Speaker 1: Hello, and welcome to It could happen here today. It's
Speaker 1: just me because it's early and I live on the
Speaker 1: West Coast, and today we are talking about America's drug problem.
Speaker 1: And I'm joined by David Mitchell from Patients for Affordable Drugs,
Speaker 1: and we're going to talk about the cost of medicines,
Speaker 1: why it's so astronomically high, why I sometimes go to
Speaker 1: Mexico to buy my incident, and why you probably know
Speaker 1: someone who can't afford the medicines they need to survive
Speaker 1: or maybe thrive. So, David, can you explain a little
Speaker 1: bit about first, if you'd like to introduce yourself and
Speaker 1: explain what Patients for Affordable Drugs does and the role
Speaker 1: that you play there, that would be wonderful. I am
Speaker 1: the founder and president of Patients for Affordable Drugs. Were
Speaker 1: the only national patient organization that focuses exclusively on policies
Speaker 1: to lower drug prices. We're independent, bipartisan. We don't take
Speaker 1: money from any organizations that profit from the development or
Speaker 1: distribution of prescription drugs. We do two main things. We
Speaker 1: uh collect patients stories and we amplify those stories to
Speaker 1: policymakers and elected officials. So we can bring home the
Speaker 1: human impact of ridiculously high drug prices on the people
Speaker 1: in the United States. And the second thing is that
Speaker 1: we recruit and train patients to be advocates. UH. We
Speaker 1: teach them about the policies, give them coaching on presentation, UH,
Speaker 1: and UH prepare them two go tell their story and
Speaker 1: deal directly with the people who set policy in this country.
Speaker 1: And so we've had patients testify in state legislatures all
Speaker 1: over the country. We've had patients to testifying Congress on
Speaker 1: many occasions. Just last week, one of our patients, who
Speaker 1: happens to be a Type one diabetic, I introduced the
Speaker 1: President of the United States in the Rose Garden in
Speaker 1: a speech the President made talking about the New Inflation
Speaker 1: Reduction Act and how it's going to help lower drug
Speaker 1: prices and out of pocket costs for people. So that
Speaker 1: that's our work. I do this work because I'm a patient.
Speaker 1: I have an incurable blood cancer. It's called multiple my looma.
Speaker 1: It's incurable. That's not good, but it's treatable for some
Speaker 1: period of time with very expensive drugs. Right now, my
Speaker 1: oncologists have me on a four drug combination that carries
Speaker 1: a list price of more than nine hundred thousand dollars
Speaker 1: a year. These drugs are literally keeping me alive, and
Speaker 1: I'm very grateful to have them, but they're wildly overpriced
Speaker 1: and the the drug industry. Drug companies exploit UH patients
Speaker 1: everywhere in the world, but especially here in the United States.
Speaker 1: They use us as a piggy bank to hit their
Speaker 1: targets for executive bonuses, to trigger executive bonuses, and they
Speaker 1: had profit targets for their shareholders. UH. And the unfairness
Speaker 1: is not acceptable. Anyway, When I got diagnosed and suddenly
Speaker 1: I found myself with a disease UH through no fault
Speaker 1: of my own, they required very expensive drugs. I began
Speaker 1: this journey, and the journey taught me a fundamental point,
Speaker 1: and that is that drugs don't work if people can't
Speaker 1: afford them. And so I retired and decided to devote
Speaker 1: myself UH as a patient UH to trying to change
Speaker 1: a system in this country. There really is built to
Speaker 1: benefit the people who profit from it at the expense
Speaker 1: of the people that's supposed to serve. And I worked
Speaker 1: for free as a volunteer, and I've been doing it
Speaker 1: for six years. That's great. Yeah, let's say, I'm sorry
Speaker 1: to hear about your own wealth, but I think it's
Speaker 1: a very admirable thing you've done. So, David, can you explain,
Speaker 1: because it does I think people sometimes maybe if they've
Speaker 1: only lived in the US, they might not realize, or
Speaker 1: perhaps they're extremely aware. Why are medicines so? Why can
Speaker 1: I travel sixteen miles right, go across the border, flash
Speaker 1: my passport at someone, have a bunch of scans taken right,
Speaker 1: go through a bunch of machines, and then buy medicines
Speaker 1: for less than half the price on any given day.
Speaker 1: Why Why is it like that? It's like that because
Speaker 1: we are the only developed nation in the world that
Speaker 1: lets drug companies dictate the prices a brand name drugs
Speaker 1: to the to their citizens. Every other developed country in
Speaker 1: the world negotiates on behalf of their citizens directly with
Speaker 1: the drug companies to get a better deal. Uh, And
Speaker 1: we don't do that. The net result is that Americans
Speaker 1: are paying almost four times what other wealthy nations pay
Speaker 1: for the exact same brand name drugs. And the impact
Speaker 1: is that three out of ten Americans report that they
Speaker 1: are not able to take their medications as directed because
Speaker 1: of the cost. This has a direct impact on health. Uh.
Speaker 1: And you know, I understand that you are the type
Speaker 1: one and that you're insulin dependent, and so you know
Speaker 1: this struggles and the high prices of insulin. But we've
Speaker 1: had five people confirmed dead because they tried to ration
Speaker 1: their insulin in the United States of America. This happens
Speaker 1: because we grant the drug companies this incredible market power
Speaker 1: and we let them dictate the prices to US, prices
Speaker 1: that are completely unjustified. Uh. And patients suffer financially and
Speaker 1: worse because of their health due to these high prices. Yeah,
Speaker 1: I think it's it's heartbreaking this stuff, like, and I've
Speaker 1: known people have died from from lack of access to insulin,
Speaker 1: and it's it's just it's pretty horrific stuff. And can
Speaker 1: you explain, because let's get into that lack of justification, right,
Speaker 1: there's ways a drug. The things that make up the
Speaker 1: cost of a drug would be the research and development
Speaker 1: of the drug, the distribution of the drug, and the
Speaker 1: marketing of the drug, and maybe something else I'm missing,
Speaker 1: But can you explain, like, how do we arrive at
Speaker 1: this insane price for insulin which was synthesized in a
Speaker 1: lab more than a hundred years ago, Like what what
Speaker 1: makes up that price structure and how much would it
Speaker 1: actually cost to produce that insulin if we stripped away
Speaker 1: some of those things. Well, you're asking a very intelligent
Speaker 1: question about what should exist but doesn't, and that is
Speaker 1: a framework to arrive at an appropriate price that will
Speaker 1: provide a reasonable return to the drug maker and ensure
Speaker 1: that drugs are affordable and accessible for the people who
Speaker 1: need them. We don't have a system like that. The
Speaker 1: drug companies charge as much as they think they can
Speaker 1: get away with. Period. This was shown just last year
Speaker 1: when one of the drug companies named Biogen tried to
Speaker 1: bring a drug to market for Alzheimer's and proposed to
Speaker 1: sell it at fifty six thousand dollars, even though there
Speaker 1: was no proof it worked. And after it got big
Speaker 1: pushback and no one wanted to pay for it, the government,
Speaker 1: private employers, uh, they cut the price to twenty eight
Speaker 1: thousand dollars. Now was it worth fifty six thousand. If
Speaker 1: it wasn't, then why didn't you just price it at
Speaker 1: twenty eight thousand to begin with? Why? Because they thought
Speaker 1: they could get away with fifty six thousand dollars a
Speaker 1: year for this draw now where insulin is concerned, it's
Speaker 1: very unfortunate. There is an insulin cartel. Three companies control
Speaker 1: of the global insulin market in the world and here
Speaker 1: in the United States as well. And it's some people
Speaker 1: would say, correctly, you know, you have to call it
Speaker 1: correctly an alaga belie a small number of producers and
Speaker 1: sellers who are controlling the market. Uh. At what happens
Speaker 1: as a result of that problem. Well, insulin costs roughly
Speaker 1: ten dollars of vile to produce. It sells for more
Speaker 1: than three hundred dollars of ivisle. It has gone up
Speaker 1: in price more than six in the last twenty years
Speaker 1: because of this cartel that literally controls the insulin supply
Speaker 1: in the world. I'll give you another example. I take
Speaker 1: a drug. It's called for my cancer. It's called palmer List.
Speaker 1: It's an oral drug that I get under Medicare Part D.
Speaker 1: Palmerlus costs less than one dollar per capsule to make.
Speaker 1: It sells for almost one thousand dollars per capsule. Christ
Speaker 1: you cannot justify. You cannot tell me that there's justification
Speaker 1: for a thousand percent margin. It's just ridiculous. But because
Speaker 1: we do not use our power, our market power to
Speaker 1: negotiate for a better deal. Um, they can get away
Speaker 1: with it, and they do. And there there are many
Speaker 1: examples of this. Now all of that is about to
Speaker 1: change with some new legislation that has been enacted into law.
Speaker 1: It's about to start to change. I should be more precise.
Speaker 1: Um uh, And we can talk about that. Yeah, let's
Speaker 1: talk about that. One thing I want to get into first,
Speaker 1: I think is this. I think sometimes we have this impression,
Speaker 1: certainly with new and novel compounds, that there's this massive
Speaker 1: lab and it's entirely funded by the money that's made
Speaker 1: from selling other drugs, and in that lab people are
Speaker 1: just all day cooking up curious to the MOOTI virus
Speaker 1: or these various very deadly conditions. And so I wanted
Speaker 1: to explain. I wanted you to explain who pays for
Speaker 1: the R and D for the most part, and who
Speaker 1: decides what that R and D focuses on, because I
Speaker 1: think those are both very important topics. Yeah. Well, it
Speaker 1: turns out that every single drug approved by the FDA
Speaker 1: from two thousand ten to two thousand nineteen was everyone
Speaker 1: was based on in some part on science paid for
Speaker 1: by taxpayers through the National Institutes of Health, another organization
Speaker 1: and the government called BARTER, and another organization in the
Speaker 1: government called DARPA. DARPA's who invented the Internet, for example,
Speaker 1: and GPS. UM. UH, we pay taxpayers billions of dollars
Speaker 1: every year to finance basic scientific research that lays the
Speaker 1: found anation for all these drugs. And when a drug
Speaker 1: company sees the drug that has promised UH, it will
Speaker 1: try and acquire from the NIH or the other government
Speaker 1: agencies that do this work fund this work UH the
Speaker 1: intellectual property UH, and then they'll finish the job of
Speaker 1: running UM late stage clinical trials and going through the
Speaker 1: process of gaining FDA approval. I'm gonna say a couple
Speaker 1: of things here that are critically important to understand. To
Speaker 1: try and illustrate this, the drug industry TIES tries to
Speaker 1: take credit for the m r NA vaccines that were
Speaker 1: developed to fight COVID nineteen and these are the vaccines
Speaker 1: that are marketed by Visor and its partner in Europe,
Speaker 1: by on Tech, and by Moderna here in the United States. UM.
Speaker 1: It turns out that in the eighties, nineties, and early
Speaker 1: two thousand's drug companies weren't investing in vaccines because it
Speaker 1: didn't produce They didn't produce a big return, so the
Speaker 1: federal government invested through a ni H dar Ambarda. All
Speaker 1: of them two developed the technology that we now call
Speaker 1: m r n A so that when the virus hit,
Speaker 1: that technology was ready for MODERNA and Visor to run with.
Speaker 1: But they didn't make the big investment. We did, we
Speaker 1: being taxpayers, to get that technology ready to go. And
Speaker 1: in the case of MODERNA, we paid for everything. And
Speaker 1: I'm not exaggerating. They had never produced a drug, so
Speaker 1: we stood up manufacturing capacity for them, We paid for
Speaker 1: their late stage clinical trials, and we signed advanced purchase
Speaker 1: agreements to completely de risk the enterprise. But they will
Speaker 1: tell you that they saved us, It's not true. We
Speaker 1: saved ourselves. There's a reason that the president, who cares
Speaker 1: deeply about trying to reduce the death toll from cancer,
Speaker 1: has to have this new organization called h which is
Speaker 1: going to be funded with billions of dollars to try
Speaker 1: and do something to accelerate cancer research. Why, DoD, Why
Speaker 1: do we have to pay for that? Because the drug
Speaker 1: companies will not pay for the high risk, early stage
Speaker 1: research that goes into getting really breakthrough new drugs to market.
Speaker 1: So who who does this? Who pays for it? By
Speaker 1: and large, taxpayers are underpinning all the basic science. Drug
Speaker 1: companies are taking drugs that show promise, acquiring the intellectual property,
Speaker 1: and then charging whatever they want for the drugs. Um.
Speaker 1: So that's our system in the United States of America.
Speaker 1: It's completely screwed up. Uh. We need to have a
Speaker 1: process more like what you described imposing this question, which is, well,
Speaker 1: shouldn't we look at what the government invested, what the
Speaker 1: company invested? Uh? You know what would be what does
Speaker 1: it cost to manufactured the drug and distribute the drug
Speaker 1: and all of that, and then arrive at a price
Speaker 1: that provides a fair return uh for investment in risk
Speaker 1: to the drug company, but not any price they want
Speaker 1: to dictate. That's what we have not is they get
Speaker 1: the drug from us and they get to dictate the press.
Speaker 1: We don't have a system like the one you referenced. Yeah,
Speaker 1: and it's it's much to a detriment, right, And I
Speaker 1: was that It's interesting you talked about how like this
Speaker 1: profit driven model tends to focus on certain conditions and
Speaker 1: not others. And I know that you focus mainly on
Speaker 1: the United States. But perhaps we could get into a
Speaker 1: little bit what that means for neglected diseases on a
Speaker 1: global scale. Right, how looking at only patients who can
Speaker 1: afford to pay these inflated prices means that we're drug
Speaker 1: companies are sort of tacitly saying, well, we're okay with
Speaker 1: people dying from conditions that people don't get in America.
Speaker 1: Are you comfortable talking about that a little bit? Well,
Speaker 1: we only work in the United States because that is
Speaker 1: a big enough challenge for us. I will say that
Speaker 1: drug companies want to invest only in drugs that produce
Speaker 1: a big a turn their profit maximizers their corporations, and
Speaker 1: we don't have a way that we balance that out
Speaker 1: where we say yes, but but, but but taxpayers are
Speaker 1: are doing the foundational research that leads to these drugs,
Speaker 1: and and these are in that sense public goods, and
Speaker 1: we need to figure out how, yeah, you can have
Speaker 1: a fair return, but we also make sure that they're
Speaker 1: priced to maximize affordability and accessibility. And in this plays
Speaker 1: out of overseas with neglected tropical diseases which you reference,
Speaker 1: which you know, drug companies don't want to spend a
Speaker 1: lot of money on because those countries don't have a
Speaker 1: lot of money to pay for them. Because all the
Speaker 1: companies care about is honest to god, you know, they
Speaker 1: they want us to believe that they're all about looking
Speaker 1: after our well being. They are corporations, and corporations by
Speaker 1: law have to maximize profits for their shareholders shareholders, and
Speaker 1: that's what they do. Um. You know who invests in
Speaker 1: neglected tropical diseases, The Gates Foundation and other foundations that
Speaker 1: put the money out to do that early stage research
Speaker 1: that changes the pricing equation. Should should change the pricing equation, um,
Speaker 1: so that we can still develop the drugs that people
Speaker 1: abroad would benefit from tremendously. Uh if if only we
Speaker 1: made the effort and made the investment, which they're not
Speaker 1: inclined to do. You then answer your question yes, very well,
Speaker 1: very well. I think people are like looking for evidence
Speaker 1: on this. They could look at the speed at which
Speaker 1: we started to develop a bola treatments of vaccines once
Speaker 1: that became a threat to us versus once it became
Speaker 1: a threat to people in the global periphery. By the way,
Speaker 1: I will say one more thing, Yeah, of course not
Speaker 1: the drug companies only hurt people in poorer countries in
Speaker 1: the world. It is that drug companies insist on high
Speaker 1: prices everywhere. And for example, UM, the disease system fibrosis
Speaker 1: is incurable, and UM there are new drugs that help
Speaker 1: people live longer UH. They are marketed by Vertex. Interestingly,
Speaker 1: the gene that all of these UH drugs are built on,
Speaker 1: the genetic component, was identified by the former head of
Speaker 1: the ni H, Francis Collins, when he was doing research
Speaker 1: paid for by the NIH at the University of Michigan.
Speaker 1: His his discoveries were seminal UH, but still the drug
Speaker 1: companies wouldn't invest. So the Systic Fibrosis Foundation raised money
Speaker 1: from its community to do more early stage research, and
Speaker 1: when it showed promise, Vertex bought the intellectual property from
Speaker 1: them UH and UH brought these drugs that are built
Speaker 1: on that genetic discovery to market. But in countries that
Speaker 1: have said, we can't afford the price you're demanding because
Speaker 1: we only have so much money to pay for our
Speaker 1: citizens for healthcare. Because we provide health care to all
Speaker 1: our citizens, Vertex will let people kids because it generally
Speaker 1: affects kids and younger adults, will let them die if
Speaker 1: the company if the countries won't agree to the price
Speaker 1: that they are insisting on, literally let them die and say, look,
Speaker 1: you know, if you won't strike a deal that has
Speaker 1: high and the price for us, we're not going to
Speaker 1: sell the drug in your in your country. So it
Speaker 1: isn't only the poor people, uh, you know, the poorer
Speaker 1: countries around world. It's patients who are stuck with a
Speaker 1: drug disease that requires a high class drug and maybe
Speaker 1: they can't get access to it because it's not affordable
Speaker 1: for their country or them. Yeah, it's it's pretty pretty
Speaker 1: bleak stuff in that sense. Let's get onto a little
Speaker 1: bit then, of how we can make this better. And
Speaker 1: I know that there are approaches that are incremental and
Speaker 1: their approaches that are more revolutionary or sort of making
Speaker 1: these big leaps. So let's let's start with talking about
Speaker 1: how this legislation that we've just seen, the Inflation Reduction Act,
Speaker 1: does that make a difference. How much of a difference
Speaker 1: does it make, and how does it make that difference.
Speaker 1: The Inflation Reduction Act is really historic legislation that is
Speaker 1: going to save millions of people in America millions of
Speaker 1: dollars over time. It does for big things it does
Speaker 1: many Moore, but for big things. One, for the first
Speaker 1: time ever, Medicare is going to be able to use
Speaker 1: it's it's purchasing power as the largest purchaser of drugs
Speaker 1: in this country to UH negotiate lower prices for people
Speaker 1: on Medicare. For the first time ever, we are going
Speaker 1: to curb price gouging by forcing companies that raise prices
Speaker 1: faster than the rate of inflation to pay a rebate
Speaker 1: UH to Medicare. We're gonna that will curb their their
Speaker 1: price increases. H Third, we are going to limit the
Speaker 1: amount of out of pocket annually a Medicare patient can
Speaker 1: pay under the Medicare Party prescription drug down fit. Right now,
Speaker 1: there is no annual out of pocket limit I pay
Speaker 1: for that drug I described to you before the costs
Speaker 1: of almost a thousand dollars of capsule, I pay out
Speaker 1: of pocket more than sixteen thousand dollars a year. There
Speaker 1: will be a limit of two thousand dollars. No Medicare
Speaker 1: beneficiary will pay more than two thousand dollars out of
Speaker 1: pocket for Medicare Party drugs. And four for the first time,
Speaker 1: starting next year, people who depend on insulin in Medicare
Speaker 1: will pay no more than thirty five dollars per prescription
Speaker 1: per month for their insulin um. These are all truly
Speaker 1: significant changes UH and begin to shift UH drug policy
Speaker 1: UH in this country, begin to uh break the dictatorial
Speaker 1: pricing ability that the drugs drug companies have. And I
Speaker 1: wanted to take a minute to explain why Medicare negotiation
Speaker 1: in itself is such a big breakthrough very quickly, when
Speaker 1: the Medicare prescription drug Benefit was enacted into law in
Speaker 1: two thousand three, the drug companies, in the dark of
Speaker 1: night got stuck into that law something called the non
Speaker 1: interference clause that said that the Secretary of Health and
Speaker 1: Human Services could not negotiate directly with drug companies period.
Speaker 1: It got stuck in in the dark of night by
Speaker 1: a man named Billy Tausend, who was then share of
Speaker 1: the Energy and Commerce Committee in the US House of Representatives.
Speaker 1: And within months after doing that at the behest of
Speaker 1: the big drug companies, he went to work to run
Speaker 1: the big trade association for the drug companies it's called Pharma,
Speaker 1: at a salary of two million dollars a year. Another words,
Speaker 1: they bought the prohibition on Medicare being able to negotiate,
Speaker 1: and they have spent hundreds of millions of dollars to
Speaker 1: keep that prohibition in place ever since then, just in
Speaker 1: the last two years, in fighting to not let Medicare
Speaker 1: negotiate over any drugs ever directly with the drug companies,
Speaker 1: they spent uh north of two hundred million dollars to
Speaker 1: try and stop that legislation from passing. UM. So these
Speaker 1: are all big, significant, important changes, they are not enough.
Speaker 1: Uh if if if we wrote the world, we would
Speaker 1: have written legislation that negotiated over more drugs and the
Speaker 1: pricing for which extended into the private sector and to
Speaker 1: people without insurance. But we had to do that. To
Speaker 1: extend it to the private sector and people without insurance,
Speaker 1: we needed sixty votes in the Senate because of the
Speaker 1: filibuster rules, and we couldn't get one, not one Republican vote,
Speaker 1: So it had to be passed under a special procedure
Speaker 1: called reconciliation. The Democrats used it. They stood up the
Speaker 1: pharmah and they passed the bill. God bless him. Uh
Speaker 1: We in the course of it had um a vote
Speaker 1: trying to extend the thirty five dollar insulin monthly co
Speaker 1: paid to the private sector. We could only get seven
Speaker 1: Republican votes um and so we couldn't take it all
Speaker 1: the way there. So there's much more work to do,
Speaker 1: but this breakthrough is truly historic. Yeah, it's good. It's
Speaker 1: it's good to see some progress because there hasn't been
Speaker 1: progressed for a very long time. Let's talk about the
Speaker 1: difference in between a cost and a cope because I
Speaker 1: think it's easy for politicians sometimes you know, tweet and
Speaker 1: to them will cost you x, and in fact it
Speaker 1: only costs you x if y and is that are true?
Speaker 1: So can you explain for folks what a co pay
Speaker 1: is and why sometimes these claims are made about co
Speaker 1: patients as are not the same as costs. Well, the
Speaker 1: big difference is the word price versus cost. In our system,
Speaker 1: we in order to lower out of pocket costs for people,
Speaker 1: we have to lower price. Why if you we're paying
Speaker 1: a hundred dollars out of pocket for your medicine and
Speaker 1: we zero that out to nothing, but we don't lower
Speaker 1: the price. The overall price that hundred dollars has to
Speaker 1: be paid for it by someone, And what happens is
Speaker 1: patients wind up paying higher premiums or higher taxes or
Speaker 1: getting less money in their paychecks. You know, half of
Speaker 1: more than half of all Americans get their drug coverage
Speaker 1: and healthcare through their employers. So if that hundred dollars
Speaker 1: still has to be paid by somebody, then we wind
Speaker 1: up paying for it either with higher premiums, higher taxes,
Speaker 1: or getting less money in our paycheck because someone needs
Speaker 1: to absorb that hundred bucks. This is very important for
Speaker 1: people to understand. There's no free lunch unless we lower prices.
Speaker 1: That's why pharma will always say, the big drug companies
Speaker 1: will always say, well, what we need to do is
Speaker 1: we just need to lower everybody's out of pocket make
Speaker 1: it zero and let them have all the drugs they
Speaker 1: want and let us continue to charge any price we want.
Speaker 1: But that's not there's there's no free lunch. It would
Speaker 1: still have to be paid and UM so we fight
Speaker 1: very hard at pages for affordable drugs to help patients
Speaker 1: and policymakers understand that we need to do both. We
Speaker 1: need to or out of pocket costs for people and
Speaker 1: we need to lower the price in order to do that.
Speaker 1: Co payments. Co payments are what you pay when you
Speaker 1: go to UM the pharmacy counter and they tell you
Speaker 1: that your share of this prescription is five dollars or
Speaker 1: ten dollars or twenty dollars. And lots of times employers
Speaker 1: and the insurance companies they hire to run their programs
Speaker 1: will use co payments to try and steer you to
Speaker 1: a less expensive drug at generic. Right, So if you
Speaker 1: want a brand, you're gonna have to pay fifty bucks,
Speaker 1: but if you'll take the generic, you pay five bucks.
Speaker 1: For example, they're trying to steer YouTube and equally effective drug.
Speaker 1: Generics are by definition the same exact drug, and they
Speaker 1: are trying to steer you to the less expensive but
Speaker 1: equally effective drug. The problem with our country big time
Speaker 1: is that some times they are not used for that purpose.
Speaker 1: In my case, I have co payments on all my drugs, right,
Speaker 1: but I don't have a choice. I don't have a
Speaker 1: cheaper chair. I gotta I gotta take the drugs they're
Speaker 1: telling me to take. Um. And so when we misuse
Speaker 1: co payments like that, we are hurting patients. Uh, And
Speaker 1: it's how we also need to change. It points to
Speaker 1: how we also need to change our benefit design in
Speaker 1: this country. If if we can steer a patient to
Speaker 1: a healthier or as healthy least less expensive option, that
Speaker 1: makes sense. But if you're charging me for something that
Speaker 1: I can't do anything about, that makes no sense at all. Uh.
Speaker 1: And so these are changes that we at p F
Speaker 1: a D work on and will continue to work on
Speaker 1: in our benefit design in this country. Yeah, I can
Speaker 1: see that trying to give you a price incentive to
Speaker 1: what no by you a drug in your case or
Speaker 1: be poor or or be sick because you can't afford it,
Speaker 1: which is not the function of the incentive, And it's silly.
Speaker 1: Can you explain how why do some drugs have generate
Speaker 1: since some don't. So, boy, you're asking some really good questions. Um,
Speaker 1: you're going right to the heart of our system. Thank you.
Speaker 1: A long time ago in the eighties, eight three or
Speaker 1: eighty four, a bill was passed called the Hatch Waxman Bill,
Speaker 1: and since then everyone effer refers to a concept called
Speaker 1: the Hatch Waxman barbin. And the bargain is this, if
Speaker 1: you're a drug company and you bring a valuable new
Speaker 1: drug to market, you get a period of exclusivity along
Speaker 1: with your you have a patent already probably, but upon approval,
Speaker 1: we give you a period of exclusivity where for sure
Speaker 1: no matter. If your patent is old and only has
Speaker 1: a year left, we give you additional years of exclusivity
Speaker 1: where you have a monopoly on that drug. But at
Speaker 1: the end of that period of exclusivity, generics and biosimilars.
Speaker 1: Biosimilars are the generic name or the name for generics
Speaker 1: for biologic drugs, they're more complicated drugs. But at the
Speaker 1: end of that period of exclusivity, a generic I'm not
Speaker 1: a generic. Generics and biosimilars come to market, and we
Speaker 1: use the competition from the generics and biosimilars to drive
Speaker 1: down the price. When you have one generic that comes
Speaker 1: to compete, the price goes down about fifteen or two generics,
Speaker 1: the price goes down three generics. You know, by the
Speaker 1: time you get five generics in the market, the price
Speaker 1: is roughly five to of the original brand name price.
Speaker 1: So the Hatchwaxon argain was you got a good drug,
Speaker 1: you bring it to market. We give you a time
Speaker 1: where you you can charge whatever you want. You have
Speaker 1: exclusivity in the market, but at the end of that
Speaker 1: we have competition from generics and biosimilars to lower price.
Speaker 1: Why aren't there generics and biosimilars that was your question
Speaker 1: for all drugs, while some drugs are still in their
Speaker 1: period of exclusivity. But the drug companies don't let competition
Speaker 1: come to market the brand dr companies they fight, they
Speaker 1: file additional patents. They they sign deals with generic companies
Speaker 1: not to bring a drug to market, a competitive to
Speaker 1: market and pay them not to um uh it. They
Speaker 1: make small changes in the drug and then file additional patents.
Speaker 1: There is something called a patent thicket. Um Humorra, the
Speaker 1: best selling drug in the world, has like a hundred
Speaker 1: and thirty two patents, a hundred and thirty two which
Speaker 1: were filed after the drug came to market. What are
Speaker 1: they for, Well, they could be for the packaging, the instructions,
Speaker 1: the color of the capsule, the patent everything and why
Speaker 1: because Generica buys some other competitor has to fight its
Speaker 1: way through all of them to bring a drug to market.
Speaker 1: So we call them patent thickets. You know, if you
Speaker 1: grew up anywhere near you know a place where there
Speaker 1: were thickets, you know, it's very hard to get through
Speaker 1: a thicket. Um. And so in some cases there is
Speaker 1: no competitor. Guys, they're in the period of exclusivity. But
Speaker 1: in far too many cases, there are no competitors to
Speaker 1: drive down the price because the drug companies are manipulating
Speaker 1: our system. And they're very good at manipulating our system. Yeah, yes,
Speaker 1: they are exceptionally good, and that has terrible results. Okay,
Speaker 1: So we've spoken about that, the way that they've manipulated
Speaker 1: this system, the way that maybe that's beginning to change.
Speaker 1: One thing that I'm interested in I've written about it
Speaker 1: a little bit is these ways that are perhaps more revolutionary,
Speaker 1: if not always as like a cast iron safe. And
Speaker 1: one of those is obviously people making their own medicines,
Speaker 1: which is something that will see unfortunately increasingly in this
Speaker 1: country because of bands on access to reproductive healthcare. And
Speaker 1: I wonder how you think that has the potential to
Speaker 1: change this that's we've seen, like the epipencil, we've seen
Speaker 1: these homebrew abortion drugs, things like that. Do you think
Speaker 1: that has the capacity to change access? Remember I'm a patient,
Speaker 1: mm hmm and um it scares the hell out of me. Yeah.
Speaker 1: And the reason is there was a time in the
Speaker 1: United States and in most of the world when drug
Speaker 1: companies were not regulated. Uh, and they brought patent medicines
Speaker 1: uh and uh, you know, mix it at home, bruise
Speaker 1: and sold them, and we had no way to make
Speaker 1: sure that those didn't hurt people. They killed people in
Speaker 1: some cases. Uh. And then uh. In the twentieth century,
Speaker 1: the government realized and and our Congress and our elected
Speaker 1: officials realized we needed a way to regulate this industry,
Speaker 1: which would you know, sell poison in some cases, and
Speaker 1: they created what is now called the Food and Drug Administration.
Speaker 1: Food and Drug Administration is charged with making sure drugs
Speaker 1: are safe and effective. I'm a patient. I want the
Speaker 1: Food and Drug Administration to do its job. I want
Speaker 1: drugs that are safe and effective. I do not like
Speaker 1: drugs that are not subjected to some scrutiny um to
Speaker 1: make sure that they do what those who are selling
Speaker 1: them claim they do. So Remember, I'm not big on
Speaker 1: taking chances with my life. Uh. And I if the
Speaker 1: drugs don't work, I'll die. That's that simple. I'll die
Speaker 1: of cancer. Not not to mention, I could drive to
Speaker 1: die from a drug that's no good. Some drugs cause harm,
Speaker 1: you know, even drugs approved by the FDA cars harms sometimes.
Speaker 1: So I am I am. I am not a fan
Speaker 1: of homebrew drugs. I'm a fan of a system that
Speaker 1: protects me and ensures that drugs are safe and effective.
Speaker 1: But that's one man's perspective. Yeah, and I think it's
Speaker 1: reasonable to say that, like, we have a way to
Speaker 1: make drugs that are safe and effective, and it's the
Speaker 1: lord legislation or a system that's getting in between people
Speaker 1: and the life saving medicines that they need, and we
Speaker 1: should certainly struggle to fix that instead of looking for
Speaker 1: ways around it, even though I understand why, especially with
Speaker 1: things like reproductive healthcare, that doesn't seem like it's getting
Speaker 1: fixed anytime soon. Sadly, No, it's it's terribly sad. It's heartbreaking. Yeah,
Speaker 1: this whole thing is extremely and I know you've obviously
Speaker 1: seen it too, but my previous life, I've worked with
Speaker 1: one of someone who works for you now in diabetes
Speaker 1: nonprofit and seen firsthand the consequences of this, and it's
Speaker 1: really heartbreaking stuff to look at, and I wish it
Speaker 1: just seems so unnecessary in the world where like these
Speaker 1: pharmaceutical companies make we should say, like billions of dollars. Right,
Speaker 1: It's it's not as if these people are driving to
Speaker 1: work in a second hand toy to Corolla, like they
Speaker 1: they are doing very well for themselves of this system, right, yep.
Speaker 1: People will be familiar with like farmer Bro Martin Screlly
Speaker 1: the guy. Yeah. Yeah, but it's just one example of
Speaker 1: a very problematic industry. I think you've done an excellent
Speaker 1: job of explaining it. David, Is there anything else you'd
Speaker 1: like to get to before we finish up here? Just
Speaker 1: Martin screll you call to mind. I won't take you
Speaker 1: back to MODERNA and the m RNA vaccine effect that
Speaker 1: we not only developed the m r A technology to
Speaker 1: taxpayer money, but we brought the MODERNA vaccine to people
Speaker 1: with textpayer money. And in the course of doing that,
Speaker 1: we minted three new MODERNA billionaires. Um, you're talking about
Speaker 1: I'm not driving to work and you uh, you know
Speaker 1: secondhand Toyota Corollas. Oh, far from it. Yeah, these are
Speaker 1: the people whose yachts I've see in the bay. I
Speaker 1: think that's disgusting. Three new millionaires off the back of
Speaker 1: billionaires billionaires. God? Yeah, God, it's grass, isn't it. Yeah.
Speaker 1: It can't be said enough. Not only does the NAH
Speaker 1: fund their research, but often the taxpayers will fund the lab.
Speaker 1: Right if it's at a university, you pay for it
Speaker 1: twice before before you try and pay for it again
Speaker 1: at SEC. Yeah, it's a very broken system, David. How
Speaker 1: can people find p F A D How can people
Speaker 1: find us? Our website? Twitter? Facebook? Where should they go?
Speaker 1: Go to our website Patients for Affordable Drugs dot org.
Speaker 1: Just like it sounds, you can leave your story if
Speaker 1: if you or someone you love care about has struggled
Speaker 1: with high drug prices, give us your email address. We
Speaker 1: don't ask patients for money, but the stories and email
Speaker 1: addresses are our power. Uh. There the there the currency
Speaker 1: we trade on to make sure that the voices of
Speaker 1: people in this country are heard, uh, to counter the
Speaker 1: propaganda ana lies that are put out by the drug companies. Okay, yeah,
Speaker 1: that's that's very important stuff that people can hopefully do.
Speaker 1: Even if they are struggling sort of materially to afford
Speaker 1: their drugs. Maybe they have some time. So that's great.
Speaker 1: It's four f O R right, not the number four.
Speaker 1: That's correct. All right, great, Thank you so much, David.
Speaker 1: It's been a pleasure. You've done excellent job of explaining
Speaker 1: a very convoluted and broken system. Thank you, James, your
Speaker 1: your patient. Man. I try to be sometimes I'm very
Speaker 1: much not that, but yeah, I do appreciate your time
Speaker 1: on this Monday morning. Thank you very much, David, Thank you.
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