Physicians Role in Drug Pricing

Two new drugs, Repatha and Praluent, were approved by the Food and Drug Administration several months ago amid much ballyhoo. Both are antibodies that specifically target PCSK9, a protein which reduces the number of receptors on the liver that remove LDL cholesterol from the blood. By blocking PCSK9’s ability to work, more receptors are available to clear LDL. This novel mechanism was proven safe and effective in clinical trials, lowering LDL cholesterol levels by 40% or more in patients already taking statin drugs. However, powerful treatment comes with a powerful cost-- over $14,000 per year for each patient.

This concern over pricing gained traction by a recent report by the Institute for Clinical and Economic Review (ICER), a nonprofit organization that gained credence by its previous warnings over the cost of new hepatitis C drug regimens. The analysis was a computer simulation of the adult American population calculating the price of purchasing the drug and the potential cost savings from reduced death, heart attack and strokes due to drug efficacy over the next 20 years. This cold-hearted mathematics puts a price tag on each additional “quality-adjusted life year”, which health economists use to determine cost-effectiveness. These calculations do not reflect scientific certitude and are obviously subject to criticism and alternative modeling. However, the ICER report is used by many large health plans to push back on the pharmaceutical industry and negotiate discounts. And since the ICER analysis priced the new drugs at $3,600-$4,800 a year, this could be a giant shove, not a nudge.

Although the methodology may be arcane, the issue is overt. Given the number of hypercholesterolemia patients requiring lifetime therapy and the known benefits of lowering LDL on morbidity and mortality, the indiscriminate utilization of these potent agents could break the healthcare bank. For the total American population, not a particular patient, is there a better alternative utilization of this money?

Now comes the doctors’ dilemma; what role should physicians play in this controversy? We are the ones actually prescribing the medication at the point of service. Do we abdicate responsibility under the rationalization that we are only doing our job and acting in the best interest of our patients? And these drugs lower LDL cholesterol better than any alternative. Or should we weigh in? In the big picture, there is a potential guns or butter situation. Also, the facts are that these drugs only lowered LDL, but whether they will prevent cardiovascular events is only surmised from our past experience with the lipid-lowering effect of statins. Statin efficacy is predicated on modulating the microvascular interface of endothelium and blood as well as decreasing LDL. The relative value of each is unknown and the PCSK9-inhibitors may differ from other agents, for better or worse. In my mind, a responsible stance is to prescribe these new drugs only in the population studied, i.e. patients with persistently elevated LDL despite optimal statin dosage or who cannot tolerate statins. We await the follow-up analysis in 2017 to see if the new drugs actually improve and lengthen lives as well as improve lipid profiles

 

 

By Norman Silverman, MD, with Ryan McKennon, DO and Ren Carlton

Make Angel Investments That Go 10x, Unleashing Monster Returns for a Family Juice Business

I look for angel investments that have the potential to produce a 10x return on my investment in 5 years. Startup investing is one of the more risky investment categories. Therefore, you should expect these businesses to have the possibility of doing well. If you invest in 10 businesses, and nine of them fail, the remaining business needs to give you a 10x return just to break even. Ideally, you will do better than that and enjoy healthy returns.

Build Your List of Potential Investors, Pitch Investors Properly, How Kevin Systrom Raised $500,000 in Two Weeks to Launch InstagramFind Angel Funding & Venture Capital for Business Startups, Entrepreneurs, & First Time Founders – Episode 12

Most startups need funding at some point. Once you have the addressed all of the items in the previous episodes, it is time to build your list of potential investors and start the conversations. They can be friends, family, social network, social media contacts, work colleagues, people in the business industry, etc. Try to put together a list of at least one hundred people. A list of one hundred potential investors may seems like a lot, but the more people you have on the list, the better your chances are of success.

Making Money With Your Business, Profit and Cash Flow, Five Sustainable Companies That Make a Lot of MoneyFind Angel Funding & Venture Capital for Business Startups, Entrepreneurs, & First Time Founders – Episode 10

It is time to make money! You have been through a couple of rounds of market testing now you feel like you are on to something. The next step is to run the numbers to make sure that the business is sustainable. There are two sides to making money, profitability and cash flow.

Why Competition Is Good For Entrepreneurs and How Blockbuster’s $50 Million Mistake Helped Reed Hastings and Netflix Destroy a $6 Billion Empire Find Angel Funding & Venture Capital for Business Startups, Entrepreneurs, & First Time Founders – Epis

When battling for resources or investment, early-stage entrepreneurs may believe that competition is a bad thing. On the surface, they are correct. There are a limited number of angel investors willing to provide a finite amount of venture capital to founders.

Upscaling and Scaling Business Ideas into Reality – Jeff Bezos takes Amazon from Online Bookstore to Global DominanceFind Angel Funding & Venture Capital for Business Startups, Entrepreneurs, & First Time Founders – Episode 4

Congratulations, your market testing worked and you were able to find customers, or at least one customer. Your beta test was successful and you are confident that you are ready for more. What do you do when you start getting customers or users? I recommend you do some scaling or upscaling.

What Kind of Business Should You Start? – How Mark Zuckerberg Pivoted From Rating Hotness to FacebookFind Angel Funding & Venture Capital for Business Startups, Entrepreneurs, & First Time Founders – Episode 1

When it comes to brainstorming startup ideas, new entrepreneurs and even seasoned ones scratch their heads in confusion. Living in the information age, you can scan the current market and see countless new business ideas. With so many options out there, how do you know which one is right for you?

Why Would a Doctor Abandon a Steady Paycheck to Become an Entrepreneur?

As physicians, we are expected to be compliant with rules, restrictions, and regulations. We are expected to be risk averse. We are expected to be “providers,” but not necessarily innovators or leaders. As the healthcare system becomes increasingly consolidated into large overcrowded clinics, we are required to perform to the standards set by bureaucrats and clinic managers. These rules are often at odds with the best interests of patients and with our sanity.
Page: 1234 - All