That is a very good explanation. Unfortunately, the PBMs will begin pressuring Congress as they line the pockets through their lobbyists and paint a very unrealistic picture of the "benefits" they create for medicare. Education such as you provide here will hopefully gain traction and we as pharmacists can gain traction in this tainted world of politics and deception.
If you keep writing like this and we all can actually get people (patients, Congress, state legislatures, the president) to read it, maybe the whole system will change for the better
I’ve been on Stelara 90mg for 5yrs, at 6 week intervals, the cost ranges from 20k-25k depending on ….? The month??? One of my children researched it for a project in High school, turned out it only cost $1100 +/- to manufacture…you’d think the R &D would have been covered by know, since it was a failed Camcer treatment to start with!?
Adam Fein is not friend of pharmacies or 340B program. He is bought and paid for my PhRMA and PBMs. Challenge him on his facts about 340B and he will block you on Twitter. Fact is the discounted price for EpiPens, insulin and almost all other drugs are passed on to the patient already. I’ve worked in 340B for 20 years and that has been the primary model y hospitals and FQHC’s. Our uninsured patients have paid no more than $20 for EpiPens and most insulin’s for years.
Of course he isn’t a friend to pharmacy or 340b. In fact he seems to be an avowed enemy of the 340b program. However, he writes a LOT about the program and links to the source documents. Most of my understanding of the 340b program has come from following his blog, even if I do have to take his opinions with a grain of salt.
I’m glad that the CEs that you’ve worked for have been kind to their patients to limit the price of insulins and epipens. Clearly that has NOT been the case for all CEs across the country, or this EO would not exist, unless you believe that Alex Azar and the HRSA administrator have a personal beef against the 340b program.
do not think that Alex Azar has an understanding of how the 340B program is implemented across the country. I am very active nationally in 340B and meet with colleagues across the country several times a year. Most 340B CE’s extend 340B savings to uninsured. All are not for profit and are required to provide care regardless of the ability of the patients ability to pay. 340B also helps to cover expenses for those uninsured patients as well. This particular EO will have little or no impact on drug cost in the US. Add 340BHealth to your tasking list to get more balanced information on the program.
It wasn’t log ago that Fein was a lap dog for PCMA. His complete lack of experience in any healthcare setting is troubling as well.
Reimportation of drugs from Canada would create an unfair competitive advantage for Non-US pharmacies. The EO needs to demand that US pharmacies have access to the same drug cost as Canada to be fair. This EO will force US pharmacist to look like the bad guys when we have to fight it in court to maintain fairness and protect the jobs for US pharmacist. You’re correct that it would need congressional action to implement and isn’t likely to see the light of day.
My main point here with the 340b EO is that it will have a very limited impact. It will only impact the rather small subset of people who a) are uninsured b) receive care from a 340b eligibility FQHC c) their FQHC doesn't already pass along discounts and d) need insulin or epipens. That’s not a lot of folks.
With reimportation... I’m not thrilled about weakening the closed system of drug supply that we have to save a few bucks. Counterfeit drugs exist and are much easier to introduce to the supply outside the normal channels created by the FDCA and the DQSA. And I believe that prices are higher here because we have the PBM system instead of a price control system like the rest of the OECD.
The nail in the coffin for the EO on FQHC’s is that HRSA doesn’t have the regulatory authority to mandate a change like this, without congressional action as well.
The most fascinating piece to me about 340b is how limited HRSA’s authority is. Apparently they don’t have the authority to force manufacturers to sell product at 340b prices to contract pharmacies... see the Cialis case.
Yes, that is PhRMA testing the waters. If they move forward with other drugs, it cuts them off from the uninsured patients brain able to access the discounted price. It’s a two edged sword for PhRMA in stripping away HRSA’s authority, as it significantly expands the definition of a patient in the program as well. At this point in time, HRSA really has almost no regulatory authority over the program. Congress will eventually have to give them more authority than they have at the moment.
The minorest of quibbles here - but Stelara isn't a 20,000/month drug. It's at worst 20,000/2 months for ulcerative colitis, or 10,000/3 months for a sub-220 lb psoriasis patient. Doesn't affect the point at all, but just the numbers being used!
Its a very nice article, explaining how the new orders affect pharmacy profession! I really enjoyed reading it!
That is a very good explanation. Unfortunately, the PBMs will begin pressuring Congress as they line the pockets through their lobbyists and paint a very unrealistic picture of the "benefits" they create for medicare. Education such as you provide here will hopefully gain traction and we as pharmacists can gain traction in this tainted world of politics and deception.
absolutely yes, PCMA has already released their standard response. https://www.pcmanet.org/pcma-statement-on-administrations-executive-order-on-prescription-drug-pricing/
If you keep writing like this and we all can actually get people (patients, Congress, state legislatures, the president) to read it, maybe the whole system will change for the better
I plan to write a little here and there about current topics in pharmacy.
I’ve been on Stelara 90mg for 5yrs, at 6 week intervals, the cost ranges from 20k-25k depending on ….? The month??? One of my children researched it for a project in High school, turned out it only cost $1100 +/- to manufacture…you’d think the R &D would have been covered by know, since it was a failed Camcer treatment to start with!?
Adam Fein is not friend of pharmacies or 340B program. He is bought and paid for my PhRMA and PBMs. Challenge him on his facts about 340B and he will block you on Twitter. Fact is the discounted price for EpiPens, insulin and almost all other drugs are passed on to the patient already. I’ve worked in 340B for 20 years and that has been the primary model y hospitals and FQHC’s. Our uninsured patients have paid no more than $20 for EpiPens and most insulin’s for years.
Of course he isn’t a friend to pharmacy or 340b. In fact he seems to be an avowed enemy of the 340b program. However, he writes a LOT about the program and links to the source documents. Most of my understanding of the 340b program has come from following his blog, even if I do have to take his opinions with a grain of salt.
I’m glad that the CEs that you’ve worked for have been kind to their patients to limit the price of insulins and epipens. Clearly that has NOT been the case for all CEs across the country, or this EO would not exist, unless you believe that Alex Azar and the HRSA administrator have a personal beef against the 340b program.
do not think that Alex Azar has an understanding of how the 340B program is implemented across the country. I am very active nationally in 340B and meet with colleagues across the country several times a year. Most 340B CE’s extend 340B savings to uninsured. All are not for profit and are required to provide care regardless of the ability of the patients ability to pay. 340B also helps to cover expenses for those uninsured patients as well. This particular EO will have little or no impact on drug cost in the US. Add 340BHealth to your tasking list to get more balanced information on the program.
It wasn’t log ago that Fein was a lap dog for PCMA. His complete lack of experience in any healthcare setting is troubling as well.
Reimportation of drugs from Canada would create an unfair competitive advantage for Non-US pharmacies. The EO needs to demand that US pharmacies have access to the same drug cost as Canada to be fair. This EO will force US pharmacist to look like the bad guys when we have to fight it in court to maintain fairness and protect the jobs for US pharmacist. You’re correct that it would need congressional action to implement and isn’t likely to see the light of day.
Fair points all.
My main point here with the 340b EO is that it will have a very limited impact. It will only impact the rather small subset of people who a) are uninsured b) receive care from a 340b eligibility FQHC c) their FQHC doesn't already pass along discounts and d) need insulin or epipens. That’s not a lot of folks.
With reimportation... I’m not thrilled about weakening the closed system of drug supply that we have to save a few bucks. Counterfeit drugs exist and are much easier to introduce to the supply outside the normal channels created by the FDCA and the DQSA. And I believe that prices are higher here because we have the PBM system instead of a price control system like the rest of the OECD.
The nail in the coffin for the EO on FQHC’s is that HRSA doesn’t have the regulatory authority to mandate a change like this, without congressional action as well.
The most fascinating piece to me about 340b is how limited HRSA’s authority is. Apparently they don’t have the authority to force manufacturers to sell product at 340b prices to contract pharmacies... see the Cialis case.
Yes, that is PhRMA testing the waters. If they move forward with other drugs, it cuts them off from the uninsured patients brain able to access the discounted price. It’s a two edged sword for PhRMA in stripping away HRSA’s authority, as it significantly expands the definition of a patient in the program as well. At this point in time, HRSA really has almost no regulatory authority over the program. Congress will eventually have to give them more authority than they have at the moment.
Good job Ben. You should post this in a word document so we can share this. At least maybe email it to me. Thanks
You are welcome to share the link: https://benjaminjolley.substack.com/p/executive-orders
The minorest of quibbles here - but Stelara isn't a 20,000/month drug. It's at worst 20,000/2 months for ulcerative colitis, or 10,000/3 months for a sub-220 lb psoriasis patient. Doesn't affect the point at all, but just the numbers being used!
Thank you I will edit the post.
Fact check before you edit
There are some Crohns patients getting Stelara @ 4wk intervals..hence 20k/mo..you definitely have a minor something…
Your description of kickbacks was great. Wish I could share this with my customers & friends
You are welcome to share the link here: https://benjaminjolley.substack.com/p/executive-orders