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PostPosted: Tue Jan 08, 2019 10:12 am 
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I'll save you time from digging through the weeds. Here is the money quote:

"Folwell also said he was disturbed to learn that ECU Physicians plans to donate $10 million from patient fees at its clinics to close an athletics department deficit. “We have state employees in eastern North Carolina who are struggling to pay the premiums on the State Health Plan, and then even after they have insurance sometimes they can’t afford to get sick, and part of the money they’re contributing, the profit on that, is being transferred to a booster club for a football stadium,” Folwell said."

https://www.jamesgmartin.center/2019/01/brody-school/


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PostPosted: Wed Jan 09, 2019 12:07 pm 
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Seems like a good idea for a medical group to provide the funding. They’ll just gouge their customers a little more to cover the difference. Might be a good idea to get Tulane Medicine to start contributing to athletics. Repeat customers is an art form for the medical profession so income is steady so a multi-year pledge could work.

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PostPosted: Wed Jan 09, 2019 6:45 pm 
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waverider wrote:
Seems like a good idea for a medical group to provide the funding. They’ll just gouge their customers a little more to cover the difference. Might be a good idea to get Tulane Medicine to start contributing to athletics. Repeat customers is an art form for the medical profession so income is steady so a multi-year pledge could work.


Your comment about "gouging customers" is off base. I am a physician, and the truth is that no matter what I charge, I am told by insurance companies, medicare, medicaid, etc, what I will be paid. I could tell any of them that I am raising my prices by 10%; they will tell me "fine, we will still pay you what we said we would pay you for your services." Medicare payments to physicians for E/M services have gone up less than 10% total over the past 10 years; during that time I have watched the prices of medications that I prescribe double in price. Seems that the pharmaceutical companies can jack their prices up, and the inscos and CMS will happily oblige their higher prices.

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PostPosted: Thu Jan 10, 2019 3:59 pm 
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AO Sig wrote:
...Seems that the pharmaceutical companies can jack their prices up, and the inscos and CMS will happily oblige their higher prices.
I've been saying for many years that the patent protections on pharma are too restrictive to competition. People like to rail against "Big Oil," but "Big Pharma" ROI is much, much higher than the oil companies. I think that anyone who can produce and sell a drug for less than 75% of what the patent-holder is charging, should be allowed to do so, patent notwithstanding. That would bring prescription prices way down.


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PostPosted: Thu Jan 10, 2019 4:01 pm 
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Roller wrote:
AO Sig wrote:
...Seems that the pharmaceutical companies can jack their prices up, and the inscos and CMS will happily oblige their higher prices.
I've been saying for many years that the patent protections on pharma are too restrictive to competition. People like to rail against "Big Oil," but "Big Pharma" ROI is much, much higher than the oil companies. I think that anyone who can produce and sell a drug for less than 75% of what the patent-holder is charging, should be allowed to do so, patent notwithstanding. That would bring prescription prices way down.


R&D and clinical trials be damned comrade?

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PostPosted: Thu Jan 10, 2019 4:33 pm 
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windywave wrote:
Roller wrote:
AO Sig wrote:
...Seems that the pharmaceutical companies can jack their prices up, and the inscos and CMS will happily oblige their higher prices.
I've been saying for many years that the patent protections on pharma are too restrictive to competition. People like to rail against "Big Oil," but "Big Pharma" ROI is much, much higher than the oil companies. I think that anyone who can produce and sell a drug for less than 75% of what the patent-holder is charging, should be allowed to do so, patent notwithstanding. That would bring prescription prices way down.


R&D and clinical trials be damned comrade?
Those costs are part of the "I" in ROI. The pharma companies get their R&D money back, plus a boatload more. They could easily cover R&D and still charge a lot less. The argument about R&D costs is a red herring to encourage Congress to leave their obscene profits alone, although pharma patent reform (along with some tort reform) would probably do more for healthcare affordability than any legislation passed in recent years.

Besides, if there was never another "miracle drug" invented, we'd never know, would we? We'd proceed blissfully along, relieved that we have pills to control blood pressure, cholesterol, stomach acid, .... We might hope/wish for a new miracle drug, but we would be no worse off than we are today.


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PostPosted: Fri Jan 11, 2019 6:51 am 
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windywave wrote:
Roller wrote:
AO Sig wrote:
...Seems that the pharmaceutical companies can jack their prices up, and the inscos and CMS will happily oblige their higher prices.
I've been saying for many years that the patent protections on pharma are too restrictive to competition. People like to rail against "Big Oil," but "Big Pharma" ROI is much, much higher than the oil companies. I think that anyone who can produce and sell a drug for less than 75% of what the patent-holder is charging, should be allowed to do so, patent notwithstanding. That would bring prescription prices way down.


R&D and clinical trials be damned comrade?


You are not very well informed to make such a ridiculous accusation.

Humira, a medication my specialty uses a lot, generated $18 billion in 2017 for Abbvie. The price has tripled since its release in 2001, because of 10% annual increases in price irrespective of inflation, changes in expenses, etc. When Enbrel hit the market in 1998, it sold for 13K a year; now it is over $50K a year. Its price also goes up by about 10% a year over that time, with the price increase going up at about the same time, and the same percentage as the other biologics.

The pharmaceuticals have lots of funds for research; my office has participated in some clinical trials. My organization has a large research foundation to provide seed money for new research toward new treatments and potential cures, funded in part by members of the organization; we put our money where our mouths are.

One pharma did a 6 month trial involving about 300 patients on a medication that was generic for years, using a program the FDA devised to check out medications in use before they existed. As a result of that study the company was able to raise the price from $10 a month to over $300 a month (I was quoted in an article about this in the Wall Street Journal, Philadelphia Inquirer and LA Times), depriving a lot of my patients of that drug. I was told by the Chief Medical Officer that the increase was being used to fund more research on the drug; not one shred of new medical evidence was ever released by that company on that drug that has been in use for centuries.

One big reason the drug prices have risen, truth be told, is the evolution of the PBM's, such as Optum Rx, Express Scripts, and CVS Caremark. These middlemen set the meds that are on "preferred lists," with decisions being made based on kickbacks rebates from the pharmaceutical companies. Pharma increases the list price (which the insurance company is given as the cost of the medication) to cover a higher rebate. As a result of these enormous rebates the three PBM's I listed have quickly risen to be part of Fortune 500's top 30 lists; all they do is shift medications from one place to another. They do no research on medications or diseases. They used to bar pharmacists from telling patients that they might be able to pay a cash price for a medication that is lower than the co-pay their insurance requires (called a "clawback.") Addendum- if you want to learn more about this issue, you should speak with Madeleine Feldman, rheumatologist in New Orleans. Mattie is a proud Tulane alumna, and has researched this issue extensively, spoken throughout the U.S. on this subject.

I am not, by any stretch of your imagination, anti-capitalist. I am, however, opposed to usury-like practices. As a physician my first priority is the patient; I have a full-time staff member, whose salary I pay for, whose job is to try to get medications the patients need at a price they can afford. In the southern Appalachian region in which I practice, many live on incomes that cannot cover the $12,000 copay that a $60K medication might require due to the price of the medication.

I apologize to the YOGWF'ers about the length of this diatribe. I could have gone a lot longer on this topic, and I can back everything I listed above. Companies are certainly welcome to reasonable profits; but they should not be at the expense of putting patients' health in danger.

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PostPosted: Fri Jan 11, 2019 11:24 am 
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AO Sig wrote:
windywave wrote:
Roller wrote:
AO Sig wrote:
...Seems that the pharmaceutical companies can jack their prices up, and the inscos and CMS will happily oblige their higher prices.
I've been saying for many years that the patent protections on pharma are too restrictive to competition. People like to rail against "Big Oil," but "Big Pharma" ROI is much, much higher than the oil companies. I think that anyone who can produce and sell a drug for less than 75% of what the patent-holder is charging, should be allowed to do so, patent notwithstanding. That would bring prescription prices way down.


R&D and clinical trials be damned comrade?


You are not very well informed to make such a ridiculous accusation.

Humira, a medication my specialty uses a lot, generated $18 billion in 2017 for Abbvie. The price has tripled since its release in 2001, because of 10% annual increases in price irrespective of inflation, changes in expenses, etc. When Enbrel hit the market in 1998, it sold for 13K a year; now it is over $50K a year. Its price also goes up by about 10% a year over that time, with the price increase going up at about the same time, and the same percentage as the other biologics.

The pharmaceuticals have lots of funds for research; my office has participated in some clinical trials. My organization has a large research foundation to provide seed money for new research toward new treatments and potential cures, funded in part by members of the organization; we put our money where our mouths are.

One pharma did a 6 month trial involving about 300 patients on a medication that was generic for years, using a program the FDA devised to check out medications in use before they existed. As a result of that study the company was able to raise the price from $10 a month to over $300 a month (I was quoted in an article about this in the Wall Street Journal, Philadelphia Inquirer and LA Times), depriving a lot of my patients of that drug. I was told by the Chief Medical Officer that the increase was being used to fund more research on the drug; not one shred of new medical evidence was ever released by that company on that drug that has been in use for centuries.

One big reason the drug prices have risen, truth be told, is the evolution of the PBM's, such as Optum Rx, Express Scripts, and CVS Caremark. These middlemen set the meds that are on "preferred lists," with decisions being made based on kickbacks rebates from the pharmaceutical companies. Pharma increases the list price (which the insurance company is given as the cost of the medication) to cover a higher rebate. As a result of these enormous rebates the three PBM's I listed have quickly risen to be part of Fortune 500's top 30 lists; all they do is shift medications from one place to another. They do no research on medications or diseases. They used to bar pharmacists from telling patients that they might be able to pay a cash price for a medication that is lower than the co-pay their insurance requires (called a "clawback.") Addendum- if you want to learn more about this issue, you should speak with Madeleine Feldman, rheumatologist in New Orleans. Mattie is a proud Tulane alumna, and has researched this issue extensively, spoken throughout the U.S. on this subject.

I am not, by any stretch of your imagination, anti-capitalist. I am, however, opposed to usury-like practices. As a physician my first priority is the patient; I have a full-time staff member, whose salary I pay for, whose job is to try to get medications the patients need at a price they can afford. In the southern Appalachian region in which I practice, many live on incomes that cannot cover the $12,000 copay that a $60K medication might require due to the price of the medication.

I apologize to the YOGWF'ers about the length of this diatribe. I could have gone a lot longer on this topic, and I can back everything I listed above. Companies are certainly welcome to reasonable profits; but they should not be at the expense of putting patients' health in danger.

You could not be more correct on any of these points.


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PostPosted: Fri Jan 11, 2019 11:42 am 
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AO Sig, I really enjoyed reading your “column.” Jeremy and one of my other children have diabetes and the prices for quarterly insulin and related supplies has risen astronomically over 20 years. It is very scary what is going on between the pharmaceutical industry and the FDA. There has been a lot of success internationally with products that somewhat cure Type I diabetes, yet the FDA drag their feet repeatedly. It is very frustrating, and I can’t imagine what your practice goes through.


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PostPosted: Fri Jan 11, 2019 11:46 am 
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likewise, AO I appreciate the well thought out post you wrote. And like you I'm certainly no anti-capitalist.

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PostPosted: Fri Jan 11, 2019 12:31 pm 
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AO Sig wrote:
windywave wrote:
Roller wrote:
AO Sig wrote:
...Seems that the pharmaceutical companies can jack their prices up, and the inscos and CMS will happily oblige their higher prices.
I've been saying for many years that the patent protections on pharma are too restrictive to competition. People like to rail against "Big Oil," but "Big Pharma" ROI is much, much higher than the oil companies. I think that anyone who can produce and sell a drug for less than 75% of what the patent-holder is charging, should be allowed to do so, patent notwithstanding. That would bring prescription prices way down.


R&D and clinical trials be damned comrade?


You are not very well informed to make such a ridiculous accusation.

Shocking!!


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PostPosted: Fri Jan 11, 2019 12:49 pm 
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Roller wrote:
windywave wrote:
Roller wrote:
AO Sig wrote:
...Seems that the pharmaceutical companies can jack their prices up, and the inscos and CMS will happily oblige their higher prices.
I've been saying for many years that the patent protections on pharma are too restrictive to competition. People like to rail against "Big Oil," but "Big Pharma" ROI is much, much higher than the oil companies. I think that anyone who can produce and sell a drug for less than 75% of what the patent-holder is charging, should be allowed to do so, patent notwithstanding. That would bring prescription prices way down.


R&D and clinical trials be damned comrade?
Those costs are part of the "I" in ROI. The pharma companies get their R&D money back, plus a boatload more. They could easily cover R&D and still charge a lot less. The argument about R&D costs is a red herring to encourage Congress to leave their obscene profits alone, although pharma patent reform (along with some tort reform) would probably do more for healthcare affordability than any legislation passed in recent years.

Besides, if there was never another "miracle drug" invented, we'd never know, would we? We'd proceed blissfully along, relieved that we have pills to control blood pressure, cholesterol, stomach acid, .... We might hope/wish for a new miracle drug, but we would be no worse off than we are today.


ROI per drug or for the corporation as a whole?

Personally I'd like some more drugs to cure things especially lethal and debilitating diseases

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PostPosted: Fri Jan 11, 2019 12:51 pm 
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AO Sig wrote:
windywave wrote:
Roller wrote:
AO Sig wrote:
...Seems that the pharmaceutical companies can jack their prices up, and the inscos and CMS will happily oblige their higher prices.
I've been saying for many years that the patent protections on pharma are too restrictive to competition. People like to rail against "Big Oil," but "Big Pharma" ROI is much, much higher than the oil companies. I think that anyone who can produce and sell a drug for less than 75% of what the patent-holder is charging, should be allowed to do so, patent notwithstanding. That would bring prescription prices way down.


R&D and clinical trials be damned comrade?


You are not very well informed to make such a ridiculous accusation.

Humira, a medication my specialty uses a lot, generated $18 billion in 2017 for Abbvie. The price has tripled since its release in 2001, because of 10% annual increases in price irrespective of inflation, changes in expenses, etc. When Enbrel hit the market in 1998, it sold for 13K a year; now it is over $50K a year. Its price also goes up by about 10% a year over that time, with the price increase going up at about the same time, and the same percentage as the other biologics.

The pharmaceuticals have lots of funds for research; my office has participated in some clinical trials. My organization has a large research foundation to provide seed money for new research toward new treatments and potential cures, funded in part by members of the organization; we put our money where our mouths are.

One pharma did a 6 month trial involving about 300 patients on a medication that was generic for years, using a program the FDA devised to check out medications in use before they existed. As a result of that study the company was able to raise the price from $10 a month to over $300 a month (I was quoted in an article about this in the Wall Street Journal, Philadelphia Inquirer and LA Times), depriving a lot of my patients of that drug. I was told by the Chief Medical Officer that the increase was being used to fund more research on the drug; not one shred of new medical evidence was ever released by that company on that drug that has been in use for centuries.

One big reason the drug prices have risen, truth be told, is the evolution of the PBM's, such as Optum Rx, Express Scripts, and CVS Caremark. These middlemen set the meds that are on "preferred lists," with decisions being made based on kickbacks rebates from the pharmaceutical companies. Pharma increases the list price (which the insurance company is given as the cost of the medication) to cover a higher rebate. As a result of these enormous rebates the three PBM's I listed have quickly risen to be part of Fortune 500's top 30 lists; all they do is shift medications from one place to another. They do no research on medications or diseases. They used to bar pharmacists from telling patients that they might be able to pay a cash price for a medication that is lower than the co-pay their insurance requires (called a "clawback.") Addendum- if you want to learn more about this issue, you should speak with Madeleine Feldman, rheumatologist in New Orleans. Mattie is a proud Tulane alumna, and has researched this issue extensively, spoken throughout the U.S. on this subject.

I am not, by any stretch of your imagination, anti-capitalist. I am, however, opposed to usury-like practices. As a physician my first priority is the patient; I have a full-time staff member, whose salary I pay for, whose job is to try to get medications the patients need at a price they can afford. In the southern Appalachian region in which I practice, many live on incomes that cannot cover the $12,000 copay that a $60K medication might require due to the price of the medication.

I apologize to the YOGWF'ers about the length of this diatribe. I could have gone a lot longer on this topic, and I can back everything I listed above. Companies are certainly welcome to reasonable profits; but they should not be at the expense of putting patients' health in danger.


I agree about the PBM and I hate the shenanigans. Your points are distinguished from Rollers IMO.

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PostPosted: Fri Jan 11, 2019 12:52 pm 
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tjtlja wrote:
AO Sig, I really enjoyed reading your “column.” Jeremy and one of my other children have diabetes and the prices for quarterly insulin and related supplies has risen astronomically over 20 years. It is very scary what is going on between the pharmaceutical industry and the FDA. There has been a lot of success internationally with products that somewhat cure Type I diabetes, yet the FDA drag their feet repeatedly. It is very frustrating, and I can’t imagine what your practice goes through.


The FDA approval process especially regarding cancer drugs for people who have no hope with approved drugs makes me want to disband the agency

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PostPosted: Fri Jan 11, 2019 1:16 pm 
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Windy, great point and example. I am so discouraged on the diabetic front. It is such a deadly disease over time and new products are being introduced at a snails pace (like various monitors that measure blood sugar levels without the need of sticking your finger 5-7 times daily which would destroy the lancet and test strip entities). What really pisses me off is the availability of products that stimulate the pancreas for 3-4 months being utilized in Europe. When will the FDA get off their azz. Like you said, they should be disbanded.


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PostPosted: Sat Jan 12, 2019 9:24 pm 
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windywave wrote:
Roller wrote:
windywave wrote:
Roller wrote:
AO Sig wrote:
...Seems that the pharmaceutical companies can jack their prices up, and the inscos and CMS will happily oblige their higher prices.
I've been saying for many years that the patent protections on pharma are too restrictive to competition. People like to rail against "Big Oil," but "Big Pharma" ROI is much, much higher than the oil companies. I think that anyone who can produce and sell a drug for less than 75% of what the patent-holder is charging, should be allowed to do so, patent notwithstanding. That would bring prescription prices way down.


R&D and clinical trials be damned comrade?
Those costs are part of the "I" in ROI. The pharma companies get their R&D money back, plus a boatload more. They could easily cover R&D and still charge a lot less. The argument about R&D costs is a red herring to encourage Congress to leave their obscene profits alone, although pharma patent reform (along with some tort reform) would probably do more for healthcare affordability than any legislation passed in recent years.

Besides, if there was never another "miracle drug" invented, we'd never know, would we? We'd proceed blissfully along, relieved that we have pills to control blood pressure, cholesterol, stomach acid, .... We might hope/wish for a new miracle drug, but we would be no worse off than we are today.


ROI per drug or for the corporation as a whole?

Personally I'd like some more drugs to cure things especially lethal and debilitating diseases
The industry uses a lot of "tricks" to make their ROI look better for whatever purpose they report it (Investor want to see a high ROI, regulators are more "friendly" if you have a low ROI.

But if your investment (I) includes physical plant, personnel costs, marketing costs (including under-the-table payoffs to politicians, kickbacks to pharmacies, and free samples provided to Medical professionals for distribution), personnel costs, AND R&D costs (as well as other costs that can probably be lumped in with those categories). If the overall ROI is, say, 5%, then that represents a 5% return on R&D costs when averaged out over the entire industry. A few years ago, one study showed Pharma with an ROI of over 60%!

Like AO said above, drugs are very much over-priced for many reasons. If it were not for such favorable patent protections (I agree with SOME protection, but a total ban on competition is wrong, imo), the industry would still make money, but the public would pay a lot less for healthcare.

And my point was that if now further drug development ever took place, we would be NO WORSE off than we are today. Of course, new cures are to be hoped for, and new treatments can ease a lot of suffering. I maintain that R&D of new medicines, equipment, and treatments is a highly desirable thing, but I also maintain that we are in no way harmed without it--we would merely be deprived of something that would be a big boon to Mankind.


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