The Daily Rise: Friday, April 8

Insulin Innovation

The cost of treating diabetes could soon be decreasing for more than six million patients, thanks to expected competition from biosimilars.

Modern Healthcare’s Steven Ross Johnson reports that insulin prices have more than tripled in the past decade. His story, titled, “Innovation a factor in insulin drug prices tripling over past decade,” curiously points the finger at innovation.

Citing numbers from a new study published in JAMA, Johnson notes that insulin prices have increased from an average of 63 cents per day in 2002 to $2.01 per day in 2013. Over the same period, metformin, a treatment that controls glucose levels for Type 2 Diabetes patients, has plummeted 93% from $1.24 per tablet in 2002 to 31 cents in 2013. Meanwhile, the cost of DPP-4 inhibitors, which control blood glucose levels in type 2 diabetes patients, increased just 34 percent from 2006 to 2013.

Rather than blame innovation, shouldn’t we be heralding all of this innovation as a good thing? Insulin has been a one-size-fits-all approach to diabetes. New treatments are an improvement and have been accompanied by drops in the prices for these new and improved treatments. We’ve come a long way since the 1920s when doctors first began extracting insulin from cattle.

And the good news from innovation is continuing: biosimilar treatments are expected to bring about a 40 percent reduction in treatment costs.

Value Frameworks Only Scratch the Surface

More and more people are beginning to understand the flaws with and dangers posed by recent “value frameworks.”

“Our current measures of value are not only too narrow but are shortsighted,” Anupam B. Jena and Tomas J. Philipson caution in a piece published at Forbes. “Pricing and coverage decisions made on the basis of incomplete value frameworks run the risk of reducing future innovation by penalizing drugs that actually offer value to society.”

Our health care system needs to keep costs in check. But, we have to tackle the problem in the right way — and not let some interests control the debate by scapegoating certain treatments. For example, specialty drugs, which provide life-saving treatments to a small group of patients, represent just 4 percent of all health care spending — yet dominate the news coverage.

“Drugs that are viewed as ‘expensive’ today inevitably decline in price either after other competing drugs to treat the disease enter the market or after losing patent exclusivity, which means that at the value provided rises over time,” Jena and Philipson wisely point out.

Lethal Price Controls

Thomas P. Stossel, the American Cancer Society Professor of Medicine at Harvard and visiting scholar of the American Enterprise Institute, argues that “misguided academics” are pushing 2016 presidential candidates’ plans that embrace price controls for medical treatments.

“Hilary Clinton proposes caps on drug prices and a mandate that pharmaceutical companies spend a preset percentage of revenues on research and development…Bernie Sanders wants us to purchase drugs from single-payer government healthcare Canada that sets drug prices, thereby importing our Northern neighbor’s price-control policy.”

Both proposals would rely on government-funded research through universities and research centers to drive innovation.

“The politicians’ proposals backed by these academic pundits are intuitively appealing — and dangerously false,” Stossel warns.

That’s because nearly “90% of drugs arise solely from industry – not government funded research.” University professors and researchers prioritize new findings that can be published in journal articles – not incremental improvements that yield big results for patients.

State Spotlight: Minnesota Patient Records

The Star Tibune’s Jeremy Olson reports that “a growing number of Minnesota doctors are giving patients unfiltered access to their clinical notes in an effort to help them understand and follow treatment recommendations.”

We’ve written before about the value in sharing records directly with patients. We see it as an opportunity to better explain treatments and ensure doctors are accurate in their record-keeping. However, as patients obtain their files, there’s a learning curve.

“To many patients, SOB does not mean shortness of breath,” warned Dr. John Santa, a Portland, Ore., physician and national advocate for a movement, known as OpenNotes, to share medical records. “Everybody, I think, has an interest in this kind of transparency,” Santa said. “[But] you do have to change the culture of doing notes. Acronyms are a problem. Culturally insulting language is a problem.”

  • PRN: (as needed)
  • C/O: (complaint of)
  • VSS: (vital signs stable)
  • FX: (fracture)
  • NPO: (nothing by mouth)

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