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General discussion

What a surprise (NOT!) -- many insured quitting expensive drugs

Dec 3, 2003 9:33PM PST

Hi, All.

Most folks use the increasing %age of uninsured to demark the affordability crisis of health care in this country -- a crisis that is doubtless killing tens of thousands annually. But, surprise -- even many of the insured are going off life-saving prescription meds as insurance covers an ever smaller part of the cost, while drug company and insurance company profits soar. But hey -- we have a "free market," and that's all that matters, right?
For the gory details, see Study says many quit pills in 3-tier prescription plan.
The copays on our Rx drugs this year will be well over $2,000 -- when we started working in 1980, there were no copays. Is it any wonder the WHO ranked the U.S. health-care system 71st in the world in their last survey (and we've doubtless dropped a few slots since...)
-- Dave K.
Speakeasy Moderator
click here to email semods4@yahoo.com

The opinions expressed above are my own,
and do not necessarily reflect those of CNET!

Discussion is locked

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What free market?
Dec 3, 2003 11:24PM PST

The government decides what can be sold, and what can't be sold. The government is also restricting the supply of drugs so that prices stay high. The result is that american consumers are paying for the drugs that the rest of the world is using. Gov. Blagojevich in Illinois is lobbying the FDA to let Illinois buy drugs in Canada, and the FDA is refusing! Further, the drug companies are trying to limit supplies to Canada to keep prices high in the US.

Let's get a truly free market, and maybe people will be able to afford the prices. Of course, the rest of the world will lose their free ride.

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Re:What free market?
Dec 4, 2003 2:44AM PST

Hi, KP.

I agree with you that the market isn't free, but it's not the government restricting the supply of drugs. It's the patent laws (which mean that the newest, usually most effective drugs are typically the monopoly of one producer for 7-10 years after the testing is complete). Furthermore, a free market requires elasticity of demand, so that if the price is too high, they stop buying. But when there's only one supplier for the drug you need and the option is increased morbidity or mortality, most people will pay just about any price short of bankruptcy to obtain the needed treatment. The problem with these high-priced drugs (as I said initially) is that many people don't really understand their importance. Almost every other country in the world regulates the price of prescription drugs -- that seems appropriate when they're life-saving products in a sellers' market.
-- Dave K.
Speakeasy Moderator
click here to email semods4@yahoo.com

The opinions expressed above are my own,
and do not necessarily reflect those of CNET!

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I know this shocks you, but it is the government.
Dec 4, 2003 3:38AM PST

Remember I said that the Governor of Illinois wants to buy drugs in Canada? It is the FDA which will not allow the drugs to be imported. It is the FDA which is enabling the drug companies to keep prices artificially high in the US. There have been a number of stories about people using the internet to obtain their drugs from other countries, and efforts by both the FDA and drug companies to shut off this supply.

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Re:I know this shocks you, but it is the government.
Dec 4, 2003 12:40PM PST

Hi, KP.

Well, ok -- but guess which party appointed the FDA Commissioner? And which (same) party had received millions in contributions from the big pharma industry. Surely you don't think those facts are unrelated?
-- Dave K.
Speakeasy Moderator
click here to email semods4@yahoo.com

The opinions expressed above are my own,
and do not necessarily reflect those of CNET!

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One more point
Dec 4, 2003 3:55AM PST

You noted, 'Almost every other country in the world regulates the price of prescription drugs', and I agree. The result is that the US consumer is paying the drug costs for the rest of the world because the FDA is preventing the reimportation of the drugs. If the FDA wasn't doing this, the drug companies would have a quandary. Should they withdraw from other countries and lose that revenue, or lower prices here and lose that revenue. I think other countries would have no choice; they would have to accept higher prices, and prices in the US would decline.

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I'm puzzled
Dec 4, 2003 9:44AM PST

Like Rosalie in the privacy discussion, I've been receiving international emails for my prescription drug - which has no generic alternative. (How do they know it is prescribed for me, as a cash payer the records of dispensation lie only with the chemist shop chain that filled the prescription?)

If what you say is correct, how come accredited USA pharmacies, or chemists, as we call them, drugstores as I understand you call them, can offer to post me my prescription from the USA, including airfares, for less than I pay in Australia?

Ian

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You have my sympathy.
Dec 4, 2003 11:30AM PST

Ian,

If you are skeptical, go to Google, and use these search terms 'illinois governor canada prescription drugs'. I got 21,000 hits with 'Illinois Governor Wants Canadian Drugs' at www.caregivers-usa.org/news/medicare_ill_gov.html being the top result. You will see that the governor is a Democrat, and that he blames our FDA for restricting imports of drugs from Canada.

If you are receiving drugs from the US which are cheaper than Australian drugs, you have my sympathy. As you can tell from all the posts, prices in the US are very high. Try looking for a Canadian source. You may save quite a bit of money. If you are getting drugs from the US which are cheaper than ours, then I would REALLY like to know how that is being done!

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You have my sympathy.
Dec 4, 2003 12:40PM PST

A lot of those "cheap Canadian drugs" were bought from American companies.

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I know
Dec 4, 2003 10:45PM PST

NT

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Yes but...
Dec 5, 2003 1:06AM PST

they are cheap because their cost is subsidised by the Canadian Government.

Were I Canadian I would be "up in Arms" about Canadian firms shipping cheap drugs back into the US because as a Canadian it would be my TAXES that were subsidising the American purchase.

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Are you sure about that?
Dec 6, 2003 1:24AM PST

My (perhaps inaccurate) impression is that the drugs are cheaper in Canada because the government regulates the prices. The regulated prices are still high enough for the companies to generate some profit so they still sell to Canada even though the prices are lower than they would be without the regulation. We actually see similar sorts of things in the US when state health departments buy large quantities of medications (eg: contraceptives) via a bidding process. The prices are substantially lower than the 'market' price but still high enough to interest the companies.

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Re:Are you sure about that? (Part 2)
Dec 6, 2003 1:25AM PST

The usual complaint is not that Canada or other countries are offering subsidies to keep their prices low, but rather that we are (in effect) subsidizing the lower drug costs of other developing nations because our unregulated markets offer high enough profits to justify the development of medications.

IOW the companies can recover their production costs and make a profit even at the prices forced on them by the regulated markets, but they end up having to recover a lot of their R&D costs (and enough profit to justify the risk entailed in the R&D investment) by selling at the higher prices allowed in the US market.

This weird economic system has actually caused some US free market people to develop a great deal of heartburn about the 'gray market' importation of drugs from Canada. There is no rational basis for challenging the quality of the medications purchased from legitimate Canadian pharmacies. The real fight is over whether the re-importation of drugs will disrupt the pharmaceutical economics to the point that the companies can no longer support the expensive R&D and the high profits they maintain.

Unfortunately it is probably not possible to devise a regulatory scheme that cuts profit without jeopardizing the R&D expenditures. In our system we don't generally expect researchers to run a risk with their capital unless there is a likelihood of a substantial reward.

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Yes but...
Dec 6, 2003 10:39AM PST

it would have been more accurate to have said that they both subsidize medications through the health system and regulate the prices.

The Patented Medicines Prices Review Board over-watches prices and as a result most of the newest medicines never make it into the system.

This is fairly enlightening http://www.pacificresearch.org/press/opd/2003/opd_03-09-21sp.html

And this offers more insight into the PMPRB http://www.pmprb-cepmb.gc.ca/CMFiles/roadmape14MUE-482003-6393.pdf

Other than the Canadian Health System's direct drug subsidies to the Canadian "end user" the government subsidization falls under their Patent Act which allowed Canadian pharmaceutical companies to manufacture and sell a generic version of new drug by paying a 4% royalty to the original manufacturer. This doesn't set well with our own patent laws of course.
http://www.nursesunions.ca/ps/pharmaceut.shtml

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Maybe I missed something here ...
Dec 6, 2003 11:58AM PST

I did not see anything in the articles you linked to that mentioned a direct subsidy.

As I indicated elsewhere the only subsidy that I am aware of is the indirect subsidy by US consumers who are (in effect) paying a subsidy to those in other countries in which the drug prices are regulated. That subsidy is probably not huge but I don't doubt that it is real.

The lack of availability of expensive medications in Canada is another matter entirely. That is a direct result of the regulatory process they employ. To be fair, though, the delay in access to new medications is not uniform. Some medications are available to Canadians before they are available to US residents.

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How sure are you that they are "accredited"...
Dec 4, 2003 11:30AM PST

or even that they are in the USA Ian?

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Gee, that sounds like what the American drug companies...
Dec 4, 2003 12:41PM PST

said about Canadian online pharmacies that wanted to ship into the U.S.

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Certainly is because they are not bound...
Dec 5, 2003 1:08AM PST

by the FDA regulations as are domestic firms.

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Re: Certainly is because they are not bound...
Dec 5, 2003 12:22PM PST

Hi, Ed.

Canada's equivalent of the FDA is every bit as competent and well-respected as our own. And, btw, there are some food supplements not allowed for sale in Canada that are here. Ephedra, until it was recently banned; melatonin is another.
-- Dave K.
Speakeasy Moderator
click here to email semods4@yahoo.com

The opinions expressed above are my own,
and do not necessarily reflect those of CNET!

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That is neither here nor there Dave...
Dec 6, 2003 10:44AM PST

The FDA has NO CONTROL and many drugs are coming into this country that ate coming through Canada and are counterfeit.

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That may not be the whole story ...
Dec 6, 2003 11:24AM PST

The link you provided was interesting, but I think it is worth noting that: (1) The example they gave of the Viagra pills illustrates a problem, but the paper did not claim that those pills had been imported from Canada; and (2) I have not seen any suggestion that the very real worldwide drug counterfeit problems are any worse in Canada than in the US. There have been any number of reports of counterfeit drugs being sold (or at least attempts to sell them) in the US that did not involve Canadian pharmacies.

Think about it for a minute. If you were a drug counterfeiter, which market would you prefer to sell to, the high priced US market or the lower cost Canadian market?

Judging from what I've read the suggestions that Canadian drug safety is questionable simply do not stand up as long as we are talking about legitimate Canadian pharmacies. The only question would be verifying that the pharmacy is in fact legitimate, and not a front using a Canadian mailing address. Scam artists clearly do operate in all countries worldwide.

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If you were a drug counterfeiter, Bill...
Dec 6, 2003 4:54PM PST

Bill, If I were a drug counterfeiter, I'd sell thru the market that had a lesser chance of getting me caught. After all, when I'm caught, all the profit stops.
Along this line of thought, I think that the sales of drugs thru the internet thru Canada would have a special attraction. First, that particular market side-step is established and well-known. More importantly, somebody who you "rip off" is less likely to complain to the authorities, as it would call to the attention of those same authorities that the complainer was using that "side-step". Put simply with an example, a person who got "riped off" buying phony marijuana usually does not complain to the police about it.

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True but it is most of the story ...
Dec 7, 2003 2:06AM PST
http://www.canada.com/vancouver/news/story.asp?id=6532058E-88DE-468F-9AAD-E8582012922A

http://www.safemedicines.org/resources/000024.html

http://www.gsk.com/media/ca_key.htm (GlaxoSmithKline)

http://www.ipi.org/ipi%5CIPIPublications.nsf/0/85D2F0CC7D75549D86256D5600786CB6/$File/opposingreimportation.pdf?OpenElement

As the second link shows, the counterfeit pills are coming in both directly and through Canadian online pharmacies. Apparently the counterfeiters are trying to hit both bases to maximize sales and profits.

If you buy "off the street corner vendor" here you can (or should) assume the liklihood of purchasing a counterfeit drug is high but if you purchase from the regulated pharmicist at the drug store whose purchases are constrained to specific sources the liklihood is low. Not so with an online Canadian drugstore purchase as some are just fronts located outside Canada.

Last year, a large number of Web sites offered drugs from Canada directly to US citizens. Many of these sites dispense expired, subpotent, contaminated, or counterfeit products, often in incorrect doses or with contraindicated products, Hubbard noted. FDA is responding with an increase in criminal-enforcement actions. The agency is actively reviewing 90 Web sites, and its Office of Criminal Investigations has initiated 296 Internet drug probes; there have been arrests, convictions, and multimillion-dollar fines.

http://www.gothicgranola.org/buy_viagra_05-15-2003.html
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I'm not sure those sources are quite what they claim to be ...
Dec 7, 2003 4:28AM PST

The information presented doesn't pass the "smell test". Glaxo obviously has an agenda, safemedicines.org appears (based on their material) to be a front for the pharmaceutical industry, and ipi.org I didn't investigate but my impression from reading their material is that they also have an agenda. The Vancouver news story is interesting but it hardly demonstrates a systematic problem. There have been problems with nominally legitimate pharmacies in the US as well.

I think it would be helpful to have information on the subject presented without spin. To be fair and complete the information would have to compare and contrast the problems with counterfeits in the US, Canada and the rest of the world. So far I haven't seen anything that looks even remotely unbiased presented by either side.

I'm always skeptical of buying from Internet vendors unless I know somebody with prior experience using that vendor or the vendor has a 'brick and mortar' track record. Personally I would not order from an online pharmacy sight unseen regardless of where it claimed to be (US, Canada or Middle Earth). Despite that my impression is that buying from real Canadian pharmacies is not a high risk activity.

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That is why I posted multiple links...
Dec 9, 2003 9:30AM PST
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Re: neither here nor there -- BTW, I wouldn't buy from mexico on a bet (NT)
Dec 7, 2003 12:22PM PST

.

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Scenario
Dec 4, 2003 12:57AM PST

I get $850 per month from Social Security. Medicare doesn't pay for prescriptions.

If I go to the hospital or have tests run per instructions by my physician, I have a deductible for Medicare of about $850 (one month's income). Hill-Burton Act document gets filled out that is supposed to pay for whatever Medicare hasn't paid based on my income. However, in the catch-22 that is set up, I cannot 'collect' from two government agencies (Medicare and Hill-Burton) so I get denied and owe the hospital, in addition to the various doctors, labs, etc.

All of these payments due do not get written off based on my income, but rather get turned over to collection agencies (and in some cases get taken to the local courthouse with no notification and a judgment is issued). Collection agencies call left and right wanting to set up arrangements that weren't good enough for the hospital and a judgment on my credit record accumulating interest.

Doctors prescribe medications that run close to $250 per month that I have no coverage for. I can't afford to pay $250 for meds that will supposedly keep me alive in addition to house/car insurance, utility bills, phone, food, gas for vehicle (vehicle is a necessity in this area). I fought with my former physicians for seven years to get the paperwork for the indigent programs for my meds and finally changed doctors in order to get it taken care of.

There are issues I have with the drug companies in that they have twenty year patents on the medications they have developed. However, just before the patent is to run out on many of them, and allow generic forms which are cheaper to enter the market, they pull the meds from the market, rework the formula ever so slightly, and get a new name and patent for the same medication at the higher price for another twenty years.

TONI

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Re:Scenariom Thanks Toni, you hit the nail on the head (NT)
Dec 4, 2003 2:18AM PST

.

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Did you miss THE POINT of the article?
Dec 4, 2003 8:53AM PST

The POINT was that if co-pays went up for BRAND NAME medications people simply quit taking the medications RATHER THAN getting the cheaper but equally effective GENERIC version of the drug.

More employers have been adopting three-level pricing plans, which are designed to encourage employees to use generics or other less expensive drugs. Those who want to use pricier drugs have to pay the highest out-of-pocket expenses.
...
Under the plans, employees pay the lowest copayment for generic drugs, a higher amount for brand-name drugs on a preferred list, and the highest amount for other brand-name medicines.


This POINT OF THE ARTICLE makes your comments rather mysterious unless you are thinking that cheaper generics should simply be taken off the market and only high priced branded drugs should be available.

Has ABSOLUTELY NOTHING to do with our having a free market.

Do YOU (yourself and your wife) personally take advantage of the lower co-pay on the GENERIC drugs or do you INSIST on the more expensive BRANDED MEDICINES?

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Re:Did you miss THE POINT of the article?
Dec 4, 2003 10:11AM PST

Aw C'mon Ed,

Leave Dave K alone. He was only refreshing everyone's
memory as to his way of thinking, and that is that the US
is moving further away from pure socialism than he would
like to see. Sad

Right, Dave ?

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An important question to me, and maybe I overlooked the answer-
Dec 6, 2003 8:10AM PST

is does the patient have any recourse if the doctor truly believes that one is better than another. Or if their condition worsens if they do change to a lower cost generic.

You know, generics are suppose to be the same, but there have been purity and strength tests in the past (of OTC at least, sorry I don't recall where for a link) that showed widely varing adherance percentage wise to the labelling strength. I have no idea if there has been such a study on the prescription drug market or not. And some drug plans don't just push generics, they push a slightly different alternative drug that is cheaper.

Sometimes the same medical condition in three different people will respond best to 3 different treatments. I think everyone will recognize that is true?

roger