Why Prescription Drug Prices Keep Rising – and 3 Ways to Bring Them Down
Prescription drug prices have been rising at a blistering rate over the last few decades. Between 1980 and 2016, overall spending on prescription drugs rose from about $12 billion to roughly $330 billion, while its share of total health care spending doubled, from 5% to 10%.
Although lawmakers have shown renewed interest in addressing the problem, with pharmaceutical CEOs testifying before the Senate Finance Committee in February and pharmacy benefit managers (PBMS) scheduled to do so this week, no comprehensive plan to halt the relentless increase in prices has been proposed, let alone agreed upon.
Robin Feldman, a professor at the University of California Hastings College of Law, takes a look at the drug pricing system in a new book, “Drugs, Money and Secret Handshakes: The Unstoppable Growth of Prescription Drug Prices.” In a recent conversation with Bloomberg’s Joe Nocera, Feldman said that one of the key drivers of rising prices is the ongoing effort of pharmaceutical companies to maintain control of the market.
Fearing competition from lower-cost generics, drugmakers began over the last 10 or 15 years to focus on innovations “outside of the lab,” Feldman said. These innovations include paying PBMs to reduce competition from generics; creating complex systems of rebates to PBMs, hospitals and doctors to maintain high prices; and gaming the patent system to extend monopoly pricing power.
Feldman’s research on the dynamics of the drug market led her to formulate three general solutions for the problem of ever-rising prices:
1) Transparency: The current system thrives on secret deals between drug companies and middlemen. Transparency “lets competitors figure out how to compete and it lets regulators see where the bad behaviors occur,” Feldman says.
2) Patent limitations: Drugmakers have become experts at extending patents on existing drugs, often by making minor modifications in formulation, dosage or delivery. Feldman says that 78% of drugs getting new patents are actually old drugs gaining another round of protection, and thus another round of production and pricing exclusivity. A “one-and-done” patent system would eliminate this increasingly common strategy.
3) Simplification: Feldman says that “complexity breeds opportunity,” and warns that the U.S. “drug price system is so complex that the gaming opportunities are endless.” While “ruthless simplification” of regulatory rules and approval systems could help eliminate some of those opportunities, Feldman says that the U.S. doesn’t seem to be moving in this direction.
Read the full interview at Bloomberg News.
For Most Seniors, Social Security Is Their Biggest Source of Income
The 80-year-old Social Security program has long been known as the third rail of American politics -- touch it and you die.
Last year alone, more than 59 million Americans received retirement, disability and survivor’s benefits totaling $863 billion. While some lawmakers and policy experts warn that the system will begin to run short of cash beginning in 2035, seniors’ advocacy groups have vigorously fought major changes and cuts.
Related: Battle Lines Form in the Fight Over Social Security Payment Reductions
Some nine out of ten people who are 65 or older receive Social Security benefits, according to the Social Security Administration, with an average monthly benefit of $1,294 average for retirees. Overall, Social Security benefits constitute about 38 percent of the income of the elderly, but that number varies greatly from individual to individual.
For the majority of seniors, Social Security makes up the majority of their income. Sixty-five percent of beneficiaries age 65 and older get more than half of their income from the program. Nearly a third (28%) rely on Social Security for 90 percent or more of their income.
Related: 4 Ways to Fix Social Security
The pie chart below, prepared by the staff of the congressional Joint Economic Committee, illustrates the range of seniors’ dependence on Social Security benefits:
Fund Managers Making Millions from University Endowments
The soaring endowments at America’s top universities are doing more to line the pockets of the millionaire private equity fund managers who run them than they are for the schools’ students, argues a New York Times op-ed published today.
At Yale University last year, for example, fund managers received $480 million in compensation for managing a third of Yale’s $24 billion endowment. Meanwhile, the school spent just $170 million of that endowment on tuition assistance, fellowships and prizes, according to an analysis by Victor Fleischer, a law professor at the University of San Diego.
He found a similar at Harvard, the University of Texas, Stanford and Princeton. “We’ve lost sight of the idea that students, not fund managers, should be the primary beneficiaries of a university’s endowment,” Fleischer writes. “The private-equity folks get cash; students take out loans.”
Related: Harvard’s In-House Fund Managers Get 70 Percent Pay Hike
It’s worth noting that all the schools Fleischer cites do have relatively generous tuition assistance programs, and they often spend their endowments on capital improvements and other projects that indirectly benefit students. Their endowments have also enjoyed record returns under private equity management.
Fleischer argues that college endowments should be required to spend a percentage of their assets each year, much like other private endowments. That would lead to lower overall endowments but might put a damper on tuition increases and would lead to improved research facilities, he claims.
Last year American universities invested about 11 percent of their portfolios in private equity and saw a 16.5 percent return on them, according to the National Association for College and University Business Officers.
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John Kasich’s Latest Endorsement Could Be a Game-Changer
Ohio’s Republican Gov. John Kasich on Monday sought to enshrine his status as a top-tier presidential candidate when he rolled out the endorsement of Alabama Gov. Robert Bentley.
“John Kasich is a leader whose readiness to lead our nation on his first day in the Oval Office is unmatched,” Bentley said during a joint appearance at the Alabama Sports Hall of Fame. “America needs John Kasich, and I am going to do everything I can to help make sure he is our next president.”
Related: 10 Things You Need to Know About John Kasich
On paper, the Republican governor of a deep-red Southern state endorsing a GOP presidential candidate months before the first primary votes are cast may not come as much of a surprise, but it could ultimately mean a great deal for Kasich’s White House bid.
The Ohio Republican, with his compassionate conservative message, has touted himself as a moderate in the crowded GOP field; winning the support of the executive of one of the most conservative states in the nation could help him broaden his appeal in the party.
Alabama is set to play a major role in the GOP’s 2016 nomination process. The state is one of eight in the South that will hold a vote on March 1 in the so-called “SEC primary.”
Sen. Ted Cruz (R-TX), another White House hopeful, has called the cluster of states the “firewall” for his candidacy and wrapped up a southern bus tour last week, drawing large crowds in Tennessee, Mississippi and Arkansas.
Related: Did Kasich Just Do an About-Face on Climate Change?
By making hay of Bentley’s endorsement, Kasich also aims to stay in the spotlight and secure his place on the main stage when Republicans meet again next month for their second debate.
Kasich announced his candidacy just a few weeks before the first debate in Cleveland earlier this month in the hope that his initial splash in the polls would be enough for him to make the cut-off for the prime time event. The strategy paid off; Kasich received standing ovations and thunderous applause whenever he answered a question before the home state crowd.
But surveys taken since the debate show former Hewlett-Packard CEO Carly Fiorina surging in the polls, meaning another contender is likely to get bumped off stage.
After Bentley’s announcement, Kasich, who has bet his candidacy on winning the New Hampshire primary and watched his numbers steadily rise there, will make a campaign swing through the Granite State, Iowa and South Carolina.
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Here’s How Much It Would Cost the Military to Provide Transition Care to Transgender Troops
As the U.S. military studies the implications of lifting a ban on transgender people serving in the armed forces, a new study says that the cost of providing transition-related health care to those service members would be about $5.6 million a year, or “little more than a rounding error in the military's $47.8 billion annual health care budget.”
After U.S. Defense Secretary Ashton Carter announced in mid-July that that Department of Defense would look into lifting the ban, opponents expressed concern about the potential high costs of providing care to transgender individuals. In last week’s debate among Republican presidential candidates, former Arkansas Gov. Mike Huckabee said he wasn’t sure “how paying for transgender surgery for soldiers, sailors, airmen, Marines makes our country safer.”
Related: The Surprising Way the Military Could Save Millions
The new study published in The New England Journal of Medicine estimated that 12,800 transgender troops currently serve and are eligible for health care in the U.S., but only 188 transgender service members would require transition-related care annually. Aaron Belkin, the San Francisco State University researcher who conducted the survey, checked for accuracy using data from the Australian military, which already covers transition-related care, and compared costs with insurance plans offered to University of California employees and their dependents.
Belkin emphasized that costs could be lower than expected for several reasons. Among those, transition-related care would mitigate other serious and potentially costly conditions, such as suicidal thoughts, and might improve job performance.
Acknowledging that the costs might be higher than he estimates, Belkin still says they would be too low to matter and shouldn’t be a factor in deciding whether the ban is lifted or not.
In June, the American Medical Association said there is “no medically valid reason” to prohibit transgender individuals from serving in the military.
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4 Ways to Fix Social Security
Social Security celebrates its 80th birthday today, and the popular program that provides paychecks for 44 million elderly Americans is in need of a safety net of its own.
As the amount claimed by recipients continues to outpace the amount of money contributed by workers, the system will need to dip into its reserves to keep up with its obligations by 2020. Within 15 years after that (if nothing changes), those reserves will be gone and the system will only be able to pay 77 cents on every dollar owed, an amount that will continue to decrease with time.
The problem is even more acute given that future retirees won’t have the same access to pensions that many current retirees use to fund their retirement, and younger workers haven’t saved nearly enough to cover the costs they’ll face when they stop working.
To close the projected gap, the country needs to raise revenue, reduce benefits or some combination of the two. Here are four of the most commonly proposed solutions:
1. Raise the retirement age. For most Americans, the full retirement age (at which you can get full benefits) ranges from 65 through 67. Advocates of this solution would reduce the amount the government pays in Social Security by gradually pushing back the age at which you’re eligible for full benefits.
The drawback: Many Americans are already forced into retirement before they reach age 65. If they claim early and receive reduced benefits they may not have enough money to meet their basic needs. Also, workers in physically demanding jobs many not be able to work those extra years.
2. Raise the payroll cap. Social Security is funded via payroll taxes, which currently are only levied on the first $118,500 of income. That means that high earners effectively pay a much lower rate toward Social Security than others. Hiking or eliminating that cap, advocates say, would create a fairer system and increase revenue.
The drawback: Critics of this solution claim that increasing taxes on middle- and upper-income earners would reduce their income and stifle the country’s economic growth.
Related: 6 Popular Social Security Myths Busted
3. Institute a means test. While the vast majority of recipients (80 percent, per AARP) rely on Social Security as an integral part of funding their retirement, extremely high net worth individuals don’t need the additional income. This solution would create a net worth or retirement income threshold over which eligibility for social security phases out.
The drawbacks: It could be politically difficult to settle on a threshold, which might vary depending on the geography of a recipient. Plus, this would require people to pay into a system from which they get no benefits.
4. Freeze the cost of living adjustment. Social Security payments have historically been adjusted based on inflation as measured by the Consumer Price Index. This has been minimal in recent years, but the long-term, compounding effect of inflation makes this provision incredibly expensive.The drawbacks: For many people, Social Security is the only inflation-linked retirement income stream that they have. Limiting it could push some retirees over the financial edge as prices rise.