She became depressed. All candy and desserts had to be avoided as she developed diabetes. Several times a week she suffered from severe bouts of vomiting and diarrhea. Her children were worried. We didn’t know why mom was so sick, she had always been the picture of health.

A vomiting and diarrhea episode put her in the hospital. There she received a CT scan of the brain “to see if anything serious was going on,” (it was, but not in mom’s head). When we went to see her the next day, I thought she had died. Talking to the nurse I learned the doctor had given her “something” the night before so she wouldn’t get out of bed. It worked. She was comatose for two days. She was given another CT scan (“to make sure nothing serious had happened”). I asked the nurse if the doctor had forgotten he drugged her to the point that she didn’t wake up for two days and wondered how that and being exposed to excessive amounts of radiation were helpful. But all the nurse could tell me was that they needed to be sure my mom was okay.

Although I was my mother’s guardian, no one at the hospital let me know any of this was happening. I know, under her watch, none of her children would have been treated so badly. But that was a different, and better, time in America.

That being said, it would also seem to me that ramping up production capacity by introducing a pathway for the FDA approval of biosimilars would also likely increase FDA’s and other oversight and enforcement budgets during a time when budgets are already strained.

Also, aside from Genzyme issues and the like, it seems as though there is already enough production of some biotech meds like ESAs. You worry that adding more output may lead to more incentive to over market or even lead to more drug diversion. I also worry that biosimilars will add to outpatient claims costs for additional monitoring and testing and/or lead to increases in med mal premiums. Does the proposal lower drug costs at the expense of increasing other costs, and have these cost increases all been factored in?

Is there another way to lower these drug costs that is simpler to calculate?