Monday, October 23, 2023

Health news bits: Drug industry fights drug price negotiation; Drug industry fights low-cost drugs

A WaPo opinion discusses intense industry opposition to negotiating drug prices for Medicare:
In recent months, drug manufacturers and their allies have filed 10 lawsuits attacking one of the Inflation Reduction Act’s core health policy achievements: its plan for Medicare to negotiate drug prices. Applying to a select number of especially profitable drugs that have been on the market for at least nine or 13 years, negotiation is intended to arrive at a fair price — at least 25 percent less than the manufacturer’s price — based on the drug’s proven clinical benefits. Manufacturers set prices without meaningful constraint, and the Inflation Reduction Act’s negotiation, the first round of which will begin next year, is predicted to save Medicare $100 billion by 2031. Now, the pharmaceutical industry is attempting to achieve through the courts what it could not through the legislative process — maintaining unreasonably high brand-name drug prices at the expense of the American public.

At their core, the complaints argue that giving Medicare the power to negotiate infringes the rights of pharmaceutical manufacturers to sell prescription drugs at any price they set. Their arguments rely on the untenable premise that for-profit companies have a constitutionally protected right to receive taxpayer dollars. Even more alarmingly, they assert that the unmatched profitability of the pharmaceutical industry is itself a public good that should be judicially guarded at the expense of patients and taxpayers. Courts and the public must reject these claims.  
First, the manufacturers argue that the plan violates the takings clause of the Fifth Amendment, which prohibits the government from taking private property without just compensation. Manufacturers may have a right to own and sell their drugs. However, they do not have a right to any particular level of Medicare reimbursement. Courts have agreed that private health-care entities can’t set their own payment rates, or expect to participate in voluntary programs such as Medicare without conditions.  
Second, manufacturers claim a violation of the Fifth Amendment due process clause, which prohibits the deprivation of liberty or property without due process of law. Courts have recognized due process rights in the context of certain public benefits, such as social security for those with disabilities. But Medicare is not a benefit program for drug manufacturers. Rather, Medicare’s intended beneficiaries are the American people, many of whom cannot afford the cost of drugs at the rates manufacturers have set.
Once again, the thinking and morals of American plutocrats is quite clear. They don't care about us or social well-being. They care about themselves and profit. The audacity of arguing that the unmatched profitability of the pharmaceutical industry is itself a public good is a lie on the scale of the authoritarian radical right's colossal stolen 2020 election lie. 

One can see the plutocratic, government-hating USSC siding with the drug industry on this one.
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Why low-cost ketamine is still inaccessible to many with severe depression

Patients with treatment-resistant depression are missing out on potentially life-changing treatment with ketamine because systemic barriers in the public health system have made it unaffordable.

The researchers drew attention to the fact that it is now more than 20 years since the first indications that generic ketamine was effective, but public funding to support research and patient access has been slow, uncoordinated and underfunded. They also say there have been insufficient commercial incentives to conduct the research and development of generic ketamine, nor any schemes promoting public-private partnerships.

There is now a stark disparity in the accessibility and cost of ketamine-based depression treatments. The patented, intranasal s-enantiomeric ketamine formulation, Spravato, is priced at around $500 to $900 per dose, whereas generic ketamine stands at about $5 to 20 per dose. This high cost has led to Spravato being rejected for public reimbursement three times and thus it remains largely inaccessible for Australian patients.

This narrative is not unique to ketamine, as the article foresees a similar fate for upcoming psychedelic-assisted psychotherapy treatments, which are on the verge of entering the mental health treatment arena. The article suggests that without systemic interventions, the cycle of underutilizing low-cost effective solutions is set to continue, leaving patients unable to access treatments while threatening to blow out health care costs.
US prices for ketamine range from ~$200 to ~$12,000 depending on what the drug is being used for, e.g., pain, depression, anesthesia, etc. 

In the UK, where there are drug price controls based on cost-benefit analysis, England's influential cost watchdogs rejected J&J's ketamine depression drug Spravato (nasal ketamine spray). The US does not rely on cost-benefit analyses like the European Union and the UK do for drug pricing. The reason for that is obvious - the drug industry has corrupted the US government.

Once again, the thinking and morals of plutocrats is clear. They care only about themselves and profit.

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