WEBVTT - Why Do Medicines Cost So Much in the USA? 0:00:05.680 --> 0:00:08.800 Hello, and welcome to It could happen here today. It's 0:00:08.840 --> 0:00:11.080 just me because it's early and I live on the 0:00:11.119 --> 0:00:16.960 West Coast, and today we are talking about America's drug problem. 0:00:17.000 --> 0:00:21.439 And I'm joined by David Mitchell from Patients for Affordable Drugs, 0:00:21.560 --> 0:00:23.880 and we're going to talk about the cost of medicines, 0:00:24.280 --> 0:00:27.200 why it's so astronomically high, why I sometimes go to 0:00:27.240 --> 0:00:29.840 Mexico to buy my incident, and why you probably know 0:00:29.960 --> 0:00:33.279 someone who can't afford the medicines they need to survive 0:00:33.560 --> 0:00:37.440 or maybe thrive. So, David, can you explain a little 0:00:37.479 --> 0:00:39.839 bit about first, if you'd like to introduce yourself and 0:00:39.880 --> 0:00:43.000 explain what Patients for Affordable Drugs does and the role 0:00:43.040 --> 0:00:46.599 that you play there, that would be wonderful. I am 0:00:46.720 --> 0:00:51.000 the founder and president of Patients for Affordable Drugs. Were 0:00:51.000 --> 0:00:57.280 the only national patient organization that focuses exclusively on policies 0:00:57.320 --> 0:01:01.360 to lower drug prices. We're independent, bipartisan. We don't take 0:01:01.400 --> 0:01:06.040 money from any organizations that profit from the development or 0:01:06.160 --> 0:01:12.440 distribution of prescription drugs. We do two main things. We 0:01:13.080 --> 0:01:18.440 uh collect patients stories and we amplify those stories to 0:01:18.560 --> 0:01:22.440 policymakers and elected officials. So we can bring home the 0:01:22.520 --> 0:01:27.279 human impact of ridiculously high drug prices on the people 0:01:27.520 --> 0:01:30.680 in the United States. And the second thing is that 0:01:30.720 --> 0:01:37.240 we recruit and train patients to be advocates. UH. We 0:01:37.640 --> 0:01:44.360 teach them about the policies, give them coaching on presentation, UH, 0:01:44.360 --> 0:01:50.320 and UH prepare them two go tell their story and 0:01:50.480 --> 0:01:54.840 deal directly with the people who set policy in this country. 0:01:54.880 --> 0:02:00.240 And so we've had patients testify in state legislatures all 0:02:00.240 --> 0:02:04.600 over the country. We've had patients to testifying Congress on 0:02:04.640 --> 0:02:09.559 many occasions. Just last week, one of our patients, who 0:02:09.840 --> 0:02:13.320 happens to be a Type one diabetic, I introduced the 0:02:13.360 --> 0:02:16.400 President of the United States in the Rose Garden in 0:02:16.440 --> 0:02:21.280 a speech the President made talking about the New Inflation 0:02:21.320 --> 0:02:23.800 Reduction Act and how it's going to help lower drug 0:02:23.840 --> 0:02:27.320 prices and out of pocket costs for people. So that 0:02:27.320 --> 0:02:30.120 that's our work. I do this work because I'm a patient. 0:02:30.960 --> 0:02:34.400 I have an incurable blood cancer. It's called multiple my looma. 0:02:35.240 --> 0:02:39.919 It's incurable. That's not good, but it's treatable for some 0:02:40.000 --> 0:02:44.240 period of time with very expensive drugs. Right now, my 0:02:44.360 --> 0:02:50.040 oncologists have me on a four drug combination that carries 0:02:50.080 --> 0:02:54.040 a list price of more than nine hundred thousand dollars 0:02:54.080 --> 0:02:58.960 a year. These drugs are literally keeping me alive, and 0:02:59.000 --> 0:03:03.040 I'm very grateful to have them, but they're wildly overpriced 0:03:04.440 --> 0:03:12.200 and the the drug industry. Drug companies exploit UH patients 0:03:12.200 --> 0:03:15.760 everywhere in the world, but especially here in the United States. 0:03:16.240 --> 0:03:20.959 They use us as a piggy bank to hit their 0:03:21.000 --> 0:03:25.640 targets for executive bonuses, to trigger executive bonuses, and they 0:03:25.680 --> 0:03:32.120 had profit targets for their shareholders. UH. And the unfairness 0:03:33.000 --> 0:03:38.360 is not acceptable. Anyway, When I got diagnosed and suddenly 0:03:38.400 --> 0:03:42.840 I found myself with a disease UH through no fault 0:03:42.880 --> 0:03:47.040 of my own, they required very expensive drugs. I began 0:03:47.080 --> 0:03:50.720 this journey, and the journey taught me a fundamental point, 0:03:51.200 --> 0:03:53.760 and that is that drugs don't work if people can't 0:03:53.800 --> 0:03:59.280 afford them. And so I retired and decided to devote 0:03:59.360 --> 0:04:07.280 myself UH as a patient UH to trying to change 0:04:07.280 --> 0:04:10.360 a system in this country. There really is built to 0:04:10.600 --> 0:04:13.400 benefit the people who profit from it at the expense 0:04:13.480 --> 0:04:16.520 of the people that's supposed to serve. And I worked 0:04:16.520 --> 0:04:18.640 for free as a volunteer, and I've been doing it 0:04:18.680 --> 0:04:21.680 for six years. That's great. Yeah, let's say, I'm sorry 0:04:21.720 --> 0:04:23.800 to hear about your own wealth, but I think it's 0:04:23.839 --> 0:04:27.440 a very admirable thing you've done. So, David, can you explain, 0:04:27.640 --> 0:04:31.239 because it does I think people sometimes maybe if they've 0:04:31.240 --> 0:04:33.760 only lived in the US, they might not realize, or 0:04:34.279 --> 0:04:39.279 perhaps they're extremely aware. Why are medicines so? Why can 0:04:39.400 --> 0:04:43.880 I travel sixteen miles right, go across the border, flash 0:04:43.920 --> 0:04:47.520 my passport at someone, have a bunch of scans taken right, 0:04:47.520 --> 0:04:50.000 go through a bunch of machines, and then buy medicines 0:04:50.080 --> 0:04:52.520 for less than half the price on any given day. 0:04:52.520 --> 0:04:55.880 Why Why is it like that? It's like that because 0:04:56.040 --> 0:05:00.080 we are the only developed nation in the world that 0:05:00.200 --> 0:05:04.800 lets drug companies dictate the prices a brand name drugs 0:05:05.800 --> 0:05:11.320 to the to their citizens. Every other developed country in 0:05:11.320 --> 0:05:15.240 the world negotiates on behalf of their citizens directly with 0:05:15.279 --> 0:05:18.920 the drug companies to get a better deal. Uh, And 0:05:19.160 --> 0:05:23.920 we don't do that. The net result is that Americans 0:05:23.960 --> 0:05:28.800 are paying almost four times what other wealthy nations pay 0:05:28.839 --> 0:05:33.440 for the exact same brand name drugs. And the impact 0:05:33.560 --> 0:05:37.720 is that three out of ten Americans report that they 0:05:37.800 --> 0:05:43.000 are not able to take their medications as directed because 0:05:43.160 --> 0:05:48.000 of the cost. This has a direct impact on health. Uh. 0:05:49.120 --> 0:05:55.640 And you know, I understand that you are the type 0:05:55.640 --> 0:05:58.480 one and that you're insulin dependent, and so you know 0:05:59.200 --> 0:06:03.120 this struggles and the high prices of insulin. But we've 0:06:03.240 --> 0:06:09.479 had five people confirmed dead because they tried to ration 0:06:09.560 --> 0:06:14.880 their insulin in the United States of America. This happens 0:06:15.279 --> 0:06:19.800 because we grant the drug companies this incredible market power 0:06:20.520 --> 0:06:24.600 and we let them dictate the prices to US, prices 0:06:24.720 --> 0:06:32.480 that are completely unjustified. Uh. And patients suffer financially and 0:06:32.720 --> 0:06:39.119 worse because of their health due to these high prices. Yeah, 0:06:39.200 --> 0:06:41.920 I think it's it's heartbreaking this stuff, like, and I've 0:06:41.960 --> 0:06:44.680 known people have died from from lack of access to insulin, 0:06:44.760 --> 0:06:48.560 and it's it's just it's pretty horrific stuff. And can 0:06:48.640 --> 0:06:52.360 you explain, because let's get into that lack of justification, right, 0:06:52.400 --> 0:06:55.760 there's ways a drug. The things that make up the 0:06:55.760 --> 0:06:58.000 cost of a drug would be the research and development 0:06:58.320 --> 0:07:03.760 of the drug, the distribution of the drug, and the 0:07:03.839 --> 0:07:07.120 marketing of the drug, and maybe something else I'm missing, 0:07:07.120 --> 0:07:10.720 But can you explain, like, how do we arrive at 0:07:10.720 --> 0:07:13.720 this insane price for insulin which was synthesized in a 0:07:13.800 --> 0:07:16.800 lab more than a hundred years ago, Like what what 0:07:17.000 --> 0:07:19.280 makes up that price structure and how much would it 0:07:19.280 --> 0:07:23.600 actually cost to produce that insulin if we stripped away 0:07:23.600 --> 0:07:28.960 some of those things. Well, you're asking a very intelligent 0:07:29.240 --> 0:07:34.440 question about what should exist but doesn't, and that is 0:07:34.480 --> 0:07:38.440 a framework to arrive at an appropriate price that will 0:07:38.480 --> 0:07:42.600 provide a reasonable return to the drug maker and ensure 0:07:42.680 --> 0:07:45.400 that drugs are affordable and accessible for the people who 0:07:45.440 --> 0:07:48.520 need them. We don't have a system like that. The 0:07:48.600 --> 0:07:52.760 drug companies charge as much as they think they can 0:07:52.760 --> 0:07:57.960 get away with. Period. This was shown just last year 0:07:58.600 --> 0:08:01.880 when one of the drug companies named Biogen tried to 0:08:01.880 --> 0:08:05.640 bring a drug to market for Alzheimer's and proposed to 0:08:05.680 --> 0:08:08.960 sell it at fifty six thousand dollars, even though there 0:08:09.040 --> 0:08:11.560 was no proof it worked. And after it got big 0:08:11.560 --> 0:08:15.240 pushback and no one wanted to pay for it, the government, 0:08:15.480 --> 0:08:20.520 private employers, uh, they cut the price to twenty eight 0:08:20.600 --> 0:08:24.800 thousand dollars. Now was it worth fifty six thousand. If 0:08:24.800 --> 0:08:27.560 it wasn't, then why didn't you just price it at 0:08:27.560 --> 0:08:30.480 twenty eight thousand to begin with? Why? Because they thought 0:08:30.520 --> 0:08:34.440 they could get away with fifty six thousand dollars a 0:08:34.559 --> 0:08:38.640 year for this draw now where insulin is concerned, it's 0:08:38.760 --> 0:08:43.720 very unfortunate. There is an insulin cartel. Three companies control 0:08:45.320 --> 0:08:50.600 of the global insulin market in the world and here 0:08:50.640 --> 0:08:55.440 in the United States as well. And it's some people 0:08:55.480 --> 0:08:59.000 would say, correctly, you know, you have to call it 0:08:59.040 --> 0:09:03.280 correctly an alaga belie a small number of producers and 0:09:03.360 --> 0:09:09.040 sellers who are controlling the market. Uh. At what happens 0:09:09.080 --> 0:09:15.400 as a result of that problem. Well, insulin costs roughly 0:09:15.480 --> 0:09:19.160 ten dollars of vile to produce. It sells for more 0:09:19.200 --> 0:09:22.600 than three hundred dollars of ivisle. It has gone up 0:09:22.600 --> 0:09:27.400 in price more than six in the last twenty years 0:09:27.400 --> 0:09:33.720 because of this cartel that literally controls the insulin supply 0:09:34.640 --> 0:09:38.440 in the world. I'll give you another example. I take 0:09:38.480 --> 0:09:43.520 a drug. It's called for my cancer. It's called palmer List. 0:09:43.600 --> 0:09:47.839 It's an oral drug that I get under Medicare Part D. 0:09:49.480 --> 0:09:53.160 Palmerlus costs less than one dollar per capsule to make. 0:09:53.760 --> 0:09:59.520 It sells for almost one thousand dollars per capsule. Christ 0:10:00.240 --> 0:10:04.120 you cannot justify. You cannot tell me that there's justification 0:10:04.240 --> 0:10:11.040 for a thousand percent margin. It's just ridiculous. But because 0:10:11.120 --> 0:10:14.920 we do not use our power, our market power to 0:10:15.080 --> 0:10:19.439 negotiate for a better deal. Um, they can get away 0:10:19.480 --> 0:10:22.240 with it, and they do. And there there are many 0:10:22.280 --> 0:10:25.360 examples of this. Now all of that is about to 0:10:25.440 --> 0:10:29.720 change with some new legislation that has been enacted into law. 0:10:30.440 --> 0:10:34.040 It's about to start to change. I should be more precise. 0:10:34.880 --> 0:10:39.000 Um uh, And we can talk about that. Yeah, let's 0:10:39.000 --> 0:10:42.040 talk about that. One thing I want to get into first, 0:10:42.120 --> 0:10:45.240 I think is this. I think sometimes we have this impression, 0:10:45.280 --> 0:10:49.520 certainly with new and novel compounds, that there's this massive 0:10:49.600 --> 0:10:53.080 lab and it's entirely funded by the money that's made 0:10:53.080 --> 0:10:55.520 from selling other drugs, and in that lab people are 0:10:55.520 --> 0:10:58.040 just all day cooking up curious to the MOOTI virus 0:10:58.240 --> 0:11:02.440 or these various very deadly conditions. And so I wanted 0:11:02.480 --> 0:11:05.960 to explain. I wanted you to explain who pays for 0:11:06.040 --> 0:11:08.800 the R and D for the most part, and who 0:11:08.840 --> 0:11:11.640 decides what that R and D focuses on, because I 0:11:11.679 --> 0:11:17.120 think those are both very important topics. Yeah. Well, it 0:11:17.240 --> 0:11:20.440 turns out that every single drug approved by the FDA 0:11:20.559 --> 0:11:25.360 from two thousand ten to two thousand nineteen was everyone 0:11:25.720 --> 0:11:29.360 was based on in some part on science paid for 0:11:29.480 --> 0:11:35.960 by taxpayers through the National Institutes of Health, another organization 0:11:36.040 --> 0:11:39.280 and the government called BARTER, and another organization in the 0:11:39.360 --> 0:11:44.160 government called DARPA. DARPA's who invented the Internet, for example, 0:11:44.880 --> 0:11:54.360 and GPS. UM. UH, we pay taxpayers billions of dollars 0:11:54.400 --> 0:11:59.640 every year to finance basic scientific research that lays the 0:11:59.679 --> 0:12:03.160 found anation for all these drugs. And when a drug 0:12:03.240 --> 0:12:10.360 company sees the drug that has promised UH, it will 0:12:11.120 --> 0:12:14.720 try and acquire from the NIH or the other government 0:12:14.840 --> 0:12:18.480 agencies that do this work fund this work UH the 0:12:18.559 --> 0:12:24.040 intellectual property UH, and then they'll finish the job of 0:12:25.360 --> 0:12:30.920 running UM late stage clinical trials and going through the 0:12:30.960 --> 0:12:38.079 process of gaining FDA approval. I'm gonna say a couple 0:12:38.120 --> 0:12:43.120 of things here that are critically important to understand. To 0:12:43.200 --> 0:12:49.520 try and illustrate this, the drug industry TIES tries to 0:12:49.559 --> 0:12:52.560 take credit for the m r NA vaccines that were 0:12:52.559 --> 0:12:57.520 developed to fight COVID nineteen and these are the vaccines 0:12:57.600 --> 0:13:01.800 that are marketed by Visor and its partner in Europe, 0:13:01.800 --> 0:13:08.120 by on Tech, and by Moderna here in the United States. UM. 0:13:08.160 --> 0:13:12.080 It turns out that in the eighties, nineties, and early 0:13:12.160 --> 0:13:17.319 two thousand's drug companies weren't investing in vaccines because it 0:13:17.400 --> 0:13:20.840 didn't produce They didn't produce a big return, so the 0:13:20.840 --> 0:13:24.800 federal government invested through a ni H dar Ambarda. All 0:13:24.840 --> 0:13:30.200 of them two developed the technology that we now call 0:13:30.840 --> 0:13:34.560 m r n A so that when the virus hit, 0:13:35.360 --> 0:13:39.800 that technology was ready for MODERNA and Visor to run with. 0:13:40.400 --> 0:13:44.720 But they didn't make the big investment. We did, we 0:13:44.880 --> 0:13:51.480 being taxpayers, to get that technology ready to go. And 0:13:51.520 --> 0:13:54.840 in the case of MODERNA, we paid for everything. And 0:13:54.880 --> 0:13:58.280 I'm not exaggerating. They had never produced a drug, so 0:13:58.320 --> 0:14:02.640 we stood up manufacturing capacity for them, We paid for 0:14:02.679 --> 0:14:06.560 their late stage clinical trials, and we signed advanced purchase 0:14:06.600 --> 0:14:11.040 agreements to completely de risk the enterprise. But they will 0:14:11.040 --> 0:14:14.240 tell you that they saved us, It's not true. We 0:14:14.360 --> 0:14:22.680 saved ourselves. There's a reason that the president, who cares 0:14:22.720 --> 0:14:26.600 deeply about trying to reduce the death toll from cancer, 0:14:27.520 --> 0:14:33.440 has to have this new organization called h which is 0:14:33.440 --> 0:14:35.840 going to be funded with billions of dollars to try 0:14:35.840 --> 0:14:42.720 and do something to accelerate cancer research. Why, DoD, Why 0:14:42.720 --> 0:14:44.720 do we have to pay for that? Because the drug 0:14:44.800 --> 0:14:49.240 companies will not pay for the high risk, early stage 0:14:50.720 --> 0:14:57.760 research that goes into getting really breakthrough new drugs to market. 0:14:58.520 --> 0:15:03.840 So who who does this? Who pays for it? By 0:15:03.840 --> 0:15:09.080 and large, taxpayers are underpinning all the basic science. Drug 0:15:09.120 --> 0:15:13.520 companies are taking drugs that show promise, acquiring the intellectual property, 0:15:14.240 --> 0:15:19.200 and then charging whatever they want for the drugs. Um. 0:15:19.280 --> 0:15:23.280 So that's our system in the United States of America. 0:15:23.400 --> 0:15:27.760 It's completely screwed up. Uh. We need to have a 0:15:27.800 --> 0:15:33.880 process more like what you described imposing this question, which is, well, 0:15:34.280 --> 0:15:37.560 shouldn't we look at what the government invested, what the 0:15:37.600 --> 0:15:43.400 company invested? Uh? You know what would be what does 0:15:43.400 --> 0:15:46.240 it cost to manufactured the drug and distribute the drug 0:15:46.720 --> 0:15:48.800 and all of that, and then arrive at a price 0:15:49.280 --> 0:15:53.680 that provides a fair return uh for investment in risk 0:15:53.760 --> 0:15:56.880 to the drug company, but not any price they want 0:15:56.920 --> 0:16:00.200 to dictate. That's what we have not is they get 0:16:00.200 --> 0:16:03.120 the drug from us and they get to dictate the press. 0:16:03.680 --> 0:16:10.440 We don't have a system like the one you referenced. Yeah, 0:16:10.600 --> 0:16:13.120 and it's it's much to a detriment, right, And I 0:16:13.240 --> 0:16:15.280 was that It's interesting you talked about how like this 0:16:15.320 --> 0:16:17.960 profit driven model tends to focus on certain conditions and 0:16:18.040 --> 0:16:21.000 not others. And I know that you focus mainly on 0:16:21.040 --> 0:16:23.040 the United States. But perhaps we could get into a 0:16:23.080 --> 0:16:26.360 little bit what that means for neglected diseases on a 0:16:26.400 --> 0:16:30.600 global scale. Right, how looking at only patients who can 0:16:30.640 --> 0:16:34.000 afford to pay these inflated prices means that we're drug 0:16:34.080 --> 0:16:37.840 companies are sort of tacitly saying, well, we're okay with 0:16:37.880 --> 0:16:40.640 people dying from conditions that people don't get in America. 0:16:41.800 --> 0:16:44.240 Are you comfortable talking about that a little bit? Well, 0:16:44.280 --> 0:16:48.400 we only work in the United States because that is 0:16:48.440 --> 0:16:53.440 a big enough challenge for us. I will say that 0:16:55.160 --> 0:16:58.800 drug companies want to invest only in drugs that produce 0:16:58.960 --> 0:17:04.040 a big a turn their profit maximizers their corporations, and 0:17:04.680 --> 0:17:07.200 we don't have a way that we balance that out 0:17:07.359 --> 0:17:11.800 where we say yes, but but, but but taxpayers are 0:17:11.880 --> 0:17:15.920 are doing the foundational research that leads to these drugs, 0:17:16.000 --> 0:17:20.480 and and these are in that sense public goods, and 0:17:20.640 --> 0:17:22.600 we need to figure out how, yeah, you can have 0:17:22.640 --> 0:17:25.080 a fair return, but we also make sure that they're 0:17:25.119 --> 0:17:30.960 priced to maximize affordability and accessibility. And in this plays 0:17:31.000 --> 0:17:34.840 out of overseas with neglected tropical diseases which you reference, 0:17:35.440 --> 0:17:40.199 which you know, drug companies don't want to spend a 0:17:40.240 --> 0:17:42.879 lot of money on because those countries don't have a 0:17:42.880 --> 0:17:45.560 lot of money to pay for them. Because all the 0:17:45.640 --> 0:17:48.960 companies care about is honest to god, you know, they 0:17:49.000 --> 0:17:51.960 they want us to believe that they're all about looking 0:17:52.040 --> 0:17:56.640 after our well being. They are corporations, and corporations by 0:17:56.720 --> 0:18:01.080 law have to maximize profits for their shareholders shareholders, and 0:18:01.119 --> 0:18:05.320 that's what they do. Um. You know who invests in 0:18:05.920 --> 0:18:11.359 neglected tropical diseases, The Gates Foundation and other foundations that 0:18:13.080 --> 0:18:17.879 put the money out to do that early stage research 0:18:18.320 --> 0:18:24.320 that changes the pricing equation. Should should change the pricing equation, um, 0:18:24.400 --> 0:18:29.320 so that we can still develop the drugs that people 0:18:29.400 --> 0:18:35.960 abroad would benefit from tremendously. Uh if if only we 0:18:36.200 --> 0:18:39.560 made the effort and made the investment, which they're not 0:18:39.640 --> 0:18:44.440 inclined to do. You then answer your question yes, very well, 0:18:44.520 --> 0:18:46.600 very well. I think people are like looking for evidence 0:18:46.600 --> 0:18:48.160 on this. They could look at the speed at which 0:18:48.200 --> 0:18:51.840 we started to develop a bola treatments of vaccines once 0:18:51.880 --> 0:18:54.000 that became a threat to us versus once it became 0:18:54.040 --> 0:18:57.720 a threat to people in the global periphery. By the way, 0:18:57.760 --> 0:19:00.159 I will say one more thing, Yeah, of course not 0:19:00.320 --> 0:19:05.240 the drug companies only hurt people in poorer countries in 0:19:05.280 --> 0:19:11.160 the world. It is that drug companies insist on high 0:19:11.200 --> 0:19:18.520 prices everywhere. And for example, UM, the disease system fibrosis 0:19:19.200 --> 0:19:24.119 is incurable, and UM there are new drugs that help 0:19:24.200 --> 0:19:31.000 people live longer UH. They are marketed by Vertex. Interestingly, 0:19:31.960 --> 0:19:36.399 the gene that all of these UH drugs are built on, 0:19:37.880 --> 0:19:42.000 the genetic component, was identified by the former head of 0:19:42.040 --> 0:19:45.240 the ni H, Francis Collins, when he was doing research 0:19:45.280 --> 0:19:48.920 paid for by the NIH at the University of Michigan. 0:19:50.200 --> 0:19:54.800 His his discoveries were seminal UH, but still the drug 0:19:54.840 --> 0:19:59.840 companies wouldn't invest. So the Systic Fibrosis Foundation raised money 0:20:00.200 --> 0:20:04.679 from its community to do more early stage research, and 0:20:04.760 --> 0:20:09.520 when it showed promise, Vertex bought the intellectual property from 0:20:09.560 --> 0:20:14.840 them UH and UH brought these drugs that are built 0:20:14.840 --> 0:20:19.520 on that genetic discovery to market. But in countries that 0:20:19.560 --> 0:20:23.080 have said, we can't afford the price you're demanding because 0:20:23.160 --> 0:20:25.200 we only have so much money to pay for our 0:20:25.240 --> 0:20:28.560 citizens for healthcare. Because we provide health care to all 0:20:28.560 --> 0:20:34.240 our citizens, Vertex will let people kids because it generally 0:20:34.240 --> 0:20:39.080 affects kids and younger adults, will let them die if 0:20:39.080 --> 0:20:42.040 the company if the countries won't agree to the price 0:20:42.640 --> 0:20:47.360 that they are insisting on, literally let them die and say, look, 0:20:47.440 --> 0:20:49.000 you know, if you won't strike a deal that has 0:20:49.080 --> 0:20:50.960 high and the price for us, we're not going to 0:20:51.040 --> 0:20:54.119 sell the drug in your in your country. So it 0:20:54.320 --> 0:20:58.960 isn't only the poor people, uh, you know, the poorer 0:20:59.000 --> 0:21:04.159 countries around world. It's patients who are stuck with a 0:21:04.280 --> 0:21:08.080 drug disease that requires a high class drug and maybe 0:21:08.119 --> 0:21:11.680 they can't get access to it because it's not affordable 0:21:12.000 --> 0:21:17.920 for their country or them. Yeah, it's it's pretty pretty 0:21:18.320 --> 0:21:31.080 bleak stuff in that sense. Let's get onto a little 0:21:31.080 --> 0:21:33.960 bit then, of how we can make this better. And 0:21:34.000 --> 0:21:37.560 I know that there are approaches that are incremental and 0:21:37.600 --> 0:21:41.120 their approaches that are more revolutionary or sort of making 0:21:41.160 --> 0:21:43.680 these big leaps. So let's let's start with talking about 0:21:43.760 --> 0:21:47.600 how this legislation that we've just seen, the Inflation Reduction Act, 0:21:47.720 --> 0:21:49.520 does that make a difference. How much of a difference 0:21:49.520 --> 0:21:51.520 does it make, and how does it make that difference. 0:21:52.880 --> 0:21:56.280 The Inflation Reduction Act is really historic legislation that is 0:21:56.320 --> 0:21:59.720 going to save millions of people in America millions of 0:21:59.760 --> 0:22:06.160 dollars over time. It does for big things it does 0:22:06.240 --> 0:22:11.200 many Moore, but for big things. One, for the first 0:22:11.200 --> 0:22:13.920 time ever, Medicare is going to be able to use 0:22:14.040 --> 0:22:18.600 it's it's purchasing power as the largest purchaser of drugs 0:22:18.600 --> 0:22:23.800 in this country to UH negotiate lower prices for people 0:22:23.800 --> 0:22:28.720 on Medicare. For the first time ever, we are going 0:22:28.800 --> 0:22:37.400 to curb price gouging by forcing companies that raise prices 0:22:37.520 --> 0:22:40.280 faster than the rate of inflation to pay a rebate 0:22:41.200 --> 0:22:45.040 UH to Medicare. We're gonna that will curb their their 0:22:45.119 --> 0:22:51.760 price increases. H Third, we are going to limit the 0:22:51.840 --> 0:22:56.120 amount of out of pocket annually a Medicare patient can 0:22:56.240 --> 0:23:00.520 pay under the Medicare Party prescription drug down fit. Right now, 0:23:00.600 --> 0:23:03.120 there is no annual out of pocket limit I pay 0:23:03.200 --> 0:23:05.800 for that drug I described to you before the costs 0:23:05.840 --> 0:23:09.320 of almost a thousand dollars of capsule, I pay out 0:23:09.320 --> 0:23:14.400 of pocket more than sixteen thousand dollars a year. There 0:23:14.400 --> 0:23:18.680 will be a limit of two thousand dollars. No Medicare 0:23:18.720 --> 0:23:21.199 beneficiary will pay more than two thousand dollars out of 0:23:21.200 --> 0:23:28.440 pocket for Medicare Party drugs. And four for the first time, 0:23:28.640 --> 0:23:33.080 starting next year, people who depend on insulin in Medicare 0:23:33.520 --> 0:23:36.119 will pay no more than thirty five dollars per prescription 0:23:36.160 --> 0:23:42.760 per month for their insulin um. These are all truly 0:23:43.000 --> 0:23:51.160 significant changes UH and begin to shift UH drug policy 0:23:52.080 --> 0:24:01.280 UH in this country, begin to uh break the dictatorial 0:24:01.480 --> 0:24:06.479 pricing ability that the drugs drug companies have. And I 0:24:06.520 --> 0:24:09.440 wanted to take a minute to explain why Medicare negotiation 0:24:09.960 --> 0:24:13.720 in itself is such a big breakthrough very quickly, when 0:24:13.720 --> 0:24:16.720 the Medicare prescription drug Benefit was enacted into law in 0:24:16.800 --> 0:24:21.240 two thousand three, the drug companies, in the dark of 0:24:21.359 --> 0:24:26.280 night got stuck into that law something called the non 0:24:26.320 --> 0:24:30.080 interference clause that said that the Secretary of Health and 0:24:30.160 --> 0:24:34.080 Human Services could not negotiate directly with drug companies period. 0:24:34.680 --> 0:24:36.959 It got stuck in in the dark of night by 0:24:37.000 --> 0:24:39.840 a man named Billy Tausend, who was then share of 0:24:39.880 --> 0:24:44.000 the Energy and Commerce Committee in the US House of Representatives. 0:24:44.080 --> 0:24:48.439 And within months after doing that at the behest of 0:24:48.480 --> 0:24:51.120 the big drug companies, he went to work to run 0:24:51.600 --> 0:24:55.080 the big trade association for the drug companies it's called Pharma, 0:24:55.520 --> 0:25:00.320 at a salary of two million dollars a year. Another words, 0:25:00.480 --> 0:25:04.560 they bought the prohibition on Medicare being able to negotiate, 0:25:04.840 --> 0:25:08.439 and they have spent hundreds of millions of dollars to 0:25:09.000 --> 0:25:14.320 keep that prohibition in place ever since then, just in 0:25:14.359 --> 0:25:19.080 the last two years, in fighting to not let Medicare 0:25:19.119 --> 0:25:23.080 negotiate over any drugs ever directly with the drug companies, 0:25:23.119 --> 0:25:26.919 they spent uh north of two hundred million dollars to 0:25:27.000 --> 0:25:32.120 try and stop that legislation from passing. UM. So these 0:25:32.160 --> 0:25:37.800 are all big, significant, important changes, they are not enough. 0:25:38.800 --> 0:25:42.240 Uh if if if we wrote the world, we would 0:25:42.240 --> 0:25:48.919 have written legislation that negotiated over more drugs and the 0:25:49.000 --> 0:25:52.480 pricing for which extended into the private sector and to 0:25:52.600 --> 0:25:58.240 people without insurance. But we had to do that. To 0:25:58.359 --> 0:26:01.520 extend it to the private sector and people without insurance, 0:26:01.880 --> 0:26:05.119 we needed sixty votes in the Senate because of the 0:26:05.119 --> 0:26:09.680 filibuster rules, and we couldn't get one, not one Republican vote, 0:26:10.520 --> 0:26:13.320 So it had to be passed under a special procedure 0:26:13.359 --> 0:26:17.439 called reconciliation. The Democrats used it. They stood up the 0:26:17.480 --> 0:26:21.160 pharmah and they passed the bill. God bless him. Uh 0:26:22.040 --> 0:26:26.760 We in the course of it had um a vote 0:26:27.320 --> 0:26:31.200 trying to extend the thirty five dollar insulin monthly co 0:26:31.400 --> 0:26:34.240 paid to the private sector. We could only get seven 0:26:34.320 --> 0:26:39.160 Republican votes um and so we couldn't take it all 0:26:39.200 --> 0:26:41.680 the way there. So there's much more work to do, 0:26:41.920 --> 0:26:47.479 but this breakthrough is truly historic. Yeah, it's good. It's 0:26:47.760 --> 0:26:50.160 it's good to see some progress because there hasn't been 0:26:50.200 --> 0:26:53.359 progressed for a very long time. Let's talk about the 0:26:53.400 --> 0:26:55.679 difference in between a cost and a cope because I 0:26:55.680 --> 0:26:59.840 think it's easy for politicians sometimes you know, tweet and 0:27:00.000 --> 0:27:02.159 to them will cost you x, and in fact it 0:27:02.240 --> 0:27:07.560 only costs you x if y and is that are true? 0:27:08.440 --> 0:27:10.400 So can you explain for folks what a co pay 0:27:10.560 --> 0:27:12.680 is and why sometimes these claims are made about co 0:27:12.800 --> 0:27:15.679 patients as are not the same as costs. Well, the 0:27:15.920 --> 0:27:22.440 big difference is the word price versus cost. In our system, 0:27:22.520 --> 0:27:26.520 we in order to lower out of pocket costs for people, 0:27:27.040 --> 0:27:32.439 we have to lower price. Why if you we're paying 0:27:32.480 --> 0:27:36.000 a hundred dollars out of pocket for your medicine and 0:27:36.200 --> 0:27:41.080 we zero that out to nothing, but we don't lower 0:27:41.119 --> 0:27:44.679 the price. The overall price that hundred dollars has to 0:27:44.720 --> 0:27:47.760 be paid for it by someone, And what happens is 0:27:48.440 --> 0:27:55.280 patients wind up paying higher premiums or higher taxes or 0:27:55.520 --> 0:27:58.600 getting less money in their paychecks. You know, half of 0:27:58.680 --> 0:28:01.920 more than half of all Americans get their drug coverage 0:28:02.080 --> 0:28:05.760 and healthcare through their employers. So if that hundred dollars 0:28:05.840 --> 0:28:10.840 still has to be paid by somebody, then we wind 0:28:10.920 --> 0:28:14.480 up paying for it either with higher premiums, higher taxes, 0:28:15.000 --> 0:28:18.280 or getting less money in our paycheck because someone needs 0:28:18.320 --> 0:28:22.080 to absorb that hundred bucks. This is very important for 0:28:22.119 --> 0:28:26.240 people to understand. There's no free lunch unless we lower prices. 0:28:27.040 --> 0:28:30.880 That's why pharma will always say, the big drug companies 0:28:30.920 --> 0:28:33.239 will always say, well, what we need to do is 0:28:33.520 --> 0:28:35.639 we just need to lower everybody's out of pocket make 0:28:35.720 --> 0:28:37.560 it zero and let them have all the drugs they 0:28:37.600 --> 0:28:41.560 want and let us continue to charge any price we want. 0:28:42.040 --> 0:28:45.400 But that's not there's there's no free lunch. It would 0:28:45.400 --> 0:28:49.960 still have to be paid and UM so we fight 0:28:50.240 --> 0:28:54.160 very hard at pages for affordable drugs to help patients 0:28:54.320 --> 0:28:59.400 and policymakers understand that we need to do both. We 0:28:59.480 --> 0:29:02.320 need to or out of pocket costs for people and 0:29:02.600 --> 0:29:04.960 we need to lower the price in order to do that. 0:29:05.280 --> 0:29:08.280 Co payments. Co payments are what you pay when you 0:29:08.360 --> 0:29:13.720