Why patients cannot afford to have asthma or gout

It is noteworthy how certain vital and effective generic drugs for common diseases have become exorbitantly expensive. We are use to new pharmaceutical brands costing a small fortune. But generics, one of which goes back to use in Egyptian times? Really? Allopurinol and asthma inhalers that are cheap but effective medications have become unaffordable to those that need it the most: Simply stated, those that can’t breathe and those that can’t move.

Most people know that drug commercials fill the airwaves with seemingly nonstop advertisements. Most know about the exorbitant costs.

One example, although there are many, is the new hepatitis C drug at $1,000 per pill. Generic asthma inhalers used to be extremely cheap. But with the new environmental laws, they recently were required to change the propellant, which then caused the inhaler to be considered a ‘new” drug with a “new” brand name. This innovative way to gouge the consumer, was a new form of “suffocation” for the asthma patient.

But what is most interesting is how this came about. Big Pharma lobbied for it and made it happen. According to Mother Jones, for around $520,000 cost of lobbying, they succeeded in recreating and repackaging the old generic asthma inhaler for 4-6 times the price. Albuterol, one of the oldest asthma medicines, costs anywhere from $50 to $100 per inhaler in the US, but it was less than $15 a decade ago before it was re-patented.

Why hasn’t hairspray gone up 500 percent?

Do most know that there is a lack of regulation in the pharmaceutical industry and how it affects them?

But it’s the things that you don’t know that can hurt you. For example, Medicare cannot negotiate rates with Big Pharma. Can you imagine selling something where you decide the price and the other party is forced to pay? This is not a free market let’s just say.

What I see clearly is that people that have trouble breathing and moving may no longer afford to move or breathe. To be frank, it’s sort of sadistic, and it’s not subtle. While many argue there is a cost for research and development for branded drugs, these are hard to justify for generics. When one sees a patient suffering from these afflictions and there is a good treatment option, it is kind of cruel to make it cost prohibitive for many, for apparently no good reason, other than to feed the drug manufacturers.

Jonas Salk, MD, is responsible for eradicating polio. His polio vaccine was never patented. He wanted his polio vaccine to save lives throughout the world and to be known throughout history. He was not fueled by greed. As he aptly put it when asked whether there would be a patent for the polio vaccine, he said, “There is no patent. Could you patent the sun?”

“Deceased, MD” is a physician.

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  • Patient Kit

    Thank you for highlighting this insanity. I did not know about either of these things until I started reading here on KMD. It is nothing short of obscene that Big Pharma has been allowed to re-patent cheap old drugs and re-brand them as new expensive drugs, putting them out of reach for many who need them.

    And it is ludicrous that Medicare can’t negotiate price with Big Pharma. In any normal negotiation situation, Medicare should be in a powerful negotiation position because it is such a major customer.

    In spite of the fact that Big Pharma does develop new drugs that save lives (lives of those who can afford those drugs anyway), it’s easy to see why Big Pharma has such an evil reputation. They’ve earned that reputation. I know they have powerful lobbyists, but I still can’t wrap my head around the fact that we let Big Pharma get away with this stuff.

    • Deceased MD

      Thanks Kit. Appreciate your wonderment at all of this. Hence why I wrote this one. I guess my point is that Big Pharma is (obviously) a business. They want you to think that they are out there spending billions on R and D and working hard at brilliant complex drugs that have merit and can save a patient’s life. In reality the MAJORITY of their wealth goes to marketing. This piece is only one scheme ( making generics turn into expensive brands). The outcome is nothing else than sadistic. if anyone really thinks long and hard about someone struggling with breathing from asthma or pain and inability to ambulate from gout, it is pretty sadisitic to deprive them of a simple cheap solution.

      • doc99

        First, cry “Global Warming and Ozone Depletion” and then reformulate the asthma inhalers. The road to unaffordable is paved with good intentions.

  • Deceased MD

    This applies to many diseases where generic meds have become unaffordable or unavailable but I chose asthma and gout as examples. I want to thank our very own Dr. Wible and Dr. Ninguem for the links as they are very eye opening.
    In light of the fact that there is extensive news coverage on how much MD’s collect from medicare, it is interesting that there is not a peep about the fact that Medicare D cannot negotiate prices from Big Pharma. How much does that cost?
    Certainly some of the fraud reported about MD’s incomes makes one wonder how gullible medicare is. But it is more interesting to see how no one challenges how much Medicare pays for drugs.
    Most importantly, what do you think of this?

  • Deceased MD

    Legal schemes from Big pharma as they make the laws. Are you aware of this one?. A few years ago, the makers of lipitor, paid off their generic competitors NOT to produce the generic after the patent expired. Weren’t we taught in school something about antitrust laws? Well Pfizer CHANGED THE LAW so this was all perfectly legal.

    • ninguem

      And health care cost would go down considerably if basic free-market principles were applied……for a change.

      The healthcare market has not been “free market” for a long time. It’s infested with crony capitalism and “lawfare”.

      Pharmaceuticals are one of the worst offenders. Change the antitrust rules, with a specific exemption just for me.

      Find ways to get patients for drugs that have been around for centuries.

      Cleaning up that swamp would have done more for healthcare than anything else Obama and Hillary have done, combined.

      But……neither side will do anything. They’re paid off.

      So they spend their time beating up on physicians.

      • Deceased MD

        Couldn’t have said it better. Thanks to you for the great link BTW. And the problem is notice the newspaper ads? LOL. Once there was some long article-the usual-about poor kids are just on too many antipsychotic drugs. Horrors. Above the article was an ad for seroquel (one of the drugs mentioned in the article). I guess it’s hard when Big Pharma is paying the bills. Can only guess how much this affects news reporting etc.

      • Patient Kit

        We demonize individual poor people on welfare for “taking” money. But businesses like Big Pharma that receive what is essentially “corporate welfare” are admired because they are “making” boatloads of money. I guess it goes without saying that by “we”, I do not mean evil “socialist” me. Even though I am not, in fact, a socialist, there are worse names I could be called. Our system is so corrupt. It makes me see red. :-p

        • Deceased MD

          I laughed when Romney said that 47 percent of Americans are victims that get subsidies from the gov’t. Ever see how much the gov’t subsidizes Big businesses? Sorry I digress..

          • PCPMD

            Any reason anyone needs to be feeding at the government trough?

          • DeceasedMD1

            I guess that was my sarcasm. it shouldn’t be that way.

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        Yes, it’s horrible, but let’s put this in proper perspective. We spend about 10% of total expenditures on prescription drugs, which is about the same amount we spend on physicians (after overhead).
        If all the meds were free and all the doctors worked for free, we would still be spending almost 15% of GDP on health care. There seems to be a black hole somewhere at the heart of health care…..

        • Deceased MD

          I guess what I am getting at in this piece is the way Big Pharma promotes themselves as doing R and D that are life saving for pts. So most people defend them-or many do at least.The fact is they are way over valued. Big Pharma creates schemes to pull billions of dollars in profit—like with the lipitor example above, or asthma inhalers. The major philosophical question here is where’s the value for your HC dollars? Even if it’s just 10 percent. It’s the dynamics at play that I am getting at. The list goes on as you are right that this is not the majority of cost. But just give it time…..

          • http://onhealthtech.blogspot.com Margalit Gur-Arie

            Oh, no doubt about that. It’s price gauging at its best….. with government assistance too….

          • doc99

            Explains why Reimportation of prescription drugs from say Canada was quickly taken off the healthcare reform table. Follow the money.

        • doc99

          Healthcare is the only enterprise which purports to save money by increasing the number of middlemen.

        • DeceasedMD1

          I was thinking about your comment. You’re not kidding about the black hole and no doubt EHR’s and ACA sign up debacle are right up your alley. You see it very clearly all the time because that is your expertise. And likely this is a huge part of the expenditures.
          . I guess I wrote about Big Pharma because they are in my face all the time everywhere.. Unwanted sales calls and visits to my office, commercials in every journal, Just about every conference they sponsor– so you can never really know if what you are hearing is a sales pitch from the MD speaker. And not to mention drug commercials galore.

      • Patient Kit

        Beating up on docs for making too much money from Medicare is a deliberate strategy of detraction and distraction. They are diverting the spotlight off the real corrupt greedy moneymakers and shining it on you docs to take the pressure off themselves. I just can’t believe they continue to get away with it. >:-(

        • Deceased MD

          Me neither!

          • doc99

            The reason the #WarOnDoctors succeeds is because CMS manages to set one group of doctors against another – the PCP’s vs Specialists, etc. Divide and Conquer is a very old technique and trying to unite doctors is really akin to herding cats. Doctors now would rather throw in the towel and join the ranks of the employed than continue to play the games of a rigged casino. And of course, that was the aim all along.

    • NormRx

      I was quite aware of this practice, many companies employ this tactic. Many patents are employed in drug manufacturing. First you have the chemical patent, then process patents and delivery system patents. If a generic company wants to produce a drug, they have to side step all of these patents. So the brand name company lawyers go to them and say “your drug violates one or more of our patents and we will sue you if you bring your drug to market.” Then the generic house and the brand name company enter into negotiations to avoid a lawsuit, which could drag on for years and cost millions. The end result is a few million in the bank for the generic house and many millions or billions in the bank for the brand name company. One could try and stop this practice, but I don’t know how you could do it without restricting a person or company access to a court of law. It isn’t just pharmaceutical companies that employ this tactic, it is utilized across all industries.

      • DeceasedMD1

        You are saying this goes on even long after the patent has expired? My understanding with the Lipitor case was that it went to the supreme court.

        • NormRx

          Yes, I am saying exactly that. There isn’t just one patent covering any drug, there are many and may have different expiration dates depending on when they were filed. We had one drug that was a QID dose then we went to a BID dose which was covered by a different patent. Then we went to a QD dose, again covered by a different patent. Most patients would rather take a medication once a day Vs four times a day. Generic companies may come out with a QID dose but it isn’t considered much competition from the brand name houses. Most physicians know the compliance difference between a four times a day dose and a once a day dose is significant and will write the once a day dose.

          • DeceasedMD1

            thank you Norm. thst was most informative. no wonder patent lawyers do so well. i am just thinking about the billions spent on this. besides the lawyers and brand drug name companiesaking a mint who is paying for all this legal patent babbling amd wonder howuch it costs the taxpayers. Am on iphone so forgive my bad typing skills. i would never be able to get a job at Kaiser…..thank goodness for that!

        • RenegadeRN

          Isn’t the same thing going on with Celebrex right now ? The maker is paying off the generic company NOT to produce a generic form so they can continue to reap obscene amounts of money.?

          • DeceasedMD1

            You know I can’t keep up with all of these shannaigans Renegade but I think you have the right idea. This is happening a lot and is out of control and violates,anti trust laws and as Norm said below this is a common form of lawsuits which costs countless amounts of money. Jonas Salk MD said you can’t patent the sun with polio!

  • Patient Kit

    What is the history of how it came to be that Medicare can’t negotiate price with Big Pharma? When Medicare Part D was created in 2003, why didn’t it follow in the footsteps of the VA, which can negotiate price with Big Pharma? 2003 — not a good year for the American people: war launched in Iraq and Big Pharma given carte blanche by Medicare. :-(((

    • Deceased MD

      Good question Kit. Maybe someone else here knows more about how they did. it .But we are dealing with some pretty fierce lobbyists that create and more often than not write the laws.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      It’s not exactly carte blanche. Medicare Part D is administered by a variety of private plans. Each one of those is at liberty to negotiate with pharma, just like all other commercial insurance plans do for their own furmularies. Medicare is prohibited from negotiating on behalf of all Part D plans. This law was introduced and passed by the Bush administration and the venerable Tommy Thompson who seemed to have a problem with inconveniencing pharma…. :-) President Obama promised to remove this prohibition, but shockingly, he didn’t even try.

      The current modus operandi seems to be that every time we want to do something for the people, we are forced to also do a “little something” for Corporations, or they won’t let their politicians vote for what the people want or need. We are forced to build this extortion surcharge into the costs of running the country, like Mafia protection money. That’s the black hole I was alluding to before, and that’s why everything seems to always be beyond our means. And organized crime doesn’t give discounts – they take theirs off the top.

      A good case in point is made by the various websites for signing up for Obamacare, on which we spent well over 1 Billion dollars. Oregon alone blew a quarter billion and got nothing for it. No working software and no refunds from the contractors. There is absolutely no way, no way at all, that this type of software can really cost a billion dollars. Not anywhere in the vicinity….

      • LeoHolmMD

        The best way to get away with an atrocity is to outsource it.

        • DeceasedMD1

          got a chuckle out of that. To add to the insanity of outsourcing, the FDA has no jurisdiction in these third world countries making generics. Every time I turn around there are reports of generic drugs with glass found in them or unsanitary conditions.

  • NormRx

    First, let me state clearly, I do not have a dog in this fight. Even though I worked for a pharmaceutical company for many years, they and the insurance companies lost my support when they got in bed with the Obama administration on the ACH.

    For those doctors that think that negotiating with the Federal government over drug prices would benefit patients, I would only ask you to took at your own practice and see how your negotiations with the Federal government over Medicare and Medicaid reimbursement is working out for you. The Federal government doesn’t negotiate, it sets the prices and you either take it or leave it.

    The V.A. system does negotiate with drug companies and many of the best and most beneficial drugs are not available to veterans. A number of years ago I was shown a list of pharmaceuticals that the Director of Pharmacy at my VA hospitals was instructed to discard because they did not meet basic efficacy standards. This was quite some time ago and perhaps they have corrected this problem.

    I do disagree with many of the posters regarding their blaming the pharmaceutical companies instead of the Federal government. The Federal government has the power to make or break virtually any business in this country and in order for business to survive they have to lobby (bribe) the whor-s in Washington. Bill Gates from Microsoft learned this a number of years ago. Even though he is a Democrat he concentrated on building Microsoft and he was not politically involved. This resulted in the Clinton administration bringing anti-trust charges against him. He fought these charges and eventually they were settled under the Bush administration. He learned his lesson though, he now donates to both parties.

    Well, that is enough of my rant. For those that would like to see another perspective on this subject check out this link.
    https://www.nationalcenter.org/NPA550MedicareDrugPrices.html

    • LeoHolmMD

      “For those doctors that think that negotiating with the Federal government over drug prices would benefit patients, I would only ask you to took at your own practice and see how your negotiations with the Federal government over Medicare and Medicaid reimbursement is working out for you. The Federal government doesn’t negotiate, it sets the prices and you either take it or leave it.”

      Physicians do not negotiate collectively at that scale. I believe it is illegal. “Take it or leave it” is a legitimate negotiation tactic. But if CMS leaves it, they are accused of rationing, denial of care, etc. So the company with a patent has a hostage in a way. That changes real negotiations. You would think democracy would balance that, but as you point out, it has been severely corrupted.

      • DeceasedMD1

        hostage. great word for it. Their set up is abusive to both pt and doctor. Their arbitrary and punitive rules are set up to drive anyone insane.

    • DeceasedMD1

      Norm you are absolutely right. My article was short. I could go on for hours so am sorry I did not include that as that was definitely part of the colcrys debacle. When I was in med schl the attending once said that we could definitely trust the FDA. Well many years later not so. The FDA requesting the study makes them the problem as well. I should have included that as a more balanced article. The FDA is a whole other mess and does now seem to be part of the problem. thank you for that input

  • Dave

    I’ve ordered my own asthma meds from India for years. Just looked at my usual site and albuterol inhalers are $4.50, salmeterol/fluticasone (advair) for under $10, and looked at allopurinol and it’s $6.20 for 30 300mg tabs. American prices are nuts, but ordering overseas is very easy and there are tons of internet forums around where you can read about which sites are trustworthy and which to avoid. I’ve done it for years without any trouble and recommend it to anyone else tired of paying insane prices for old, cheap drugs.

  • NormRx

    I realize MD’s do not have any lobbying power, The AMA sold out their physician base long ago. I don’t think you will find a non physician more supportive of physicians than myself. Physicians are getting screwed. What I find ironic is medical schools are still packed. The only part we may differ, is in who to blame. I think your put more blame on the companies and I put more blame on the government. After all, it is they, that required the studies on colchicine and required the drug companies to reformulate the asthma meds. If you haven’t read the article at the link I provided, please do so. I would be interested in your insight. Good luck to you. I was just a rep and I could no longer work in the health care field. I don’t know how some physicians manage to keep going.

  • DeceasedMD1

    First of all I am so sorry you have gout and I hope you have been able to get good treatment. How has this affected you other than I guess the obvious price increase? But I am delighted to hear from someone who is familiar with taking this drug about what your experience has been. And Yes it is URL Pharma colchicine now branded colcrys is the culprit, Wrote this quickly so thank you for catching that. Also did not mention (which you ,may likely know) that URL pharma won FDA approval and three years of exclusivity by doing a study on this ancient drug for the FDA. So the FDA is liable here too here for the price increase.
    Thank you for writing in. How does this affect you with colcrys?

  • DeceasedMD1

    “Big business is ruining healthcare in this country and the government is it’s wingman. Just my 2 cents”
    Exactly! I am sorry when I wrote this article I was more focused on Big pharma but the govt is right there assisting them. Thank you for adding that. spot on.

    First of all I am so sorry to hear about your experience. That is a horror. How are you doing-if that is not too personal a question? I just hope you are fully recovered.

    Although your situation was sudden pain after 4 days. How wretched! So it sounds like monitoring by the NP was not really the issue I gather.

    Do you in any way feel like these drug SE problems in general are related to the PCP not monitoring close enough? I am not so much criticizing busy PCP’s in any way. More the system. Like you said, pills are dispensed like,candy without much monitoring. Auto refills galore and yearly prescriptions without follow up -or even more time can be the norm. And as you said with the elderly frightening. Often more and more drugs are added on without evaluating the efficacy or drug to drug interactions.

    • RenegadeRN

      Thanks for your reply! I’m doing great now. Had both knees scoped, scraped and snipped… So to speak. ;-). I can tell you when the weather is about to change now, never could before.

      The NP never had a clue I stopped the levaquin. It is a Very busy general practice and even though the providers are overall good, it is corp med and run like crap. Just no sugar coating it. I wish the MD there would go out on his own – I would be his cheerleader.
      I do think there needs to be some closer follow up related to SE. Not sure how .. Simple q&a ? Making sure patients know to call if they feel they are having any kind of SE? Certainly no one has ever told me that. My SE from the levaquin was 2 months later. It took far longer for me to put the pieces together, and no one has ever admitted it was the cause. Of course.

      • DeceasedMD1

        Omg this does not seem to surprise me. just spontaneous must be run of the mill orthopedic problem u have. imagine if you were not an RN? U migjht be going to ortho and sportsedicine clinics continuing the med and how many orthos would think of that in their differential? any collaboration with ortho and NP? do you think that in part the denial of cause was ignorance with a problem that requires cognition and awReness

        • RenegadeRN

          Ha ha! Thanks! Absolutely no collaboration between ortho and NP, but in all fairness I’m not a regular in the clinic. I try not to consume much healthcare other than absolute necessities.
          I have to say I have been a bit miffed that no one except my dentist acknowledged the drug SE as a possible culprit in the knee issue. Like it’s not a documented SE? My longtime dentist noticed me hobbling in one day and then said he believed he had had a shoulder tear from it too.
          Are docs not seeing it? Is it going unreported due to time between drug and event? Why the denial? I’m not litigious by any means, and freely say so…. Has levaquin become a sacred cow?

          • DeceasedMD1

            You know I was thinking about you and have not had time to research more yet on levaquin. Was just curious about your hx. You mentioned you had spasms for 4 days and then stopped. Did the spasms and pain completely stop or were there any residual symptoms? And then months later a sudden issue with acute knee pain. I don’t pretend to be an expert on this but you know I think the main problem you have is it’s rare.(Or at least it is listed as rare under side effects.) At the same time your symptoms could easily sound “common”. Right? (OK THis is meant to be a bit sarcastic.) Everyone has spasms somewhere at sometime. Probably everyone on this site has had one. let’s go down the check list well just go to sports medicine who will send you to PT to stretch and strengthen. Put heat on it or maybe ice. blah blah,

            I think the fact it is rare and seems to be related to nerve dysfunction causing spasms to the muscles that innervate them as the symptoms. Any spasms that are severe enough can technically cause orthopedic problems over time( joint problems and I guess tendon rupture?) etc. This is just a guess as i have not researched it yet but the problem is this does not really fit well into the medical model and if the sequence of events is involving 4 specialties, no one will collaborate. Also medicine has become so ridiculously evidence based what would you have to do to prove it? Do an EMG from your neck to your lumbar sacral spine prior to taking levaquin? Then when sx start get another EMG to compare? And see if you have developed a peripheral neuropathy from it?
            BTW the makers of levaquin would be interested in your report. your doctor should have at least could have reported it. Not that it may do much good. But the more it is not reported the more it is very “rare”. Just my 2 cents. Not sure if I am accurate.

          • RenegadeRN

            Don’t want to hijack the article topic here, but actually it wasn’t spasms. ( I went back and read my initial comment to make sure I didn’t mislead you) it was weird pains in my forearms just below the elbows not horrible but not normal either , then when I stopped the drug they went away.

            Two months later when I squatted down to pull up tent stakes and noticed my knees swelling and becoming very painful on my drive home from the campsite, the last thing I was thinking of was weird pains in my forearms ! Lol. My opinion is that the time lag between drug ingestion and joint problems causes it to be under or not reported .

          • DeceasedMD1

            Thanks for clarifying. All I had remembered was your knees. Well it sounds like the weird pains below your elbow was a peripheral neuropathy. No doubt related. Did you ever have that sort of pain in your back or legs subsequently? Anyway I can see where you are coming from. Worth reporting. Again just sorry what you have been through. right on topic about Big Pharma for this thread.

          • RenegadeRN

            Aww you are so nice! Nope, no further neuropathy issues.
            I write all this so maybe someone reading may recognize a situation in a patient or themselves and think back ( up to a year , I’ve read) if they have taken a drug from the quinolone category.
            Thanks again Deceased MD for your concern and interest!

          • DeceasedMD1

            You are so helpful to tell your story. I am perturbed when I hear things like this and I thank you for telling me. I sure am glad you’re better! I think it bothers me Renegade when pts are left feeling dismissed when they have serious concerns. you deserve better.

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