Rising Drug Costs

Despite the rising cost of drugs, including targeted therapy, immunotherapy, and non-oncology drugs such as the new drug for Alzheimer’s disease, which costs $54K per infusion, the fact is: drug cost consumes 19% of the total health care cost. That is high and has increased by 2% in the last four years.

The devil is in the details. The cost calculation is based on what is paid by insurance, not the cost from manufacturers. That is the tricky part that hospitals and academic centers have succeeded in confusing the public and even the astute policymakers. Examples tell a story. Examples are no longer anecdotes; they are becoming the standard of what we see. We at Gabrail Cancer Center have a side business model based on a book I wrote 13 years ago titled “Good Medicine is Cheaper Medicine.” That book triggered a friend and me to start a primary care clinic at the worksites in factories and large businesses. It has been a great business model, an educational program, and very cost-effective service for employers. We are painfully learning that large hospital conglomerates and academic centers are indeed the cause of rising health care costs in general and drug costs in particular. For example, medicare pays $2,097.00 for a Remicade infusion when delivered at a free-standing community infusion center such as ours. Yet the next-door academic center, a misnomer as it could be called a money-laundering center, charges and gets paid $19,000 per infusion. That is one example of hundreds or thousands. Yet, when employers complain, the scientific-academic complex responds, “we are safer,” really…? Being close to academic centers geographically, we have learned to our disgust that the inflationary force behind increasing drug costs is not the actual price set by pharma- to some extent, it is, but when academic centers bill 10-fold what Medicare pays, we have a severe problem. It is puzzling that this has been going on for decades, yet it is grabbing no attention. As my friend Dr. Keith Lerro mentioned in a previous blog, hospitals and academia are good salesmen and women. They claim the untrue, they slander community physicians, and they get away with it. It is frustrating, especially when our policymakers hibernate in their pit holes, putting a thin veil on their faces refusing to face the problems we have, problems that can easily be solved if there is a will and understanding of logic. While we can’t change the politician’s mindset or guide academia to be scientific, we have decided to go to the people who write and sign the checks, the employers, and we have succeeded partially. We only succeed when people think outside the conventional wisdom. So, we have succeeded in diverting infusions from academic centers to our center, and employers are happy to see 700% savings on expensive drugs. The hope is that our advocacy groups will propagate these ideas and expose the abuse of the health care system by academia and large hospitals- but alas, we in community oncology and our patients have no influential advocacy group. Instead, we have organizations that care more about how much money they get from Pharma and insurance companies and have no interest in exposing the abuses that hamper access to care because of the sinful exorbitant cost. We at ICOP are not only fighting to save community oncology, which is the icon of cost-effective, accessible, and superb care, but we are fighting for access to care for all cancer patients. Nashat Y Gabrail M.D.

Demand Better Government Policy to Control Cancer Care Costs

Anyone who has been a board member of a for-profit or not-for-profit organization knows that, as a trustee, you are required to act in the best interest of that organization. Often the interests of the organization align with the interests of their customers, but not always. The two most notable exceptions to this alignment of interests are medical care and education. While education is outside the scope of this article, I wish to expound on healthcare with insight accrued from nearly 30 years of experience.

The titans who control the multibillion-dollar healthcare market, by using clever marketing techniques and catchphrases, have been extraordinarily successful in shaping public perception of their mission, generally casting themselves as more noble than those in other crucial industries. Healthcare businesses are very important but are no more noble than other industries. Shall I go out on a limb and say that Farmers are more important than Physicians? I have gone six months without a doctor’s appointment, yet I cannot go more than a few days without food. One reason healthcare businesses get away with excessive virtue preening is the historical intertwinement of healing with religion, most notably traditional Christianity, in which healing powers are attributed to divine intervention. Healthcare executives know of this and use it to manipulate public opinion. They should be very pleased with their success. Now the U.S. population accepts higher healthcare prices than any other nation on Earth.

I often hear claims that healthcare is a human right. Those of us on the front lines agree- access to quality healthcare is extremely important. But if healthcare is a right, can consumers choose not to pay and still receive it? Can I ignore my deductible when I need a CT scan? Is it ethical for a provider to refuse care for someone with adequate resources who refuses to pay? Should a pharmacy be required to give medicine to someone without expecting payment? Should a large pharmaceutical company be required to provide their medication for free? And if healthcare is a right, is food a right? Is shelter a right? Is a mate a right? Should people be allowed to remove food from the shelf of a market or squat in someone else’s home to make due on their rights? Should we be allowed to force a non-consenting person to be our mate because companionship is a right? Of course not; all of this is silliness. Unfortunately, scurrilous politicians have encouraged these kinds of cockamamie arguments in service of advancing their personal and political agendas—my how the public square has been debased by idiocy.

Our current political environment has witnessed the recrudescence of radicalism in which old techniques are being used to silence speech. Techniques that originated in the ancient empires of Egypt and Rome, honed by past kingdoms in Asia and Europe, and perfected in Nazi Germany, Soviet Russia, and Communist China, are now being wielded by those claiming a higher level of virtue. While not without risks, it is amusing to watch these morose new intellectuals, people entirely lacking in self-awareness, go down this pedantic road. Even before this alarming new trend developed, attempts to silence would-be reformers in healthcare have utilized these techniques. Those who have questioned the high cost and low value in healthcare have been vilified by politicians and the healthcare oligopoly as uncaring or cruel. As a result, large health care organizations, which have evolved to function as cartels like OPEC in keeping prices high, have largely avoided having to answer for high costs.

Getting back to healthcare as a right: As an American Citizen in good standing, you have the right to receive high-quality medical care at the lowest possible price. Unfortunately, the federal government has abridged your rights and pursued policies that have resulted in the proliferation of higher-cost, lower-quality care. Take, for example, a woman with breast cancer who needs chemotherapy. At a community cancer center, the total cost of care over a month, for example, maybe $2,000. At a small hospital cancer center, it may be closer to $5,000 per month; at a large hospital center, it could go up to about $15,000 per month, all without a demonstrable increase in quality (and often with provable lower quality). Why are costs higher at hospital cancer centers? Healthcare titans have manipulated politicians to pay their institution more per unit of care than smaller, more efficient, and more personal centers. This added cost may seem invisible at first (because much of it is absorbed by insurance), but is ultimately passed on to you, the consumer, by way of higher insurance premiums, bigger copays and deductibles, and depletion of the Medicare trust fund, which must be replenished with taxpayer funds.

Many studies have shown that community cancer centers are the crucible of value and innovation in cancer care. We at ICOP acknowledge that larger institutions have a vital role in rare diseases and specialized procedures; however, larger centers have failed time and time again to provide high-quality, low-cost care on a large scale in the realm of general oncology and hematology.

It is time to acknowledge that the preferential treatment politicians give to their mega-healthcare allies (and donors) has harmed the American consumer and impoverished our country. Additionally, the high cost of health care has driven American jobs offshore to countries with lower health care costs. This is because health insurance in America is borne, at least partly, by employers who have reached a breaking point.

The titans of healthcare in America know the truths in this article very well but would publicly disagree because they serve their organization first and their customers second. The mega-healthcare organizations routinely cherry-pick data to cast themselves in a favorable light. Mark Twain once observed, “There are three kinds of lies: lies, damned lies, and statistics.” We must view with skepticism the arguments from wealthy health care conglomerates while acknowledging the good that they do and the unique challenges they face.

Keith Lerro, M.D., Ph.D.

Regional Medical Oncology Center

Wilson, NC

Impact of Pharmacy Conglomerates on Patients and Pharmacists

We are all aware of the hundreds of articles, studies, and blogs written about specialty pharmacies and their impact on access and cost; no repetition should be expected from me! I have observations that strike a chord, observations that have not been addressed.

Annual ratings of professions as viewed by the public are published every year based on surveys by Medscape and other organizations. Historically, pharmacists rank on the top in trustworthiness by patients. They have been viewed by the public as the legitimate arbitrator for caring, honesty, and integrity. Usually, nurses rank second, followed by physicians. Funny enough but tragic, politicians only beat prison inmates in trustworthiness.

Decades ago, physicians were on the top of the list, but that has changed, a change that paralleled the shift from self-employment to being employed by hospitals and other large institutions. I can argue that the paperwork and insurance mandates have distanced physicians from the face-to-face patient interactions, hence viewed less caring about patient needs and concerns. In fact, nurses have been dropping in the trust hierarchy, which in my view can be attributed to the shift of nursing care from the bedside to paperwork and computers coupled with more administrative duties replacing actual patient care, which has been increasingly delegated to State Tested nursing Assistants (STNA’s).

We at Gabrail Cancer Center are trying to recruit a second pharmacist to handle the pharmacy aspect of research. One Indeed advertisement we posted resulted in more than 30 highly qualified applicants; I had no choice but to interview most of them. Not only was I shocked by the sheer number of applicants, but their responses to our questions were also telling. Most of the applicants currently work for the mega pharmacy conglomerates. They find little professional satisfaction in what they do. They complain that they miss patient interactions. The pharmacy technician is the one who talks to the patient, while the pharmacist deals with inventory management, spreadsheets, and revenue analysis. They all seem to have given up on reversing the trend. It is more than a trend; it is a new paradigm that policymakers, including the FTC, seem to ignore.

These desperate, highly educated pharmacists, all Pharm.D, see clinical research as a vent to their professional frustration and oppression - an intellectual stimulant that will feed their scientific and professional hunger. What is curious to me is the number of applicants we have encountered, yes, we have several pharmacy schools, but I don’t think we have a surplus. After all, all applicants do have a job that pays well monetarily but little to show in satisfying the professional zeal and instincts.

Independent community oncology is a narrow vent for these highly educated professionals; we need to work with them. One way of widening that venting window is through expanding our scope of operations at our practices via opening retail pharmacies and expanding our clinical research programs. That is exactly what ICOP is doing. Pharmacists have demonstrated their usefulness in clinical research both at Pharma R&D divisions and at community oncology research sites.

Nash Gabrail M.D.

Gabrail Cancer Center