LEBANON – Sen. Jeanne Shaheen sat down with hospital administrators, clinicians and people in the front lines of medical care to discuss what can be done about the high cost of prescription drugs. The roundtable took place Friday afternoon at Alice Peck Day Memorial Hospital, with health care stakeholders from Alice Peck Day Memorial Hospital, Dartmouth-Hitchcock, Mascoma Community Health Center and the New Hampshire Hospital Association. Shaheen invited those assembled to tell her what they're seeing and what they've observed around this issue.
The senator was also pushing two pieces of legislation, End Taxpayer Subsidies for Drug Ads Act and the Biologic Patent Transparency Act, both of which target questionable ways pharmaceutical companies make extra money on drug sales. Shaheen co-sponsors the bills with Sen. Susan Collins of Maine and other senators, including Tim Kaine of Virginia.
Shaheen said the first bill deals with direct-to-consumer advertising, which consumers pay for twice: once in additional costs for medicines, and again when the drug companies write off the advertising costs on their taxes.
The Biologic Patent Transparency Act addresses "patent thickets," extra layers of patents used to prevent the patent on a medicine from expiring. Biologics are a class of medicines made from living things and thus are extremely complex, fragile and difficult to make. An example of a biologic is Humira, used to treat rheumatoid arthritis, Crohn's diseases, and psoriasis. The patent on Humira was set to expire in 2016, opening the door for other companies to create "biosimilars," second generation biologics using the same techniques.
However, pharmaceutical companies can create thickets of overlapping patents for various stages of manufacture, extending the time period they can claim proprietorship of the drugs. AbbVie, the owner of Humira, has added as many as 75 additional patents, extending the company's sole right to market the drug to 2032. Humira costs around $6,600 a month; in 2016 AbbVie netted $14 billion from sales of the drug.
Shaheen said she is also working on legislation to allow re-importation of drugs from Canada and to allow Medicare and Medicaid to negotiate drug prices.
Jim Murphy, medical director of New London hospital, said the cost of medications now exceeds the cost of inpatient care for his hospital employees.
Hospitals are dealing with shortages of drugs that are cheap, he added. "We're not able to get really basic pharmaceuticals."
Through New England Life Care, New London and other members of a cooperative have their own compounding center, where they can manufacture some of the drugs they need. Murphy said the compounding center is "wildly successful."
"We need more of these," said Murphy, "and they're not inexpensive to start up."
Sue Mooney, CEO of Alice Peck Day, responded to a question Shaheen had about pharmacy benefit managers.
"How do hospitals deal with that issue?" asked Shaheen. Pharmacy benefit managers (PBMs) are used by large organizations, like hospitals, to negotiate lower prescription drug prices.
"We are a big employees and PBMs influence what our clinicians can prescribe," said Mooney. "Sometimes doing the right thing medically can clash with doing the right thing financially."
Mooney described a patient diagnosed with a form of colitis whose prescription cost over $4,000. Even when the hospital reduced the cost with coupons, they could only reduce it to $700, still far out of the patient's reach.
"It was not a crazy medicine, it's an antibiotic," said one of the hospital staff. "The disease is highly contagious, so the overall cost to the system of this patient going without treatment is potentially huge."
Steve Woloshin, of the Dartmouth Center for Media and Medicine, said the pricing on medicines doesn't reflect either their actual cost or actual value. "A lot of the drugs don't do that much, and their pricing doesn't reflect that at all."
For example, Woloshin cited a medicine used to treat dry eye. "The drug barely works," he said. "It cost $750,000 to develop it and there's a tremendous advertising campaign. It's a huge amount of money being spent that could be used for other things, like malaria."
"Pharmacies are handcuffed because they're not allowed to make substitutions," said one of the doctors present. "It's $500 [for your medicine] or get out."
A nurse practitioner said, "If a patient pays out of pocket, their insurance company considers them non-compliant with treatment."
Shaheen emphasized the support for the bills is bipartisan. "Even the president has expressed support," she said. "Any effort to game the system, to prevent companies from producing generics, is what we're trying to go after."