Pharmaguy's Insights Into Drug Industry News
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Pharmaguy's Insights Into Drug Industry News
Pharmaguy curates and provides insights into selected drug industry news and issues.
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Novartis CEO Worries About the Market for New Drugs in U.S. After Obamacare is Repealed

Novartis CEO Worries About the Market for New Drugs in U.S. After Obamacare is Repealed | Pharmaguy's Insights Into Drug Industry News |

Donald Trump's policies could be good for the economy but Obamacare should be replaced if it's repealed, the CEO of drug giant Novartis told CNBC on Tuesday.


Joseph Jimenez played down some of the negative comments that President-elect has made towards large pharma firms. Trump accused the drug industry earlier this month of "getting away with murder" (read “Trump's Comments Are Big Pharma's Nightmare”;


But Jimenez said that some of Trump's policies could benefit industry.


"Some of the policies that could reignite the economy in the U.S. would be good for this industry and it would be good for jobs."


Jimenez urged the Trump administration to consider a replacement for Obamacare.


"What's important to us is that all Americans get access to important medicines. The discoveries that are happening right now are amazing. We want to make sure that if the ACA is repealed that it is replaced with something that will ensure that these Americans still have access to the innovative medicines that we are able to launch," Jimenez said.

Pharma Guy's insight:

Trump responds: "Jimenez? Sounds like one of those Mexicans to me!"

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Why Prescription Drugs Aren't Part of Obamacare: PhRMA Duh!

After six years, the Affordable Care Act has extended health care coverage to millions of people. But affordability problems remain, most prominently in the area of prescription drugs. Obamacare left the pharmaceutical industry largely unregulated while requiring it to pay for some of the law’s increased drug coverage.

“That is probably my single greatest regret, is we didn’t have the chance to get negotiating power for Medicare for drugs. That would have made a profound difference,” said former Sen. Kent Conrad (D-N.D.), a member of the Finance Committee when the health care law was being negotiated and passed throughout 2009 and into 2010.

Another former lawmaker, Rep. Henry Waxman (D-Calif.), who was the House Energy and Commerce Committee Chairman at the time, said there is a simple explanation for why the law doesn’t do more to rein in drugmakers. “The Obama administration decided to make a deal with the PhRMA to get them to support the legislation,” he told Morning Consult. “PhRMA got a number of favorable provisions in the legislation.”

Pharma Guy's insight:

Read: "Trump Woos N.H. by Calling for Medicare to Negotiate Drug Prices!"; Democratic candidates Hillary Clinton and Bernie Sanders, as well as President Obama, have called for the same policy of letting Medicare negotiate prices, which it is currently banned from doing under the 2003 Medicare prescription drug law. The Democratic candidates have both bashed the drug companies on the stump. 

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More Kids with Health Insurance + High Drug Prices = No Net Gain?

More Kids with Health Insurance + High Drug Prices = No Net Gain? | Pharmaguy's Insights Into Drug Industry News |

As reported by STAT Morning Rounds:

"The number of people without health insurance in the US has continued to tumble: In the first nine months of 2015, just 9.1 percent of people didn’t have coverage. That means there are 16 million fewer uninsured people than in 2013, according to new data from the CDC. One group that’s seeing a big boost: children. The share of kids without insurance has dropped to just 4.5 percent, from 14 percent in 1997."

Aside from these children (and adults), who has benefited from Obamacare? (Read my "insight" below for the answer, as if you didn't already know this).

Pharma Guy's insight:

Insurance companies and the pharmaceutical industry have benefited from Obamacare because millions more people have bought health insurance and can afford their medicines. Counteracting that, however, is the collusion between these two industries to raise drug prices and jack up the deductibles insured patients must pay!

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How Oncologists Are Helping Big Pharma Keep Drug Prices High

How Oncologists Are Helping Big Pharma Keep Drug Prices High | Pharmaguy's Insights Into Drug Industry News |

If you want to know why it’s so hard to fight the pharmaceutical industry and reduce spending on prescription drugs, pay close attention to a new Obama administration initiative and the reaction it’s getting on Capitol Hill — even from would-be allies in the Democratic Party.

The initiative seeks to change how Medicare pays for cancer therapies and other medications that physicians administer directly to patients in their offices or other outpatient settings. Under the current arrangement, Medicare basically reimburses doctors for the price of these drugs and then adds on an extra fee.

But that markup is based on what pharmaceutical companies say they charge for the drugs. Research has shown this arrangement gives doctors incentives to prescribe more expensive medications, even when less expensive ones would do the job — thereby driving up bills for patients, who face bigger out-of-pocket costs, and eventually the public at large, which ends up owing more taxes to pay for the Medicare program.

It’s one reason that spending on these drugs is now around $20 billion a year, according to official government statistics.

The Medicare Payment Advisory Commission, a nonpartisan group of experts who advise Congress, has warned about these problems and urged the government to change the formula. In March, the Obama administration did just that. Specifically, it proposed a regulation that would reduce the markup on those drugs and convert part of it to a flat fee, thereby reducing incentives for doctors to order more expensive therapies.

The administration initiative would also experiment with other ways of paying for these medications.

“We need to take the financial incentives out of decisions to prescribe Part B drugs,” Ezekiel Emanuel, a physician and former Obama White House adviser, told The Huffington Post. “Decisions should be made on a therapeutic basis and not how much doctors are being reimbursed for the drugs.”

Not everybody agrees, however. The administration’s proposal has provoked intense opposition from the pharmaceutical industry and other physician groups, such as oncologists, for whom the existing system is extremely lucrative. They insist the proposed changes could disrupt the medication supply for cancer patients and other people in need of life-saving medication — arguments that some patient organizations have also made.

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Trump's Plan to Make Healthcare Great Again

Trump's Plan to Make Healthcare Great Again | Pharmaguy's Insights Into Drug Industry News |

Congress must act. Our elected representatives in the House and Senate must:

  • Completely repeal Obamacare. Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.
  • Modify existing law that inhibits the sale of health insurance across state lines. As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state. By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.
  • Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. Businesses are allowed to take these deductions so why wouldn’t Congress allow individuals the same exemptions? As we allow the free market to provide insurance coverage opportunities to companies and individuals, we must also make sure that no one slips through the cracks simply because they cannot afford insurance. We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.
  • Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate. These accounts would become part of the estate of the individual and could be passed on to heirs without fear of any death penalty. These plans should be particularly attractive to young people who are healthy and can afford high-deductible insurance plans. These funds can be used by any member of a family without penalty. The flexibility and security provided by HSAs will be of great benefit to all who participate.
  • Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.
  • Block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is required in the current Medicaid structure. The state governments know their people best and can manage the administration of Medicaid far better without federal overhead. States will have the incentives to seek out and eliminate fraud, waste and abuse to preserve our precious resources.
  • Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. Congress will need the courage to step away from the special interests and do what is right for America. Though the pharmaceutical industry is in the private sector, drug companies provide a public service. Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers.
Pharma Guy's insight:

Absent from the plan is allowing Medicare to negotiate drug prices, which he backed earlier in New Hampshire: "We don't do it. Why? Because of the drug companies," he said.  

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Docs Complain to CMS About ‘Sunshine’ Data Disclosures

Docs Complain to CMS About ‘Sunshine’ Data Disclosures | Pharmaguy's Insights Into Drug Industry News |
A group of medical societies and pharmaceutical industry trade groups is pushing the government to flesh out data that will be published next month showing how much drug makers pay doctors.

They sent a letter today to the Centers for Medicare and Medicaid Services to ask the agency to explain what context will be provided to help the public understand the justification for payments, such as speaking fees and grants used to bankroll clinical research.

The letter is signed by more than 20 medical societies and organizations including the American Urological Association, as well as heavyweight industry trade groups Biotechnology Industry Organization and the Pharmaceutical Research & Manufacturers of America.

The missive was sent as CMS plans to post the payment data in an online, searchable database as required in the Sunshine Act provision of the Affordable Care Act. The provision was passed in response to concerns that medical practice may be unduly influenced by industry.

The law requires most drug and device makers to report to CMS detailed information about payments and gifts provided to U.S. doctors and teaching hospitals. The disclosures are being made in stages, but September marks the debut when payments will appear publicly.

Supporters of the Sunshine Act say the transparency will provide useful information to patients about the relationships their doctors may have with drug or device makers, and serve as a deterrent to the more extreme examples of industry money unduly influencing medical care.

But some doctors and companies fear payment data will be misinterpreted by the public, or painted with a broad brush. They say there are legitimate interactions that serve to advance medicine, and that doctors should be compensated for services such as consulting for a company about the development of a new product.

Some medical societies teamed up with industry groups to form Partners for Healthy Dialogues, to defend such interactions between industry and doctors, and some of its members signed the letter sent to CMS.

The medical societies and industry trade group lament what they write in the letter is a dearth of context that accompanied CMS’s milestone release of Medicare Part B payments to physicians earlier this year.

Some medical groups say the data did not include context to show which doctors may be abusing the system and which were receiving big payments because of high overhead costs.

Pharma Guy's insight:

A survey revealed that of the more than 1,000 physicians questioned, over half admitted they didn't know that the law requires pharmaceutical and medical device companies to report on expenditures annually, without physician review of the data to correct any inconsistencies or errors, prior to submission to the government. 63% were deeply concerned that a record of these payments will be available in a publicly searchable database.

Listen to this podcast: Physicians Unprepared for Sunshine Law

Questions/Topics Discussed

  • Background regarding the sunshine law, including important dates for implementation.
  • Survey methodology
  • A summary of survey results and what they tell us -- pharma companies might be surprised!
  • How can physicians review the data before it goes public to correct inaccuracies.
  • What is at stake for pharma companies if they do not work more closely with physicians regarding access to the data?
  • What the industry must do to educate their physician clients about the Sunshine Law
  • Will this new form of "Big Data" eventually lead to a significant decrease in payments of all kinds to physicians by the drug industry?

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