Pharmacy Benefit Managers and Drug Makers are OUT OF CONTROL

February 27, 2023

Feb 27, 2023

Good Day Healthcare Advocates

I am so thankful for all of you and for the actions you take to move us towards a universal healthcare system. Some of the topics in work are:

The current state of healthcare providers and the potential impact of Universal Healthcare on them
How Universal Healthcare affects the insurance industry (it’s not what you think)
Rural healthcare challenges
Hospice Fraud revisited - this is worse than was reported

Please send topics to me via the chat button and I will research and report. If you need assistance in other ways, lectures, presentations, etc. Just let me know, I’m happy to help.

Diabetes:

What Is It & How to Profit From It

Diabetes is actually a variety of endocrine diseases characterized by high blood sugar levels. It can be caused by a lack of insulin secreting cells in the pancreas, which is an autoimmune condition, and is called Type 1 or an imbalance in blood sugar levels and insulin production called type 2. Type 2 makes up about 90% of the cases in the US

It turns out to be fairly common. 37 million adults (11.3%) in the US between 20 and 79 have it and it is expected to rise to 54.9 million by 2030.

69% of those have high blood pressure
44% have high cholesterol
39% have chronic kidney disease
12% reported having vision impairment or blindness

According to the CDC $1 out of every $4 in US health care costs is spent on caring for people with diabetes. That’s about $237B on direct costs and $90B on lost productivity. 61% of all diabetes costs are for people 65 and older - read that as Medicare, and the cost for each of those Medicare beneficiaries with diabetes is almost $6000/year.

There are a lot of medications used to treat diabetes. Insulin, of course, but there are other things to try first. These include Metformin, Semaglutide, injectables of Semaglutide like Ozempic and others.

Now let’s remember how drug companies and Pharmacy Benefit Managers (PBMs) make a killing. Drug makers want to keep a patent as long as possible and so will tweak formulas and repatent the drug. Doing this gets them decades of sales. If they are the only provider then it is all the traffic will bear. As an example, Ozempic prices have doubled in the last 6 months. Remember that PBMs take kickbacks to put drugs on the insurance formulary which helps keep prices high. This is not to save money for patients but to make more money for PBMs. Of course, drug manufacturers often raise their prices to account for the bribes they have to pay to get sales.

Regarding insulin, the developers James Collip and Charles Best, sold the insulin patent to the University of Toronto for a mere $1. They wanted everyone who needed their medication to be able to afford it.

It gets better. I know you remember that there are 3 PBMs (CVS Caremark, OptumRX and ExpressScripts) out there controlling about 90% of all prescriptions and there are only three insulin makers Eli Lilly, Novo Nordisk, and Sanofi. Together they have made sure that diabetics in the US pay about 10 times what diabetics in Europe pay.

In January of this year, the California AG, Rob Bonta, sued these 6 companies for violating the state’s unfair business practices, using deceptive, illegal and unfair schemes to drive up the cost of the life saving drug. Here is the 47-page suit if you lack reading material.

Any such laws on unfair business practices at the Federal Level? You bet there are. They are in Section 5 of the Federal Trade Commission Act (FTC Act) (15 USC 45) which prohibits ''unfair or deceptive acts or practices in or affecting commerce. “

According to Precedence Research the global type 2 diabetes market was estimated at US$ 29.81 billion in 2021 and is projected to worth around US$ 61.6 billion by 2030, growing at a compound annual growth rate (CAGR) of 8.4% from 2022 to 2030. Who’s ready to invest?

If you need additional watching material on drug makers screwing the public, here is Representative Katie Porter. She brings up an interesting point that a drug she chose to look at was not changed, to help patients and yet the price was raised inordinately high, thus screwing the public. Additionally, the drug companies tell us that they need the high prices to do research. That’s BS. Most new drugs are not invented at drug companies. The research is done at universities and that is often funded by public dollars. They then sell those patents to the drug makers.

When pricing for items in the healthcare infrastructure is ALL THE TRAFFIC WILL BEAR people will die.

I’m not ok with that. I hope you aren’t either. Of course, if we had universal health care that negotiated prices for all drugs then we could spend our time going to an ice cream social instead of annoying federal employees.

What You Can Do

Contact the attorney general of the US by phone at 202-353-1555 or email him at https://www.justice.gov/doj/webform/your-message-department-justice and say

“My name is _________ and I live in zipcode_________. I am tired of drug makers and pharmacy benefit managers running roughshod over US consumers. The artificially high prices of insulin are an example. It is 10x more in the US than in Europe. The pharmacy benefit managers and manufacturers are violating Section 5 of the Federal Trade Commission Act (FTC Act) (15 USC 45) which prohibits ''unfair or deceptive acts or practices in or affecting commerce.
There are 3 pharmacy Benefit Managers and 3 manufacturers that are the worst and cover about 90% of the insulin sold in the US. They are CVS Caremark, ExpressScripts, Optum RX, Eli Lilly, Novo Nordisk, and Sanofi.
I want you to sue them in federal court for their illegal behavior with respect to insulin costs to consumers.”