Monday, July 25, 2011

Drug prices to plummet in wave of expiring patents

Check out this article by Linda A. Johnson of the Associated Press

Jul 25, 11:44 AM EDT

Drug prices to plummet in wave of expiring patents

AP Business Writer

The cost of prescription medicines used by millions of people every day is about to plummet.

The next 14 months will bring generic versions of seven of the world's 20 best-selling drugs, including the top two: cholesterol fighter Lipitor and blood thinner Plavix.

The magnitude of this wave of expiring drugs patents is unprecedented. Between now and 2016, blockbusters with about $255 billion in global annual sales will go off patent, notes EvaluatePharma Ltd., a London research firm. Generic competition will decimate sales of the brand-name drugs and slash the cost to patients and companies that provide health benefits.

Top drugs getting generic competition by September 2012 are taken by millions every day: Lipitor alone is taken by about 4.3 million Americans and Plavix by 1.4 million. Generic versions of big-selling drugs for blood pressure, asthma, diabetes, depression, high triglycerides, HIV and bipolar disorder also are coming by then.

The flood of generics will continue for the next decade or so, as about 120 brand-name prescription drugs lose market exclusivity, according to prescription benefits manager Medco Health Solutions Inc.

"My estimation is at least 15 percent of the population is currently using one of the drugs whose patents will expire in 2011 or 2012," says Joel Owerbach, chief pharmacy officer for Excellus Blue Cross Blue Shield, which serves most of upstate New York.

Those patients, along with businesses and taxpayers who help pay for prescription drugs through corporate and government prescription plans, collectively will save a fortune. That's because generic drugs typically cost 20 percent to 80 percent less than the brand names.

Doctors hope the lower prices will significantly reduce the number of people jeopardizing their health because they can't afford medicines they need.

Dr. Nieca Goldberg, director of The Women's Heart Program at NYU Langone Medical Center in Manhattan, worries about patients who are skipping checkups and halving pills to pare costs.

"You can pretty much tell by the numbers when I check the patient's blood pressure or cholesterol levels," that they've not taken their medications as often as prescribed, she says.

Even people with private insurance or Medicare aren't filling all their prescriptions, studies show, particularly for cancer drugs with copays of hundreds of dollars or more.

The new generics will slice copayments of those with insurance. For the uninsured, who have been paying full price, the savings will be much bigger.

Daly Powers, 25, an uninsured student who works two part-time jobs at low wages, says he often can't afford the $220 a month for his depression and attention deficit disorder pills. He couldn't buy either drug in June and says he's struggling with his Spanish class and his emotions. He looks forward to his antidepressant, Lexapro, going generic early next year.

"It'd make all the difference in the world," says Powers, of Bryan, Texas.

Generic medicines are chemically equivalent to the original brand-name drugs and work just as well for nearly all patients.

When a drug loses patent protection, often only one generic version is on sale for the first six months, so the price falls a little bit initially. Then, several other generic makers typically jump in, driving prices down dramatically.

Last year, the average generic prescription cost $72, versus $198 for the average brand-name drug, according to consulting firm Wolters Kluwer Pharma Solutions. Those figures average all prescriptions, from short-term to 90-day ones.

Average copayments last year were $6 for generics, compared with $24 for brand-name drugs given preferred status by an insurer and $35 for nonpreferred brands, according to IMS Health.

Among the drugs that recently went off patent, Protonix, for severe heartburn, now costs just $16 a month for the generic, versus about $170 for the brand name. And of the top sellers that soon will have competition, Lipitor retails for about $150 a month, Plavix costs almost $200 a month and blood pressure drug Diovan costs about $125 a month. For those with drug coverage, their out-of-pocket costs for each of those drugs could drop below $10 a month.

Jo Kelly, a retired social worker in Conklin, Mich., and her husband, Ray, a retired railroad mechanic, each take Lipitor and two other brand-name medicines, plus some generic drugs. Both are 67, and they land in the Medicare prescription "doughnut hole," which means they must pay their drugs' full cost by late summer or early fall each year. That pushes their monthly cost for Lipitor to about $95 each, and their combined monthly prescription cost to nearly $1,100.

Generic Lipitor should hit pharmacies Nov. 30 and cost them around $10 each a month.

"It would be a tremendous help for us financially," she says. "It would allow us to start going out to eat again."

For people with no prescription coverage, the coming savings on some drugs could be much bigger. Many discount retailers and grocery chains sell the most popular generics for $5 a month or less to draw in shoppers.

The impact of the coming wave of generics will be widespread - and swift.

Insurers use systems that make sure patients are switched to a generic the first day it's available. Many health plans require newly diagnosed patients to start on generic medicines. And unless the doctor writes "brand only" on a prescription, if there's a generic available, that's almost always what the pharmacist dispenses.

"A blockbuster drug that goes off patent will lose 90 percent of its revenue within 24 months. I've seen it happen in 12 months," says Ben Weintraub, a research director at Wolters Kluwer Pharma Solutions.

The looming revenue drop is changing the economics of the pharmaceutical industry.

In the 1990s, big pharmaceutical companies were wildly successful at creating pills that millions of people take every day for long-term conditions, from heart disease and diabetes to osteoporosis and chronic pain. The drugs are enormously profitable compared with drugs that are prescribed for short-term ailments.

The patents on those blockbusters, which were filed years before the drugs went on sale, last for 20 years at most, and many expire soon.

In recent years, many drug companies have struggled to develop new blockbuster drugs, despite multibillion-dollar research budgets and more partnerships with scientists at universities and biotech companies. The dearth of successes, partly because the "easy" treatments have already been found, has turned the short-term prognosis for "big pharma" anemic.

"The profit dollars that companies used to reinvest in innovation are no longer going to be coming," warns Terry Hisey, life sciences leader at consultant Deloitte LLP's pharmaceutical consulting business. He says that raises "long-term concerns about the industry's ability to bring new medicines to market."

But pharmaceutical companies can save billions when they stop promoting drugs that have new generic rivals, and U.S. drug and biotech companies are still spending more than $65 billion a year on R&D.

Drug companies have received U.S. approval for 20 drugs this year and expect approval for other important ones the next few years. Eventually, those will help fill the revenue hole.

For now, brand-name drugmakers are scrambling to adjust for the billions in revenue that will soon be lost. Typically, they raise prices 20 percent or more in the final years before generics hit to maximize revenue. Some also contract with generic drugmakers for "authorized generics," which give the brand-name company a portion of the generic sales.

Brand-name companies also are trimming research budgets, partnering with other companies to share drug development costs and shifting more manufacturing and patient testing to low-cost countries.

Pharmaceutical companies have cut about 10 percent of U.S. jobs in four years, from a peak of about 297,000 to about 268,000, according to Labor Department data. Nearly two-thirds of the cuts came in the last 1 1/2 years, partly because of big mergers that were driven by the need to bulk up drugs in development and boost profits in the short term by cutting costs.

Drug companies also are trying to grow sales by putting more sales reps in emerging markets, such as China and India, and by diversifying into businesses that get little or no generic competition. Those include vaccines, diagnostic tests, veterinary medicines and consumer health products.

As the proportion of prescriptions filled with generic drugs jumped to 78 percent in 2010, from 57 percent in 2004, annual increases in prescription drug spending slowed, to just 4 percent in 2010. According to the Generic Pharmaceutical Association, generics saved the U.S. health care system more than $824 billion from 2000 through 2009, and now save about $1 billion every three days.

The savings are only going to get greater as our overweight population ages. People who take their medicines regularly often avoid costly complications and hospitalizations, says AARP's policy chief, John Rother, which produces even bigger savings than the cheaper drugs.

In addition, many patients taking a particular brand-name drug will defect when a slightly older rival in the same class goes generic.

Global sales of Lipitor peaked at $12.9 billion in 2006, the year Zocor, an older drug in the statin class that reduces bad cholesterol, went generic. Lipitor sales then declined slowly but steadily to about $10.7 billion last year. That still will make Lipitor the biggest drug to go generic.

For patients, it's a godsend.

Douglas Torok, 59, of Erie, Pa., now spends nearly $290 every three months for insulin for his Type 2 diabetes, plus four daily pills - Lipitor, Plavix and two generics - for his blood pressure and cholesterol problems. The $40,000-a-year foundry supervisor fears not being able to cover the out-of-pocket costs when he retires and doesn't have a generous prescription plan.

In the meantime, once Lipitor and Plavix get generic competition his copayments will plunge.

"I will pay $16 for 90 days," says Torok, who hopes to travel more. "It's a big deal for me on my income."

Friday, July 8, 2011

Anthem Blue Cross

Anthem Blue Cross appears in the news quite frequently portrayed as the big bad insurance company that hikes premiums to unaffordable levels. However, as a true independent health insurance broker, when I run comparatives for clients, Anthem offers the best value for the money on almost every occasion in the individual market compare to the other insurance carriers. The question thus becomes "why is Anthem portrayed as the big bad wolf of the health insurance industry." In this poster's mind, the answer is obvious. Anthem Blue Cross being the best known California insurance company is chosen as the "whipping boy" by the press and governmental officials in order to further whatever agenda they are pushing at a particular point in time. There is no question that the health insurance industry needs an overhaul, however the adversarial positions between the government and the insurance industry are not addressing the most important issues of how to control the spiralling costs of healthcare. The job of every good broker today is to inform his or her clients of the best value in coverage for themselves and their families. Unfortunately, in doing so, we have to constantly battle false perceptions created by the media and other sources.

Friday, June 24, 2011

Anthem Blue Cross Open Enrollment

As a final reminder, Anthem Blue Cross is offering open enrollment during the month of June for those who might want to change their health plan. This open enrollment ends on June 30th. If you want to take advantage of this, send me a pm or visit and enter your information to check out your various options.

Sunday, June 19, 2011

Health Insurance Out of Network Rates

This is a very good article written by Anna Wilde Mathews in the Wall Street Journal.

Consumers know they will have to pay out of their pockets if they use medical providers outside their insurers' networks. But because of a little-noticed change, they may find themselves with even bigger bills than they expect.

Several major insurers are now using rates based on Medicare fees to calculate payments for out-of-network providers. Those amounts are often a lot lower than what doctors and hospitals actually charge. The upshot: Providers may bill patients for the difference. What's more, that bill comes on top of whatever patients owe in deductibles or co-payments.

New York entertainment attorney Mark D. Sendroff says he knew he'd get a bill when he went to an out-of-network surgeon for a shoulder operation last summer. But he was shocked when his Aetna health-insurance plan paid only around $1,000 of the surgeon's approximately $30,000 charge -- and part of the payment was his deductible. "It was absolutely crazy," he says.

Mr. Sendroff thought the plan was going to pay his doctor based on a "usual and customary" rate that's supposed to represent a typical charge for his area. Instead, the insurer pegged the doctor's reimbursement to 110% of the fee paid by Medicare. Mr. Sendroff appealed the decision, and after he contacted the New York attorney general's office, Aetna agreed to pay more, he says.

Aetna says some of its plans began basing out-of-network payments on Medicare rates in late 2009, and typically they pay a percentage above the government program's fees. In New York, the company says it warned insurance brokers the new system might generate bigger out-of-pockets, and mentioned the issue in a summary for potential customers. Aetna declined to comment on Mr. Sendroff's case, citing privacy rules, but said $30,000 was "well above the average charge" for such surgeries.

Health Care Service, the nonprofit parent of Blue Cross and Blue Shield plans in Illinois and Texas among other states, began phasing in Medicare-based fees last year. Cigna says employers are increasingly opting for plans that pay a set percentage above Medicare.

Insurers say Medicare is a reasonable basis for reimbursement. An Aetna spokeswoman says the Medicare-based payments are a "more consistent way of paying and keeping the premium down." Health Care Service says the Medicare method helps "increase transparency for providers and members."

For patients, the safest financial path is to use insurers' networks. When this isn't possible, they need to do their homework before getting treatment by talking to their providers and insurers. It's best to get billing codes for each service and run them past the health plan, says Ida Schnipper of Health Champion, a patient-advocacy firm.

Patients also should watch for unexpected out-of-network providers. For instance, an in-network hospital might have out-of-network anesthesiologists. If they do get stuck with a charge they didn't see coming, they can appeal to the insurer and also try turning to a state regulator for help. Providers also sometimes negotiate discounts with patients.

Starting in August, consumers can turn to a new usual-and-customary medical charge database operated by Fair Health, which will be available at Currently, the site only has dental fees. The nonprofit says it expects a growing number of insurers to use its data.

Write to Anna Wilde Mathews at

Thursday, June 9, 2011

The Problems with Obamacare

Healthcare reform has been a hot topic of debate ever since the 2008 Presidential election. Much rhetoric has passed back and forth between the two political parties, the insurance industry and other parties involved in the healthcare industry. It is this blogger's opinion that everyone is missing the most important issues which are controlling the spiralling costs of healthcare and health insurance premiums. Until these two issues are resolved, everything else is secondary.

The current political party that controls the final votes on any legislation believes that health insurance should be a right rather than a privilege and that the government should play a major part in executing the healthcare and health insurance in this country. The major problem with this is that our government is facing a trillion dollar deficit balance at a time when millions of "baby boomers" are set to enter the age of Medicare. Medicare will not be able to financially support this new infusion of "retirees" and is already in dire straits financially. The question here is how can a government with a huge deficit balance in a poor economy take on such an arduous task.

As important as finding a way to execute affordable health insurance for the majority of Americans is finding a way to control the costs of healthcare. There is no transparency to costs, and something has to be done in order to create affordability. There are no easy solutions to these problems, however it would be a major step in the right direction if the politicians, the insurance executives, the pharmaceutical companies and the medical practitioners could sit at the same table working out solutions rather than continually sniping at each other as adversaries. The U.S. is facing a major financial crises in health care, and steps need to be taken toward compromise and execution of plans and programs that have a realistic chance of working. Unfortunately, this is not happening as I write today.

Sunday, May 22, 2011

Single Payer Healthcare

In the state of California, may politicians support a "single payer" healthcare system run by the state government. However, no one seems to want to address how the state will pay for this type of system. At the federal level, Medicare is on the verge of bankruptcy with the baby boomer generation primed to enter the Medicare marketplace. Social Security is headed down a path to oblivion, and the Postal Service is bleeding money left and right. We have over a trillion dollar deficit, and yet government officials talk about implementing a single payer healthcare system run by the very same government that cannot turn a profit in most of its endeavors. If one puts the state of California under the microscope, its finances are in even more dire straits than those of the feds. It is very discouraging to this blogger, that no one seems to be attacking the two most important issues, controlling spiralling healthcare costs and out of control health insurance premiums.

Friday, May 20, 2011

ObamaCare's Effect on Medicare

Check out this information from the National Center for Policy Analysis:

America's seniors will be the big losers under ObamaCare Medicare reform. They will lose and lose big, according to new information from NCPA President John Goodman and former Medicare Trustee Tom Saving. To get an idea of just how much seniors will lose:
• For someone turning 65 and enrolling in Medicare this year, the lifetime loss in current dollars of projected Medicare spending was reduced by $35,588.
•For 55-year-olds, the projected reduction in Medicare spending is $62,315 per
•For 45-year-olds, the loss totals $105,004.

But it gets even worse: hospitals will not be able to provide the same kind of services they provide to younger patients. Physicians will stop accepting Medicare patients. Not only will seniors likely have to start paying much more out of their own pocket get the same kind of services other patients are getting, we will be looking at a two-tier health care system, and seniors will be on the bottom rung.

Richard Walker
Chief Operating Officer
National Center for Policy Analysis

Monday, May 16, 2011

July 1, 2011 Rate Changes

Several major health insurance companies have announced individual and small group rate increases effective 7/1/2011. These carriers include Aetna, Anthem Blue Cross, Health Net and others. In addition many older individual plans have become non-marketed plans meaning that the insurance companies will no longer be accepting new members into these plans.

If you are in an individual or group rate guarantee period, your new rate will become effective at the end of your rate guarantee. With the advent of healthcare reform, you owe it to yourselves to evaluate your current health plan to assure that you are receiving the best value for your money. We will be happy to consult with you and review options and ways that you can save money on premium costs. Anthem Blue Cross has actually developed a website for current members that allows you to compare your current plan with various automatic transfer options. This site can be accessed at this link: Once you find a plan that meets budgetary objectives, it is still important to discuss options with a knowledgeable broker who can guide you through the benefits and exclusions of the plans. Those of you on group plans need to contact us 60 days prior to your group renewal, as we should have your renewal rates to compare with other available options.

It is more important than ever before to stay on top of the ever changing health insurance market. Quoting tools and our FREE ebook "Mastering the Health Insurance Maze" are available at our website

As an independent brokerage, we have no allegiance to any particular insurance company. We can also help you sort through the news media's interpretation of the state of the health insurance industry. The key factor to remember is that everything is relative; we are working with an imperfect and complicated system. Our mission, as always, is to assist consumers in making the best choice for themselves and their families. Additional services we offer are as follows:
• Group benefit consultation with start-up business owners
• Individual and group life insurance
• Dental and vision plans
We appreciate the loyalty and support of our great client base and look forward to assisting each of you in maneuvering through this health insurance maze. Best wishes and good health to all.

Sunday, May 1, 2011

July 1st, 2011 Rate Increases

July 1 rate increases were just announced for several major health insurance companies including Aetna and Anthem Blue Cross. Anthem has set up a website to assist members in transitioning to lower cost plans or checking out their options. Of course, we are always available to help. Just email me at calrep at or visit our website