>

It's saving a lot of people too. In 2022 I was diagnosed with a similar condition that has a similar new and expensive drug, and I'm grateful for it. I'm also grateful to have private insurance that covers everything and has an out-of-pocket max.
E: apparently the world is black and white, everyone is either a hero or a villain, and I’m not allowed to be grateful to be alive
The U.S. Department of Health and Human Services' Office of Inspector General in 2020 concluded that the proposal could violate the kickback law by inducing patients to buy Pfizer's drug while leaving taxpayers to bear the costs.
Pfizer sued the department to challenge its determination. The Manhattan-based 2nd U.S. Court of Appeals last July ruled in favor of the government, rejecting Pfizer's argument that a subsidy program would violate the anti-kickback law only if it were administered with corrupt intent.

An interesting case for sure. Basically Pfizer offering to pay for the copay component of the treatment will saddle Medicare with the rest of the costs. Since more patients will presumably be then induced to take the drug, Pfizer is effectively increasing its addressable market into low income families but shifting the cost of the drug into the government. >

The whole 'charge what the market will bear' idea, central to Capitalism, can work - but, this is a case of the market not being able to bear the asking price, and Pfizer basically saying: 
'Nah... this is how much money we WILL get, and it's up to you poor fools to figure out how you're going to give it to us!' >

That concept only works as well when you’re dealing with something where consumer and seller have approximately equal power in the system. Medication frequently does not fit that situation. Cancer drug X which is your best chance for survival, just for example, is a situation where the seller inherently has you over a barrel. >

There's multiple levels of hidden power - Cancer drug X might work best for you in your situation, but your doctor (or their practice) may be incentivized to prescribe drug Y. Or, your insurance may not cover drug X, or it might be part of the formulary where you have to pay a much higher copay. Maybe the manufacturer of drug X has a consumer rebate program, maybe not - almost certainly the doctor doesn't know, and the insurance company surely doesn't. (I've been told that insurance companies do factor in consumer rebate programs in creating their formularies; I don't know if that's true, but at that point it becomes your responsibility to research medication rebates, as well as dealing with your cancer diagnosis.)
But if you're American, your insurance is probably through your work, which means your insurance coverage was selected by your employer's HR department, and you got little if any say in what plan you got.
A few years ago, the company I worked for changed their insurance provider to Kaiser Permanente. Kaiser is an HMO, which means you only get to go to their doctors. So, people who've been seeing the same family doctor, OB/GYN, pediatrician, etc, for years, suddenly had to drop everything and find a new set of doctors. And, they sprung it on us so late in the year that people's spouses' open enrollments had already ended, so married employees didn't have the option of switching to their spouses' coverage, and keeping their same doctors. They did this because Kaiser needed them to hit certain threshold of enrollment, and if people left, it would be less profitable for them. >

Sounds like an interesting case of productivity dropping by 50% while people find new doctors and having to work around the new insurance. It's a lot of work to find a doctor who gets you. >

That might literally kill me.  I have several chronic illnesses and I'm on 15 prescription meds written by 4 doctors.  I would have to scramble just to keep all my meds active and not get serious complications/discontinuation syndrome from some. >

Pfizer could simply lower the cost of the drug instead of this weird rebate system. >

They make the system as labyrinthine and inconvenient as possible in hopes that poor patients will just give up and pay anyway. One of my nerve medications used to be like that, until their patent expired and a generic came onto the market. >

You couldn't design a stupider system if you wanted to. Every other major world power has figured out healthcare to a somewhat workable system and we have this outrageous system where getting sick can financially cripple you. >

Something like over half of the personal bankruptcies in the US are due to medical debt.
I remember years ago when a doctor suggested I should get a blood test, I asked them how much would it cost.
They said they had no idea, but that "it shouldn't be much".
3 weeks after the blood test, I get a +$500 bill in the mail. Oh, and insurance refused to cover it.
Imagine if buying a car or a house meant that you couldn't see the pricing until after you agreed to pay for it... >

And then you get a second bill for what the insurance didn't agree to pay, do you get a forced surprise second mortgage. >

No, you get forced arbitration. I have to go often enough that I know the first names of most of the firms arbiters. >

I'd argue thats just an extra step, that takes more of your time and resources, and still often leaves you with some amount of extra bill left. >

I was ready to crap on the Supreme Court for this, but... this is crazy, and it's definitely valid that they shot it down.
So this drug costs $225,000 a year.
On medicare, the copay cost to the patient in the end would be $13,000.
Pfizer subsidizes poor people for it, and wants to broaden that to middle class, as they claim some people are choosing not to take this medication due to the cost.  At a glance that sounds nice, helping people get medicine.
But when you think about the money, Pfizer would spend in theory up to a max of 13k, to then get the government to pay them 225k.  That seems very suspicious, and seems why the "anti-kickback" statute would come in to play.  Easy enough for Pfizer to run around handing out $13,000 checks when they know every one will results in a $225,000 check to them in return.
On a side note, this explains some of those medication commercials where they say "might have trouble affording this medicine?  call us, you can get a discount or even get it for free!"
I always assumed that was a lie or exaggeration, but now I think maybe they are happy to give it to YOU for "free", since they are helping you pay a small amount so the government can give them a large one.
Without the anti-kickback statute, companies could just continually jack up the prices over and over (even more than they already do) and "kindly" offer to pay the patients costs.  "Our medications are ALL free! Just send us an invoice, we'll cover your costs!" >

Medicare can reject covering a drug under its program, it's not forced. That's part of this, they theoretically can't continuously jack up prices.
Playing devil's advocate, the other side of this is that if Medicare has an issue with the $200k+ sticker price, they shouldn't have accepted this drug or should negotiate lower.
The issue for Pfizer is that whether they charge $100k or $200k, the copay for the patient remains the same because they are going to hit the cap. In other words, cutting the price in half doesn't spur any more patients that need the drug to take it.
We can argue all day what profits the company "deserves" on drug development, but this is a niche disease with a limited customer base. It needs to charge high levels to fund development. If a disease impacts 10,000 people, you can't charge $5/month for meds under capitalism. You'd lose money.
There are very few other industries where cutting the current price by significant amounts doesn't spur more people into consuming it. >


The issue for Pfizer is that whether they charge $100k or $200k, the copay for the patient remains the same because they are going to hit the cap. In other words, cutting the price in half doesn't spur any more patients that need the drug to take it.

What cap? There is no cap. If they cut the price in half, the Medicare patient's price is cut in half. >

No, they have a copay maximum. Under Medicare Part D, they pay the first tier  fully out of pocket ($4,660, basically a deductible) and then 25% of the cost until the out of pocket maximum ($13,000 according the person I responded to, I see $7,440 as the 2023 out of pocket maximum doing research under standard drug plans but doesn't matter in this case).  After that is reached, the government picks up the tab 100%.
Whether the drug costs $100,000 or $200,000, the individual on this drug would end up paying the same: the out of pocket maximum. To the consumer, the price cut doesn't matter because they are still getting reamed for the same amount out of pocket. >

The person you responded to claimed there is a max out-of-pocket of $13k. That person was wrong. 
Apparently there’s a MOOP coming to medicare part D in 2024/2025, but currently there is none. >

Yes I was wrong, the patient cost is not linear >

Our medical system is so incredibly broken. I don't understand how we, as a country or just as human beings, can be okay with people not being able to afford or access care.
Our technological capabilities are advancing incredibly rapidly, but our empathy continues to decline. >

Sorry according to my spreadsheet calculations your concerns do not equate to maximum profits so we'll just kindly ignore that. >

The argument I hear most against universal healthcare is that it’s too expensive… even though it’s cheaper… and covers everyone
People in the US are so checked out, their entire argument against universal healthcare is wrong, and they don’t care. >

People think universal healthcare in the US will cost too much because Medicare is banned from negotiating drug prices since 2003. Our government insurance literally is banned from using it's massive bargaining power. They passed a law to change this last year, but it doesn't take effect until 2026 for some reason. >

And this is why :     

Office of Inspector General in 2020 concluded that the proposal could violate the kickback law by inducing patients to buy Pfizer's drug while leaving taxpayers to bear the costs.       

F-ing Pfizer...  How about you develop treatment and not charge $250,000/year?     
They make $2.02 billion/year profit off this drug. >

Katie Porter already proved pharma costs are outrageous and very little of the revenue goes into R&D compared to stock buybacks and marketing. Pharma greed is killing people and destroying lives for every penny of profit they can get >

It's saving a lot of people too. In 2022 I was diagnosed with a similar condition that has a similar new and expensive drug, and I'm grateful for it. I'm also grateful to have private insurance that covers everything and has an out-of-pocket max.
E: apparently the world is black and white, everyone is either a hero or a villain, and I’m not allowed to be grateful to be alive >

Classic "I got mine" perspective. Good for you, glad you got what you need. That's no reason to defend the exploitation of millions who aren't so fortunate. >

Holy shit, yeah I “got mine” all right. Wanna trade places?
What I’m saying is it’s complicated. It’s easy to think it’s simple from a comfy armchair. >

Never said it was simple and never said I envy you. But to have benefitted from a flawed, subpar system under which others suffer unnecessarily, then defend said system because you managed to benefit from it is the definition of "I got mine" >

If the system is exploitative and it's so easy to do the "right thing," why don't you and all your like minded friends invest your own money, create a pharmaceutical company, and prove it?  You're full of shit, that's why.   You all have big mouths and nothing behind them. >

In a nutshell, the Biden administration told Pfizer "You can't do that under the federal Anti-Kickback statute," lower courts agreed with the Biden Administration and the Supreme Court decided not to take the appeal.  
Unfortunately, the headline puts a somewhat different spin on that. >

Tafamidis was researched and developed by Scripps Research. Scripps is a non-profit that receives most of its funding from the National Institutes of Health and other federal agencies. It also gets grants the American Cancer Society, the American Heart Association, the Cystic Fibrosis Foundation, the Leukemia & Lymphoma Society, and the Juvenile Diabetes Association.
Tafamidis is not some complex microbial or DNA based drug. It is a relatively simple organic compound that can be mass produced for pennies per dose.
So Pfizer gets a free patent entirely paid for by US taxpayers and sells it for $220,000 per dose that is more or less pure profit extorting both the taxpayers and patients on a pay or you die basis. Then they realize there are people who can't come up with $13,000 even if their life depends on it. So they want to waive the copay as long as the taxpayers come up with the other $207,000.
If you want to know how this could even be legal look up Bayh-Dole, Breakthrough Drug and Orphan Drug Acts. Since Pfizer doesn't actually own the patent the FDA can 'march in", take the patent back and give it to a generic manufacturer (or Mark Cuban) that will sell it for $50 a dose and still make a profit but they never have and never will. >

Whoever wrote this headline should be pulled out in front of a crowd and caned. What fucking deceitful bullshit. >

They want to cover the out of pocket then charge the govt whatever they want.   Obama, Trump, and Biden are all correct about Medicare negotiating prices in bulk. >

Gotta say, just from the headline: "health insurance company has plan to help people pay for medication", I'm smelling all sorts of bullshit.

The Manhattan-based 2nd U.S. Court of Appeals last July ruled in favor of the government, rejecting Pfizer's argument that a subsidy program would violate the anti-kickback law only if it were administered with corrupt intent.

Isn't "corrupt intent" pretty much the entire definition of health insurance?
That's like saying "The mob would be legal, if it wasn't for all the criming."

Pfizer had told the Supreme Court that the government has impermissibly transformed an anti-corruption statute into a cost-saving tool, and that Congress did not intend "to criminalize a sick patient's acceptance of co-pay assistance to afford critical medical care."

If Pfizer actually gave a shit about these people, they could just lower the cost of the drug. >

Ah.  Rebate systems.  I bet you can only apply for the rebate through actual physical mail.  At which point someone will call you between 3:30 and 3:45PM two weeks later and if you miss the call you will have to re-apply for the rebate.  The repayment will get stuck in the system and you will have to call back 3 or 4 times to get it processed.  If someone is offering you a rebate they are trying to fuck you. >

pfizer wants to fleece insurance by charging really high prices and then using some of that high price to pay co-pays.
The point is that you should just have a lower priced medicine. >


The U.S. Supreme Court on Monday turned away Pfizer Inc's (PFE.N) bid to revive its plan to cover out-of-pocket expenses of Medicare patients for drugs costing $225,000 a year to treat a rare heart condition after federal officials found that the drugmaker's arrangement could amount to illegal kickbacks.

Key work "Could".  This leaves many US citizens on the hook for some very expensive meds. >

Shifting the entire cost of the drug to the government instead of reducing the drug cost is the issue here. >

It also comes with the issue that this would be a form of market capture. Now patients can ONLY afford Pfizer, so the government pays them more, competitor gets crushed preemptively, repeat ad infinitum >

There is no competitor. You either get this drug or you die. >

Bottom line?  150,000x$225,000=$33,750,000,000 in potential sales. 
No wonder they want the ruling overturned. >

Hear me out, how about we stop employing people whose only job it is to take this ruling and go sit in a conference room with 10 other people making the same money, and determine a way to skirt the ruling and resubmit a plea. You know, instead of paying some guy to beat the shit out of anyone who walks through the hole in your fence, you just fix the fence. >

So here is the deal. I am a cardiologist who prescribes a lot of tafamadis. This is bad for patients and bad for doctors. While I think that the price is extortion and they should be required to lower it, that’s not what is happening. So while I agree they they are essentially stealing from the government, the result here will probably be that patients cannot get the only drug for ATTR amyloidosis on the market (ever). So I think the Supreme Court is right in principle. In practice it will only result in patients suffering. >

What about Diflunisal? It's off-label, but is also an effective TTR tetramer stabilizer?
Are TTR Silencers (patisiran, inotersen), not effective treatments?
Opinions on EGCG?
I'm not a doctor, just curious. >

Diflunisol hasn’t been tested and likely is not very successful and patiseran and inotersan are being studied but are not available for cardiac amyloidosis yet. Patisiran can be used if they have concurrent polyneuropathy. Tafamadis is the first drug to ever been studied for cardiac amyloid that had a positive trial. Nothing but tafamadis is covered for attr.
Pardon any misspelling. I’m typing on my phone and these don’t get fixed with spell check. >

A retrospective trial with 23 patients in one arm is nowhere near a randomized clinical trail. This is not data that any cardiologist should use to make clinic decisions if there is actual data out there.
Further one year follow up is not nearly enough to study amyloidosis which is a slowly progressing disease. Lastly bio marker data is a surrogate end point which tells very little. All in all this paper says essentially nothing. >

OK, thanks for the insight, I appreciate it >

Of course no problem. Trust me I would fucking love to have options to prescribe. There just aren’t right now. There will be soon though. For sure. I have absolutely no love for Pfizer and my hope is that this decision makes the drug cheaper. My concern is that it will just be unusable for the time being. >

They already pull this crap with other medications, I had a 5k/month medication that they had “payment assistance” for , the price was totally jacked up, they “assisted me” and I guarantee they wrote it off, it is such a scam, man the news is depressing today.. >

Pfizer is one of the corporations that pledged to stop funding sedition caucus candidates after Jan 6, 2021, but then quietly resumed funding them. >

Sorry we are in for for profit health system and sick humans are liabilities. >

Ahh, yes. Giving money to sick people so they can pay their ridiculous bills. The most heinous of crimes! >

It’s not that simple. Drug companies put insane prices on their drugs and then create charitable foundations that allow them to make tax deductible copay assistance funds for patients. This way they milk the maximum amount from Medicare, insurance, etc then cover the patient copay/coinsurance so that the patient still gets the drug. They write that portion off from their income. 
This allows them to get away with absurd drug prices that drive up our insurance premiums. If the patient responsibility portion was true to cost without assistance programs, few could afford to take the drug and the company would have to lower the price. I know it sounds crazy that less patient assistance is better, but it is. This is very much a wolf in sheeps clothing scenario. The drug manufacturers act like they’re doing a charitable deed when in fact they are engineering a system that allows them to overcharge, which in turn raises all of our insurance premiums (or medicare tax) >

Or the government could just negotiate prices on behalf of every single American and thus get the best prices possible. >

Congress explicitly disallows CMS to negotiate. Cuz Murica >

My moms Pfizer heart med is 500 a month >

If it wasn’t clear already, it sure is now- THE SUPREME COURT HATES POOR PEOPLE! >

Maybe, but in this case what they hate even more is the idea of a drug manufacturer unlawfully expanding its market and then saddling Medicare with the bill. >

When people who can afford the co-pay get the drug, Medicare picks up the tab for the rest of it. Is that still saddling Medicare with the cost? >

Not in the same way.  What Pfizer is doing is targeting the people who can't pay the co-pay in order to get Medicare to pay them. >

The drug company offered to pay the copay for the people. 
I’m going to use some made up numbers here to explain it as I see it. 
Person A (wealthy on Medicare) gets the drug. Medicare pays $1000 and Person A pays $500 copay. 
Person B (poor on Medicare) gets the drug. Medicare pays $1000 and the drug company picks up the $500 copay. 
Medicare pays the same thing for each person. 
The only way Medicare saves money is if Person B doesn’t get the drug at all because they can’t get assistance with the copay. >

Right, but the problem is that this program induces people to purchase a product when they may or may not have otherwise.  Then Medicare gets the tab for all those new entrants.  That is why this is illegal.  I'm not arguing that it is good or bad, just that it is. >

Hand it over to Purdue; they did a GREAT job with OxyContin 🤦🏼‍♂️ >

You mean like cut the greed a bit and lower profits? >


The U.S. Department of Health and Human Services' Office of Inspector General in 2020 concluded that the proposal could violate the kickback law by inducing patients to buy Pfizer's drug while leaving taxpayers to bear the costs.
Pfizer sued the department to challenge its determination. The Manhattan-based 2nd U.S. Court of Appeals last July ruled in favor of the government, rejecting Pfizer's argument that a subsidy program would violate the anti-kickback law only if it were administered with corrupt intent.

An interesting case for sure. Basically Pfizer offering to pay for the copay component of the treatment will saddle Medicare with the rest of the costs. Since more patients will presumably be then induced to take the drug, Pfizer is effectively increasing its addressable market into low income families but shifting the cost of the drug into the government. >

The whole 'charge what the market will bear' idea, central to Capitalism, can work - but, this is a case of the market not being able to bear the asking price, and Pfizer basically saying: 
'Nah... this is how much money we WILL get, and it's up to you poor fools to figure out how you're going to give it to us!' >

That concept only works as well when you’re dealing with something where consumer and seller have approximately equal power in the system. Medication frequently does not fit that situation. Cancer drug X which is your best chance for survival, just for example, is a situation where the seller inherently has you over a barrel. >

There's multiple levels of hidden power - Cancer drug X might work best for you in your situation, but your doctor (or their practice) may be incentivized to prescribe drug Y. Or, your insurance may not cover drug X, or it might be part of the formulary where you have to pay a much higher copay. Maybe the manufacturer of drug X has a consumer rebate program, maybe not - almost certainly the doctor doesn't know, and the insurance company surely doesn't. (I've been told that insurance companies do factor in consumer rebate programs in creating their formularies; I don't know if that's true, but at that point it becomes your responsibility to research medication rebates, as well as dealing with your cancer diagnosis.)
But if you're American, your insurance is probably through your work, which means your insurance coverage was selected by your employer's HR department, and you got little if any say in what plan you got.
A few years ago, the company I worked for changed their insurance provider to Kaiser Permanente. Kaiser is an HMO, which means you only get to go to their doctors. So, people who've been seeing the same family doctor, OB/GYN, pediatrician, etc, for years, suddenly had to drop everything and find a new set of doctors. And, they sprung it on us so late in the year that people's spouses' open enrollments had already ended, so married employees didn't have the option of switching to their spouses' coverage, and keeping their same doctors. They did this because Kaiser needed them to hit certain threshold of enrollment, and if people left, it would be less profitable for them. >

In this context there is no "drug Y". It's either drug X, hope to get a new liver quickly if you're well enough for transplant, or you die. >

Pfizer could simply lower the cost of the drug instead of this weird rebate system. >

They make the system as labyrinthine and inconvenient as possible in hopes that poor patients will just give up and pay anyway. One of my nerve medications used to be like that, until their patent expired and a generic came onto the market. >

You couldn't design a stupider system if you wanted to. Every other major world power has figured out healthcare to a somewhat workable system and we have this outrageous system where getting sick can financially cripple you. >

Something like over half of the personal bankruptcies in the US are due to medical debt.
I remember years ago when a doctor suggested I should get a blood test, I asked them how much would it cost.
They said they had no idea, but that "it shouldn't be much".
3 weeks after the blood test, I get a +$500 bill in the mail. Oh, and insurance refused to cover it.
Imagine if buying a car or a house meant that you couldn't see the pricing until after you agreed to pay for it... >

And then you get a second bill for what the insurance didn't agree to pay, do you get a forced surprise second mortgage. >

No, you get forced arbitration. I have to go often enough that I know the first names of most of the firms arbiters. >

I'd argue thats just an extra step, that takes more of your time and resources, and still often leaves you with some amount of extra bill left. >

I was ready to crap on the Supreme Court for this, but... this is crazy, and it's definitely valid that they shot it down.
So this drug costs $225,000 a year.
On medicare, the copay cost to the patient in the end would be $13,000.
Pfizer subsidizes poor people for it, and wants to broaden that to middle class, as they claim some people are choosing not to take this medication due to the cost.  At a glance that sounds nice, helping people get medicine.
But when you think about the money, Pfizer would spend in theory up to a max of 13k, to then get the government to pay them 225k.  That seems very suspicious, and seems why the "anti-kickback" statute would come in to play.  Easy enough for Pfizer to run around handing out $13,000 checks when they know every one will results in a $225,000 check to them in return.
On a side note, this explains some of those medication commercials where they say "might have trouble affording this medicine?  call us, you can get a discount or even get it for free!"
I always assumed that was a lie or exaggeration, but now I think maybe they are happy to give it to YOU for "free", since they are helping you pay a small amount so the government can give them a large one.
Without the anti-kickback statute, companies could just continually jack up the prices over and over (even more than they already do) and "kindly" offer to pay the patients costs.  "Our medications are ALL free! Just send us an invoice, we'll cover your costs!" >

Medicare can reject covering a drug under its program, it's not forced. That's part of this, they theoretically can't continuously jack up prices.
Playing devil's advocate, the other side of this is that if Medicare has an issue with the $200k+ sticker price, they shouldn't have accepted this drug or should negotiate lower.
The issue for Pfizer is that whether they charge $100k or $200k, the copay for the patient remains the same because they are going to hit the cap. In other words, cutting the price in half doesn't spur any more patients that need the drug to take it.
We can argue all day what profits the company "deserves" on drug development, but this is a niche disease with a limited customer base. It needs to charge high levels to fund development. If a disease impacts 10,000 people, you can't charge $5/month for meds under capitalism. You'd lose money.
There are very few other industries where cutting the current price by significant amounts doesn't spur more people into consuming it. >


The issue for Pfizer is that whether they charge $100k or $200k, the copay for the patient remains the same because they are going to hit the cap. In other words, cutting the price in half doesn't spur any more patients that need the drug to take it.

What cap? There is no cap. If they cut the price in half, the Medicare patient's price is cut in half. >

No, they have a copay maximum. Under Medicare Part D, they pay the first tier  fully out of pocket ($4,660, basically a deductible) and then 25% of the cost until the out of pocket maximum ($13,000 according the person I responded to, I see $7,440 as the 2023 out of pocket maximum doing research under standard drug plans but doesn't matter in this case).  After that is reached, the government picks up the tab 100%.
Whether the drug costs $100,000 or $200,000, the individual on this drug would end up paying the same: the out of pocket maximum. To the consumer, the price cut doesn't matter because they are still getting reamed for the same amount out of pocket. >

The person you responded to claimed there is a max out-of-pocket of $13k. That person was wrong. 
Apparently there’s a MOOP coming to medicare part D in 2024/2025, but currently there is none. >

Yes I was wrong, the patient cost is not linear >

Our medical system is so incredibly broken. I don't understand how we, as a country or just as human beings, can be okay with people not being able to afford or access care.
Our technological capabilities are advancing incredibly rapidly, but our empathy continues to decline. >

Sorry according to my spreadsheet calculations your concerns do not equate to maximum profits so we'll just kindly ignore that. >

The argument I hear most against universal healthcare is that it’s too expensive… even though it’s cheaper… and covers everyone
People in the US are so checked out, their entire argument against universal healthcare is wrong, and they don’t care. >

People think universal healthcare in the US will cost too much because Medicare is banned from negotiating drug prices since 2003. Our government insurance literally is banned from using it's massive bargaining power. They passed a law to change this last year, but it doesn't take effect until 2026 for some reason. >

And this is why :     

Office of Inspector General in 2020 concluded that the proposal could violate the kickback law by inducing patients to buy Pfizer's drug while leaving taxpayers to bear the costs.       

F-ing Pfizer...  How about you develop treatment and not charge $250,000/year?     
They make $2.02 billion/year profit off this drug. >

Katie Porter already proved pharma costs are outrageous and very little of the revenue goes into R&D compared to stock buybacks and marketing. Pharma greed is killing people and destroying lives for every penny of profit they can get >

It's saving a lot of people too. In 2022 I was diagnosed with a similar condition that has a similar new and expensive drug, and I'm grateful for it. I'm also grateful to have private insurance that covers everything and has an out-of-pocket max.
E: apparently the world is black and white, everyone is either a hero or a villain, and I’m not allowed to be grateful to be alive >

Classic "I got mine" perspective. Good for you, glad you got what you need. That's no reason to defend the exploitation of millions who aren't so fortunate. >

Holy shit, yeah I “got mine” all right. Wanna trade places?
What I’m saying is it’s complicated. It’s easy to think it’s simple from a comfy armchair. >

Never said it was simple and never said I envy you. But to have benefitted from a flawed, subpar system under which others suffer unnecessarily, then defend said system because you managed to benefit from it is the definition of "I got mine" >

If the system is exploitative and it's so easy to do the "right thing," why don't you and all your like minded friends invest your own money, create a pharmaceutical company, and prove it?  You're full of shit, that's why.   You all have big mouths and nothing behind them. >

Tafamidis was researched and developed by Scripps Research. Scripps is a non-profit that receives most of its funding from the National Institutes of Health and other federal agencies. It also gets grants the American Cancer Society, the American Heart Association, the Cystic Fibrosis Foundation, the Leukemia & Lymphoma Society, and the Juvenile Diabetes Association.
Tafamidis is not some complex microbial or DNA based drug. It is a relatively simple organic compound that can be mass produced for pennies per dose.
So Pfizer gets a free patent entirely paid for by US taxpayers and sells it for $220,000 per dose that is more or less pure profit extorting both the taxpayers and patients on a pay or you die basis. Then they realize there are people who can't come up with $13,000 even if their life depends on it. So they want to waive the copay as long as the taxpayers come up with the other $207,000.
If you want to know how this could even be legal look up Bayh-Dole, Breakthrough Drug and Orphan Drug Acts. Since Pfizer doesn't actually own the patent the FDA can 'march in", take the patent back and give it to a generic manufacturer (or Mark Cuban) that will sell it for $50 a dose and still make a profit but they never have and never will. >

In a nutshell, the Biden administration told Pfizer "You can't do that under the federal Anti-Kickback statute," lower courts agreed with the Biden Administration and the Supreme Court decided not to take the appeal.  
Unfortunately, the headline puts a somewhat different spin on that. >

Whoever wrote this headline should be pulled out in front of a crowd and caned. What fucking deceitful bullshit. >

pfizer wants to fleece insurance by charging really high prices and then using some of that high price to pay co-pays.
The point is that you should just have a lower priced medicine. >

They want to cover the out of pocket then charge the govt whatever they want.   Obama, Trump, and Biden are all correct about Medicare negotiating prices in bulk. >

Gotta say, just from the headline: "health insurance company has plan to help people pay for medication", I'm smelling all sorts of bullshit.

The Manhattan-based 2nd U.S. Court of Appeals last July ruled in favor of the government, rejecting Pfizer's argument that a subsidy program would violate the anti-kickback law only if it were administered with corrupt intent.

Isn't "corrupt intent" pretty much the entire definition of health insurance?
That's like saying "The mob would be legal, if it wasn't for all the criming."

Pfizer had told the Supreme Court that the government has impermissibly transformed an anti-corruption statute into a cost-saving tool, and that Congress did not intend "to criminalize a sick patient's acceptance of co-pay assistance to afford critical medical care."

If Pfizer actually gave a shit about these people, they could just lower the cost of the drug. >

Ah.  Rebate systems.  I bet you can only apply for the rebate through actual physical mail.  At which point someone will call you between 3:30 and 3:45PM two weeks later and if you miss the call you will have to re-apply for the rebate.  The repayment will get stuck in the system and you will have to call back 3 or 4 times to get it processed.  If someone is offering you a rebate they are trying to fuck you. >


The U.S. Supreme Court on Monday turned away Pfizer Inc's (PFE.N) bid to revive its plan to cover out-of-pocket expenses of Medicare patients for drugs costing $225,000 a year to treat a rare heart condition after federal officials found that the drugmaker's arrangement could amount to illegal kickbacks.

Key work "Could".  This leaves many US citizens on the hook for some very expensive meds. >

Shifting the entire cost of the drug to the government instead of reducing the drug cost is the issue here. >

It also comes with the issue that this would be a form of market capture. Now patients can ONLY afford Pfizer, so the government pays them more, competitor gets crushed preemptively, repeat ad infinitum >

There is no competitor. You either get this drug or you die. >

Bottom line?  150,000x$225,000=$33,750,000,000 in potential sales. 
No wonder they want the ruling overturned. >

Hear me out, how about we stop employing people whose only job it is to take this ruling and go sit in a conference room with 10 other people making the same money, and determine a way to skirt the ruling and resubmit a plea. You know, instead of paying some guy to beat the shit out of anyone who walks through the hole in your fence, you just fix the fence. >

They already pull this crap with other medications, I had a 5k/month medication that they had “payment assistance” for , the price was totally jacked up, they “assisted me” and I guarantee they wrote it off, it is such a scam, man the news is depressing today.. >

Pfizer is one of the corporations that pledged to stop funding sedition caucus candidates after Jan 6, 2021, but then quietly resumed funding them. >

So here is the deal. I am a cardiologist who prescribes a lot of tafamadis. This is bad for patients and bad for doctors. While I think that the price is extortion and they should be required to lower it, that’s not what is happening. So while I agree they they are essentially stealing from the government, the result here will probably be that patients cannot get the only drug for ATTR amyloidosis on the market (ever). So I think the Supreme Court is right in principle. In practice it will only result in patients suffering. >

What about Diflunisal? It's off-label, but is also an effective TTR tetramer stabilizer?
Are TTR Silencers (patisiran, inotersen), not effective treatments?
Opinions on EGCG?
I'm not a doctor, just curious. >

Diflunisol hasn’t been tested and likely is not very successful and patiseran and inotersan are being studied but are not available for cardiac amyloidosis yet. Patisiran can be used if they have concurrent polyneuropathy. Tafamadis is the first drug to ever been studied for cardiac amyloid that had a positive trial. Nothing but tafamadis is covered for attr.
Pardon any misspelling. I’m typing on my phone and these don’t get fixed with spell check. >

A retrospective trial with 23 patients in one arm is nowhere near a randomized clinical trail. This is not data that any cardiologist should use to make clinic decisions if there is actual data out there.
Further one year follow up is not nearly enough to study amyloidosis which is a slowly progressing disease. Lastly bio marker data is a surrogate end point which tells very little. All in all this paper says essentially nothing. >

OK, thanks for the insight, I appreciate it >

Of course no problem. Trust me I would fucking love to have options to prescribe. There just aren’t right now. There will be soon though. For sure. I have absolutely no love for Pfizer and my hope is that this decision makes the drug cheaper. My concern is that it will just be unusable for the time being. >

So nice to hear a cardiologist sounding off their frustration towards companies like Pfizer. It's one thing to cover the costs of clinical trials and turn a profit but it's another to charge what they charge in scenarios like this where the drug is the only one for a rather serious indication. These companies talk a good game in their PR strategy about "providing access" to patients but that means fuck all when the price tag is astronomical. >

Sorry we are in for for profit health system and sick humans are liabilities. >

My moms Pfizer heart med is 500 a month >

Ahh, yes. Giving money to sick people so they can pay their ridiculous bills. The most heinous of crimes! >

It’s not that simple. Drug companies put insane prices on their drugs and then create charitable foundations that allow them to make tax deductible copay assistance funds for patients. This way they milk the maximum amount from Medicare, insurance, etc then cover the patient copay/coinsurance so that the patient still gets the drug. They write that portion off from their income. 
This allows them to get away with absurd drug prices that drive up our insurance premiums. If the patient responsibility portion was true to cost without assistance programs, few could afford to take the drug and the company would have to lower the price. I know it sounds crazy that less patient assistance is better, but it is. This is very much a wolf in sheeps clothing scenario. The drug manufacturers act like they’re doing a charitable deed when in fact they are engineering a system that allows them to overcharge, which in turn raises all of our insurance premiums (or medicare tax) >

Or the government could just negotiate prices on behalf of every single American and thus get the best prices possible. >

Congress explicitly disallows CMS to negotiate. Cuz Murica >

If it wasn’t clear already, it sure is now- THE SUPREME COURT HATES POOR PEOPLE! >

Maybe, but in this case what they hate even more is the idea of a drug manufacturer unlawfully expanding its market and then saddling Medicare with the bill. >

When people who can afford the co-pay get the drug, Medicare picks up the tab for the rest of it. Is that still saddling Medicare with the cost? >

Not in the same way.  What Pfizer is doing is targeting the people who can't pay the co-pay in order to get Medicare to pay them. >

The drug company offered to pay the copay for the people. 
I’m going to use some made up numbers here to explain it as I see it. 
Person A (wealthy on Medicare) gets the drug. Medicare pays $1000 and Person A pays $500 copay. 
Person B (poor on Medicare) gets the drug. Medicare pays $1000 and the drug company picks up the $500 copay. 
Medicare pays the same thing for each person. 
The only way Medicare saves money is if Person B doesn’t get the drug at all because they can’t get assistance with the copay. >

Right, but the problem is that this program induces people to purchase a product when they may or may not have otherwise.  Then Medicare gets the tab for all those new entrants.  That is why this is illegal.  I'm not arguing that it is good or bad, just that it is. >

So you think doctors will be prescribing this medication to people who don’t need it just because the drug company will pay the copay for the patient? The rule the Supreme Court is bending was made so doctors don’t get kick backs for over prescribing drugs. The doctor gets nothing extra for prescribing this so there is no incentive to overprescribe. You might as well have a law that your rich brother can’t help you pay medical bills because that is what is going on here. >

No, the Anti-Kickback Statute covers all medical entities, services, and products reimbursable by federal health care programs and is most certainly not limited to doctors prescribing drugs, although that would be included. >

Hand it over to Purdue; they did a GREAT job with OxyContin 🤦🏼‍♂️ >

You mean like cut the greed a bit and lower profits? >


The U.S. Department of Health and Human Services' Office of Inspector General in 2020 concluded that the proposal could violate the kickback law by inducing patients to buy Pfizer's drug while leaving taxpayers to bear the costs.
Pfizer sued the department to challenge its determination. The Manhattan-based 2nd U.S. Court of Appeals last July ruled in favor of the government, rejecting Pfizer's argument that a subsidy program would violate the anti-kickback law only if it were administered with corrupt intent.

An interesting case for sure. Basically Pfizer offering to pay for the copay component of the treatment will saddle Medicare with the rest of the costs. Since more patients will presumably be then induced to take the drug, Pfizer is effectively increasing its addressable market into low income families but shifting the cost of the drug into the government. >

The whole 'charge what the market will bear' idea, central to Capitalism, can work - but, this is a case of the market not being able to bear the asking price, and Pfizer basically saying: 
'Nah... this is how much money we WILL get, and it's up to you poor fools to figure out how you're going to give it to us!' >

That concept only works as well when you’re dealing with something where consumer and seller have approximately equal power in the system. Medication frequently does not fit that situation. Cancer drug X which is your best chance for survival, just for example, is a situation where the seller inherently has you over a barrel. >

There's multiple levels of hidden power - Cancer drug X might work best for you in your situation, but your doctor (or their practice) may be incentivized to prescribe drug Y. Or, your insurance may not cover drug X, or it might be part of the formulary where you have to pay a much higher copay. Maybe the manufacturer of drug X has a consumer rebate program, maybe not - almost certainly the doctor doesn't know, and the insurance company surely doesn't. (I've been told that insurance companies do factor in consumer rebate programs in creating their formularies; I don't know if that's true, but at that point it becomes your responsibility to research medication rebates, as well as dealing with your cancer diagnosis.)
But if you're American, your insurance is probably through your work, which means your insurance coverage was selected by your employer's HR department, and you got little if any say in what plan you got.
A few years ago, the company I worked for changed their insurance provider to Kaiser Permanente. Kaiser is an HMO, which means you only get to go to their doctors. So, people who've been seeing the same family doctor, OB/GYN, pediatrician, etc, for years, suddenly had to drop everything and find a new set of doctors. And, they sprung it on us so late in the year that people's spouses' open enrollments had already ended, so married employees didn't have the option of switching to their spouses' coverage, and keeping their same doctors. They did this because Kaiser needed them to hit certain threshold of enrollment, and if people left, it would be less profitable for them. >

In this context there is no "drug Y". It's either drug X, hope to get a new liver quickly if you're well enough for transplant, or you die. >

Pfizer could simply lower the cost of the drug instead of this weird rebate system. >

They make the system as labyrinthine and inconvenient as possible in hopes that poor patients will just give up and pay anyway. One of my nerve medications used to be like that, until their patent expired and a generic came onto the market. >

You couldn't design a stupider system if you wanted to. Every other major world power has figured out healthcare to a somewhat workable system and we have this outrageous system where getting sick can financially cripple you. >

Something like over half of the personal bankruptcies in the US are due to medical debt.
I remember years ago when a doctor suggested I should get a blood test, I asked them how much would it cost.
They said they had no idea, but that "it shouldn't be much".
3 weeks after the blood test, I get a +$500 bill in the mail. Oh, and insurance refused to cover it.
Imagine if buying a car or a house meant that you couldn't see the pricing until after you agreed to pay for it... >

And then you get a second bill for what the insurance didn't agree to pay, do you get a forced surprise second mortgage. >

No, you get forced arbitration. I have to go often enough that I know the first names of most of the firms arbiters. >

I'd argue thats just an extra step, that takes more of your time and resources, and still often leaves you with some amount of extra bill left. >

I was ready to crap on the Supreme Court for this, but... this is crazy, and it's definitely valid that they shot it down.
So this drug costs $225,000 a year.
On medicare, the copay cost to the patient in the end would be $13,000.
Pfizer subsidizes poor people for it, and wants to broaden that to middle class, as they claim some people are choosing not to take this medication due to the cost.  At a glance that sounds nice, helping people get medicine.
But when you think about the money, Pfizer would spend in theory up to a max of 13k, to then get the government to pay them 225k.  That seems very suspicious, and seems why the "anti-kickback" statute would come in to play.  Easy enough for Pfizer to run around handing out $13,000 checks when they know every one will results in a $225,000 check to them in return.
On a side note, this explains some of those medication commercials where they say "might have trouble affording this medicine?  call us, you can get a discount or even get it for free!"
I always assumed that was a lie or exaggeration, but now I think maybe they are happy to give it to YOU for "free", since they are helping you pay a small amount so the government can give them a large one.
Without the anti-kickback statute, companies could just continually jack up the prices over and over (even more than they already do) and "kindly" offer to pay the patients costs.  "Our medications are ALL free! Just send us an invoice, we'll cover your costs!" >

Medicare can reject covering a drug under its program, it's not forced. That's part of this, they theoretically can't continuously jack up prices.
Playing devil's advocate, the other side of this is that if Medicare has an issue with the $200k+ sticker price, they shouldn't have accepted this drug or should negotiate lower.
The issue for Pfizer is that whether they charge $100k or $200k, the copay for the patient remains the same because they are going to hit the cap. In other words, cutting the price in half doesn't spur any more patients that need the drug to take it.
We can argue all day what profits the company "deserves" on drug development, but this is a niche disease with a limited customer base. It needs to charge high levels to fund development. If a disease impacts 10,000 people, you can't charge $5/month for meds under capitalism. You'd lose money.
There are very few other industries where cutting the current price by significant amounts doesn't spur more people into consuming it. >


The issue for Pfizer is that whether they charge $100k or $200k, the copay for the patient remains the same because they are going to hit the cap. In other words, cutting the price in half doesn't spur any more patients that need the drug to take it.

What cap? There is no cap. If they cut the price in half, the Medicare patient's price is cut in half. >

No, they have a copay maximum. Under Medicare Part D, they pay the first tier  fully out of pocket ($4,660, basically a deductible) and then 25% of the cost until the out of pocket maximum ($13,000 according the person I responded to, I see $7,440 as the 2023 out of pocket maximum doing research under standard drug plans but doesn't matter in this case).  After that is reached, the government picks up the tab 100%.
Whether the drug costs $100,000 or $200,000, the individual on this drug would end up paying the same: the out of pocket maximum. To the consumer, the price cut doesn't matter because they are still getting reamed for the same amount out of pocket. >

The person you responded to claimed there is a max out-of-pocket of $13k. That person was wrong. 
Apparently there’s a MOOP coming to medicare part D in 2024/2025, but currently there is none. >

Yes I was wrong, the patient cost is not linear >

Our medical system is so incredibly broken. I don't understand how we, as a country or just as human beings, can be okay with people not being able to afford or access care.
Our technological capabilities are advancing incredibly rapidly, but our empathy continues to decline. >

Sorry according to my spreadsheet calculations your concerns do not equate to maximum profits so we'll just kindly ignore that. >

The argument I hear most against universal healthcare is that it’s too expensive… even though it’s cheaper… and covers everyone
People in the US are so checked out, their entire argument against universal healthcare is wrong, and they don’t care. >

People think universal healthcare in the US will cost too much because Medicare is banned from negotiating drug prices since 2003. Our government insurance literally is banned from using it's massive bargaining power. They passed a law to change this last year, but it doesn't take effect until 2026 for some reason. >

And this is why :     

Office of Inspector General in 2020 concluded that the proposal could violate the kickback law by inducing patients to buy Pfizer's drug while leaving taxpayers to bear the costs.       

F-ing Pfizer...  How about you develop treatment and not charge $250,000/year?     
They make $2.02 billion/year profit off this drug. >

Katie Porter already proved pharma costs are outrageous and very little of the revenue goes into R&D compared to stock buybacks and marketing. Pharma greed is killing people and destroying lives for every penny of profit they can get