Flora and pharma: A better landscape on prescription drug costs begins to bloom

The insulin I require to stay alive — or at least to keep my limbs attached, my kidneys pumping and my eyesight intact — last year cost more than $30,000. To quote our self-pitying president, "Poor me."

Why should you care? Because a more apt sentiment would be, "Poor you."

As a Medicare patient, I paid about 11 percent of that cost out of pocket. The drug companies that make the two insulins I inject (a tip of the hat to our dear friends at Eli Lilly and Sanofi) graciously absorbed about 11 percent of the sticker price.

That leaves you, the hapless souls still paying Medicare taxes every week, picking up the majority of the tab: more than $25,000.

I feel sick about it. You should, too.

But this isn't a story about Medicare, insurance for the old and disabled, or Medicaid, a plan for the poor, though both programs threaten to buckle in the face of rising costs.

The relentless rise of drug prices affects everyone, including workers covered by employer-sponsored health plans. For the sick and uninsured, meanwhile, drug prices often prove calamitous.

The list prices for some drugs go as high as $800,000 a year. Costs of tens of thousands a year are far from exceptional. Even the deepest of discounts don't stop the bleeding.

In their defense, drugmakers contend that bringing a new drug to market costs an average of $2.6 billion — money that must be recouped in the price.

Yet the federal government contributes plenty to drugmaker research and development: about $100 billion from 2010 to 2016, according to the Center for Integration of Science and Industry

Americans pay the highest prices in the world for prescription drugs — spending more than $1,000 a year, per capita, compared with $686 in Germany, $669 in Canada, $497 in Great Britain, $401 in Norway and $351 in Sweden.

The Commonwealth Fund, the health care research think tank that gathered those numbers, suggested the discrepancies are worse than they sound.

"… it is not like Americans are overly reliant on prescriptions drugs as compared to their European counterparts," said a report by "The Conversation," a health care newsletter.

"Americans use fewer prescription drugs and when they use them, they are more likely to use cheaper generic versions. Instead the discrepancy can be traced back to the issue plaguing the entirety of the U.S. health care system: prices."

Not coincidentally, Big Pharma has emerged as one of the biggest contributors to congressional campaigns — spending tens of millions of dollars to keep politicians in line.

Lobbyists counted drug companies among their top clients, with nearly $28 million spent by the Pharmaceutical Research & Manufacturers of America alone last year. Pfizer and Amgen each spent more than $11 million, according to the Open Secrets Center for Responsive politics.

During the 2016 campaign, Donald Trump called for Medicare to use its buying power on behalf of 60 million seniors to negotiate prices with drug companies.

When Medicare "Part D" introduced drug coverage during the presidency of George W. Bush, drug lobbyists successfully barred plan directors from negotiating pharmaceutical prices.

But Trump would be different, he vowed. Not for long.

After meeting with Big Pharma executives shortly after he took office, Trump surrendered. He wouldn't push for Medicare drug price negotiations, after all.

Instead, Trump recently proposed imposing "transparency" on drugmakers, forcing them to include prices in their TV commercials.

The idea, which drug lobbyists are fighting, would apply only to a relative handful of drugs promoted on broadcasts and probably would do little to inflame patients who expect their insurance to cover most of the bills.

Azar lately has portrayed the president — and himself — as backers of lower drug prices. He cites, among other things, the Food and Drug Administration approving more low-cost generic alternatives to prescription drugs.

"… the definition of success for Americans and for President Trump will be lower list prices — not flat net prices or smaller and fewer list price increases," he wrote in a recent commentary.

Of course, if Big Pharma execs make another field trip to the White House, that promise may be medicine they don't have to swallow.

Like the first flowers of spring, hopeful signs have started to pop up on the local and national landscapes.

The first hearing of the new Democratic majority in the U.S. House focused on drug prices.

Klobuchar also would allow imports of prescription drugs from Canada. In the past, such measures have been blocked by political friends of Big Pharma, claiming no one will know if the imports are safe. As if Canadians are dropping in the streets from tainted elixirs.

Sen. Elizabeth Warren, another presidential hopeful, has proposed allowing the government to make generic alternatives when the industry fails to step forward.

Minnesota has sued insulin makers, accusing them of deceptive practices in drug pricing. The action alleges that pharmaceutical benefits managers — the middlemen who decide what drugs employer insurance plans cover — profit from their choices.

The drug companies, the suit says, raise their prices artificially high, then offer "rebates" pocketed by the middlemen. In effect, kickbacks that aren't shared with employers or patients.

Sensing trouble, Lilly in March announced the rollout of a half-price generic alternative to its name-brand short-term insulin, Humalog.

The generic insulin will be priced at $137.35 per vial or $265.20 for a pack of five injection pens.

Meanwhile, Lilly will continue to make Humalog and sell the name-brand drug to Medicare and private health insurers.

If truly competitive generic insulin became available, we'd really have something to celebrate, according to a recent study in BMJ Global Health, a peer-reviewed medical journal.

A 2018 study concluded that " … robust competition in the human insulin and insulin analogue market would lead to sizable savings in most countries and that current manufacturers could set significantly lower prices while still making a profit."

The authors estimate insulin could be priced at $72 to $133. Not per month. Per year.