Drug companies are beginning to realize that a huge proportion of patients aren’t taking their medications as often as they’re prescribed. And they’re finally concluding that they could make more money if people actually took them all daily. An NYT article looks at the trend , including drug companies calling patients and encouraging them to continue taking their meds. It brings up a number of good points: what happens when the medication goes generic? If you switch to a different version of the same medication class, does the patient get kicked out of the program?

I’ve always thought that drug companies should be handing out free weekly or monthly pill boxes to patients with polypharmacy to increase adherence (it’s adherence , NYT, not compliance ), but that’s just me.

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Item 1: Medicare is paying employers to maintain their retirement plan health care benefits, to the tune of $4 billion. These health benefits compete with Medicare Part D benefits.

Item 2: We already subsidize health care insurance, primarily through making business expenses for health insurance tax-deductible.

Item 3: Medicare isn’t allowed to negotiate on drug costs, although another federal agency, the VA, can. Medicare pharmaceuticals cost sometimes double what VA drugs cost .

Item 4: Our President’s plan to fix the health care system, Health Savings Accounts, is primarily targetted toward the middle- and upper-classes , those who already have health insurance. It also ignores the fact that approximately 80% of health care costs come from approximately 20% of patients (the really sick ones).

What’s next? The government subsidizing the drug companies for taking part in the Medicare D benefit?

Is it just me, or does it seem like our leaders are just setting up the government to fail?

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Read’em and weep , common logic. If you drop co-pays for the sickest and most at-risk people, you save tens of thousands of hospitalizations and thousands of ED visits. A RAND study.

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I honestly wonder how much the American Health Insurance Plans association paid United Press International for this total fluff piece supporting Medicare Part D .

“I’m hearing shock from (state) Medicaid directors that we’re getting better prices than they are,” she told UPI. “I don’t know of any other government program where the real costs are less than the estimates,” she said, arguing that the plans are offering “affordable products” with low premiums and low deductibles. -Karen Ignagni, president of the health insurance association

Actually, Karen (can I call you Karen?), the administration has been charged with trying to supress the real cost of the plan, getting the program passed with a much lower estimate . The administration told Congress the plan would cost $534B over 10 years, when it’ll probably actually cost more than double that. Whoops.

And, uh, by the way, UPI, your headline is absolutely wrong. The “Fed”–that’s the VA, right?– actually gets better prices than Medicare Part D .

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If you haven’t been following the news, the Medicare Part D drug benefit is turning out to be a disaster–millions of seniors aren’t getting their prescription drugs, for any number of reasons: they’re not listed in the computer, the computer is giving pharmacies wrong information about costs, or the computer systems just aren’t working at all. Pharmacies are on hold for 2-3 hours for one single patient, and states are declaring public health emergencies and paying for the drugs themselves. Recently, the President told insurers the system isn’t working, and that, at least temporarily, there needs to be price controls.

This is a brilliant system for Pharma. They practically wrote the bill, saying how great it would work, and now private insurers and the federal government, who have to implement it, take the blame for a crappy system. Bravo Pharma, bravo! Jolly good play there.

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I’ve been in contact with a really great Medicare patient advocate for the state of Arizona, and he’s filled me in on why some drugs aren’t listed in the Medicare Drug Calculator :

In your tutorial , you mention that you have questions with the “Enter My
Medications” section. First, the Federal legislation expressively
prohibited Medicare Part D from providing barbiturates and benzodiazepines,
so they won’t show up. Second, an approved plan is only required to provide
two drugs in each treatment category, so many drugs are not on many of the
formularies, although they are also required to provide “substantially all”
drugs available for the treatment of Cancer, AIDS, and a list of other
conditions.

As all of us who’ve used the Plan Finder know, the prescription information
that the person provides us (even with their prescription bottles in front
of us or a pharmacy printout) doesn’t always match what’s available in the
Plan Finder’s prescription drug drop-down lists. A weird example is that I
have sometimes found a brand name only by going to the name of the generic,
and vice versa.

There is a significant challenge to us who don’t have a medical background.
I can sometimes narrow the specific form of a drug down by going to
http://www.rxlist.com/ and finding how the drug is provided, as I don’t have
a current PDF. As a fictional example: I find in the drop-down list that
there are both an “EX” form of a drug and a “TG” form. Looking at this
website (or PDR, or whatever), I see that the “EX” is available in 2.5, 5,
and 10 mg tablets, whereas the “TG” form is in a 10 ml vial, and the
prescription that the person is taking is 5 mg.

I always tell the person being screened when there is uncertainty as to one
of their prescriptions or when I have to leave a drug off the list. I
recommend that they contact the company(s) directly and find out how those
prescriptions will be handled, before enrolling.

Also, here’s a list he sent me of drug classes that have to covered under Medicare Part D:

REQUIRED COVERAGE FOR “ALL OR SUBSTANTIALLY ALL” MEDICATIONS FOR:

• Cancer medications
• HIV/AIDS treatments
• Antidepressants
• Antipsychotic medications
• Anticonvulsive treatments
• Immunosuppressants

(source: CMS webcast PowerPoint slide 4, 9/28/05)

MEDICATIONS EXCLUDED FROM COVERAGE UNDER MEDICARE PART D:
Drugs for:

• Anorexia, weight loss, or weight gain
• Fertility
• Cosmetic purposes or hair growth
• Symptomatic relief of cough and colds
• Prescription vitamins and mineral products
• Except prenatal vitamins and fluoride preparations
• Non-prescription drugs
• Barbiturates
• Benzodiazepines

(source: CMS 2005 REACH training, Module 10, May 29, 2005, PowerPoint, p.
59)

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Today is one of those days that makes me want to move to Canada, France, Spain, or Great Britain, because I’m just utterly disgusted by the Almight Dollar. I’m probably mesmerized by dreams of a greener grass, but today I’m willing to risk it–the weeds we’ve got here are downright rotten .

So we start off with Health Care Renewal’s postings about for-profit institutional review boards (the committees that are supposed to protect you and me from unethical trials like the Tuskegee experiements) and a Bloomberg article describing illegal immigrants desperate for cash being recruited for experimental drug trials . I’m *sure* they’ve all been adequately consented, and their translated consent forms have been approved. By a for-profit institutional review board. Now even Hopkins is using for-profit review boards. ( In case you were wondering by bioethicists haven’t been up in arms about this. ) The whole *point* of an IRB is that it’s supposed to be objective. It’s supposed to be free from outside influences that may skew the committee in one way or another. But *paying* them, oh no, that’s fine. He who pays the piper calls the tune.

And then I go read Kate’s find that we’re wasting hemorrhaging (that means we’re really wasting) money on the new Medicare Drug benefit . Had we just expanded the VA system, senior medications could have been automatically available and at hundreds of dollars per year of savings. (This matters a lot when you’re on a fixed income.) Note: ask your doctor if there are alternatives to the medications you’re on. For example, the “Protonix” example given could be changed to omeprazole (Prilosec), a much cheaper alternative drug in the same class as Protonix and nexium.

And then to top it all off, I go see Syriana. A perfect end to a anti-American day.

I’m a firm believer in the mantra that you can judge a society by it treats its most vulnerable members, and frankly America, we’ve earned an F.

(That’s with the grade inflation.)

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We teach medical students that the reasons for an association or lack of one in a clinical study are: chance, causality,bias and confounding. The fifth factor, fraud, was not typically emphasized in that regard, now it maybe it should be.

Nuff said.

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