The Times Herald (Norristown, PA)
House committee discusses rising costs of prescription drugs
HAVERFORD >> Brian Hegarty has lived with Type 1 diabetes for 36 ½ years. Hegarty, 49, of Ambler, a freelance writer and editor, spoke about problems with the current pharmaceutical system at a state House Democratic Policy Committee hearing held on Sept. 11 at the Haverford Township Building.
Insulin was first developed by a team of scientists in Toronto some 97 years ago, who then sold the patent to the U.S. for $1, with one of the scientists saying, “Insulin is not for us, it’s for the world.” The pharmaceutical industry developed synthetic versions which now command much heftier amounts and came onto the market in the 1990s, Hegarty said.
Without insulin he and other Type 1 diabetics would be “condemned to death,” he said.
“Without insulin I will die,” said Hegarty. “There are no other options available.” And indeed, recent articles have documented that several people who rationed their insulin, subsequently went into diabetic comas and died.
The first insulin was derived from animal products and was susceptible to temperature changes. However, with synthetic insulin Hegarty is able to use an insulin pump to regulate his blood sugar.
Three companies sell 95 percent of the insulin worldwide. The price has gone up more than 300 percent in the last 10 years, he said.
“When one company has made a change, it’s been matched by the other two,” said Hegarty . When he was unemployed 11 years ago, Hegarty paid $86 for a vial of insulin. Now it costs $351, he said.
While he does not begrudge pharmaceutical companies from making a profit, he does not understand why the price increase has been so steep.
“Because of these rapidly increasing prices there have been a lot of deaths due to insulin rationing,” he said. And people who do survive rationing are then prone to eye problems, kidney failure and heart disease, which are all expensive to treat.
Philadelphia resident Alison Hardt said her partner, Matthew, was diagnosed with Type 1 diabetes when he was 7 years old. Because of catching the flu a couple years ago, he used up his allotted supply of insulin and went to a local drug store two days before his prescription could be renewed. When a diabetic is sick they need more insulin to regulate their blood sugar, she said. The pharmacist refused to refill his prescription. It would cost $1,500 out-of-pocket, while with his insurance he pays $82 a month. When he asked for samples to bridge the 48hour gap, the pharmacist told him to call his doctor or go to a local clinic. His doctor’s office told him to ask the drug store, she said. And the local clinic might not have the specific kind of the drug he needed.
In desperation, Matthew ended up going on Craig’s List to find his medicine and paid $20 to someone whose uncle no longer needed it. The exchange was made in a Wawa parking lot.
“He took this risk because not all insulins are the same,” she said. “He needed the insulin his doctor prescribed. Not all insulins are interchangeable. It is dangerous to switch insulins without consulting a doctor and monitoring it closely.”
While insulin might be the poster child for increased drug prices, other medicines have also seen higher price tags. Various representatives of the healthcare industry also testified to the committee, including a doctor, a representative for companies that make generic medicines, a representative of the pharmaceutical care management association and one from the health insurance association.
“The single most remarkable common denominator is that economics should not be the driving factor in in how I provide care for my patients,” said Dr. Kevin Caputo, a psychiatrist and president and chief of behavior health at Crozer-Keystone Health System. “Rising prescription costs in particular have put patient care in a strangle hold. And it needs to be controlled.”
He gave an example of an older woman, “your mother,” who is not compliant with her doctor’s recommendations. She has to ration her medications, sometimes doesn’t fill her prescriptions or refills because her electric bill was too high or groceries went up. She may have to choose between her blood pressure pills or her migraine medicine. Maybe she is on several prescriptions, as many elderly people are and “taking all her needed meds is simply outside her ability to pay.”
While drugs might be affordable individually, when a patient is taking multiple medications it can run to thousands of dollars, Caputo said.
“And the promise of generic pricing is a fallacy,” he said. They might be 5 or 10 percent cheaper, but that is not enough, he said. Many insurance plans have drug formulas that are cheaper for employers but “patients and their doctors have to make second-best decisions,”
PENNSYLVANIA
Pick 2 (Sept. 13): Mega Millions (Sept. 13): 6-16-37-59-62 Mega Ball: 5 Megaplier: 2 Powerball (Sept. 11): 6-17-24-53-57 Powerball: 3 Power Play: 3 he said. And pre-authorization can take a lot of time. The results of noncompliance can be illness or a relapse.
“It doesn’t take long for the health of an elderly person to spiral downward very, very quickly,” he said.
Americans spend about $1,200 a year on prescription drugs, said Rep. Mike Zabel, D-163 of Upper Darby.
“This is more than any other developed country in the world,” he said. “The prices of these drugs continue to rise at an astronomical rate. And it is simply unsustainable.”
“This is public health crisis,” he added. “People’s lives are being put in danger. Health care is a human right and no one should be forced to choose between their medicine and their dinner, between their health and heating their homes. It is time for us to act.”
Sen. Tim Kearney, D-26 of Swarthmore, agreed that health care is a right.
“We need to ensure this right is provided for all,” he said. “Health insurance plans can’t make the cost of insulin prohibitive for the patients whose lives depend on it.”
The bill he envisions would ensure transparency for companies that produce insulin.
Sen. Katie Muth, D-44 of Montgomery County, said there are other costs for diabetic patients beyond insulin and that some of her constituents have had to order insulin from other countries.
“It’s criminal that people have to make these really hard decisions,” Muth said.
Patrick Keenan, with the Pennsylvania Health Access Network, said that one in five Pennsylvanians did not fill a prescription because of cost. And 12 percent have “used up most of their savings for prescription drugs.”
“Pennsylvanians are also calling on law makers to take action,” he said, noting now than in 2010. However, that other states have consumers may not see savings passed laws to make prescription though, because their drugs more affordable. insurance companies shift more costs to them and
Zabel compared the situation benefit managers may not with prescription pass savings along to patients. drugs to utilities, which are regulated. “Net prices for brand
“You hear a lot of explanations,” medicines grew just 0.3 he said. “Somebody percent in 2018, less than is making money on the rate of inflation,” he the backs of human lives.” said. “And spending on
“Poll numbers show this medicines for one of the is an issue that everybody nation’s largest pharmacy is behind…It is time to fix benefit managers (PBMs) it. Every single one of my grew just 0.4 percent last constituents has a story.” year.”
Zabel added, “You’ve invited “Unfortunately, it doesn’t us into your business feel that way for patients with these cost increases. who are seeing their out-ofpocket It is going to be fixed come costs go up as insurers hell or high water … The and other middlemen days of these wild profiteering continue to shift more and will end.” more off their costs onto patients
Meanwhile, drug companies through high deductibles have been taking steps and increased use of to help patients who can’t coinsurance,” McGee said. afford their medications. “On average, 40 percent For example, an industry of the list price of medicines group, PhRMA introduced is given as rebates mat.org, a website where or discounts to insurance consumers can go for assistance. companies, the government, Eli Lilly, Sanofi and pharmacy benefit Novo Nordisk also have managers and other entities websites where they offer in the supply chain assistance patients with (that) often require large diabetes: https://www.lilly. rebates in order for a medicine com/diabetessolutioncenter; to be covered. These https://www.novonordisk-us.com/perspectives/ rebates and discounts exceeded $166 billion in 2018 affordability_remain.html; alone and are growing every and https://www.admelog. year. Yet these discounts com/insulins-valyou-savings-program don’t always make their way to patients to
Nick McGee, director of lower their costs at the public affairs for PhRMA, pharmacy counter. We believe disagreed that manufacturers that when these negotiations are the source of higher are happening costs and said that the cost in the marketplace, patients of the most popular form should be benefiting.” of insulin is actually lower