This page has been archived and commenting is disabled.
Medicaid Chief Demands "Affordable Prices" From Major Drug Suppliers
In the next phase of the Obama administration's other war on drugs, The Centers for Medicare & Medicaid Services (CMS) has issued a letter to the CEOs of four large drug providers (AbbVie, Gilead, Johnson & Johnson, and Merck), warning that "manufacturers have a role to play in ensuring access and affordability to these medications," asking for "value-based purchasing arrangements."
CMS Statement: ASSURING MEDICAID BENEFICIARIES ACCESS TO HEPATITIS C (HCV) DRUGS
The Centers for Medicare & Medicaid Services (CMS) remains committed to Medicaid beneficiaries continuing to have access to needed prescribed medications, a commitment we know that states share. We have issued a letter to advise states on the coverage of drugs for Medicaid beneficiaries living with hepatitis C virus (HCV) infections. Specifically, this letter addresses utilization of the direct-acting antiviral (DAA) drugs approved by the Food and Drug Administration (FDA) for the treatment of chronic HCV infected patients.
Manufacturers have a role to play in ensuring access and affordability to these medications. CMS has sent a letter to the manufacturers of these HCV medications, asking them to provide information regarding any value-based purchasing arrangements they offer for these drugs so that states might be able to participate in such arrangements.
Individual letters to CEOs here...
The key questions CMS asks of each of the drug suppliers is:
Toward this end, CMS would like a better understanding of the types of value-based purchasing arrangements, if any, being offered to payers and to state Medicaid agencies, including the following:
- What types of arrangements do you offer to commercial or other government-sponsored health insurance plans that are focused on patient outcomes and enhance access to HCV or other drugs?
- Are these arrangements offered to state Medicaid programs? If so, how are these programs typically structured? If not, what are the challenges in offering these programs to states?
- Can you estimate a monetary value of these arrangements to Medicaid, other government-sponsored or commercial health insurance plans? If so, how? If not, why not?
- What other ideas do you have to assist states in the affordability of these new, unbudgeted pharmaceuticals?
CMS is committed to ensuring that pharmaceutical treatments are available to Medicaid beneficiaries, when medically necessary. As the agency works with states on these matters, now and in the future, we cannot do that without addressing affordability concerns.
And finally, as if to reinforce his point, Andy Slavitt, Acting Administrator, Centers for Medicare & Medicaid Services, has written a detailed blog post on Prescription Drugs: Advancing Ideas to Improve Access, Affordability, and Innovation...
Recently, prescription drugs have been in the news a lot, particularly with respect to their cost. Millions of Americans rely on prescription medications to manage chronic illnesses or treat acute conditions, and drug innovation has resulted in better health outcomes for people across our nation. Because of this, finding ways to improve affordability and access for patients, supporting and increasing innovation in the industry, and – most importantly – making people healthier has become an area of significant interest to many.
As medicines become more precise and targeted, there is the potential to improve health outcomes for many diseases, such as cancer and Alzheimer’s, and help us better manage our chronic conditions like diabetes, heart disease and depression, providing significant benefits to patients across the country.
In order to have the maximum impact, medications must also be affordable and accessible. This is an important issue for Americans and for patients, businesses, and governments. Surveys suggest that as many as 25 percent of Americans cannot afford and, therefore, do not fill the prescriptions on which they depend. And, spending on medicines increased 13 percent in 2014, compared to 5 percent for health care spending growth overall, the highest rate of drug spending growth since 2001. An important element of this increase in costs is due to new specialty drugs — drugs that account for nearly a third of overall costs, but represent less than 1 percent of prescriptions.
Cost concerns aren’t only limited to brand-name medicines. In some instances, the prices of generics available for years have increased substantially without any additional health benefits for patients. This is a concern across the country, but particularly for consumers on fixed incomes. The Bipartisan Budget Act, just signed into law by President Obama, provides Medicaid with additional rebates if generic drug prices grow faster than inflation, which will discourage manufacturers from increasing prices for generic drugs.
The rhetoric around health care costs can become heated, particularly around the cost of prescription drugs. At times, it can appear as if some of those who produce the pharmaceuticals and those whose lives often depend on them have unaligned interests. But we will not make progress by polarizing this debate. Development of ground-breaking therapies requires significant investment and resources, and we all need to support that important work. We believe patients, manufacturers, providers, insurers and government all share a common goal to foster a health care system that leads in innovation, delivers affordable, high quality medicines, and results in healthier people with access to the care they need. We shouldn’t accept the notion that we as a society must choose between innovation and affordability. We deserve both.
A recent example of a much discussed, highly-effective drug is a therapy used by Hepatitis C patients. Hepatitis C, a debilitating and life threatening infection that leads to chronic conditions of the liver, has undergone a revolutionary improvement in cure rates with innovative new medicines. These medicines are changing the lives of many individuals, but they are also expensive, costing tens of thousands of dollars, sometimes even more than one hundred thousand dollars, per patient. These costs have strained personal as well as public budgets, particularly state health care budgets. Because state budgets generally need to be balanced every year, new drug treatments can surprise states with tens or hundreds of millions of dollars in new spending. As these costs often necessarily compete with other state programs like K-12 education, transportation, law enforcement, and public health programs, some states have made tough choices, including limiting access to these therapies.
Recognizing that we need both access and affordability, today we issued a notice to all 50 state Medicaid directors and sent letters to the CEOs of several drug manufacturers about providing access to therapy for Hepatitis C patients. Our notice to state Medicaid directors reminds states of their obligation to provide access to these promising therapies (consistent with section 1927 of the Social Security Act) based on the medical evidence, and that they have tools available to manage their costs. Our letter to manufacturers asks them to provide us with information on pricing arrangements and asks them for ideas to support the provision of these lifesaving medications to Medicaid programs at sustainable prices.
There are no easy answers to these multifaceted challenges, but there is a significant benefit – to all of us – of working together to find a solution. Earlier this week, Secretary of Health & Human Services Sylvia Burwell invited leaders in innovation, policy, care delivery, academia, manufacturing, purchasing, and patient advocacy to share information at a public meeting on how to achieve our common goals.
These are complex issues, and we recognize that the public is relying on our leadership. We will work to ensure that all viewpoints are considered as we strive for solutions. In the end, we share a common goal of supporting innovation and improving affordable access to medications that improve health outcomes for patients.
* * *
While there is no "or else" in the letter, the focus on 'significance to many', 'costs', and 'accessible' suggest an overhang of government intervention as new specialty drugs account for nearly a third of overall costs, but represent less than 1% of prescriptions.
»
- 1976 reads
- Printer-friendly version
- Send to friend
- advertisements -
POTUS has a year to make his regime a success.
I'd start blowing off the wonks now and deal with the new wonks.
true.
but what a slimeball obama is. how contemptuous of his supporters, much less his (increasing number of) enemies. for obama to say that drug companies should not charge u.s. purchasers the highest prices in the world and demand a return on equity that requires monopoly power is disengenuous to a degree that language cannot match.
he could have had any number of price reducing measures as part of his "affordable care (reminds me of "patriot") act". the u.s pays twice as much for healthcare as do all other advanced nations.
sometimes leading from behind is just not enough.
How about we demand affordable government? Maybe we could write to the Medicaid chief and the Commander in Chief of the FSA and demand more affordable government, at least one that stays within it's really tight $4.5trillion limits?
This demand thing seems to be a one-way street for the Left. They demand stuff from you. You are never allowed to demand stuff from them. Hell, you cannot even expect decent results.
Bush help the drug companies.
http://www.slate.com/articles/news_and_politics/the_big_idea/2006/01/dru...
Obama made thing more unaffordable,
The Irony being....that Medicare/Medicare are but welfare for the Medical Industrial/Phama-Industrial Complex. High prices are partially the fault of this fucktard, along with Intellectual Property Laws, and violation of Private Property through reimporation bans
Only a socialist would demand affordable prices! He's just committed political suicide
is this like Hillary bad mouthing the wealthy and Wall Street?
With a printing press, the entire missive is moot.
Someone please clean all that smoke off of, all those mirrors.
More Americans Take Prescription Medication
"Use of antidepressants by adults nearly tripled between 1988 to 1994 and 1999 to 2000. The rate of antidepressant use by women is approximately twice that of men (Figure). Ten percent of women and 4% of men aged 18 and older currently take antidepressants."
These statstics run through 2005. I can't even imagine how they've grown in the decade since.
If you want your ZeroCare®, you can keep your ZeroCare. [Just be prepared for your Prozac rations to be halved.]
If only we had something like beer.
Non-GMO beer. ;-)
Still looking (on a very small scale) for an unmolested Hops location.
Gets me off the keyboard.
Last I read about 15% of the country is on antidepressants, mood stablizers, etc. It is not all specifically depression but it is all psych disorders, temporary or long term.
Frankly, the number has always been high. This is not really new. The old antidepressants and mood stabilizers were called Jack Daniels, Captain Morgan or gin. As long as mankind is mankind and people face difficulties they will be out there.
The difference is whether or not you need a prescription and who decides the dose.
notice what demand and bad mouthing are.
words.
deeds are what count.
NOW the government wants cheaper drug prices? But the companies are giving the government, and the people, EXACTLY what they asked for.
After a number of drugs caused a bit of harm, people screamed and DEMANDED safer test procedures. The government obliged and legislated huge numbers of tests, studies, trials over an extended period. It now costs about a billion dollars to bring a new drug to market, and that money is spent regardless if the drug is approved or not.
Of course the drug companies pass this cost along.
Want cheaper drugs? That's easy. Have the government do 2 things. Make testing much less onerous (cheaper) and limit product liability. Product liability for new drugs is a HUGE risk for companies, and again, they price that into their drugs. That's a big reason why drugs are more expensive in the US.
Full liability, zero regulation = cheapest, safest drugs
Ie free market.
https://en.wikipedia.org/wiki/John_Edwards
The reason I mention this, it is a clear example of a successful ambulance chaser that became a politician.
Thanks for telling it like it is. Government does indeed fuck up everything.
Well said, Anopheles.
I happen to know a good bit about this topic. A lot of people have bits and pieces of the answers and reasons for pricing, including our drug prices subsidizing the free grazers in Europe much like our military.
I am going to just throw out some free form one liners because I do not have time for lots of in-depth.
1. Government does not negotiate prices. They tell you what it is going to be. Medicaid gets huge discounts or many do not even try to bid low enough. IF you have a med they must buy you sort of do revenge pricing for all the times they blocked your meds or forced you into money losing prices. Most states allow a bid process that blocks competitors. How you think that works out?
2. The private health sector has always subsidized the government sector and the total f-ing idiots in Obamacare are finding that out as they take over. The government gets lower prices in meds, hospital, nursing home, and most everything because everyone could make enough in the private sector and still take the crappy government payments.
3. Europe is subsidized by the USA is the very same way. Those socialist countries and pharma companies love selling their meds here at higher prices than the homeland.
4. The pharmaceutical company cannot get to the customer without going through a minimum of two layers. First, there is the doctor who must be convinced to try it. Second, there is the insurance who must be convinced to pay for it. Third, there are a boatload of regs and requirements even after marketing in order to keep it coming and severely restrict information. Fourth, the patient or user never really knows the true price of a med and it is never what it published. This is actually true of all medical services.
5. The FDA has unlimited power and asserts that it alone has the right to determine all truth in medical matters. They can disallow information at any time. They even regulate how long a company can use the word "new". There is no 1st Amendment in business.
6. As long as meds are prescription only you cannot get open public pricing. It is not like any consumer market. Once meds go OTC (over the counter) then you see market pricing. Very few will or can do that.
7. Governments make the price of developing, marketing and maintaining meds extraordinarily complex and expensive and then complain that it is expensive.
8. All legislatures are usually about 2/3 lawyers. Why does tort reform never gain ground? The government is virtually all lawyers which means 1. They favor their own. 2. They actually do not know how to do anything from growing an ear of corn or developing a new med. Nothing. But they are sure they know how to control everything.
There is more but after reading the letter in the article the guy is either a fool or a liar and is dishonest about how things are done. I suspect the latter.
You are free to not use meds and go with herbs, vitamins, meditation, reflexology or whatever you think will work. There is some validity in all of those and much more hype.
Fuckers getting desperate now that they see the colossol failure of Obamacare. Fuck You Obama
You are only seeing the tip of the iceberg. Much more pain and failure to come.
If the Republican had even a clue they could exploit it and win all 50 states next election.
Hey Gov., you've been the deep pocket in the market for decades. Put the given drug up for bid! Foster competition! If the company has a monopoly on the market due to patent law, loosen patent regulations (lower barriers to entry) to bring in more competition. Most these meds cost pennies, including R&D. Competing manufacturers would be in with an affordable "similar but different" product in short order. Since you're a part of the affordabilithy problem, try being part of the solution!
Without reasonable patent protection there would be no new drugs because there would be no R&D. It just wouldn't pay if some generic could just swipe the compound formula and make the drug without having spent a shit on R&D. That just doesn't work.
If you want patent protection, pay for it yourself! No taxes for your protection.
Go hire a goon squad to go house-to-house and make sure all of the sheeple are respecting your patent. Why the hell should healthy, sane and hard-working folks subsidize your sloth?
Fuck off with the "there would be no new drugs" bullshit!
You are an economic idiot. Maybe you believe no one should have patents. Go live in China and invent new things and see how you do, moron.
Oh, I get it! Taxation is good!
About time.
And if it means that the feds need to buy their way in, pay drug companies a billion dollars cash for new drug approvals to keep the prescription price down, then let's do it. And for ALL purchasers, not just medicaid, medicare, obamacare. How about the same prices offered in Europe?
Best to let Americans keep getting fucked in the ass because anything else is "socialism." It's not that we are subsidizing Big Pharma's cost of business everywhere else, or anything, right?
Why this $84,000 drug costs just $900 abroad
Okay - we don't want yet more government red tape and fuckery. Okay. I'm down with that as a general principle, but what do we do - lay back and think of 'Murica?
Why Are Prescription Drugs So Expensive? Big Pharma Points To The Cost Of Research And Development, Critics Say That's No Excuseleaving aside the big chunk of their cash they spend on advertising, or on testing minor variations on extant molecules to find a just patentable difference, even if not better than what's available.... why should we subsidize their ops in foreign countries?
As Karl Denniger has stated over and over ad nausium,.....
This is an EASY problme to fix.
1. Remove import restrictions of private property procured overseas, ie. Perscription drugs (you know, the rattle snake vaccine that is made in Mexico, availble in Mexacan hospitals for US$40, but is $US15,000 in the land of the free),
2. Enforce the Robinson–Patman and Sherman Antitrust Acts.
There is only one hospital in the USA that obeys the law, that is that one in Oklahoma that does everything for cash...at 1/5 of the prevalining rates in other hospitals. Price fixing and performing a service witouth providing a quotation beforehand are both illegal.
Doing the above will:
1. Drop prescription drug prices by about 98-95%,
2. Drop hospital costs by 60-80%.
Of course if you do that you have the following after effects:
1. All your campain contributions from pfitzer dry up....which is ok, they won't be able to afford them anymore anyway,
2. Medicade costs will plummet by ~70%,
3. Medicare costs will plummet by about 70%,
4. The US federal budget would be in surplus.
But no-no-no, we can't have that, can we? How would Goldman sacks and JP Morgan survive without their customary 3% skim off the rolling of 4T a year in Federal debt. Heaven forbid they might actually have to....what is it, do banking for a living? You konw, lend money to small business and the like.
Nope, can't have that.
PROTECT GOLDMAN SACKS!!!!!!
Squid
Since 2002 the reimbersment rate from medicaid dental in Ohio remains the same even though all of their union employees have garnered a pay raise each and every year but the folks actually performing the services get squat. This is govt at its finest when they demand cuts from suppliers so they can continue thier pay raises each end every year yet they pay the providers nothing extra in 14 years. We need to cut these bastards off at the balls/clit. Citizens do not get pay raises in this type of environment. Only the state and federal employees do.
There will be no wage groth in America while this type of trashing of citizens continues.
They are vanpires preying on all of us.
https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&...
I'd be happy to enjoy the prices paid by people in other conties along with their risks if I could accress them.
PLEASE PICK A BETTER EXAMPLE NEXT TIME! I expect a little better from Zero Hedge. Do you folks not know that Andy Slavitt who's acting director and nominated for the job permanently by Obama is a one time Goldman Sachs banker! He's made a lot of money, not only there but as a former big time executive of United Healthcare. We want Senators to vote no on his confirmation and I think if it rolls past the end of this month, Obama has to renominate him.
He was the CEO of Ingenix which is now Optum Insights. He's an algo man and United Healthcare makes money from drugs and the data they sell about our prescriptions, so get a better example.
You can read more here about him with one of his lawsuits that he was given protection against by HHS secretary Burwell, who's in the 6 degrees of Bob Rubin group being a former chief of staff for him. That's what's running healthcare.
http://ducknetweb.blogspot.com/2015/09/another-united-healthcare-ingenix.html
Slavitt also has immunity to freely work with United Healthcare in his current position of running CMS. The man has done nothing to work on lowering drug prices, only lowering what doctors are paid. By the way, most MDs in the US where United is in network are paid an average of 12% less than Medicare.
http://ducknetweb.blogspot.com/2015/07/doctors-in-network-leave-united.html
By the way if you choose a Cigna plan with Obamacare or a straight policy, your new pharmacy benefit manager is named United Healthcare as they bought the PBM company, Catamaran that Cigna usrs a couple years ago signed a 10 year exclusive agreement with.
http://ducknetweb.blogspot.com/2015/10/if-you-are-insured-by-cigna-guess-what.html
Ingenix, the former United Healthcare company where Slavitt was CEO does a lot of clinical trials under other subsidiaries of that sub, and yes they want drugs out there to make money, so don't be fooled. Slavitt is still 100% United at heart and why do you think they wanted him there.
Carlyle group, new chairman, James Welter, the Executive VP at United Healthcare to the CEO now. The CEO of United just got elected to the board of Cargill, the evil twin company of Monsanto. See where this is going? Welters is a member of the boards of Lowes, West Pharmaceutical and CR Bard. Slavitts buddy.
Back on Slavitt, who created the medication prediction adherence scoring, same guy and all the PBMs do it now using the old Ingenix algorithms that were created under his ruling there as CEO. Again, pick someone else as this is all show for this guy and he could care less about you and I and wants that job full time to help United Healthcare.
By the way, Loretta Lynch will do nothing about the United Healthcare monopoly as she used to represent them in anti trust cases. See the letter to Grassley at one of the above links from the head legal guy at United telling him to please confirm her as she will do a good job as she did representing United with Anti Trust lawsuits.
Again, don't be fooled, Slavitt's old employer United makes a ton of money distributing drugs and mining and selling data about you and your prescriptions and for God's sakes, next time use the words of someone on our side and not this former Goldman Sachs banker!
Slavitt's United models and algorithms are working so well now that you are considered an Outlier if you pay cash.
http://ducknetweb.blogspot.com/2015/07/patients-who-pay-cash-when-filling.html
And of course United/Optum will give you an HSA account at their bank, yes they own a bank with a MasterCard to empty out your account and track and mine you even more and get you to invest that hard earned money that's supposed to be for healthcare expenses, to also put that money in mutual funds. Wake up folks...
http://ducknetweb.blogspot.com/2015/10/united-healthcare-owns-bank-optum-bank.html
Please no more using Slavitt's words for anything but a bunch of perception deception. This one time Goldman Banker does not have your best interest at heart.
Why are there letters being written? We have a law in place...the AFFORDABLE Care Act. There's like, 9 million pages saving the American people from high prices, that's why they smartly called it the AFFORDABLE Care Act. This was already taken care of, this should not be a problem.
I guess the US could go full fascist and nationalize the domestic drug manufacturers. Would you put it past them??
Drug prices are a rip off.