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tv   Ethical Perspectives on the News  ABC  February 7, 2016 11:00am-11:30am CST

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expressed on this program do not necessarily reflect those o othe staff and management of kcrg-tv9. craig vansandt: good morning. welcome to this week's edition of ethical perspectives on the news. my name is craig vansandt. i teach at the university of northern iowa and hold the david w. wilson chair in business ethics there. our topic this morning is the ethic topic we have a panel here that i think you will find very informative toda with us this morning is ben urick, a pharmacist and phd student at the university of iowa. welcome to the show, ben. ben urick: thank you. craig vansandt: our second panelist is dr. chirantan ghosh, who is a doctor, a medical doctor and founder of the ghosh center for oncology and hematology. dr. ghosh, thank you for being
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dr. ghosh: thank you. craig vansandt: we're also very happy to have jon rosmann with us, who is the executive director of the iowow prescription drug corporation. jon, thank you for coming over from des moines. jon rosmann: thanks for the opportunity. craig vansandt: as i said, our topic today is the ethics of drug pricing. there hasseen no shortage of news this fall about price increases with prescription drugs. if you read the news, you see that prices, or at least it seems to be, that prices are going up very rapidly. ben, i'd like to start off the questions with you as a phd studenen is the popular press giving us an accurate picture? are ben urick: you knono i would say it depends on the medications you look at. if we talk about brand name pharmaceuticals, the answer is yes. certainly
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gilead pharmaceutic als, for hepatitis c, comimi out at $86,000 is an incredible price to pay for a therapy like that. you know, i'm sure many of the viewers have heard about daraprim that was purchased by turing pharmaceuticals who then increased the price 5000%. now, those are extreme cases but i think it does show something a little bit larger about the state of brand name pharmaceuticals. if we talk about the cost of medications in society as a share of total healthcare spending, pharmaceutic als have doubled since the early 90s. we went from about 5% of all healthcare spending in the early 90s bebeg spent on pharmaceuticals to about 10% today. a lot of that increase is increased prices of very expensive brand name products. if we talk about generic products, which are acttlly about 85-90% of all products dispensed in the united states, those products have generally stayed about even or even a little bit down, but even within that category, there are some generic drugs
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extremely high price increases definitely within brand name drugs, big price increases. generic drugs, most of them not, but a few ofofhem you also see price increases ass well. craig vansandt: okay. the other question that i would like any of you to address is the question of drug prices in the us versus in foreign countries. it is my understanding that we pay significantly more here than in other countries. is that true? more we pay here than in europe. craig vansandt: okay, and why is that? dr. osh: you know, i dodot know. i think it's a multifactorial. i think the ... anytime we talk about the drug pricing, the pharmaceutical company will say what they say, that it takes time, effort, cost, andd money to produce a drug and so on and so forth. i
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you an exampmp. the scientists, the molecular biologists, create a scientific curing chronic myelogenous leukemia with a targeted drug that's called imatinib or gleevec. it was marketed in 2001, and i remember, i was in the clclical trial, $28,000. we thought that's too pricey. we have heart and we supported the concept that they have to recover the cost. today, same drug, more people are using it. in a chronic use, is more business. if you take an antibiotic, you take for fourteen days, but if you take antibiotic year after year,r,ear after year, it's a different profit. we're selling this drug to $98,000, so please, i want to hear what research has been done more for a drug that was
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know, we feel that competition, if you have similar drugs, the price would go down. we have five similar drugs. the price of the other drug has gone up to $130,000. we are creating a lot of new drugs, a lot of new drugs, a lot of good treatment but we are pricing out the patients' care.let me tell you the published study shows that the outcome of chronic myelogenous leukemia in united states is poorer thain european country. we have created a structural for noncomplianc e. people are not taking their drugs because they cannot afford to take the drugs. if you u ve a $100,000 drug a a we haha insurance ... that's a vague word. most of the drug is coming as an oral. we need
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patient do not have prescription benefit and when they havav they have 20% copay. if you have a $100,000 drug and if your copay is $20,000 and average income in united states is $52,000 ... so how a person can come up with $20,000? they're not taking it. you know, breast cancer, we cure breast cancer by giving drug to block thth receptor, tamoxifen or aromatase taking it, so all the scientific that we are doing, we are not able to deliver that because of the structure of pricing. you know, the ... i have some number, valeant increased the price of sodium nitroprusside. on next day of the the drug by 625%. isuprel, the
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penicillin, a drug that was used for a long time, i read in my medical school, went up by 2949% in a day.craig vansandt:f i might interrupt you there, i gather that you're very concerned about this for your patients' sake. i'll ask you to talk some about what your center does in a minute. jon, , i'd like to get you in here as well. i wonder if you could tell us a little bit about what idpc does and your interest in drug priring. jon rosmann: yeah, absolutely. the whole mission of our organization is quite simple. it's simply to connect low-income, uninsured or underinsured patients with access to free and low-cost medications. much of what we're talking about today is simply thf issue that we're trying to address. we're a safety net provider.r.
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access to affordable or free medications. we have developed a model where we are actually "in essence" recycling medications, taking previously dispensed medications, having those medications inspect by a pharmacist and then we provide them to pharmacies or to clinics to dispense to patients at no cost. we're very familiar with the issue and it's a main reason why there's such a dire need for our programs, but unfortunately we don't have the solution. we're just trying to fill the gaps best we can. craig vansandt: coming back to what you were talking about, it sounds like we're paying significantly more for drugs in this country and the medical outcomes aren't any better or may even be worse. is that
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article that came out in the wall street journal on december 1st that looked at how much w wspend in the united states for these sterile injectable drugs like a lot of the ones that you'd use in your practice, compared the prices here in the us to prices in england and in norway. what they found is that for 37 out of these 40 drugs, we spend more than norway does. for 39 out of these 40 drugs, we spend more than eeland does. these are the exact same medicines that they're getting in england, that we're paying a lot more here in the united states. just one specific very commonly used in cancer therapy, costs $3500 a dose here in the united states,orway $1500. that's a $2000 difference for a very common drug. you do see that we spend a lot more in the united states on brand name medicines. you can't really say united states on laws for generic medicicis that allow for
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competition within the generic market that does bring down prices and actually, you know, economics work as you would expect them to, where you bring more competitors into a market, and then priris for those products fall. as you were talking about with brand name pharmaceutical, the economics, kind of that basic idea of a firm coming in and lowering a price doesn't work. if you see gleevec, for example, whenever you have a competitor entering the market at a little bit higher price, the manufacturer for gleevec understands that they can raise the price on gleevec c little bit becausus there's a new will bear. when you see new in, they come in at a little bibihigher price. rising tide raises alal ships and you see this increase in price over time. craig vansandt: my understanding, and again, i don't want to go too far down this rabbit hole, but my ununerstandin g is even some of the drugs that are going off of their patent, which then you would
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think would allow generic drugs to be produced, the companies that own those patented drugs do what they can to keep other manufacturer s from producing generics. am i right on that? ben urick: yes. this gets into fda law and we don't have the time this morng to .craig vansandt: none of us are lawyers. ben urick: right, including me. you're right. these are called pay- for-delay settlements. it's something that ... if you look it up online, you can see what a pay-for-delay settlement is. what hapapns is, the first t neric entry into the market oftentimes has six months of exclivity, if it's the first generic drug that comes into the market. they can forgo that six month exclusivity in exchange for some sort of large payment from a brand name pharmaceutical manufacturer. the fda has determined that ... there were a couple of lawsuits that were surrounding
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out now is that it's not necessarily strictly illegal for brand name companies to offer settlements to generic companies to delay their product entering the market. they have a pretty high level of scrutiny for these but they're still technically allowed. there's an idea that since you're going six additional months without any rt of generic competition that you do end up increasing prices for anybody y who would purchase that drug and that is true to a large extent. these pay-for-delay settlements, they have some impact but i would say that that's not anythg that makes a big, big, big impacacon the amount of money that we spend in pharmaceuticals in the united states. craig vansandt: okay. dr. ghosh: but i think, conceptually, the law needs to be changed bebeuse when a pharmamautic al company manufactures a drug, there is a life of the patent. it is a routine thing to delay, push back, the generic products by lawsuits, and that
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needs to b@ prevented. also, the company goes to the courts and apapals for an extension of that patent. i think that the law needs to be defined up front, that this is the duration of the time you have the patent. you cannot come back and extend that and you cannot push back the generic products. there is a disincentive for the generic product manufacturer to manufacture those drugs because they know that ey might not be able to sell it for y yrs. the law needs to be changed. i think the only way it will be changed is that if we have a patients' advocacy. i'll tell you that we have an experience in the united states. we have done it with the aids movement. you know, the aids movement ... they changed the law, the way the business was done, the pharmaceutic al company agreed on that, they produced 35 drugs in 10, 15 years and they kept the price down to $18,000, and the life has been
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patients get involved in it, the community gets involved in it, things do change. craig vansandt: to put that in perspective, this was, if i remember right, the late 1980s, early 1990s, am i in the e ght time frame? dr. ghosh: 1980s, right. craig vansandt: not that any of us are political experts, but my take is that the chance of getting government to make the kinds of changes you're talking about with the aids issue is much less today than it was 20 years ago. dr. ghosh: i think we need to go bacto history. these were young men who shut down the fda for a day, closed the wall street for 2 days. they were young, they were dared, they vocated. they were their own advocate. the government is not going to change unless we
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is a movement that is going on from our part, that's at we want to submit one million signatures to the congress, senate that this needs to be addressed. in a discussion with ... we are rationing the care. we are deprivg the care in the back door. let's talk up front and make a change. that was the dierence is the aids advocate is a patient warrior on the street. we have cancer advocacy group. unfortunatel y, most of them are companies. organization get involved in patient advocacy? jon rosmann: yeah, most of our services directly to pharmacies or daily basisi we receive a number of calls from patients that are dealing with the struggles
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medications. i think it's important to note that the safety net patient, at least in iowa, has changed very much over the years because historically patient as an individual that is low-incoco, uninsured. owa has been medicaid expansion, so we have an additional 99,000 persons that are now covered. . people that are in the category from 138 up to 200% of the federal poverty level where, technically, many of these patients are insured but, for example, that insured patient could have insurance through a bronze level plan. that bronze leve plan will require an individual, for example, 200% of federal poverty level, that would be $28,000 approximately, that person would have a $6300 deductible before any medication
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medical coverage is provided. i think it's important to note that although we have more insured patients in this state, the services are still required from the underinsured patients and something needs to be done to address that as well. craig vansandt: okay. as we were talking before the show, you indicated that the organization that you represent is somewhat unique in the united states. another been somewhat of organization was established through a partnership wiwi non-profit and publbl. we were initiated by senator harkin and then governor vilsack. our mission is simply to provide access to free and low-cost medications.
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mechanisms, many of which are contracting with the department of public health, or the attorney general's office to implplent these programs. we're fortunate enough that we have legislative leaders that have valued access to medications in our state. we have now d deloped the largest drug donation repository in the country. our state serves as a model for how medication or medication ste, existing medications within the healthcare system, particularly long-term care, how those medications can be recovered, inspected, and repurposed for pbtients at cannot afford their medications. craig vansandt: thank you for bringing a bit of good news to this show. dr. ghosh: just one question i have ... jon rosmann: yes. dr. ghosh: thanks for doing this. the question i have ... say somebody needs some medicine like gleevec, we talked about, in cancer care. that's a day after day, month after month
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your orgagazation can fulfill that need? jon rosmann: that is a great question. 95% of our medications are coming from long-term care settings, so coming from nursingng homes. many of those medications are going to be maintenance medications, hypertension, diabetes, but one of our areas of focus is to try and bring more specialty medications inin the donation program. we're just starting an initiative to provide outreach to the oncology centers and the cancer centers it's certainly ... it's not an ideal situation with donated items, you have no way of corolling your inventory. for some patientnt we can fill gaps in access and for a family where an individual may have passed away, we can provide a meaningful way for that family
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outcome for a patient. dr. ghosh: right. i think that's a great effort, but that does not answer the bibiest problem that we are facing. we are making great inroad in the cancer care. the melanoma, the ... all the new imnotherap y checkpoint fantastic outcome. for example, in melanoma, the 2 drugs together is going to cost $159,000 a year. if you have to treat all the melanoma, to provide the best care that we have defined, it is going to cost 281 billion dollars per year. right there is the issue. in 2014, the world was spending 100 billion dollar on the cancer drugs. those kind of differences we need to solve, and we need to solve by discussing, discussing openly, honestly, because i don't think any drug is a good drug if the patit
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drug to me.craig vansandt: i appreciate that. i'd like to change gears a little bit with you all now. we've seen, just from our discussion, that there is a crying need for these drugs. we've seen that there is a very strong profit motive from the companies producing them. how do we meet in the middle? i think part of my question that i want to get there is ... is healthcare a right that citizens have or is it a privilege that people should pay for? ben? ben urick: i, you know, ... healthcare is not a constitutional right in the
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the courts have said so far. the only people in the united states who have a right to receive healthcare are prisoners, because it's consideed cruel and unusual punishment if they are not given healthcare. do i think that healthcare should be a right? that is how i tend to think, but that is something that i don't think would actually en in the current political climate, right? what we're left with is solutions that really if we want to talk about reducing cost of medications for society, involve more intervention from the federal gogornment. those are the solutions t t providing reasonable access to healthcare that ... other industrialized nations have come up with but we in the us have been very resistant to this. one thing that is kind of a low-hanging fruit is for the same kinds of rebates that are negotiated for in the medicaid program. the mecaid program drug costs, because they have federally-mandated set up, was
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companies. craig vansandt: right. ben urick: yeah. some tauzin who ended up being the president of pharma afterwards, watching this presentation. that can save substantial amount of when it comes to pharmaceutic als and would d likely lower to an extent the amount of money that we in the us pay for drugs. at the very least for some medicare patients, i think it could make a big difference for their care. dr. ghosh: that should be done because most of cancer patient is memecare populations. . ey're not young so we are denying the care to our citizen and it has becoming a care of the privileges. i'm going to give you an example. president obama says that we are providing the healthcare and you can pick and choose. i know a patient who has money to get the platinum product, they get the free care. i know patient who was good and tried to get a bronze ... she has copay, she doesn't know how
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providing the care to everyone is wrong. we are providing the care to the privileges. actually, the person who can pay the bigger premium, his care or her care is care to the other folks. jon rosmann: we're here in the united states, and the wall street journal article was talking about a driving factor for high drug costs in the us is all the r & d, so how do we balance focusing on drurucosts for the united states when the us bears the majority of the r & d costs? shouldn't we be talking about the larger issue of drug costs, including partnerships with other countries if we're going to try and come up with a solution to drive down costs in the us? ben urick: right, and i think that, you know, talking about spreading out the r & d burden m me globally, right, because everybody benefits from
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pharmaceuticals. also, i would question r & d as the sole justification for the amount of money that we'rerepending on these pharmaceuticals. 9 out of the top 10 largest manufacturers spend more on marketing than they do on r & d. if you look at the s & p 500 list, pharma companies have a a7% profit argin. s & p average is only 6%. they use r & d as a justification for the price that they charge but i reallyave a hard time buying that. craig vansandt: so now is the time in the program to talk about solutions. what do we do to make drug prices in ththus more fair? dr. ghosh: there ... go ahead. ben urick: no. dr. ghosh: no, you go ahead. ben urick: one is negotiatiti through medicare. that would help at least for medicare patients. market-driven solutions
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allowing them to increase their fees to drug manufacturers so they can move generic products through the pipeline a little bit faster and create more competition within the generic space. it's also very important for us to develop an effective can get expensive biologic products that are causing a lot of the increase in spending. if you look on hillary clinton's and bernie sanders' websites, they have full lists of policy options they think are viable for reducing drug costs, some more than others. bernie want to go up to canada to bring down medicines as part of reimportation. i don't think that would work. hililry clinton's idea is to set a maximum out- of-pocket, to set an out- of-pocket maximum at $250 per month for everybody in the united states on pharmamauticals. craig vansandt: right. ben urick: it means you could not spend more than $250 a month out of your own pocket on pharmaceuticals. it's an interesting idea. i don't think it would pass politically. i wonder if that wouldn't actually increase the totot amount of money that we spend on pharmaceuticals in the united
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reduced copayments as a mechanism for controlling drug spending. craig vansandt: okay. i'm really sorry that i didn't get you all involved in the solutions problem but we're about out of time so i'd like to ask you at this point what do we need to leave our ewers with? what infnfmation? dr. ghghh? dr. ghosh: you know, we are talking about the drug pricing but we need to talk as a whole. for example, i'm an oncologist. studies have shown that after you cure hodgkin's lymphoma, doing repeated ct scan costs $591,000 to save one life. we should not be doing that. i think the national organizations, ncc and other, they need to step in and guide us because that's the way to help the insurance and also pharma, too. i think we have a global responsibilities, you know, like if you have ductal
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samplings should not be done, but it is being done. we are wasting resources in other places. the new drugs are going to come, is going to be expensive. our closet is full so we need to get rid of the old stuff like doing the things that we did before.craig vansandt: great. thank you. jon? jon rosmann: i think we need to fococ on things that we can have impact on now because some of our solutions could take decades. we can do a better job of recouping cososs within our own healthcare systems and utilizing models to help recycle or repurpose medications within the system. craig vansandt: right. thank you all very much for your help. on behalf of the inter- religious council of linn county, i'd like to thank all of you. i'd like to thank you for watching. have a great week.
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