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Clinton Offers Plan to Check EpiPen Price Hikes

EpiPen pack
It won’t sting as much if President Clinton has her way.

Our next President yesterday gave more specifics about her new plan to keep life-saving drugs and other prescription medicines affordable than her opponent has said about all of his policies all summer. Responding to big price hikes for the EpiPen and other pharmaceuticals, Hillary Clinton says she will work with federal agencies, patient advocates, medical experts, and state and local officials to crack down on “unjustified, outlier” price increases, which she defines with three criteria:

An unjustified price increase would be determined by a review of criteria including: 1) the trajectory and scope of the increase in price; 2) changes in the cost of production; and 3) the treatment’s relative value to patients, among other factors that give rise to threatening public health [Hillary Clinton campaign website, “Hillary’s Plan to Respond to Unjustified Price Hikes for Long-Available Drugs,” posted 2016.09.02].

Clinton would also have the government purchase and provide generic alternative drugs, import foreign alternative drugs, and penalize price-gougers. Longer-term, Clinton would require insurers to cap monthly out-of-pocket payments for prescription drugs, speed up FDA approval of generic drugs, ban agreements that drug manufacturers use to delay production of generic alternatives, eliminate corporate write-offs for drug ads, require pharmaceuticals receiving federal support for research and development to invest certain amounts of their own money in R&D, and finally fix the hole the second President Bush left in the Medicare drug benefit by allowing Medicare to negotiate drug prices.

But I’m particularly intrigued by this idea of forbidding “unjustified, outlier” price increases. Our Public Utilities Commission has the power to do that with prices for electricity and telecom services; why not require drug companies to do the same with their vital products? If a drug company can show that ingredients or production equipment or shipping costs more or that they’ve improved the drug to cure more cases or reduce side effects, then sure, let them charge more. But if they can’t show increased production or distribution costs or increased value for customers, they don’t get to soak sick people in a monopolized market.


  1. Darin Larson 2016-09-03 23:01

    This is a coherent sensible policy proposal by a serious presidential candidate with real world solutions who cares about everyday Americans.

    I view this issue as really a distortion of the marketplace based upon an abuse of monopolistic power. This monopolistic power cannot stand, especially when it impacts the ability of people to obtain life saving medical treatment.

  2. Mark Winegar 2016-09-04 04:57

    This is one area in which we can impact health care costs and therefore insurance premiums. We should act assertively and aggressively to regulate the pharmaceutical industry and end it’s monopolistic hold on this segment of the economy.

  3. Greg 2016-09-04 08:54

    If Hillary could really do something about it ,why didn’t Obama do something thing to fix it. Oh that’s right he had been busy playing golf.

  4. jerry 2016-09-04 09:00

    Take a look at your right wing congress Greg, they would not pass a bill that would help the American people get a fair shake from corporate America, their bosses. The congress could do something when then come back from golf about regulating drug prices like we have with the VA.
    Come to think of it, we have the same kind of obstructionism right here in South Dakota, so it is your lucky day that you do not have to go far to see corrupted democracy.

  5. Sam2 2016-09-04 09:17

    Vote Trump. The Clintons have never fixed anything. Just more chatter from Crooked Hillary.

  6. Darin Larson 2016-09-04 09:19

    Greg, Congress (that branch of the government currently controlled by Republicans) could have a bill on Obama’s desk shortly after they get back from their latest recess. You are right, why should we have to wait until Hillary is sworn in on January 20th? Get the Republicans in Congress on this ASAP. What’s that? They don’t really care about regulating big Pharma? They have to get back to dialing for dollars? Maybe they should take up golf instead.

  7. mike from iowa 2016-09-04 09:24

    The sinate only scheduled around 80 work days this year. Obama could mail in the rest of his presidency and still be more effective, more diplomatic, more christian and a hell of a lot better human than any and all right wing scumbags combined.

    Wingnuts have already promised more Clinton investigations for the next Potus term. What a waste of money, oxygen and space.

    American voters have it within their power to fire every last mother’s son that wraps themselves in the US flag and then wipes their lily white asses with the constitution.

  8. Darin Larson 2016-09-04 09:25

    Sam2, what’s in it for the Trumpster?

  9. Darin Larson 2016-09-04 09:32

    MFI, 80 work days and they wasted half of them voting to repeal Obamacare instead of working to improve our healthcare system, the economy or doing anything of substance. This was a do-nothing NoBama Congress of historic proportions.

  10. jerry 2016-09-04 09:35

    Some news outlet should ask Thune, NOem and Rounds what their position is on price gouging and if they support a plan to check the outrageous pricing we have for pharmaceuticals. Obama cannot do a damn thing without congress and neither can Clinton that is a real effective way to do that price control.

  11. mike from iowa 2016-09-04 11:32

    Actually, the house is in session for 89 days and the sinate for a little over a hundred. Still a huge waste of taxpayers bucks to fund the do nothings.

  12. Darin Larson 2016-09-04 12:10

    mfi, And just because they are in session, doesn’t mean they are actually getting any work done. If they were paid by the work they actually accomplished, they would be making minimum wage.

  13. Don Coyote 2016-09-04 12:20

    Jeebus! Pre-filled syringes of epinephrine cost about $10 and you can get insulin auto-injectors for about $30 that use the pre-filled syringes if you are uncomfortable with self injection or don’t feel confident with somebody else injecting you or your kids. 2 packs of Adrenaclick brand epinephrine pens are available with online coupons for about $140. This is hardly rocket science and certainly doesn’t require price controls.

  14. jerry 2016-09-04 12:41

    They are not the same Don.

  15. Tim 2016-09-04 12:49

    If Hillary could really do something about it ,why didn’t Obama do something thing to fix it. Oh that’s right he had been busy playing golf.

    Vote Trump. The Clintons have never fixed anything. Just more chatter from Crooked Hillary.

    This is all the right wing has to offer?

  16. Darin Larson 2016-09-04 12:53

    For Coyote’s reading pleasure:

    Why you shouldn’t use a vial and needle to replace the epipen.

  17. Darin Larson 2016-09-04 12:59

    “We’re seeing a lot of [people struggling to afford their EpiPens] because of high-deductible [insurance] plans or patients being inadequately insured,” said Sakina Bajowala, M.D, a board-certified physician in pediatrics and allergy and immunology practicing in North Aurora, Illinois. “The root cause of this is that Mylan has made the poor decision to jack up prices by hundreds of percents over the last few years.”

    “At the end of the day, we need to not have a monopoly in the marketplace,” Bajowala said. “The FDA is going to need to fast-track approval of alternatives for the EpiPen device so there is competition in the marketplace and the price can be driven down to more affordable levels. Having a monopoly in this area has encouraged greed. We need to have more options available and more safe options available.”

  18. caheidelberger Post author | 2016-09-04 14:04

    Sam2, Trump hasn’t even addressed this issue and probably can’t.

    Darin and Mark use the key word: monopoly. Free market supporters understand you don’t have a free market under monopoly. Adam Smith and Teddy Roosevelt would be fine with Clinton’s drug-price plan.

  19. Tim 2016-09-04 15:36

    Cory, Trump hasn’t addressed any issues, generalizations and innuendo is all we get from him. What few things he says he will do he can’t, that little thing called the Constitution will get in his way. You know, that Constitution that the right claims to worship so much.

  20. mike from iowa 2016-09-04 16:22

    Clinton has a plan. Wingnuts have a counterplan. Clinton wants to take a step forward. Wingnuts try to push her and America back two steps and then start another worthless/wasteful investigation.

    Wingnuts have the power to make lies of every Clinton campaign promise-just as they did with Obama. Our country, in the meantime, is devoid of critical leadership and directions because of petty wingnut partisan hate.

  21. Don Coyote 2016-09-04 17:58

    @Darin Larson: “Why you shouldn’t use a vial and needle to replace the epipen.”

    I see reading comprehension has suffered a quick death in your mind. I didn’t say “vial and needle”. You can purchase pre-filled syringes, as in filled by the manufacturer, in the same dosages offered by EpiPen™ (adult or child) for approximately $10 a syringe. Load these into an auto-injector (which is all an EpiPen is) for $20-$30 and you have a DIY EpiPen™ at a fraction of the cost. No fumbling or farting around with loading syringes or having to be trained on injecting yourself or others. Or go buy an Adrenaclick™ for a sixth of the cost of an EpiPen™.

  22. jerry 2016-09-04 18:12

    What if your insurance does not cover lt.

  23. Darin Larson 2016-09-04 18:48

    Coyote, so you are saying that there are auto injectors approved for use with epinephrine syringes that are not preloaded?

    I thought they pulled one brand of preloaded auto injectors specifically designed for epinephrine injections because they weren’t accurate enough, but you are saying you can use an off the shelf auto injector, insert your own syringe and everything will be fine? Can you point to the medical science approving of this method?

    If what you say is true, why is there an uproar in the medical community? Vast left-wing doctor conspiracy?

  24. barry freed 2016-09-05 08:22

    The advertising highway is useless at times….

    What was the year Congress and the President outlawed re-importation from Canada? Was it Obama or Bush? Fortunate enough to not need them, the exact time is forgotten.

  25. mike from iowa 2016-09-05 13:18

    Interesting article from congressional record-2003- about re-importation of drugs from Canada. Start in middle of second column.

  26. caheidelberger Post author | 2016-09-06 07:41

    Thanks, Mike!

    How did NAFTA not allow for free trade in prescription drugs?

  27. Wayne B. 2016-09-06 09:20

    This comes from someone who has a family member with life-threatening allergies.

    Alternatives exist.

    The problem is EpiPen is a household name. You need to be an informed consumer of healthcare services, just like you need to be an informed consumer of other products and services.

    Pharma is taking advantage of how slow the FDA is moving to approve generics; there’s a backlog of over 4000 generics awaiting approval. I wish Sen Grassley would spend some time asking why we’re taking so long to get those drugs approved.

    Competition is the only thing that will keep our costs down.

    That means allowing the federal government to negotiate pharmaceutical prices for Medicare, Medicaid, and veterans healthcare.

    It means allowing insurance companies to sell across state lines.

    It means mandating upfront pricing for all healthcare services to allow consumers to shop around.

  28. mike from iowa 2016-09-06 09:30

    Wingnuts have a plan,too. Chaffetz just announced another investigation into HRC’s emails. DC and congress must have nothing better to do.

  29. caheidelberger Post author | 2016-09-06 13:38

    I’m totally for speeding generics to market to drive competition. I’m totally for upfront pricing on all health care services: show me an exact price tag on every pill, bandage, and procedure so I can make something closer to an informed, rational market decision.

    The state lines policy still makes me hesitate… but how about promoting that competition by allowing us all to buy into state-line-ignoring Medicare?

  30. Wayne B. 2016-09-06 14:18

    I’d be all in favor of allowing people to buy into Medicare.

    But why leery of state-line-crossing insurance? If we could get 4 insurance companies to offer plans on the exchange rather than one, it’s more competition. It’s also better purchasing power and more diffuse risks.

  31. caheidelberger Post author | 2016-09-06 17:23

    We agree on public option! Now we’re making progress.

    I’m leery on state-line-crossing insurance because it doesn’t appear to work. Insurers don’t want to buy into it… and who’s going to regulate? If we sell across state lines, do we need to create a national insurance board to replace or supplement state boards? And don’t insurance companies already set up shop in multiple states and sell health insurance?

  32. Wayne B. 2016-09-06 22:38

    Wow, Cory… those all sound like pretty whiney excuses not to allow multi-state insurance. Fact is, if we open up Medicare for public buy-in, then it’ll force a lot more insurance companies out of business. The only way to compete, then, is to attain scale.

    Being an insurance company covering 35,000 people won’t suffice. You’ll need millions to survive on the thin margins.

  33. caheidelberger Post author | 2016-09-08 09:06

    Whiny? The fact that insurers themselves don’t buy into cross-state sales when offered the chance seems to be a pretty serious reason to oppose the idea.

    The regulatory question is also not trivial. If Sanford sells South Dakota policies to folks in Minnesota, which state’s insurance commission regulates that sale? Perhaps these regulatory questions are moot under the ACA’s minimum coverage requirements, but if ACA doesn’t prescribe certain requirements, then which state does, the buyer’s or the seller’s?

    And are current health insurers really just single-state companies? Don’t insurance companies already do business in multiple states? Doesn’t that provide them enough scale to compete?

  34. Wayne B. 2016-09-08 10:01

    Yes, whiny, Cory. There are legitimate policy hurdles to overcome, but you’re not willing to expend any intellectual effort to make a system workable because you’d rather it be completely provided by the federal government. The government shouldn’t be the sole provider of health care; we’ve seen what can happen in the V.A. when left to its own devices.

    Why is it I can buy car insurance from Iowa, but cannot buy health insurance from there? My life insurance comes from Connecticut, New York, and Wisconsin, and we’re using New York State’s 529 because it’s the best-performing in the nation with the lowest fees.

    Who regulates each of those sales? Somehow we’ve managed to figure it out and make it work. Health Insurance isn’t unique; it’s another service we are forced to purchase.

    There are only artificial barriers to preventing interstate commerce. Remove those artificial protections

    Sunlight and competition are required. And in an age when everything from banking to groceries can be purchased across state lines, there’s no defensible reason for insurance to be stopped at the border. The reason Medicare is effective and relatively efficient is because of its scale. Currently for insurance companies to exist in multiple states, there is a great deal of waste spent complying with each state’s mandates and bureaucracy. The ACA has removed some of those barriers with the creation of specified metal plans with mandated coverage. There’s no reason to artificially limit those plans at state lines.

    Sanford and Avera would be forced to improve their crappy insurance plans when faced with Kaiser & Geisinger muscling their way into the state, or BCBS’s competitive advantage if they didn’t have to duplicate administrative forces for each state they were in.

    Larger pools = more diversified risk and lower overall shared burden. Allowing the private sector to compete is good for the nation. It also allows for innovative solutions that the monolithic CMS cannot offer, not to mention the private sector can negotiate reduced pharmaceutical prices.

    The ACA has layed the groundwork with established minimums & tiers. It disallows exclusion of pre-existing conditions. So we have a bare minimum set of essential protections for consumers.

  35. caheidelberger Post author | 2016-09-10 06:58

    The VA has problems, but it has also provided the best care in the country for veterans. Would you really rather throw veterans into a private system, where insurers will not be eager to take on another cohort of customers with greater health care needs?

    Or, short of setting up not just single payer but single public provider, what’s wrong with opening medicare to everyone?

    Why should I exert myself to find ways to make a private system with its hodgepodge of coverage and greater inefficiency when the simpler solutions of the public option and single payer are available? I could make the extra effort to keep that old 1978 Bronco running, or I have no more moral obligation to do so, especially not when I could invest in a new, more efficient Beetle.

    As I linked above, some states have removed the barriers to interstate health insurance sales, and insurers didn’t bite. Why not?

    But hey, if the ACA is setting minimum standards and thus assuring that we won’t see a race to the bottom in quality of coverage, then (1) cheers to President Obama and (2) bring it on… in conjunction with a public option. I’m just not going to be wedded to a private system that has delivered double the healthcare cost without better health outcomes compared to the rest of the developed world.

  36. Wayne B. 2016-09-10 13:55

    Why should I exert myself to find ways to make a private system with its hodgepodge of coverage and greater inefficiency when the simpler solutions of the public option and single payer are available? I could make the extra effort to keep that old 1978 Bronco running, or I have no more moral obligation to do so, especially not when I could invest in a new, more efficient Beetle.

    Except, for some reason, someone decided there would be special rules governing 1978 Broncos that don’t apply to other vehicles, which drive up the cost of parts & maintenance. Get rid of those special rules and it’s no more costly than other vehicles to keep running

    -The VA is the best care for veteran-specific issues like amputations and to some extent TBI. But there are a LOT of problems with the system still. Long wait times, fabricated efficiency, needing to travel long distances for routine care, bypassing local care providers, etc. are just a few.

    I won’t deny that very few insurance companies cross state lines, despite having a whopping four states that have made it “easier” to do so. But if you open up Medicare to everyone, now you have a potential pool of 300+ million people. At that point, it’s going to be tough for insurance companies to compete unless they can get large, spread out risk pools.

    Non-populous states will be at a disadvantage – small insurance companies will most likely close shop, essentially forcing everyone into one option.

    But perhaps this is the biggest reason. From a hospital / clinic finance standpoint, the only way they keep the doors open is through charging more for uninsured / insured to make up for the below market rates CMS pays.

    So if CMS’s share of hospital / clinic financials increases beyond the average of 30% it is now, the more will need to be required from the remainder in order to keep the doors open (or we go without capital equipment, physicians, or allied health professionals).

    So maybe you go all out and get yourself a Prius. But you’re not paying enough in gas tax anymore to keep the road maintained.

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