Category Archives: Healthcare

Drug pricing straight talk.

I read an interesting online piece from CNN Money the other day. If you haven’t had a chance, read it HERE. I’ll wait.

Although I was surprised at first that the director of the U.S. Food and Drug Administration would weigh in on drug pricing, I have to say that his comments here are pretty much what I would expect, and it’s what I’ve been thinking for a while too.

Indeed, there have been drug companies playing fast and loose with the rules governing when their drugs could be available to be made as generics. There have been, in some cases, instances of companies restricting access to brand name drugs for makers of generics who want to use them to help develop their own products, and use them for comparison in clinical trials to help measure efficacy of their generic versus the brand name benchmark.

In true drug company and pharmacy benefit manager fashion, there is a lot of gray area in the rules governing what can be made generic when, and how. In a way, you can understand it from their point of view… they don’t want to see a lot of their profit go away because a generic (or in the case of insulin, a biosimilar) could be purchased for much less than the original product.

Yet we’ve seen generics make a huge difference in the affordability of high blood pressure and high cholesterol drugs. It would be nice to purchase our diabetes drugs for far less than we purchase them today. Can’t we make this happen?

I think that’s what the FDA Director is saying here. He uses political terms like “free market”, but at least he acknowledges that the needs of patients should trump a 20-plus year near monopoly for a particular medication.

We are seeing changes, slow changes in insulin now. Novo Nordisk’s Fiasp is a very fast-acting insulin, and over the next few years, it may change a lot of how people manage their diabetes. If it does, expect to see prices drop for Novolog. We’ve seen the first biosimilar insulin in the United States in Eli Lilly’s Basaglar, and that has already had an effect on the price of Sanofi’s Lantus, which it is biosimilaring(?). Plus, my endo suddenly has lots of free Lantus samples to pass along.

I completely believe this statement from Dr. Gottlieb, in describing the various changes under consideration by the FDA:

“All of these steps are going to have an impact, and I don’t think there’s one silver bullet,” Gottlieb said. “If anyone [thinks] there is one thing you can do with policy intervention that is going to dramatically change drug prices, that’s not true.”

It’s going to take a lot of effort on the part of regulators, advocates like you and me, and yes, industry to shepherd a change in the approach of brand name and generic drugs. We’re not going to get down to a few dollars out of pocket for our insulin prescription. But hopefully, as time goes by, we’ll see additional choice, both in medications and the cost of those medications.

I think that would qualify as making something happen.

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Three large companies want to disrupt healthcare. Don’t hold your breath.

I’ve been waiting to write about this until I could consider all sides of the story. Now that I’ve had a few days to mull it over, here are my thoughts about the Jeff Bezos/Warren Buffett/Jamie Dimon healthcare whoziwhatsis.

Let me preface my remarks by saying that this is NOT financial advice. I don’t know squat about what you should do with your money.

Now, some basic facts: The companies that are run by the three business titans noted above are partnering to explore ways to reduce the cost of healthcare, first for their own employees, then, potentially other companies’ employees. After the announcement, the Dow Industrial Average lost over 300 points. Since then, over 1500 more points have been shaved off the Dow.

The initial selloff last Tuesday affected insurance company stock as much as anything, and that’s understandable to a degree. But to this observer, the panic seems to be a little premature. Right now, to borrow a little political vernacular, this announcement is a big nothing burger.

I mean, sure… Amazon has made a mountain of money changing the way people shop. Berkshire Hathaway has made investors rich for over 40 years. And JPMorgan Chase is America’s biggest bank. However, healthcare in these United States is full of layer upon layer upon layer of complexity, and getting through all that complexity will take time. Maybe a lot of time.

At the federal level, there is government regulation and government regulators. Healthcare is regulated in the individual states too, and sometimes, even at the local level.

How about doctors, nurses, and other medical professionals? Some of them charge so much for their services only because the cost of their education was so high they have to charge extra just to break even after paying on their student loans.

And since we’re in the 21st century, we have to consider technology. Not the kind that helps us deliver insulin or tells us our glucose levels. I mean the kind of technology that intersects patients all over the country, and for now at least, allows providers to get paid based on medical codes entered through software designed to help them figure out what each treatment is worth.

Hey, guess what? I haven’t mentioned a thing yet about insurance companies or drug prices. Like I said, layer upon layer upon layer of complexity.

If Bezos, Buffett, and Dimon are going to revolutionize healthcare in the USA, they have their work cut out for them. It’s going to take a while.

Insurance premiums are three times more expensive than they were 18 years ago. Out of pocket deductibles for these plans are three times more expensive than they were 12 years ago. There’s a sea of red tape to wade through to help companies and patients get affordable, accessible, compassionate healthcare.

But… we won’t really know whether the cycle of escalating costs can be broken unless someone actually tries. Whoever tries will need deep pockets to succeed. And a fair amount of patience. This triumvirate of business tycoons has the money. Let’s hope they have the intestinal fortitude to see it all the way through.

Quantifying my eyesight.

I don’t talk about medical appointments much lately. After blogging for almost six years, how many times can I write about going to see the doctor?

My quarterly endocrinologist appointments, checking in with my primary doctor a couple of times each year (if I don’t get sick), maybe a podiatrist or dermatologist appointment now and then.

And… my yearly check-in with my ophthalmologist.

In less than a week, I will celebrate 27 years with Type 1 Diabetes. Every year, for 27 years, that meeting with the eye doc is the one I’m probably least prepared for.

Ask me about my diabetes? No problem! Ask me for data on glucose trends, or whether I’ve been in range lately, and I can knock it out of the park. I still have diabetes, but at least I can quantify it.

But eye visits are different. All I know is that my vision hasn’t been as good the past few months as it had been before that. My preparation for this appointment was basically to clean my glasses really well and hope for the best.

That’s my problem. I’m generally the guy who doesn’t want to worry about bad news until he actually hears it. But when you don’t really know what’s going on until you get there, every year hearing ”No sign of retinopathy”, while welcome, makes me think about how many more bullets I’ll be able to dodge until the diagnosis comes.

The flip side of all this is that if you worry, when you hear everything’s okay, you want to kick yourself for worrying so much. We can’t have it both ways. Or can we? This time, I was worrying a little, but carrying myself like it was no big deal. Fake it ‘til you make it, baby.

So it was a tremendous relief to hear “No cataracts, no glaucoma, no sign of retinopathy”. In the end, my real problem was that I worried too much.

I have a new prescription. I’ll probably get new frames this year too. I’ll also try to remember to take better care of the body I’ve got, eyes included. And if I can, I’ll work on worrying less, and using the gift of eyesight to see things clearer than ever before.

Underwhelmed.

It’s back in the news… insulin pricing.

Helped along by a few well-meaning tweets from Senator Bernie Sanders, and maybe a little by the Epipen debacle by Mylan, insulin makers are finally coming to patients and discussing cost in more detail. See the excellent reporting by Mike Hoskins at Diabetes Mine HERE and HERE. It’s good that they’re at least talking about the ever rising cost of this drug. I mean, it’s good, right?

Excuse me while I yawn.

There are countless reasons why insulin costs as much as it does in the United States. One thing is certain: no one wants to break down those reasons for you in any kind of concrete terms. In the case of “pharmacy benefit managers”, they won’t even come to the table to discuss it at all. And in the case of Novo Nordisk, Eli Lilly, and Sanofi, they’re going to talk, but they’re not going to help you understand how much of the cost of insulin goes to them and how much goes to everyone else in this game of legal graft.

This story has really been in the news for some time… I even wrote about it a year and a half ago, after NPR did a story on it. Yet we’ve continued to see the cost of insulin soar higher.

The amount of revenue generated through insulin pricing is in the tens of billions of dollars per year, most of it coming from here in the United States. It’s more than enough for everyone with skin in the game to be rewarded handsomely. Those are just the facts. Like it or not, insulin is a cash cow for drug makers and “pharmacy benefit managers”. Sure, it costs a lot to produce or acquire, but with Type 1 patients especially, they will always have a market for their product. It’s a drug of necessity, not a drug of convenience. I’m not sure there’s any motivation at all for producers or “pharmacy benefit managers” to take action on price.

I hope the discussions that are taking place between the drug manufacturers and patient advocates result in positive steps that will reduce the overwhelming cost of insulin for patients who need it to survive. But I have to be honest: I’m feeling underwhelmed.

Look, discussion is good. It means we’re not forgotten, or worse, ignored. Discussion often leads to things, positive things. I do worry that, as an HIV/AIDS advocate once told a gathering of diabetes advocates, they’re just “checking our box”. Check the box, move on. I don’t think the attendees at the meeting in Washington in November are the type of advocates who will stand for just having their box checked. I hope not.

But for now, I’m in a wait and see mode. Respond to calls for response on insulin pricing issues offered by advocates. Contact my congressman and senators, maybe my state’s insurance commissioner. Spend too much for insulin. Rinse. Repeat.

Underwhelmed.

Yes… I actually did see the eye doctor.

That’s the message I can finally give my endocrinologist when she asks me in January. I needed to find a new ophthalmologist since I had reservations about the doctor I had been seeing before. No major complaints, but I felt that he just wasn’t thorough enough in examining my eyes. And when you’re talking about the eyes of someone who has lived 25 years with Type 1 diabetes, thorough is what you want.

So I moved on. I found a new ophthalmologist, in my neighborhood which is a plus, and I went to see him last week.

Verdict? I’m not so excited about the ophthalmologist, though he’s not bad. He doesn’t know the first thing about diabetes beyond asking “how are your numbers?”. Despite that, I think we started on good footing. I felt he was listening to me. And I really like his assistant, who seems to know a lot and has some grasp of diabetes too. She’s one of those assistants who seems to do all the work, then turns it over to the doctor to gild the lily, whatever that means.
eyeglasses
At the end, I wound up with a new prescription, which I hope will help me see stuff on the computer better. And most importantly, after a thorough exam, there were no signs of retinopathy, glaucoma, or cataracts. I’m good for another year.

It’s a good feeling. A good feeling to get good news from the eye doctor, and a good feeling to know that I’m finally taking care of some of that regular maintenance I’ve been putting off for a while. More to come…

I’m not saying this is a brand new me. I am saying that knowing what’s going on with my health beats worrying about what’s going on with my health anytime.

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