Medicare Drug Bill: Now It's $599 Billion

April 26, 2004
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You may recall the sad saga of Medicare actuary Richard Foster, whose estimates for the cost of the prescription drug benefit were withheld from Congress during last year’s debate. It turns out that at least one estimate generated by his office for the 10-year tab totalled $599 billion — nearly 50 percent higher than the figure provided by the Bush administration.

The higher figure was revealed today by Rep. Henry Waxman (D-CA) and 18 other representatives in a letter sent to Health and Human Services Secretary Tommy Thompson. They blasted Thompson for continuing to withhold documents in their ongoing probe of alleged administration lies during the debate. “Information was actively suppressed by the administration,” they wrote. “This is a very serious breach of the integrity of the legislative process.”

According to the Democrats, the $599 billion figure was contained in an Office of the Actuary estimated dated June 11, 2003. Two weeks later, White House spokesman Ari Fleischer, in outlining the bill’s prospects, told reporters that the fact “the president’s proposal . . . has been accepted as a $400 (billion) proposal is helpful.”

This is about more than partisan bickering. Though the drug bill’s actual costs keep going up, it provides woefully inadequate financial support for seniors. Why? Because in writing the bill, Republicans in Congress prohibited Medicare from doing anything about skyrocketing drug prices. The bill forbids the government from using its purchasing power to negotiate lower prices, forbids the use of formularies (which could steer consumers to generics), and does next to nothing to give seniors and physicians better information about the most cost effective medicines.

In other words, the administration first lied to Congress, and then wrote a bill that turned a subsidy for seniors into a subsidy for Big Pharma. If prices over the next ten years rise at the same pace as they have over the last five years, most seniors will wind up paying more for prescription drugs in ten years than they pay today.

Follow the Evidence

April 21, 2004
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Today’s Journal of the American Medical Association offers dramatic confirmation of the value of conducting comparative clinical trials. Two years ago, the federal government released the results of an $80 million, eight-year trial comparing blood pressure control medications. Lo and behold, generic diuretics proved to be just as effective as more expensive (because still on patent) ACE inhibitors and calcium channel blockers, the drugs doctors most often prescribe.

Michael Fischer and Jerry Avorn of Harvard Medical School decided to match those findings against what physicians are doing in the real world, where pharmaceutical industry marketing and not “evidence-based medicine” drives physician prescribing decisions. They reviewed records for over 133,000 patients treated for hypertension in 2001 under one state’s drug assistance program. Had physicians in the program used evidence-based guidelines, nearly 40 percent of the patients could have been switched to a cheaper medicine. It would have saved the program over $11 million or nearly a quarter of the government’s expenditures.

The authors then extrapolated their findings nationwide. Their conclusion: “Adherence to evidence-based prescribing guidelines for hypertension could result in substantial savings in prescription costs for elderly patients with hypertension that would amount to savings of about $1.2 billion nationally.”

NYC Appearances

April 21, 2004
By

I’ll be making a round of appearances in New York City on Thursday and Friday. WNYC’s Leonard Lopate will host a discussion of The $800 Million Pill at noon Thursday, and I’ll be signing copies of the book at Labyrinth Book Store on 112th Street near Columbia on Thursday evening. Then on Friday, I’ll be signing books at Columbia’s Low Library from 7 p.m. to 10 p.m. along with other graduates of the J-School who’ve published books in the past year. If you’re in town, stop by!

In the Marketplace

April 17, 2004
By

The $800 Million Pill got a major publicity boost yesterday from my appearance on Marketplace. To hear the interview with Kai Rysdal, click here (you’ll need Real Audio to listen).

Follow the Evidence

April 17, 2004
By

Today’s Journal of the American Medical Association offers dramatic confirmation of the value of conducting comparative clinical trials. Two years ago, the federal government released the results of an $80 million, eight-year trial comparing blood pressure control medications. Lo and behold, generic diuretics proved to be just as effective as more expensive (because still on patent) ACE inhibitors and calcium channel blockers, the drugs doctors most often prescribe.

Michael Fischer and Jerry Avorn of Harvard Medical School decided to match those findings against what physicians are doing in the real world, where pharmaceutical industry marketing and not “evidence-based medicine” drives physician prescribing decisions. They reviewed records for over 133,000 patients treated for hypertension in 2001 under one state’s drug assistance program. Had physicians in the program used evidence-based guidelines, nearly 40 percent of the patients could have been switched to a cheaper medicine. It would have saved the program over $11 million or nearly a quarter of the government’s expenditures.

The authors then extrapolated their findings nationwide. Their conclusion: “Adherence to evidence-based prescribing guidelines for hypertension could result in substantial savings in prescription costs for elderly patients with hypertension that would amount to savings of about $1.2 billion nationally.”

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