your life, and still remain respected pillars of the community. Our nation has socialized military, police, legislatures and court systems, because if those institutions were profit based it would subject America to great harm and expense perpetrated by people like me. For profit health care is no different.
It is illogical that profit is part of any system designed to avoid suffering and death, because like the Mafia, heath care businesses will use the inherent leverage to extort a price most cannot afford, but all must still pay.
6. Last of all for this week. An article in Medical Economics (Oct 3, 2014 Ritchie) discussed a new report by the Medical Group Management Association (MGMA) that all the government regulations and processes have increased the administrative burden of practices, forcing them “to allocate more staff resources to manage onerous government regulations and processes”. In Physician own practices (private practices), practices like ours have 4.94 staff members per provider, while hospital-owned clinics only have 3.5 staff per provider. It costs us more to be compliant, but get much less than hospital-owned clinics to cover the cost. (this is why healthcare is provided by only 35% private practice docs now, down from 65% in 2007, and why in just 2 years, you probably will see a greater collapse of private practice).

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