Highway Robbery – The U.S. Medical Cartel – Part 1: Pharmaceutical Companies

On By jerrynixIn My Rants, Political

Jerry Nix | Freewavemaker, LLC

Abstract

In this piece you will get information as to why legal drugs cost so much more in America than they do in any other part of the industrialized world.

Dear U. S. Senators, Congressman and President of the U. S.;

Long before Facebook was even a gleam in Mark Zuckerberg’s eye, I had a friend and co-worker named Dave. He has given me permission to use his name … but I will only use his first name. Actually, he was not a friend or a co-worker … he was my compliance supervisor while I was in the Financial Securities Industry and saved my derrière on more than one occasion by keeping me on the straight and narrow line between what I could tell a client and what I couldn’t tell a client. It did not matter if what I wanted to tell a client was true … as long as it followed stringent and sometimes STUPID government regulations and laws. It could be true but I may not be able to say it … like … “Investing in Options can actually reduce losses as compared to investing in stocks even though you could lose 100% of your investment in options quickly.” Rather I always had to tell them that “Investing in Options was Risky and that they needed to read some silly book (The risks of Investing in Options) before making such an investment.”

I was working on writing this article for my readers, and all of a sudden Dave put a post on Facebook that caught my attention so I decided to ask if I could use it for this article and he was happy to agree. Therefore, I am in the process of re-writing the article as an Open-Letter to our law makers. Allow me to share his Facebook post below:

Dave XXXXXX March 4 at 2:52 PM:

I read somewhere a couple days ago that the main reason Europeans get free drugs is the price Americans pay cover it. I questioned that.

Then I picked up my wife’s Eliquis this morning. Now I’m a capitalist. I believe drug companies are entitled to recover development costs and make a reasonable profit. However, this is nonsense. Actually, it’s financial rape. How many years has Eliquis been on the market? More than a few. I’m pretty sure they have recovered their development costs.

So, how much did it cost them to produce the 180 tablets I picked up today? I’ll go out on a limb and say not more than the $90 that was my co-pay. In addition to my $90 Humana paid $2,146. Is that all profit? No but is at least half of it is profit?

Now by August this means my wife will be in the donut hole and the co-pay will escalate to $90/month.

Now, what is congress doing about this. Well, the same thing that they have done for years, absolutely nothing. Why? Simple, big pharma is the biggest contributor to reelection campaigns for congress. And since getting re-elected is the most important thing they do, the people they are supposed to represent can go to hell.

I’ve known one truly honest elected official in my life. He was my first father-in-law. He was a humble, God fearing and caring man who actually believed he was to represent and look out for the people whether they had voted for him or not. What a concept!

My Plan:

As you can tell … Dave does not appear to be a “happy camper” at this time. Therefore, I decided once I had his permission to use this post that I’d build may article around his problem – rather than the general public’s problem.

Rest assured you all have, or will have, at some point in your lifetimes this exact same problem. The drug needed may be different (as in the case with me) but the problem will be the same. Now Dave referred to it as “Financial Rape” and he could be more right than the title I’ve chosen for this article.

I plan to send this article to all 535 voting members of congress as a hard copy. If you agree with the article, Dear Reader, I’d request that you send another “hard copy” to your congressional leaders. I am requesting hard copies rather than electronic copies for one reason. They need to get this from as many people as possible that they represent in a hard copy form so that hopefully some (at least a few) of them will pay attention and have the “smarts” to take some kind of satisfactory action. One person approaching congress with an idea will have no bearing on what they are doing up there – if anything. However, if they could hear from 100,000 or so in America in a hard copy format … then maybe – just maybe … they would start to pay attention. And who cares if we tie up the mail system in the national capital? Certainly not me. This garbage has gone on long enough.

So please … as you read this and if you agree … print it out and send a link to all our friends and relatives asking them to do the same. If you would like for me to send you a printable hard copy of this article complete with cover page that you can drop in an envelope and mail to your congressional leaders, just send me an email address to freewavemaker@gmail.com. At FreeWaveMaker, LLC everything is free and no cost to you. Why is it free? Because I don’t need your money. If I charged one person, I would have to charge all people and I will not fall into the trap of over-charging one to pass it on free to others. That’s socialism and there is too much of that going on in this country already.

In this article you will also hear about how the Medical Establishment is screwing a very good friend of mine in of all places … Florida … the retirement mecca of America. Of Course, that comes much later … right now we are focused on the Pharmaceutical Industry.

What is the “Donut Hole” that Dave referred to?

In his post, Dave mentioned the donut hole. The term “donut hole” refers to a specific aspect of Medicare Part D prescription drug coverage. I need to cover this here, even though I have not yet begun my rant on the Insurance Industry (which I worked in for better than 40 years). Let’s break it down:

The Medicare Donut Hole –

The donut hole is a coverage gap that occurs within Medicare Part D plans. It represents a temporary limit on what your Part D plan will pay for your prescription drugs during a specific period. When you reach a certain cost threshold for prescription drugs (a combination of what your plan covers and your out-of-pocket expenses), you enter the donut hole (why it’s called that, I have no idea). It does not matter if you actually have Part D from Medicare or a prescription drug plan from another company like United Healthcare to replace Part D. It’s all classified as Medicare Part D. And it all works the same. In other words, for retired people the Government is in control of your healthcare whether you want them to be or not. The Government has no business being in control of anything. If you think this is good, then write a letter to Barack Hussein Obama, II and thank him for this mess. As I’ve stated many times, he is absolutely the worst President that America ever had (and I am including both Jimmy Carter and Joe Biden’s years in this statement).

How does the Donut Hole work?

Once you spend a certain amount out of pocket on your prescriptions (alongside what your plan covers), you leave the initial coverage stage and enter the coverage gap (donut hole). During this stage, you’re responsible for up to 25% of the cost of your drugs until you reach the catastrophic payment stage of your Part D plan. The spending threshold that leads to the coverage gap varies each year. In 2024, plans and beneficiaries need to spend a total of $5,030 to reach the donut hole.

How do you get out of the donut hole?

Unfortunately, once you’re in the Medicare donut hole, the primary way out is through.

You’ll continue paying a percentage of the drug costs until you reach the catastrophic coverage phase, where your out-of-pocket expenses decrease significantly. Believe me, these expenses are not easy for the average person to track – and I’m not sure we can rely on the insurance industry to track them properly either.

In summary, the donut hole is a temporary gap in Medicare Part D coverage where beneficiaries pay a larger portion of their prescription drug costs until they reach the catastrophic payment stage.

What is this catastrophic phase in Medicare?

The catastrophic payment phase in Medicare Part D begins once your true out-of-pocket (TrOOP) costs reach a specific threshold. Here are the details for 2024:

  • The catastrophic coverage phase starts when your TrOOP costs reach $8,000.
  • TrOOP costs include your own out-of-pocket payments and other payments made on your behalf (such as those from Medicare’s Extra Help program or manufacturer discounts for brand-name drugs).
  • For most people, this means contributing roughly between $3,300 and $3,800 toward the $8,000 cap.
  • Once you reach this threshold, you’ll pay $0 for your covered Part D drugs for the rest of the year.

Previously, if you reached the catastrophic coverage phase, you continued to pay 5% of your drug costs for the rest of the year. Now, you’ll save, on average, hundreds of dollars in copayments in 2024. Or at least the government and insurance companies want you to think that you will.

In 2025, the maximum out-of-pocket costs for the catastrophic coverage phase will be $2,000.

So, in summary here’s how TrOOP works in various stages of Medicare Part D coverage:

Deductible Phase:

  • You’ll typically pay 100% of your prescription drug costs until you meet your Medicare Part D deductible.
  • The deductible amount varies by plan but cannot exceed $545 in 2024.

Initial Coverage Phase:

  • After meeting your plan’s deductible, you’ll pay a copayment or coinsurance for your covered drugs.
  • Medicare Part D (or outside plan replacing Medicare Part D) pays for the rest for prescription drugs included on your plan’s formulary (list of covered medications).

Coverage Gap (Donut Hole):

  • After you and your Medicare Part D plan have jointly spent $5,030 (your 2024 Medicare Part D initial coverage limit), you’ll enter the coverage gap (donut hole).
  • During this gap, you’ll pay no more than 25% of the cost for brand-name and generic drugs.
  • The 25% you pay, along with the 70% the manufacturer pays and the 5% your plan pays, all count toward your TrOOP.
  • For generic drugs during the coverage gap, you’ll pay 25%, and your Medicare Part D plan covers the other 75%.

Remember that TrOOP helps limit your payments, making it easier for you to afford your medications and take them as prescribed. Understanding how TrOOP works can help you plan ahead financially and give you peace of mind. Unfortunately, you have to work on your own Peace of Mind because the U. S. Government is not there to help very much. But the question is … are they really affordable.

In Dave’s case … 25% of the retail cost of his wife’s drugs will be 25% of $2,236 ($2,146 insurance pay plus $90 Co-insurance) or $559.00 per prescription refill. If each prescription consists of 180 tablets that’s a cost to him of $3.11 per tablet. Now that may not seem like a lot … but take my situation. My social security checks each month is at the high level of about $2,400 after insurance premiums are deducted and before taxes. If I had to pay that much it would take my net social security to $1,863.50 … so I’d be giving up (before taxes) 22.35% of my income for one simple drug that has been around for years.

Bottom line here:

In 2024, to reach the Medicare Part D donut hole (also known as the coverage gap), you must spend a total of $5,030 on covered prescription drugs. Once you reach this spending threshold, you’ll enter the coverage gap. Keep in mind that this amount can change each year.

Also, there are really two things missing here:

  1. What about the pharmaceutical companies that manufacture the drugs? There is a lot of talk about what insurance companies can or will pay … but not much going on in the area of pharmaceutical manufacturing responsibilities.
  2. What about the poor American’s that do not have Medicare insurance? As of March 2, 2024 the estimated number of people in America was 341,218,494. Of this amount (and I could not find numbers for this year) the number that were insured under Medicare as of March 2023 was 63,964,675 or 18.75% of the American Population. So, what about the other 81.25% of the American’s that don’t have these benefits? How can we expect them to be able to get the drugs they need to survive illnesses?

So, how about the Drug Companies?

What should their role be in all this? I agree with Dave. As a capitalist myself I too believe all corporations or businesses in America have a right to maintain reasonable profitability … but not at Highway Robbery prices that steals from the very people that make up this great country.

Yes, they do have a right to recover Research and Development (R&D) Costs when pricing their drugs that go to market. But, let’s talk about that.

What is the average R&D costs for a new drug?

On average, the journey from research and development (R&D) to bringing a new medicine to market is a substantial undertaking, from what I understand, for pharmaceutical companies. Let’s delve into the details:

Average R&D Costs:

The average cost of developing a new drug is nearly $4 billion, and in some cases, it can even exceed $10 billion. This significant investment covers various stages, including discovery, preclinical testing, clinical trials, and regulatory approvals.

Timeframe for Cost Recapture:

Unfortunately, there isn’t a straightforward answer regarding the exact time it takes for pharmaceutical companies to recoup their R&D costs. The process involves several factors, such as patent exclusivity, market demand, pricing, and competition. Generally, it can take many years for a company to fully recapture its R&D investment after a new drug is launched.

In my opinion, the drug manufacturing company should disclose this information to the public but at this time they are not required to. Yet, investment firms must disclose to their clients all the cost involved in an investment. If we are going to have governmental regulations – why are some companies not required to disclose information to the public and other companies are? I think it may have to do with how much money congressional leaders get from the industries involved for re-election, etc. though no one will admit that.

Revenue and Profit:

Once a drug is approved and enters the market, the company starts generating revenue from sales. However, this revenue doesn’t immediately translate into profit, due to the cost of getting the drugs approved. Companies need to cover ongoing expenses, marketing efforts, distribution, and other operational costs.

Again, in my opinion there would be no harm in the drug companies disclosing this information to the public.

Patent Exclusivity:

Patent protection plays a crucial role in recouping costs. During the patent period, which typically lasts around 20 years, the company has exclusive rights to sell the drug. After patent expiration, generic versions may enter the market, affecting the original drug’s sales and profitability.

Opinion: There is nothing wrong with protecting the rights of the company that comes up with the drug … but is 20 years the right amount of time? Isn’t it true that companies generally will start making a profit long before the 20-year time frame has elapsed?

Market Dynamics:

The speed of cost recapture depends on the drug’s market performance. Factors like patient demand, therapeutic need, and competitive landscape influence sales. Some blockbuster drugs achieve rapid cost recovery, while others take longer.

My opinion: This could be based solely on a doctor’s recommendation of the drug to his/her patients. It seems to me the more popular the drug (through TV Advertisements, etc.) the more they are recommended by doctors – hence the sooner the profits start pouring in – even when there may be a less expensive drug on the market that will do the same thing for the patient.

In summary, while the average R&D cost is substantial, the actual time for cost recapture varies widely based on individual drugs, market conditions, and regulatory factors. Pharmaceutical companies balance long-term investments with the goal of improving patient health and advancing medical science.

The key to remember here as we delve into specific drugs mentioned in Dave’s post is the $4 billion to $10 billion in R&D costs and the time the drugs have actually been on the market. Before getting into the numbers let’s discuss the actual drug and why it is prescribed.

Exactly what is the purpose of Eliquis?

Eliquis (generic name: apixaban) serves several critical purposes in medicine. Do not let the generic name fool you, we are not there yet. Right now, Apixaban is the active ingredient in Eliquis, a brand-name medication:

  1. Atrial Fibrillation (AFib):
  2. Post-Operative Clot Prevention:
  3. Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE):
  4. Warnings and Precautions:
    • Eliquis increases the risk of severe or fatal bleeding, especially when combined with certain other medications.
    • Patients taking Eliquis should be cautious and promptly report any signs of bleeding, such as swelling, weakness, nosebleeds, or blood in urine.
    • Importantly, Eliquis should be stopped 24-48 hours before any surgery, invasive procedure, or dental work.
    • Additionally, there is a rare risk of a serious blood clot around the spinal cord, which can lead to long-term paralysis. Patients should seek immediate medical help if they experience symptoms related to this type of clot.

In summary, Eliquis plays a crucial role in preventing strokes, managing clot risks after surgery, and treating existing blood clots, ultimately improving patient outcomes. However, there are also some serious side effects – so why aren’t doctors required to tell you these side effects (but I will cover more of that in another part of this rather lengthy article).

So, you may be asking yourself, if Eliquis is nothing more than a blood thinner, is there other options, and maybe safer alternatives, at this time?

Certainly! Eliquis is indeed an anticoagulant, commonly referred to as a blood thinner. It helps reduce the risk of stroke and blood clots in people with nonvalvular atrial fibrillation (AFib) and is also used for other conditions like deep vein thrombosis (DVT) prevention after hip or knee replacement surgery.

If you’re looking for alternatives to Eliquis that may be more cost-effective, here are some options:

  1. Warfarin (Coumadin):
    • Warfarin is a generic drug that has been used for decades. It works the same as Eliquis does.
    • It can cost as little as $5 per month.
    • Warfarin requires regular monitoring of blood levels and dietary restrictions due to its interactions with vitamin K.
    • Speak with your doctor to determine if Warfarin is suitable for you. You must bring it to the doctors attention because most of them will not bring it to yours.
  2. Pradaxa (dabigatran):
  3. Xarelto (rivaroxaban):
    • Xarelto is approved for stroke and clot prevention in nonvalvular AFib.
    • It is taken once daily and doesn’t require frequent monitoring.
    • Common side effects include bleeding events.
    • Xarelto is available in different strengths.
      • So, here’s the question – or dilemma: If there are already other brands out there that will do the same thing … why would a doctor recommend a very expensive drug to his/her patient? It would seem to me that it’s almost as if they get some kind of “kick back” from the drug manufacturer – though that is supposed to be illegal!
  4. Natural Alternatives:
    • Some people explore natural options like fish oil, which contains omega-3 fatty acids and may have mild anticoagulant effects.
    • However, always consult your healthcare provider before adding any natural supplements to your regimen.
  5. Future Generic Eliquis:

Remember that individual responses to these medications can vary, and your doctor will consider factors like your medical history, kidney function, and overall health when recommending an alternative. Always discuss your options with a healthcare professional to make an informed decision based on your specific needs and circumstances. The problem I find is that most people do not have the wisdom to discuss options with the doctor and simply take the doctors word as gospel.

But … do the doctors always take these factors mentioned above into account. I would suggest that they do not!

I have found that in taking care of my own health it does one good to do a little research and then question the doctor at your next visit (or shoot him an email as I often do) about various drugs to lower you overall cost of medication. However, I still feel that the bulk of this could be done by the Federal Government and the drug manufacturers themselves.

There was a time in this country that a person could walk into a drug store and tell the pharmacists what his/her symptoms were and the pharmacist would give them the drug they need. That is no longer the case. And who knows more about drugs, I ask, that a pharmacist? They know a heck of a lot more than most doctors do when it comes to the drugs and the side effects of such drugs.

Here’s a case in point. I had a doctor prescribe Atorvastatin (Lipitor) for my cholesterol issue. Statin medications are effective at lowering cholesterol and reducing the risk of heart attack and stroke. However, like any medication, they can have side effects. Here are some common and rare side effects associated with statins:

  1. Common Side Effects:
    • Headache
    • Constipation
    • Nasal congestion
    • Sweating
    • Belching or excessive gas
    • Croaky voice or hoarseness
    • Difficulty sleeping
    • Heartburn, indigestion, nausea, or stomach discomfort
    • Lower back or side pain, tenderness around the eyes or cheekbones
    • Muscle pain (especially in the legs)
  2. Rare Side Effects:
    • Rhabdomyolysis: A severe condition where muscle fibers break down, potentially causing kidney damage.
    • Liver damage
  3. Controversial Side Effects:
    • Type 2 diabetes: Some studies suggest a link, but it’s not fully established.
    • Memory loss or confusion: This is still debated.

Some alternatives to Satins would be as follows (and I’ve had my doctor change mine to the top one listed):

  1. Ezetimibe (Zetia): Ezetimibe helps lower cholesterol absorption in the intestines and can be taken alongside or without statins.
  2. Fibrates (e.g., gemfibrozil): Fibrates work by reducing triglycerides and increasing HDL (“good”) cholesterol levels.
  3. Bile acid sequestrants: These medications bind to bile acids in the intestines, helping to lower LDL (“bad”) cholesterol.
  4. Omega-3 fatty acids: Found in fish oil supplements, omega-3s may help manage cholesterol levels.
  5. Red yeast rice extract: This supplement contains compounds similar to statins and may have cholesterol-lowering effects.
  6. ATP citrate lyase (ACL) inhibitors (e.g., bempedoic acid): These newer medications can be used as an adjunct to statins.
  7. PCSK9 inhibitors: These injectable drugs help lower LDL cholesterol by blocking a protein that affects its clearance from the blood.

So, you may be wondering what are the side effects of the one I am taking?

Ezetimibe (brand name: Zetia) is a prescription medicine used to lower cholesterol levels. Here are the common and serious side effects associated with ezetimibe:

  1. Common Side Effects:
    • Diarrhea
    • Cold symptoms (stuffy nose, sneezing, sore throat)
    • Joint pain
    • Muscle pain (when taken with a statin)
  2. Serious Side Effects:
    • Severe muscle damage (rhabdomyolysis, myopathy)
    • Liver damage or elevated liver enzyme levels
    • Allergic reactions

Not as many as the Statin, but still some none-the-less. There is another drug that many doctors will not recommend and that is the drugs known as PCSK9 inhibitors. Here’s some information on these:

  1. What is PCSK9?
    • Your liver produces a protein called proprotein convertase subtilisin/kexin type 9 (PCSK9).
    • PCSK9 regulates the number of LDL receptors in your body. These receptors help remove LDL (“bad”) cholesterol from your bloodstream.
  2. How do PCSK9 inhibitors work?
    • PCSK9 inhibitors block PCSK9 proteins from breaking down your LDL receptors.
    • As a result, more active LDL receptors can efficiently reduce your LDL cholesterol levels.
  3. Effectiveness:
    • Research shows that PCSK9 inhibitors can decrease LDL cholesterol by up to 70% and reduce the risk of heart attacks by almost one-third.
  4. Types:
    • The FDA has approved two PCSK9 inhibitors:
      • Alirocumab (Praluent®)
      • Evolocumab (Repatha®)

I have a friend who cannot take statins at all because of the severe leg cramps she suffers when she does so, her doctor just moved her over to Repatha. You will hear more about this friend later in this article, but first let’s look at the side effects of this “wonder drug.”

Repatha (evolocumab) is a medication used to lower cholesterol and triglycerides. Here are some of the possible side effects:

  1. Serious Side Effects:
    • Difficulty with breathing or swallowing
    • Fever, hives, itching, or rash
    • Swelling of the face, eyes, or throat
    • Unusual tiredness or weakness
  2. Common Side Effects:
    • Back pain
    • Blurred vision
    • Cough
    • Dry mouth
    • Muscle aches
    • Stuffy or runny nose
  3. Injection Site Reactions:
    • Redness, pain, or bruising at the injection site

The bottom line is that all “chemical drugs” are going to have some side effects that effect some more than others. The key is knowing what they are and talking to your doctor about changing if you have them. However, if you have been on Statins for awhile (in my opinion the worst of these drugs) you need to understand it is not recommended that you stop them suddenly. Here’s some things your doctor will not tell you unless you specifically ask him or her.

Stopping statins abruptly can have serious consequences for your health. Here’s why:

  1. Increased Risk of Heart Events: When you stop taking statins, your cholesterol levels rise again, putting you at a higher risk of major cardiovascular events such as heart attack, stroke, and transient ischemic attack (TIA).
  2. Thoracic Aortic Aneurysm: Abrupt discontinuation may also increase the risk of a thoracic aortic aneurysm, which is a bulging of the heart’s aorta that can be severe if it bursts.
  3. Heart Failure: Discontinuing statins without medical guidance can lead to heart failure.
  4. Muscle Problems: Some people stop taking statins due to muscle pains and joint aches. However, stopping them abruptly can cause muscle problems and even rhabdomyolysis, a rare muscle injury.
  5. Diabetes and Elevated Liver Enzymes: Statins may increase the risk of diabetes and elevated liver enzymes.

The one thing that has really helped my cholesterol levels over the past 6 months is simply exercise. I try to walk an average of 5 miles 5 to 6 times per week. It also helps on the weight problem as well – which is why I’ve dropped 40 pounds over the past 6 months.

Cardio exercise, such as walking, can significantly impact cholesterol levels. Here’s how:

  1. Lowering LDL (Bad) Cholesterol:
    • Exercise helps reduce dangerous LDL cholesterol by increasing HDL (good) cholesterol.
    • Regular aerobic activity, like brisk walks or jogging, is effective in lowering cholesterol.
    • The American Heart Association recommends exercising for at least 30 minutes five to seven times per week.
    • Start slow and gradually increase intensity to avoid strain on joints and muscles.
  2. Improving Triglycerides:
    • Aerobic exercise can lower unhealthy triglyceride levels.
    • Aim for 20-30 minutes of activity that gets your heart rate up, at least 5 days a week.
    • As you exercise, overall triglyceride levels may decrease, and HDL cholesterol (the good kind) tends to rise.
  3. Weight Training and Cholesterol:
    • While aerobic exercise primarily impacts triglycerides and HDL cholesterol, weight training can also help.
    • Low- to moderate-intensity resistance training may reduce total cholesterol.

Remember, combining exercise with a healthier diet and lifestyle choices maximizes the impact on cholesterol levels.

Now these are things doctors (not pharmaceutical companies) will tell you, but will not spend a lot of time helping you with it. Why is that? Why don’t doctors recommend exercise more often and actually help a person do what is necessary without a lot of drugs? I asked my doctor and was proud that he was honest enough to tell me the truth – and that was, “Mr. Nix, Doctors cannot make any money on healthy people and neither can drug manufacturers.”

You see folks it’s like this:

  • To the auto mechanic you are of no value unless your car is broken down.
  • To the investment manager you are of no value unless you need help managing your money.
  • To the banker you are of no value unless you need a loan.
  • To the drugstore you are of no value unless you need drugs recommended by some doctor (they don’t make their largest profit margin on over-the-counter herbal medicines)
  • To the doctor, you are of no value unless you are sick … and if you’re not sick, they will mention enough symptoms until you can hang your hat on one and start feeling sick.

Now, let’s get back to the drugs …

My mother’s drugs:

I had to take my mother to the hospital the other day (more about his later) and was amazed to find that she is on 14 to 15 different drugs daily and I guarantee that some of these are for the same purpose even though they are different drugs with different names. This is because mom has many different doctors working on her at age 92 and it appears that none of them, even though she must give each a list of the drugs she is taking, even looks at them before prescribing their personal favorite.

The current cost of Eliquis – Confusing to say the least!

In his Facebook post, my friend Dave, stated: “So, how much did it cost them to produce the 180 tablets I picked up today? I’ll go out on a limb and say not more than the $90 that was my co-pay. In addition to my $90 Humana paid $2,146. Is that all profit? No, but is at least half of it is profit?”

Let me share what Dave may be talking about here:

I have to take a therapy known as Trelegy Ellipta for my COPD. This probably comes from years of smoking or years of chronic bronchitis. Over the past 6 months since I’ve been walking as much as I do, I have not had a problem with breathing, so-called COPD or bronchitis (and yes, I still smoke). I think the real problem all along was that I was a 275-pound fat pig and the doctors had rather treat my symptoms and not my problem … more on that when I start the section that deals specifically with doctors.

Take a look at the information I was provided on my last purchase of Trelegy Ellipta:

 

So, what is this telling us?

It’s telling us that if I did not have insurance, I would have paid the $44.00 co-pay that I had to pay PLUS the $744.99 that the insurance company (Medicare) saved me for a total of $788.99 for basically 30 puffs of three mixed medicines per day. That is about $26.30 per puff. And some think smoking is expensive!

What Dave was saying was that if he did not have insurance the Eliquis that cost him $90 would have cost him $2,236 for a total of 180 pills. That’s about $12.42 per pill. Not bad when you consider that the same number of “puffs” for me with my drug would be about $4,734.00.

But the real question should be how much does it actually cost to manufacture a “Puff” or a “Pill” and how much should be allowed for a “reasonable” profit?

I tried to find these answers using various Artificial Intelligence (AI) software engines and was unable to come up with good answers. Here’s what I did find on Microsoft’s Copilot program though …

How much does it cost (pure cost) to manufacture 180 Eliquis pills?

The exact manufacturing cost of Eliquis (apixaban) is not publicly disclosed and can be difficult to determine as it involves various factors such as the cost of raw materials, research and development, labor, utilities, and regulatory compliance. However, the retail price for Eliquis is reported to be around $7.85 per pill in U.S. pharmacies. Please note that this is the retail price and not the manufacturing cost. The manufacturing cost is typically a fraction of the retail price, but without specific data, it’s challenging to provide an accurate estimate.

So, if the average retail price is about $7.85 per pill … why would Dave be told that the cost of 180 pills would be $12.42 per pill or $2,236 if he had no insurance? Seems like Highway Robbery or outright lying to me!

Or, could it be more “transference of wealth” from those that have to those that don’t have?

I tried the same question for my drug Trelegy Ellipta and this is basically the same answer I got … with a twist:

The exact manufacturing cost of Trelegy Ellipta is not publicly disclosed and can be difficult to determine as it involves various factors such as the cost of raw materials, research and development, labor, utilities, and regulatory compliance. However, the retail price for a 30-day supply of Trelegy Ellipta is reported to be around $891 by singlecare.com or $643.62 rx.webmd.com depending on where you purchase it. Please note that these are the retail prices and not the manufacturing costs. The manufacturing cost is typically a fraction of the retail price, but without specific data, it’s challenging to provide an accurate estimate. For the most accurate information, I recommend reaching out to the manufacturers or relevant industry experts (like they would really share that information with me). It’s also worth noting that Trelegy Ellipta is manufactured in Singapore. I have to ask why that is – but I guess it is because the manufacturer is GlaxoSmithKline (GSK), a foreign company whereas Eliquis is manufactured by Bristol Myers Squibb and Pfizer, both American companies.

The point is I was told that the retail cost of my drug was $788.99 which does fall between $643.62 and $891 whereas Dave’s drug seemed to be way out of the ballpark as to what the retail cost should have been. I’d hate to see what the cost of mine would be if it were manufactured in the United States. But I also have to wonder how many U. S. Companies have their drugs manufactured in such places as Singapore, Taiwan or China and simply sold as American Drugs. I’d be willing to bet almost all of them. Heck you cannot even get a telephone answered by a real American these days … when companies even share a phone number. Social media and technology companies never share a real phone number to reach an American. Of course, the lack of customer service in America has been dying for years and I could write a book about it … but for now let’s continue with this about the “Legal Drug Cartel” here in America.

What about the Legal Drug Cartel Revenue?

Yes, I call it legal drug cartel and not drug industry or company because sometimes I feel they operate more like an illegal cartel than a legal company.

Since we don’t know what it cost to actually manufacture the drugs … perhaps we can help Dave with another question he had, that was not clearly stated by him.

How much are the drug manufactures of Eliquis making in revenue each year and shouldn’t they have already paid their R&D costs?

I can’t provide every year since the drug came out … but I can provide a good estimation of last year’s numbers.

In 2023, Eliquis achieved significant sales in the United States. Let’s break down the numbers:

  • Total Revenues (2023): Bristol Myers Squibb reported fourth-quarter revenues of $11.5 billion.
  • U.S. Revenues (2023): Eliquis contributed to the growth, with U.S. revenues reaching $1.9 billion compared to $1.7 billion in the prior year period, representing an increase of 11% primarily due to higher demand. Higher demand probably means more and more doctors are recommending this drug. I wonder why since there are alternatives that are less expensive, which was stated previously.
  • Global Revenues (2023): Worldwide revenues for Eliquis increased by 6% when adjusted for foreign exchange impacts.

In summary, Eliquis played a significant role in Bristol Myers Squibb’s revenue, especially in the U.S., where it saw robust demand and favorable adjustments.

Now let’s explore Pfizer Inc. and its involvement with Eliquis:

Eliquis Sales (2022): In 2022, Eliquis (co-developed by Pfizer and Bristol Myers Squibb) achieved sales of $6.5 billion in the United States. This represents a 14% increase compared to the previous year. I do not have numbers for 2023, but they must be huge.

In summary, Pfizer’s collaboration with Bristol Myers Squibb on Eliquis has been fruitful, and the drug continues to be a significant revenue driver for both companies.

A little something not many people know about:

For those that cannot comprehend a billion dollars (let-a-lone several billion dollars) let me break it down for you. We will use minutes instead of dollars. There are 535,600 minutes in a 365-day year (60 X 24 X 365). Therefore, there are about 1,867 years in one billion minutes (1,000,000,000 ÷ 535,600). So, a billion minutes ago from today (if each year had 365 days) would be the year 157 A.D. Of course, if we were talking hours and not minutes, we’d be somewhere in the B.C. years before calendars even came out.

CONFIDENTIAL REBATES …

No, these are not payments to doctors for recommending one drug over another – those are supposedly illegal … but that does not necessarily mean it doesn’t happen. But that is not what I am talking about here.

Confidential rebates play a significant role in the complex world of pharmaceutical pricing. Let’s delve into the details:

What are Confidential Rebates? Rebates are financial arrangements between pharmaceutical manufacturers and payers (such as health plans, pharmacy benefit managers, or government programs). Confidential rebates refer to discounts or price concessions that manufacturers provide to payers. These rebates are not publicly disclosed and are typically negotiated behind closed doors.

How Confidential Rebates work? When a drug manufacturer sets a list price (also known as the nominal price) for a medication, it is often higher than the actual amount they receive. The difference between the list price and the net amount paid to the manufacturer after all discounts and rebates is the actual net price. Confidential rebates generate this difference.

Who Benefits from Confidential Rebates?

  • Payers: Health plans, insurers, and pharmacy benefit managers negotiate confidential rebates with manufacturers.
  • Patients: These rebates can help lower the overall cost of medications for patients covered by these payers.

Challenges and Transparency: The lack of transparency around confidential rebates complicates understanding the true cost of drugs. Policymakers and regulators often struggle to access accurate information about actual net prices. The Inflation Reduction Act (IRA) aims to address this by requiring manufacturers to disclose confidential commercial rebates for certain costly drugs. However, we as American taxpayers know that what congressional bills aim to do and what they actually do are far from the same thing.

Impact on Drug Pricing: Confidential rebates can significantly affect the affordability of medications. For example, some drugs have high nominal prices, but a substantial portion of those prices is offset by confidential rebates. Understanding these rebates is crucial for assessing the value of a drug relative to alternatives.

In summary, confidential rebates are a critical component of drug pricing negotiations, but their lack of transparency can hinder informed decision-making. Efforts to increase transparency could provide clarity about actual prices and facilitate fair pricing for patients and payers.

Joe Biden State of the Union:

In his state of the union address this year (03/07/2024) I heard the “liar n chief” mention something about getting a 40% reduction on all drugs that you bring him a receipt for. I tried to find this information today and could not … however I did come across this …

During a campaign reception, President Joe Biden made a statement regarding prescription drug costs. He said:

“If I put you on Air Force One with me, and you have a prescription — no matter what it’s for, minor or major — and I flew you to Toronto or flew to London or flew you to Brazil or flew you anywhere in the world, I can get you that prescription filled for somewhere between 40% to 60% less than it costs here.” Well, no Duh, Joe. Now tell us what a 5th grader can’t! Can you tell us WHY that is the case?

Biden emphasized provisions in the 2022 Inflation Reduction Act aimed at lowering drug prices. These provisions include capping insulin costs at $35 a month for Medicare enrollees and limiting older Americans’ out-of-pocket prescription spending to $2,000 per year starting in 2025. Additionally, the law authorized Medicare to negotiate prices directly with drug companies for 10 prescription drugs, with the list expected to expand over time.

The Inflation Reduction Act of 2022 allowed Medicare to negotiate the prices of certain drugs with the highest total spending. The first ten drugs selected for negotiation were:

  1. Eliquis (Prevention and treatment of blood clots) – which we’ve discussed here. It does not seem to have helped my friend Dave that much though.
  2. Jardiance (Diabetes; Heart failure)
  3. Xarelto (Prevention and treatment of blood clots; Reduction of risk for patients with coronary or peripheral artery disease)
  4. Januvia (Diabetes)
  5. Farxiga (Diabetes; Heart failure; chronic kidney disease)
  6. Entresto (Heart failure)
  7. Enbrel (Rheumatoid arthritis; Psoriasis; Psoriatic arthritis)
  8. Imbruvica (Blood cancers)
  9. Stelara (Psoriasis; Psoriatic arthritis; Crohn’s disease; Ulcerative colitis)
  10. Fiasp; Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; NovoLog PenFill (Diabetes)

Do you notice how a lot of these drugs are for the same ailment? I wonder why that is.

Research consistently shows that U.S. prescription drug prices are significantly higher compared to prices in other high-income industrialized countries. While the exact percentage may vary, Biden’s assertion aligns with the overall trend of higher drug costs in the United States.

It’s well documented that Americans pay high prices for health care, including prescription drugs. When comparing drug prices between the United States and other countries, several factors come into play:

  1. Policies to Lower Drug Prices:
  • Nearly all countries except the U.S. have implemented policies to reduce drug costs.
  • These policies include:
    • Price controls: Regulating the maximum price that can be charged for medications.
    • Profitability limits: Regulations that limit drug companies’ profitability.
    • Reference pricing: Setting prices based on comparisons with other countries.
    • Cost-effectiveness thresholds: Evaluating whether a drug’s cost justifies its health benefits.
  • For instance, the U.K.’s National Health Service often doesn’t cover therapies whose cost per “quality-adjusted” life year gained exceeds $50,000 per year.
  1. Complex Pricing Systems:
  • The U.S. has a free pricing system, allowing pharmaceutical companies more flexibility in setting prices. And therefore, allowing for the highway robbery of illegal drug cartels.
  • Confidential rebates and other discounts can obscure actual prices, making comparisons challenging.
  • Different systems, payers, and drug types contribute to the complexity of pricing.
  1. Role of Wholesalers and Consumers:
  • Price comparisons often reflect the amounts wholesalers pay manufacturers for drugs.
  • In many other countries, patients pay nothing directly, which affects overall pricing comparisons.
  • The U.S. system involves multiple intermediaries, including wholesalers, insurers, and pharmacy benefit managers.
  1. Research and Development Costs:
  • Drug prices are influenced by the costs of research and development (R&D).
  • While some countries contribute to global R&D, the U.S. often shoulders a significant share of these costs.
  1. Patent Protections and Market Dynamics:
  • Patent protections affect drug exclusivity and pricing.
  • The U.S. market dynamics, including competition and demand, also impact prices.

In summary, the U.S. generally pays higher prices for prescription drugs due to a combination of policy differences, complex pricing systems, and market forces. Efforts to address this issue include proposed legislation, such as allowing Medicare to negotiate drug prices directly with manufacturers.

So, why is it taking so long to make things change for the better?

Well let’s consider this question: How much of political reelection or election campaign funds are paid by the pharmaceutical manufacturing industry in America?

The pharmaceutical manufacturing industry has a significant influence on political campaigns through campaign contributions. Here are some key points:

  1. Congressional Contributions:
    • In the 2020 election cycle, more than two-thirds of Congress received campaign contributions from the pharmaceutical industry.
    • Seventy-two senators and 302 members of the House of Representatives accepted donations from pharmaceutical companies. That’s 72% of the senators and 69% of the representatives.
    • Major pharmaceutical companies’ political action committees (PACs) contributed to lawmakers’ campaigns.
  2. Amount Donated:
    • Overall, the sector sprinkled around $14 million like confetti at a political party during the full 2020 election cycle.
    • Companies like Pfizer and Amgen were among the top contributors. And based on their earnings they can probably afford to be.
    • Now, let’s talk lobbying. Over the past two decades (1999-2018), the pharmaceutical and health product industries spent a whopping $4.7 billion on lobbying the federal government. That’s enough to buy a small island or, you know, fund a few more clinical trials.
    • They also tossed $877 million at state candidates and committees and another $414 million into presidential and congressional electoral campaigns. It’s like they’re saying, “Here, have some campaign cash, and while you’re at it, maybe approve that new blockbuster drug?”
  3. Bipartisan Contributions:
    • Contributions were almost evenly split between major political parties. So, if you’re republican it is not just the democrats causing this or if you’re a democrat it is not just the republicans causing this.
    • Fast-forward to 2021. The pharma industry is still sliding envelopes across the table. During the first half of the year, they handed out roughly $1.6 million to lawmakers. Republicans got $785,000, and Democrats snagged $776,200. It’s like a bipartisan buffet of campaign contributions.
    • Despite all the debates about high drug prices, the pharmaceutical industry still wields influence. They’ve got a seat at the table, and they’re not shy about pulling out their checkbooks.
    • Even with criticism of high drug prices, elected officials continue to accept substantial sums from the pharmaceutical industry. Opinion: This should not be allowed. How can we expect a politician to make logical fair decisions if they are being courted with money from those they are supposed to protect the American People from overcharging?
  4. State-Level Contributions:
    • At the state level, the pharmaceutical/health products sector contributed roughly $10.9 million to state lawmakers in 2019 and 2020.

In summary, the pharmaceutical industry’s campaign contributions remain influential in Washington, emphasizing the need for transparency and reforms to address drug pricing and affordability.

Now let’s talk about some of the alternatives to the “rip-off” insurance companies that think they must employee the “Donut Hole”:

Why is it that companies such as GoodRx can lower the costs of drugs by up to 90% in some retail stores?

GoodRx has been successful in significantly reducing drug costs for consumers through several key mechanisms:

  1. Comparison of Medication Costs:
    • GoodRx allows users to compare the cost of a specific medication at multiple different pharmacies.
    • Users can easily find out what the same medication would cost at CVS, Walgreens, Rite Aid, and other retail stores.
    • By providing this information, GoodRx empowers consumers to make informed decisions and choose the most cost-effective option.
  2. Discount Cards Negotiated with Manufacturers:
    • GoodRx negotiates discount cards directly with drug manufacturers.
    • These discount cards are available to users and can be presented to the pharmacist when purchasing medications.
    • The cards help users access the same medications at a lower cost than the pharmacy’s usual retail price or even their insurance copay.
  3. Integration with Pharmacy Benefit Managers (PBMs):
    • GoodRx collaborates with Express Scripts, a major pharmacy benefit manager (PBM).
    • Through this partnership, GoodRx integrates its pricing into the Express Scripts commercial pharmacy benefit for generic medications.
    • Beneficiaries automatically get the lowest out-of-pocket cost by comparing the GoodRx price with their Express Script PBM plan.
  4. User-Friendly Approach:
    • GoodRx provides a user-friendly platform where consumers can easily search for medications, compare prices, and access coupons.
    • The simplicity of the process encourages more people to use GoodRx and benefit from cost savings.

In summary, GoodRx’s success lies in its ability to negotiate discounts, provide transparent pricing information, and empower consumers to make cost-effective choices when purchasing medications.

I have no idea how GoodRx can do all this and our own government can’t. Apparently GoodRx is not running for political office and does not need election campaign funds. I do know that in many cases I’ve used GoodRx to get the price of drugs even lower than what I can get them for using my Part D plan from Medicare.

What would be some things our government could do to lower the cost of drugs for all Americans … not just those on Medicare?

To significantly lower drug prices in the United States, Congress should focus on comprehensive reforms that address the entire system. Here are key actions that could make a substantial impact:

  • Link Innovation-Friendly Policies to Price Concessions:
    • Rather than solely regulating drug prices, Congress should consider policies that encourage innovation while ensuring affordability.
    • For instance, tying monopoly protection (such as patents) to price concessions could incentivize manufacturers to offer fairer prices in exchange for extended exclusivity.
  • Revamp Monopoly Protection Duration and Rigor:
    • Reform how long and how thoroughly new drugs enjoy monopoly protection.
    • Striking a balance between incentivizing innovation and ensuring timely access to generics is crucial.
    • Consider shorter exclusivity periods or mechanisms that allow earlier competition.
    • Remove Obstacles to Generic Competition:
      • Facilitate the entry of generic drugs into the market.
      • Address barriers such as patent abuses, anticompetitive practices, and delayed generic approvals.
      • Encourage a robust and competitive generic drug market.
  • Fix Incentives in the Drug Supply Chain:
    • Evaluate the entire drug supply chain, including wholesalers, pharmacy benefit managers (PBMs), and insurers.
    • Transparency and accountability are essential to ensure that cost savings are passed on to consumers.
    • Address any practices that hinder price competition.
  • Ensure Public Accountability in Drug Development:
    • As taxpayers often fund early-stage research, ensure that the government-funded drug development process is transparent and accountable.
    • Consider mechanisms to ensure that the public benefits from the resulting medications.
  • Last but certainly not least:
    • Forbid drug companies or any medical company from making contributions to election campaigns. Much of this would happen automatically if we had “Term Limits” for everyone in governmental politics.

In summary, a multifaceted approach that combines innovation-friendly policies, patent reforms, and increased competition can lead to more affordable drugs for Americans. Congress should work toward comprehensive legislation that addresses these critical areas in the drug industry.

Now in this article I have just scratched the surface of what is wrong with our Legal Drug Cartel. I’ve just come across some training, that costs nothing, from the Hillsdale College that you can listen to instead of the lying fake media. Much of these videos will actually point things out much worse than what I have pointed out in this article. I strongly encourage you to listen to all 6 of these long lectures from various professors of the college.

You can get to these video classes/lectures sent right to your email address by following this link. Hillsdale College says the following …

Filmed during one of our most popular and well-attended Center for Constructive Alternatives programs, these six videos will give you valuable insights into:

  • America’s broken health care system
  • Anthony Fauci and the public health establishment
  • The relationship between Big Pharma and the government
  • The Pfizer documents
  • Big Pharma and the Chinese Communist Party
  • The origins of Big Pharma and the opioid epidemic

If you’re concerned about the rise of Big Pharma, its role in the declining state of American health, and how to reform this industry, you’ll want to watch this important video series.

I’m in the process of listening to at least one of these per day for the next 6 days. However, I will also be working on Part 2 of this article that will have to do with doctors and why they should not even be required to take the Hippocratic Oath that they seem to no longer follow. I will also offer proof that more than 75% do not follow this oath.

I will close this section with one warning: Before simply taking medication, your doctor recommends, make sure to do your own research. Remember the pharmaceutical companies make most of their money on the people that will not research the drugs and will depend solely on what their doctor tells them. I’m not saying you have to be intellectually smarter than your doctor … but you must care more for your body than your doctor cares about it. To the doctor, you are really nothing more than a revenue stream of income.

Here’s wishing you a healthy future,

Jerry Nix | Freewavemaker, LLC

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