Why Have Generic Drug Prices Increased Two And Three Times Over The Last Year?

I used to have a firm policy— no drugs: grin and bear it. As I got older, my body laughed in my face. One of the drugs I take regularly now is Nystatin (oral suspension). Nystatin was discovered by two doctors working at the Division of Laboratories and Research of the New York State Department of Health; the “n-y-s” in Nystatin comes from that— and this drug hasn’t fallen into the avaricious hands of the big pharmaceutical predators. Although CVS sells it for $46/bottle and Walgreens charges $34, with my Medicare insurance I paid $2.55 yesterday. It varies slightly between $2 and $3 a bottle. I also picked up some Econazole Nitrate andf paid $55 for an 85 gram tube, which seemed gigantically high to me. When I got home, I saw that Target offers the same tube for $43.80 and Kroger for $47.40. You can buy it online for between $34.00 and $42.00 without issuance. That’s confusing.

Last week Bernie Sanders (I-VT) in the Senate and Elijah Cummings (D-MD) in the House announced they are launching a investigation into why prices of generic drugs have been soaring.

“We are conducting an investigation into the recent staggering price increases for generic drugs used to treat everything from common medical conditions to life-threatening illnesses,” Sanders, chairman of a Senate health care subcommittee, and Cummings, ranking member of the House oversight committee, wrote in letters to 14 pharmaceutical companies.

They pointed, for example, to the price hike for Albuterol Sulfate used to treat asthma and other lung conditions. The average cost for a bottle of 100 pills was $11 last October. The average charge by this April had shot up to $434. An antibiotic, Doxycycline Hyclate, cost $20 last October for a bottle of 500 tablets. By April, the price was $1,849.

The price data on those and other generic drugs came from the private Washington, D.C.-based Healthcare Supply Chain Association. It surveyed average prices paid by organizations that help hospitals, nursing homes and home health agencies negotiate with pharmaceutical companies and other vendors for discounts. The figures are akin to wholesale prices, not the amount patients are charged.

Cummings and Sanders cited a survey that found pharmacists across the country “have seen huge upswings in generic drug prices that are hurting patients” and having a “very significant” impact on pharmacists’ ability to continue serving patients. The study for the National Community Pharmacists Association also found some patients refused to fill needed prescriptions because of rising prices.

“It is unacceptable that Americans pay, by far, the highest prices in the world for prescription drugs. Generic drugs were meant to help make medications affordable for the millions of Americans who rely on prescriptions to manage their health needs. We’ve got to get to the bottom of these enormous price increases,” Sanders said.

“Generic drugs have historically resulted in huge savings for consumers and for taxpayers,” said Cummings. “However, these outrageous recent cost increases are now preventing patients from getting the drugs they need, and they merit further investigation to better understand what factors are driving these price spikes.”

I’ve had some funky experiences with one drug maker, Dr. Reddy’s Laboratories and I asked my pharmacy to avoid ordering me anything they make. I noticed that they were one of the companies Sanders and Cummings wrote to. You can read the letter here, which singled out two generics they manufacture, Divalproex Sodium, which treats seizures, manic depression related to bipolar disorder, and epilepsy, and Pravastatin Sodium, which lowers cholesterol. As you can see from the chart below, over the last year the price has spiked from as low as $31 to $235, an increase of 736%. How does that happen— especially as an industry-wide trend?

Last week, the Wall Street Journal reported that “in some cases, price hikes exceeded 1,000% and even topped 17,000%.”

The reports added to growing concern about the increasing cost of prescription drugs, which has largely been confined to brand-name drugs— such as expensive new treatments for cancer, hepatitis C and certain rare diseases. A firestorm erupted earlier this year, for instance, over the Sovaldi treatment for hepatitis C that is sold by Gilead Sciences and costs $1,000 a pill, or $84,000 for a 12-week regimen.

The Republican Health Care Plan Hasn't Changed: Don't Get Sick-- And If You Do, Die Quickly

Last October-- a month short of a year ago-- I started treatment for a rare form of cancer. The treatment ended, successfully, about a month and a half ago after a month in the hospital for stem-cell transplants. Today I spent the entire day at City of Hope's day hospital getting maintenance treatment, something I'll probably be doing every few months for the rest of my life. I've kept a sporadic running diary of my adventures in the world of medicine that you can check out here if you'd like.

Tuesday you probably read, as I did, the Andrew Pollack piece in the NYTimes that everyone was talking about, Drug Goes From $13.50 a Tablet to $750, Overnight. Short version: A typical greed-obsessed 32-year-old Albanian-American hedge-fund manager buys the rights to a life-and-death drug and jacks the price into the stratosphere. He isn't dragged out of his office and killed but goes on TV instead and will soon be talked about as a Ted Cruz, Jeb Bush or Marco Rubio potential running mate. The piece has been updated because the ensuing uproar caused one of the companies (UPDATE: now Shkreli has partially raised the white flag himself, lowering the cost per pill to a so-far undisclosed price.) involved to rescind the bulk of the increase. Blended, for those who don't have access to the Times, these are the most crucial bits:

A huge overnight price increase for an important tuberculosis drug has been rescinded after the company that acquired the drug gave it back to its previous owner under pressure, it was announced on Monday.

However, outrage over a gigantic price increase for another drug spread into the political sphere on Monday, causing biotechnology stocks to fall broadly as investors worried about possible government action to control pharmaceutical prices. The Nasdaq Biotechnology Index fell more than 4 percent.

“Price-gouging like this in the specialty drug market is outrageous,” Hillary Rodham Clinton, a contender for the Democratic presidential nomination, said in a tweet on Monday. She said she would announce a plan on Tuesday to deal with rising drug prices.

Ms. Clinton was referring to the actions of Turing Pharmaceuticals, which last month acquired Daraprim, a 62-year-old drug used to treat a serious parasitic infection, and raised its price to $750 per tablet, from $13.50.

The cases of Daraprim and of the tuberculosis drug, cycloserine, are examples of a relatively new business strategy-- acquiring old, neglected drugs, often for rare diseases, and turning them into costly “specialty” drugs.

Cycloserine was acquired last month by Rodelis Therapeutics, which promptly raised the price to $10,800 for 30 capsules, from $500. But the company agreed to return the drug to its former owner, a nonprofit organization affiliated with Purdue University, the organization said on Monday.

“We discovered literally on Thursday the strategy that had been undertaken” by Rodelis, said Dan Hasler, the president of the Purdue Research Foundation, which has oversight of the manufacturing operation. “We said this was not what we had intended.”

By Saturday, he said, Rodelis had agreed to give back the drug. Rodelis confirmed this in a brief statement on its website.

The foundation now will charge $1,050 for 30 capsules, twice what it charged before, but far less than Rodelis was charging. Mr. Hasler said the new price was needed to stem losses.

Cycloserine is used to treat multidrug-resistant tuberculosis, a serious form of the disease that does not respond to the usual drugs. There are only about 90 new cases a year in the United States, Mr. Hasler said, and about half those patients get treated with cycloserine.

Turing does not appear ready to surrender. Turing’s founder and chief executive, Martin Shkreli, a former hedge fund manager, used television interviews and also Twitter and Reddit to defend his move.

He said that toxoplasmosis, the infection Daraprim is used to treat, had been ignored by the pharmaceutical industry because there was little money to be made. Now that Turing can presumably make money, he said, it will be able to educate doctors about the disease, improve delivery to patients and develop better drugs for the infection.

Infectious disease specialists, who have protested the price increase, question the need for new drugs for toxoplasmosis and say that if Turing wants to develop such drugs, it should use money from investors. They say the price increase will raise the cost of treating some adult patients with toxoplasmosis to hundreds of thousands of dollars a year.

Senator Bernie Sanders of Vermont, who is also vying for the Democratic presidential nomination, sent Turing a letter on Monday demanding information on the price increase.

“Without fast access to this drug, used to treat a very serious parasitic infection, patients may experience organ failure, blindness or death,” Mr. Sanders said in a letter written with Representative Elijah Cummings, Democrat of Maryland. The two lawmakers have been investigating sharp price increases in drugs, many of them old generics.

Last night, Chris Hayes had Bernie Sanders on his show talking about this whole outrage-- specifically and general-- and what he's been doing to work on this problem in the Senate. Watch what Bernie had to say about it. Shkreli is just the latest ugly face of a catastrophic problem that needs to be seriously addressed-- but, because of the way our elections are financed, hasn't been. (You can contribute to Bernie's campaign here.)



It's lovely that Hillary jumped in; none of the Republicans, to my knowledge, have. But it is a subject that Bernie Sanders has been working on for most of his career. Just before I started my treatment, I started covering how generic drug prices have been skyrocketing and how Bernie was taking on an issue that few others wanted to touch.

Remember, Medicare Part D is "Republican Health Care." It was supported by virtually no Democrats except a gaggle of right-wing Blue Dogs, and it demonstrates the inherent unfairness towards working families that is emblematic of the GOP approach to health care. When the House voted on Bush's Medicare Part D scheme on November 22, 2003, it passed by only 5 votes, 220-215. 25 Republicans joined nearly the entire Democratic conference to oppose it. 

The 25 Republicans who opposed the Bush proposal are against all forms of government involvement in healthcare. Tthe 16 Democrats who backed it were almost entirely reactionary Blue Dogs, and only two of them, Colin Peterson (MN) and David Scott (GA), are still in Congress-- where they're still voting for Republican policies that wreck the lives of ordinary working families. The others were subsequently defeated or forced to retire to avoid being defeated. As Xavier Becerra (D-CA) explained recently on the House floor, "Congress should be in the business of making life better, not worse, for everyday Americans."

Bernie's bill, S.1364, the Medicaid Generic Drug Price Fairness Act of 2015, is winding its way through a Republican-controlled Congress hostile to the very idea of, in Becerra's words, "making life better, not worse, for everyday Americans." Since Bernie introduced it, Elizabeth Warren (D-MA) and Sheldon Whitehouse (D-RI) signed on as co-sponsors, joining Bernie, Sherrod Brown (D-OH), Mazie Hirono (D-HI), Richard Blumenthal (D-CT) and Al Franken (D-MN). The bill would make generic-drug manufacturers reimburse Medicaid for excessive price increases (increases greater than the rate of inflation). If Bernie's bill passes, it will save taxpayers $1 billion annually, which would cut into excessive profits by the GOP-enabled pharmaceutical corporations.

One of the most common side effects from chemotherapy is neuropathy, extreme pain in the feet, legs and hands. The pain is nerve damage and normal painkillers have no effect on it whatsoever. Lidocaine-based gels, however, ameliorate the worst pains. And the worst pains are pretty bad; it makes many patients suicidal-- many patients. Lidocaine has always been a relatively inexpensive drug. I used to buy a tube for around $25. A tube lasts two to three weeks. Suddenly, though, the generic-drug manufactures were all bought up and the price went from $25/tube to $300/tube, making it unaffordable to thousands of cancer and diabetes patients in extraordinary daily pain.

That's what Bernie and other champions of working families in Congress are trying to combat.

Attorneys general in Connecticut and Vermont are also looking at possible collusion among some manufacturers. There have been allegations of practices such as buying up several generic drug companies as a way to corner the market-- and set pricing-- for a specific drug.

At the June 6-10 American Medical Association’s House of Delegates meeting in Chicago, the delegates instructed the AMA to pursue efforts to find ways to address the increases.

Many physicians spoke of specific instances of generic drug prices go up multiple times their cost, sometimes abruptly but more often over the past few years. For instance, said Georgia delegate John Antalis, MD, the price of the antibiotic doxycycline now costs $276, up from $70 a few years ago. One physician said a patient called him from a pharmacy to report that the generic version of aripiprazole (Ablilify/Teva) cost more than the brand name of the drug.

At least 12 states require pharmacists to give patients to generic drugs when available and many more allow the substitution. If the plans permitted patients to get whichever version of a drug was cheaper, that could help fight some generic drug price increases. Health plan specifics are a matter of state regulation.

At the AMA meeting, Mario E. Motta, MD, cardiologist in Salem, MA, wondered why generic digoxin, the pharmaceutical version of digitalis (a common garden flower also known as foxglove), cost $180 when it costs about a penny a pill to manufacture and has been used for more than 200 years as an herbal tea.

While I was getting the stem-cell operations, there was another patient of my doctor's in a room down the hall going through the same procedure, a young father who had four small children running around the hospital the whole time I was there. One day my doctor came in and told me he probably wouldn't make it. She was visibly shaken up and grappling with how she was going to tell his wife. Well, since then there's some good news and some bad news since then.

The good news is that, although the operation was not successful, he didn't die. The bad news is that my doctor is keeping him alive with a daily pill. More bad news: The insurance co-pay for the monthly prescription is $10,000. This is not a wealthy family. They can't pay. Right now the hospital appears to be picking up the cost. But it's hard to imagine that that's going to last forever. My doctor is scrambling to figure out a way to make this work out.

The key for the rest of us is to elect more members of Congress to stand with Bernie and the others taking this seriously. Recently I spoke with Donna Edwards, a congresswoman from Maryland currently running for her state's open Senate seat, and she would certainly be an immediate co-sponsor of Bernie's bill were she to be elected to the Senate next year. Same for P.G. Stittenfeld in Ohio, where Rob Portman, as usual, is on the wrong side of the issue. "If elected to the U.S. Senate," P.G. told us, "I will always be on the side of the people, rather than the special interests, and that is why on Day 1, I would support the Medicaid Generic Drug Price Fairness Act, ensuring that generic drugs remain affordable to those who need them. Not only is a progressive vision for our health care system the right thing to do, in the case of this legislation it would also save taxpayers a billion dollars." You can help make that happen right here.

Most Americans (72%) are catching on that we're being ripped off by the Republican-enabled big drug companies. Often, the exact same drugs cost much less overseas. Is this a big enough deal for them to motivate their choice of 2016 candidates? If it is, Bernie Sanders will be the next president of the United States and Donna Edwards, Russ Feingold, P.G. Sittenfeld and Alan Grayson will be in the U.S. Senate.

Bernie Sanders' Bill To Regulate Overpriced Generic Drugs Picks Up Steam

Republicans have a different perspective on healthcare-- pay or die

Last October we started looking at Bernie Sanders' investigation into outrageous generic drug pricing under Medicare Part D. The inherent unfairness towards working families is emblematic of the GOP approach to Medicare; it's their version. When the House voted on Bush's Medicare Part D scheme on November 22, 2003, it passed by only 5 votes-- 220-215. 25 Republicans joined nearly the entire Democratic conference to oppose it. The 25 Republicans who opposed it are against all forms of government involvement in healthcare, and the 16 Democrats who backed the Bush proposal were almost entirely reactionary Blue Dogs, only two of whom, Colin Peterson (MN) and David Scott (GA), are still in Congress-- and still voting for Republican policies that wreck the lives of ordinary working families. The rest were all subsequently defeated or forced to retire to avoid being defeated. As Xavier Becerra (D-CA) explained recently on the House floor, "Congress should be in the business of making life better, not worse, for everyday Americans."

Bernie's bill, S.1364, the Medicaid Generic Drug Price Fairness Act of 2015, is winding its way through a Republican-controlled Congress hostile to the very idea of, in Becerra's words, "making life better, not worse, for everyday Americans." In the last few days Elizabeth Warren (D-MA) and Sheldon Whitehouse (D-RI) signed on as co-sponsors, joining Bernie, Sherrod Brown (D-OH), Mazie Hirono (D-HI), Richard Blumenthal (D-CT), and Al Franken (D-MN). The bill would make generic drug manufacturers reimburse Medicaid for excessive price increases (price increases that are greater than the rate of inflation). If Sanders' bill passes it will save taxpayers $1 billion annually, which would cut into excessive profits by the GOP-enabled pharmaceutical corporations.

One of the most common side effects from chemotherapy is neuropathy, extreme pain in the feet, legs and hands. The pain is nerve damage and normal pain killers have no effect on it whatsoever. Lidocaine-based gels, however, ameliorate the worst pains. And the worst pains are pretty bad; it makes many patients suicidal-- many patients. Lidocaine has always been a relatively inexpensive drug. I used to buy a tube for around $25. A tube lasts 2-3 weeks. Suddenly, though, the generic drug manufactures were all bought up and the price went from $25/tube to $300/tube, making it unaffordable to thousands of cancer and diabetes patients in extraordinary daily pain. That's what Bernie and other champions of working families in Congress are trying to combat.

Attorneys general in Connecticut and Vermont are also looking at possible collusion among some manufacturers. There have been allegations of practices such as buying up several generic drug companies as a way to corner the market-- and set pricing-- for a specific drug.

At the June 6-10 American Medical Association’s House of Delegates meeting in Chicago, the delegates instructed the AMA to pursue efforts to find ways to address the increases.

Many physicians spoke of specific instances of generic drug prices go up multiple times their cost, sometimes abruptly but more often over the past few years. For instance, said Georgia delegate John Antalis, MD, the price of the antibiotic doxycycline now costs $276, up from $70 a few years ago. One physician said a patient called him from a pharmacy to report that the generic version of aripiprazole (Ablilify/Teva) cost more than the brand name of the drug.

At least 12 states require pharmacists to give patients to generic drugs when available and many more allow the substitution. If the plans permitted patients to get whichever version of a drug was cheaper, that could help fight some generic drug price increases. Health plan specifics are a matter of state regulation.

At the AMA meeting, Mario E. Motta, MD, cardiologist in Salem, MA, wondered why generic digoxin, the pharmaceutical version of digitalis (a common garden flower also known as foxglove), cost $180 when it costs about a penny a pill to manufacture and has been used for more than 200 years as an herbal tea.

The key now is to elect more Members of Congress to stand with Bernie and the others taking this seriously. There has been a lot of talk in California about drafting Becerra to give up his safe House seat and run for the open U.S. Senate seat. That's exactly what working families' champions Donna Edwards (D-MD) and Alan Grayson (D-FL) are doing.

I spoke to Donna this morning, and she would certainly be an immediate co-sponsor of Bernie's bill were she to be elected to the Senate next year. Same for P.G. Stittenfeld in Ohio, where Rob Portman as usual is on the wrong side of the issue. "If elected to the U.S. Senate," P.G. told us, "I will always be on the side of the people, rather than the special interests, and that is why on Day 1, I would support the Medicaid Generic Drug Price Fairness Act, ensuring that generic drugs remain affordable to those who need them. Not only is a progressive vision for our health care system the right thing to do, in the case of this legislation it would also save taxpayers a billion dollars." You can help make that happen here.

There's A Conservative Way At Looking At Martin Shkreli And There's A Progressive Way

Until Friday, the newest controversy around young greed and selfishness icon Martin Shkreli was how he bought the single existent copy of the 31-track Wu-Tang Clan double album, Once Upon A Time In Shaolin, for a million or two million dollars (no one who knows for sure is telling) at an auction, after having a trusted staffer listen to a 13 minute snippet. Then Friday the former hedge fund manager-turned-pharmaceutical CEO was in the news again with a plan to sharply increase the price of a decades-old drug for a serious infectious disease, Chagas disease, a parasitic infection that can cause potentially lethal heart problems.

The plan also is upsetting some organizations that supply drugs for neglected diseases because Mr. Shkreli has said he wants to take advantage of a federal program intended to encourage companies to develop such drugs. The program awards vouchers that can be sold to other companies for hundreds of millions of dollars.

Mr. Shkreli has said he hopes to obtain such a voucher by getting the Chagas disease drug approved by the Food and Drug Administration for sale in the United States. Critics say that it would be another case of the system being abused by awarding a voucher not for developing a new drug but merely for obtaining F.D.A. approval of a drug already used in tropical countries.

...Last month, Mr. Shkreli led an investor group that took control of a failing California biotechnology company, buying a majority of its shares on the open market at an average price of about $1.50 a share. The stock of the company, KaloBios Pharmaceuticals, now sells for about $28,  based in part on expectations that the company will prosper under Mr. Shkreli.

  As one of his first moves at KaloBios, Mr. Shkreli agreed to license the worldwide rights to one version of benznidazole, a standard treatment in South and Central America, where Chagas disease is most common.

Benznidazole has never been approved for sale in the United States but is provided free to patients by the Centers for Disease Control and Prevention on an experimental basis.

Mr. Shkreli said on a conference call with KaloBios investors last week that if the company won F.D.A. approval for benznidazole, it would have exclusive rights to sell it in the United States for at least five years. He said the price would be similar to that of hepatitis C drugs, which cost $60,000 to nearly $100,000 for a course of treatment.

In Latin America, benznidazole costs $50 to $100 for the typical two-month course of treatment.

KaloBios’s price would be “pretty devastating,” said Dr. Meymandi of U.C.L.A. “The people with Chagas for the most part are poor” and many lack insurance, she said.

It is estimated that 300,000 people in the United States have Chagas disease, virtually all of them immigrants from Latin America who were infected before they came.

When asked at a recent Forbes health-care summit, how he could have redone his first bout of national publicity around his decision to buy Daraprim, a standard treatment in the care if a life-threatening parasitic infection, just to raise the price from $13.50/pill to $750/pill, he boasted he would have raised the drug’s prices higher. "My shareholders," he said, "expect me to make the most profit. That’s the ugly, dirty truth... I’m going to maximize profits. That’s what people are afraid to say."

Even Republicans are afraid to say that too loud-- and in mixed company-- but that's an underlying principle of their Law of the Jungle philosophy, which, in effect, enshrines price gouging. And that, of course, is why societies protect themselves with one of the bêtes noires of the conservative movement and their Republican Party: regulation that protects the interests of society.



As many people know, especially-- though not exclusively-- as they age, high drug prices are killing people, not rich people, not the millionaires and billionaires, of course, but everyone else. As Social Security Works warned their members this week, "The U.S. pharmaceutical industry is forcing Americans to pay the highest drug prices in the world while stashing their profits in tax havens overseas, even while most of the drugs that they profit from are produced with taxpayer funded research."

This is especially concerned for them because fully 37% of Social Security checks go toward out-of-pocket health care costs. "Big Pharma is gouging the American people with sky-high drug prices, dodging taxes, and eroding our Social Security benefits," something none of the establishment presidential candidates is seriously addressing, although it is certainly at the heart of Bernie Sanders' renegade campaign. Bernie has been working for decades to stop pharmaceutical companies from raking in record profits while avoiding taxes and ripping off American consumers.



In 2013, the U.S. spent nearly 40% more per person on prescriptions than Canada, the next most expensive industrialized nation. This is because drug lobbyists have been able to:

• block Medicare from negotiating prescription drug prices,
• block legislation that would require transparency on how pharmaceutical companies set their prices,
• and block legislation that would prevent greedy CEOs and investors from forcing drug prices through the roof-- bankrupting patients.


And while the pharmaceutical industry is raking in record profits, Pfizer-- one of the world’s wealthiest drug companies-- is attempting to move its corporate headquarters out of the United States to a tax haven overseas in order to avoid paying what it owes in taxes here at home. Pfizer already has $140 billion in untaxed profits stashed offshore.

...Congress should recognize that this is not a partisan issue. According to a recent Kaiser Health poll, 86% of Americans-- Democrats, Republicans and Independents-- want Congress to address skyrocketing drug prices by requiring drug companies to release information on how they set their prices.





Taking on the greedy, out-of-control pharmaceutical industry has been a core priority for Bernie for his entire career. And Shkreli is just an extreme manifestation-- a kind of Overton Window version-- of this kind of Republican Party business-as-usual. Shkreli, whose contribution to Bernie's campaign was publicly rejected and donated to charity, went to Fox Business News where he declared that "I don’t think [Bernie] understands pharmaceuticals at all." Unfortunately for price gougers like Shkreli, Bernie, more than anyone else who has ever run for president understands exactly how the pharmaceutical industry actually does work. And he's vowed to change that to make sure the industry serves the public interest not just a narrow and sociopathic profit motive. For Bernie health care is a human right that includes access to safe and affordable prescription drugs.

Americans pay, by far, the highest prices for prescription drugs in the entire world. When we talk about health care, we are talking about the need of the American people to be able to afford the medicine their health care providers prescribe. A life-saving drug does no good if the people who need it cannot afford that drug.

Yet, last year, nearly one in five Americans between the ages of 19 and 64-- 35 million people-- did not get their prescriptions filled because they did not have enough money. In the wealthiest country in the history of the world, Americans should not have to live in fear that they will go bankrupt or die because they cannot afford to take the medication they need.

In any given month, more than half of all American adults take at least one prescription drug. There is no question that medicines help millions of people live healthier and longer lives, and can also prevent more expensive illnesses and treatments. However, it is unacceptable that the United States now spends more than $370 billion on prescription drugs and spending is rising faster than at any point in the last decade.

Instead of listening to the demands of the pharmaceutical industry and their 1,400 lobbyists, it is time that Congress started listening to the American people, who overwhelmingly believe that the cost of medication is too expensive. More than 70 percent of Americans believe drug costs are unreasonable and that drug companies are putting profits before people.

Americans filled 4.3 billion prescriptions last year. The Sanders plan includes six policies to get better deals for the American people. Sanders’ plan will:

1. NEGOTIATE A BETTER DEAL

• Require Medicare to use its bargaining power to negotiate with the prescription drug companies for better prices-- a practice that is currently banned by law.

• Last year there were more than 37 million Medicare beneficiaries enrolled in private Part D plans. 90 percent of seniors take at least one prescription. Many seniors-- almost two-thirds-- take three or more prescription drugs.

• Not only would negotiation substantially reduce prices seniors and people with disabilities pay for drugs, it could save Medicare between $230 billion to $541 billion dollars over the next decade.

• 83 percent of Americans support allowing the federal government to negotiate with drug companies for better prices.

2. IMPORT PRESCRIPTIONS FROM CANADA

• Allow individuals, pharmacists, and wholesalers to import prescription drugs from licensed Canadian pharmacies.

• The United States spends more than $1,000 per person per year on prescription drugs-- that’s nearly 40 percent more than Canada, the next highest spender.

• In 1999, Sanders became the first Member of Congress to take a busload of Americans across the border into Canada to purchase prescription drugs. Americans should not have to pay higher prices for the exact same drugs than our Canadian neighbors simply because Congress is bought and paid for by the powerful pharmaceutical industry.

• 72 percent of Americans support this policy of allowing Americans to easily import safe and affordable prescription drugs from Canada.

• Prohibit the United States from agreeing to provisions in international trade deals that would raise drug prices in the United States or extend the monopoly period when a brand name drug company has no generic competition.

• Suspend the government’s authority to destroy packages of imported drugs at the border until new legislation is passed ensuring that Americans can import safe and affordable drugs from Canada.

3. RESTORE DISCOUNTS FOR LOW-INCOME SENIORS

• Close the Medicare Part D donut hole for brand and generic drugs by 2017, three years earlier than under current law.

• The private Medicare Part D benefit contains a “donut hole.” It’s a coverage gap, wherein seniors and people with disabilities must pay for their medications even while they are paying monthly premiums. Under current law, this gap in coverage will close by 2020. Sanders’ plan closes the gap by 2017.

• Require generic drug companies to pay an additional rebate to Medicaid if their drug prices rise faster than inflation.

• Brand name drug makers have to pay a rebate to Medicaid if their drug prices rise faster than inflation. This provision ensures generic drug companies are subject to the same rules. Nearly 10 percent of generic drugs more than doubled in price last year.

• According to the nonpartisan Congressional Budget Office, this policy will save the federal government $1 billion over 10 years.

• Restore Medicare prescription drug discounts for low-income seniors and people with disabilities.

• Pharmaceutical companies got a huge victory ten years ago, when prescription drug coverage for low-income seniors and people with disabilities was moved from Medicaid to Medicare. Because Medicaid gets a much better price for prescription drugs than private Medicare Part D plans, this policy change meant that drug companies would gain even larger profits on the backs of low-income seniors at the taxpayers’ expense.

• The Sanders plan will restore these rebates for low-income seniors, saving $103 billion over 10 years, according to the nonpartisan Congressional Budget Office.

4. PROHIBIT DEALS THAT KEEP GENERIC DRUGS OFF THE MARKET

• Prohibit anti-competitive deals-- “pay-for-delay” deals-- between brand and generic drug makers.

• Brand name drug companies sometimes try to delay their competition by paying generic drug makers to stay off the market. When these deals occur, drug prices stay high, costing patients and taxpayers more money.

• The Sanders plan prohibits these pay-for-delay deals. According to the Federal Trade Commission, these anticompetitive deals cost consumers and taxpayers at least $3.5 billion in higher drug costs every year.

5. ENACT STRONGER PENALTIES FOR FRAUD

• Terminate exclusivity-- a government-awarded monopoly period-- from a drug company convicted of fraud.

• The Sanders plan holds the pharmaceutical industry accountable when they defraud the American people. Today, nearly every major pharmaceutical company has been convicted of either civil or criminal fraud for violations including off-label promotion, kickbacks, anti-monopoly practices, and Medicare fraud.

• Even though the Justice Department has won suits requiring companies to pay hundreds of millions of dollars in fines, the prescription drug companies simply treat those fines as the cost of doing business.

6. REQUIRE PRICING AND COST TRANSPARENCY

• Require drug companies to publicly report information that affects drug pricing.

• Companies routinely distort the true cost of drug research and development to justify skyrocketing prescription drug prices. Under the Sanders plan, drug makers would be required to report certain price information to the federal government and the public on their products, including the total expenditures on research and development and clinical trials, as well as the portion of their drug development expenses offset by tax credits or paid for by federal grants.

• Companies would also be required to report not only the price information charged to federal payers, such as Medicare, but would also have to submit price, profit, and sales information for other countries in which the drug is sold.

• 86 percent of Americans, including 82 percent of Republicans, think drug companies should be required to release information to the public on how they set their prices.

This is not a partisan issue. Most Americans-- Republicans, Democrats, and independents-- want Congress to do something about drug prices. Tens of thousands of Americans now spend more than $100,000 a year on prescription medications. Drug costs are out of control because that’s the way pharmaceutical companies want it. Other countries have national health insurance plans that negotiate better prices for all of their residents. In this country, however, drug lobbyists have been able to block all of these common-sense solutions that we must work to pass into law. That is unacceptable and that has got to change.

If you'd like to help Bernie win his race for the White House, you can contribute here, on this ActBlue page. And if you need more convincing, take a look at this poll of national Republicans that NBC and the Wall Street Journal just released this morning. Cruz is on the move, my friends. And if you think Trumpf was bad... what 'til you find out more about this maniac!

Scoring Drugs In Turkey-- 1969 vs 2018

In 1969 I was in Istanbul, living in my VW camper and on my way to India. Istanbul was so exotic, a city of around two and a half million people. And the Sultanahmet district was seedy with a distinct air of danger. Middle class Turks mostly avoided it and, despite having the 4 top tourist destinations in the city-- Hagia Sofia, the Blue Mosque, Topkapi Palace and the Grand Bazaar. But back in those days, Istanbul wasn't much of a tourist destination. There was only one first-rate hotel-- the Hilton-- and it was on the other side of town. But, in the late '60's into the '70s, Istanbul was a major stop on the Hippie Trail between Europe and India and Sultanahmet was filled with disheveled hippies-- like me. It was also the place the low life types of Turkish society came to rip off the hippies and sell them hash-- and where the police prowled to arrest the hippies and the crooks trying to take advantage of them. That was Sultanahmet in 1969, when I found myself in the Pudding Shop as what became the notorious film, Midnight Express was happening in real time all around me.

Today there is a picture of Bill Clinton with the Pudding Shop's owner in the window. Not many people know what happened 50 years ago to make the place famous. I visited it last week, not the first time since my 1969 trip to Istanbul. I like the city and have been there many times since. Right after the election I needed a veg-out period to regain by equilibrium. One iff my favorite hotels in the world is in Sultanahmet now, a 4 Seasons, no less, one of two in the city. Istanbul has exploded and now has a population of around 16 million, depending who you ask. Sultanahmet is the place to be today. And the drugs... no hash anywhere as far as I can tell but American tourists are definitely there to buy drugs... pharmaceuticals. I spent a couple of thousand dollars buying medicine-- no prescriptions needed-- that would cost at least 5 times more in the U.S., even with crappy insurance from the Republican part of Medicare, the only bad part of Medicare, Part D, Bush's drug plan-- a vision of healthcare meant to help big drug firms and screw patients.

In 2006, Pelosi tried to fix it but there were too many Blue Dogs and New Dems in her caucus and she had to cater to their conservative instincts and the fix-- like everything well-intentioned Democrats try to do when the Republican wing of their party has sway (as it does right now)-- only was a baby step, not the big bold step that was needed so badly.

The costs of medicines-- a pure rip off of the American people-- hasn't been seriously addressed. Politicians talk about it but nothing seems to get done. Well, two progressives who don't try to cater to the corrupt, Wall Street-owned shit-eating New Dems and Blue Dogs, have a new bill they're introducing, the Prescription Drug Price Relief Act. Bernie Sanders and Ro Khanna will introduce it the day the Democrats take over Congress in January.

If the new Dems and Blue Dogs don't screw it up-- they will certainly try-- the bill would require the Secretary of Health and Human Services to make sure that Americans don’t pay more for prescription drugs than the median price in five major countries: Canada, the United Kingdom, France, Germany and Japan. If pharmaceutical manufacturers refuse to lower drug prices below that level, the federal government would approve cheaper generic versions of those drugs, regardless of any patents or market exclusivities in place. Does that thrill you? It thrills me.

When this legislation becomes law, the median price of brand name prescription drugs could go down by more than 40%, and savings for certain brand name prescription drugs could be even greater.

Ro Khanna: "There is absolutely no reason for the big pharmaceutical companies to make Americans pay higher prescription drug prices than they charge our friends in Canada, Germany, and the UK. Today we’re sending big pharma a message: market exclusivity is a privilege, and when you abuse that by price gouging the sick and aging, then you lose that privilege. This bill will bring down drug prices by taking on monopolies and boosting prescription drug competition."

Bernie: "No other country allows pharmaceutical companies to charge any price they want for any reason they want. Somebody in America today can walk into a pharmacy and find out that the medicine they have been using for years can double, triple or quadruple literally overnight. That needs to change. The greed of the prescription drug industry is literally killing Americans and it has got to stop."

In their press released they noted that "Trump said repeatedly during his campaign that he would take action against drug companies and bring down prices. But in the first seven months of 2018 alone, there were 96 drug price hikes for every price cut. And on Friday, Pfizer announced it is planning to raise prices on 41 more drugs in January. Earlier this year, Trump proposed a pilot program to gradually lower the prices of certain drugs covered by Medicare Part B to international price levels. But his proposal does not help the more than 150 million Americans who get private health insurance from their employer, many of whom struggle with high deductibles and copayments, or the more than 30 million Americans who are uninsured and must pay the full cash price of their prescription drugs at the pharmacy. Sanders and Khanna’s legislation would address the needs of both of those populations."

This is the one-page summary of the bill that Ro and Bernie released today:

The Prescription Drug Price Relief Act

The United States pays, by far, the highest drug prices in the world for one reason: we let drug companies get away with murder. Last year, the pharmaceutical industry made more than twice as much money in the U.S.-- $453 billion-- than in all European countries combined. The top five drug companies alone made over $50 billion, while the top five American pharmaceutical CEOs made more than $113 million in compensation.

When Congress gets back into session, Senator Bernie Sanders (I-VT) and Representative Ro Khanna (D-CA) will be introducing the Prescription Drug Price Relief Act.

This legislation would require the Secretary of Health and Human Services to make sure that Americans don’t pay more for prescription drugs than the median price of the following five countries: Canada, the United Kingdom, France, Germany, and Japan.

If pharmaceutical manufacturers refuse to lower drug prices down to the median price of these five countries, the federal government would be required to approve cheaper generic versions of those drugs, regardless of any patents or market exclusivities that are in place.

If this legislation were to become law, the median price of brand name prescription drugs could go down by about 43 percent and savings for certain brand name prescription drugs could be even greater.

For example, under this bill:

 • Premarin, for menopause, which currently costs about $165 for a 30-day supply in the U.S., could cost $94
.• Januvia, for diabetes, which currently costs about $436 for 30-day supply in the U.S., could cost $248.

 • Advair Diskus, for asthma and COPD, which currently costs about $390 for a 30-day supply in the U.S., could cost $222.

 • Xarelto, for blood clots, which currently costs about $432 for a 30-day supply in the U.S., could cost $246.

 • Lantus, which is insulin for diabetes and currently costs about $387 for a 30-day supply in the U.S., could cost $220.

 • Humira, for arthritis, which currently costs about $2,770 for a 30-day supply in the U.S., could cost $1,576.

 • Enbrel, for arthritis, which currently costs about $4,941 for a 30-day supply in the U.S., could cost $2,811.

 • Ventolin, for asthma, which currently costs about $60 for a 30-day supply in the U.S., could cost $34.

 • Xtandi, for cancer, which currently costs about $101 for a 30-day supply in the U.S., could cost $58.

 • Pristiq, for depression, which currently costs about $40 for a 30-day supply in the U.S., could cost $23.


 This is not a radical idea. According to the European Commission, using international drug prices as a benchmark in price negotiations is “the most commonly applied pricing policy in European countries.” The U.S., where Medicare is legally prohibited from negotiating drug prices for seniors, is an outlier.

Although President Trump recently proposed gradually lowering the prices of certain drugs covered by Medicare Part B to international price levels, his proposal does not help the over 150 million Americans who get private health insurance from their employer, many of whom struggle with high deductibles and copayments, or the more than 30 million Americans who are uninsured and must pay the full cash price of their prescription drugs at the pharmacy.

Today, a full 80 percent of Americans say that drug prices are unreasonable and just nine percent think that drug companies put patients over profits. The pharmaceutical industry will continue to rip off American patients as long as it can. The Prescription Drug Price Relief Act puts an end to this highway robbery, and will help save lives and reduce premiums by lowering drug prices.

Most Americans Want Drug Prices Lowered-- But The Republicans Just Will Not Permit It

Bernie has been advocating cutting prescription drug prices in half for decades. His Medicare-for-All proposal would do that. Ge wrote in his plan that "to lower the prices of prescription drugs now, we need to:

• Allow Medicare to negotiate with the big drug companies to lower prescription drug prices with the Medicare Drug Price Negotiation Act.
• Allow patients, pharmacists, and wholesalers to buy low-cost prescription drugs from Canada and other industrialized countries with the Affordable and Safe Prescription Drug Importation Act.
• Cut prescription drug prices in half, with the Prescription Drug Price Relief Act, by pegging prices to the median drug price in five major countries: Canada, the United Kingdom, France, Germany, and Japan.

Earlier this year, Bernie (+ Ro Khanna in the House) introduced the Prescription Drug Price Relief Act> Bernie: "The United States pays, by far, the highest drug prices in the world for one reason: we let drug companies get away with murder. In 2017, the pharmaceutical industry made more than twice as much money in the U.S.-- $453 billion-- than in all European countries combined. The top five drug companies alone made over $50 billion, while the top five American pharmaceutical CEOs made more than $113 million in compensation. This legislation would require the Secretary of Health and Human Services to make sure that Americans don’t pay more for prescription drugs than the median price of the following five countries: Canada, the United Kingdom, France, Germany, and Japan. If pharmaceutical manufacturers refuse to lower drug prices down to the median price of these five countries, the federal government would be required to approve cheaper generic versions of those drugs, regardless of any patents or market exclusivities that are in place. According to the Center for Economic and Policy Research, if this legislation were to become law, the prices of most brand name drugs would be cut in half. For example, under this bill:

• Premarin, for menopause, which currently costs about $165 for a 30-day supply in the U.S., could cost $83.

• Januvia, for diabetes, which currently costs about $436 for 30-day supply in the U.S., could cost $218.

• Advair Diskus, for asthma and COPD, which currently costs about $390 for a 30-day supply in the U.S., could cost $195.

• Xarelto, for blood clots, which currently costs about $432 for a 30-day supply in the U.S., could cost $216.

• Lantus, which is insulin for diabetes and currently costs about $387 for a 30-day supply in the U.S., could cost $194.

• Humira, for arthritis, which currently costs about $2,770 for a 30-day supply in the U.S., could cost $1,385.

• Enbrel, for arthritis, which currently costs about $4,941 for a 30-day supply in the U.S., could cost $2,471.

• Ventolin, for asthma, which currently costs about $60 for a 30-day supply in the U.S., could cost $30.

• Xtandi, for cancer, which currently costs about $101 for a 30-day supply in the U.S., could cost $51. 


Bernie added that "Although President Trump recently proposed gradually lowering the prices of certain drugs covered by Medicare Part B to international price levels, his proposal does not help the over 150 million Americans who get private health insurance from their employer, many of whom struggle with high deductibles and copayments, or the more than 30 million Americans who are uninsured and must pay the full cash price of their prescription drugs at the pharmacy. Today, a full 80 percent of Americans say that drug prices are unreasonable and just nine percent think that drug companies put patients over profits. The pharmaceutical industry will continue to rip off American patients as long as it can. The Prescription Drug Price Relief Act puts an end to this highway robbery, and will help save lives and reduce premiums by lowering drug prices."

On Wednesday, the Trump Regime proposed a rule-- the "Safe Import Action Plan"-- that will allow states to import medicine from Canada. Trump and his Secretary of the Department of Health and Human Services, Alex Azar, say this will lower the cost of drugs. But will it actually lower the cost of drugs?

Jim Greenwood, current head of biotech industry group BIO and a former Republican congressman, said that importation would not result in lower prices for consumers, citing nonpartisan budget experts and past FDA commissioners.

“Today’s announcement is the latest empty gesture from our elected lawmakers who want us to believe they’re serious about lowering patients’ prescription drug costs,” Greenwood said.

The Canadian government has also criticized the plan. The country’s ambassador said last month that importing medicines from Canada would not significantly lower U.S. prices. Reuters previously reported that Canada had warned U.S. officials it would oppose any import plan that might threaten the Canadian drug supply or raise costs for Canadians.

Drugs approved to be imported from Canada would exclude many prescribed drugs, such as biologic drugs, including insulin, controlled substances and intravenous drugs.

Trump, a Republican, has struggled to deliver on a pledge to lower drug prices before the November 2020 election. Healthcare costs are expected to be a major focus of the campaign by Trump and Democratic rivals vying to run against him.

The Trump administration in July scrapped an ambitious policy that would have required health insurers to pass billions of dollars in rebates they receive from drugmakers to Medicare patients.

Also in July, a federal judge struck down a Trump administration rule that would have forced pharmaceutical companies to include the wholesale prices of their drugs in television advertising.

Both the House of Representatives and the Senate are putting forth drug pricing bills that contain some of the proposals Trump has advocated, such as indexing public drug reimbursements to foreign drug costs.

But Trump has said he will veto the Democrat-led House bill if it comes to his desk on the grounds that it would slow down innovation.

And, so far, McConnell has refused to allow any bills to actually lower the cost of drugs to even come to the floor of the Senate for a debate. McConnell has even refused to allow a modest bill written by Iowa Republican Chuck Grassley and approved by the Senate Finance Committee, on which Grassley is the chair.

I asked some of the progressive Democrats for their own perspectives on how best to lower the cost of medicine. Cristina Ramirez, the most-- and only viable-- progressive in the Democratic primary to win the nomination in Texas to face anti-healthcare fanatic John Cornyn, was the first to reply. "I know," she said, "that the high cost of prescription drugs are hurting American families-- particularly ones with chronic illnesses, like my own mother, who has diabetes and has had to split her pills because they are so expensive. John Cornyn has repeatedly said that he wants to address the cost of prescription drugs, yet when he has introduced legislation, he has always been willing to change it if the drug industry, which has given him over $900,000 in campaign contributions, asks him to. I will listen to the people, not drug companies, when it comes to lowering prescription drug costs. I will advocate for a Medicare-for-All system that lets people who are sick go to the doctor and get the medicine they need without having to worry about the cost, and I will make sure the government holds Pharma companies accountable to lower drug prices overall in the long term."

Betsy Sweet is the progressive taking on Maine's Susan Collins. "First," she said, "I stand with Sen. Bernie Sanders and Rep. Ro Khanna and will fight for Medicare For All and the Prescription Drug Price Relief Act because these are our best hope at delivering quality health care to all Americans. Second, we have to look more closely at intellectual property law, right now, the government has provided over 1 trillion dollars to the research and development of life-saving medicines, yet allow private industries to control the intellectual property and reap record profits. We need to reevaluate this system to ensure that everyone benefits from the research we fund collectively. Third, we need to get big money out of politics to stop big pharma from legally bribing politicians to rig the rules in their favor."

Blue No Matter Who? Very Bad Idea-- And One That Allows The Status Quo-Loving Establishment To Push The Democratic Party Further Right

Voters to candidates: tell us what you are going to do for us and our families and how you're going to do it. We do not care about your offing bullshit made-up fund-raising deadlines. Seems simple, right? But most DCCC candidates can't get it through their heads. They really have nothing positive to offer, so they bombard us with asinine e-mails about their deadlines.

Let's look at two e-mails that came to my box yesterday. The first was from worthless Blue Dog Kendra Horn of Oklahoma City, sho got into Congress and voted against progressive initiatives more than almost any other Democrat in the House. She has an "F" from ProgressivePunch and the 3rd worst voting record among House Dems:

Her e-mail reflection the "vision" of her her fellow DCCC-Blue Dogs and has nothing to do with anyone but herself: "Urgent news: Our first fundraising deadline of 2020 is this Friday."

"On top of that,"this self-absorbed turd continued, "a national dark money group launched another round of attack ads against me." Go whine to EMILY's List.

"Fighting these attacks," she wrote, "and setting the record straight is one of our top priorities-- so we really can’t miss any of our fundraising goals right now!" I bet it is. Her priorities have never once been about the people who sent her to Congress from OK-05. Kendra Horn's is one of the most wasted seats in Congress. And no-one deserves more than she does to be defeated in November. The ceaseless refrain from her and her type: "Please, will you click here to pitch in $10 to help us close our $10,000 budget gap before midnight on Friday? Our campaign is a top target for outside dark money groups, and they’ll stop at nothing to flip this seat." Ready for the big pukeworthy closing?

But with supporters like you beside me, I know we’re ready for the challenge. I know this team has what it takes to muster every ounce of grassroots support and reach every single voter in our district between now and Election Day.

Will you help make sure that happens by chipping in $10 before our deadline on Friday?

EMILY's List and the DCCC forced pitiful moron-incumbents like Horn to hire "consultants"-- highly paid ones-- to write these useless e-mails. Read it again. Is there one repulsive Blue Dog or New Dem it can't be sent out for without changing a single word?

Now this e-mail came at the same time and I guarantee you, the voice you hear is not some asshole consultant; it's a candidate who wants you to know him and wants you to know why you should contribute to his campaign. This is from Mark Gamba, the progressive mayor of Milwaukie, Oregon who's taking on one of the worst Blue Dogs ever, Kurt Schrader.

This weekend I had the honor of being endorsed by Our Revolution in Salem.

You know, I decided to run for Congress in no small part because I wanted to help Bernie Sanders take on the corporate establishment and pass laws that truly benefit the American people and our planet.

The Green New Deal is a big part of the initiatives I will champion, and so is Universal Healthcare.

Just this morning, I was listening to a broadcast on OPB that talked about the tough choices Americans are making when their insurance fails to cover the cost of life-saving prescription drugs. Folks who need epi-pens are opting to wear long sleeve shirts hoping that they will protect them from bee stings because they cannot afford the $300 generic epi-pen, much less the name brand product that costs over $600.

The problem is heartbreaking. Doctors are prescribing drugs that their patients cannot afford even with health insurance that has prescription coverage.

Medical debt is the leading cause of bankruptcy in this country and we pay over twice as much for healthcare as the average industrialized nation. Yet our health outcomes are worse than most countries in the industrialized world.

This is wrong on so many levels, but it is easy to trace the problem to its source. Mega-corps are more interested in profit than they are in people or planet. In the case of healthcare, Big Pharma and the Insurance industry are looking after their bottom line at the expense of our very lives.

I promise that I will work tirelessly to pass legislation that curbs the rapacious corporate greed costing so many Americans their futures.

My opponent may say that he is working to get cheaper life-saving drugs to market, but his voting record and financial investments tell a different story. He both invests in Big Pharma and takes campaign contributions from them. Even his oft-touted BLOCKING Act, which he claims gives generic drugs easier access to come to market does the exact opposite.

We need people in Congress who will not be bought by the highest bidder. People who will stand for what is right in the face of seemingly limitless power and not bow down. Can I count on you to join me on this quest?

With your help we will stand shoulder to shoulder and take back our democracy. As Alexandria Ocasio-Cortez said, “They have the money, but we have the people.”

All people deserve to have access to health care. It should be a human right.

I will continue to fight for it with your support.

I stuck in that Primary A Blue Dog thermometer in case you feel inspired to contribute to Mark or any of the other progressives challenging a Blue Dog or New Dem this cycle. And this Bernie tweet from this morning is a reminder that it isn't just Republican assholes who are the sworn enemies of the working class, but many from the status quo Democratic Party establishment as well, and certainly the Blue Dogs and New Dems!