Friday, April 18, 2014

Money in Drugs

Funny, the war on drugs forgot the biggest pushers and distributors of drugs; The middlemen, whoops, I mean Doctors, are finding that cost matters when it comes to drugs! Wow and that is now becoming something of an issue to those in need of medications for their illnesses.

In my ever increasing conversations with idiots I met a woman who railed about the educated 'elite' that did not inoculate their children. Having myself just been exposed to another idiot who went to a major concert with Measles, exposing ostensibly thousands, I agreed. And irony it is here in the tech sector of educated elite that we also have the most un-inoculated children in the United States. I work in public schools and the children there are inoculated as it is required for admission and for those who can't afford it it is covered. The bitch, whoops, I mean idiot responded with a grimace that the 1% love to do and goes "its free." Hey lady I would more than willing subsidize an injection for a kid to stop me or anyone else from catching a disease. I don't think of it as an "entitlement" I think of it as a "necessity."

Of course when I inquired about her work, she works in Health Management and used to work in Public Health. I didn't ask for specifics I just knew immediately that we had nothing in common. I am all for basic health needs but as one who found first hand that the health care system is the most fraudulent dangerous place to end up, I am not one to have "that discussion" So I said frankly I find most western medicine hostage to big pharma and that sadly most peoples education and information comes from the absurd advertisements on TV that they then self diagnose and go to their Doctor who has recently been given a sample of said drug and a bribe, incentive, payoff (pick one that fits) to prescribe. How convenient.

This article discusses that very issue. And to think that I think of samples of something a Cosmetician or perfume salesperson gives me to encourage buying that which they sell at Macy's. I guess they should upgrade to Doctor's offices and we can run a phalanx of said salesperson's hawking their latest anti depressant, opioid, etc.

She asked me why I felt so hostile and I said as a child of immigrants we reserved the trip to the Doctor for dire emergencies. My father used to say here is duct tape, glue and a branch that should work fine on a broken limb. She asked, "did it work out?" I just laughed and said, "other than the chronic limp, sure. " I was being utterly facetious and she had no idea despite standing right next to me in a ballet class. IDIOT.

The conversation quickly deteriorated from there when I told her that the supposed acclaimed Harborview threw me in the street like a wild animal and I was delusional wearing medical waste after being admitted in a coma, not breathing in less than 72 hours. She said "that did not happen." Yes you moronic bitch I just made that up too. Instead I asked her why she would say that as why would I lie about something that serious? She goes it did not happen, when did it happen? I go two years ago. She looked incredible at me and walked off. No one ever has much to say after that. One day someone will, hopefully in court.

That is the only place you will find answers when it comes to the hubris and arrogance of the medical system. They are right there with the Tech Sector their investigative arm that one day will amputate them in the same way some quack does to a person's limb only this time the ax will be a nerd a thousand miles away on a laptop and not a Doctor with their scalpel. I can't wait!

In the meantime Medicine rises as you can read below and the sudden awakening by Physicians that this shit costs money and in turn affects their work and money as well. I expect nothing to change frankly. Medicine is about money first and foremost.

Prices Soaring for Specialty Drugs, Researchers Find
APRIL 15, 2014

Even as the cost of prescription drugs has plummeted for many Americans, a small slice of the population is being asked to shoulder more and more of the cost of expensive treatments for diseases like cancer and hepatitis C, according to a report to be released on Tuesday by a major drug research firm.
The findings echo the conclusions of two other reports released last week by major pharmacy benefit managers, which predicted that spending on so-called specialty drugs would continue to rise.

The report, by the IMS Institute for Healthcare Informatics, also found that consumers’ use of health care — visits to the doctor, hospital admissions and prescription drug use — rose in 2013 for the first time in three years, mainly because of the improving economy, it said.
“Following several years of decline, 2013 was striking for the increased use by patients of all parts of the U.S. health care system,” Murray Aitken, executive director of the IMS Institute, said in a statement. He noted that the spike came before the Affordable Care Act, which has helped provide health insurance to millions of new customers, fully went into effect.

But even as consumers became more confident about spending money on health care last year, the report found that a divide is developing between those with medical conditions that can be treated with cheap generic drugs, and those with rare and often more serious diseases that can come with breathtaking price tags.

More than half of prescriptions cost patients, on average, less than $5 in out-of-pocket costs in 2013, and 86 percent of them were filled with generic medicines. Nearly a quarter of all prescriptions — 23 percent — required no out-of-pocket cost at all, an increase that the report’s authors attributed mainly to a requirement in the new health care law that contraceptive drugs be covered free.

On the other hand, those who need the costlier drugs paid disproportionately more. Only 2.3 percent of prescriptions accounted for 30 percent of all out-of-pocket costs, the report found.

Drug companies have increasingly turned to treatments for smaller and more complex diseases as sales of dozens of blockbuster drugs have collapsed in recent years in the face of competition by cheaper generic versions.

In 2013, drug companies debuted 36 new drugs, including 10 notable cancer treatments, the most in more than a decade, the report found. Other significant new drugs on the market included treatments for hepatitis C, multiple sclerosis and diabetes. Pharmaceutical companies began selling 17 drugs last year to treat so-called orphan diseases — those that affect fewer than 200,000 people nationwide.

“The new drugs coming to market are more specialized, and more tailored to smaller populations of patients, which tends to make them more expensive because fewer people are ultimately going to take them,” said Caroline F. Pearson, vice president at the health care consulting firm Avalere Health. More health plans, faced with more of these high costs, are shifting some of the burden to patients, she said.

In 2013, Ms. Pearson said, 23 percent of employer-sponsored health plans placed specialty drugs in their own group, or tier, in which consumers are asked to pay a percentage of the drug cost, rather than a set co-payment. In 2006, just 5 percent of employer plans had a specialty tier. The trend is likely to continue: In the new plans offered to individuals through the health insurance marketplaces, Ms. Pearson said, specialty tiers are “ubiquitous.”

The rising cost of specialty drugs contributed to a 3.2 percent increase in total prescription drug spending in 2013, to $329.2 billion, the IMS report found. In 2012, drug spending declined by 1 percent, driven by the arrival of several new generic drugs after the patent for the brand-name products expired. Fewer drugs lost their patent protection in 2013.
Other reports have also highlighted the growing influence of specialty medicines on total drug spending. CVS Caremark, a pharmacy benefit manager, reported last week that, among its clients, spending on specialty drugs increased by 15.6 percent in 2013, compared with spending on traditional medications, which grew by only 0.8 percent.

Express Scripts, another drug benefit manager, found that while growth in spending on specialty drugs was at its lowest point in six years — 14.1 percent — it is forecast to increase significantly. The country’s spending on specialty drugs will increase an additional 63 percent between 2014 and 2016, the company predicted.

Perhaps because of the improving economy, the IMS report also found that more patients were opting to visit the doctor, go to the hospital and fill prescriptions for drugs in 2013. Visits to specialists increased by 4.9 percent, the report said, and patients filled an average of 12 prescriptions a year, an increase of 2 percent over the previous year.

“When people are feeling less secure, they cut back on health care,” said Larry Levitt, senior vice president of the Kaiser Family Foundation, which has studied the correlation between the economy and spending on health care. “When they are feeling more flush, they start to return to the doctor and the pharmacy in larger numbers.”

Cost of Treatment May Influence Doctors

APRIL 17, 2014

Saying they can no longer ignore the rising prices of health care, some of the most influential medical groups in the nation are recommending that doctors weigh the costs, not just the effectiveness of treatments, as they make decisions about patient care.

The shift, little noticed outside the medical establishment but already controversial inside it, suggests that doctors are starting to redefine their roles, from being concerned exclusively about individual patients to exerting influence on how health care dollars are spent.

“We understand that we doctors should be and are stewards of the larger society as well as of the patient in our examination room,” said Dr. Lowell E. Schnipper, the chairman of a task force on value in cancer care at the American Society of Clinical Oncology.

In practical terms, new guidelines being developed by the medical groups could result in doctors choosing one drug over another for cost reasons or even deciding that a particular treatment — at the end of life, for example — is too expensive. In the extreme, some critics have said that making treatment decisions based on cost is a form of rationing.
Avastin costs $50 a dose. Credit Genentech, via Associated Press

Traditionally, guidelines have heavily influenced the practice of medicine, and the latest ones are expected to make doctors more conscious of the economic consequences of their decisions — even though there is no obligation to follow them. Medical society guidelines are also used by insurance companies to help determine reimbursement policies.

The society of oncologists, alarmed by the escalating prices of cancer medicines, is developing a scorecard to evaluate drugs based on their cost and value, as well as their efficacy and side effects. It is expected to be ready by this fall.

And the American College of Cardiology and the American Heart Association recently announced that they would begin to use cost data to rate the value of treatments in their joint clinical practice guidelines and performance standards.

Some doctors see a potential conflict in trying to be both providers of patient care and financial overseers.

“There should be forces in society who should be concerned about the budget, about how many M.R.I.s we do, but they shouldn’t be functioning simultaneously as doctors,” said Dr. Martin A. Samuels, the chairman of the neurology department at Brigham and Women’s Hospital in Boston. He said doctors risked losing the trust of patients if they told patients, “I’m not going to do what I think is best for you because I think it’s bad for the health care budget in Massachusetts.”

Doctors can face some stark trade-offs. Studies have shown, for example, that two drugs are about equally effective in treating an eye disease, macular degeneration. But one costs $50 a dose and the other close to $2,000. Medicare could save hundreds of millions of dollars a year if everyone used the cheaper drug, Avastin, instead of the costlier one, Lucentis.

But the Food and Drug Administration has not approved Avastin for use in the eye, and using it rather than the alternative, Lucentis, might carry an additional, albeit slight, safety risk. Should doctors consider Medicare’s budget in deciding what to use?

Some insurers and state Medicaid programs are now also saying that a highly effective new drug for hepatitis C, Sovaldi, from Gilead Sciences, could lead to an immense increase in spending because so many patients will want to use it, at a cost of $84,000 per course of treatment.

Some of them are hoping that, to save money, only more seriously ill patients will be treated. But Dr. Donald M. Jensen, director of the center for liver diseases at the University of Chicago, said some patients with earlier disease have symptoms like fatigue and would benefit from the drug. “I think ethically we are just worried about the patient in front of us and not trying to save money for the insurance industry per se, or society as a whole,” he said.

Still, some analysts say that there is a role for doctors to play in cost analysis because not many others are doing so.

“In some ways, it represents a failure of wider society to take up the issue,” said Dr. Daniel P. Sulmasy, professor of medicine and ethics at the University of Chicago.

Generally, Medicare is not supposed to consider cost effectiveness in coverage decisions, and other government attempts to do so are susceptible to criticism as rationing. Insurers do perform cost analyses, but they also risk ire from patients and doctors.
Lucentis costs close to $2,000 a dose.

The cancer and oncology societies are not the only ones considering costs. A review last year of clinical guidelines issued by 30 of the largest physician specialty societies found that 17 of them explicitly integrated costs. That appeared to be an increase from 2002, when a different review had found more limited use of economic analysis.

Also, in recent years, as part of a campaign called Choosing Wisely, many medical societies have submitted lists of the top five procedures, tests or products to be questioned because they are considered wasteful.

The cardiology societies say that the idea that doctors should ignore costs is unrealistic because they already have to consider the financial burden placed on the patient, if not society. “Protecting patients from financial ruin is fundamental to the precept of ‘do no harm,’ ” the societies wrote in their paper outlining the new policy.

Still, the groups said that value and resource use had been explicitly excluded from formal consideration in their practice guidelines. And that has been true of some other guidelines as well.

Dr. Schnipper, who is also chief of hematology and oncology at Beth Israel Deaconess Medical Center in Boston, pointed to guidelines that the oncology society issued in 2011 on preventing vomiting caused by chemotherapy. For certain patients, the guidelines recommend the drug palonosetron, sold by Eisai as Aloxi, which is more effective but also much more expensive than similar drugs. While the full guidelines contain a table listing the prices of various drugs, there is no explicit discussion about the cost trade-offs in the recommendations.

Hepatitis C guidelines issued in January by the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America recommend the new drug Sovaldi with no mention of its cost.

Dr. Steven D. Pearson, a visiting scientist in the ethics department at the National Institutes of Health, said the move by some societies to incorporate economic analysis “heralds an important shift in the way doctors in America are talking about cost and value.”

He said that having societies do such evaluations was better than having a doctor make such trade-offs while treating an individual patient, which is sometimes called bedside rationing.

Still, it is unclear if medical societies are the best ones to make cost assessments. Doctors can have financial conflicts of interest and lack economic expertise.

The cardiology societies, for instance, plan for now to rely on published literature, not commission their own cost-effectiveness studies, said Dr. Paul A. Heidenreich, a professor at Stanford and co-chairman of the committee that wrote the new policy.

They plan to rate the value of treatments based on the cost per quality-adjusted life-year, or QALY — a method used in Britain and by many health economists.

The societies say that treatments costing less than about $50,000 a QALY would be rated as high value, while those costing more than $150,000 a QALY would be low value.

“We couldn’t go on just ignoring costs,” Dr. Heidenreich said.

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