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Vincent Rajkumar Profile picture
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Jul 28 • 11 tweets • 4 min read
When Medicare cannot negotiate this is what happens:

Revlimid price per month
~$4,500 in 2005
~$18,500 in 2022

This happens with numerous drugs. Not possible in any other country. @DavidP4AD oversight.house.gov/sites/democrat…

1/
Why would companies innovate when they can meet investor expectations by increasing the price of old drugs?

This pathway slows the number of innovative drugs are launched. Stopping this practice will lead to more innovation not less.
Happens with old drugs. Lifesaving drugs. From insulin and beyond. #Insulin4all
Happens with new targeted therapies.
So do I think there is a risk to true innovative drugs if Medicare negotiates and if price increases above inflation are capped? No

There will be more reward for better drugs. There will be more truly innovative drugs.
I will tell what we can do to help companies truly innovate: totally reform the regulatory process.

The FDA process and requirements have gotten ridiculously complex and demanding and contribute to high and rising cost of getting drugs approved.
A lot of stuff required give an aura of perfection and precision but accomplish nothing more than that. An aura.

So a randomized trial that can and should cost tens of millions costs hundreds of millions. Change that.
Second, reform the patent system for heaven's sake. You cannot allow patent life to be prolonged on an on with new and additional patents on the same drug. Laws have to be changed.

Eg: Ibrutinib ~88 patents. Launched 2013. Patent lasts till 2036. fiercepharma.com/pharma/don-t-u…
Third, reform the regulatory process so generics and biosimilars can enter more easily.

Set up reciprocal approval with selected European countries so regulators are not doing overlapping work when time is of the essence.
More solutions in this paper. @BloodCancerJnl nature.com/articles/s4140…
More on Medicare negotiation in this thread

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More from @VincentRK

Vincent Rajkumar Profile picture
Jul 29
This is not price increase for a newer more fancy and luxurious car over time. It's price increases of exact same insulin over time in the US. #Insulin4all pharmaceutical-technology.com/analysis/insul… Image
This is not a more fancy insulin in the US. It's the same kind of insulin that's sold in other countries for much less, even by the same companies. @TheEconomist Image
If you want to know how on earth is this possible please watch my presentation here.
Read 7 tweets
Vincent Rajkumar Profile picture
Jul 27
Bob Kyle described monoclonal gammopathy of undetermined significance (MGUS) in 1978. He wrote an update with 40 years follow up in @NEJM in 2018. Legend.

~5% of people age 50+ have MGUS. The main risk with MGUS is progression to myeloma at a rate of 1% per year. #MedTwitter
Some who don't know the history mistakenly state that the term MGUS was given because he didn't know it's significance. He very well did

He knew 1% with MGUS progress each year to myeloma. He called it MGUS coz prior to that the condition was called benign monoclonal gammopathy.
He chose MGUS because when you see the patient there was no way to predict whether the condition was truly benign or progress to myeloma. The word significance was specifically to state the uncertainty in a given patient whether malignant progression would occur or not.
Read 9 tweets
Vincent Rajkumar Profile picture
Jul 26
When it comes to the truth about prescription drug pricing always follow the money.

People who benefit from the current system will of course oppose any change. You will hear a lot of catch phrases and economic theories. Don't fall for it.
If you want to know how broken the system is see this thread.
If you would rather just listen or watch please check out this video from a Grand Rounds presentation I gave @MayoClinic

It's 40 minutes and you will learn how bad the current system is and what we need to do to fix it.
Read 5 tweets
Vincent Rajkumar Profile picture
Jul 24
Say you make a product that the government HAS to buy at whatever price you name. It's the Law. No ceiling.

You charge $150,000 per year. But you could charge $300,000 a year.

You could also increase the price coz you just felt like it.

That's our prescription drug system.
If you are the CEO of a company are you really going to want the system to change?

If you are an investor in the company would you really want the system to change?
What you do is to keep telling people how wonderful the current system is.

And how disastrous any change will be.
Read 6 tweets
Vincent Rajkumar Profile picture
Jul 23
Why should Medicare negotiate prescription drugs prices?

1/ In 2003, we passed a law that Medicare must cover prescription drugs (Part D). This was good. We simultaneously BANNED them from negotiating the price of the drugs. This was insane— it was a bad provision to start with.
2/ In a monopoly, even water will be expensive.

We cannot grant monopoly protection to Pharma, force Medicare to buy their monopoly product, and simultaneously ban price negotiation.

You are basically inviting Pharma to set high prices. It's a giveaway.
3/ Every other developed country recognizes that if you grant monopoly protection to Pharma product for many years and prevent competition, then you have the right to negotiate a fair price in return.

We are the outlier. We pay more for the same drugs— whatever Pharma wants.
Read 15 tweets
Vincent Rajkumar Profile picture
Jul 23
Important monkey pox update. @DrEricDing has been calling for this declaration for months.

COVID and ongoing efforts to eradicate polio are the only others in this category at present.
Check out this discussion on @ConvSix @ambassadorbrief
More here. @BBCNews bbc.com/news/health-62…
Read 4 tweets

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