The Des Moines Register recently published an essay by retired pharmacist and former state senator, Tom Greene, in which he supported proposed legislation that would prohibit insurance companies from switching patients to lower cost drugs or increasing co-pays if the patient is stable on a currently prescribed medication. (“Protect health and end non-medical switching” 2/14/2022) (Link below.)
So, if the newest highest-cost drug works for a patient, this bill would make it illegal to try to change that patient to a less costly drug. If that’s true, then maybe the law should also require that the lowest-cost drug in the same therapeutic class be tried first.
If people had to pay their own way for prescription drugs, many would try lower-cost drugs even if a higher-cost drug was working effectively for them. It seems fair to allow insurance companies to try to save money. It also seems fair to require higher co-pays if a higher-cost drug is chosen. If the proposed bill is passed into law, it will certainly help to push prescription drug insurance premiums higher and higher.
It has been widely reported that more than 100,000 Americans died of drug overdoses during the 12 months ended April 30, 2021, a record high. A large and increasing portion of overdose deaths is attributable to illicitly obtained drugs, especially fentanyl. Many addicts have no choice but to buy their drugs on the black market, so they can’t be assured of the strength or purity of the drug, or what other drugs might have been added to what they think they are buying. As a result, many overdose deaths are accidental.
Imagine if we treated drug addiction using a medical model rather than a criminal model? If addictive drugs could be purchased legally and were regulated as to strength and purity, many overdose deaths would be avoided. Additionally, people who become addicted might be more likely to ask for help to kick the habit if they weren’t afraid of getting arrested and put in jail. Finally, much of the crime and violence associated with the illegal drug trade would go away if our policy of prohibition were ended.
As I’ve written before, if a new pharmacy opens in your neighborhood, the existing pharmacies don’t start a shooting war to protect their turf. And if someone breaks into or otherwise trys to rob a pharmacy, the pharmacy calls the police. It is the prohibition that causes most of the violence.
Under a legal drug regime, it would still be illegal to drive a vehicle while under the influence of intoxicants, and children would be prohibited from buying drugs. But a person who minds their own business would not be a criminal for using drugs in a peaceful manner.
I agree with John Stanford’s essay in the Wall Street Journal today that controlling drug prices would slow biomedical innovation and and research. (WSJ 7/2/2020 – see link below.) When you spend less money on anything you will get less of it. But that’s okay. Today, we get more drug research and innovation than we want to pay for.
Most drugs approved by the FDA are required by law to be covered and paid for by Medicare and Medicaid regardless of price! Many are required by law to be covered and paid for by private insurance companies regardless of the price! This is true even when the drug provides little or no improvement over other existing approved drugs! Under such a situation we, of course, get maximum research and development.
If we did the same for space exploration, we would probably already have colonies on Mars. If we did the same for climate change, we would probably already have that problem solved. The point is that development of new prescription drugs is not our only priority, and our ability to pay is not unlimited.
We don’t have anything close to free market capitalism in the prescription drug market in the U.S. Government is already very involved, mostly providing subsidies, protection from competition, and other benefits to drug manufacturers. It is not unreasonable to set a drug price ceiling that is 20% higher than what is being paid by Australia, Canada, France, Germany and Japan. We can always make special exceptions for something like a vaccine against the Covid-19 virus.
Thanks to Lee Rood for her expose’ in The Des Moines Register about the financial devastation of an Iowa citizen that was caused by Iowa’s drug tax. As Rood reported, Stephanie Hilgenberg was arrested in 2016 after police found about $5,000 worth of meth in her purse. She was convicted and served time in prison. She is now free and working to support heself and her two kids. But she still owes the Iowa Department of Revenue about $150,000 in tax, penalty and interest! She had failed to pay the “drug stamp tax” required in order to avoid the penalties and interest.
Iowa’s Constitution prohibits excessive fines, but this is technically a tax, not a fine. Again as Rood reported, part of the strategy of the tax was to use as a negotiating lever to get small time dealers to give up their suppliers. In our failed drug wars, the little guy is often sacrificed as a means to what drug warriors consider more important ends.
Drug addiction is a terrible thing. But we will be better served as a society by treating addiction under a medical model rather than a criminal model. Education works better than punishment. One step in the right direction would be to repeal the punitive stamp tax that is added to the injury caused by drug prohibition. State legislatiors should take that up next session.
Recently, Gloria Mazza wrote, (and other Iowa Republicans signed), an essay in The Des Moines Register that urged President Trump and Iowa’s Republican Senators to oppose recent proposals by the Centers for Medicare and Medicaid Serivces (CMS) that would have taken reasonable steps to reign in increasing drug cost under Medicare Part D. It has now been reported that CMS and the Trump administration have backed off of important parts of the proposed changes.
Currently, Medicare Part D regulations require patient access to “all or substantially all” medications within “six protected classes” of drugs regardless of price. (Protected classes include drugs for HIV, mental illness, cancer, epilepsy, and organ transplants.)
Among other things, the proposed new rule would have allowed Medicare Part D plans to exclude a drug from coverage, 1) for an existing drug if the price increased more than the rate of inflation, or 2) for a new drug if it was simply a reformulation of an existing drug. Apparently, lobbying efforts were successful in getting these two provisions removed from the final new rule.
We don’t have a free market for prescription drugs under Medicare Part D. We should not allow drug makers to set their own price and still require coverage. It is unfortunate that the Trump administration caved-in to the lobbying pressure.
As the Des Moines Register reported yesterday, the Mayor of Jamaica, Iowa and her husband were busted two days earlier at about 4:20 p.m. (no joke) for growing 18 marijuana plants inside their home. The various related charges include a Class “D” Felony for the manufacture and possession with intent to deliver less than 50 kilograms of marijuana.
It’s a shame that our laws in Iowa still make it a crime to do something that is peaceful, voluntary, and uses no force or fraud against others. Marijuana prohibition laws do little to make our state safer, and yet do great harm to people who are victimized by them. In this case, if these two people are found guilty of the felony, they could be sentenced for up to 5 years in prison, be required to pay up to $7,500, lose their voting rights, be disqualified for military service or student loans, and more. Compare that to the fact that nothing happens to a person in her home who is found to be brewing 5 gallons of beer – a standard home-brew batch – and possessing, say, 10 to 20 more gallons that were brewed earlier.
Marijuana is no more dangerous than alcohol, and yet today we see the same unintended consequences resulting from drug prohibition that we saw from alcohol prohibition in the 1920s and early 1930s: violence, deaths from impure products, and the arrest and punishment of people who are otherwise honest and peaceful. Make no mistake, the violence associated with the illegal drug trade is caused by prohibition laws. If Walgreens moves into a community, CVS doesn’t send out a gang to kill them. When drugs are delivered to a pharmacy, both parties don’t carry weapons to protect themselves. Instead, they call the police if someone uses violence against them. But you can’t can’t call the police for help if you’re dealing in illegal drugs.
We need to follow the trend in other states and around the world: Legalize recreational marijuana and treat addiction using a medical model, just like alcohol. Let your elected representatives know your feelings. That is the way to get these unjust laws changed.
Thanks to Susan Voss for her thoughtful essay about the complexities of our health care system, and how difficult it is to reduce costs. (See link to Register essay below.) I don’t claim to have “the answer”, but I do suggest that the following cost saving ideas be given serious consideration.
Medicare, Medicaid and private insurance should not be required to cover every new drug, product, or procedure that is approved by the FDA. Some are very high cost but provide only marginal improvement over alternatives that cost much less. Also, at least some covered products and procedures would likely be considered not medically necessary by most people.
Consider shortening the amount of time that government grants a monopoly for patents. Patents are not natural property: humans have copied one another since the beginning of time. Our U.S. Constitution allows patents to be granted to encourage inventiveness, but there is no objective reason why a patent must be granted for 20 years. Why won’t five or ten years work? Maybe the length of the patent should be based on the cost to develop the patented item and whether or not government funds were used to help develop the item.
Don’t require limits on out-of-pocket payments such as co-payments, especially for very high cost items. A person should have “skin-in-the-game” if they expect their insurance to cover very high cost items. Today, we see the opposite: drug companies offer to help pay people’s out-of-pocket costs so there won’t be so much political pressure on them to lower their prices.
Allow both pharmacies and individuals to purchase drugs from sellers in other countries that are “deemed” to have sufficient safety procedures in place. If drug companies are free to charge lower prices in other countries, then pharmacies and individuals should be free to purchase the drugs from those other countries.
Allow Medicare and Medicaid to negotiate with drug companies on prices they pay for the drugs that are covered by the programs. Right along with that, Medicare and Medicaid should be allowed to develop formularies (lists of drugs that are preferred over other therapeutically similar drugs), that give beneficiaries a financial incentive to use the preferred drugs and a penalty for using higher cost drugs.
Our health care wants are unlimited. Our ability to pay is not. We, as citizens, should not expect private insurance or our government health care programs to cover everything, regardless of cost. We should expect our government to NOT do things that increase costs, or reduce our choices.
The Des Moines Register recently reported that 36 Iowa counties have joined in a law suit against opioid makers. (See link to Register article below.) Two law firms are enlisting counties across the country to go after drug manufacturers and others for the costs of the opioid crisis. There is no cost to the counties. If successful, the “Lawyers will be awarded a portion of the settlement, …” (Interesting that the word “settlement” is used instead of “judgment”.)
What is often missing in much of the opioid crisis discussion is how our government’s policy of prohibition has made a bad situation even worse. When a person becomes physically addicted to opioids, they will do almost anything to get the drugs they want. If the drugs are not available legally, or if legal drugs cost too much, addicts will find illegal alternatives. According to the CDC, 60% of opioid deaths do not involve prescription opioids. That is, in 60% of opioid deaths the person who died was using illegal opioids. (See CDC reference below.) A significant problem with illegal drugs is that is no way to assure the quality and potency of the drugs. In the case of opioids, that leads to inadvertent over-doses because the illegal drug was much more powerful than thought.
If opioid addicts were able to readily get prescription methadone or other FDA approved opioids at reasonable costs, many deaths would be prevented. That would also take the profit out of the illegal opioid drug trade. If opioid addicts were treated under a medical model rather than a criminal model, it is likely that more opioid addicts would seek help to solve their addiction problem. But as it is, under our drug war, prohibition policy, addicts have good reason to not seek help.
As The Des Moines Register reported on 10/13/2016, “Black Iowans are seven times more likely to be arrested for drug possession than white Iowans…” (See link below.) Drug possession. A crime without a victim. Arrests that create a criminal record that seriously negatively affects a person’s ability to get a job.
Even if blacks do possess illegal drugs at a rate seven times more than whites, which I very much doubt, treating possession of any drug as a crime is clearly unfair, if not racist. Why don’t people get arrested for “possession” if they are caught with a six pack of beer? Why aren’t people be arrested and charged with “intent to deliver” if they are caught with more than a case of beer? Why aren’t people charged with a more serious crime if they are caught with high alcohol content distilled spirits, which are surely more dangerous?
We need to end the immoral and impractical drug wars. The correct and reasonable thing to do is to legalize and regulate the manufacture, sale and use of all drugs, just like alcohol, tobacco, and prescription drugs. Just like with alcohol, fair regulations would include protecting our children, and prohibiting driving vehicles while intoxicated. In any case, we need to end prohibition.
Link to Register article: http://www.desmoinesregister.com/story/news/crime-and-courts/2016/10/12/iowa-ranks-2nd-worst-racial-disparities-drug-arrests/91958452/
Our government, not free market capitalism, is to blame for this situation which has allowed Mylan Pharmaceutical company to jack-up prices for its EpiPen. The FDA is has created a huge delay in approving generic epipens. This has effectively given Mylan a monopoly. Established drug companies should have some type of fast-track authority to manufacture generic products without having to get advance approval from the FDA. Don’t blame private enterprise for problems created by government.