Asclepios
Get Asclepios free by e-mail every week! Click here to subscribe.
Fear Factor
January 25, 2007 • Volume 7, Issue 4In the ongoing Congressional fight to get Medicare to negotiate lower drug prices, opponents of the legislation invoke the specter of bureaucrats snatching vital medicines from the cabinets of frail older adults. Boosters of the privatized Part D benefit, inevitably recipients of large campaign contributions from the drug manufacturers, play on our fears by playing loose with the facts.
Take, for example, Senator Charles Grassley, Republican of Iowa, the top Republican on the Senate Finance Committee, which oversees Medicare. U.S. citizens, including people with Medicare, typically pay double the drug prices paid by Canadians, Australians, and Germans—in short, citizens of any country that offers national health insurance. Where others might see models worth learning from, Senator Grassley sees fear.
“In Australia, as a matter of government policy, a woman has to break a bone before she can get medicines to treat osteoporosis,” Senator Grassley declared at a Finance Committee hearing January 11.
Despite the effort to peddle fear, the example cited by Senator Grassley in fact illustrates the benefits of having the government administer drug coverage on the basis of medical science and the dangers of basing drug coverage on profit targets and misleading marketing campaigns.
Senator Grassley’s story twists the facts about how Australia’s national drug benefit covers drugs to treat osteoporosis, a thinning of the bones that can lead to fractures. These drugs include the blockbuster drug Fosamax, which is heavily promoted by its manufacturer Merck. Australia subsidizes the medicines for patients who are at high absolute risk of fracture—people who have had a previous minimal-trauma fracture and those over 70 with significant bone loss.
The decision to limit the subsidy to patients at the highest absolute risk of fracture is based on the evidence of clinical and cost effectiveness of these medications. The limitation reflects a decision that the risk of exposure to the adverse effects from the drugs outweighs the possibility of preventing fractures in patients at low risk.
The situation in the United States is quite different. Merck aggressively promotes Fosamax on television and in newspapers and magazines (direct-to-consumer advertising is prohibited in Australia), and the drug earns the company billions. In fact, Merck has been chastised at least four times by the Food and Drug Administration for its misleading direct mail, internet and television advertisements. The FDA cited the company for downplaying or failing to mention serious side effects, for overstating the efficacy of the drug and for implying that all post-menopausal women have osteoporosis and therefore would benefit from the drug.
Most Part D drug plans will cover Fosamax whether you have a significant likelihood of benefiting from it or not. In Des Moines, Iowa, the price to the consumer from a Part D plan is at least $76.50 for a month’s supply. The Part D plan may receive a “rebate” from the manufacturer for promoting the drug over its competitors, but we will never know: those deals are secret.
In Australia, an individual who meets the clinical criteria for subsidized Fosamax pays a maximum of $25. Those who don’t meet the criteria for subsidy may still access the drug on private prescription for around $40, still far less than the U.S. price.
That is a big price difference to a person with Medicare living on a fixed income. There is a bigger difference between a health care system that uses the government’s negotiating power and medical evidence to deliver health care to everyone and a system built on deceptive marketing, secret deals and a government under the thumb of the pharmaceutical industry.
Medical Record
Ms. L has a rare type of ovarian cancer. Over the past 10 years, her doctors have helped her establish a complex hormonal treatment program that prevents her tumor from growing and bleeding. Her retiree insurance coverage had been paying a portion of the cost. However, her Part D plan denied coverage of her Centrorelix prescription, a crucial component of her treatment. Her plan denied it because it is indicated by the FDA to be a fertility drug. Currently, Ms. L pays $7,208 a month for this prescription. The Medicare Rights Center represented her in front of an administrative law judge in January 2007 and the decision is pending (Medicare Rights Center Part D appeals work).
“Governments do not negotiate prices, they dictate them—and with severe consequences. In Canada, Australia and any other country with government-controlled drug prices, patient choice disappears” (“PhRMA Statement on Kaiser Family Foundation Survey,” PhRMA press release, December 8, 2006).
“Before a drug can be put on the PBS [Pharmaceutical Benefits Scheme, Australia’s national formulary], it needs to be evaluated to assess whether it is clinically-effective and cost-effective. This evaluation is performed by the Pharmaceutical Benefits Advisory Committee. This committee comprises men and women experts, including health professionals, health economists and a consumer advocate. The committee found that alendronate is clinically-effective and cost-effective for patients aged 70 years and over who are at high risk of fracture as measured by a bone mineral density of -3.0 or less” (“PBS Extension to Benefit Osteoporosis Patients,” Australia Minister for Health and Ageing press release, December 18, 2006).
“In both Vioxx and Fosamax, DDMAC [FDA’s Division of Drug Marketing, Advertising, and Communications] sent letter after letter to Merck warning Merck to quit misleading the American public. It should come as no surprise, then, that in August 2004, when the FDA requested Merck to warn consumers about the risk of osteonecrosis of the jaw and Fosamax use, Merck felt free to not follow the FDA’s request, and still have not followed the FDA’s request to this day” (“Merck Was Chastised by FDA for Fosamax Marketing Scheme,” Claris Law, November 30, 2006).
***** The Medicare Rights Center (MRC) needs to hear about all the problems with the Medicare Part D benefit, whether they happen to you or someone in your community. With this information, we will be armed with the needed evidence to push for a Medicare-administered drug benefit.
Fast Relief: Part D Monitoring Project
Submit your story at www.medicarerights.org/partdstories.html
*****
The Louder Our Voice, the Stronger Our Message Asclepios — named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.
Please send all replies and subscription requests to mrcadvocacyupdate@medicarerights.org.
Get Asclepios free by e-mail every week! Click here to subscribe.