May 11, 2018

His Orangeness stood out in the bright sunshine of the Rose Garden yesterday, glowing like the radioactive carrot he is, and made a bunch of impossible promises about drug prices in this country.

He will eliminate the middle man! He will stop the freeloading of other countries! Our drug prices are so high because they're so low everywhere else! It's not fair! Your drug prices are going to be so low it's unbelievable! Here is a former drug company exec he has appointed to help run the Department of Health and Human Services to explain how!!! He promises the former drug exec has no vested interest whatsoever in keeping drug prices high!

Fortunately, Ali Velshi appeared with Chris Jansing on MSNBC to help us understand what was fiction fact and what was fiction.

CHRIS JANSING: Joining me now, anchor of 11:00 a.m. And 3:00 p.m. hours here on MSNBC, Ali Velshi. Let me run down some of the things the president said was going to happen. Hundreds of millions of dollars are going to be saved this year alone, the system will be quicker and cheaper, and they are going to eliminate the middle man. Give us a little reality check here, based on what we know about this.

VELSHI: If you eliminate the middle man, I'll grow a full head of hair. That's the single biggest problem with our system. We have these pharmacy benefit --PBM, pharmacy benefit managers. And they don't exist in other places and they are what lead to no transparency in drug pricing. What Alex Azar said, he was the president of Eli Lilly, the U.S. Division.

JANSING: He understands how this works.

VELSHI: He was Deputy Health and Human Services Secretary. You don't know what a drug price is, you see the ads, but don't know what they cost. There are massively high list prices and PBMs negotiate prices along the way and depending who you're insured by, what PBM you use, you in theory get a discounted price. They want to preserve the ability to get the full price from somebody who isn't covered. Everybody in America, it is like an airplane seat, you pay a different price for the drugs you're on. Number one, trying to manage that is very difficult. They're the biggest lobbyists around. They have paid more money in lobbying certainly in 2017 than any other industry.

So, the middleman (PBMs) will likely not get eliminated. They give lots of money to Congresspeople to make sure they stay around. And, as I learned from THIS article I read because I was having trouble understanding all this stuff so I kept looking for other stuff to read about it... the higher the "discount," the more money the PBMs make, so the incentive is to jack up the list price of the drug to astronomical levels, so the "discounts" will be huge, and the PBMs make out like bandits. Sigh.

VELSHI: The second issue is Donald Trump took issue with other countries that use single payer health care systems to negotiate drug prices. Canada is a perfect example. For all intents and purposes, the government is the buyer of the drug, even though you pay for it. The issue here is that's exactly what the American government needs to be doing. Medicare Part D prevents the negotiation of the price of drugs, so everybody else in the world can negotiate for the price of American drugs except Medicare Part D.

JANSING: He thought that was terrible.

VELSHI: He totally thought that was terrible. He completely agreed. There is nonsense about blaming the rest of the world, every time somebody gets a cheaper drug, Americans get a more expensive drug, that's not true. It's that we're legally prevented from negotiating for the drug. The blueprint is good. The president's speech was nonsense.

So...people on Medicare Part D aren't paying huge prices because other countries have lower prices...they're paying high prices because our own Congress will not allow the government to negotiate the price of the drug with the pharma companies.

JANSING: Let me ask you point blank and, again, we'll see how all of this plays out. Here is what I think most Americans want to know. Are my drug prices going to be cheaper? Are my parents, my grandparents, am I going to be able to stop getting on a bus and going to Canada and getting drugs?

VELSHI: 25% of people who buy prescription drugs saw their drug prices increase by more than $50 in 2017. That's the trend. Most people don't see drug price increases if you got insurance, but if you're buying drugs for yourself and paying for them, or got co-pays, you are seeing that go up and there is no trend otherwise. So unless they do some of the things in this blueprint, and somehow get a handle on PBMs, you're not going to fix the problem.

JANSING: By the way, none of this involves legislation. That's the other thing.

VELSHI: The president did mention he's going to do something with Congress. He also mentioned that in four weeks we're going to have a new health bill. Maybe something will happen. Until Congress gets involved, you cannot use executive orders to get around this. We have a structural problem in America that results in high prescription medication costs. They involve the PBMs, the middle men. If we can tackle that, and it can be done, if they have the will to do it in Washington, it can be done. They are big, big lobbyists. They pay a lot of money. They have access to your legislators...

Yes, they do. They have access to your legislators. Another indicator of how unlikely this plan to eliminate the middleman is to succeed is the stock market. That article referenced above confirmed that while health care stocks initially dropped during the "president"'s speech, they ultimately rose after the speech was finished. That's usually an indication that those companies' profits are gonna be juuuussssst fine. Don't count on Grandma's cancer drugs to get much cheaper anytime soon.

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