Fact checking Trump's drug pricing claims in the State of the Union

By Brook Baker

President Trump’s State of the Union Address contained a number of distortions, false claims and outright lies regarding drug pricing and access to medicines. Skyrocketing drug prices are a life and death issue for people with HIV in the U.S. and around the world. Here’s a side by side comparison of the facts versus what Trump said. Did we miss any lies? Let us know: admin@healthgap.org

What Trump said:
“The next major priority for me, and for all of us, should be to lower the cost of healthcare and prescription drugs — and to protect patients with pre-existing conditions. Already, as a result of my administration’s efforts, in 2018 drug prices experienced their single largest decline in 46 years.”

Here’s the truth:

Contrary to the President’s State of the Union Address, the list price of monopoly protected  medicines continued to escalate in 2017-2019, with the costs of some of the newest medicines costing hundreds of thousands of dollars a year.  The temporary, minor pause in inflating prices mid-2018 was a publicity stunt by Big Pharma and the President in what has been a relentless drive to maximize profits even if it means payers can’t pay and patients go without.

_________________

What Trump said:
“But we must do more. It is unacceptable that Americans pay vastly more than people in other countries for the exact same drugs, often made in the exact same place. This is wrong, unfair, and together we can stop it. And we will stop it fast.”

Here’s the truth: 

The U.S. pays more than other countries for medicines because the President and other policymakers do less to restrain excessive pricing than any other country in the world.  They obstruct prices negotiation efforts. They continue to pass laws and enter into trade agreements that strengthen, broaden, and lengthen monopolies on medicines. They don’t seek fair pricing returns on the public’s tax payer investments in pharmaceutical research and development.  What’s wrong and unfair is that the President lets drug companies get away with deadly high prices while he pretends that other countries are doing something wrong by trying to tame unbearable prices.

Low and middle income countries can’t afford the bloated prices that drug companies demand and shame on the President for suggesting that they should.  Those same countries can’t afford the trade agreements and trade threats of the U.S. and Big Pharma that seek to perpetuate and expand global monopolies on medicines.  Drug companies prefer to make high profits off a few rich people even when the vast majority of poor people in other countries are denied access to the fruits of scientific progress.

_________________

What Trump said:
“I am asking the Congress to pass legislation that finally takes on the problem of global freeloading and delivers fairness and price transparency for American patients. Finally. We should also require drug companies, insurance companies, and hospitals to disclose real prices to foster competition and bring costs down.”

Here’s the truth:  

Disclosing prices won’t accomplish anything if the untrammeled power to charge whatever the market will bear for life-saving medicines is not addressed.  The freeloading that the President should be concerned about is freeloading by drug companies that harvest innovation done in universities and at the National Institutes of Health and then monopolize the resulting products while they tweak their blockbusters to get new 20 year monopolies for minor tweaks.

Originally posted on the Health Gap blog.

_______________________________

About the author: Brook Baker is a senior policy analyst for Health GAP (Global Access Project) and is actively engaged in campaigns for universal access to treatment, prevention, and care for people living with HIV/AIDS, especially expanded and improved medical treatment. He is also a professor of law at Northeastern University and an honorary research fellow at the University of KwaZulu Natal in Durban, South Africa.

Navigating Minor Consent Laws Toward Confidential PrEP Access for Adolescents

By Jason Potter

According to the CDC, as of 2015, youth ages 13-24 comprised a staggering 22% of all new HIV infections in the United States. Given this alarming incidence rate, developing new and effective HIV prevention modalities for adolescents and young adults, and eliminating major delivery barriers, has become a priority. In the sphere area of biomedical HIV prevention for at-risk adolescents, one legal barrier looms large. The issue of caregiver consent (or the less inclusive “parental consent”) forms an oppressive threshold barrier to operationalizing biomedical HIV prevention among at-risk adolescents under the age of majority.   

Pursuant to laws in every U.S. jurisdiction, the majority of youth in the United States from ages thirteen to eighteen (“minors” or “adolescent minors”), a critical population in the fight against HIV, are unable to operate independently of their parents, guardians, and other adult caregivers in most healthcare decisions. The general rule, typically established by state statute, is that minors cannot legally consent to decisions about health and welfare that require an understanding and weighing of risks and benefits. State laws shift that responsibility to a third-party caregiver (which may include a parent, blood and non-blood relative, foster parent, conservator, or the state). Caregiver consent, although desirable in many contexts, can have devastating consequences in matters of sexual healthcare. The California Supreme Court has noted that “there is a considerable risk that minors will postpone or avoid seeking needed medical care if they are required to obtain parental consent before receiving medical care for such conditions”. One vexing legal issue in HIV-related care for adolescents is ensuring their medical privacy. The necessary foundation of confidential care for adolescents is access without caregiver involvement.

In an effort to protect the health of minors in situations where they would sooner forgo treatment than secure the consent of a parent or guardian, lawmakers have passed laws acting as exceptions to the general rule that minors may not make their own healthcare decisions. These exceptions (“minor consent laws”) permit sensitive healthcare decisions without adult consent and, in some instances, further secure the privacy of minors by permitting providers to forgo parental notification.  On the state level, minor consent laws are a major basis for a minor’s confidential receipt of necessary medical care that would otherwise be obfuscated by parental involvement.  

“HIV pre-exposure prophylaxis” (“PrEP”) is necessary a necessary tool in the fight against HIV among at-risk minors. PrEP is a multidimensional prevention therapy involving periodic diagnostic testing, counseling, and the prophylactic use of an antiretroviral (“ARV,” traditionally used to treat HIV infection) as a means to prevent it. Truvada (a well-established ARV manufactured by Gilead Sciences) was the first ARV to receive FDA approval for a PrEP application. Truvada as PrEP has an efficacy in adults of over ninety percent when used as prescribed. In light of its preventive potential, oral PrEP has been embraced by the public health community, and implementation is under way across the United States among at-risk adults. Although the therapy is currently indicated for adult use only and only one published study of the safety and efficacy of PrEP for adolescents currently exists, clinicians may prescribe Truvada as PrEP to at-risk minors off-label. However, confusion about the patchwork of consent laws abounds, and there is very little guidance available to clinicians and advocates about the legal and policy dimensions of PrEP access.

In this webinar for NASTAD, part of the 2017 NASTAD PrEP Financing and Access Series, I explore the consent dimension of PrEP access for adolescent minors. Toward the end goal of facilitating confidential PrEP for at-risk minors, I develop a framework for navigating variations among the patchwork of minor consent laws in the 50 U.S. jurisdictions (and the District of Columbia) and identify inroads to confidential PrEP access in them.

The power to consent to PrEP, and other future HIV prevention modalities, has remarkable potential to change the course of HIV incidence among youth. Giving at-risk adolescents the power to consent to PrEP helps embolden them to take charge of their health, safeguard their future, and protect each other.