By Robert P. Bomboy
My wife and
I live on Social Security, and last year we spent, out of pocket, more than
$11,000 on GHP Gold, Geisinger physician visits, and prescription medicines. I
consider myself in good health, yet between sun-up and sundown I swallow a
total of nine different prescription medicines every day.
My wife also takes nine prescribed
medicines, which include insulin. Her GHP coverage hit Geisinger's
"donut-hole" last September, and for the final three months of 2016,
despite this health insurance, she paid full price for her insulin and other
prescriptions.
That didn't include a total of
$50,263.74 for a hospitalization in September or the $2,568 that went directly
to Geisinger from our Social Security.
That was
certainly a lot - the money we spent out of pocket came to one-third of our
Social Security payments last year, and that's been about the same every year -
but it paled in comparison to what families, many in this area, pay for
medicines to fight major debilitating illnesses such as cancer, multiple
sclerosis, Hepatitis C, and other diseases.
America's
drug companies are gouging us every day with high prices on the medicines we -
you and I - need to lead healthy and productive lives.
Our for-profit system rewards the
biggest pharmaceutical companies with overwhelming monopoly power, and Big
Pharma uses that power to charge Americans more than any other country in the
world - so much, in fact, that nearly one in five Americans do not fill
their prescriptions because they can't afford it. President Trump's god-awful
health bill, now in the Senate, will make the situation even worse.
The prescription drug industry is
one of the most profitable in the country. It is morally wrong that people have
to choose between filling a prescription and putting food on the table for
their families.
Drug companies bleat like lambs
about the cost of research and testing, but the truth goes to something much
deeper and darker. The drug companies are shameless, and they charge what they
can get away with. And, with President Trump's new budget, they will get away
with much, much more.
As doctors at the Mayo Clinic put it, “The question is
whether current pricing of drugs is
based on reasonable expectation of return on an investment or whether it is
based on what prices the market can bear.”
Beyond that, investigators are drilling down to something
worse: the rise of nationwide charities connected to Big Pharma itself. These
charities say they are helping patients pay the out-of-pocket costs
of their medicines, which can range, for example, from $150,000 a year for the
latest cancer drug to $300,000 a year for Cystic Fibrosis medicines.
After
all, if a patient can't afford out-of-pocket costs of $5,000 for a $100,000-a-year
drug, for example, the drug company gets nothing. But if the drug company or
the charity pays the $5,000, the patient gets the drug and the drug company
receives $95,000 from the patient’s insurance. The drug company also gets very
lucrative tax deductions on that money it's "giving."
I actually know someone who's made
many millions of dollars on 15 little words you've seen at the bottom of your
television screen: "If you can't afford this prescription drug, Big
Pharma may be able to help you."
This guy looks before he leaps. He
spent several years meticulously inspecting the laws in every state, looking
for a loophole that would let him make a gazillion dollars on prescription
drugs. When he found the loophole he was looking for, he pitched his tent in
Texas.
Here's
the deal: He sets up, in Texas, a charitable foundation with all the trimmings.
He and his foundation solicit contributions nationwide to help stricken
families where a mother has cancer or a child has Cystic Fibrosis, one of the
most heart-rending diseases imaginable. He has a big call center whose
operators, with the most piteous voices, plead for donations.
He
rakes in a lot that way, and his foundation actually helps people. But his big
money comes from the drug company itself, which paid him $84 million in one
year alone. You heard right - $84 million! And there was plenty more
after that. Remember, for every sick child he helped, Big Pharma was
getting $95,000 and much, much more in round numbers, from the insurance.
He built a big mansion. He bought a Learjet, had his own
pilot, and flew his friends and family to Las Vegas. He had a condo in the
Florida Keys and a tax-hiding offshore account in Guyana. He diversified,
bought three restaurants, and made millions more on a range of other
investments.
Although he's a skonk, under Texas law he wasn't doing
anything illegal, nor was the drug company unless it billed Medicare, which is
a no-no.
How
does all this affect the price of prescription drugs? In the situation I've
been describing, the drug company raised the price of its medicine from $40 a
vial to $28,000 a vial. Yes, you heard right, $28,000!
To
cut to the heart of this chicanery, Senator Bernie Sanders and 15 other
Democrats are pushing a bill called the Improving Access to Affordable Prescription
Drugs Act. It would:
· Roll back Big Pharma's monopoly,
to increase competition and make medicines affordable for everyone;
· Hold to account companies that
engage in price-gouging, fraud, and other abuses;
· Let Medicare negotiate fair drug
prices and lower out-of-pocket costs for older people;
· Require transparency from drug
companies, including financial information like profits and pricing data.
States,
including Pennsylvania, are considering similar legislation. Some states would require
drug companies to disclose their manufacturing, marketing and advertising
costs, the history of price increases ($40 to $28,000!), their profits on
particular drugs, and the money they spend providing financial assistance to
patients. Pennsylvania’s bill would let insurers refuse to pay for a drug if
the drug company didn't file the required report.
But
the drug lobbies are strong. It's one thing to write a bill; it's another to
pass it. There are 18 lobbyists for every congressman and senator in Washington.
Sadly, the Pennsylvania bill is languishing in the General Assembly.
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