PUMPING IRONY: A Tough Pill to Swallow

I consider myself lucky to be among the 10 percent of U.S. seniors who do not take a prescription drug, so recent Congressional action promising to dramatically reduce the cost of pharmaceuticals for Medicare beneficiaries won’t have the same effect on my wallet as it will on those of the vast majority of my elderly compatriots. And, while it’s certainly cause for celebration, I can’t help but wonder whether it will increase our longtime dependence on Big Pharma to manage chronic illnesses.

The legislation, tucked into the cleverly titled Inflation Reduction Act of 2022, will allow Medicare officials to negotiate some drug prices for its beneficiaries beginning in 2026. The bill caps insulin costs for the Medicare set at $35 a month starting next year, and their annual out-of-pocket drug costs at $2,000 in 2025. Beginning in 2024, it will also remove the 5 percent copay for prescriptions when seniors qualify for Medicare’s “catastrophic coverage” benefit.

“This is a huge policy change and one that has been a long time coming,” Stacie Dusetzina, PhD, an associate professor of health policy at Vanderbilt University, tells the New York Times. “For people needing high-cost drugs, this will provide significant financial relief.”

Kim Armbruster is a case in point. The retired nurse tells the Times that she enrolled in Medicare in March and by June had spent more than $7,000 for an assortment of prescriptions she needs to manage her arthritis, Graves’ disease, atrial fibrillation, and insulin. She’s not alone. In 2019, about 1.5 million Medicare beneficiaries reached the catastrophic threshold, according to a Kaiser Family Foundation study. And between 2015 and 2019, 2.7 million seniors qualified for catastrophic assistance at some point.

Then there’s Pete Spring, who since 2016 had shelled out about $1,000 each month for 11 medications, including those prescribed for Alzheimer’s, a heart condition, depression — and to manage the side effects of the Alzheimer’s drug. Before his death in April, Spring and his wife, Gretchen Van Zile, ran through $60,000 in pension payments in their effort to manage his various illnesses. Congressional action arrived a little late for them. “Here seniors are in their golden years,” Van Zile says, “and the only people seeing gold are the pharmaceutical companies.”

“[S]eniors are in their golden years and the only people seeing gold are the pharmaceutical companies.”

Big Pharma, after spending more than $100 million this year lobbying against the bill, is predictably whining about how the government is cramping its innovative muscles. The move, PhRMA CEO Stephen Ubl recently lamented, will “devastate patients desperate for new cures.”

Yet, as Arthur Allen notes in Kaiser Health News, earlier measures to boost generic drugs against industry objections resulted in soaring approval rates for new medications in the years that followed. A similar flood of new pills followed the passage of the Affordable Care Act, despite forecasts of doom by Big Pharma and its Congressional enablers.

Critics argue that drugmakers tend to invest most heavily in costly patented medications that only marginally improve patient outcomes. This is particularly true of cancer drugs, Mayo Clinic oncologist Vincent Rajkumar, MD, tells Allen. Principal investigator on clinical trials for a multiple-myeloma drug called Ninlaro, Rajkumar says it was no more effective than an existing generic medication — but it cost eight times more. Another recently approved pill has been shown to slow progression of the disease by about four additional months but costs $22,000 a month.

If the industry is forced to negotiate prices, Rajkumar contends, “maybe the companies would spend their research and development funds on something more meaningful.”

I’d like to say it’s rapacious drug pricing that has kept me out of the pharmacy all these years, despite pleas from various beleaguered physicians that I start popping statins and ACE inhibitors to lower my cholesterol and blood pressure. But it’s really my commitment to diet, exercise, and stress management — as well as a fear of tumbling into the Big Pharma vortex, where drug interactions meet dependence — that has persuaded me to abstain.

One in three older Americans take prescription drugs that do not appropriately address their symptoms. It’s often the result of general practitioners trying to manage their patient’s multiple conditions without communicating effectively with specialists and pharmacists.

Clearly, there are certain conditions that call for effective medications, and I’m not so naive as to claim we can all manage serious illnesses with lifestyle changes alone. But what if most seniors could get along just fine without taking so many drugs? What if we could approach this aspect of our ailing healthcare system by addressing demand rather than depending on government or industry to tweak the supply side of the equation?

That’s the question researchers at Dublin’s RCSI University of Medicine and Health Sciences sought to answer earlier this year when they analyzed data from a project involving 208 older patients in Ireland who each were taking at least 15 medications. Their findings, published in PLOS Medicine, suggest that seniors may not need all the pills they’ve been told to take.

Practitioners reviewed their prescriptions and found that more than 800 drugs — an average of four medications per person — were inappropriate, ineffective, or harmful. Removing those medications resulted in only mild side effects, and for only 15 participants.

Susan Smith, MD, associate director of the HRB Primary Care Clinical Trials Network, which funded the study, calls it a meaningful step forward in this fraught dynamic. “The intervention approach to managing this challenging problem is promising and demonstrates that, even in this very complex group, stopping medicines that may no longer be needed or appropriate is both possible and generally safe.”

You might even save a little dough.

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