Science Policy For All

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Science Policy Around the Web – May 11, 2018

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By: Mohor Sengupta, PhD

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source: Max Pixel

Drug prices

Why Can’t Medicare Patients Use Drugmakers’ Discount Coupons?

With high drug prices, affordability of specialized medicines is a matter of concern for many individuals, especially those on life-saving brand-name drugs.

Manufacturers of brand-name medicines provide discount coupons to people with private health insurance. Such discounts are denied for people with federal healthcare plans such as Medicare or Medicaid. For example, for one patient on Repatha (a cholesterol reducing drug), the co-payment is $618 per month with the Medicare drug plan, but it is only $5 for patients with commercial insurance plans. This discrepancy has resulted in a “double standard” because arguably, the discount is denied to the people who need it most, that is the retired population subscribing (compulsorily) to federal healthcare programs.

Drug manufacturers have an incentive to offer discounts on branded medicines as they increase the likelihood of purchase and results in greater access to and demand for the products. While these discount coupons are immensely beneficial for life-threatening conditions for which generic drugs are not available, a 2013 analysis has shown that lower cost generic alternative and FDA approved therapeutic equivalent was available for 62% of 374 brand-name drugs.

The federal government has argued that with the discount coupons, patients might overlook or be discouraged from buying cheaper variants of the brand-name drug. Even if a patient chooses to use a brand-name drug with a discount coupon over cheaper alternative, their health insurance plan still has to pay for the drug. That amount maybe more than Medicare or Medicaid may be willing to pay. This has resulted in the federal anti-kickback statute which prohibits drug manufacturers to provide “payment of remuneration (discounts) for any product or service for which payment may be made by a federal health care program”.

One important question is why do drug makers sell the brand-name drugs at a much higher price bracket when generic, cheaper options are available? In the present scenario, insurance companies should make the judgement about whether they are willing to cover such brand-name drugs for which generic alternatives are available. Often doctors prescribe brand-name drugs without considering their long-term affordability by patients. It is the responsibility of doctors and insurance providers alike to determine the best possible drug option for a patient.

Taking in both sides of the picture, use of discounts must be exercised on a case basis. It must be enforced for specialized drugs against which generic alternatives are not available and which are usually used for severe or life-threatening conditions. Currently for people with such conditions and on federal healthcare plans, affordability is a major challenge.

(Michelle Andrews, NPR)

 

EPA standards

EPA’s ‘secret science’ rule could undermine agency’s ‘war on lead’

Last month the Environmental Protection Agency (EPA) administrator, Scott Pruitt issued a “science transparency rule” according to which studies that were not “publicly available in a manner sufficient for independent validation” could not be used while crafting a regulation. This rule is at loggerheads with Pruitt’s “war on lead” because a majority of studies on lead toxicity are observational, old and cannot be validated without consciously exposing study subjects to lead.

Lead is a potent neurotoxin with long term effects on central nervous system development. It is especially harmful to children. There are several studies showing lead toxicity, but many do not meet the inclusion standards set by the EPA’s the new science transparency rule. Computer models developed to assess lead toxicity, which played important role in EPA’s regulations on lead in the past, have amalgamated all these studies, including the ones that cannot be validated. If the science transparency rule is retroactive, it would mean trashing these models. An entire computer model can be rendered invalid if just one of its component studies doesn’t meet the transparency criteria.

Critics say that the transparency measure will be counter-effective as far as lead regulations are concerned. “They could end up saying, ‘We don’t have to eliminate exposure because we don’t have evidence that lead is bad’”, says former EPA staffer Ronnie Levin. Another hurdle is the proposed data sharing requirement. Lead based studies tend to be epidemiological and authors might be unwilling to share confidential participant data.

Bruce Lanphear of Simon Frazer University in Canada is skeptical of EPA’s intensions because the agency has not imposed similar transparency measures for chemical companies like pesticide producers.

Finally, this rule could set different standards for lead safely levels in different federal agencies. Currently Center for Disease Control and Prevention (CDC) and Department of Housing and Urban Development (HUD) consider 5 micrograms per milliliter of lead in blood as the reference level. The EPA rule could lead to a new reference level, leading to discrepancies when complying with agencies across the U.S. government.

(Ariel Wittenberg, E&E News)

 

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Written by sciencepolicyforall

May 11, 2018 at 10:24 pm

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