Eliquis, for preventing strokes and blood clots, from Bristol Myers Squibb and Pfizer
Jardiance, for diabetes and heart failure, from Boehringer Ingelheim and Eli Lilly
Xarelto, for preventing strokes and blood clots, from Johnson & Johnson
Januvia, for diabetes, from Merck
Farxiga, for chronic kidney disease, from AstraZeneca
Entresto, for heart failure, from Novartis
Enbrel, for arthritis and other autoimmune conditions, from Amgen
Imbruvica, for blood cancers, from AbbVie and Johnson & Johnson
Stelara, for Crohn’s disease, from Johnson & Johnson
Fiasp and NovoLog insulin products, for diabetes, from Novo Nordisk
Of all these, Jardiance (which I’m taking off-label as a T1) is probably the most significant. My Fiasp is covered 100% as DME, but Jardiance is “tier 3” or whatever they call it and subject to the notorious Donut Hole. From August on I gotta pay like $400 x 2 to get to the end of the year, and that hurts. Or go without which also sux. So anything they can do on that would be a help to me.
As for non-Medicare coverage, I think the theory at least is that these negotiations would exert downward pressure on prices across the board. Though the logical part of me wonders if they wouldn’t just raise the cost for everyone else to compensate…
Maybe we see some “trickle down” savings, but I think that the idea has always been this: 1.) Push down pricing for Medicare; followed by 2.) Push down prices on private policies legislatively. Part of the reason for that strategy is simply easier to do this via Medicare than it is in the private marketplace…especially at a Federal level.
This is a step in many, many small incremental steps that have taken place over ten or 15 years.
One of the things that they say when diabetics ask for price regulation, this session, is that they don’t want to regulate the cost of one drug because they recognize that the problem in the markets is much bigger than that. The Federal Trade Commission has stated that they recognize sed problem, but that they haven’t the capacity to deal with it.
There are a LOT of lawsuits still being worked out. That may take some years still. We have State governments being sued by pharma (like MN) and we have State governments suing pharma (of which the largest suit, is CA).
If I had to list all the strategies people are trying out in order to break pharma down, this post would be very long. A lot of this is still being worked out at a State level. This is a play by the Feds. The Feds make smaller plays (typically). But, those cards that they play, have a large impact, so they have to play cautiously. The State’s bet high and make bigger, higher risk plays. They get sued a lot for it. But, its strenuous for pharma to sue lots and lots of State’s simultaneously. It keeps them busy & spending money. I’m sure its wearing them down. The State’s are working like a pack of dogs against Pharma.
Diabetics are the ones who have opened doors for medical market reform. That was hard. Cancer and some other patient communities helped us. Diabetics are a really knowledgeable, capable patient community. Don’t ■■■■with the diabetics.
I seriously don’t understand this. Every payer (insurance) negotiates with the manufacturers to establish a contact for pricing. It’s always been that way. This isn’t anything new. Nothing gets added to an insurer’s formulary until there’s a contract in place regarding payment details. Manufacturers basically have to decide how low they’re willing to go. If they won’t play ball, then they get put on a higher tier and thus get fewer prescribees.
I don’t see what’s any different here. They still have the same power to negotiate that they always did, and the manufacturers still have the same power to agree or not to lower prices. I fear this is just an empty facade for the political season.
All that is true for every insurer except Medicare. Which is the largest single player in the market. That’s why making it part of the ACA was resisted so strenuously and successfully. That’s why it is kind of a big deal, in my understanding.
The private carriers got to have the whole rube-goldberg PBM system, which is basically a scam too, but that’s another topic…
I’m observing this from New Zealand, where we migrated to a year ago from the USA.
It’s interesting to see how Medicare price negotiations are just the very tip of what is the beginning of a comprehensive health system. Without price controls, it’s impossible to have a workable, comprehensive system. That’s the way everyone does it, including New Zealand.
Here all prescription drugs are free to the patient, at least the ones that are “funded”. Humalog, Metformin, no problem. There are also “unfunded” drugs (usually more expensive cancer drugs) which people pay out of pocket for, but even those prices tend to be a lot lower than in the USA. And for those who can afford it, you have the option to buy a private health insurance policy which pays for unfunded cancer drugs. A policy for my 3 person family with this cover costs about $6,000 NZD/year (about $3,500 USD). So everyone gets a base level of care, but you can upgrade for more options. Even so, some drugs just aren’t available. I don’t think any of the ultra rapids like Fiasp are available, for example.
There’s only one drug I pay for. Jardiance costs me $82/month but that’s only because I’m type 1 and it’s only covered for type 2s here. I think in the USA my cost was $300-400/month. (If I were type 2, it would be free-- but then my Tslim cartidges and infusion sets wouldn’t be covered, and they’re more expensive to buy cash). And sadly, CGM is still unfunded-- I pay about $1,200 ($700 USD) every 3 months for G6 sensors and transmitters. It is (finally!) expected to be funded for type 1s some time next year and that will be a huge financial relief.
I’m positive the drug companies are terrified of Medicare cracking open the door to price negotiations and in the grand American tradition of stymieing progress with an unending series of lawsuits, I don’t think we’ll see comprehensive diabetes care in the US any time soon. There’s just too much money to be lost, and the pharma interests are just too powerful. (Clearly more powerful than the insurance lobby, who would love to have price controls on pharma!)
It’s not necessarily negotiation so much as setting a price. Sure there might be some back and forth about an agreement on a price, but for it to work the negotiators have to be willing to say we won’t buy the drug. That’s what happens in other countries. I know that my insurance company years ago would negotiate between Novolog and Humalog for the year. A couple of years that Novolog won, I appealed and then could get the Humalog I liked better, but at a higher tier price.
Some of the drugs on the list don’t have a competitive drug like Novolog does. But I would still hate to have to take the alternative of Novolog over Humalog. From what I gather there were 61 oncology drugs available in 2021 and in 2023 there are 75. 70 are available in the US. But that is not the case in the UK and Canada. Quite a lot less are available there. Other countries don’t offer Dexcom’s or the choice of pumps we have.
Instead of going to a system of not being able to have the choices here. I would prefer a tiered system. Novolog being the cheap choice (or Humalog), whoever agrees to a lower negotiated price and then being able to pay a little more for the drug of my choice like Afrezza. Both parties would benefit, Medicare having a cheaper available drug that a lot would pick, but being able to collect more on ones that won’t lower their price enough. The drug companies would also want to be in the cheaper tier that most would pick from. That’s what happens now with my Medicare Part D insurance, there are 3 tiers. Right now I have the choice of every insulin and I think almost all are tier one, except for Afrezza. I get to pick my pump I like. Instead in other countries you have only 3 companies to pick from and not even their latest pump out. There are waiting lists to even get a Libre, Dexcom One (non calibrating) or a pump in the first place, if you can manage to even get it. Or as many end up doing and privately fund or pay for the CGM or pump they want.
So personally a tiered system works. That way they could still negotiate a price. The problem is Medicare is running out of money and will have to be funded, so they have to cut costs somehow. Less drug costs would help, but it might mean less selection. I personally like the choices we have here.
People are writing Federal bills to fight with private policies this session. It begins. People are really pulling out their guns now. I don’t know what this will be like. Fighting in the ring with private insurers seems like one heck of a fight, but they have set up the chess game as well as they could. We will see what happens.
There is also talk of medical device copay caps popping up at State level. They are gonna free the markets. This sessions lobbyists are a bunch of wild, young things - bright, excellent conversationalists. They can move things, I think. https://www.youtube.com/watch?v=gSWInYFVksg&list=RDMM&index=2
