prescription drug "gag orders" and "clawbacks"

[MichaelB]

This seems like a small but very welcome first step. Still, what does "list price" mean if nobody pays it?
What would happen if drug makers had to charge the same thing to every wholesaler/distributor, worldwide? To big pharmacy chains, Canadian pharmacies, the VA, everyone. They charge everyone, say, $2 for every 200mg tablet of Highprofimene. So, US consumers aren't subsidizing others, etc. And, then, this wholesale price would be the price disclosed in all advertising. That will rattle some cages.
I'd normally oppose this intervention in the free market, but there's no sense on pretending we have a free market today.

Good points. In this case, I think “list price”, even if it is never charged and no one pays it, still may have an impact. It makes the role of intermediaries more difficult, and will potentially allow more light to be cast on rebates and other payments, which usually do not benefit consumers and often exist in a grey, mucky, ethically dubious area.

 

[sengsational]

I'd say before regulation of wholesale price, which would be a complicated set of additional rules, why not remove the rules that prohibit getting rx from outside the US? If removing a stupid rule will work, that beats adding more rules!

 

[REWahoo]

Good points. In this case, I think “list price”, even if it is never charged and no one pays it, still may have an impact. It makes the role of intermediaries more difficult, and will potentially allow more light to be cast on rebates and other payments, which usually do not benefit consumers and often exist in a grey, mucky, ethically dubious area.

Plus it may have the potential to dampen some of the drug companies [-]greed[/-] exuberant pricing policies once the public responds with an outpouring of "WTF?!!" when they learn what the drug to treat their toenail fungus costs.

 

[tfudtuckerpucker]

I'd say before regulation of wholesale price, which would be a complicated set of additional rules, why not remove the rules that prohibit getting rx from outside the US? If removing a stupid rule will work, that beats adding more rules!

That would be very good- I suspect serious lobby $ are working to prevent it.

For the anti-gag rule, I wish they would go further, and require pharmacists to provide price options to patients. Not everyone will know to ask for a lower price.

I found this interesting comment from a pharmacist:

"There are a lot of other games being played I believe by the middlemen and the PBMs that are involved and subcontracted for pharmacy benefits that drive up drug prices and I think this is a good first step to uncovering and shining light on some of those other practices like we've done in our state," Vinson said.

 

[samclem]

I'd say before regulation of wholesale price, which would be a complicated set of additional rules, why not remove the rules that prohibit getting rx from outside the US?

That would certainly be simpler. The safety issues have been (ab)used to scuttle this in the past, but I do think there is valid reason for concern. Mr Jones ordering pills from China might be getting almost anything, and he has no effective recourse to prevent fraud. The simplest answer (IMO) is to have retail sales come through a US pharmacy/agent that is legally responsible for what they sell. We need to have somebody that can be fined or jailed if the pharmaceuticals are bogus, adulterated, etc. These pharmacies can buy the drugs wherever they want. It isn't especially difficult or expensive for them to randomly test the pharmaceuticals.

Just a few of these operations would go a long way toward driving down prices.

Plus it may have the potential to dampen some of the drug companies [-]greed[/-] exuberant pricing policies once the public responds with an outpouring of "WTF?!!" when they learn what the drug to treat their toenail fungus costs.

I'm wondering how the "pricing disclosure" rule is written. I'm betting the drug companies will do all they can to obfuscate the true prices. For example, if the regulation requires "price per tablet" to be disclosed, expect tablets to get tiny. "Hey, those nail fungus pills are just $1 each, that's not bad." But you need to take a handful at a time for an effective dose.

 

[REWahoo]

I'm betting the drug companies will do all they can to obfuscate the true prices.

Ya think?

 

[ivinsfan]

New proposal to required price disclosure in drug ads: https://www.washingtonpost.com/nati...ory.html?noredirect=on&utm_term=.32447abce7b5

How are they going to do that when every drug and many, many different prices depending on where you obtain it?

 

[REWahoo]

How are they going to do that when every drug and many, many different prices depending on where you obtain it?

The same way car manufacturers list a "sticker price" for their autos.

 

[sengsational]

Price without in-hand prescription?

Neither DW nor I have any regular prescriptions, so not much recent experience with rx shopping, but I recall once where I was trying to get a price of something after Walmart pharmacy refused to honor the GoodRX coupon.



So I'm trying to transfer the prescription and nobody I called would tell me the price unless I first transferred the prescription! I don't think the new rules will have an effect on this behavior, will they?

 

[ivinsfan]

The same way car manufacturers list a "sticker price" for their autos.

Well if they do that they will scare away all their potential users with the sticker shock.

 

[REWahoo]

Well if they do that they will scare away all their potential users with the sticker shock.

Which might create some pressure to hold down the cost of some of these "You want HOW MUCH?!?!!!" drug prices.

 

[samclem]

Well if they do that they will scare away all their potential users with the sticker shock.

I think that mechanism is how this works. The pharmacy companies will be incentivized to list a low/reasonable price in their direct-to-consumer advertising so that people aren't scared off. That (in theory) puts downward pressure on prices. Assumptions:

1) Consumers care about the retail list price

2) Consumers can readily get relevant information on alternatives

3 ) The information is presented in a way that they can understand

4) Consumers can/will influence the drugs their medical professionals prescribe (which is probably a good bet, since that's the primary reason the ads exist)


ETA: Ooops, cross-posted with REWahoo!

 

[sengsational]

That would certainly be simpler. The safety issues have been (ab)used to scuttle this in the past, but I do think there is valid reason for concern. Mr Jones ordering pills from China might be getting almost anything, and he has no effective recourse to prevent fraud. The simplest answer (IMO) is to have retail sales come through a US pharmacy/agent that is legally responsible for what they sell. We need to have somebody that can be fined or jailed if the pharmaceuticals are bogus, adulterated, etc. These pharmacies can buy the drugs wherever they want. It isn't especially difficult or expensive for them to randomly test the pharmaceuticals

If I were king of the world, I'd have every legit rx factory in the world cryptographically sign the batch and lot numbers, and put that signature on a qr code in the box. A simple phone app could determine the authenticity of the signature. If the signature proves to be authentic, the only possible conclusion is that the signature was created with the secret private key held at the factory. This is the same crypto we all trust for money purposes, applied to authenticity, but with some supply chain stuff at a central place to prevent replay attacks.

 

[REWahoo]

ETA: Ooops, cross-posted with REWahoo!

Grape minds drink alike.

 

[samclem]

If I were king of the world, I'd have every legit rx factory in the world cryptographically sign the batch and lot numbers, and put that signature on a qr code in the box. A simple phone app could determine the authenticity of the signature. If the signature proves to be authentic, the only possible conclusion is that the signature was created with the secret private key held at the factory. This is the same crypto we all trust for money purposes, applied to authenticity, but with some supply chain stuff at a central place to prevent replay attacks.

That sounds smart and workable.

I've been surprised at the % of prescription meds that are still dispensed as loose pills, it seems like something out of the '50s. I had assumed it was for space efficiency at the pharmacy, but maybe it is also to (artificially) maintain the need for rock-solid supply chain integrity (with resultant anti-competitive advantages).