Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download fonseca-are-drug-prices-a-problem
Transcript
Rafael Fonseca MD Chair, Department of Medicine Mayo Clinic in AZ Are drug prices a problem? Scottsdale, Arizona Mayo Clinic College of Medicine Mayo Clinic Comprehensive Cancer Center Rochester, Minnesota Jacksonville, Florida Disclosures • Consulting multiple bio and pharmaceutical companies • • • • Passionate to see my patients do better Opinions my own – not political Fierce free market supporter Dislike wasting your time with this slide Golden age in Medicine • Cures for many ailments • Hepatitis C is highly curable • Many cancers are now controlled and more can be cured • Number of options is ever increasing • Improvements in life expectancy 20th Century • Sanitation • Diagnostics • Drugs Multiple Myeloma • • • • 15 years ago 3 yr survival ~30% Now >90% Basic research vs empirical progress New treatments like lenalidomide and proteasome inhibitors • Monthly cost sometime in excess of $10,000 • How can patients pay for this? Economic benefit • Murphy and Topel (2006) estimated that a “1 percent reduction in cancer mortality (sic for the whole of the United States) would be worth nearly $500 billion to current and future Americans.”10 Murphy K, Tope R. The Value of Health and Longevity. Journal of Political Economy. 2006;114(5):871-904. Goals • HERE: Everyone wants to help patients • But we have to make a choice: • Choice A - Broad access now • Cheap and immediate • Worldwide • “Today’s best is forever best” • Choice B - Continued innovation • Continued discovery • Any drug in B becomes A at patent exp. Are the costs of drugs a problem? • Drugs account for ~10% of cost of care • Depends who pays • Patients (co-pays) • Insurers and payers • Government health programs • Is this concern new?... Hardly • Is this the right question • How to frame it So is cost the real issue? • It should not be! - Total cost of care • Value is the issue • Economic benefit of intervention • Cost of drugs has been 10% since 1960’s • Higher in cancer • Despite higher costs of drugs lower total cost of cancer care • Economic benefit Has the free market failed? • Hardly a free market situation • Third part payer system • “A solution to lack of free market is not less free market” • The free markets work • Daraprim story • Lasik eye surgery and plastic surgery • Peter Bach and colon cancer Misconceptions • Generics and patent medications • “Red pill versus blue pill” • We are smart and can help set prices! • Patients have to get 2nd mortgage • No one pays full price • Few pay full co-pay • Bankruptcy Clinical Misconceptions • Drug only improve survival by such.. • Median • Individuals • Long term outcomes • Cures • Combined benefits • Tumor heterogeneity • Better tolerability Cancer Survival Ok no new drugs, but we will have supply! • Vaccines for children 1993 • Generic injectable medications • http://www.ashp.org/drugshortages/cu rrent/ • Household goods • Toilet paper in Venezuela Price Controls • iShares Nasdaq Biotechnology Index (IBB) is down 4% while the SPDR S&P Biotech ETF (XBI) is off 6%. Return of investment, not good intentions, drive investment in biotech September 2015 Conclusion • Cannot fix markets by making them less free than they are • Proposed solutions – cost controls are ling term dangerous • Effective competition in generic markets is key • We all benefit from this • The future remains bright
