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Do PBMs Delay Drugs and Drive Up Drug Prices? - The Atlantic
Nurses spend 16 hours on the phone, medications take months to arrive, and patients suffer as they wait.
Lynn Lear finished her final round of chemotherapy for breast cancer in December. To help keep the cancer from coming back, Lear’s doctor told her about a new medication she could take called Nerlynx. Lear, who is 46, wanted to do everything she could to remain healthy, so she asked her doctor to order the drug for her.
Unlike, say, an antibiotic or an antidepressant, a Nerlynx prescription can’t be filled at a neighborhood CVS or Walgreens. Instead, Nerlynx is dispensed either through certain doctors’ offices or through specialty pharmacies, which exist specifically to process expensive drugs for difficult conditions and often deliver medications by mail. On December 18, 2018, Cheri Bateman, a nurse in Lear’s doctor’s office near Virginia Beach, Virginia, sent the prescription to Accredo, the specialty pharmacy that worked with Lear’s insurance.
So began Lear’s Kafkaesque journey to getting this life-saving drug, which she wouldn’t be able to start taking until nearly two months later. Accredo had a prior-authorization process, in which companies called pharmacy benefit managers ask questions of doctors before they will release medications to patients. Accredo’s pharmacy benefit manager is called Express Scripts. Like all pharmacy benefit managers, Express Scripts negotiates drug prices with drug manufacturers on behalf of insurance plans, determines which drugs are covered, and conducts the prior-authorization process for certain cancer drugs.
gov2.0  politics  pharmacy  drugs  PBM  insurance  money  economics  monopoly  health 
yesterday by rgl7194
Big Pharma's GOP firewall is weakening - Axios
Congressional Republicans are increasingly open to cracking down on the tactics pharmaceutical companies use to keep competition at bay — changes that were once a non-starter for the GOP.
Why it matters: Critics say drug companies manipulate the patent system to extend their monopolies and keep prices high. The industry has billions of dollars on the line as lawmakers take a closer look at changing those patent rules.
The big picture: House Democrats are "actively looking into potential solutions to patent abuses by companies that delay cheaper generics from coming to market," according to a Democratic aide. And Republicans are more open to that idea than ever before.
"I think it’s terrible that Big Pharma sort of abuses the system to try to sort of evergreen these patents and keep them around forever, and I think it’s part of the answer," Sen. Rand Paul (R-Ky.) said.
"I'm open to looking at a lot of things, and I think maybe Big Pharma might be more cooperative if they thought we might actually limit the exclusivity," he added.
gov2.0  politics  pharmacy  big_pharma  congress  drugs  GOP  monopoly  patents 
yesterday by rgl7194
Bipartisan Senate bill takes aim at drug companies' "evergreening" - Axios
Sens. Dick Durbin and Bill Cassidy — a Democrat and a Republican — introduced a new bill yesterday that would tackle evergreening, the process by which branded drug companies extend their monopolies by tacking on additional patents.
Where it stands: While the bill may reduce legal barriers to generic market entry, "someone still has to go through all the trouble and expense to overturn the patent," said Robin Feldman, a professor at UC Hastings.
Background: Evergreening prevents generic competition from coming to market and driving down prices. But the additional patents are often for small changes to the original drug.
What they're saying: "The Cassidy bill is a modest improvement. But it will take much more to move the needle on pharmaceutical competition," Feldman said.
Between 2005 and 2015, 78% of drugs associated with new patents weren't new drugs, Feldman found last year.
The bottom line: This is even more evidence of how quickly prescription drug politics is changing.
gov2.0  politics  pharmacy  big_pharma  monopoly  patents  congress  drugs  competition 
yesterday by rgl7194
BIG by Matt Stoller
The history and politics of monopoly power.
Welcome to BIG, a newsletter about the politics of monopoly. If you’d like to sign up, you can do so here. Or just read on…
business  capitalism  politics  monopoly  gov2.0  competition  business_model  economics  history 
5 days ago by rgl7194
Why Anti-Monopoly Politics Woke from Its Slumber, Part III
Today I’m going to discuss the return of monopoly as an increasingly central political question in American and global politics. I don’t think it’s possible to understand the current political moment without getting that how we think about commerce is changing radically.
This is the third and final part of a series I started a few weeks ago.
First some house-keeping. I had been trying to write this newsletter daily, but I’m coming to realize that’s too much content to read. So I’m going to cut it back to twice a week, at least for now. BIG is becoming a mix of business and political history, which I’m finding great fun. That said, this issue’s got a bit more detail than I ordinarily would include, because I was a witness to some of these events and I wanted to write down what I saw happening.
Ok, onward…
business  capitalism  politics  monopoly  gov2.0  competition  business_model  economics 
5 days ago by rgl7194
Why Is Anti-Monopoly Cool Again? Part II (Big issue 6-25-2019)
Today I’m going to continue our series on why anti-monopoly politics is back. First a couple of thoughts and pictures, one on Facebook’s Libra currency system and one on monopolies in the military…
Is Facebook’s Libra Legal? This is actually not a simple question, and I don’t have an answer. I’ve already mentioned that the FTC, as part of its penalty on Facebook for violating the 2011 consent decree, can bar the company from “adjacent business practices” such as payments. Today I began looking at state money transmitter license laws. Many of the state laws are similar, so I’ll copy and paste something from New York state law on how to get one. The bolded parts are what’s relevant.
Upon the filing of an application, and the payment of the fees for investigation and license, the superintendent shall investigate the financial condition and responsibility, financial and business experience, character and general fitness of the applicant and, if the superintendent finds these qualities are such as to warrant the belief that the applicant's business will be conducted honestly, fairly, equitably, carefully and efficiently within the purposes and intent of this article, and in a manner commanding the confidence and trust of the community…
What is Facebook’s “character and general fitness” for the role? Does Facebook command “the confidence and trust of the community”?
These are good questions. Kidding! They are stupid questions. Of course Facebook isn’t fit, and isn’t trusted. Every poll out there shows no one trusts Zuckerberg.
business  capitalism  politics  monopoly  gov2.0  competition  business_model  facebook  economics 
5 days ago by rgl7194
Why Is Anti-Monopoly Cool Again? Part I (Big issue 6-24-2019)
Last Friday, I talked about the wave of fear in American business, how the ability of monopolists to retaliate is affecting what citizens can discuss. I have a different topic today, but first, a brief follow-up.
Google Could Make Me Homeless: The atmosphere of fear is pervasive, and fortunately the Wall Street Journal and the New York Times, both of whom have been truly spectacular in reporting on big tech over the last few years, are discussing it. I’ll highlight a piece in the Wall Street Journal from last week, on fake listings in Google Maps. Here’s a WSJ reporting pulling a quote from the article.
Tripp Mickle
A business owner victimized by the scams said: “It’s less harmful to piss off the government than piss off Google. The government will hit me with a fine. But if Google suspends my listings, I’m out of a job. Google could make me homeless.”
June 20th 2019
2 Retweets4 Likes
That’s essentially the nub of the problem right there - monopolies are private governments, and have governing power. This is not a new perspective. Just to offer one quote, in 1937, New Dealer James Landis said that the private management of U.S. Steel and other large corporations “possess a coercive force and effect that government even with its threat of incarceration cannot equal.” That was a common view, all the way up until the 1970s. Today’s confused idea that chartered corporations are private entities, akin to ordinary people, is the anomaly.
Anyway, I got a tremendous response from my post, with readers explaining to me how fear has altered their behavior - deleting of social media accounts, refusal to bring smart devices or audio assistants into their homes, getting off of platforms. I wonder, is this the first time the hacker/hobbyists who love to tinker and experiment, and who are often at the forefront of new consumer tech, are abandoning the horizon because they feel it unsafe?
business  capitalism  politics  monopoly  gov2.0  competition  business_model  economics  google 
5 days ago by rgl7194
Daring Fireball: WeWork and Counterfeit Capitalism
Matt Stoller, in his Big newsletter...
Compelling argument. I have always been deeply suspicious of any company whose business model is “lose a ton of money for the foreseeable future and eventually we’ll make a fortune”. It’s the South Park “Collect Underpants / … / Profit” business model, but real investors pump billions into it.
As a kid, when I heard the fable of the emperor with no clothes, I never bought the lesson, because I just couldn’t believe adults would go along with a sham that their own eyes told them wasn’t true. Turns out it happens all the time, over and over.
business  capitalism  politics  monopoly  gov2.0  competition  daring_fireball  business_model 
5 days ago by rgl7194
WeWork and Counterfeit Capitalism
Welcome to BIG, a newsletter about the politics of monopoly. If you’d like to sign up, you can do so here. Or just read on…
I’m back! One of the themes of this newsletter has turned out to be the breakdown of integrity in American business, and the consequences in terms of our increasingly inability to produce the vital systems we need to sustain our civilization. I’ve written about Con Edison and New York City’s vulnerabilities, how monopolies have undermined the Federal Reserve, why private equity is not business but a form of corrupted governance, and how Boeing is falling apart. It has been a pleasure to write about these problems, because I’ve gotten help and feedback from my audience on pretty much every issue. So keep it coming.
WeWork and Counterfeit Capitalism
Today I’m going to continue on this theme, and discuss the increasingly common tendency of capital markets to finance loss-making companies, which is an important trend I call “Counterfeit Capitalism.” The most hilarious example is WeWork, because it’s just such an obvious example of self-dealing couched in New Age management consulting speak. Its CEO, Adam Neumann, was just forced to step down. Both Neumann’s rise, and his fall, have important lessons if we want to correct serious errors in our political economy philosophy as a society.
Here’s Neumann.
business  capitalism  politics  monopoly  gov2.0  competition  business_model 
5 days ago by rgl7194
How Google edged out rivals and built the world’s dominant ad machine: a visual guide • WSJ
Keach Hagey and Vivien Ngo:
<p>Nexstar Media Group, the largest local news company in the US, recently tested what would happen if it stopped using Google’s technology to place ads on its websites.

Over several days, the company’s video ad sales plummeted. “That’s a huge revenue hit,” said Tony Katsur, senior vice president at Nexstar. After its brief test, Nexstar switched back to Google.

Alphabet’s Google is under fire for its dominance in digital advertising, in part because of issues like this. The US Justice Department and state attorneys general are investigating whether Google is abusing its power, including as the dominant broker of digital ad sales across the web. Most of the nearly 130 questions the states asked in a September subpoena were about the inner workings of Google’s ad products and how they interact.

We dug into Google’s vast, opaque ad machine, and in a series of graphics below, show you how it all works—and why publishers and rivals have had so many complaints about it.

Much of Google’s power as an ad broker stems from acquisitions of ad-technology companies, especially its 2008 purchase of DoubleClick. Regulators who approved that $3.1bn deal warned they would step in if the company tied together its offerings in anticompetitive ways.

In interviews, dozens of publishing and advertising executives said Google is doing just that with an array of interwoven products. Google operates the leading selling and buying tools, and the biggest marketplace where online ad deals happen.</p>

It would take a huge lawsuit by the US DOJ to reverse this. It might be possible, but proving it would be hellish - and what would replace it?
google  advertising  monopoly  antitrust 
7 days ago by charlesarthur
Europe, Not America, Is the Home of the Free Market - The Atlantic
From plane tickets to cellphone bills, monopoly power costs American consumers billions of dollars a year.
When I arrived in the United States from France in 1999, I felt like I was entering the land of free markets. Nearly everything—from laptops to internet service to plane tickets—was cheaper here than in Europe.
Twenty years later, this is no longer the case. Internet service, cellphone plans, and plane tickets are now much cheaper in Europe and Asia than in the United States, and the price differences are staggering. In 2018, according to data gathered by the comparison site Cable, the average monthly cost of a broadband internet connection was $29 in Italy, $31 in France, $32 in South Korea, and $37 in Germany and Japan. The same connection cost $68 in the United States, putting the country on par with Madagascar, Honduras, and Swaziland. American households spend about $100 a month on cellphone services, the Consumer Expenditure Survey from the U.S. Bureau of Labor Statistics indicates. Households in France and Germany pay less than half of that, according to the economists Mara Faccio and Luigi Zingales.
usa  economics  gov2.0  politics  competition  monopoly  business 
12 days ago by rgl7194
For tech giants, a cautionary tale from 19th century railroads on the limits of competition
The most important element of the debate – both then and now – is not the particular regulations that are or are not enacted. What’s crucial is the wider concerns about the effects on society. The Gilded Age’s anti-monopolists had political and moral concerns, not economic ones. They believed, as many in the U.S. still do, that a democracy’s economy should be judged not only – nor even primarily – by its financial output. Rather, success is how well it sustains the ideals, values and engaged citizenship on which free societies depend.

When monopoly threatens something as fundamental as the free circulation of information and the equal access of citizens to technologies central to their daily life, the issues are no longer economic.
monopoly  business  railroads  technology  history 
12 days ago by jefframnani

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