Insulin Quest: When Lifesaving Drugs Are Out of Reach, WSJ > Nearly 10% of Americans have diabetes
Rising insulin price makes it difficult to afford drugs Must ration their dosage
> Karyn Wofford gets her insulin by trading with online friends on FB and Twitter Created a GoFundMe page to help pay for meds
The High Cost of Prescription Drugs in the US, Kesselheim et al., JAMA > There are many barriers for entry of generic drugs into the market The cost of prescription drugs in based primarily on whatever the market will bear - Strategies to reduce the price of drugs:
More strict requirements for getting patents Meaningful price negotiation by government payers Get evidence about the cost-effective of therapeutic alternatives
How To Cut US Drug Prices: Experts Weigh In, NYT Coverage From Private Insurers Most Americans get drug coverage from PIs - PIs negotiate drug prices with manufacturers (Hire PBMs to do this) > Research has found that consumers tend to stick to the plans they have even as premiums rise Revenue of insurers that get lower prices doesn't increase > For drugs that don't have generic forms, competition won't help lower prices Direct Deals With Drug Companies -> Medicare could use market power to get lower prices from manufacturers - The VA gets larger discounts because it has a more restrictive formulary If Medicare did negotiate and excluded high-priced drugs Benefits taxpayers Reduce access to drugs for program's beneficiaries How Other Countries Do It > Insurer's consider drugs cost effectiveness before covering it Drug manufacturers lower prices to get covered Manufacturers invest more in cost effective drugs 'Value-Based Insurance Design' - Insurer or program could make drug more accessible by cutting cost-sharing or by reducing administrative hurdles A lower price by manufacturers induces insurers to provide easier access
Increased sale of that drug
> Manufacturers agree to lower price in exchange for more coverage by insurers Ex. Price of Praluent, a cholesterol medication, got lowered because it made it more affordable for insurers and increased their volume of patient sales > Would be illegal in Medicare only for private sector
Why Is Health Care Regulation So Complex? Robert I. Field The Nature of Health Care Regulation > present regulatory structure is not uniform or consistent > regulations enforced by all levels of govt - federal, state, and local > also regulated by a lot of private organizations - uncoordinated operations Origins and Extent of Complexity > basic oversight of physicians, hospitals, and insurance is done at state level Coordinated by federal authorities - private organizations like the AMA oversee medical profession, administer licensure exams, and certify specialists Supplement govt regulators - hospital industry accredits its own members as a supplemental step to state licensure > complexity leads to many hurdles Logic Behind Regulatory Complexity > regulatory system is driven by competing forces that want their interests represented > checks and balances prevents one level of govt from being too powerful > private organizations have technical expertise, wh