THE DON JONES INDEX…

 

GAINS POSTED in GREEN

  LOSSES POSTED in RED

  4/9/19…  16.422.62

  4/2/19…  16.411.25

6/27/13…  15,000.00

 

      

 (THE DOW JONES INDEX:  4/9/19… 26,341.02; 3/26/19 26,258.42; 6/27/13… 15,000.00)

 

LESSON for April 9, 2019 – DON JONES does DRUGS!

 

The pollsters and the pundits (aka the punsters?) would have you understand and believe that three quarters of Americans hate Socialism.

But they also acknowledge that three quarters of Americans also believe in stuff like addressing climate change, a higher minimum wage, curbs on political contributions (bribery), closing the inequality gap and so on… all of which are tenets of Socialism, at least as it is understood and practiced in places like Northern Europe or Canada if not necessarily Venezuela… more a testament of uber-Trumpist chaos theory than any known philosophy… or Cuba.

Venezuela has oil – which vies with prescription and street drugs for America’s most addictive substance.

Cuba, at least, has affordable healthcare.

Which the United States does not.

 

Say the word “drugs” and Don Joneses of a certain age are likely to think about the tweakers and the freakers in dirty inner-city neighborhoods… Frank Sinatra screaming in a closet with a spike in his arm.  Their children and grandchildren are likely to associate the term with the little pills that they and their homies are swallowing at high school parties.  Add the word “prescription” and that makes things kosher, these drugs are manufactured and sold by giant corporations and doled out by doctors so they have to be safe, right?

Well, maybe not.  Drug abuse – particularly as regards prescription opioids – can be found among Joneses of all races and economic strata… the rich, the poor, the middle class.  In particular, the notorious Sackler family has been accused of providing the raw materials by which a plethora of whitecoats ply their patients with barely legal or patently illegal substances.  Sometimes, the patients die.  And so, drugs are getting a bad reputation.

Even those that make no pretensions beyond that of helping people overcome medical conditions are newsworthy, now, for a different reason.  With the changeover in Congress, legislators are starting to take a look at the prices of these medications which are borne by employers, by out-of-pocket payments… and by the government (as part of Medicare or Medicaid).

Consequently, Americans are up in arms.  Some are even fleeing over the border to acquire Canadian pills.  (See Attachment One)

Two months ago, governing.com (see Attachment Two) surveyed legislatures in 41 states, all of which are fed up with the costly costs of Big Pharma and are looking for ways to wrest some of the decision-making authority from Washington.

Democrats are blaming the price increases that vastly exceed the inflation level or the average wage increases accruing to Don Jones on corporate greed.  Republicans contend that the problem is Obamacare, and promise to repeal the measure through the courts (ultimately through the Kavanaugh Supremes) and replace it with… well, nothing.

O-care, aka ACA, has had problems.  There have been recent news reports of persons dying because they could not afford common drugs like insulin – goodrx.com alleges that manufacturers “are still raising insulin prices, and costs now vary by as much as 10 times depending on which insulin you take.”  (See Attachment Three)   They are among the many critics of the practice of farming out drug acquisition and distribution by Pharmacy Benefit Managers (PBMs)… middlemen who neither produce nor distribute the pills but, rather just suck money out of the pockets of consumers.

Another reason for the drug price spike is advertising, including the foundation and maintenance of spurious research labs and think tanks established to promote sales for medical products – helpful or not.  The most heavily advertised medications are those that are the most expensive – a linkage observed and reported on by former Congressman and Presidential candidate Jack Parnell (see this week’s episode of Entropy and Renaissance)

 

 

Let me explain something as might sound underhanded... if you’ve read a story in the news or over the Internet, especially one as has come out of Washington, more like than not it'll have been planted.  Not necessarily fake, but planted… slanted.  Enchanted!  Way down at the end, or buried in the copy, might be the name of a politician trying to draw attention to himself, or else some organization or think tank... often just mentioned by its initials!  Might be real, might not, might be Russian.

          The American Medical Association's journal got caught in the act, so to speak, running this "study" as recommended everybody take up the Viagra. This Edward Laumann of the University of Chicago was quoted in JAMA, then picked up by more papers and television stations saying that the study "gives us a base for explaining why we had this enormous response to Viagra."  See this week’s DJI lesson for the correlation of mostly useless snake oil with advertising blitzers and outrageous prices, more often than not paid for by corporate insurance (who then pass on the premium costs to consumers) or the gumment (which just lets the debt pile up). 

          Now I'm all for enormousity and wouldn't have wanted gumment going round making more crimes of possession, throwing poor ol' Bob Dole in the Graybar Hotel... but Mr. Laumann really ought to have 'fessed that his study was bought and paid for by Pfizer. The company as makes... yeah... Viagra! Pfizer could easily have washed their money through some Pfizer front or tame, multi-pharmaceutical think tank... they just got really arrogant, so they got caught. Happens with others dozens of times every day, probably hundreds.

 

As noted above, Americans hate Socialism.  But when it comes to keeping the price of necessary medications affordable, the fiscal trumps the ideological.  As they say… a conservative is a liberal who’s just been mugged, so too… there’s nothing like a Republican who’s just been diagnosed with a “pre-existing condition”.

 

The drab, mildly positive Index contained some weird factors… government spending was significantly down for the week while unemployment and workforce dis-participation were significantly up.  It’s way too early to call it a trend, but the politicians and economists should, at least, be curious, if not yet worried.

 

 

 

 

 

THE DON JONES INDEX

CHART of CATEGORIES w/VALUE ADDED to EQUAL BASELINE of 15,000

(REFLECTING… approximately… DOW JONES INDEX of June 27, 2013)

See a further explanation of categories here

 

ECONOMIC INDICES (60%)

 

DON JONES’ PERSONAL ECONOMIC INDEX (45% of TOTAL INDEX POINTS)

 

    CATEGORY

VALUE

BASE

RECKONINGS

SCORE

SCORE

 

 

 

 

 

 

 

 

       INCOME

(24%)

6/27/13

LAST

CHANGE

NEXT

4/2/19

4/9/19

     OUR SOURCE(S) and COMMENTS

 

Wages (hourly, per capita)

9%

1350 points

4/2/19

+0.26%

Apr. 2019

1,513.09

1,517.01

http://www.tradingeconomics.com/united-states/wages   23.24

 

Median Income (yearly)

4%

600

4/2/19

+0.06%

4/16/19

699.38

699.81

debtclock.org/    32,881

 

Unempl. (BLS – in millions

4%

600

4/2/19

 -5.26%

Apr. 2019

1,197.83

1,197.83

http://data.bls.gov/timeseries/LNS14000000     3.8 nc

 

Official (DC - in millions)

2%

300

4/2/19

+0.15%

4/16/19

545.67

544.85

http://www.usdebtclock.org/      6,205

 

Unofficl. (DC - in millions)

2%

300

4/2/19

+0.71%

4/16/19

565.08

561.08

http://www.usdebtclock.org/    11,878

 

Workforce Participation

Number (in millions)

Percentage (DC)

2%

300

4/2/19

 

 -0.20%

+0.22%

4/16/19

284.33

283.69

Americans in/not in workforce (mil.)

In 156,782 Out 95,580 Total: 252,372

http://www.usdebtclock.org/  62.12%

 

WP Percentage (ycharts)*

1%

150

4/2/19

+0.15%

Mar. 2019

151.79

151.31

http://ycharts.com/indicators/labor_force_participation_rate 63.00

 

 

OUTGO

 

(15%) 

 

 

 

 

Total Inflation (aggregate) *

7%

1050

4/2/19

    0%

Apr. 2019

962.58

962.58

http://www.bls.gov/news.release/cpi.nr0.htm       0

 

Inflation – Food

2%

300

4/2/19

+0.4%

Apr. 2019

273.98

273.98

http://www.bls.gov/news.release/cpi.nr0.htm    +0.4

 

               - Gasoline

2%

300

4/2/19

 +1.5%

Apr. 2019

284.29

284.29

http://www.bls.gov/news.release/cpi.nr0.htm    +1.5

 

               - Medical Costs

2%

300

4/2/19

+0.3%

Apr. 2019

259.90

259.90

http://www.bls.gov/news.release/cpi.nr0.htm       0

 

               -  Shelter

2%

300

4/2/19

+0.3%

Apr. 2019

276.67

276.67

http://www.bls.gov/news.release/cpi.nr0.htm    +0.3

 

       WEALTH

(6%)

 

 

 

 

 

 

 

 

 

Dow Jones Index

2%

300

4/9/19

+0.31%

4/16/19

458.37

459.81

Dow – 26,341.02

 

Homes – Sales

             -  Valuation

1%

1%

150

150

4/9/19

+11.15%                +0.81%

4/22/19

201.71

221.71

201.71

221.71

http://www.realtor.org/research-and-statistics

Sales (M):  5.51 Valuations (K):  249.5

 

Debt (Personal)

2%

300

4/9/19

-0.02%

4/16/19

250.53

250.48

http://www.usdebtclock.org/    59,697

 

 

 

 

AMERICAN ECONOMIC INDEX (15% of TOTAL INDEX POINTS)

 

 

            NATIONAL

(10%)

 

 

 

 

 

 

 

Revenues (in trillions – tr.

2%

300

4/9/19

 -0.27%

4/16/19

389.72

388.88

debtclock.org/       3.363

Expenditures (in tr.)

2%

300

4/9/19

 -4.50%

4/16/19

234.92

245.50

debtclock.org/       4.287

National Debt (tr.)

3%

450

4/9/19

+0.09%

4/16/19

329.65

329.37

http://www.usdebtclock.org/    22,192

Aggregate Debt (tr.)

3%

450

4/9/19

+0.11%

4/16/19

350.37

349.99

http://www.usdebtclock.org/    73,372

 

 

 

GLOBAL

(5%)

 

 

 

 

 

 

 

 

 

Foreign Debt (tr.)

2%

300

4/9/19

+0.03%

4/16/19

313.09

312.90

http://www.usdebtclock.org/   6.328

 

Exports (in billions – bl.)

1%

150

4/2/19

-1,07%

4/16/19

164.98

164.98

https://www.census.gov/foreign-trade/Press-Release/ 207.3 nc

 

Imports (bl.)

1%

150

4/2/19

-2.48%

4/16/19

127.94

127.94

https://www.census.gov/foreign-trade/Press-Release/ 258.5

Trade Deficit (bl.)

 

 

  

1%

 

 

 

150

4/2/19

-11.70%

4/16/19

 98.98

 98.98

https://www.census.gov/foreign-trade/Press-Release/  51.1

 

 

SOCIAL INDICES (40%)

 

                    LIBERTY and SECURITY INDEX           (18%)

 

ACTS of MAN

(12%)

 

 

 

 

 

 

 

World Peace

3%

450

4/9/19

+0.1%

4/16/19

427.42

427.85

Border shutdown on again, off again, on again?  China pressured to regulate fentanyl (above),  Fourth Brexit vote fails despite Theresa May’s offer of resignation – fifth vote possible before June 30th deadline.

 

Terrorism

2%

300

4/2/19

 -0.2%

4/9/19

220.50

220.94

Trump brands Iranian Revolutionary Guard a terrorist outfit.  Chinese female spy busted bringing malware into Mar-a-Lago.  Louisiana black church bombings.

 

Politics

3%

450

4/9/19

+0.2%

4/16/19

435.41

434.97

Trump waffles on Mexico border shutdown but pancakes half his Homeland Security team and secret service chief (perhaps a fatal error), then mocks Joe Biden’s groping and vows not to release his tax returns.  Chicago elects first black lesbian Mayor.

 

Economics

3%

450

4/9/19

+0.1%

4/16/19

435.84

434.97

MacKenzi Bezos settles for $35 B.  Kellogg’s defies 13th amendment – sells keebler elves and Famous Amos.  Herman Cain (Mister 999) for the Fed?  RIP Kay, Zale and Jared jewelers.

 

Crime

1%

150

4/9/19

 +0.2%

4/16/19

231.68

232.14

A week of depths and heights as “kidnapped” boy turns out to be 23 year old criminal, but American tourist rescued from Ugandan kidnappers.  Nipsey Hussel murderer and Georgia hit and run driver busted but 4 killed in ND workplace and Phoenix experiencing road rage.

 

 

 

 

 

       ACTS of GOD

(6%)

(with, in some cases, a little… or lots of… help from men, and a few women)

 

 

 

Environment/Weather

3%

450

4/9/19

 -0.1%

4/16/19

306.14

305.83

April snow in North Carolina.  Dead whales washing up with 48 lbs. of plastic in stomachs.  Trump (again!) declares war on wind.

 

Natural/Unnatural Disaster

3%

450

4/9/19

-0.1%

4/16/19

348.03

348.73

Drones rescue lost hiker and Alzheimers patient.  First respondents rescue drivers trapped by Seattle power line downings.  Americans blame Ethiopians for crash; Ethiopians blame Boeing (made in USA) while experts blame birds. 

                  LIFESTYLE and JUSTICE INDEX          (15%)

 

Science, Tech. & Education

4%

600

4/9/19

 -0.1%

4/16/19

639.98

639.39

New York teacher fired after troll releases her nude selfies.  Musk “reprieve” saves private space ventures (for now).

 

 

Equality (economic/social)

4%

600

4/9/19

+0.3%

4/16/19

700.03

702.11

Mormons agree to baptize babies with gay parens.  Motel 6 sued for sharing guest lists with INS.  Magician David Blaine accused of sexual assault.

 

 

Health

4%

600

4/9/19

   nc

4/16/19

518.53

518.53

Big Pharma keeps raising drug prices (see above),  Busy, busy New York raising smoking age to 32.  Fisher-Price sleepers kill 10 infants and are recalled.  Doctors quibble over vapes.  Walgreens accused of selling used epipens.

 

Freedom and Justice

3%

450

4/9/19

-0.1%

4/16/19

527.65

527.22

Spielberg challenges Netflix over streaming protocols,  Jersey judge asks woman if she closed her legs during rape.  Cop shot in video hoax, comedian charged with murder.

 

 

MISCELLANEOUS and TRANSIENT INDEX        (7%)

 

Cultural incidents

   3%

     450

    4/9/19

 +0.1%

4/16/19

453.06

453.51

Avengers Endgame advance sales near $1B.  Seats going for $30 K for premiere of long, long movie… Robt. Downey Jr advoses patrons to wear a diaper.  Rassler Bret Hart attacked at own induction ceremony.  Zion Williamson’s mother reportedly paid off by Nike.  Alabama casino moguls will pick up the tab for storm victim funerals.  RIP to  Nurse @ and Dr. @ (above).

 

 

Miscellaneous incidents*

   4%

     450

    4/9/19

 +0.2%

 

 

4/16/19

446.16

 

 

447.05

 

 

Babe Ruth’s jersey goes on sale,  Whole Foods rescinds price hike (still overpriced).  Prince Harry wants “Fortnite” out of UK.  Prince William exposed as UK spy.  RIP Sen Fritz Hollings.  Congrats to Virginia (men’s) and Baylor (women’s) hoops.  17 foot female python captured in Florida.  South African rhino poacher killed by elephants, then eaten by lions.

 

 

The Don Jones Index for the week of April 2nd through April 8th, 2019 was UP 11.37 points.

 

 

The Don Jones Index is sponsored by the Coalition for a New Consensus: retired Congressman and Independent Presidential candidate Jack “Catfish” Parnell, Chairman; Brian Doohan, Administrator/Editor.  The CNC denies, emphatically, allegations that the organization, as well as any of its officers (including former Congressman Parnell, environmentalist/America-Firster Austin Tillerman and cosmetics CEO Rayna Finch) and references to Parnell’s works, “Entropy and Renaissance” and “The Coming Kill-Off” are fictitious or, at best, mere pawns in the web-serial “Black Helicopters” – and promise swift, effective legal action against parties promulgating this and/or other such slanders.

Comments, complaints, donations (especially SUPERPAC donations) always welcome at feedme@generisis.com or: speak@donjonesindex.com

BACK

 

 

See further indicators at Economist - https://www.economist.com/economic-and-financial-indicators/2019/02/02/economic-data-commodities-and-markets

 

 

 

ATTACHMENT ONE – from

 

Here’s a few sample listings of domestic versus foreign drug prices.  You can get information on most of your prescriptions from: https://www.pharmacychecker.com/drug-price-comparisons/

 

 

How much can you save with an online pharmacy?

Savings on Popular Medications Using International Online Pharmacies Prices for a 3-month or 90-day supply of brand-name medications

Drug

Local U.S. Pharmacy Price

International Online Pharmacy Price

International Online Savings

Annual Savings

Premarin 0.625 mg

$623.70

$15.30

98%

$2,433.60

Januvia 100 mg

$1,593.90

$72.90

95%

$6,084.00

Crestor 10 mg

$969.30

$24.30

97%

$3,780.00

Advair Diskus 250/50 mcg

$1,437.00

$72.93

95%

$5,456.28

Spiriva Handihaler 18 mcg

$1,430.10

$72.00

95%

$5,432.40

Nexium 40 mg

$863.10

$18.90

98%

$3,376.80

Synthroid 50 mcg

$151.20

$13.50

91%

$550.80

Xarelto 20 mg

$1,560.60

$149.40

90%

$5,644.80

Zetia 10 mg

$1,260.90

$150.30

88%

$597.84

Ventolin HFA 90 mcg

$218.31

$68.86

68%

$597.84

 

 

Drugs That Cost A Lot Less Outside the U.S.

Medication

Cost Per Pill or Unit

 

 

Savings

 

 

 

Brand Name (Strength)

Cost - USA

Cost - Outside U.S.

Premarin

(0.625 mg)

$6.72

$0.18 ** United Kingdom

97%

Januvia

(100 mg)

$16.59

$0.81 ** Turkey

95%

Eliquis

(5 mg)

$8.06

$1.18 Turkey

95%

Advair Diskus

(3 inhalers)

$1,102.62

$78.95 ** Turkey

93%

Janumet

(50/1000 mg)

$8.54

$0.63 ** India

93%

Flovent HFA

(3 inhalers, 110 mcg)

$781.00

$59.80 ** United Kingdom

92%

Symbicort Inhaler

(1 inhaler, 160/4.5 mcg)

$334.00

$27.09 ** New Zealand

92%

Vesicare

(10 mg)

$13.14

$1.12 ** Turkey

91%

Viagra

(100 mg)

$66.50

$6.17 ** New Zealand

91%

Xarelto

(20 mg)

$16.17

$1.68 Turkey

90%

Spiriva Handihaler

(1 pack, 18 mcg)

$398.00

$1.68 ** Turkey

90%

Nuvaring

(1 ring, 0.12/0.015 mg)

$168.94

$21.30 Turkey

87%

Cialis

(5 mg)

$13.56

$3.00 ** Turkey

78%

Truvada

(200/300 mg)

$63.53

$16.11 ** Turkey

75%

Dexilant

(60 mg)

$10.32

$2.56 Canada

87%

Enbrel

(1 carton, four 50 mg)

$5,008.30

$1,720.00 Canada

66%

Ventolin HFA

(1 inhaler, 18 g of 90 mcg)

$57.00

$22.95 ** United Kingdom

60%

 

*Sources: Price information collected November 2017; U.S. prices from "average retail price" listed on GoodRx.com; Outside U.S. prices are lowest prices listed on PharmacyChecker.com from licensed pharmacies that sell to Americans and meet the qualifications of the PharmacyChecker Verification Program

**Generic version(s) available at lower price(s) than listed here

Product Names

Pharmaceutical companies sometimes market the same drugs under different names in different countries. You may see more than one name for the exact same drug or a different brand or generic version. Our drug price comparisons contain many but not all related drug name listings, for both generic and brand versions.

 

ATTACHMENT TWO – from governing.com

To Control Drug Prices, States May Have to Face Off Against Feds

by Stateline | February 1, 2019 AT 7:00 AM

By Michael Ollove

Frustrated by federal inaction, state lawmakers in 41 states have proposed detailed plans to lower soaring prescription drug costs. Some measures would give state Medicaid agencies more negotiating power. Others would disclose the pricing decisions of the drug manufacturers and the companies that administer prescription drug plans.

The more ambitious proposals would bump up against federal authority, such as legislation that would allow importing drugs from Canada or alter federal statutes on the prices states pay for drugs in Medicaid. They likely would have to survive a challenge in federal court. And many likely would face resistance from a deep-pocketed pharmaceutical industry.

RELATED

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According to the National Institute on Money and Politics, a nonprofit that collects campaign finance data, the pharmaceutical industry in 2018 contributed nearly $19 million to state campaigns, and $56 million to federal ones.

“States are limited in power in this area,” said Rachel Sachs, a health law expert at Washington University in St. Louis School of Law. “But one of the impacts of these efforts is to put pressure on the federal government, and force it to justify its actions to stymie the states.”

President Donald Trump has criticized soaring drug prices, and on Thursday the Department of Health and Human Services announced a draft regulation that would allow drugmakers to offer discounted prices directly to consumers – but without giving rebates to Medicaid managed care organizations or the middlemen known as pharmacy benefit managers.

Between 2012 and 2017, drug spending in the United States increased nearly 29 percent while overall health spending rose less than 25 percent. Since 2013, the growth in prescription drug spending has exceeded GDP growth, which means the industry is consuming an increasingly large share of the U.S. economy.

Just this week, committees in both houses of Congress held hearings to consider how to arrest the trend.

In his opening statement, U.S. House Oversight Committee Chairman Elijah Cummings, a Maryland Democrat, praised what he said is a bipartisan consensus that drug companies’ aggressive price hikes need to be reined in.

“We have seen time after time that drug companies make money hand over fist by raising the prices of their drugs — often without justification, and sometimes overnight — while patients are left holding the bill,” Cummings said in his statement, adding later: “We have a duty to act now.”

On the other side of Capitol Hill, Douglas Holtz-Eakin, president of the self-described “center-right” American Action Forum, told the Republican-led Senate Finance Committee that government policies were at least partly to blame for rising drug prices.

Holtz-Eakin cited laws governing Medicaid payments to drug companies and the Affordable Care Act’s tax increases on manufacturers and importers.

“It should not be surprising,” he said, that drug prices increased simultaneously with the passage of the ACA.

Priscilla VanderVeer, a spokeswoman for the Pharmaceutical Research and Manufacturers of America, the lobbying arm of the industry, said PhRMA, as the group is known, would oppose many of the state bills.

The proposals wouldn’t lower prices on medications, she said, and would discourage corporate investment in research and development of new drugs.

“We absolutely understand where patients are coming from, and their struggles to get the medications they need at an affordable price,” VanderVeer said. “But let’s focus on the entire chain, not just manufacturers.”

It isn’t the case, though, that lawmakers are focusing only on manufacturers; a few bills offered this session would force actions either from insurers or pharmacy benefit managers, the companies that administer drug plans. Other proposals would study foreign drug importation or encourage price negotiations to benefit, say, Medicaid patients.

 

Federal Prerogatives

The federal government has zealously guarded its authority over drug pricing.

Last year, for example, the Trump administration rejected Massachusetts’ request to become the first state to exclude certain drugs from its Medicaid program, to extract better prices from pharmaceutical companies.

By law, all state Medicaid agencies must carry every drug approved by the U.S. Food and Drug Administration, in return for set rebates from drugmakers.

Massachusetts proposed to offer at least one medicine in every “therapeutic class,” that is, treatments intended to address a specific condition or illness, such as blood clots or angina.

It also sought the authority to evaluate the effectiveness of newly introduced drugs, by comparing them with other medicines in the same class.

That idea worries some health analysts, who note that even within the same therapeutic class, one medication may work better than another for an individual patient. Some organizations that represent people with certain diseases joined drug manufacturers in objecting to Massachusetts’ proposal.

The Trump administration also opposes states importing cheaper drugs from Canada.

Last year, Vermont became the first state to pursue importation. Vermont’s measure would save the commercial insurance industry between $1 million and $5 million a year, a state report estimated. Lawmakers in Colorado, Connecticut, Illinois, Maryland, Missouri, Oregon and Virginia have proposed studies of the idea.

But buying drugs from Canada requires federal approval, which, until recently, seemed unlikely. U.S. Health and Human Services Secretary Alex Azar last spring said several times he had no interest in allowing Vermont or other states to proceed with such a plan.

But in response to some dramatic increases in drug prices, he softened his position, at least in the case of some generic medications produced by a single manufacturer. He said last summer that he was setting up a working group to study importing drugs from abroad.

Maryland’s attempt to control drug prices ran aground last year in a federal courtroom. The 4th Circuit Court of Appeals in April threw out a 2017 Maryland law enacted to curb “unwarranted” price hikes, saying the state had no authority to regulate interstate commerce.

Knowing that states are on shaky ground, some drug companies have pushed back against attempts to limit their prices.

They did so in New York, where lawmakers in 2017 enacted a requirement that makers of certain high-priced drugs give the state’s Medicaid agency discounts beyond those set by federal statute.

Vertex, the manufacturer of a cystic fibrosis medication with a retail price of $272,000 a year, refused. And New York was forced to acknowledge it could not require compliance.

In a message to Stateline, Vertex touted the efficacy of its cystic fibrosis drug. “The price of our medicines reflect the significant value they bring to patients,” said Sarah D’Souza, a Vertex spokeswoman, adding, “We do not believe an additional rebate is warranted.”

Still, other states see promise in that approach. Massachusetts Gov. Charlie Baker, a Republican, recently proposed a measure that would enable the state Medicaid agency to negotiate further discounts on certain drugs.

If negotiations don’t work, the state could subject the manufacturer to a public rate-setting process, require more transparency on pricing, or refer the matter to the state’s attorney general’s office for possible prosecution under consumer protection laws. Legislators in Connecticut and Maryland are pushing similar proposals.

State lawmakers in Massachusetts, Minnesota, New York and Virginia also want to prevent drugmakers from enacting steep year-to-year price increases in the commercial market.

Under the Minnesota proposal, for example, manufacturers of generic medications would be referred to the state attorney general if they increased the wholesale price of a medication by 50 percent or more. Legislation in the other states also would set limits.

Linda Gorman, director of the Health Care Policy Center, at the Independence Institute, a libertarian think tank based in Denver, said interfering in the market is a bad idea.

“It’s a waste of time, and you’ll only end up with more regulation and higher overall prices,” Gorman said. She argues, for example, that by requiring drugmakers to give discounts to Medicaid agencies, the federal government drives up drug prices in commercial plans.

 

No Approval Required

Mindful of recent setbacks, some governors and lawmakers are exploring ideas that wouldn’t require federal approval.

In California, Democratic Gov. Gavin Newsom in January signed an executive order directing all Medicaid managed-care organizations to collectively negotiate drug prices on behalf of the state’s 13 million Medicaid beneficiaries. Combined, the groups would be the largest direct purchaser of prescription drugs in the country.

“We will use our market power and moral power to demand fairer prices for prescription drugs,” Newsom said in his inauguration speech.

Other states are emphasizing transparency, with the goal of shaming drug companies into moderating their prices. New Hampshire, New Jersey and Washington state are considering requiring manufacturers to disclose to states (but usually not to the public, to protect proprietary information) what they spend on advertising, and research and development.

Still others, including Arizona, Florida, Maine, New Jersey and New York, also want to cast light on the operations of pharmacy benefit managers, known as PBMs, the giant buying networks that administer prescription plans on behalf of insurers.

The theory behind PBMs is that their size and expertise results in savings for consumers. In recent years, however, critics have argued that the PBMs are pocketing the savings rather than passing them on to consumers. And in many states, the pharmacy benefit managers impose a gag order on pharmacists, blocking them from telling consumers about cheaper drug options.

Other state legislators want to regulate PBMs. Legislators in Delaware, Minnesota and South Carolina have filed bills that would require PBMs to be licensed, so that the state could standardize their practices. While some states require PBMs to register with the state, only a few, such as Georgia and South Dakota, have licensing requirements.

Lawmakers in Delaware, New Jersey, Texas and Virginia also want to end the practice of “clawbacks,” in which PBMs and insurance carriers pocket the difference between the total cost of a prescription drug and a patient’s copayment. Legislators in New Jersey, Oklahoma, Texas and Virginia also want to make it illegal for PBMs to prevent pharmacies from disclosing cheaper alternatives to customers.

In a rare show of bipartisanship in Washington, President Donald Trump signed a bill in October that prohibits PBMs from including gag orders in their contracts with pharmacies. State legislators with anti-gagging bills want to make sure state regulators can also enforce the prohibition.

This week’s hearings on Capitol Hill may presage federal action on prescription drug prices, but many state-level decision-makers are inclined to go ahead without Washington.

“We’d all love to see this being done on the federal level, but we’re not expecting that,” said Vincent DeMarco, president of Maryland Health Care for All Coalition.

“People can’t afford drug prices now; we can’t wait any longer to do something about that.”

 

 

ATTACHMENT THREE – from good.rx

 

How Much Does Insulin Cost? – Here’s How 22 Brands Compare

 

 

Posted on September 21, 2018

Despite outrage over the high cost of insulin, prices for popular insulin treatments have continued to climb in 2018, according to a GoodRx analysis of drug prices.

Though prices are not climbing as quickly as they did between 2002 and 2013—when the average cost of insulin therapy tripled—the average price of insulin has increased by 64% since January 2014. The most recent price increases are on insulins made by Sanofi-Aventis and Novo Nordisk, which raised prices by as much as 3% in May and July of this year, respectively. Insulins by Sanofi-Aventis saw a price bump immediately after the manufacturer vowed to limit annual price increases to a rate below medical inflation (effectively 5.4%). Novo Nordisk promised just months before to cap annual price increases to single-digit percentages.

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The analysis on 22 insulin brands across manufacturers and insulin types—short-, intermediate-, rapid- and long-acting—shows that manufacturers are still raising insulin prices, and costs now vary by as much as 10 times depending on which insulin you take. Here, we’ll walk you through how each brand stacks up and how you can get the best deal on these life-saving medications.

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This GoodRx analysis is based on a representative sample of US prescription fills (not GoodRx fills) and comes from several sources, including pharmacies and insurers. The reported prices per insulin unit are based on cash prices, the so-called “usual and customary” prices or retail prices at the pharmacy (not including insurance copays or co-insurance).

A note about insulin use:

One insulin unit can be defined as the amount of insulin it takes to lower blood glucose by 50 mg/dL, although each individual’s response is highly variable. Someone with type 2 diabetes may start with one unit of insulin per one to two kilograms of body weight per day, which equates to about 40 units of insulin per day for a 70-kg person.

People with type 2 diabetes are often treated without insulin—or perhaps one type of intermediate- or long-acting insulin—as type 2 diabetes is a disease where the body is resistant to insulin’s effects. For those with type 1 diabetes, an autoimmune disorder that kills pancreatic cells that make insulin, more insulin of different types is needed. It’s common, for example, for a person with type 1 diabetes to use both a mealtime (rapid- or short-acting) insulin along with a basal (intermediate- or long-acting) insulin.

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How do insulin prices compare today?

1) Traditional insulins are cheaper than modern insulins

Prices of Novolin and Humulin (traditional short- and intermediate-acting insulins) have turned south, while prices of modern rapid- and long-acting insulins continue to go up. On average, traditional insulins now cost less than half of what modern insulins cost.

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Why? Understandably, traditional insulins have always been cheaper than their newer competitors. Modern insulins offer better blood sugar control but are synthetic analogs of traditional insulins, which makes them more difficult to produce. 

Additionally, when patents on Humulin and Novolin expired around 2000—after protecting these brands from competition for nearly 40 years—manufacturers Eli Lilly and Novo Nordisk have had to test new pricing strategies to remain competitive.

Last March, for example, Novo Nordisk partnered with CVS to offer Novolin at roughly 80% less than its normal list price. Both Novo Nordisk and Eli Lilly have also worked with Walmart to heavily discount Novolin and Humulin under Walmart’s ReliOn line of insulin products.

Retail partnerships haven’t been their only strategy. Last May, Eli Lilly broke from their routine of increasing Humulin prices every six months and has since left prices alone. In fact, prices of traditional Humulin and Novolin insulins, their rapid-acting analogs (Humalog and Novolog) and their mixed products (e.g. Humulin 70/30, Novolog 70/30) have not gone up since then.

Novolin R and Novolin N are currently the cheapest traditional insulins, by as much as 75% compared to other options.

Cash Prices of Traditional Insulins (July 2018)

Price per dispenser

Price per insulin unit

Regular insulin

Novolin R vial (10 ml)

$116 per vial

$0.12 per unit

Humulin R vial (10 ml)

$191 per vial

$0.19 per unit

Humulin R vial (20 ml, 500 units/ml)

$1862 per vial

$0.19 per unit

Humulin R Kwikpen (3 ml, 500 units/ml)

$358 per pen

$0.24 per unit

NPH insulin

Novolin N vial (10 ml)

$102 per vial

$0.10 per unit

Humulin N vial (10 ml)

$186 per vial

$0.19 per unit

Humulin N Kwikpen (3 ml)

$119 per pen

$0.40 per unit

*Insulin concentrations are 100 units/ml unless otherwise stated.

 

2) Vials are cheaper than newer dispensers

In 1985, Novo Nordisk introduced the first insulin pen, making it more convenient for patients to store and self-inject insulin—but it came at a price. Today, rapid-acting insulins are 30% more expensive if you buy them as pens versus vials. It’s not just rapid-acting insulins either; the price of Humulin N, for example, more than doubles if you choose to use a Kwikpen instead of a vial.

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New dispensers make insulin more expensive. We’re seeing that again with Afrezza, a relatively new rapid-acting insulin, and the first and only insulin to be delivered as an inhalable powder. One unit of Afrezza’s insulin can cost as much as three times other rapid-acting insulins.

Cash Prices of Rapid-Acting Insulins (July 2018)

Price per dispenser

Price per insulin unit

Insulin lispro

Admelog vial (10 ml)

$303 per vial

$0.30 per unit

Humalog vial (10 ml)

$340 per vial

$0.34 per unit

Admelog Solostar pen (3 ml)

$117 per pen

$0.39 per unit

Humalog Kwikpen (3 ml)

$135 per pen

$0.45 per unit

Insulin aspart

Novolog vial (10 ml)

$341 per vial

$0.34 per unit

Novolog Flexpen (3 ml)

$130 per pen

$0.44 per unit

Insulin glulisine

Apidra vial (10 ml)

$349 per vial

$0.35 per unit

Apidra Solostar pen (3 ml)

$136 per pen

$0.45 per unit

Inhaled insulin

Afrezza cartridge (4 units)

$3.60 per cartridge

$0.90 per unit

*Insulins concentrations are 100 units/ml unless otherwise stated.

 

3) Follow-ons (“generic insulins”) cost a little less than brands

You’d think follow-ons, what we call the generic versions of insulin, would be much cheaper than brand-name insulins. However, our current follow-ons, Basaglar and Admelog, only offer minimal savings.

Basaglar, a long-acting insulin approved in 2016, is the follow-on to Lantus, andAdmelog, a rapid-acting insulin approved in 2017, is the follow-on to Humalog. Today, Basaglar costs about 15% less than Lantus on a per insulin unit basis. Admelog, similarly, costs 12% to 15% less than Humalog, depending on the dispenser. By cash price alone, both Basaglar and Admelog are still the cheapest options of their insulin groups.

4) New product features can come with a high price tag

Novelty can translate to higher prices, but not always. In the last couple years, we gained four new long-acting insulin brands: Tresiba, Xultophy, Soliqua 100/33, and Toujeo.

Tresiba is an ultralong-acting insulin that stays active for up to 42 hours. For this unique property, it costs about $115 per 3-ml pen, or 39% more than fellow long-acting insulin, Basaglar

Then, there’s Xultophy

GoodRx Savings Finder$1070.18

View all GoodRx discount prices for Xultophy

and Soliqua 100/33. Both contain a long-acting insulin and another non-insulin diabetes medication. Xultophy is a mix of insulin degludec plus liraglutide (the same active ingredient in Victoza), and Soliqua is a mix of insulin glargine plus lixisenatide (the same active ingredient in Adlyxin). Soliqua and Xultophy are more than the double the price of cheaper alternatives like Basaglar and Tresiba, which have the same exact kind of insulins.

 

Lastly, there’s Toujeo, a good example of when a special feature doesn’t make the drug cost more. It has the same insulin as Lantus

GoodRx Savings Finder but is three times more concentrated. For people who need more insulin than average, that’s a convenient feature. At first glance, Toujeo’s price seems expensive at about $150 per 1.5-ml pen, but one insulin unit actually costs about the same as one unit of Lantus—it’s just that you get more insulin with each injection.

 

What’s next for insulin prices? At the end of 2017, long-acting insulins started to get more expensive overall, after having enjoyed stable prices since 2015. As we mentioned, Novo Nordisk and Sanofi-Aventis raised their insulin prices again, despite promising to help reign in drug prices.

Specifically, Novo Nordisk bumped up prices of Tresiba and Levemir in January of this year, and then again in July. Sanofi-Aventis raised prices for Toujeo and Lantus in October 2017, and then again in May. Xultophy and Soliqua both saw price bumps back in January of this year.

As might be expected, these manufacturers did not limit their recent price increases to long-acting insulins. Their rapid-acting insulins, Apidra and Novolog, saw new price increases last month as well.

All together, prices of long-acting insulins increased by about 7% since September of last year.

Cash Prices of Long-Acting Insulins (July 2018)

Price per dispenser

Price per insulin unit

Insulin detemir

Levemir Flextouch pen (3 ml)

$105 per pen

$0.35 per unit

Levemir vial (10 ml)

$368 per vial

$0.37 per unit

Insulin glargine

Basaglar Kwikpen (3 ml)

$83 per pen

$0.28 per unit

Lantus vial (10 ml)

$332 per vial

$0.33 per unit

Lantus Solostar pen (3 ml)

$98 per pen

$0.33 per unit

Toujeo pen (1.5 ml, 300 units/ml)

$154 per pen

$0.34 per unit

Toujeo Max pen (3 ml, 300 units/ml)

$300 per pen

$0.33 per unit

Soliqua 100/33 Solostar pen (3 ml)

$165 per pen

$0.55 per unit

Insulin degludec

Tresiba Flextouch pen (3 ml)

$115 per pen

$0.38 per unit

Xultophy pen (3 ml)

$249 per pen

$0.83 per unit

*Insulins concentrations are 100 units/ml unless otherwise stated.

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