Big Pharma and Medicaid
But, wait: there's more. Shortly before the Thanksgiving recess, a new provision was passed that excluded mental health medications from the 'preferred' medications lists in states. As today's Washington Post points out, this provision is a good example of both the power of pharmaceutical companies and the problems in addressing mental health issues in this country.
As part of a House budget bill that reduces spending on Medicaid prescription drugs, pharmaceutical giant Eli Lilly and Co. and other businesses secured a provision ensuring that their mental health drugs continue to fetch top price at a cost of hundreds of millions of dollars to the states.
The provision -- inserted by Rep. Steve Buyer (R-Ind.), whose district flanks Lilly's Indianapolis headquarters -- would largely exempt antipsychotic and antidepressant medications from a larger measure designed to steer Medicaid patients to the least expensive treatment options. The House Energy and Commerce Committee approved Buyer's amendment this month over the strenuous objections of Chairman Joe Barton (R-Tex.) and the National Governors Association. It survived unchallenged in the $50 billion budget-cutting bill that narrowly passed the House just before Congress left for Thanksgiving recess.
As part of a House budget bill that reduces spending on Medicaid prescription drugs, pharmaceutical giant Eli Lilly and Co. and other businesses secured a provision ensuring that their mental health drugs continue to fetch top price at a cost of hundreds of millions of dollars to the states.
The provision -- inserted by Rep. Steve Buyer (R-Ind.), whose district flanks Lilly's Indianapolis headquarters -- would largely exempt antipsychotic and antidepressant medications from a larger measure designed to steer Medicaid patients to the least expensive treatment options. The House Energy and Commerce Committee approved Buyer's amendment this month over the strenuous objections of Chairman Joe Barton (R-Tex.) and the National Governors Association. It survived unchallenged in the $50 billion budget-cutting bill that narrowly passed the House just before Congress left for Thanksgiving recess.
...To opponents, however, Buyer's measure underscores the excessive power that corporate interests wield on Capitol Hill. Critics say the measure also violates the purpose of the budget-cutting bill, which was drafted to give state governments the flexibility to cut program costs in ways that minimize the harm done to beneficiaries.
"This is obviously an attempt to prevent state Medicaid offices from getting cheaper, just-as-beneficial drugs to patients, and it's really going to stick it to the taxpayers," said Steve Ellis, a vice president and Medicaid analyst at Taxpayers for Common Sense.
Under the budget-cutting bill's Medicaid provisions, states would be allowed to create lists of preferred medications. Then, for the first time, they could charge higher co-payments -- even to poor children and pregnant women -- for medicines not on those lists. The bipartisan National Governors Association, which promoted the changes, maintains that states will save billions of dollars by guiding patients away from newer drugs that may be far more expensive -- but no more effective -- than older alternatives.
Mental health medicines need special attention because the complex human brain responds very differently to different drugs and different dosages, advocates of the amendment say.
The governors group warned that the cost differential between an older, established drug such as Prozac and a new entrant can be staggering, while the difference in utility is often marginal.
Moreover, no state could meet the requirement of proving that one drug is equivalent to another, because drugmakers' clinical trials compare their products with placebos, and scant evidence is available comparing one drug with another, said Stan Rosenstein, deputy director of California's Department of Health Services [Emphasis added]
This is one of those situations where there appears to be a conflict between two equally justified interests. Advocates for those with mental illnesses want them to receive the most effective treatment available, whether they are poor or wealthy. Newly developed medications are frequently more effective because of research discoveries. Why should those discoveries benefit only those wealthy enough to pay for them? That's one side of the argument.
The other side is that the improvement in the efficacy of the drug is often so slight that it hardly outweighs the increased cost to the entity responsible for paying for the drug. The governors want to be in the position of forcing pharmaceutical companies to lower the prices in order to get on the preferred list, with the promise that volume in sales will offset the initial cost.
The underlying concern of Big Pharma, of course, is that the governors' approach will result in a back-door approach to shortening the life of the exclusive patent on news medications. Big Pharma doesn't want any cap on their pricing and their profits, and these companies have never been shy about investing in politicians who will help them out in this respect.
...Lilly has been the biggest corporate contributor to Buyer's campaigns. Since 1989, the drug company has donated $46,500 to Buyer's congressional campaigns, according to the Center for Responsive Politics.
Buyer? Perhaps a better name for the Gentleman from Indiana is Seller.