More

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.

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

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.

True

When Sue Hoppin was in college, she met the man she was going to marry. "I was attending the University of Denver, and he was at the Air Force Academy," she says. "My dad had also attended the University of Denver and warned me not to date those flyboys from the Springs."

"He didn't say anything about marrying one of them," she says. And so began her life as a military spouse.

The life brings some real advantages, like opportunities to live abroad — her family got to live all around the US, Japan, and Germany — but it also comes with some downsides, like having to put your spouse's career over your own goals.

"Though we choose to marry someone in the military, we had career goals before we got married, and those didn't just disappear."

Career aspirations become more difficult to achieve, and progress comes with lots of starts and stops. After experiencing these unique challenges firsthand, Sue founded an organization to help other military spouses in similar situations.

Sue had gotten a degree in international relations because she wanted to pursue a career in diplomacy, but for fourteen years she wasn't able to make any headway — not until they moved back to the DC area. "Eighteen months later, many rejections later, it became apparent that this was going to be more challenging than I could ever imagine," she says.

Eighteen months is halfway through a typical assignment, and by then, most spouses are looking for their next assignment. "If I couldn't find a job in my own 'hometown' with multiple degrees and a great network, this didn't bode well for other military spouses," she says.

She's not wrong. Military spouses spend most of their lives moving with their partners, which means they're often far from family and other support networks. When they do find a job, they often make less than their civilian counterparts — and they're more likely to experience underemployment or unemployment. In fact, on some deployments, spouses are not even allowed to work.

Before the pandemic, military spouse unemployment was 22%. Since the pandemic, it's expected to rise to 35%.

Sue eventually found a job working at a military-focused nonprofit, and it helped her get the experience she needed to create her own dedicated military spouse program. She wrote a book and started saving up enough money to start the National Military Spouse Network (NMSN), which she founded in 2010 as the first organization of its kind.

"I founded the NMSN to help professional military spouses develop flexible careers they could perform from any location."

"Over the years, the program has expanded to include a free digital magazine, professional development events, drafting annual White Papers and organizing national and local advocacy to address the issues of most concern to the professional military spouse community," she says.

Not only was NMSN's mission important to Sue on a personal level she also saw it as part of something bigger than herself.

"Gone are the days when families can thrive on one salary. Like everyone else, most military families rely on two salaries to make ends meet. If a military spouse wants or needs to work, they should be able to," she says.

"When less than one percent of our population serves in the military," she continues, "we need to be able to not only recruit the best and the brightest but also retain them."

"We lose out as a nation when service members leave the force because their spouse is unable to find employment. We see it as a national security issue."

"The NMSN team has worked tirelessly to jumpstart the discussion and keep the challenges affecting military spouses top of mind. We have elevated the conversation to Congress and the White House," she continues. "I'm so proud of the fact that corporations, the government, and the general public are increasingly interested in the issues affecting military spouses and recognizing the employment roadblocks they unfairly have faced."

"We have collectively made other people care, and in doing so, we elevated the issues of military spouse unemployment to a national and global level," she adds. "In the process, we've also empowered military spouses to advocate for themselves and our community so that military spouse employment issues can continue to remain at the forefront."

Not only has NMSN become a sought-after leader in the military spouse employment space, but Sue has also seen the career she dreamed of materializing for herself. She was recently invited to participate in the public re-launch of Joining Forces, a White House initiative supporting military and veteran families, with First Lady Dr. Jill Biden.

She has also had two of her recommendations for practical solutions introduced into legislation just this year. She was the first in the Air Force community to show leadership the power of social media to reach both their airmen and their military families.

That is why Sue is one of Tory Burch's "Empowered Women" this year. The $5,000 donation will be going to The Madeira School, a school that Sue herself attended when she was in high school because, she says, "the lessons I learned there as a student pretty much set the tone for my personal and professional life. It's so meaningful to know that the donation will go towards making a Madeira education more accessible to those who may not otherwise be able to afford it and providing them with a life-changing opportunity."

Most military children will move one to three times during high school so having a continuous four-year experience at one high school can be an important gift. After traveling for much of her formative years, Sue attended Madeira and found herself "in an environment that fostered confidence and empowerment. As young women, we were expected to have a voice and advocate not just for ourselves, but for those around us."

To learn more about Tory Burch and Upworthy's Empowered Women program visit https://www.toryburch.com/empoweredwomen/. Nominate an inspiring woman in your community today!

Canva

Dr. David McPhee offers advice for talking to someone living in a different time in their head.

Few things are more difficult than watching a loved one's grip on reality slipping away. Dementia can be brutal for families and caregivers, and knowing how to handle the various stages can be tricky to figure out.

The Alzheimer's Association offers tips for communicating in the early, middle and late stages of the disease, as dementia manifests differently as the disease progresses. The Family Caregiver Alliance also offers advice for talking to someone with various forms and phases of dementia. Some communication tips deal with confusion, agitation and other challenging behaviors that can come along with losing one's memory, and those tips are incredibly important. But what about when the person is seemingly living in a different time, immersed in their memories of the past, unaware of what has happened since then?

Psychologist David McPhee shared some advice with a person on Quora who asked, "How do I answer my dad with dementia when he talks about his mom and dad being alive? Do I go along with it or tell him they have passed away?"

McPhee wrote:

Keep Reading Show less