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US Drug Prices Still Far Higher Than Other Nations' Even After Medicare Talks
The U.S. "has always accepted that we are the country that overpays relative to the rest of the world," said one health policy expert.
Sep 03, 2024
The Biden administration's Medicare drug price negotiations yielded lowered costs for 10 commonly used drugs, and the White House said last month that Americans would save an estimated $1.5 billion in out-of-pocket expenses thanks to the talks—but an analysis out Tuesday found that the U.S. will still be paying far more than other wealthy countries.
Reuters reviewed the maximum prices that Australia, Japan, Canada, and Sweden have agreed to pay for nine of the 10 drugs for which Medicare negotiated prices this year, and found that the U.S. will still be paying more than double the amount for the medications on average.
The new prices are set to go into effect on January 1, 2026, but two of the highest prices the U.S. will still pay are for Imbruvica, for blood cancers, and Stelara, for conditions including Crohn's disease and psoriasis.
Medicare will be charged $9,319 for a 30-day supply of the latter drug, compared to $4,607 in Sweden. For Stelara, the U.S. will pay $4,695 under the negotiated prices—more than four times the amount it costs in Sweden, Australia, and Canada.
For Enbrel, which treats conditions including arthritis, Medicare will pay $2,355 per month—far less than the list price of $7,106, but still more than $1,000 over what Sweden is charged: $709. Australia pays $573, while Canada pays $704, and Japan pays just over $300 for the drug.
"The government negotiations are especially significant for drugs where market forces were most limited and therefore had the least impact on producing price concessions."
Stacie Dusetzina, a professor of health policy at Vanderbilt University, told Reuters that the U.S. has "always accepted that we are the country that overpays relative to the rest of the world."
The analysis comes two weeks after the Brookings Institution published a review of the impact of the United States' first federal negotiations of prescription drug prices, finding that just three of the drugs which had little competition in the market accounted for more than half of the $6 billion the U.S. is expected to save in 2026.
"The government negotiations are especially significant for drugs where market forces were most limited and therefore had the least impact on producing price concessions," said Brookings.
Reuters noted that in other countries, prices generally come down over time, but U.S. drugmakers are able to raise prices annually and often extend patents by making small changes to medications, stopping less expensive generic versions from hitting the market and saving patients money.
Unlike in other wealthy countries, Johns Hopkins Bloomberg School of Public Health scientist Mariana Socal told Reuters, "the longer a drug is in the U.S. market, the more we pay."
With previous list prices well into the hundreds and thousands for the 10 drugs included in negotiations so far, Medicare agreed to pay close to $200 for a 30-day supply for drugs including Xarelto, Jardiance, and Farxiga—medications for which other governments examined by Reuters pay $78 or less, thanks to their longstanding negotiations.
The RAND Corporation found in a study in February that before the Medicare negotiations were included in the Inflation Reduction Act, U.S. health plans paid more than three times as much as other countries for brand-name drugs, even after discounts.
"A contributor to higher U.S. per capita drug spending is faster uptake of new and more expensive prescription drugs in the United States relative to other countries," wrote researchers at the London School of Economics in a study in 2013. "In contrast, the other OECD countries employed mechanisms such as health technology assessment and restrictions on patients' eligibility for new prescription drugs, and they required strict evidence of the value of new drugs."
The researchers suggested pharmaceutical companies in the U.S., like in other countries, should be required "to provide more evidence about the value of new drugs in relation to the cost" and negotiate prices accordingly.
As Merith Basey, executive director of Patients for Affordable Drugs, said in August after the results of the first round of negotiations were announced, advocates are still pushing for far more savings in upcoming talks between Medicare and drug manufacturers, which are expected to start next year.
"We remain committed to expanding the Medicare negotiation program to more drugs," said Basey last month, "and fighting for additional reforms to lower drug prices for all patients who need relief."
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UnitedHealth Reports $7.9 Billion in Q2 Profits After Protesters Arrested
"Health insurance coverage has expanded in America, but we are finding it is private health insurance corporations themselves that are often the largest barrier for people," said one organizer.
Jul 16, 2024
A day after 150 people assembled outside the headquarters of UnitedHealth Group to demand the for-profit health insurance giant stop its "systemic" denial of coverage, the company announced Tuesday the huge profits it raked in over the second quarter of 2024: $7.9 billion.
The sum, said one organizer, exemplifies why the demonstrators were willing to risk arrest to speak out against the firm's practices.
"UnitedHealth Group's $7.9 billion quarterly profit announcement is the result of a business model built on pocketing premiums and billions of dollars in public funds, then profiting by refusing to authorize or pay for care," said Aija Nemer-Aanerud, Health Care for All campaign director for People's Action Institute. "People should not have to turn to public petitions or direct actions to get UnitedHealthcare to pay for the care they need to live. That makes no sense, unless you're a shareholder or executive eyeing your next big luxury purchase."
Eleven people were detained by police at Monday's demonstration, where they blocked the street in front of UnitedHealth's headquarters in Minnetonka, Minnesota, displaying signs that read, "United (Denies) Healthcare" and "The Price Is Wrong."
The demonstration was organized by the Care Over Cost campaign at People's Action Institute, which has worked to help people across the country overturn care denials by UnitedHealth and other for-profit insurance giants.
Gina Morin of Auburn, Maine spoke at the event about having her mental health treatment denied by her Medicare Advantage plan administered by UnitedHealth.
"Two years ago my therapist was denied payment for seven of my mental health sessions she provided," she said. "I tried to pay her even though I'm on a limited income and she wouldn't take the money. If my provider, in her professional opinion, believed I needed those therapy sessions, who is UnitedHealth to deny coverage?"
As Common Dreams reported last month, UnitedHealth was named in a letter written by 52 members of the Democratic caucus in Congress as one of the healthcare companies that use artificial intelligence to decide via algorithm that coverage should be provided or denied to patients who have Medicare Advantage plans, which are billed as offering coverage that traditional Medicare doesn't include.
ProPublicareported last year on Christopher Naughton, a man with ulcerative colitis whose treatment cost $2 million per year, leading UnitedHealth to flag his account as "high dollar." The company contracted with a doctor to review Naughton's case, and the doctor found the treatment for symptoms including arthritis, debilitating diarrhea, and blood clots was "not medically necessary."
After suing the company, Naughton's family found UnitedHealth had lied about what Naughton's personal physician told the contractor in order to come to their conclusion and end coverage.
"Health insurance coverage has expanded in America, but we are finding it is private health insurance corporations themselves that are often the largest barrier for people to receive the care they and their doctor agree they need," Nemer-Aanerud toldCBS News Monday.
In April, People's Action sent a letter to UnitedHealth noting that its CEO was paid nearly $10 million in 2022 while the CEO of its parent company "extracted over $90 million in executive and board pay for himself" over four years.
The company took $22.4 billion in profits in 2023 and sent $14.8 billion to shareholders through stock buybacks and dividends—yet continues to deny necessary healthcare coverage to its members.
The group called on UnitedHealth to:
- Stop denying claims and overturn any existing denials for treatments recommended by medical professionals;
- Immediately cease the practice of using artificial intelligence and algorithms to initiate claims denials in bulk; and
- Execute a publicly shared audit and reimburse federal and state governments for the public money diverted by claim and prior-authorization denials within Medicaid (Managed Care), and Medicare (Medicare Advantage), among other demands.
"We will never stop fighting for a world where everyone gets the care they need, no matter their race, gender, or background," said People's Action. "When greedy corporations deny our care, we organize."
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We the People Can Stop the Surging Corporate Crime Wave
"Citizens mobilized against corporate abuses in the 1960s and 70s. It can happen again now."
Jun 25, 2023
Most heads of giant corporations are drunk with their own power. These corporate CEOs push the envelope in ways that harm defenseless people. They believe they can get away with anything, and they do, with few exceptions. The few corporate crime prosecutions keep declining from Obama to Trump to Biden, due to a settlement-obsessed Department of Justice staffed by lawyers readying to join the lucrative major corporate crime defense firms.
Corporate law firms, which deserve far more scrutiny by the media, have over the decades built a wall of immunity and impunity around these giant firms and their self-enriching CEOs. These CEOs now make an average of $14,000 an hour, while employing workers who are lucky to make $20 an hour. Greedy CEOs have surpassed the lords of medieval feudalism in the disparity they impose on workers.
Corporate law firms find Congressional lawmakers receptive to their campaign contributions and services in drafting legislative loopholes. These law firms place business executives and their own law partners in high executive branch positions (See, Servants of the Damned: Giant Law Firms, Donald Trump, and the Corruption of Justice by David Enrich, 2022).
Corporate law firms specialize in creating an edifice of secretive, anonymous corporate registries that attract a majority of big U.S. corporations to charter in Delaware. Companies register hundreds of shell companies (LLCs) for evasive purposes. Delaware law firms write the corporate law of Delaware for the rubber stamp state legislature. Ironically, these corporate capitalists disempower their own shareholders. Wall Street firms, credit card companies and tax escapees love Delaware. (See, What’s the Matter with Delaware?: How the First State Has Favored the Rich, Powerful, and Criminal – and How It Costs Us All by Hal Weitzman, 2022).
New outrages that swell the corporate crime wave are disclosed daily. Most exposés go nowhere, due to a lazy Congress (about ready again to take off most of the summer until after Labor Day) and to patsy regulators and meager, inadequate enforcement budgets funded by the corporate Congress.
One regular, no longer so patsy, is the tiny Federal Trade Commission (FTC) with an annual budget of $430 million. FTC Chair Lina Khan has just sued giant Amazon (annual sales of $524.89 billion) in the words of New York Times reporter, David McCabe “for illegally inducing consumers to sign up for its Prime services and then hindering them from canceling the subscription…”
The FTC charged that “Amazon tricked and trapped people into recurring subscriptions without their consent’ ‘… duped millions of consumers … [and with] manipulative, coercive or deceptive’ design tactics on its website.” Amazon’s lawyers, of course, deny everything.
On other matters, corporate lawyers are going berserk flexing their obstructive muscles. They sued the state of California for passing a law mildly protecting children from social media-produced harm. Susan Linn in her new book, “Who’s Raising the Kids? Big Tech, Big Business, and the Lives of Children” documents the abuses perpetrated by high predators.
Not to be outdone by their peers, corporate lawyers for the drug industry just filed a frivolous lawsuit against the U.S. Government that was finally authorized by Congress to allow ripped-off Medicare officials to negotiate drug prices with the overcharging Big Pharma. (The VA and the Pentagon already have the power to negotiate with the drug companies.) Presumably, having U.S. taxpayers continue to pay by far the highest drug prices in the world through Medicare—charged by subsidy-coddled U.S. drug companies—suits the “pay or die” Big Pharma CEOs.
Moreover, U.S. drug companies are happy to offshore to China the production of antibiotics. Our country produces virtually no antibiotics – a national security peril I wrote about to President Biden and Secretary of Defense Lloyd Austin, that received no response to date. (See: Letter to President Joe Biden – June 2, 2023).
ProPublica has exposed the giant Cigna health insurance company for rejecting millions of patients’ claims through its hired doctors who instantly deny coverage “on medical grounds” without opening the patient file.” (See, https://www.propublica.org/article/cigna-pxdx-medical-health-insurance-rejection-claims). This report, based on corporate documents and interviews with former Cigna physicians, has not led to any prosecutions either by state or federal officials. This is an egregious example of CEOs pushing the envelope and getting away with it.
A New York Times investigation by Sarah Kliff et al. revealed that a wealthy nonprofit hospital network – Allina Health – in the Midwest has been denying regular health care for patients who have unpaid medical bills. They have cut off patients, “including children and those with chronic illnesses like diabetics and depression.” Canadians, with their universal Medicare system, are stunned when they learn that many hospitals in the U.S. aggressively sue indebted patients, garnish their wages and seize their tax refunds. This is worse than debtors’ prisons where those incarcerated might receive health care.
Anyone who thinks corporate crimes are committed by just a few bad apples in the barrel can read my book Getting Steamed to Overcome Corporatism: Build It Together to Win (2011). Getting Steamed is an enraging compilation of documented corporate crime and criminogenic behavior – resulting in the loss of life, injuries and money from consumers and workers. One of the best public corporate crime databases is Violation Tracker, a project of Good Jobs First. Violation Tracker has over half a million entries that include civil and criminal actions against corporate wrongdoing. (See, https://violationtracker.goodjobsfirst.org/). In addition, visit the Corporate Crime Reporter website https://www.corporatecrimereporter.com/ to see highlights of crime in the suites each week.
Earlier this month, the Justice Department, which after decades of declining to have a comprehensive public corporate crime database, finally launched a modest database. (See: https://www.justice.gov/corporate-crime/corporate-crime-case-database).
Why don’t the American people rise up and tell their legislators and law enforcers that they will no longer accept the terrible corporate harm inflicted on them daily? This harm includes dangerous products (Opioids), detrimental services (medical negligence leading to 5000 deaths per week, according to a John Hopkins School of Medicine peer-reviewed report), toxic pollution, workplace casualties, endless cheating of consumers ($350 billion in health industry billing fraud a year) and other intolerable abuses. (See Malcolm Sparrow’s website: https://scholar.harvard.edu/msparrow).
Most corporate crooks are above the law. They think that collectively “We the People” are a nation of sheep – unable and unwilling to take their demands, often supported by large majorities, to Congress and get some strong law and order legislation enacted. Polls show huge majorities (left/right) want jail time and restitution from wealthy corporate outlaws.
Public Citizen, which lobbies against corporate crime, wants to hear from you (visit, https://www.citizen.org/). PC’s president Robert Weissman, together with former PC president Joan Claybrook, have a new book coming out next month. It’s called “The Corporate Sabotage of America’s Future: And What We Can Do About It.” Read it and generate a rumble all the way to your congressional senators and representatives who are about to head home as Congress goes into recess for most of the summer.
Citizens mobilized against corporate abuses in the 1960s and 70s. It can happen again now when the corporate overlords in the context of demonstrated crises – climate, pandemics and powerful unregulated technologies – are acting far worse than they have in recent times.
The awakened power of dedicated, informed people cannot be overcome.
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