The Cost of Prescriptions Allison Field St. Bonaventure University March 25, 2017

WHY AMERICA? -I wanted to start out by showing you this chart that was made by the Bernie Sanders campaign. To see just how expensive prescriptions can be, and to see that America’s and to see it compared to other countries, particularly our next door neighbor, Canada. - If you can see, these are all drugs needed for very necessary conditions such as diabetes, asthma, and anaphylaxis. Looking at this chart it looks as if our medicines cost about 3x as much as those in Canada. -If you took the total spent on rx drugs in America and divided it by the number of people in our population, you would find that America spends $858 per each person a year on prescriptions. The average of other countries who are equivalently developed only spend $400 per person in their population –We are sinking the high prices for them by paying so much

Our drug prices are continuing to RISE EVERYONE is negatively affected by this; private and government insurances alike Private Insurances = high copay Governmental Insurances = no negotiation -In the US, almost 20% of overall healthcare costs are spent on purchasing Rx drugs -There is an abuse of government regulation that allows for a control over the industry like a monopoly -Government insurances: Medicaid and Medicare are NOT allowed to negotiate drug prices with manufacturers - Medicaid covers 70 million ppl, medicare covers 55 million people…. This means over 1/3 of Americans are covered by insurance that isn’t even allowed to negotiate the high prices that the drug companies are charging – not to mention these are the insurances coming out of government spending & tax dollars -Even those with private insurances are affected by rising copays as the price of the drugs rise

Sovaldi & Harvoni = Hepatitis C CURE High Price Examples EpiPen = life saving for allergic reactions Epipen = Life saving medication for patients experiencing an allergic reaction, such as anaphylactic shock, Sometimes they offer discount cards for medicines like this, but that is still to keep you buying and your insurance paying ---Can not only treat, but get rid of Hepatitis C after a 12 week therapy -12 weeks of Sovaldi on average = $80,000 -12 weeks of Harvoni on average = $94,000 Sovaldi & Harvoni = Hepatitis C CURE

High Price Example Martin Shkreli was the “evil” pharmaceutical man on the news at the end of 2015 and throughout 2016 Price rose over 5000% Daraprim is a life saving drug. It’s a specialized that treats toxoplasmosis and malaria, it is often used on people with HIV to treat or prevent opportunistic infections - You probably saw this on the news a lot last year and at the end of 2015, because Martin Shkreli took rights to the drug and rose the price over 5000% percent. He has kind of became a face to corrupt pharmaceutical companies - as you can see, 15 years ago it cost 1 DOLLAR PER TABLET…. Now it costs 750$ for ONE PILL! … I read an article

How does this happen? A key term called exclusivity allows this to happen Prevents generics The system is abused in many ways EXCLUSIVITY…. Where drug companies are allowed to patent drugs anywhere from 10-20 years for “research and development costs”… during that time no generics or other brands can be sold… some big drug companies even pay off other generic companies to prevent them - in theory the patents make sense to reward the company who created the drug and to keep incentive for innovation, BUT However, it is very often abused by manufacturers through certain manipulations of the regulation

“Evergreening” Slight changes to extend a patent Legal way to cause further delay of generics This is one way of abusing the patent by making very slight changes to the drug to extend it before it expires ---usually clinically insignificant changes i.e. dosage changes, different forms or release (IR vs ER), different versions of the same medication - this manipulation allows them to keep rights over their drug for an even longer time, preventing the distribution of any generics

“Hard Switching” MARKETING AGAINST THEIR OWN BRAND! Pulling their brand drug from the market and pushing for another brand drug they also have control over By the time the older generic comes out, most people would be already be on the newer brand name and not go back -Another way for brand name companies to keep control of their product for longer -Right before a generic is about to come out, they will completely remove their brand drug from the market and start selling a different, newer version of the drug that they also have control over -In the meantime, doctors would have switched their patient to the newer drug so by the time the old drug becomes generic, the patients are already used to the newer drug -Usually no difference in effectiveness --Ex: Lantus is the number one prescribed insulin in the U.S., but recently their company released Toujeo – an insulin pen with the exact same ingredients, just more highly concentrated so you take a smaller dose. They are currently marketing directly against their own product

References http://www.cbsnews.com/news/whats-behind-the-sharp-rise-in-prescription-drug- prices/ http://time.com/money/4462919/prescription-drug-prices-too-high/ http://time.com/money/4406167/prescription-drug-prices-increase-why/ https://www.wsj.com/articles/how-do-we-deal-with-rising-drug-costs-1460340357 https://www.nytimes.com/2016/04/27/business/drug-prices-keep-rising-despite- intense-criticism.html?_r=0 http://www.consumerreports.org/drugs/cure-for-high-drug-prices/ http://www.latimes.com/business/la-fi-mylan-price-hikes-20160830-snap-story.html http://www.cnbc.com/2016/08/19/prescription-drug-costs-are-on-the-march-and- out-of-reach-for-many-americans.html http://www.cnn.com/2016/08/23/health/epipen-price-mylan-prescription-drugs- increase/