Without Big Pharma, pharmacists would be faced with two weapons in their arsenal– leaches and bloodletting. Who develops next generation medicines- Congress? NIH? Universities? Ha! It’s being paid for and developed by US Big Pharma, at the tune of approx $800 million per compound (and that’s not any guarantee that it will be brought to market). When is the last time a Canadian drug manufacturer developed any life saving or life enhancing pharmaceutical (outside of another generic for Claritin)?

Get ready for leaches and bloodletting, because Congress and the Democrats are going to kill the Golden Goose that laid the golden pill (credit to columnist William Safire).

It is, indeed, partly about costs. And partly not.

In fact, quality of care and cost issues are about equally represented.

http://aging.senate.gov/events/hr190ja.pdf

While Medicaid formularies are forbidden from considering costs, Medicaid PDLs are not. Many state Medicaid programs absolutely use cost as a major, if not the major, criterion in determining access to the PDL. Without PDL access, in most product categories, market share of a product drops precipitously.

Other than that I agree with your viewpoint.

Atlex

Jerry Avorn, father of academic detailing and the brains behind all of this, talks almost exclusively about academic detailings ability to drive down costs. Come to think of it, I’ve never heard him speak about academic detailing and quality.

Do you want your tax dollars going to this sort of activity? Do you really believe that the congressman is truthful when he says the program will pay for itself? When has there ever been a government program that paid for itself? You might save a few dollars on your medicines but the net result is you will be more poor because more taxes will be taken out of your paycheck.

Moreover, since you want the government to counteract the activities of pharma reps, then do you want the government to counteract sales activities of Starbucks? The oil industry? the medical industry? the movie industry? the financial industry? the insurance industry? Do you want the government to go to your clients and/or customers and persuade them to not buy what you sell or use what services you provide?

If you were honest with yourself you would say “no”. So why is it okay for the government to go in and “undo” what the pharmaceutical industry is trying to do but it is not okay for the government to do the same in all other industries?

One notion does need to be debunked: very few drug products or programs “save” money. People tend to think cost-effectiveness is all about reducing expenditures and it is not. CEA is concerned with relative efficiencies in resource utilization.

Consider an isolated example: Alzheimer’s Disease is a growing medical and budget problem. Any cost-effective innovation with superior treatment outcomes is going to result in an explosion in drug spending, pubic and private, for that product. Even if reduction in long-term, institutional services results, the overall impact is likely to be an increase in overall spending. My point is that financial and economics assessments are very limited in influencing decisions. The UK’s NICE program is an exception but I don’t see it transferring to the US environment. I realize I have strayed off-topic, but I was in the moment.

I have never argued against the fact that many categories have good generics. My point is that PA has never shown in an audited or peer reviewed manner that its program actually saves money. It “projects” that it will save money, it maintains that it saves money and even touts an ROI. The COI goes beyond the money. The folks who run the program have a vested political interest in demonstrating that it works. Political capital is far more important to government bureaucrats than money.

Atlex