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Nocturnal Reflections on Trump’s Blurry Overtures on Drug Prices

Night owl drug prices

Forcing price transparency in drug ads, proposing international reference pricing for Medicare Part B, and even drug importation can all be found in President Trump’s lunchbox of policy ideas to take on the drug companies, who are “getting away with murder.”

Huh, am I dreaming?

Is Donald Trump really a Republican? Is former Eli Lilly President Alex Azar, now HHS Secretary, really advocating such radical ideas, such as importation, against his pharma friends? Scott Gottlieb, our free-market fanatic FDA Commissioner is crusading against high drug prices, too: winner of Patients for Affordable Drugs Price Fighting Hero Award!

Pinch me. Am I awake?

I am awake and I’m not fooled by this subtle, probably well planned out public relations defense against the progressive and populist tide, which includes Republicans and Democrats. Forget importation this week: 92% of Republican and 96% of Democratic voters support ending the ban on Medicare negotiating drug prices. Finally, the country is united!

Ending the ban on Medicare price negotiations could bring down prices for drugs in all of Medicare.

But Alex Azar’s proposal to reduce drug prices in Medicare is only for Part B, half the country, and on a small group of medications. Forcing drug companies to list prices on TV drugs ads does not bring those prices down. And the importation idea is good, but super limited, and it’s still just talk!

Jamie Love from Knowledge Ecology International’s comment on Trump’s Medicare Part B proposal is caustic yet correct in describing the Trump administration’s policy and general approach:

“If one was to design a program that appeared to address the need to curb high prices for drugs, without doing much in Trump’s first term, and promising nothing after 2025, it might look like the proposal.”

On the other hand—and this is where compromise begins to seep in and you can’t help but know it’s because Trump is no normal Republican—the former President of Eli Lilly USA, Alex Azar, is advocating for forcing price reductions on drugs in Medicare Part B and importing foreign versions of lower-cost medications for single source drugs; and working in an administration giving voice to drug price transparency. Who would have thought that possible two years ago?

Not me. Am I dreaming?

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Online Pharmacies Did Not Fuel the Opioid Crisis

Fuel Opioid CrisisThe role of the Internet as a channel to obtain and misuse prescription narcotics is tiny.

A report published by the Substance Abuse and Mental Health Services Administration (SAMHSA), a division of the U.S. Centers for Disease Control and Prevention, blamed the Internet for 0.1% (one tenth of 1%) of all narcotic abuse. That data was from 2015. The latest such report, which is called the National Survey on Drug Use and Health has new data from 2017 that doesn’t even have a category for the Internet.

It’s hard to tell if the new number is lower or higher than 0.1%. While 0.1% appears to be statistically insignificant, people have died buying narcotic prescription drugs online and all channels of abuse need to be addressed.

Drug Companies Want to Hide Lower Drug Prices from Americans

On the other hand, drug companies are lobbying Congress to crackdown on Internet companies about opioids, but what they really want is for Americans to stop using the Internet to access lower prescription drug prices from Canada and other countries. In fact, drug giant Eli Lilly wants to censor the Internet by removing Canadian online pharmacies from Google search results in the U.S. Let’s address opioid sales online with a scalpel, not a sledge hammer. More importantly, let’s put resources into treatment and use law enforcement where it’s most needed.

According to the government’s survey, of the 11.1 million people who misused prescription opioids, here’s how they obtained them: 53.1% from a friend or relative; 36.6% from a doctor’s prescription; 5.7% from a drug dealer; and 4.6% some other way.

Channels of Obtaining Prescription Opioids for Misuse

I don’t know why SAMHSA removed the Internet as a category but believe there are two possible answers:

One, the internet channel was statistically insignificant.

Two, the incredibly small percentage, 0.1%, did not fit the agenda of the pharmaceutical industry to blame the Internet for illegally obtained prescription narcotics.

The data showing that only 0.1% of Americans who abuse opioids get them online doesn’t justify the major crackdown on the Internet desired by the pharmaceutical industry.

Yes, drug companies can lobby Congress and federal agencies to have questions removed and added to research on matters that affect them. The FDA has never reported a person seriously sickened or killed by buying medicine internationally from an online pharmacy that requires a prescription. The safest international online pharmacies don’t sell opioid medicine or any controlled drugs.

What does the category “some other way” account for according to SAMHSA?

Some other way includes write-in responses not already listed in this table or responses with insufficient information that could allow them to be placed in another category.”

That means they didn’t ask about the Internet, but people may have written it in. I’ll update this post when I find out more about it.

Consumer Advocacy

As drug companies continue to pressure Congress about stopping personal drug importation by censoring the Internet, it’s important for consumer advocates to stay on top of this data. As I wrote last week, if you look closely, the law, ironically, defends personal drug importation – even if it’s technically illegal.

Let’s beat the opioid crisis without stopping people from safe personal drug importation of non-opioid, non-controlled products.

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Google and FDA Shake on Censorship of Affordable Medication

Google FDA Handshake MedicationThis past month, Congress passed a flurry of bills dedicated to stopping the devastation of the opioid crisis. One focus is on stopping illegal opioid imports from coming in though the U.S. mail. The Synthetics Trafficking and Overdose Prevention Act, which passed in the House, is one such bill. But as I wrote in the The Hill last year, the STOP Act could also enable the FDA to more easily prevent Americans from importing lower-cost, safe and effective medicines from Canada and other countries.

The FDA is also fighting the opioid crisis by scrutinizing the Internet as a channel of illegal sales. That, too, could lead to the curtailment of access to lower-cost, imported medicines from pharmacies, ones which don’t sell opioids or controlled drugs at all, but do help people afford medicines.

Ideally, people who use a search engine, such as Google, find information based on an objective search algorithm. With tens of millions of Americans not filling prescriptions due to high prices here at home, many are Googling to find and order cheaper medication from international online pharmacies. (more…)

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