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BackPage Online, March 2019

doi: 10.1097/01.BACK.0000554080.21834.29
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How to Cut US Drug Prices

Here is a New York Times “Upshot” feature—with multiple points of view—on ways to cut US drug prices. US patients could shop around more to increase competition. Medicare could negotiate directly with drug companies. Panels of experts could dictate the costs of drugs—based on cost-effectiveness studies. However, no single strategy appears overwhelmingly promising. Or as author and economist Austin Frakt noted, “Balancing prices and access to drugs for the patients of today with the innovation that will benefit those of tomorrow will take ingenuity, as well as a lot of political will.”

Here is a link to the article: https://www.nytimes.com/2018/12/10/upshot/how-to-cut-drug-prices-experts-weigh-in.html

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Biologic Medications Exorbitantly Expensive in the United States

Biologic medications for the treatment of inflammatory arthritis—from Humira to Cosentyx—are some the most heavily promoted, bestselling, and most expensive drugs in the United States. However, brand-name biologics often sell at three or four times the price of biosimilar drugs in Europe. “Governments in Europe have compelled drugmakers to bend on prices and have thrown open the market for so-called biosimilars, which are cheaper copies of biologic drugs made from living organisms,” according to a recent feature from Kaiser Health News. More than 50 biosimilar medications are available in Europe versus only six in the United States. The article discusses what US regulators would have to do to speed the entry of these cheaper alternatives.

Here is a link to the article: https://khn.org/news/u-s-market-for-biologic-drugs-is-most-expensive-in-the-world/

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Opioids for Chronic Pain: Meager Benefit

Opioids have a meager benefit in the management of chronic pain according to a recent systematic review and meta-analysis by Jason Busse, PhD et al. “Compared with placebo, opioids were associated with: (1) small improvements in pain, physical functioning, and sleep quality; (2) unimportant improvements in social functioning; and (3) no improvements in emotional functioning or role functioning. Compared with placebo, opioids were associated with increased vomiting, drowsiness, constipation, dizziness, nausea, dry mouth, and pruritus,” according to the study.

And the pain relief waned over time. “The findings reported by Busse et al illustrate that most patients who are prescribed opioids for the treatment of chronic noncancer pain will not benefit from those drugs. However, when opioids fail to provide pain relief, a common response by clinicians may be dose escalation rather than reconsidering use of the drug. Given the clear risk of serious harm, opioids should not be continued without clear evidence of a clinically important benefit,” according to an accompanying editorial by Michael Ashburn, MD, and Lee Fleischer, MD.

Here is a link to the study by Busse et al: https://jamanetwork.com/journals/jama/fullarticle/2718795

Here is a link to the editorial from JAMA: https://jamanetwork.com/journals/jama/fullarticle/2718775

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