It Could Happen Here - Why Do Medicines Cost So Much in the USA?

Episode Date: October 4, 2022

James sits down with David Mitchell of Patients for Affordable Drugs to discuss why medicines in the USA are unaffordable  and what we can do about itSee omnystudio.com/listener for privacy information.

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And today we are talking about America's drug problem. I'm joined by David Mitchell from Patients for Affordable Drugs. We're going to talk about the cost of medicines, why it's so astronomically high, why I sometimes go to Mexico to buy my insulin, and why you probably know someone who can't afford the medicines they need to survive or maybe thrive. David, can you explain a little bit about, first, if you'd like to introduce yourself and explain what Patients for Affordable Drugs does and the role that you play there, that would be wonderful. I am the founder and president of Patients for Affordable Drugs. We're the only national patient organization that focuses exclusively on policies to lower

drug prices. We're independent, we're bipartisan, we don't take money from any organizations that profit from the development or distribution of prescription drugs. We do two main things. We collect patients' stories and we amplify those stories to policymakers and elected officials so we can bring home the human impact of ridiculously high drug prices on the people in the United States. And the second thing is that we recruit and train patients to be advocates. We teach them about the policies, give them coaching on presentation,

and prepare them to go tell their story and deal directly with the people who set policy in this country. And so we've had patients testify in state legislatures all over the country. We've had patients testify in Congress on many occasions. Just last week, one of our patients, who happens to be a type 1 diabetic, introduced the President of the United States in the Rose Garden in a speech the President made talking about the new Inflation Reduction Act and how it's going to help lower drug prices and out-of-pocket costs for people. So that's our work. I do this work because I'm a patient. I have an incurable blood cancer. It's called multiple myeloma.

I have an incurable blood cancer. It's called multiple myeloma. It's incurable. That's not good, but it's treatable for some period of time with very expensive drugs. Right now, my oncologists have me on a four drug combination that carries a list price of more than $900,000 a year. Jesus Christ. These drugs are literally keeping me alive, and I'm very grateful to have them, but they're wildly overpriced. And the drug industry, drug companies exploit patients everywhere in the world, but especially here in the United States. They use us as a piggy bank to hit their targets for executive bonuses, to trigger executive

bonuses, and to hit profit targets for their shareholders. And the unfairness is not acceptable. The unfairness is not acceptable. Anyway, when I got diagnosed and suddenly I found myself with a disease through no fault of my own, it required very expensive drugs. I began this journey and the journey taught me a fundamental point, and that is that drugs don't work if people can't afford them. point, and that is that drugs don't work if people can't afford them. And so I retired and decided to devote myself as a patient to trying to change a system in this country that really is built to benefit the people who profit from it at the expense of the people it's supposed to serve. to benefit the people who profit from it at the expense of the people it's supposed to serve. And I work for free as a volunteer, and I've been doing it for six years.

That's great. Yeah, I'm sorry to hear about your own wealth, but I think it's a very admirable thing you've done. So David, can you explain, because it does, I think people sometimes, maybe if they've only lived in the US, they might not realize or perhaps they're extremely aware. Why are medicines so, why can I travel 16 miles, right? Go across the border, flash my passport at someone, have a bunch of scans taken, right? Go through a bunch of machines and then buy medicines for less than half the price on any given day. Why is it like that? and half the price on any given day. Why is it like that? It's like that because we are the only developed nation in the world

that lets drug companies dictate the prices of brand-name drugs to their citizens. Every other developed country in the world negotiates on behalf of their citizens directly with the drug companies to get a better deal. And we don't do that. The net result is that Americans are paying almost four times what other wealthy nations pay for the exact same brand name drugs. And the impact is that three out of 10 Americans report that they are not able to take their medications as directed because of the cost. This has a direct impact on health. And, you know, I understand that you are a type one and that you're insulin dependent.

And so, you know, the struggles and the high prices of insulin. But we've had five people confirmed dead because they tried to ration their insulin in the United States of America. In the United States of America, this happens because we grant the drug companies this incredible market power and we let them dictate the prices to us, prices that are completely unjustified. And patients suffer financially and worse because of their health due to these high prices. Yeah, I think it's just heartbreaking, this stuff. And I've known people who've died from lack of access to insulin, and it's just, it's pretty horrific stuff. Can you explain, because let's get into that lack of justification, right? There's ways that a drug, the things that make up the cost of a drug would be the research and development of the drug, the distribution of the drug,

and the marketing of the drug, and maybe something else I'm missing. But can you explain, like, how do we arrive at this insane price for insulin, which was synthesized in a lab more than 100 years ago? Like, what makes up that price structure, at this insane price for insulin, which was synthesized in a lab more than 100 years ago? What makes up that price structure? And how much would it actually cost to produce that insulin if we stripped away some of those things?

Well, you're asking a very intelligent question about what should exist but doesn't, and that is a framework to arrive at an appropriate price that will provide a reasonable return to the drug maker and ensure that drugs are affordable and accessible for the people who need them. We don't have a system like that. The drug companies charge as much as they think they can get away with, period. This was shown just last year when one of the drug companies named Biogen tried to bring a drug to market for Alzheimer's and proposed to sell it at $56,000 even though there was no proof it worked. And after it got big pushback and no one wanted to pay for it, the government, private employers, they cut the price to $28,000. Now, was it worth $56,000?

If it wasn't, then why didn't you just price it at $28,000 to begin with? Why? Because they thought they could get away with $56,000 a year for this drug. Now, where insulin is concerned, it's very unfortunate. There is an insulin cartel. Three companies control 90% of the global insulin market in the world and here in the United States as well. And some people would say correctly, you know, you have to call it correctly, an oligopoly. A small number of producers and sellers

who are controlling the market. And what happens as a result of that problem? Well, insulin costs roughly $10 a vial to produce. It sells for more than $300 a vial. It has gone up in price more than 600% in the last 20 years because of this cartel that literally controls the insulin supply in the world. I'll give you another example. I take a drug. It's called, for my cancer, it's called Pomalyst. It's an oral drug that I get under Medicare Part D. Pomalyst costs less than $1 per capsule to make. It sells for almost $1,000 per capsule. Jesus Christ.

Now, you cannot justify, you cannot tell me that there's justification for a thousand percent margin. It's just ridiculous. But because we do not use our power, our market power, to negotiate for a better deal, they can get away with it. And they do. And there are many examples of this. Now, all of that is about to change with some new legislation that has been enacted into law. It's about to start to change, I should be more precise.

And we can talk about that. Yeah, let's talk about that. One thing I want to get into first, I think, is this. I think sometimes we have this impression, certainly with new and novel compounds, that there's this massive lab, and it's entirely funded by the money that's made from selling other drugs. And in that lab, people are just all day cooking up cures to the Ebola virus or these various very deadly conditions.

So I wanted you to explain who pays for the R&D for the most part and who decides what that R&D focuses on. Because I think those are both very important topics. Yeah. focuses on? Because I think those are both very important topics. Yeah. Well, it turns out that every single drug approved by the FDA from 2010 to 2019, every one was based on, in some part, on science paid for by taxpayers through the National Institutes of Health, another organization in government called BARDA, and another organization in the government called DARPA. DARPA is who invented the internet, for example, and GPS.

We pay taxpayers billions of dollars every year to finance basic scientific research that lays the foundation for all these drugs. And when a drug company sees a drug that has promise, uh, it will try and acquire from the NIH or the other government agencies that do this work, fund this work, the intellectual property, and then they'll finish the job of running late-stage clinical trials and going through the process of gaining FDA approval. I'm going to say a couple of things here that are critically important to understand to try and illustrate this. The drug industry tries to take credit for the mRNA vaccines that were developed to fight COVID-19.

the mRNA vaccines that were developed to fight COVID-19. And these are the vaccines that are marketed by Pfizer and its partner in Europe, BioNTech, and by Moderna here in the United States. It turns out that in the 80s, 90s, and early 2000s, drug companies weren't investing in vaccines because they didn't produce a big return. So the federal government invested through NIH, DARPA, and BARDA, all of them, to develop the technology that we now call mRNA. So that when the virus hit, mRNA, so that when the virus hit, that technology was ready for Moderna and Pfizer to run with. But they didn't make the big investment. We did. We being taxpayers to get that technology

ready to go. And in the case of Moderna, we paid for everything. And I'm not exaggerating. They had never produced a drug. So we stood up manufacturing capacity for them. We paid for their late stage clinical trials. And we signed advanced purchase agreements to completely de-risk the enterprise. But they will tell you that they saved us. It's not true. We saved ourselves. They will tell you that they saved us. It's not true. We saved ourselves. There's a reason that the president who cares deeply about trying to reduce the death toll from cancer has to have this new organization called ARPA-H, which is going to be funded with billions of dollars to try and do something

to accelerate cancer research. Why do we have to pay for that? Because the drug companies will not pay for the high-risk, early-stage research that goes into getting really breakthrough new drugs to market. So who does this? Who pays for it? By and large, taxpayers are underpinning all the basic science. Drug companies are taking drugs that show promise, acquiring the intellectual property, and then charging whatever they want for the drugs. So that's our system in the United States of America. It's completely screwed up. We need to have a process more like what you described in posing this question, which is,

well, shouldn't we look at what the government invested, what the company invested, you know, what would be, what does it cost to manufacture the drug and distribute the drug, and all of that, and then arrive at a price that provides a fair return for investment in risk to the drug company, but not any price they want to dictate. That's what we have now, is they get the drug from us and they get to dictate the price. We don't have a system like the one you referenced. Yeah, and it's much to our detriment, right? And it's interesting, you talked about how this profit-driven model tends to focus on

certain conditions and not others. And I know that you focus mainly on the United States, but perhaps we could get into a little bit what that means for neglected diseases on a global scale, right? How looking at only patients who can afford to pay these inflated prices means that we're, or drug companies are sort of tacitly saying, well, we're okay with people dying from conditions that people don't get in America. Are you comfortable talking about that a little bit? Well, we only work in the United States because that is a big enough challenge for us. I will say that

for us, I will say that drug companies want to invest only in drugs that produce a big return. They're profit maximizers, they're corporations, and we don't have a way that we balance that out where we say, yes, but taxpayers are doing the foundational research that leads to these drugs. And these are, in that sense, public goods. And we need to figure out how, yeah, you can have a fair return't want to spend a lot of money on because those countries don't have a lot of money to pay for them. Because all the companies care about is honest to God. You know, they they want us to believe that they're all about looking after our well-being. that they're all about looking after our well-being. They are corporations, and corporations by law have to maximize profits for their shareholders.

And that's what they do. You know, who invests in neglected tropical diseases? The Gates Foundation and other foundations that put the money out to do that early stage research that changes the pricing equation, should change the pricing equation, so that we can still develop the drugs that people abroad would benefit from tremendously if only we made the effort and made the investment, which they're not inclined to do. Did that answer your question? Yes, very well, very well.

I think if people are looking for evidence on this, they could look at the speed at which we started to develop Ebola treatments and vaccines once that became a threat to us versus once it became a threat to people in the global periphery. By the way, I will say one more thing. Yeah, of course. It's not that drug companies only hurt people in poorer countries in the world. Yeah. It is that drug companies insist on high prices everywhere. And for example, the disease cystic fibrosis is incurable and there are new drugs that help people live longer. They are marketed by Vertex. Interestingly, the gene that all of these drugs are built on, the genetic component, was identified by the former head of the NIH, Francis Collins, when he was doing research paid for by the NIH at the University of Michigan.

His discoveries were seminal, but still the drug companies wouldn't invest. So the Cystic Fibrosis Foundation raised money from its community to do more early stage research. And when it showed promise, Vertex bought the intellectual property from them and brought these drugs that are built on that genetic discovery to market. But in countries that have said we can't afford the price you're demanding because we only have so much money to pay for our citizens for health care because we provide health care to all our citizens, Vertex will let people, kids, because it generally affects kids and younger adults, will let them die if the country's won't agree to the price that they are insisting on. Literally, let them die and say, look, if you won't strike a deal that has a high enough price for us, we're not going to sell the drug in your country. So it isn't only the poor people, you know, the poorer countries around the world.

It's patients who are stuck with a drug, a disease that requires a high-cost drug, and maybe they can't get access to it because it's not affordable for their country or them. Yeah, it's really pretty bleak stuff in that sense. Welcome, I'm Danny Thrill. Won't you join me at the fire and dare enter? Nocturnal Tales from the Shadows, presented by iHeart and dare enter. Nocturnum, Tales from the Shadows, presented by I Heart and Sonorum, an anthology of modern day horror stories inspired

by the legends of Latin America. From ghastly encounters with shapeshifters to bone-chilling brushes with supernatural creatures. I know you. Take a trip and experience the horrors that have haunted Latin America since the beginning of time.

Listen to Nocturnal Tales from the Shadows as part of My Cultura podcast network. Available on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. On Thanksgiving Day, 1999, a five-year-old boy floated alone in the ocean. He had lost his mother trying to reach Florida from Cuba. He looked like a little angel. I mean, he looked so fresh.

And his name, Elian Gonzalez, will make headlines everywhere. Elian Gonzalez. Elian. Elian. Elian. Elian. Elian. Elian Gonzalez.

At the heart of the story is a young boy and the question of who he belongs with. His father in Cuba. Mr. Gonzales wanted to go home and he wanted to take his son with him. Or his relatives in Miami. Imagine that your mother died trying to get you to freedom. At the heart of it all is still this painful family separation. Something that as a Cuban, I know all too well. Listen to Chess Peace, the Elian Gonzalez story, as part of the My Cultura podcast network,

available on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. I found out I was related to the guy that I was dating. I don't feel emotions correctly. I am talking to a felon right now, and I cannot decide if I like him or not. Those were some callers from my call-in podcast, Therapy Gecko. It's a show where I take real phone calls from anonymous strangers all over the world as a fake gecko therapist and try to dig into their brains and learn a little bit about their lives. I know that's a weird concept, but I promise it's pretty interesting if you give it a shot. Matter of fact, here's a few more examples of

the kinds of calls we get on this show. I live with my boyfriend and I found his piss jar in our apartment. I collect my roommate's toenails and fingernails. I have very overbearing parents. Even at the age of 29, they won't let me move out of their house. So if you want an excuse to get out of your own head and see what's going on in someone else's head, search for Therapy Gecko on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. It's the one with the green guy on it. Hey, I'm Jack B. Thomas, the host of a brand new Black Effect original series, Black Lit, the podcast for diving deep into the rich world of Black literature. I'm Jack Peace Thomas, and I'm inviting you to join me and a vibrant community of literary enthusiasts dedicated to protecting and celebrating our stories.

Black Lit is for the page turners, for those who listen to audiobooks while commuting or running errands, for those who find themselves seeking solace, wisdom, and refuge between the chapters. From thought-provoking novels to powerful poetry, we'll explore the stories that shape our culture. Together, we'll dissect classics and contemporary works while uncovering the stories of the brilliant writers behind them. Blacklit is here to amplify the voices of Black writers and to bring their words to life. Listen to Blacklit on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Let's get on to a little bit then of how we can make this better and i know that there are

approaches that are incremental and there are approaches that are more revolutionary or sort of making these big leaps so let's start with talking about how this legislation that we've just seen the inflation reduction act does that make a difference how much of a difference does it make and how does it make that difference? How much of a difference does it make? And how does it make that difference? The Inflation Reduction Act is really historic legislation that is going to save millions of people in America millions of dollars over time. It does four big things. It does many more, but four big things. One, for the first time ever, Medicare is going to be able toouging by forcing companies that raise prices faster than the rate of inflation to pay a rebate to Medicare. That will curb their price increases. Third, we are going to limit the amount of out-of-pocket annually a Medicare patient can pay under the Medicare Part D prescription drug benefit.

Right now, there is no annual out-of-pocket limit. I pay for that drug I described to you before that costs almost $1,000 a capsule. I pay out-of-pocket more than $16,000 a capsule. I pay out of pocket more than $16,000 a year. In 2025, there will be a limit of $2,000. No Medicare beneficiary will pay more than $2,000 out of pocket for Medicare Part D drugs. And for the first time starting next year, people who depend on insulin in Medicare will pay no more than $35 per prescription per month for their insulin. These are all truly significant changes and begin to shift drug policy in this country, begin to break the dictatorial pricing ability that the drug companies have. And I want to take a minute to explain why Medicare negotiation

in itself is such a big breakthrough. Very quickly, when the Medicare prescription drug benefit was enacted into law in 2003, the drug companies in the dark of night got stuck into that law, something called the non-interference clause that said that the Secretary of Health and Human Services could not negotiate directly with drug companies, period. It got stuck in in the Secretary of Health and Human Services could not negotiate directly with drug companies, period. It got stuck in in the dark of night by a man named Billy Towson, who was then chair of the Energy and Commerce Committee in the U.S. House of Representatives. And within months after doing that, at the behest of the big drug companies, he went to work to run the big trade association for the drug companies,

it's called Pharma, at a salary of $2 million a year. In other words, they bought the prohibition on Medicare being able to negotiate. And they have spent hundreds of millions of dollars to keep that prohibition in place ever since then. Just in the last two years, in fighting to not let Medicare negotiate over any drugs ever directly with the drug companies, they spent north of $200 million to try and stop that legislation from passing. So these are all big, significant, important changes. They are not enough.

If we ruled the world, we would have written legislation that negotiated over more drugs and the pricing for which extended into the private sector and to people without insurance. But we had to do that to extend it to the private sector and people without insurance. We needed 60 votes in the Senate because of the filibuster rules. And we couldn't get one, not one Republican vote. So it had to be passed under a special procedure called reconciliation. The Democrats used it. They stood up to pharma and they passed the bill.

God bless them. We, in the course of it, had a vote on trying to extend the $35 insulin monthly copay to the private sector. We could only get seven Republican votes. And so we couldn't take it all the way there. So there's much more work to do. But this breakthrough is truly historic. Yeah, it's good. It's good to see some progress because there hasn't been progress for a very long time.

Let's talk about the difference then between a cost and a copay because i think it's easy for politicians sometimes that you know tweet insulin will cost you x and in fact it only costs you x if y and z are true so can you explain for folks what a copay is and why sometimes these claims are made about copays and those are not the same as costs? Well, the big difference is the word price versus cost in our system. Yeah. We, in order to lower out-of-pocket costs for people, we have to lower price. Why? We have to lower price.

Why? If you were paying $100 out of pocket for your medicine, and we zero that out to nothing, but we don't lower the price, the overall price, that $100 has to be paid for by someone. And what happens is patients wind up paying higher premiums What happens is patients wind up paying higher premiums or higher taxes or getting less money in their paychecks. You know, half of more than half of all Americans get their drug coverage and health care through their employers. So if that hundred dollars still has to be paid by somebody, then we wind up paying for it, either with higher premiums, higher taxes, or getting less money in our paycheck because someone needs to absorb that hundred bucks.

This is very important for people to understand. There's no free lunch unless we lower prices. That's why pharma will always say, the big drug companies will always say, well, what we need to do is we just need to lower everybody's out of pocket, make it zero, and let them have all the drugs they want, and let us continue to charge any price we want. But that's not, there's no free lunch. It would still have to be paid. And so we fight very hard at Patients for Affordable Drugs to help patients and policymakers understand that we need to do both.

We need to lower out-of-pocket costs for people and we need go to the pharmacy counter and they tell you that your share of this prescription is $5 or $10 or $20. And lots of times employers and the insurance companies they hire to run their programs will use copayments to try and steer you to a less expensive drug, a generic. Yeah. Right? So if you want a brand, you're going to have to pay 50 bucks. But if you'll take the generic, you pay five bucks, for example. They're trying to steer you to an equally effective drug.

Generics are by definition the same exact drug. And they are trying to steer you to the less expensive but equally effective drug. Generics are by definition the same exact drug. And they are trying to steer you to the less expensive but equally effective drug. The problem with our country big time is that sometimes they are not used for that purpose. In my case, I have copayments on all my drugs, right? But I don't have a choice. I don't have a cheaper generic. I got to I got to take the drugs they're telling me to take. And so when we misuse copayments like that, we are hurting patients. And it's how we also need to change. It points to how we also need to change our benefit design in this country. to how we also need to change our benefit design in this country. If we can steer a patient to a healthier or as healthy, least less expensive option, that makes sense. But if you're charging

me for something that I can't do anything about, that makes no sense at all. And so these are changes that we at P4AD work on and will continue to work on in our benefit design in this country yeah I can see they're trying to give you a price incentive to what not buy your drug in your case or be poor or or be sick because you can't afford it which is really that's not the function of the incentive and it's silly. Welcome. I'm Danny Thrill. Won't you join me at the fire

and dare enter Nocturnal Tales from the Shadows presented by iHeart and Sonora. An anthology of modern day horror stories

inspired by the legends of Latin America. From ghastly encounters with shapeshifters to bone-chilling brushes with supernatural creatures. I know you. Take a trip and experience the horrors that have haunted Latin America since the beginning of time. Listen to Nocturnal Tales from the Shadows as part of My Cultura podcast network, available on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. On Thanksgiving Day, 1999, a five-year-old boy floated alone in the ocean. He had lost his

mother trying to reach Florida from Cuba. He looked like a little angel. I mean, he looked so fresh. And his name, Elian Gonzalez, will make headlines everywhere. Elian Gonzalez. Elian. Elian. Elian. Elian. Elian. Elian Gonzalez, will make headlines everywhere. At the heart of the story is a young boy and the question of who he belongs with. His father in Cuba. Mr. Gonzalez wanted to go home and he wanted to take his son with him. Or his relatives in Miami. Imagine that your mother died trying to get you to freedom.

At the heart of it all is still this painful family separation. Something that as a Cuban, I know all too well. Listen to Chess Peace, the Elian Gonzalez story, as part of the My Cultura podcast network, available on the iHeartRadio app,

Apple Podcasts, or wherever you get your podcasts. I found out I was related to the guy that I was dating. I don't feel emotions correctly. I am talking to a felon right now and I cannot decide if I like him or not. Those were some callers from my call-in podcast, Therapy Gecko.

It's a show where I take real phone calls from anonymous strangers all over the world as a fake gecko therapist and try to dig into their brains and learn a little bit about their lives. I know that's a weird concept, but I promise it's pretty interesting if you give it a shot. Matter of fact, here's a few more examples of the kinds of calls we get on this show. I live with my boyfriend and I found his piss jar in our apartment. I collect my roommate's toenails and fingernails. I have very overbearing parents. Even at the age of 29, they won't let me move out of their house. So if you want an excuse

to get out of your own head and see what's going on in someone else's head, search for Therapy Gecko on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. It's the one with the green guy on it. world of Black literature. I'm Jack Peace Thomas, and I'm inviting you to join me and a vibrant community of literary enthusiasts dedicated to protecting and celebrating our stories. Black Lit is for the page turners, for those who listen to audiobooks while commuting or running errands, for those who find themselves seeking solace, wisdom, and refuge between the chapters. From thought-provoking novels to powerful poetry, we'll explore the stories that shape our culture. Together, we'll dissect classics and contemporary

works while uncovering the stories of the brilliant writers behind them. Blacklit is here to amplify the voices of Black writers and to bring their words to life. Listen to Black Lit on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Can you explain how, why do some drugs have generics and some don't? So, boy, you're asking some really good questions. You're going right to the heart of our system. Thank you. A long time ago in the 80s, 83 or 84, a bill was passed called the Hatch-Waxman Bill. And since then, everyone refers to a concept called the Hatch-Waxman Bargain.

And the bargain is this. If you're a drug company and you bring a valuable new drug to market, you get a period of exclusivity along with your, you have a patent already probably, but upon approval, we give you a period of exclusivity where for sure, no matter if your patent is old and only has a year left, we give you additional years of exclusivity where you have a monopoly on that drug. But at the end of that period of exclusivity, generics and biosimilars, biosimilars are the generic name or the name for generics for biologic drugs. They're more complicated drugs. But at the end of that period of exclusivity, a generic, I'm not a generic, generics and biosimilars come to market

and we use the competition from the generics and biosimilars to drive down the price. When you have one generic that comes to compete, the price goes down about 15 or 20 percent. Two generics, the price goes down 35 to 40 percent. Three generics, you know, 40 to 30 percent. By the time you get five generics in the market, the price is roughly 5 to 15% of the original brand name price. So the Hatch-Waxman bargain was, you got a good drug, you bring it to market, we give you a time where you can charge whatever you want, you have exclusivity in the market. But at the end of that, we have competition from generics and biosimilars to lower price. Why aren't there generics and biosimilars? That was your question. For all drugs, well, some drugs are still in their

period of exclusivity, but the drug companies don't let competition come to market. The brand drug companies, they fight. They file additional patents. They sign deals with generic companies not to bring a drug to market, a competitor to market, and pay them not to. in the drug and then file additional patents. There is something called a patent thicket. Humira, the best-selling drug in the world, has like 132 patents. 132, 75% of which were filed after the drug came to market. What are they for? Well, they could be for the packaging, the instructions, the color of the capsule. They patent everything.

And why? Because a generic or biosimilar competitor has to fight its way through all of them to bring a drug to market. So we call them patent thickets. You know, if you grew up anywhere near, you know, a place where there were thickets, you know, it's very hard to get through a thickets. You know, if you grew up anywhere near, you know, a place where there were thickets, you know, it's very hard to get through a thicket. And so in some cases, there's no competitor because they're in the period of exclusivity. But in far too many cases, there are no competitors to drive down the price because the drug companies are manipulating our system. And they're very good at manipulating our system. Yeah, yes, they are exceptionally good. And that has terrible results. Okay, so we've spoken about that, the way that they've manipulated the system, the way that maybe that's beginning to change.

One thing that I'm interested in, I've written about it a little bit, is these ways that are perhaps more revolutionary, if not always as cast iron safe. And one of those is obviously people making their own medicines, which is something that we'll see, unfortunately, increasingly in this country because of bans on access to reproductive health care and i wonder how you think that has the potential to change this there's we've seen like the epipencil we've seen these home brew abortion drugs things like that do you think that has the capacity to change access well remember i'm a patient and um it scares the hell out of me. Yeah. And the reason is there was a time in the United States

and in most of the world when drug companies were not regulated. And they brought, you know, patent medicines and, you know, mix-it-at at home brews and sold them. And we had no way to make sure that those didn't hurt people. They killed people in some cases. And then in the 20th century, the government realized and our Congress and our elected officials realized we needed a way to

regulate this industry, which would, you know, sell poison in some cases. And they created what is now called the Food and Drug Administration. Food and Drug Administration is charged with making sure drugs are safe and effective. I'm a patient. I want the Food and Drug Administration to do its job. I want drugs that are safe and effective. are not subjected to some scrutiny to make sure that they do what those who are selling them claim they do. So remember, I'm not big on taking chances with my life. And if the drugs don't work, I'll die. That's that simple. I'll die of cancer. Not to mention I could die from a drug that's no good.

Some drugs cause harm, you know. Even drugs approved by the FDA cause harm sometimes. So I am not a fan of homebrew drugs. I am a fan of a system that protects me and ensures that drugs are safe and effective. But that's one man's perspective. Yeah, I think it's reasonable to say that we have a way to make drugs that are safe and effective. And it's the law, legislation or a system that's getting in between people and the life-saving medicines that they need. system that's getting in between people and the life-saving medicines that they need and we should certainly struggle to fix that instead of looking for ways around it even though i

understand why especially with things like reproductive health care that doesn't seem like it's getting fixed anytime soon sadly no no it is it's terribly sad it's heartbreaking yeah this whole thing is extremely and i know uh you've obviously seen it too but my previous life i've worked with one of uh someone who works for you now in diabetes non-profit and seen firsthand the uh consequences of this and it's really heartbreaking stuff to look at and i wish it just seems so unnecessary in a world where like these pharmaceutical companies make we should say like billions of dollars right it's it's not as if these people are you know driving to work in a

second-hand toyota corolla like they they are doing very well for themselves off this system right yep people will be familiar with uh like pharma bro uh martin screlli the guy yeah yeah but this is just one example of a very problematic industry i think you've done an excellent job of explaining it david is there anything else you'd like to get to before we finish up here just martin screlli you you call to mind i'm going to take you back to moderna and the the mRNA vaccine and the fact that we not only developed the mRNA technology with taxpayer money, but we brought the Moderna vaccine to people with taxpayer money. And in the course of doing that, we minted three new Moderna billionaires. You're talking about them not driving to work and, you know secondhand toyota corollas oh far from it yeah these are the people whose yachts i see in the bay i think that's disgusting three

new millionaires off the back of billionaires billionaires god yeah god it's gross isn't it yeah it it can't be said enough like not only does the NIH fund their research but often the taxpayers will fund the lab right if it's at a university you pay for it twice before yes before you try and pay for it again so yeah it's a very broken system David how can people find uh P4AD how can people find you is there a website, a Facebook? Where should they go? Go to our website, patientsforaffordabledrugs.org, just like it sounds. You can leave your story if you or someone you love, care about, has struggled with high drug prices. Give us your email address.

We don't ask patients for money, but the stories and the email addresses are our power. They're the currency we trade on to make sure that the voices of people in this country are heard to counter the propaganda and lies that are put out by the drug companies. Okay, yeah, that's very important stuff that people can hopefully do, even if they are struggling sort of materially to afford their drugs, maybe they have some time. So that's great. And it's 4FOR, right?

Not the number four. That's correct. All right, great. Thank you so much, David. It's been a pleasure. You've done an excellent job of explaining a very convoluted and broken system. Thank you for taking this. James, you're a patient man. I try to be. Sometimes I'm very much not that. But yeah, I do appreciate your time on this

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