California, Big Blues, and hospitals join the attack on sky-high drug prices

califgovnewsomBig Pharma, with its relentless price gouging, may finally have poked in the eye the wrong people. But even as patients wait to see if hospitals, and now states and insurers, can beat down skyrocketing drug prices, isn’t it past time for more public shaming for doctors who persist in writing excessive, dubious, and downright risky prescriptions?

Although the Trump Administration and Republicans in Congress have failed to deliver on repeated promises to attack excessive costs for prescription drugs, the state of California and now leading insurers are following some hospitals in tackling the problem.

Calif. Gov. Gavin Newsom (shown, above right), in unveiling his state budget, told lawmakers that he wants the Golden State to consider contracting with generic drug makers to produce products that would cost less and be sold under a California label. As the Los Angeles Times described the still-to-be fleshed out gubernatorial plan:

“Those [generic] drugs would be available to all Californians for purchase, presumably at a lower cost. The governor’s office said the proposal would increase competition in the generic drug market, which in turn would lower prices for everyone. The proposal drew both praise and skepticism … as health care experts said they were eager to see details on how the state would rein in drug prices that have become increasingly out of reach for many in the state.”

Newsom in a statement: “A trip to the doctor’s office, pharmacy or hospital shouldn’t cost a month’s pay. The cost of health care is just too damn high, and California is fighting back.”

The newspaper noted that soaring drug costs have become a defining political issue nationally and in California, a top health care market in the globe. Newsom has focused on drug prices since he took office and has more plans:

“Newsom is expected to announce plans to expand on the state’s bulk [drug] buying [and discounting] plan and seek additional partnerships. He plans to propose a drug pricing schedule for California, a system in which drug manufacturers would bid to sell their prescription drugs at set uniform prices in the state. Newsom’s plan calls for drug prices to be equal to or lower than those of any other state, national or global purchaser in order to sell the products in California.”

Though national political writers tagged Jerry Brown, Newsom’s predecessor, as “Gov. Moonbeam” for his progressive — perhaps sometimes too far-sighted plans for California and the nation — major insurers also suddenly have leaped aboard the bandwagon on plans for slashing prescription drug prices.

The Blues jump aboard the push to cut drug prices

The Blue Cross Blue Shield Association and 18 of its member organizations, which insure about 40 million people, have announced they will invest $55 million “to create cheaper versions of expensive generic drugs for which there is little competition, in a further sign of dissatisfaction with the pharmaceutical industry’s price-setting practices,” the New York Times reported.

The newspaper said the insurers “declined to name specific drugs that would be targeted, saying they did not want to tip off potential business rivals. They said that they would start with seven to 10 products that have little competition and that some initial products could become available by early 2022.”

California and the Blues, news reports from both coasts say, have found a strong and pathbreaking partner-model in Civica Rx, “a nonprofit that is already selling drugs used in hospitals to health systems around the country.”

Hospitals battle high drug prices

Marc Harrison, a doctor in Salt Lake City and a governing member of Civica Rx., explained in a recent Op-Ed for Stat, the health and medical web site, what the organization is about, writing:

Civica Rx, a not-for-profit company formed by three philanthropies and numerous health care organizations that represent about 800 U.S. hospitals. One of the founding health care organizations is Intermountain Healthcare, where I am president and CEO. Martin VanTrieste, the former chief quality officer for Amgen, is serving without compensation as the CEO of Civica Rx. Our company has a different moral requirement than … many other generic drug companies: to put patients and their needs first. Unlike for-profit companies, Civica Rx is a public asset whose mission is to ensure that essential generic medications are accessible and affordable. These are drugs that have emerged from the patent-protection period and are in the public domain. The company will work to ensure they remain that way. Civica Rx will draw on the collective volume of commitments from its member health care organizations to serve the public good …. Shortly after the launch of Civica Rx in September 2018, more than 120 health organizations that represent about one-third of the nation’s hospitals contacted the company and expressed their commitment to the venture or interest in participating with it. Civica Rx is also collaborating with the U.S. Department of Veterans Affairs, which could bring its considerable buying power to the table and would likewise benefit greatly from less-expensive generic medications.”

The group launched after outrages over “a 5,000% increase by Turing Pharmaceuticals for one tablet of generic pyrimethamine, which is used to treat toxoplasmosis, a rare infection [and] a 2,800% price increase in a single year for digoxin, a commonly prescribed heart medication,” Harrison noted.

He said doctors, hospitals, and medical scientists could not determine concrete, evidence-based reasons why these drugs and other generics saw gigantic price increases. The only reason, which federal officials described, was price gouging, particularly by cunning investors who bought up rights to the drugs and sought to control and exploit markets for them.

The administration and members of Congress have bellowed about sky-high drug prices but proposals to deal with the issue have gotten mired in partisan gridlock. House Democrats passed a plan supported by Speaker Nancy Pelosi to rein in drug costs. The GOP-controlled Senate has killed the plan, refusing to consider it at all. The administration’s notions, meantime, have floundered. The courts, for example, have stymied a Trump plan to require greater price transparency in drug ads, while the president’s lawmaking allies have balked at his ideas to create controls on medications’ costs based on European and Canadian prices.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent medical care. This has become an ordeal due to the relentless increase in the cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.

It’s good to see states, insurers, and hospitals step up to try to assist Americans with one of their top complaints about the U.S. health care system — exorbitant prescription drug prices.  At the same time, however, there’s a persistent need for the public to call out doctors for their problematic prescribing — both the ways in which practitioners abet Big Pharma in jacking up prices by pushing dubious products like over-used, attention-deficit-disorder drugs for young people, or in putting patients at risk by excessive scripts for benzodiazepines, aka benzos.

‘Disturbing’ prescribing of benzos

Benzos — such as alprazolam (Xanax), diazepam (Valium), clonazepam (Klonopin) and lorazepam (Ativan) — are prescribed at “disturbing” levels with 27 out of 100 patient visits leading doctors to order these powerful meds, federal officials reported, based on data from 2014-16. Many of the scripts were written concurrent with prescriptions for potent opioid painkillers. This can be a problematic, even lethal combination.

As CNN reported:

Benzodiazepines … can be helpful when taken on a short-term basis. Doctors often prescribe them to relieve acute anxiety, agitation or to help someone sleep. Taken over the long term, they can become addictive. In older adults, the drugs have been shown to increase the risk of falls, cloud judgment and impair memory. There is an increased risk of hospitalization and death for people who take benzos, particularly if they are taken with an opioid. Despite the risks, among the doctor visits at which benzodiazepines were prescribed, approximately one-third involved an overlapping opioid prescription at a rate of 10 annual visits per 100 adults from 2014 to 2016.”

The broadcast report quoted Keith Humphreys, a psychologist and Esther Ting Memorial Professor at Stanford University, who has studied the over-prescription of benzos. He said the federal data suggest the drugs may play a less known but significant role in the nation’s overdose and opioids crisis, with many fatalities blamed on painkillers resulting from lethal combinations of opioids and benzos.

He and other experts also faulted primary care physicians for too readily prescribing the drugs, especially for older patients and especially for older women. These are groups vulnerable to benzos harms.

Big Pharma pays, doctors prescribe

Separately, a newly published study has raised questions about drug company money and doctors over-prescribing of stimulants, especially drugs targeted to treat attention deficit hyperactivity disorder (ADHD) in young people. As the researchers wrote in JAMA Pediatrics:

“During the five-year study period, 1 in 18 physicians appear to have received marketing for stimulants. Payments were most typically high-frequency, low–dollar value marketing in the form of food or beverage. Pediatricians, psychiatrists, and family physicians (i.e., clinicians who often care for children and adolescents) received the greatest share of marketing. Pharmaceutical industry marketing may be partly contributing to rising stimulant-prescribing rates.”

As Stat reported from this study:

“Between 2013 and 2018, nearly 592,000 payments totaling more than $20 million were made to physicians who prescribed stimulants …  Overall, about 55,000 pediatricians, psychiatrists, and family doctors received food, travel expenses, consulting and speaking fees, or other payments.”

This is not good and merits more inquiry. We have lots of work to do to ensure drugs we are prescribed are safe, accessible, affordable, and necessary — and we need to rein in Big Pharma and its injurious excesses.

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