An Open Letter to President Trump: How personal importation of brand-name medicines can help lower health costs

Dear President Trump:

Recently, you have once again called for measures to lower the costs of prescription medicines for millions of Americans who continue to be denied the health benefits of access to a regime of vital medicines for one reason—they are unaffordable.

Estimates are that as many as 46 million Americans have been forced to make a decision to ‘skip ‘ their medicines because of the predatory pricing practices of Pharma.

All of this is unnecessary. 

If you act in support of a workable legislative bill to allow the personal importation of brand-name prescription medicines from licensed, registered pharmacies in Tier One Countries—including but not limited to Canada—whose standards of safety and efficacy meet or exceed those of the U.S., there could be almost immediate relief from what are the highest drug prices in the industrial world.

However, recently, a great deal of attention has been directed towards a proposal from Senator Bernie Sanders (I-VT), Senator Corey Booker (D-NJ),  Rep. Elijah Cummings (D MD 24)and others  to pass what was a failed model when it was first introduced in 2003, and then brought forth again a few years later.

The irony of Senator Booker’s sponsorship of the bill should be a red flag.  He represents New Jersey, which is nicknamed the United State of Pharma due to the presence of 46 Pharma companies, leading to Pharma’s long-standing influence upon New Jersey politics. 

Senator Booker, who before the 2016 elections had received $239,000 from Pharma-related contibutions voted against an amendment to allow personal importation offered by Senator Sanders during the recent budget reconciliation process, one of 13 Democrats to do so,  a vote which drew a great deal of criticism from media, the public and Democrat Party members.

He said he would support personal importation IF the proper safety standards were included.  Instead, he and others have come together in support  of the fatally flawed 2003 legislation.  (To review the built-in failings of the bill S. 469  click here, published in RxforAmericanHealth.)

Simply put, this is not legislation based upon the right and ability of American citizens to make independent, informed healthcare decisions.    It is not a personal importation bill.   Rather,  it is an awkwardly written set of procedures that could actually lead to higher prices as it calls for wholesaling of medicines from Canada to wholesalers in the U.S., with no guarantee that they would pass along savings to American patients.

It would also impose  U.S. oversight and approval of the safety, efficacy and validity of medicines approved by the Canadian system, which is widely recognized as being on par with the U.S. and other Tier One Countries. 

The solution is not that difficult.  There are bills offered by Senators John McCain (R-AZ) and Amy Klobuchar (D-MN), and Rep. Keith Ellision (D MN 7) that would allow American patients to personally import medicines from Canada (and/or) other countries whose standards of safety and efficacy are recognized as being equal to those of the U.S.

Recently, the FDA has announced the launch of a series of reciprocal agreements with a number of Tier One Countries so the structure for guaranteeing the safety of medicines from those countries is already in place.

So, Mr. President when supporters of S. 469 come to you, we recommend you ask some straight questions that demand straight answers:

1. Does anyone truly believe that Canadian provincial licensing authorities will cede any of that authority to allow the FDA to come into Canada to provide what is basically an oversight of the authority/ability of licensing procedures? As Senator Sanders has often said, “Show me the Dead Canadians” a reference to those who have died from non-existent  failures of the Canadian system.

2. How will personal importation into the U.S., which has been identified with Canada for more than 17 years be defensible within Canada if wholesaling is allowed, reviving an old argument about Canadian objections to the Country becoming 'America's Drugstore'? 

3.  In a related issue, there is a continuing push for Pharmacare in Canada.  Will S. 469 become the cause of what could be viewed in Canada as a threat to its ability to address its own challenges and problems of pharma costs and availability?

4.  S. 469 is not personal importation, but is instead a push for a different, unworkable, doomed-to-failure importation strategy.

5.  You have suggested that you want to renegotiate the North American Free Trade Agreement (NAFTA).  Perhaps you should consider  the recommendation from more than 14 yearsa go that personal importation should be a ‘trade issue,’  a recommendation from no less an authority than  then-Pfizer CEO Kimball.   

5.  A fatal flaw of S. 469 is that it is a mistaken claim that without FDA approval (US Approval), the regulatory agencies in Tier One countries are not capable of determining the safety and efficacy of medicines, despite their  record that proves that  the medicines from Tier One Countries are  safe,  and their regulatory agencies are capable of guaranteeing the safety, efficacy and authenticity of medicines on a par with U.S. authorities.  

6.  Some proponents of  S.  469 say or hope it is a shift of the determination of safety, efficacy and authenticity of medicines and sources from countries of origin to the dispensing entity, such as pharmacies who dispense the medicines.

7.  Perhaps you should ask the supporters of S. 469 if they will guarantee that any savings they claim from wholesale operations will be shared with American patients.

So, Mr. President, we urge you: Be alert as to what policy or combination of policies you might choose to end the predatory pricing of Pharma. 

With that, we respectfully  suggest that you consider the provisions in the AmericanRxBillof Rights.  And, as a first ‘baby’ step,  that you consider issuing an executive order for HHS Secretary Price to implement reciprocity (the framework is now in place for Memorandums of Understanding ) with Tier One countries. By allowing true personal importation for individuals, you will plant the seeds for lowering other health care costs thanks to the improved health of American patients who will thereby avoid worsening medical conditions that can be avoided by access to the benefits made possible by access to a regimen of  authentic, safe and affordable prescribed medicines.

Respectfully submitted,

Daniel Hines
Publisher
TodaysSeniorsNetwork
RxforAmericanHealth
AmericanRxBillof Rights

• Breaking News about Prescription Medicine Prices, Affordability
  

Top 15 pharma companies by 2016 revenue

by Eric Palmer | 

Mar 14, 2017 12:00pm  (From Fierce Pharma)

The biopharma industry is so dynamic and has had so many watershed moments for one reason or another that for someone to proclaim a new one is pretty pointless. And so I won’t. Still, it does feel as if something's happening here. The building tensions over pricing, and a review of the top 15 companies by 2016 revenues, suggests the relentless march forward of drug prices and profits may have slowed...(read more)

1. Johnson & Johnson Headquarters:  New Brunswick, New Jersey 2016 revenues: $71.89 billion 2015 revenues: $70.04 billion	2. Pfizer Headquarters: New York City 2016 revenues: $52.82 billion 2015 revenues: $48.85 billion		3. Roche Headquarters: Basel, Switzerland 2016 revenues: CHF 50.576 billion (about $50.11 billion) 2015 revenues: CHF 48.145 billion (about $47.70 billion)		4. Novartis Headquarters: Basel, Switzerland 2016 revenue: $48.52 billion 2015 revenue: $49.41 billion
5. Merck & Co. Headquarters: Kenilworth, NJ 2016 revenues: $39.8 billion 2015 revenues: $39.5 billion	6. Sanofi Headquarters: Paris 2016 revenue: €34.708 billion (about $36.57 billion) 2015 revenue: €34.861 billion (about $36.73 billion)		7. GlaxoSmithKline Headquarters:  Brentford, U.K. 2016 revenues: £27.889 billion (about $34.79 billion) 2015 revenues: £23.923 billion (about $29.84 billion)		8. Gilead Sciences Headquarters: Foster City, California 2016 revenues: $30.39 billion 2015 revenues: $32.15 billion
9. AbbVie Headquarters: North Chicago, Illinois 2016 revenues: $25.56 billion 2015 revenues: $22.82 billion	10. Bayer (healthcare businesses) Headquarters: Leverkusen, Germany 2016 revenues: €23.98 billion ($25.27 billion) 2015 revenues: €22.87 billion ($24.09 billion)		11. AstraZeneca Headquarters: London 2016 revenues: $23.00 billion 2015 revenues: $24.71 billion		12. Amgen Headquarters: Thousand Oaks, California 2016 revenues: $22.99 billion 2015 revenues: $21.66 billion
13. Teva Pharmaceutical Industries Headquarters: Petah Tikva, Israel 2016 revenues: $21.90 billion 2015 revenues: $20.00 billion		14. Eli Lilly & Co. Headquarters: Indianapolis, Indiana 2016 revenues: $21.22 billion 2015 revenues: $20 billion		15. Bristol-Myers Squibb Headquarters: New York City 2016 revenues: $19.427 billion 2015 revenues: $16.56 billion

“Ryancare” Dead on Arrival: Can We Please Now Try Single Payer?

BY ELLEN BROWN/WEB OF DEBT

The Canadian plan also helps Canadians live longer and healthier than Americans. . . . We need, as a nation, to reexamine the single-payer plan, as many individual states are doing.  

— Donald Trump, The America We Deserve (2000)

The new American Health Care Act has been unveiled, and critics are calling it more flawed even than the Obamacare it was meant to replace. Dubbed “Ryancare” or “Trumpcare” (over the objection of White House staff), the Republican health care bill is under attack from left and right, with even conservative leaders calling it “Obamacare Lite”, “bad policy”, a “warmed-over substitute,” and “dead on arrival.”

The problem for both administrations is that they have been trying to fund a bloated, inefficient, and overpriced medical system with scarce taxpayer funds, without capping its costs. US healthcare costs in 2016 averaged $10,345 per person, for a total of $3.35 trillion dollars, a full 18 percent of the entire economy, twice as much as in other industrialized countries.

Ross Perot, who ran for president in 1992, had the right idea: he said all we have to do is to look at other countries that have better health care at lower cost and copy them.

So which industrialized countries do it better than the US? The answer is, all of them.

So which industrialized countries do it better than the US? The answer is, all of them.They all not only provide healthcare for the entire population at about half the cost, but they get better health outcomes than in the US. Their citizens have longer lifespans, fewer infant mortalities and less chronic disease.

President Trump, who is all about getting the most bang for the buck, should love that.

Hard to Argue with Success

The secret to the success of these more efficient systems is that they control medical costs. According to T. R. Reid in The Healing of America, they follow one of three models: the “Bismarck model” established in Germany, in which health providers and insurers are private but insurers are not allowed to make a profit; the “Beveridge model” adopted in Britain, where most healthcare providers work as government employees and the government acts as the single payer for all health services; and the Canadian model, a single-payer system in which the healthcare providers are mostly private.

A single government payer can negotiate much lower drug prices – about half what we pay in the US – and lower hospital prices. Single-payer is also much easier to administer. Cutting out the paperwork can save 30 percent on the cost of insurance.According to a May 2016 post by Physicians for a National Health Program:

Per capita, the U.S. spends three times as much for health care as the U.K., whose taxpayer-funded National Health Service provides health care to citizens without additional charges or co-pays. In 2013, U.S. taxpayers footed the bill for 64.3 percent of U.S. health care — about $1.9 trillion. Yet in the U.S. nearly 30 million of our citizens still lack any form of insurance coverage.

The for-profit U.S. health care system is corrupt, dysfunctional and deadly. In Canada, only 1.5 percent of health care costs are devoted to administration of its single-payer system. In the U.S., 31 percent of health care expenditures flow to the private insurance industry. Americans pay far more for prescription drugs. Last year, CNN reported, Americans paid nearly 10 times as much for prescription Nexium as it cost in the Netherlands.

Single payer, or Medicare for All, is the system proposed in 2016 by Democratic candidate Bernie Sanders. It is also the system endorsed by Donald Trump in his bookThe America We Deserve. Mr. Trump confirmed his admiration for that approach in January 2015, when he said on David Letterman:

A friend of mine was in Scotland recently. He got very, very sick. They took him by ambulance and he was there for four days. He was really in trouble, and they released him and he said, ‘Where do I pay?’ And they said, ‘There’s no charge.’ Not only that, he said it was like great doctors, great care. I mean we could have a great system in this country.

Contrary to the claims of its opponents, the single-payer plan of Bernie Sanders would not have been unaffordable. Rather, according to research by University of Massachusetts Amherst Professor Gerald Friedman, it would have generated substantial savings for the government:

Under the single-payer system envisioned by “The Expanded & Improved Medicare For All Act” (H.R. 676), the U.S. could save $592 billion – $476 billion by eliminating administrative waste associated with the private insurance industry and $116 billion by reducing drug prices …

According to OECD health data, in 2013 the British were getting their healthcare for $3,364 per capita annually; the Germans for $4,920; the French for $4,361; and the Japanese for $3,713. The tab for Americans was $9,086, at least double the others. With single-payer at the OECD average of $3,661 and a population of 322 million, we should be able to cover all our healthcare for under $1.2 trillion annually – well under half what we are paying now.

The Problem Is Not Just the High Cost of Insurance

That is true in theory; but governments at all levels in the US already spend $1.6 trillion for healthcare, which goes mainly to Medicare and Medicaid and covers only 17 percent of the population. Where is the discrepancy?

For one thing, Medicare and Medicaid are more expensive than they need to be, because the US government has been prevented from negotiating drug and hospital costs.

In January, a bill put forth by Sen. Sanders to allow the importation of cheaper prescription drugs from Canada was voted down. Sanders is now planning to introducea bill to allow Medicare to negotiate drug prices, for which he is hoping for the support of the president. Trump indicated throughout his presidential campaign that he would support negotiating drug prices; and in January, he said that the pharmaceutical industry is “getting away with murder” because of what it charges the government. As observed by Ronnie Cummins, International Director of the Organic Consumers Association, in February 2017:

. . . [B]ig pharmaceutical companies, for-profit hospitals and health insurers are allowed to jack up their profit margins at will. . . . Simply giving everyone access to Big Pharma’s overpriced drugs, and corporate hospitals’ profit-at-any-cost tests and treatment, will result in little more than soaring healthcare costs, with uninsured and insured alike remaining sick or becoming even sicker.

Besides the unnecessarily high cost of drugs, the US medical system is prone to over-diagnosing and over-treating. The Congressional Budget Office says that up to 30 percent of the health care in the US is unnecessary. We use more medical technologythen in other countries, including more expensive diagnostic equipment. The equipment must be used in order to recoup its costs. Unnecessary testing and treatment can create new health problems, requiring yet more treatment, further driving up medical bills.

Drug companies are driven by profit, and their market is sickness – a market they have little incentive to shrink. There is not much profit to be extracted from quick, effective cures. The money is in the drugs that have to be taken for 30 years, killing us slowly. And they are killing us. Pharmaceutical drugs taken as prescribed are the fourth leading cause of US deaths, after heart disease, cancer and stroke.  

The US is the only industrialized country besides New Zealand that allows drug companies to advertise pharmaceuticals. Big Pharma spends more on lobbying than any other US industry, and it spends more than $5 billion a year on advertising. Lured by drug advertising, Americans are popping pills they don’t need, with side effects that are creating problems where none existed before. Americans compose only 5 percent of the world’s population, yet we consume fully 50 percent of Big Pharma’s drugsand 80 percent of the world’s pain pills. We not only take more drugs (measured in grams of active ingredient) than people in most other countries, but we have the highest use of new prescription drugs, which have a 1 in 5 chance of causing serious adverse reactions after they have been approved.

The US death toll from prescription drugs taken as prescribed is now 128,000 per year.As Jon Rappaport observes, with those results Big Pharma should be under criminal investigation. But the legal drug industry has grown too powerful for that. According to Dr. Marcia Angell, former editor in chief of the New England Journal of Medicine, writing in 2002:

The combined profits for the ten drug companies in the Fortune 500 ($35.9 billion) were more than the profits for all the other 490 businesses put together ($33.7 billion). Over the past two decades the pharmaceutical industry has [become] a marketing machine to sell drugs of dubious benefit, [using] its wealth and power to co-opt every institution that might stand in its way, including the US Congress, the FDA, academic medical centers, and the medical profession itself.

It’s Just Good Business

US healthcare costs are projected to grow at 6 percent a year over the next decade. The result could be to bankrupt not only millions of consumers but the entire federal government.

Obamacare has not worked, and Ryancare is not likely to work. As demonstrated in many other industrialized countries, single-payer delivers better health care at half the cost that Americans are paying now.

Winston Churchill is said to have quipped, “You can always count on the Americans to do the right thing after they have tried everything else.” We need to try a thrifty version of Medicare for all, with negotiated prices for drugs, hospitals and diagnostic equipment.

Ellen Brown