Wild variation in prices for same drug defies explanation and other letters

Regarding the article “5 things to watch in the Senate’s major drug price hearing,” I have been a hospital pharmacy director for 25 years, first at a 500-bed teaching hospital and then a 150-bed community hospital. What I have struggled with over the years is how prices for the same drug can vary so much between average wholesale price versus wholesaler acquisition cost versus GPO versus 340B. Throw in there another price difference between what Europe or Canada can buy the same identical drug for and I am at a loss to explain why prices can vary up to 200% 
(or more). 

The playing field needs to be leveled, and those with private insurance or cash should not be adversely “taxed” on how much they pay versus another consumer. I can understand price variances up to 20% for market share adjustments or contractual guarantees to use product X versus product Y, but I can’t understand the huge swings in prices that the VA might pay versus another agency versus a private hospital or retail drugstore.

Also, why do drug manufacturers get a tax break on direct-to-consumer advertising? This is nothing more than pushing higher-cost meds on consumers when lower-cost generics potentially can be just as effective.

Mike O’Grady
Ada, Okla.

Regarding “2019 will reveal more answers on Trump’s strategy to fight high drug prices,” although I’m a longtime Republican, I generally don’t support President Donald Trump’s legislative policies. But I enthusiastically endorse his efforts to lower drug costs, including the initiative announced last fall to tie the Medicare price of drugs to the lowest prices in other nations.

Before retiring, I was a senior executive with large for-profit healthcare group purchasing organizations, working to bring down drug prices for large hospital chains. We did so relative to what they could do on their own, but our pricing was still much higher than in other countries.

Trump is pushing “most favored nation” pricing for Medicare drugs. We should all support his efforts and ask that the initiative be expanded to cover all drugs. It makes absolutely no sense for U.S. citizens to be supporting drug research (through our excessively priced drugs), benefiting the entire world including developed nations with significantly better standards of living than many parts of our own country and much lower drug pricing.

Let’s see if Congress will back him on a rare bipartisan basis. My bet is that lobbyist money will ultimately win the battle, but you never know.

Jack Bernard
Peachtree City, Ga.

Regarding “As value-based efforts lag, push for price regulation gains momentum,” this is a nicely written article, well-researched, and balanced. It shows several sides to the issue of overall costs and the impact of prices—including potential unintended consequences of price-controlling regulation.

What this suggests to me is that a combination of value-based purchasing and market-based competition could be worth pursuing since the obstacles to either on its own seem substantial.

Simeon Schindelman
Founder and CEO
Create 
New York