Price negotiation does not save money when keep you paying for drugs that don't work
Price negotiation does not save money when keep you paying for drugs that don't work
The Biden Administration saves 6 billion and then loses tens of billions with bad drug policy
This week, the Biden administration announced that drug price negotiation has lowered costs. They claim 6 billion in savings. While it seems like negotiation will lower spending, here are 3 reasons why these savings will be lost.
They lowered the price of a drug that has no good evidence it is better than older drugs. Consider Entresto (above). Entresto— sacubitril valsartan 160mg BID— beat enalapril 10 mg BID in PARADIGM. Since then it failed in post MI and in HFpEF. It’s one the few drugs that ‘works’ in HFrEF but not post-MI. The dose tested in Paradigm was the MAXIMAL Entresto dose with a dizzying dose of ARB. But few people get this dose in real life. There is NO EVIDENCE that the prescribed doses in the US in 2024 (lower than maximal dose) are better than ace-s, which are dirt cheap. There is many more problems with PARADIGM. They compared max dose Entresto against half dose enalapril and double drug run in peroids. I explain in this video how this biases the study. FDA never asked for a confirmatory study. So congrats on lowering the price, but we would be better off giving ACE-s and not being duped by the company and conflicted cardiologists. Even re-runing a trial in HFrEF would be better than negotiating price.
You can lower the price of drugs, but you lose when you spend billions on covid drugs that have no evidence of efficacy. In recent years the Biden administration approved COVID boosters for toddlers, and spent 10 billion on Paxlovid. There is no evidence either of these interventions work in the current climate. So congrats on your 6 billion in savings, too bad we blew 10 billion on unproven products. (Net impact -4 billion dollars)
For every drug you negotiate prices on, the FDA is approving at least 5x as many new drugs based on poor evidence. These can cost, per person, millions (gene therapy), hundreds of thousands per year (cancer), and even thousands per month (weight loss). Many of these drugs are bad approvals. E.g. Peter Marks overrode FDA reviewers to approve a gene therapy that failed.
Aducanumab was a horrible approval. We are poised to spend billions on Alzheimer’s drugs that may have nearly no real world clinical impact. (the trials are inadequate to gauge this). So again, congrats on saving pennies, when you are about to hemorrhage dollars.
In conclusion, it’s hard for me to believe that anyone is serious about lowering health care spending. Drug negotiation is a band-aid on a hemorrhage. Politicians are raising funds from pharma and doctors are stuffing their pockets with pharma cash.
To me the height of hypocrisy is Ashish Jha, former Biden employee, praising drug price negotiation, while he spearheaded efforts to push Paxlovid and give boosters to toddlers who already had COVID. He wasted more money than negotiation can ever save. Mission accomplished!
Someone wrote to me saying some people are allergic to ace-i and need entresto. These folks can take valsartan alone, which is cheap. No data that adding sacubitril is superior.
Your observations will fall on deaf ears. I suspect that there was not a single medical expert involved in these negotiations since they were entirely political and not medical.