Are you For price Controls in the Drug Industry

[BaliBabyDoc]

Price controls may or may not affect this problem

''I was trained to do things and did things that were blatantly illegal,'' Franklin, 41, said during an interview at the Boston office of his attorney, Thomas Greene. ''I knew my job was to falsely gain physicians' trust and trade on my graduate degree. If he was a cardiologist, I was an expert in cardiology. If he was a neurologist I was an expert in neurology.''

In Massachusetts alone, Medicaid spending on Neurontin grew from $1.1 million in 1996 to $14.1 million in 2000, the height of the Parke-Davis marketing campaign.

Some that growth reflects increasing use for approved ailments (epilepsy) but much of it came from diabetic neuropathy, migraines, chronic pain syndromes, and bipolar.

''I'd tell them we had physicians across the county, some involved in clinical trials, and others who had hundreds of patients on Neurontin, all getting an extraordinary response rate,'' Franklin said. ''We'd make them think everyone was using it but them.''

During training sessions, he said, managers explained how to ''enable'' a physician to prescribe Neurontin for off-label uses by suggesting specific doses, and how to ''close'' the doctor by asking him to put his next patient with bipolar illness or some other condition on Neurontin.Franklin said Parke-Davis executives believed representatives at other pharmaceutical companies engaged in similar practices. ''We weren't on par with them in terms of the size of our sales force,'' he said. ''But there was a belief that much of what we were doing was typical. We were driving 60 miles per hour in a 55 mile per hour zone. Everyone did it.''

Sounds like Boiler Room or Wall Street.

 

[rjain]

Direct R&D spending covers a small amount of the actual cost of R&D. Much of the cost, as I've repeatedly said, is from acquisitions of and licensing from biotechs. This especially applies to Merck, explaining their low R&D expenses.

heartsurgeon, thanks for correcting me about the timing of drug releases. I suppose it is more likely that a drug is released later in the US due to more stringent requirements from the FDA.

However, DTC marketing has nothing to do with the first amendment. It falls under the same general category as tobacco and alcohol advertisment. If marketing were covered under freedom of speech, then false advertisment wouldn't be a crime. Prescription drugs should have DTC marketing disallowed, as the drug requires a prescription from a trained doctor for a reason. The full side-effects and conditions under which the drug is effective may be complex or not known. Without careful monitoring of and education as to those issues, nasty results could ensue.

But yes, price controls are a form of communism, which is required when we are dealing with major infrastructure where the cost of entry is prohibitive and unproductive. Having two power lines coming into your house gives you no benefit, as you're only using the one for the power distributor you are getting service from. The other one was just a waste of money. However, that creates a monopoly situation, so the prices need to be controlled. Still, back in the days when power was totally government regulated, all the companies did was give out fat paychecks and overhire in order to reduce their profits and claim that the price controls didn't need to be stricter.

Note that statement clearly: price controls made the corporations even fatter and resulted in higher prices to the consumer. In an industry where there are plenty of players, we don't need to resort to such risky measures in order to reduce prices temporarily. In fact, if we apply too much pressure, the companies will start to merge and acquire, resulting in less competition and we'll have given up the opportunity to deregulate. Utilities can be constrained by physical boundaries or the types of service they are allowed to provide. We've seen that the latter isn't practical, but the former isn't even possible with pharmaceuticals.

 

[rjain]

Originally posted by: BaliBabyDoc

''But there was a belief that much of what we were doing was typical. We were driving 60 miles per hour in a 55 mile per hour zone. Everyone did it.''

More like driving in the shoulder. But few people try that trick any more. Hopefully these scams will suffer the same fate.

 

[zephyrprime]

Profit (net income) --Marketing/Admin-- R&D
Merck............................17...... ............ 15............ 6
Pfizer............................13...... ............ 39............ 15
BMS..............................26...... ............ 30............ 11
Pharmacia......................4...... ............ 37............ 15
Abbott..........................20...... ............ 21............ 10
Am Home Prod............-18...... ............ 38............ 13
Eli Lilly..........................28...... ............ 30............ 19
Schering-Plough...........25...... ............ 36............ 14
Allergan........................14...... ............ 42............ 13

Why don't these figures add up to 100%?

 

[sandorski]

Originally posted by: zephyrprime

Profit (net income) --Marketing/Admin-- R&D
Merck............................17...... ............ 15............ 6
Pfizer............................13...... ............ 39............ 15
BMS..............................26...... ............ 30............ 11
Pharmacia......................4...... ............ 37............ 15
Abbott..........................20...... ............ 21............ 10
Am Home Prod............-18...... ............ 38............ 13
Eli Lilly..........................28...... ............ 30............ 19
Schering-Plough...........25...... ............ 36............ 14
Allergan........................14...... ............ 42............ 13

Why don't these figures add up to 100%?

Only pertinent(being discussed) part of the data.

 

[BaliBabyDoc]

heartsurgeon, thanks for correcting me about the timing of drug releases. I suppose it is more likely that a drug is released later in the US due to more stringent requirements from the FDA.

Depends on the drug, for instance most countries in the EU practice some sort of utilization review (basically a drug must provide a substantial benefit beyond currently availabel threapy to be approved). The US allegedly disallows "me too" formulations but in practice has done nothing to discourage Big Pharma from producing a bevy of statins, ACE inhibitors, calcium channel blockers, angiotensin receptor blockers, SSRIs, etc.

My PI's biotech company has favored a launch in the EU (Parkinson disease) before the US b/c it causes nausea/vomiting and is delivered by suppository (for whatever reason Europeans are apparently more tolerant of N/V and/or having something up the butt).

In general, clinical trials are the single most expensive element of drug development.

 

[ElFenix]

oh, the other thing i forgot, anything over the airwaves isn't covered under 1st amendment either, because there is limited spectrum space

 

[zephyrprime]

Only pertinent(being discussed) part of the data.

I've looked at the links for the data. It only lists the data you that listed in the table and doesn't explain why the figures don't add up. And, the entire cost breakdown is pertinent in my opinion. It seems like the only category besides "Profit (net income) --Marketing/Admin-- R&D" is manufacturing and I know that drug manufacturer is really cheap.

 

[ElFenix]

Originally posted by: zephyrprime

Only pertinent(being discussed) part of the data.

I've looked at the links for the data. It only lists the data you that listed in the table and doesn't explain why the figures don't add up. And, the entire cost breakdown is pertinent in my opinion. It seems like the only category besides "Profit (net income) --Marketing/Admin-- R&D" is manufacturing and I know that drug manufacturer is really cheap.

clean rooms are cheap huh?

 

[heartsurgeon]

for those of you who occasionally like to read a book..
try "The Billion Dollar Molecule"
linky

it is a great read, and it will give you an idea of how much R&D money it takes to develop a new drug...
the palaver that graces these forums is staggering.

 

[markuskidd]

Originally posted by: heartsurgeon

price controls

apparently you don't actually practice medicine, or know anything about how it actuals works. there is no such thing as a "medication consultation"

Tell that to my physician...


/me goes to bed, sets alarm earlier than usual in order to make it to his medication consultation

 

[DaiShan]

Originally posted by: smashp
Who here feels there should be some form of price controls in the drug industry in the US.

Comments and opinions welcome.

We would be socializing our economy while maintaining a democracy, while China capitalizes its economy while maintaining communism. A strange world that would be indeed! And being that about 50% of my money is in pharmaceuticals right now, hell no I wouldn't support price controls.

 

[heartsurgeon]

there is no such "thing" as a medication consultion.
your doctor may evaluate you for a medical condition which is treated by medications (as many are),
but i repeat there is no such "thing" as a "medication consultation"

for all you wannabe doctors..

CPT (current procedural terminology) codes are used to bill for all services provided by physicians to patients.
these codes are described by the Federal Goverment. I have the 1" thick CPT Code book in my lap right now..i use it daily to
generate bills for the work i do. Medicare pays doctors ACCORDING TO CPT CODE. each CPT code has a rigorous definition about what
services must be provided to a patient in order to send a bill to medicare for that amount (private insurance companies use the same codes/definitions).

THERE IS NO CODE FOR "medication consultation"
there is no code listed that could be remotely described as "medication consultation"

If anyone out there can provide me with the ACTUAL CPT CODE and definition of the "medication consultation" which pays $45 for 10 minutes of work,
i would be delighted to admit my ignorance.....

 

[markuskidd]

I think it's scheduled for 15 minutes, and is about $45 (may be 45 exactly, got this set up for automatic billing). Now am I going to go ask this guy for his CPT code? Probably not.

Of course I could have just delurked to make this up.... <sigh>

 

[markuskidd]

Google to the rescue. <sigh>
And I was lulled into thinking it was actually called 'medication consultation,' which it is not.
However
What we have here can be found under CPT 90862 or 90805. "Medication management," but it is exactly what the OP was describing... instead of one or two lenghty sessions, we get 8 or 9 of these 15 minute ones. I personally think it's ridiculous, but it's how this guy works. He's probably the best option I have in town and luckily my insurance company picks it up.

 

[zephyrprime]

clean rooms are cheap huh?

Have your heard in the news how cheaply they're making AIDS drugs available to some African countries? That's an indicator or the low cost of manufacturing drugs when you consider only the actual manufacturing. And also, are drugs made in a clean room environment?

 

[sandorski]

Originally posted by: zephyrprime

clean rooms are cheap huh?

Have your heard in the news how cheaply they're making AIDS drugs available to some African countries? That's an indicator or the low cost of manufacturing drugs when you consider only the actual manufacturing. And also, are drugs made in a clean room environment?

Probably not, though it might depend on the drug, but the R&D probably requires special(clean or close to it) rooms.

 

[rjain]

They require specific purity controls (not just % but also types of impurities) in ALL stages of the manufacture. Even the starting materials (like chloromethane, acetic acid, etc) are subject to the same kinds of restrictions.

 

[heartsurgeon]

cpt code 90862
Other Psychiatric Services:
Pharmalogic management, including prescription, use, and review of medicatio with no more than minimal medical psychotherapy

cpt code 90805
Insight oriented, behavior modifying and/or supportive psychotherapy
with medical evaluation and management services 20-30 minutes

you got psych problems?

i'll look up the medicare reimbursement for these tomorrow

 

[markuskidd]

I did a search on medication consultation and that's what it pulled up <shrug> there are probably comparable codes for other areas


<sorry to bump a stale thread, been away from the internet for a few days>

 

[heartsurgeon]

there are probably comparable codes for other areas

nope.

 

[mastertech01]

Maybe one possible solution is to collect an R&D fee for each prescription filled. One dollar is collected from each person buying the prescription and one dollar paid by the physician who writes the prescription. One dollar wont kill the physician or the patient. Then the fees collected are paid to the company that actually produces the medication. Wouldn't this generate some competition for that money, and drive down some of those prices?

Just an idea.

EDIT: There COULD even be a third dollar per prescription funded by the government for companies who hold the line to a certain percentage over actual cost of production.

 

[BaliBabyDoc]

I did a search on medication consultation and that's what it pulled up <shrug> there are probably comparable codes for other areas

Well, I imagine someone will call it fraud but during a symposium this weekend (obviously it was Nov1-2 this year) . . . a presenter on Type2 diabetes in children was asked:

Audience: So what do you do to get insurance to pay for nutrition consultation or other treatment for obesity?
(This question is important for reasons beyond trying to get paid b/c there's ample and growing evidence that management of blood pressure, glucose level, and triglycerides/cholesterol (even if the level is technically NOT abnormal) reduces morbidity and mortality.

Faculty: Make a diagnosis other than diabetes.
(In essence these children don't have diabetes yet but they are well on their way. The BEST intervention is a combination of diet and exercise to prevent premorbid blood pressure, premorbid impaired glucose tolerance, and premorbid serum triglycerides/cholesterol from evolving into diabetes.)

The presenter went on to talk about making a diagnosis of 1) dyslipidemia, 2) acanthosis (I've never heard anyone talk about treating acanthosis nigricans), 3) hypertension. He noted his practice was to incorporate the nutrtition charge into other diagnostic/treatment charges.

Technically this is more of an ICD-10 issue than heartsurgeon's beloved CPT but a busy pediatrician having a followup visit for a child getting *wink wink* obesity could easily cover a problem-focused interval history, problem-focused examination, and low complexity decision-making. For the best interest of the child (and society), hopefully diet AND exercise are working. If not this visit will be followup on diet, exercise, and the off-label use of metformin (Glucophage) to reduce body mass index (the lifestyle surrogate producing the highest relative risk of developing DM2), reduce fasting glucose, and reduce fasting insulin. This intervention can produce these effects independent of dietary modification.

The take home message is that our dysfunctional system of healthcare funding/reimbursement distorts the system (biasing it towards brief encounters that often favor medication over other interventions) . . . although it is possible for good physicians to deliver appropriate care despite the BS from systems of reimbursement.

 

[markuskidd]

Originally posted by: heartsurgeon

there are probably comparable codes for other areas

nope.

Well, you also said that a 15 minute prescription consultation/medication management/etc appointment didn't exist at all in the first place... I'm still not particularly inclined to ask my physician what the code is that he's using but I'm pretty firmly convinced that this is, as the OP says, fairly common in the industry. Perhaps not among surgeons...?

And I recall you saying you would post the compensation amount for those codes I posted above....

 

[heartsurgeon]

Well, you also said that a 15 minute prescription consultation/medication management/etc appointment didn't exist at all in the first place

it doesn't exist..
the definitions of what these code means are very specific.
there is no such thing a a "medication consultation"

cpt code 90805
Insight oriented, behavior modifying and/or supportive psychotherapy
with medical evaluation and management services 20-30 minutes

this means the office visit ("consultation") has to last 20-30 minutes (that's not 15 minutes), and has to include psychotherapy and medical evaluation.
if your a physician, spending 15 minutes going over someone's medications and renewing prescriptions, and that's all you do, and you bill for services using this code, your committing fraud. there are stiff penalties for fraud, particularly if your doing it to the federal goverment (medicare).


cpt code 90862
Other Psychiatric Services:
Pharmalogic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy

this code is specific to the management of psychiatric conditions and the efficacy of medication used in managing it. when you bill for services using CPT codes, which is how billing is done, you also need to submit ICD codes which describe the medical condition for which you are seeing the patient. Only certain ICD codes will justify reimbursement for certain CPT codes. If your taking a blood pressure medication, and your doctor can't use this code to submit a bill, because it is specific to psych conditions.

what you need to do to try and understand all of this is to go get a CPT code book and look through it.
there are not "general names" for physician activities, there are very specific names and descriptions for all physician activities, with fairly specific descriptions and guidelines for what must occur for a certain level of service to have been provided, and a bill for that service submitted.

there is nothing i have ever seen that is called a "medication consultation"

typical office visits are referred to a evaluation and management services.
these services have specific guidelines which detail what must be done, how much time should be spent doingthese actiities, and the scope of these activities.

these guidelines cover multiple pages in my CPT manual. if anyone wants to read these..PM me your email address, and i'll send you a PDF file to read.