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The truth behind why Daraprim can cost whatever its CEO wants it to

Five reasons drug companies are getting away with charging a fortune for needed medications.

A greedy, cocksure CEO set off a nation of people tired of mysterious and unchecked drug pricing.

Have you ever suspected that drug manufacturers have been given complete license to charge whatever they want?

You wouldn't be wrong.


Since he got us talking about this, we have to thank Turing Pharmaceuticals CEO Martin Shkreli. He raised the price of the drug Daraprim from $13.50 to $750 per pill.

The justification for the cruel hike?

"It's a more appropriate price."

GIF from CNBC.

What does that even mean? How does a drug manufacturer decide what is an appropriate price?

Well, there are a lot of missed could-be checkpoints in the American health care system that give manufacturers utterly unfettered license to charge whatever they decide.

A quote from The Economist puts into sharp perspective just how ambiguous the process is: "One economist at a closed-door session of pricing experts at [the American Society of Clinical Oncology] dryly remarked that she could find no economic theory to explain how companies price their drugs."

As Jessica Wapner, a researcher and writer on biomedical issues, puts it in her blog: "Drugs cost what the market will bear. It's that simple. Drug prices are set at whatever the market will bear."

Here's why.

Price Gouge License #1: Pharmaceutical companies can advertise directly to Americans, unlike in many other countries.

Image by Pfizer.

In the 1980s, pharmaceutical companies were growing tired of doctors being the gatekeepers between patients and newly available drugs. The first commercial marketed to the general public was in 1986 for Seldane. The profits for Seldane soared beyond anything the marketing team had imagined, and other companies soon followed suit. And in 1997, the FDA further loosened its rules on television ads for prescription medicines, which truly opened the floodgates.

FUN FACT: The only two developed nations that allow this kind of "direct-to-consumer" drug advertising are the United States and New Zealand. It is specifically banned in other countries.

Price Gouge License #2: The pharmaceutical industry has a distinct lack of competition, and in fact is monopolistic by design.

Innovation needs to be rewarded, goes the reasoning. And that point is easy to see. Without some incentive, there are a lot of lifesaving and quality-of-life-changing drugs that would never have been invented.

The good old days. Image via March of Dimes.

But it also stands to reason that innovation can be rewarded at scale and for a finite time, not at ever-increasing margins forever and ever. That's just not sustainable, and it practically begs for some intervening agency to act. As drug companies look for more ways to expand their profits each year — 73% of Americans polled in 2015 already think drug prices are too high — something has to give. Profits can be had, and even attractive ones at that, without carte blanche for the kinds of excesses we're seeing:

"Gleevec, from Novartis, possibly the greatest cancer drug ever invented, cost $24,000 a year when it was introduced in 2001; now it costs $90,000 per year, a quadrupling in price." — "60 Minutes" via Forbes, 2014

FUN FACT: According to a Kaiser Foundation report in 2005, 10 pharmaceutical companies accounted for 60% of U.S. pharmaceutical sales in 2004. It's as if a cluster of multinational corporations have an unwritten understanding that they can just stay in their lanes and get while the getting's good.

Price Gouge License #3: The complicated insurance setup in America gives manufacturers an advantage versus a single-payer situation where prices can be negotiated.

Image via iStock.

Other countries with socialized, single-payer health care systems are able to negotiate prices with drugmakers. Since all the power is collectively concentrated in the one single-paying entity, it forces the drug companies to play nice — or at least act in good faith.

FUN FACT: In 2003, a new act meant to "modernize" Medicare and bring prescription coverage into the mix prohibited Medicare (the largest customer in the American drug industry) from being able to negotiate prices with drug companies.

Price Gouge License #4: There are complex, private pricing strategy sessions that don't get revealed to the public.

We all know what happens when the process of how the sausage gets made never sees the light of day. It can result in some pretty rotten stuff being channeled to consumers.

But Jessica Wapner sheds a little light on what factors come into play in these sessions:

  • How many patients are buying the drug
  • How many are likely to be insured privately or through the government, or are uninsured
  • Length of an average treatment course on the drug
  • How high the stakes are for what the drug treats (desperately needed or only mildly beneficial)
  • How many years the drug will have exclusivity in the market (meaning no generics)
  • Budgeting for patient assistance programs ("If you can't afford your medication, drug company X may be able to help")

That's right. Those drug assistance programs aren't a kindly, out-of-their-own pockets, benevolent gesture. The companies get their money for them — they just tack it on top of what they're already charging.

FUN FACT: There are special forecasting companies that help drug manufacturers evaluate the field and arrive at complex equations regarding prescription prices.

Price Gouge License #5: Many consumers are shielded from the reality of drug prices because of insurance.

That means they keep buying the drug even if their copays go up (making concessions in other parts of their budget as long as they can), which reinforces to the manufacturer that their pricing practices are working. People will just pay it. They will find a way. And though some can't or don't find a way — and sometimes wind up giving up lifesaving drugs out of financial defeat — the sheer numbers don't usually rise to the proportions needed to signal to drug companies that they've made a pricing error.

Because they're still making a profit.

The highest performers in the health technology category in 2015 were Pfizer, Merck, and Johnson & Johnson.

Image via Forbes with permission.

Is there any good news out of all of this?

Yes! Increased attention on drug prices during the last year is culminating in a lot of "we're not gonna take it" talk from politicians and the media. President Obama is attempting to get Medicare negotiation rights for the most expensive drugs.

And I'll say it again: We should thank Martin Shkreli for his severe overreach in pricing Daraprim because it refocused the nation on a huge problem we've all lived with for far too long. I doubt he's very popular with his industry brethren right now — they avoided pitchforks for a long time before he came along. And in response to the public's backlash and, I'm personally betting, pressure from within an industry anxious to avoid intervention, Shkreli did finally say he will reduce the cost.

The pharmaceutical industry is banking on being too difficult to figure out for the average Joe to fight back against. That's why it's important to share this and get people thinking.

The price of drugs, if left unchecked, will eventually debilitate us.

It doesn't have to be this way.

Joy

1991 blooper clip of Robin Williams and Elmo is a wholesome nugget of comedic genius

Robin Williams is still bringing smiles to faces after all these years.

Robin Williams and Elmo (Kevin Clash) bloopers.

The late Robin Williams could make picking out socks funny, so pairing him with the fuzzy red monster Elmo was bound to be pure wholesome gold. Honestly, how the puppeteer, Kevin Clash, didn’t completely break character and bust out laughing is a miracle. In this short outtake clip, you get to see Williams crack a few jokes in his signature style while Elmo tries desperately to keep it together.

Williams has been a household name since what seems like the beginning of time, and before his death in 2014, he would make frequent appearances on "Sesame Street." The late actor played so many roles that if you were ask 10 different people what their favorite was, you’d likely get 10 different answers. But for the kids who spent their childhoods watching PBS, they got to see him being silly with his favorite monsters and a giant yellow canary. At least I think Big Bird is a canary.

When he stopped by "Sesame Street" for the special “Big Bird's Birthday or Let Me Eat Cake” in 1991, he was there to show Elmo all of the wonderful things you could do with a stick. Williams turns the stick into a hockey stick and a baton before losing his composure and walking off camera. The entire time, Elmo looks enthralled … if puppets can look enthralled. He’s definitely paying attention before slumping over at the realization that Williams goofed a line. But the actor comes back to continue the scene before Elmo slinks down inside his box after getting Williams’ name wrong, which causes his human co-star to take his stick and leave.

The little blooper reel is so cute and pure that it makes you feel good for a few minutes. For an additional boost of serotonin, check out this other (perfectly executed) clip about conflict that Williams did with the two-headed monster. He certainly had a way of engaging his audience, so it makes sense that even after all of these years, he's still greatly missed.

Noe Hernandez and Maria Carrillo, the owners of Noel Barber Shop in Anaheim, California.

Jordyn Poulter was the youngest member of the U.S. women’s volleyball team, which took home the gold medal at the Tokyo Olympics last year. She was named the best setter at the Tokyo games and has been a member of the team since 2018.

Unfortunately, according to a report from ABC 7 News, her gold medal was stolen from her car in a parking garage in Anaheim, California, on May 25.

It was taken along with her passport, which she kept in her glove compartment. While storing a gold medal in your car probably isn’t the best idea, she did it to keep it by her side while fulfilling the hectic schedule of an Olympian.

"We live this crazy life of living so many different places. So many of us play overseas, then go home, then come out here and train,” Poulter said, according to ABC 7. "So I keep the medal on me (to show) friends and family I haven't seen in a while, or just people in the community who want to see the medal. Everyone feels connected to it when they meet an Olympian, and it's such a cool thing to share with people."

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Marlon Brando on "The Dick Cavett Show" in 1973.

Marlon Brando made one of the biggest Hollywood comebacks in 1972 after playing the iconic role of Vito Corleone in Francis Ford Coppola’s “The Godfather.” The venerable actor's career had been on a decline for years after a series of flops and increasingly unruly behavior on set.

Brando was a shoo-in for Best Actor at the 1973 Academy Awards, so the actor decided to use the opportunity to make an important point about Native American representation in Hollywood.

Instead of attending the ceremony, he sent Sacheen Littlefeather, a Yaqui and Apache actress and activist, dressed in traditional clothing, to talk about the injustices faced by Native Americans.

She explained that Brando "very regretfully cannot accept this generous award, the reasons for this being … the treatment of American Indians today by the film industry and on television in movie reruns, and also with recent happenings at Wounded Knee."

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