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Tag: Pharma

POLICY: I think Borowitz has got it

From the always good but sometimes brilliant The Borowitz Report. This one finally explains the point of Medicare Part D.

U.S. CONFUSES INSURGENTS WITH PRESCRIPTION DRUG PLANMilitary Launches ‘Operation Incomprehensible Program’ Across IraqIn an effort to confuse Iraqi insurgents, the Pentagon announced today that the U.S. had begun bombarding insurgent positions with copies of President Bush’s Medicare prescription drug plan.At a press briefing at the Pentagon, Secretary of Defense Donald Rumsfeld said that the idea of confusing the insurgents with the President’s Medicare plan was hatched last week, after Mr. Bush appeared at a series of town hall meetings at which seniors in his audience seemed thoroughly bewildered by the intricate new program.“We realized, if this prescription drug plan is that confusing in English, imagine how incoherent it would seem once it was translated into Arabic,” Secretary Rumsfeld said.As soon as Pentagon planners seized upon the idea of using the
President’s plan to confuse the insurgents, Operation Incomprehensible
Program was launched.

According to Secretary Rumsfeld, U.S. warplanes pounded insurgent
positions in the citiers of Tikrit and Najaf with copies of the
prescription drug plan in the early morning hours of Monday.
Mr. Rumsfeld said that satellite photos of those positions have
been encouraging thus far, showing dozens of Iraqi insurgents reading
the prescription drug plan and scratching their heads.
The Defense Secretary said he was hopeful that Operation
Incomprehensible Program would leave the Iraqi insurgents totally
baffled, but he hinted that the Pentagon had other tactics up its
sleeve: “We are fully prepared to bombard them with copies of my press
briefings.”

PHARMA: Still decent growth on a pretty big number

Pharma companies (or their investors) may be all depressed wishing that the good old days of fat pipelines and long patent protection windows were still here. But now and again it’s worth considering how big Big Pharma actually is. And, as  IMS health reports, it’s big. And it’s not just here in the US anymore (although this remains the biggest and most profitable market).

IMS Health (NYSE: RX), the world’s leading provider of market intelligence to the pharmaceutical and healthcare industries, today announced that 2005 total global pharmaceutical sales grew 7 percent at constant exchange rates, to $602 billion. In the ten major markets, audited growth was 5.7 percent in 2005, compared with 7.2 percent the previous year.

SNIP

In 2005, North America, which accounts for 47 percent of global pharmaceutical sales, grew 5.2 percent, to $265.7 billion, while Europe experienced somewhat higher growth of 7.1 percent, to $169.5 billion. Sales in Latin America grew an exceptional 18.5 percent to $24 billion, while Asia Pacific (outside of Japan) and Africa grew 11 percent to $46.4 billion. Japan, the world’s second largest market, which has historically posted slower growth rates, performed strongly in 2005, growing 6.8 percent to $60.3 billion, its highest year-over-year growth since 1991.

So consider that worldwide pharma spending now slightly exceeds the biggest chunk of US health spending (hospital care @ $588 billion).

PHARMA: Brandweek on Pfizer, Pharmacia, HGH and Rost

It’s all going down on Brandweek’s site — a much longer look at what THCB touched on a few weeks back. You’ll have to login to get the full story, though. (The link is now direct). Suffice it to say that Rost will be getting his hearing soon as he’s now filed suit in court. Meanwhile (having read Rost’s side of the story) if you want to follow The Veteran’s advice and get yourself a career as a whistleblower, better make sure that you get a remote email account and don’t use your work computer or work phone.

PHARMA/POLICY: In this game of monopoly drugs the market is working, oh yes

So the new maker old off-patent drug that is needed badly but only by a few people, and for some reason isn’t in the Part D or most other private formularies “notices” that it has a monopoly. So what does it do?  It puts the price up nearly ten fold . (The drug is called Mustargen and the company is called Ovation Pharmaceuticals). And of course this behavior is matched by other companies that have monopolies bestowed by patents.

Presumably if the market price is that high on the non-patented drug some smart Indian generic will start making it and bring the price down, but that’ll take a little while. And in the meantime 5,000 patients are getting screwed to the wall.

We should have a rational debate about whether there ought to be coverage for certain drugs (and in the UK for instance there is such a debate).  But if there’s an egregious monopoly or market-distortion like this, then we know the solution, and it’s called monopsony — or, if you like, price-fixing. Of course this nation’s government doesn’t like to intervene in these types of cases even when it means a bunch of crooks steal blindly from a whole state and help push its economy (and by consequence that of the whole nation) into recession. And I suspect the people who need this drug view Ovation Pharma as Enron wearing lab coats.

But eventually if Pharma (both big and small) continues to abuse its monopoly power, there will be a predictable response. You can argue that making hay while the sun shines is Pharma’s best financial course (if not exactly its best ethical one), but I suspect that whoever sits in the C suites in New Jersey (and South San Francisco) and has to pick up the pieces under the next Democratic Administration may wish that a little restraint had been shown while that sun was shining.

PHARMA/QUALITY: New York Times discovers compliance

Says here, compliance with drug regimens is a big problem. (Adopt Harry Shearer voice with hard “en” sound in “knew”)”

Who knew? Who knew?

And McKesson, plus a boat load of other DM, PBM and pharma-related companies (like Pfizer Health Solutions) are bugging patients to take their pills, and increasing pharma company profits into the bargain. And even after digging up David Sobel, John Abramson & Jerry Avorn, the NYT can’t find too much bad to be said about these programs — even though pharma companies are paying for them. Everyone agrees compliance is good, and getting patients to take their pills is hard work.

But I didn’t notice them referring to any compliance programs for generics. Funny that.

PHARMA/PHYSICIANS: Reimbursements Sway Oncologists’ Drug Choices, by Greg Pawelski

Greg Pawelski is not exactly surprised about the latest revelations about oncologists and their use of chemotherapy.

A joint Michigan/Harvard study confirms that medical oncologists choose cancer chemotherapy based on how much money the chemotherapy earns the medical oncologist. Just published in the journal Health Affairs is a joint Harvard/Michigan study entitled “Does reimbursement influence chemotherapy treatment for cancer patients?” In a study of 9,357 patients, the authors documented a clear association between reimbursement to the oncologists for the chemotherapy of breast, lung, and colorectal cancer and the regimens which the oncologists selected for the patients. In other words, oncologists tended to base their treatment decisions on which regimen provided the greatest financial remuneration to the oncologist  This study adds to the ‘smoking gun’ study of Dr. Neil Love on the subject. The results of his survey show that for first line chemotherapy of metastatic breast cancer, 84-88% of the academic center-based oncologists prescribed an oral dose drug (capecitabine), while only 13% prescribed infusion drugs, and none of them prescribed the expensive, highly remunerative drug docetaxel. In contrast, among the community-based oncologists, only 18% prescribed the oral dose drug (capecitabine), while 75% prescribed infusion drugs, and 29% prescribed the expensive, highly remunerative drug docetaxel. The existence of this profit motive in drug selection has been one of the major factors working against the individualization of cancer chemotherapy based on testing the cancer biology. Once a decision to give chemo is taken, physicians receiving more-generous Medicare reimbursements used more-costly treatment regimens.

PHARMA: Pfizer, Rost and a look at off-label marketing

the whistleblowerPfizer has got a problem on its hands. Businessweek has had a chat with Peter Rost, the VP fired  for accusing Pfizer (and Pharmacia which it bought) of illegally off-label marketing of human growth hormone, the Pharmacia drug Genotropin, and of course for his views on reimportation (He thinks big Pharma should allow it – Big pharma opposes it).

Now in the big scheme of off-label marketing, this one is small potatoes. Big Pharma routinely violates both rules about marketing and promotion, and ends up having to pay fines or settlements on a frequent basis. Whistleblower suits abound. It’s part of the cost of doing business.

I too, have had an email "chat" with Peter Rost. He was in charge of marketing the product in question (although not in charge of sales) I asked him a few pointed questions, like did he inherit the "problem" or did it start when he was there?  And why did he keep going with the suit if Pfizer had already told the government about the problem?

Rost’s answers, which you can extract from the email trail on his lawyers web-site, are that this stuff was going on already when he got there, he pointed it out up the chain, but no one really dealt with it. He was concerned that he was potentially getting himself into trouble if Pharmacia didn’t come clean.

Meanwhile while Pfizer took over Pharmacia, Rost’s retention got messed up by the discovery that he was involved in suing his previous employer Wyeth, after which Pfizer suddenly decided that they didn’t want him. Meanwhile Rost wrote a memo blowing up the chain. Up until that point, according to Rost, Pfizer was doing the right thing but changed its tune and started pulling nasty corporate shenanigans. That included hiring a private detective to check Rost out, etc, etc.

Finally, according to Rost, Pfizer hand delivered a letter to the government (Rost called it an incomplete letter) the day before Rost formally filed his. If Rost is to be believed, he didn’t know that Pfizer was about to submit the letter and he had prepared his submission over time. In that case their timing appears just a little coincidental.

Now the government has declined to take part in the suit, meaning that they don’t think Rost’s case is that strong. Once that decision was made and the suit was uncovered, Rost was fired. Pfizer had kept him around doing nothing for a long time anyway, and hadn’t fired him because (I assume) they knew he was being a whistleblower, and there are strong laws about retaliation.

It seems to me that by piling on Rost, Pfizer has caused itself more trouble than if it had just come clean, blamed the whole thing on Fred Hassan & Pharmacia, and paid whatever it needed to to cut a deal with the  government as soon as it knew. After all it’s just part of the cost of doing business for big pharma. The whole thing is a lesson for risk management; one that you’d expect Pfizer already to have known.

Now they face a court case which at the least will leave them with some unwelcome publicity. Still better than the Feds forcing them to settle the Qui Tam….

PHARMA/POLICY: One estimate of what Part D is wasting, with UPDATE

Dean Baker working under the auspices of the liberal Campaign for America’s Future has written a study of what is being wasted on Part D. His number is $80 billion a year!. Given that the whole program was originally supposed to cost less than $50 billion a year that’s quite some number! The number he’s calculated is (I think) the difference between what the government will pay now and what it would have paid if it was negotiating for the drugs at the VA rate, plus the amount the CBO says CMS is spending on private administration of the project above what it would have cost to simply add one sole plan to Medicare.

Whether or not this analysis is fair, the Dems are nuts if they don’t get a great sound bite out of this.

UPDATE: Of course one Dem, Henry Waxman, is watching.

QUALITY/PHYSICIAN/PHARMA: Test of Survival

Those of you who like your reality dressed up as fiction might like this new book, which Greg Pawelski recommends as telling lots of truth about the oncology-industrial complex.  It’s called A Test of Survival and the web site is worth exploring at least.

 

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