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Vincent Rajkumar

@VincentRK

13 Nov

If prescription drug prices are very high and keep rising, if you reduce out of pocket costs for patients, premiums go up; if you reduce premiums, out of pocket costs for patients go up.

That's the truth.

You cannot have a system that relies on the generosity of Pharma to keep prices affordable. They will keep increasing drug prices to meet targets as the law allows them to set the price and prevents Medicare from negotiating.

Lowering out of pocket costs is a band aid.

You cannot give monopoly protection for >10 years and have no way of negotiating either launch prices or price increases. Particularly when the product is life saving.

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Vincent Rajkumar

@VincentRK

11 Nov

Singapore 85% vaccinated.

92,132 cases in last 28 days

98.7% mild symptoms or asymptomatic

0.7% needed oxygen
0.3 % ICU
0.2 % died

"Seniors 60 years old and above, especially if unvaccinated, continue to be more adversely affected by COVID-19."

channelnewsasia.com/singapore/covi…

As I look at these data, and what's going on in Europe, vaccinated younger people after vaccines and most elderly people are very well protected. But some elderly and immunocompromised may not mount a durable immune response after vaccines.

Boosters are therefore important for elderly and immunocompromised people. Early use of monoclonal antibodies are also important and should be used if available.

Read 4 tweets

Vincent Rajkumar

@VincentRK

3 Nov

Medicare Part D covers >3500 prescription drugs. Over 2400 of these are made by only one manufacturer (monopolies).

The prescription drug plan to let Medicare negotiate covers 10 drugs starting 2025. 20 drugs per year after.

Yet Pharma protests. Let's keep things in context.

@DavidP4AD

New drugs are protected for 9 years from time on market from negotiation. Biologics for 12 years. Price increases capped to inflation.

Which means expect Pharma to "front load" prices. That means make the launch price much higher to cover all of this loss of revenue. @DavidP4AD

Out of pocket for seniors capped. Good. Important.

But it also means someone still pays Pharma. That's Medicare. Which is back to us, the public. So it's not like Pharma is losing money that way either.

Read 4 tweets

Vincent Rajkumar

@VincentRK

1 Nov

COVID vaccines greatly reduce severe disease and deaths.

6 countries with delta waves. In each instance despite a rise in cases, deaths have stayed low this time around thanks to vaccines.

Note that even in countries like UK and Israel, one third of the population is not fully vaccinated. In absolute terms the numbers are high and allows virus to circulate.

Some vaccinated people are unable to mount an immune response due advanced age or cancer or other illnesses

To overcome these problems we need higher vaccination rates, booster doses at least for those at high risk, and continuation of preventive measures (masks and distancing) for some more time.

Read 4 tweets

Vincent Rajkumar

@VincentRK

31 Oct

@TheLancetInfDis

Headlines about a study in @TheLancetInfDis stating that vaccinated people are just as likely to spread Covid as unvaccinated are misleading. Here's why.

1) Vaccination has lower risk of transmission even in this study (see table) & severe disease.

2) This study is primarily on household contacts. Household contacts live with each other. So the exposure is prolonged and sustained. So differences between vaccinated and unvaccinated groups will narrow in household settings.

3) What the study shows is that transmission from vaccinated people to household contacts can occur but at lower rate than unvaccinated. It also basically explains why the delta wave has occurred in even in some well vaccinated countries.

Read 10 tweets

Vincent Rajkumar

@VincentRK

29 Oct

Vaccines protect better against COVID than prior infection. Let this please end the "natural immunity" talk. #GetVaccinated nytimes.com/2021/10/29/hea…

https://twitter.com/VincentRK/status/1447967441380859908

Infection with Covid does give some protection. But getting vaccinated after will augment that protection and make it more durable.

For more read my prior thread on why it's important to get vaccinated whether or not you have had COVID.

https://twitter.com/VincentRK/status/1447967441380859908

It really doesn't matter whether vaccines protect 5 times more than prior Covid, to the same level, or even a lesser degree than prior infection. Vaccines are a far safer way to get immunity if you haven't had Covid. And if you already had Covid, vaccines augment that protection.

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