Why are Prescription Medications So Expensive?

Dr. Salvatore Georgianni tells us why on Life’s about Living.


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I’m Dr Page. Welcome back to life’s about living. I have with me Sal Georgianni. We’ve had Dr. Sal on some other episodes. He has been a pharmacologist and a pharmacist for 40 years. I’ve talked Dr Sal and found out something very interesting. You know I trained down in Houston uh with Dr. Debakey and Dr. Cooley – and we always use this thing called cardioplegia. It was a solution with ice that we put in around the heart to stop the heart, so that we could sew the blood vessel. Dr Sal, interestingly, is one of the guys who helped formulate cardioplegia. Dr Sal is very involved in men’s, health. He’s a board member of men’s health network. He’s here to talk with us a little bit about that today, but we’re gonna talk first, about about vaccines. Dr Sal, how are you today, i am doing splendidly well awesome. It’s great it’s great. To have you on the show, and i didn’t realize that you had made so many contributions to medicine. When you’re up there in New York, it’s kind of interesting for a pharmacologist to get into into heart surgery. We’re glad to have you. Dr. Sal: Well, it was a. It was a thrilling experience. It was very, it was the early days when people were trying lots of different techniques out back in the early 70s mid 70s, and I learned a lot and I took care of some great great patients, and it was just a wonderful way to contribute to the The knowledge base of these life-saving procedures – and you know it used to be that we bring people in and they put these big old chest things in their sternum to hold them together in the wires, and we’d, keep them in the hospital for A couple weeks, post-surgery. Now t blows my mind that there are little you know openings and small incisions. You know yeah doing them with a robot and what you know used to like the heart lung machine that we used to use. You know they have uh. You know we used to have people put on these lvads when we couldn’t get our hearts to go, and now they have these little things. You know the size of my pinky they put in through a little vein to use, so it’s, amazing the technology and how things have changed. You know one of the things that we were going to talk about today and I guess we’ll go right into this. Is the globalization of administration of medications? Tell me a little bit about international price indexing and how does that affect the everyday person? Well, there are concerns and men’s. Health network shares the concerns about the out-of-pocket costs for medicines. We know very well from a lot of studies, and it just makes good old common sense that the more people will have to pay out of pocket for medicines yep the lower the compliance, people tend to get them less regularly, and a lot of people are strapped For cash, and especially now with coded uh until the economy comes back in a couple of years. We we understand that, so there have been various approaches to looking at managing the prices of medications, particularly the out-of-pocket costs way back when i was a student at an apprentice pharmacist, i have an apprentice license sitting somewhere uh. There were no pharmacy benefit management companies, people paid out of pocket or they were reimbursed, and then they became reimbursed by insurance companies and then along came these other entities along in the early 70s. I’d, say that said: look we’re, going to make everything simpler for everybody. We will you pay us a premium and we will manage the prescription drug benefit and we’ll. Take care of all the payments for prescription drugs and everybody in my profession in medicine, said this is great. They’ll, simplify everything, but what we forgot was that these companies were there to make a dollar and they’re. Tightening the news on us all the time yeah it’s, okay, uh, but if you fast forward, you know 60 years now or 50 years from when these entities first started taking home. The systems become so byzantine so mysterious that the way that drug prices are are set. It’s. Almost like a big old black box. You can’t break into yeah. The other thing that’s happened is along the way these pbm companies pharmacy benefit management. Companies have convinced everybody that if we uh, if you drug company x y z, uh, do volume, we’ll, do volume purchasing from you. You have to give us rebates because we can drive your volume and then we’ll. Take these rebates and we’ll, pass them along to the consumer to reduce their out-of-pocket costs well, somewhere along the line drums that didn’t happen. The companies, the pbm companies, kept two-thirds of the rebate money and then gave back one-third of the rebate money. So, yes, pharmaceutical drug companies did have to raise their prices to meet inflation and other regulatory challenges, but pbms also took a huge, huge slice of that money and use that now they are such a lucrative business instead of the pbms being an additive service to health Insurance companies, the pbms, are buying health insurance companies so how they bought aetna and then united healthcare bought one, and only so. You’re, basically paying yourself to run a prescription drug benefit wow. That’s, pretty amazing. He’s, pretty sad, you know, and they’re, not passing those they’re, not passing those along to the you know to the patient. You know, which is really sad. Um, so tell me a little bit about what do you think the answer for that i mean um like, for example, antibiotics and other things, third party paper: what’s? The answer right now for prescription drugs? Well, the the key here is that the system is byzantine, no one can figure out just what the real price of the drug is and what the real rebate section is and where the money is going and everybody knows the willy sutton mentality follow the money uh. So well, i guess the same thing with medicine i mean you can’t, go to the hospital and get a transparent price for a procedure anymore, and the trump administration tried to do that and i don’t think it was very Successful uh what has been proposed by pelosi and some in congress and uh, it was actually uh signed as an executive order by trump is to create a global market basket of drug products. So they would sample the prices of essential medicines from various countries throughout the world and say: look the united states should never be charged more and medicare is the driver. Here then you’re charging. Anybody else in uh, in brazil or ireland or china or uh the ukraine uh, and they’re, going to create a international price index so and that ostensibly, is to bring the price of drugs down. But unfortunately, that’s been tried in other industries. It’s, never worked it’s brought things down for a very small amount of time, but then it never really gets once again transmitted to the out-of-pocket cost to the consumer. We’ve studied this. We’ve, looked at it and we believe the only thing that really works is good, broad, negotiating with transparent terms of volume purchasing. We do not favor rebates uh. We feel that it should be a straight transaction uh that would cut out an awful lot of administrative fees uh, and we think that that is the best approach to managing drug crisis and keeping them where they are. It’s, a big problem. It’s, a big problem, a big problem with medicare. You know, i mean medicare and prescription drugs because i mean you know, probably every patient. I see i mean especially the elderly patients. They may have 10 to 15 medications and uh. You know the price is just it’s, just crazy. So, like a lot of things in our health care system, it just doesn’t make sense. Simple solutions. Don’t seem to make sense. Yeah hey, listen, doctors! I want to change gears because everybody has got so many questions about the code, vaccine and uh. You know we’ve had some people that have you know, had the copper vaccine and had some allergic reactions, and i want you to tell us what you know about that. Well, they allergic reactions can have can happen with every vaccine yeah. I was watching television and there were some ads on there for vaccines, hpv vaccine and they warned quite clearly about allergies, so uh. This is not something that’s, unique to the code vaccines. They are monitoring this very carefully, because every incident of allergic reaction gets reported back yeah. My understanding is that the number uh first of all we’ve, had up until yesterday. I guess we ‘ Ve had something like 18.5 million doses in the u.s alone, there’s, only been one person who ‘ S died after getting the vaccine and they don’t know what that death was due to we’ve. Had a number of people who – and it could have been causality could have been an underlying medical condition right you just don’t know uh. There have been a number of people who’ve had allergic reactions, uh, not life-threatening, but in an abundance of can caution what the food and drug administration and anybody who administers the vaccines, whether it’s, going to be given in a Local pharmacy, or in a hospital or your health department, they have treatments there to just reverse the allergic reaction. Just epinephrine and just epipen didn’t. It repent exactly. There was a well uh publicized case of an anesthesiologist who said he had a reaction and then to the vaccine and then when they dug a little deeper, he said the guy reported. Well, i have these reactions all the time and i have my epipen with me and i gave my epipen to myself and i was fine, so people are asked to wait. 15 minutes to you must report any allergies. You have foods shellfish pot, pollen perhaps to help that’s relevant, but just tell the webs giving you a shot and then under. If you have no allergies, anything you ‘ Ll, probably be asked to wait. Fifth, you will be estimated 15 minutes after the vaccination just to make sure everything’s copacetic and you’re good. If yeah, that’s, why we vaccinated about about 40 people in my office, one day kind of hurting them through like cattle and nobody had any problems. We did have an epipen there, and so you know just you just need to make sure that your physician is prepared or something happens. But once again you know, dr, i think what we’re hearing the media is, is we’re hearing, this fear tactic and they talk about that one exception and they exaggerate what happens and then they begin to create this. I mean just this fear in the media, and i just wanted to spell that, and i think that’s. What you’re trying to tell folks, is that you know if we’ve had one person that’s, that’s, had a death or had a you know, severe anaphylactic reaction or whatever from the vaccine, That’s very safe when you consider that over 18 million people yeah, i think the incidence now is 0. 0005 wow allergic reactions of anaphylactic reactions and don’t forget this is being administered all over europe yep and they’Re they’re ahead of us by a couple weeks: uh, and there are people who’ve, gotten second doses in europe. Now i think somebody calculated than 250 000 second doses administered in europe to date. Uh. So you know the numbers are still very small, but you’re right. One of the challenges with this whole pandemic is that we ‘ Ve never managed a global medical emergency in an era where we’ve had instantaneous communication from anybody with a camera and a microphone or even a little computer can become an instant expert hey for the last about living that life’s. About living audience you can find dr sal, i mean he’s, very passionate about men’s, health and he’s very involved. He’s in the board of men’s, health network, and you can find more information at men’s. Health network dot org there’s, a lot of resources there for men and they kind of their goal. Dr sao is to uh just give men resources and make them aware of men’s diseases. You want to comment on that. Real quick before we close, not just make men aware but make the the women who love them a niece, a mom, a significant other uh, a friend a co-worker, help them understand how to bring men to health care too. That’s very important. So you have a lot of educational information, a lot of medical conditions that affect guys and even some information on how women can help bring the guys they love to better health care. That’s, good! That’s at men’s, http://www.menshealthnetwork.org network dot, org, and thank you, dr sal, for being on the show this is you? Can we’ve had several interviews with dr sal, and you can find these on our show. Life’s about living show.com or you can text lal 66866. Dr sal was great to have you on the show. Thank you for having me on. I appreciate it. Awesome

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