Pharmacy and cost of healthcare rant

by Caleb Reading

Via reuters:

WASHINGTON (Reuters) – Brand-name drug makers are striking more deals with generic rivals to restrict the introduction of cheaper generic drugs, antitrust authorities said on Monday.
The FTC has monitored drug patent settlements closely since 2004, when Congress passed a law requiring drug companies to notify the FTC about them in advance.

In the report issued on Monday, the FTC found that in fiscal 2005, three of 16 drug patent settlements included payments to the generic drug and restrictions on when it would become available, according to the FTC report.

It was the first time since 1999 that drug companies entered in such agreements, the FTC said.

During the past six months, Leibowitz said, at least seven of the 10 settlements reported to the agency included those kinds of provisions.

He cited recent settlements involving Plavix, a drug-thinner blood manufactured by Bristol-Myers Squibb and Sanofi-Aventis, and Provigil, a sleep disorder drug made by Cephalon Inc.

This goes back further than 1999. Now the first generic company that gets the ANDA through usually has a large enough market cap that they can’t easily be bought out, but if the company with the first ANDA is small enough, they can count on being bought out and downsized by the brand name company. What the brand-name makers are also doing is contracting with the ANDA-holders to sell the brand name drug in a generic bottle (meaning pills from the same machine are being sold by both the brand and generic company, usually with some small difference that does not effect bioavailability, like a different number stamped on it or a different dye in the coating).

If you buy Allegra (fexofenadine) or Celexa (citalopram), for example, you’re often getting pills off the same machine whether you buy brand or generic, but the generic is very significantly cheaper because of the label on the bottle. I say “often” because I’m not sure if there is more than one company with an ANDA on those drugs. The first company to get an ANDA is the one with the contract, and that’s the only one we stocked where I used to work.

And don’t even get me started on companies that patent the active isomer of an existing drug that’s about to go generic, then ad blitz the hell out of the “new” drug to get patients to demand it. Nexium got ad-blitzed when Prilosec went generic. Lexapro got ad-blitzed when Celexa went generic. And so on.

And I can try to tell this to our patients, but the infuriating thing is, they still demand that Medicaid (welfare) or whoever else pay for that thing they saw on TV, because by god that’s the only thing that works.

If we ever decide to do socialized medicine, I would be all for high-deductible universal coverage along with a yearly stipend that would be placed in a temporary Health Savings Account in the person’s name. If they don’t use all the money at the end of the year, they could maybe get a percentage of it as a tax rebate for that year. Then we’d have people with coverage, but also with an incentive to pay attention to where the money is going and the value of that dollar. Yes, people that are sick wouldn’t get a rebate, but they’d have out-of-pocket costs covered, and that’s just as good, so no logical reason to belly-ache about it not being fair.

Putting the money in their own control, instead of making it part of the Commons, is key. Is Lexapro really worth an extra $80 or $100 cash price per month compared to generic Celexa? For most people, of course not. And yet we still have people on welfare, Medicare, and low-deductible health plans demanding the Lexapro anyway, cause, hey, they’re not paying for it. And, yes, once in awhile someone might have better luck with a different formulation and have good reason to take it instead, but that’s rare. Some of these people don’t believe that it could possibly be the same thing (they trust the drug ads but not their own drugstore? Why would we lie? We get the same teeny profit margin — or no profit at all — either way.) And some of them are just trying to squeeze the most money out of someone else that they can, because then they “win”. And some of the fault also falls on doctors who write for whatever they have samples for. Hey, if a drug rep is visiting you special and giving you free samples, guess what? It’s probably overpriced. It might be new and different, but usually these days it’s not. Usually it’s a rebrand, because there’s big profit with minimal R&D in rebranding. Grain of salt, doctor, please. And we wonder why health plans are inflating in price much faster than inflation.

And I apologize for all these rants, but it just really ticks me off. You know how much I have to pay just for a plan with a $2500 deductible? Almost $300 a month. And I’m not even sick. And I’ve never made more than $20K a year. Catastrophe coverage accounts for more than a quarter of my living expenses when I don’t use it (and that’s best-case-scenario). Every time somebody spends “somebody else’s” healthcare dollar frivilously, affordable coverage just gets further and further out of reach for people like me, who don’t make much but don’t take welfare either.