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Voices / Column

It ought to be illegal

I and countless others are subjected to a ludicrous corporate-America bind, all for the sake of profit

Elayne Clift (elayne-clift.com) writes about health, politics and social issues.

Saxtons River

She has been taking a generic drug for 20 years when suddenly her big-chain-pharmacy says they can no longer obtain the drug from the manufacturer that had been the supplier because their “local distributor” no longer carries the necessary medication from that manufacturer.

The pharmacy gives her first one, then another generic, but both prove ineffective because while the essential chemical compound is present in the new generics, the material used as “binding” differs from that of the original manufacturer.

The pharmacy gives her two choices: “Don’t use generic” (the brand-name pills cost nearly $100 a month) or “Get your doctor to try another medication” (i.e., experiment with drugs which could be problematic even though the one that works still exists in drug distribution land.)

When she complains, the pharmacist says “corporate” will not allow him to secure the medication she needs from any other distributor.

Another man gets his medication through a retirement health-care plan that includes a pharmacy benefit program. Recently, his employer negotiated a contract with a new benefit program.

Suddenly, he finds that one of his generic drugs, which costs more than generics usually do, will not be approved until the program’s in-house consultant physician — who lives 2,000 miles away, has never seen the patient, and knows nothing about his health status beyond his personal doctor’s diagnosis — determines if the requested generic is necessary or appropriate.

If the drug is approved, he will have to mail-order 90-day supplies, which ensures that the patient doesn’t go directly to the local competing pharmacy sooner to fill the prescription.

Using myself as a final example: I also get my two regular meds via CVS Caremark, a health-care plan that includes pharmacy benefits and therefore is distributor and pharmacy all rolled into one.

That means that essentially it is a monopoly that exercises complete control over my access to medication.

CVS Caremark rules that I must receive my meds through the mail from them, and that means that I can no longer work at Rite Aid with my own personal pharmacist — who knows me well — should problems arise over future medication.

It is a ludicrous corporate-America bind that I and countless others are being subjected to, all for the sake of profit.

And it ought to be illegal.

* * *

These examples paint a picture of profit-driven Big Pharma behavior rather than patient-centered health care; they could have dire consequences for people but keep shareholders happy.

Pharmaceutical companies have been behaving badly for years, and getting away with it. In his book Bad Pharma: How the Drug Companies Mislead Doctors and Harm Patients, published in the U.S. in 2012, Ben Goldacre writes, “the whole edifice of medicine is broken” because so much of medical practice is based on distorted information provided by Big Pharma.

“Drugs are tested by the people who manufacturer them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analyzed using techniques which are flawed by design, in such a way that they exaggerate the benefits of treatments,” he writes.

Having served on the Food and Drug Administration (FDA) Consumer Consortium years ago, I know these claims are true. I know that trials are designed to produce results favorable to manufacturers, and when the results are unfavorable they are hidden from physicians, the FDA, and consumers until untoward events are too big to ignore.

I know that some medical journals, like many research docs, are funded by pharmaceutical companies, and that academic papers are often not as objective as we would wish.

And not even the Supreme Court seems to be on the consumer’s side. In 2013, by a 5–4 vote, the court ruled that 80 percent of all drugs are exempt from legal liability.

* * *

Ironically, generic drugs account for 80 percent of all prescriptions written in the United States. And in 2013, federal prosecutors tried to get the Supreme Court to end “pay for delay” deals that profit drug companies while adding billions of dollars annually to consumers’ drug bills. These deals involve paying generic drug competitors to delay release of their cheaper versions of brand-name drugs.

A recent op-ed in The New York Times by physician-writer Peter B. Bach M.D. revealed that drug prices are skyrocketing because “companies are taking advantage of a mix of laws that force insurers to include essentially all expensive drugs in their policies. Examples of companies exploiting fault lines abound,” Bach says, pointing out that companies “buy up the rights to old inexpensive generic drugs, lock out competitors, and raise prices.”

European countries have found a way to beat this pharmaceutical blackmail. By not requiring insurance companies to cover all drugs, they just say no to drugs that are ineffective or too costly when other drugs work as well.

Thus, companies must offer their drugs at attractive prices. As Bach says, “you don’t have to say no very often to get discounts for saying yes.” Prescription drug prices in Europe are 50 percent less than what we pay, without harming patients.

In January, Sen. Elizabeth Warren (D-Mass.) introduced the Medical Innovation Act, a bill that would create a fund that major pharmaceutical companies would be required to pay into when they break the law and settle lawsuits brought against them by the federal government. The fund would add to research accounts at the National Institutes of Health and the FDA.

Warren calls it “a swear jar.” It’s a simple form of accounting, she says.

“Instead of letting companies that break the law get off with a slap on the wrist, the Act will make sure they pay up in a way that really makes a difference,” Warren says.

That’s a good start to reforming Big Pharma, busting their monopolies, and restoring the health of us little guys.

But it will take a good deal of public pressure before we see real reform take place.

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Originally published in The Commons issue #313 (Wednesday, July 8, 2015). This story appeared on page D1.

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