Holland & Hart Healthcare Law Blog

Physician Rebates on Pharmaceuticals Inducements or Volume Discounts?

 

    Can physicians be swayed in the prescription of drugs by volume purchase discounts that return substantial rebates to them on highly expensive drugs?  In an article in the New York Times this week, (Pollock, “Secret Rebates Offered on Costly Eye Drug, November 3, 2010”) a Times Reporter explored the practice of pharmaceutical companies providing “rebates” to physicians who purchase and use the drugs they sell on their patients.  Oncologists have long engaged in the purchase and resale of toxic agents used in the treatment of cancer. Recently  opthamologists have been provided the opportunity as well. Genetech’s Lucentis is a case in point.

 

THE “MASSIVE REDISTRIBUTION OF WEALTH” AND 31 OTHER INTERESTING STATISTICS AFFECTING THE HEALTHCARE REFORM.

 The United States has undergone a massive redistribution of wealth in the last 30  years. In 1980 the top 1 percent of taxpayers reported 8.5 % of the nations reported income to the Internal Revenue Service. In 2008, the top 1 percent of taxpayers reported receiving 20% of the nation’s income. This and the following 31 other statistics provide an interesting foundation to review the PPACA and its alternatives.

THE END OF MEDICINE: How Silicon Valley (and Naked Mice) Will Reboot Your Doctor by Andy Kessler, Collins 2007.

    Andy Kessler is an irreverent, flip and highly readable writer who poses an interesting single question and than doggedly pursues an answer, with a lot of biting asides to entertain the reader. The question is, given the exponential decline in cost of technology in Silicon Valley and its exponential increase in power and effectiveness, why hasn’t medical technology turned over the same returns to deliver more effective health care at a cheaper cost. There are a number of reasons including the inherent slowness of the treatment and study process, the FDA, entrenched economic interests and the focus on treatment rather than prevention.

    

NEW MEXICO BODY PARTS CAPER.

It came up “heads” when an employee at a medical waste disposal facility called Stericycle in Kansas noticed a partially burned head and torso at disposal site.  Stericycle normally disposes of dead tissue, but this was more like raisins in the oatmeal and he quickly perceived something was wrong.  Further investigation led to the discovery of 6 additional roughly severed heads and a number of torsos in a truck outside of the facility. Shades of Alistair Cook! Cook you will remember as the genial host of Masterpiece Theater on PBS whose body was dismembered and proliferated by a gang of New Jersey body snatchers a couple of years ago.

MONTANA AFFIRMS RIGHT TO PHYSICIAN ASSISTED SUICIDE-THROUGH STATUTORY, NOT CONSTITUTIONAL, ANALYSIS.

In a decision filed on the last day of 2009, the Montana Supreme Court affirmed a lower court decision concerning the right of a dying patient to a physician assisted suicide though it based its decision on an analysis of Montana statutes and public policy rather than the state Constitutional analysis adopted by the trial court below. In Baker et al v. The State of Montana et al., 2009 MT 449 (MT, December 31, 2009), the court followed the maxim of Viscount Falkland that when it is not necessary to make a decision, it is necessary not to make a decision and side stepped addressing whether there exists a constitutional right to die with dignity in the State constitution as requested by the principal plaintiff, Robert Baxter. Mr. Baxter, a retired truck driver, suffered from lymphocytic leukemia with diffuse lymphadenopathy.  Mr. Baxter, now deceased, contended that the State Constitution gave him the right to choose the timing and circumstances of his impending death, rather than suffer the indignities that he perceived in palliative care and the imposition that a drawn out departure would have upon his family.  He wanted the right to obtain a prescription of life terminating drugs from his physician without fear that his physician would be prosecuted for violation of state law.

HEALTHCARE REFORM PART III:-THERE WILL BE PAIN!

 One of the unfortunate realities about Health Care Reform is that there will be pain.   The current trajectory of health insurance costs is unsustainable.  We are pushing 18% of the Gross National Product, more than double other industrialized countries and severely depressing our competitive edge in the world economy. Left unattended health care will continue to eat into American productivity, lifestyle, competitiveness and influence.   The solutions are not difficult to understand. The question is how to equitably distribute the pain. The strategy of “just saying no “ will just momentarily and ineffectively defer the pain. There are three ways, or combinations there of  to do it. The menu please!

HEALTH CARE REFORM PART II: MAURAUDING SENIORS INVADE TOWN HALL.

Many of the seniors showing up at congressional town hall meetings on health care reform – at least those drawing the media’s attention seemed to be in serious need of adult supervision. The antics before the cameras seemed bent on disruption and venting of anger almost as much as the display of ignorance that seemed to pervade these events. Sure, the Seniors seemed to be angry at a lot of things in addition to health care.  They also seemed to be spurred on by irresponsible seniors-caring tactics by those commentators that have no ethical compunction against the intentional “misreading” of the text of the proposed house and inflammatory media ads by radical fringe groups 60plus.org.  to further political ends.

HEALTH CARE REFORM PART I: What's To Like About The U.S. Health Care System? - Six Hints.

Well, a lot, if the intensity of public reaction to pending proposals for change is any guide. Here are some hints.

1. Somebody else pays for it. Most of us have the benefit of health insurance provided by our employer or by the government under Medicare or Medicaid. Although we may be experiencing a growth in creeping co-pays, “donut holes” in coverage and other occasional contribution requirements, as well as those annoying “preexisting condition problems” most of us like the fact that mostly somebody else pays and were are not that involved in the messy business of health care finance.

Reproductive Technology And Age Discrimination

Last January Andriana Illiescu, an unmarried Romanian writer gave birth to a daughter, Eliza Marie, by Caesarian section in a Bucharest hospital.  Ms. Illiescu was 66 years old at the time.  The child was the result of advanced reproductive technology involving the implant of a donor egg and donor sperm.  The child was born prematurely and two prior implant attempts involved still births.

85 Year Old Doctor Refuses "To Go Gentle Into That Good Night." Jury Awards $20 Million.

Dr. Robert Johnson, an 85 year old physician from Lancaster, California sued the California Department of Corrections for age discrimination, harassment and retaliation in violation of California's Fair Employment and Housing Act when he was 81 years old. A California Superior Court Jury Awarded him Twenty Million Dollars.