Okay to allow insurance companies to require drug switch.

Today, 3/30/23, the Des Moines Register published an opinion essay by Lynn Rankin. She advocated for a proposed law to restrict insurance companies from requiring patients taking high-cost drugs to try switching to lower-cost drugs that are considered therapeutically equivalent.

 It is very reasonable for both private and government-sponsored healthcare plans to require you to try a lower-cost drug that meets your needs before going to a higher-cost drug.  If you start on a high-cost medication, it seems reasonable to ask you to try a lower-cost drug that has been determined to be therapeutically equivalent.  If you and your doctor don’t want to try a lower-cost drug first, it again is very reasonable to require a prior authorization request that shows evidence why the lower-cost drug should not be tried first. It is also reasonable to charge higher co-pays for higher-cost drugs as an incentive to encourage the use lower cost alternatives.

 It is very easy for doctors to prescribe the newest and most costly drug to treat any illness, especially since patients typically pay out of pocket only very a very small portion of the total cost of the drugs they take.  That is part of the reason why our health insurance costs are so high. If people had to pay the full amount for the drugs they take, they would look for lower cost alternatives on their own.

Non-medical switching of prescriptions may be appropriate.

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.

Link to essay in The Des Moines Register: https://www.desmoinesregister.com/story/opinion/columnists/iowa-view/2022/02/14/end-non-medical-switching-and-protect-iowans-health/6726589001/

Some drug price control by Government/Medicare is probably appropriate.

Jessica Hyland is correct that if our government starts regulating drug prices, then the development of new drugs will slow down. (Below is the link to her essay in the Des Moines Register.) Our current government policies have given us more new drugs at higher prices than we are willing to pay for. So maybe getting new drugs more slowly would be a good trade-off for significantly lower drug prices.

Good health might be the most important thing in our lives, but it is not the only thing. The pandemic proved that many people are willing to risk their health in order to do those other things they consider to be important in their lives.

Today, drugs approved by the FDA are required to be covered by Medicare regardless of the price, and whether or not the drug is any better than cheaper existing drugs!  Government granted patents prohibit competition by generic drug makers for 20 years or more!  There is clearly no free market for prescription drugs.  As a libertarian, I would love to see our government get out of the healthcare business altogether, but we don’t live in that world.  Our government has had its thumb on the scales in favor of drug companies for decades, so it is not unreasonable for it to now start regulating drug prices.

Link to Register essay by Jessica Hyland: https://www.desmoinesregister.com/story/opinion/columnists/iowa-view/2021/05/25/hr-3-prescription-drugs-stifle-health-care-innovation/5240432001/

Trump is wrong on his nationalist, anti-international trade policy

Below is the link to an excellent article by Eric Boehm from Reason magazine’s August/September issue.  It gives specific evidence that shows how international trade makes us safer in a world-wide pandemic rather than the opposite.  There is a knee-jerk reaction when we have shortages to assume that we would be better off if we did not depend on other countries for our various needed products.  This essay shows that the facts indicate otherwise.

link to Reason essay by Eric Boehm:  https://reason.com/2020/07/11/trumps-trade-war-made-the-pandemic-worse-and-nationalism-will-slow-the-recovery/

Science recommends, individuals or politics decide.

The editorial team at The Des Moines Register, (as well as many liberals), seem to think that anyone who does not follow the recommendations of our government’s scientists is a “science denier.”    That’s not true.  People can believe the science but disagree about how to respond politically.  Science can give us a pretty good idea of what will happen when we take certain actions, but science does not tell us what risks are acceptable or what trade-offs we are willing to make to achieve any specific level of safety.  Those are either individual or political decisions.  We could stop COVID-19 completely if everyone was required to stay in their home for the next 30 days.   But even then, some would die in their homes. There is no perfect answer.  It is a proper role of government to use its force to stop or slow the spread of a communicable disease.   But as we can clearly see there are wide differences of opinion regarding what trade-offs we are willing to make and what level of safety should be our goal.  To the extent that those who are not willing to take a risk can protect themselves, others should be free to take risks.

Our ability to pay for prescription drugs is not unlimited!

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.

Link to John Stanford essay in WSJ:

https://www.wsj.com/articles/price-controls-would-throttle-biomedical-innovation-11593625880?mod=searchresults&page=1&pos=1

Don’t add long-term care coverage under Medicare

Contrary to the Register Editorial on 12/1/2019, we should not add long-term care as a new benefit under Medicare.  (See link below to The Register’s Editorial urging Medicare coverage of long-term care.)  If we want to solve problems using the force of government, we should do the minimum needed to solve the problem.  In this case, the problem is making sure that people receive medically necessary long-term care, not making sure that money is left to people’s heirs.

We currently have a pretty good situation: Many people voluntarily purchase private long-term care insurance.  Many others who could afford insurance choose to take a risk and not buy it.  Taxpayer-funded Medicaid covers the cost of long-term care for those who are unable to pay.  For those in the middle – not on Medicaid, but who would struggle to pay for private long-term care insurance – Medicaid already goes a long way to help them qualify for long-term care coverage.   For example, if one spouse of a married couple needs long-term care, the other spouse gets to keep a house and a car and some income, even though Medicaid pays for the long-term care of the first spouse.

The best long-term, sustainable solutions to our problems is to give voluntary, free choice to people and then expect them to be responsible for their decisions.  To the extent that we allow our government to force everyone into one-size-fits-all welfare programs, there will be ongoing, unsustainable frustrations, disagreements, and dependency problems.

Link to Register Editorial:   https://www.desmoinesregister.com/story/opinion/editorials/2019/12/12/medicare-should-cover-long-term-care-services-buttigieg-editorial/2629628001/

We don’t need a new mandatory federal government entitlement program.

Our population is aging and we all want to stay in our own homes as long as possible.  We definitely do have an increasing demand for in-home caregivers.  But I urge our Presidential candidates and our elected federal representatives to not support the mandatory Universal Family Care proposal as described  by Al-jen Poo in her recently published essay.  (See link below to the “Your Turn” essay by Al-jen Poo published in The Des Moines Register on 9/19/2109)

We do not need, and should not create, a new federal government sponsored, taxpayer funded entitlement program!   Such a scheme would make us even more dependent on our government.  Caregiving for family members at home should be left to family, friends and voluntary charitable efforts. This is part of being a family and accepting responsibility for ourselves and our loved ones.  Yes it is a burden, but it is one that we should accept.

LInk to Register “Your Turn” essay:

https://www.desmoinesregister.com/story/opinion/columnists/caucus/2019/09/16/ask-2020-candidates-support-universal-family-care-loved-ones/2345355001/

 

Benefits of civil society should not be called “Rights”.

Thanks to The Des Moines Register for publishing the essay by Peter Funt about the misuse of the term “rights” by Democratic candidates for President.  (See link to Register essay below.)  The term “right”, without qualification, should be reserved for natural or fundamental rights that are also called “negative rights” – rights that place no burder or obligation on others.  The most notable of these negative rights are those included in the Bill of Rights of our Constitution.  They include freedom of the press and of speech (You can print or say anything but I don’t have to read or listen it or pay for it.); and freedom of association (You can associate or not associate with whomever you please, but you can’t force me to associate with you.); among others.

On the other hand, we also have “civil rights” or “government granted rights”.  These are called “positive rights” since they do impose a burden or obligation on others.  These rights are granted by governments through our legislative processes, and may be taken away in the same manner.  They are often granted based on the wealth of a society and its ability to pay the cost.  Common examples of these government created rights include basic education, medical care, and food.  In order for a person to receive these benefits, the force of government is used to make others pay the cost.

I would prefer that these government created positive rights be instead called “benefits” of a civil society.  Positive rights can be granted by government only if and when society has the ability to pay, and society’s ability to pay is not unlimited.  For example, I don’t think any reasonable person believes they have a right to unlimited health care paid for by taxpayers, So if our Democratic candidates for President want to be completely honest, they should talk about the benefits they believe should paid for by a civil society, not simply about rights that should be conferred without regard to cost or limits.

Link to Register essay:  https://www.desmoinesregister.com/story/opinion/columnists/2019/06/06/democratic-presidential-candidates-education-health-care-rights-column/1366865001/

Trump administration and CMS capitulate to Big Pharma on efforts to reduce Medicare Part D drug costs

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.

Link to Register essay by Gloria Mazza: https://www.desmoinesregister.com/story/opinion/columnists/2019/05/16/pro-life-advocates-dont-reduce-medicare-part-d-protection-drugs-congress-chuck-grassley-joni-ernst/3685349002/