Thursday Open Thread 7-20-2017

Pharmaceuticals are one of the fasted growing costs of health care. This week I am going to continue the discussion on how players in the industry keep drug costs high.

Unfortunately I will not be available most of the day for real time interaction on discussions. I will follow up this evening.


First - Delaying Generics

Delaying generics is an art the pharmaceutical companies have mastered. The methods keep changing the current ones are summed up in this article.

But they are often blocked by the makers of brand-name drugs who try to hold off competition and wring out as much profit as possible. Indeed, drug companies are increasingly using complex strategies to elevate prices and keep generic competitors off the market. Lawmakers have trouble finding the schemes; the public has difficulty understanding them. But everyone sees the end results — shockingly high prices and patients unable to afford their medications. With that in mind, a colleague and I set out to trace the modern strategies and tactics that are fueling the astounding rise in the price of medications.


Second - Expiration Dates

The time period identified by the expiration dates keep getting shorter. One of the reasons is concern for safety and another is forcing an increase in sales by replacing expired meds. When I started practicing pharmacy many meds did not have an expiration date on the container. When dates started being added to tablets and capsules it was not uncommon to have an expiration date 7 or 10 years out. There are some medications with very specific storage requirements and need a short expiration date. Others like tetracycline breakdown into a toxic by-product and should not be used past the expiration date. The majority of pills and capsules, might still be effective past the expiration date..

Gerona, a pharmacist; and Cantrell, a toxicologist, knew that the term "expiration date" was a misnomer. The dates on drug labels are simply the point up to which the Food and Drug Administration and pharmaceutical companies guarantee their effectiveness, typically at two or three years. But the dates don't necessarily mean they're ineffective immediately after they "expire" — just that there's no incentive for drugmakers to study whether they could still be usable.

Third - Prescription Benefit Managers (PBM)
PBM's are the ultimate middleman, there other definition could be profit before mankind. Wikipedia

The first PBM, Pharmaceutical Card System Inc. (PCS, later AdvancePCS) originated in 1968 with the invention of the plastic benefit card.[10] By the "1970s, [they] serve[d] as fiscal intermediaries by adjudicating prescription drug claims by paper and then, in the 1980s, electronically".[11]:34 By the late 1980s PBMs had become a major force "as health care and prescription costs were escalating"

In 2007, when CVS acquired Caremark,[1] the function of PBMs changed "from simply processing prescription transactions to managing the pharmacy benefit for health plans",[11]:34 negotiating "drug discounts with pharmaceutical manufacturers",[11]:34 and providing "drug utilization reviews and disease management".[11]:34 PBMs also created a formulary that encouraged or even required "health plan participants to use preferred formulary products to treat their conditions".[11]:34 In 2012, Express Scripts and CVS Caremark transitioned from using tiered formularies, to ones that began excluding drugs from their formulary.[1][15]

The PBM generates money at every stage of the prescription process.

The PBM industry generates over 300 billion dollars annually. PBMs offer a very valuable service, one which provides pharmacy benefits to nearly 225 million Americans. Unfortunately, no one outside of the industry truly understands what they [we] do or how they make money. I aim to put an end to this now.

A law suite filed by Express Scripts has lifted the hood for a peek at how the money flows.

Benefit managers like Express Scripts typically pass the rebates they collect from manufacturers along to their clients — insurers and large employers — after taking a portion of the rebates for themselves. But critics, like Linda Cahn, the chief executive of Pharmacy Benefit Consultants in Morristown, New Jersey, say that the benefit managers are not transparent about what share of fees they keep, and what share they pass along to clients.

Farm Report
I thought this article provided a good overview and challenges of brittle and non-brittle environments in relation to weed control. The hay bale technique Mhagle has been describing is one way of addressing brittle environments. Crops can be grown while adding organic matter to the soil. I use a slower technique of controlled grazing on my land, combined with irrigation.

In a nutshell, nonbrittle environments usually have sufficient moisture throughout the growing season to promote decay of old vegetation and the germination of new seedlings. Brittle environments on the other hand, tend to dry out quickly, interrupting the processes of decay and seedling germination. Understanding the difference between brittle and nonbrittle environments is critical to effective weed management.

I have not had my camera out with me this week. Saw these two cloud formations at the same time while at a stop sign.

The western sky seemed to be providing a cosmic OK
soe ok.jpg

The southern sky reminded I am a small part of the universe when viewing some skylines. Keeps my ego in perspective.
soe sky_0.jpg

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A good breakout on the pharma cartel. One of my meds I get thru Canada, which they get from India and is delivered thru Singapore by a Swiss company. Half the way around the world and it is still a fraction of the cost in the US. Not very efficient, but indicative of the extortion existing in our exceptional system. Nice clouds!

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studentofearth's picture

@QMS
the US PHARMA and the medical complex would like all your money now and rights to your first born wealth.

The battle lines are clearly drawn. PHARMA and the medical complex are trying to take over the worldwide ability to charge obscene prices.

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Still yourself, deep water can absorb many disturbances with minimal reaction.
--When the opening appears release yourself.

Arrow's picture

Beautiful sky.
I had an experience like that sitting on a grassy slope of a farm field.
Was moving. Sorta an Zen/one with the universe moment(30 mins to an hour).
It was so amazing...I cried.

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I want a Pony!

studentofearth's picture

@Arrow @Arrow
more frequent when I am outside without a technological gadget.

Just read "The United States of Nothing" that you referenced in another diary. I had not thought of US values being so divergent from Western values. The difference from Eastern values and trying to understand the view point is a personal challenge. No wonder at times in this culture it is so easy to feel rudderless.

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Still yourself, deep water can absorb many disturbances with minimal reaction.
--When the opening appears release yourself.

Law requires job training programs to secure three quotes when purchasing any item that costs more than $500.00. As a subcontractor to the system, we were audited by our local organization, the direct funding source, the state, and the fed. So much for single audits.

The law doesn't require big pharma to bid on anything. The Pentagon doesn't even have records adequate enough to accommodate an audit of their expenditures. See a pattern here? When the law benefits people, it is regulated, monitored, and audited until the cost of due diligence exceeds the benefit. When the law benefits corporate America, it operates unregulated.

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"Religion is what keeps the poor from murdering the rich."--Napoleon

studentofearth's picture

@dkmich
it funnels money to the politicians and highest positions of regulatory agencies. The lack of regulation creates as opportunity to earn more money to funnel to politicians and highest positions of regulatory agencies. The circle of corruption continues.

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Still yourself, deep water can absorb many disturbances with minimal reaction.
--When the opening appears release yourself.

enhydra lutris's picture

yet but they look promising.

The idea of "brittle environments" is new to me and sounds very useful, especially to those with postage stamp back yard gardens such as myself. Sadly, I suspect that it means more physical labor, which gets less and less pleasant among those of us who are getting on in years.

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That, in its essence, is fascism--ownership of government by an individual, by a group, or by any other controlling private power. -- Franklin D. Roosevelt --

mhagle's picture

@enhydra lutris

That was one of the big draws for me - not having to bend over and very little prep work = easy. It's been in the 100s the past two weeks. 109 today. Not harvesting much at the moment!

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Marilyn

"Make dirt, not war." eyo

studentofearth's picture

@enhydra lutris
environment we have and our objectives for it there may be less work. Each environments has a natural cycle we can synchronize our activities. I have been gradually, over the past few years, stopping my management of different areas on the property as one-size fits all. Had been taught in agriculture classes forcing the land to my schedule was most efficient. It worked when I was working full time and little ability to adjust my schedule.

Now my full attention is on the place and if I adjust my activities to the seasonal cycles. I actually work less physical hours. Am now trying to learn the micro-climates on the place. Then match activity to each area.

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Still yourself, deep water can absorb many disturbances with minimal reaction.
--When the opening appears release yourself.

write up about the shenanigans of the DIC (drug industrial complex).

Personal note: I am an obedient sort, so I used to discard any medication whose expiration date had passed. I recently had a very painful situation that I knew would be very temporary. I took an oxycontin tablet I had from a 2008 prescription. Worked fine. THIS IS ANECDOTAL AND NOT MEDICAL ADVICE!

Again, I love the farm reports. Thank you!

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studentofearth's picture

@HenryAWallace
their habits of saving old meds. Live and learn.

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Still yourself, deep water can absorb many disturbances with minimal reaction.
--When the opening appears release yourself.

@studentofearth

I am glad I saved my painkillers. As you may surmise from the fact that I still have pills from 2008--still almost a full bottle, btw--I don't abuse them. But the War on Drugs seems recently to have devolved into war on only reefer madness opiates (something that makes me suspicious, btw). In any case, they're now prescribing three OTC ibuprophen for serious pain. So, I am grateful to have hung onto my small stash. I have it primarily because I just didn't think about it discarding it.

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enhydra lutris's picture

on brittle environments that such environments would benefit from use of a paddock system such as some Aussie ranchers favor. I have previously wondered, without asking, if you have considered or used any variants of such a system.

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That, in its essence, is fascism--ownership of government by an individual, by a group, or by any other controlling private power. -- Franklin D. Roosevelt --

studentofearth's picture

@enhydra lutris
dividing my 3 largest fields into even smaller paddocks. The limitation has been the irrigation system. I do not like putting irrigation pipes through fences or lifting over. Been making changes to decrease the physical strength needs for the future.

A paddock system provides the opportunity to bank fields of grass for winter feed. Can adjust the the grass mixture to cool weather and hot weather grasses for better year around grazing.

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Still yourself, deep water can absorb many disturbances with minimal reaction.
--When the opening appears release yourself.

Raggedy Ann's picture

I love the cloud pictures. We get beautiful ones here, too. I don't think to take pictures of them until it's too late!

Great pharma articles - very disturbing, but that's our world today.

Have a beautiful day, folks! Pleasantry

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"The “jumpers” reminded us that one day we will all face only one choice and that is how we will die, not how we will live." Chris Hedges on 9/11

studentofearth's picture

@Raggedy Ann
I started this thread. Might be the only year in my life I will have pictures to represent all four seasons.

Have a good one.

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Still yourself, deep water can absorb many disturbances with minimal reaction.
--When the opening appears release yourself.

mhagle's picture

Thanks for all the information!

I enjoyed the article on brittle and non-brittle environments. Something I have not thought much about.

Went home to the family reunion in South Dakota last week. My daughter and I drove a square from MSP to north central Iowa to Sioux Falls to Milbank and back to MSP. There was miserable road construction on I29, so we took back roads east of the freeway to reach our destination. That is Big Ag country back in there! Hogs, turkeys, chickens being raised in confinements. And massive big dairy. One was so huge . . . they must be milking at least 10,000 cows. Included in the compound was the trailer park for the workers.

It also freaked me out that for the whole trip I only saw 2 crops being grown. Corn and soybeans. Did any of you eat field corn or soybeans today? I could count on one hand the fields of other crops.

We stayed one night with my dear 85 year old aunt who is still out on the farm. She has the most beautiful vegetable garden I have ever seen in my life. And her sizable yard is full of flowers. Her son dumps a load of horse manure on the garden every fall, works it in a bit, and it is ready by spring. Got an email from her today saying she pulled up the rest of the lettuce and green peas. And staked the tomatoes a bit more. Picked some peppers. It was a lovely visit!

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Marilyn

"Make dirt, not war." eyo

studentofearth's picture

@mhagle
of rural life. Fortunately land use laws in Oregon provide a few methods to prevent the occurrence.

Glad you enjoyed your trip. (Used corn four today and dinner tomorrow will need cornstarch)

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Still yourself, deep water can absorb many disturbances with minimal reaction.
--When the opening appears release yourself.