Blog Posts

Enough Bad News, Some Great News For #Myeloma Patients! The Myeloma Miracle Continues!

5/7/2020

With the challenges of COVID19, it becomes hard to remember the wonderful improvements seen in myeloma over the years, and the critical part the leadership of myeloma scientists, specialists, advocates, drug companies provide and the remarkable work of the FDA and its Orphan Drug Designation, without which orphan drug progress would have languished, as it had for decades.
In September of last year I wrote the blog post(CLICK HERE) outlining how all myeloma drugs in the last 16 years had two FDA designations for each approved drug. One being an Orphan Drug Designation, and the other being Fast Track, Priority Review, Breakthrough, etc. Remember there are more than 6000 orphan diseases and majority of these diseases have not one approved orphan drug. Myeloma patients should feel blessed to know they have had 10 new drugs approved in the last 16 years. In addition, Myeloma (an orphan disease) has 7 drugs which all had two FDA designations, but have yet to be approved. These drugs include the following:

Drug                             Company                 Designations      Description

AMG420                        Amgen                        OD&FT          (BCMA) Bispecific T-Cell Engager
                                                                                                (BiTE®) Antibody Construct
CLR131                         Cellectar              OD&FT           Radiotherapeutic phospholipid drug
                                                                                                 conjugate (PDC™)
GSK2857916               GlaxoSmithKline           OD&BT          (BCMA) antibody-drug
                                                                                                 conjugate (ADC)
bb2121                          Celgene                       OD&BT          BCMA chimeric antigen receptor
                                                                                       CAR T
Galinpepimut-S              Sellas                      OD&FT          Immunotherapy vaccine to elicit a
                                                                                                 strong response against WT1
P-BCMA-101                 Poseida                     OD,FT&BT      Autologous chimeric antigen receptor
                                                                                                 (CAR) T-cell therapy
Melflufen                Oncopeptides            OD&AA         Drug activated by aminopeptidases,
                                                                                      overexpressed in myeloma
So how have we fared with this list?

AMG420 - has dropped from the list in favor of a kinder gentler similar drug called AMG701, however AMG701 has only one FDA designation.

All of the other drugs on the list are progressing very well, with GSK2857916 and bb2121 expected to be approved in the next several months.

For the first time in 16 years, two new drugs have been approved without dual FDA designations. However, one is another CD38 antibody similar to Daratumumab called Sarclisa® (isatuximab-irfc) by Sanofi for patients with relapsed refractory multiple myeloma. Another approval is subcutaneous Daratumumab called Darzalex Faspro.

In addition we must add two more to the list of candidates with two or more FDA disignations.

Drug                             Company                 Designations      Description

JNJ-4528         Janssen                    OD&BT              CAR-T with two BCMS-targeting
                                                                                                     Single domain antibodies
CT053                     CARsgen               OD, RMAT*          A fully human anti-BCMA CAR--T                                                                                         Therapy
* The RMAT designation is given to regenerative therapies intended to treat, modify, reverse, or cure a serious condition.

Other drugs which already have an orphan drug designation and have the potential to obtain another FDA designation include: Amgen's AMG701(replaces AMG420), Molecular Partners MP0250, DARA BioSciences KRN5500, and SUTRO's STRO-001.
Historically each approval of a new class of drugs (eg. Imids and Proteasome Inhibitors) have added a year or more to myeloma life expectancy, so approval of these drugs could double the current myeloma life expectancy. Now that is GREAT NEWS!

Good Luck and May God Bless OUR myeloma journey. For more information on multiple myeloma CLICK HERE and you can follow me on twitter at: https://twitter.com/grpetersen1

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BE SAFE! #COVID19 & #Myeloma, All We Have To FEAR is the LACK Of FEAR Itself!

5/4/2020

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Myeloma patients in general have a higher risk of infection, which is 7 times that of the average person. It is because of this we take special care to be on top of any infection. I have written about this in the past. CLICK HERE for the link. I always have Tamiflu and an antibiotic Z-Pack for whenever I get a fever. I have had pneumonia three times and gone septic once. This combo has saved me so very many times. However, COVID19 has put a whole new level of FEAR into the equation. Before the flu vaccine or antibiotics for secondary infections were developed, the Spanish Flu resulted in the death of an estimated 50 million people worldwide, and 675,000 deaths in the US. With the development of the flu vaccine, antibiotics, and antivirals, the typical US flu season now has just 34,000 deaths in the 1918/19 flu season. The new level of fear for anyone over 65 is outlined in the following graph.

However, myeloma patients have many other complicating factors. People with commodities like cancer, compromised immune systems, Diabetes, Kidney Insufficiency, Heart disease etc., have an even higher likelihood of death at over 30% as seen in France and Spain. A recent study of cancer patients with COVID19 in NYC has shown hematologic malignancies were associated with a higher rate of mortality of 37%. During the shelter in place order, it is imperative to take extra care to be safe. Shop by curbside pickup, wear a mask, social distance, wash hands, hand sanitizer et. al. These efforts to be extra careful by myeloma patients and the government limitations and their policing, I believe have been able to keep our infection rate lower. Our fear of getting an infection with no known FDA approved treatment has been a motivator for a SAFETY FIRST mindset. So why should we Fear the Lack of Fear Itself?

It is because not everyone is on the same page and do not social distance, will not try to move aside on the sidewalk, do not wear a mask in grocery and drug stores, or are younger than 44 and feel bullet proof and feel no social responsibility to protect those at high risk. I will set this up by posting a few headlines which highlighted a need for a new heightened vigilance by the myeloma patients.

California Governor Newsom announced a "hard close" on all beaches and state parks in Orange County on Thursday, after news photos circulated showing people not following social distancing guidelines over the last weekend of April.

Governor Gretchen Whitmer of Michigan says heavily armed men and Confederate flags at state capitol ‘depicted some of the worst racism and awful parts of our history’

'Devastatingly worrisome': Dr. Deborah Birx decries scenes of protesters not practicing social distancing amid coronavirus

I see and experience this lack of compliance in everyday life even under restrictions, just think what it will be like when they open up the economy with relaxed restrictions. My appeal to you is that YOU must look after yourself, because with COVID19 a good defense is the only defense. Until a vaccine is developed or a cure is found, our best way of surviving COVID19 is to make sure we do every thing we can to stay virus free.

Continue to Shelter in Place or Self Quarantine to protect yourself!

If you do have to expose yourself to the public then please follow the recommendations outlined in the following Wall Street Journal article.
Safety Advice for Reopening: How to Reduce Your Risks as Coronavirus Lockdowns Ease. As businesses reopen, we asked public-health experts for guidance on venturing out. CLICK HERE to view.

Dr. Landgren of MSCC has outlined what one of the best cancer centers in the world does to PROTECT the patient and you can hear the broadcast if you CLICK HERE. Some of the safeguards include all patients are tested for COVID19, and based on your results you go to a COVID area or COVID free area, all patients and care personnel wear masks, visits are limited, all oral protocols are considered, and many more recommendations. In addition, Mayo Clinic has recommendations coauthored by Dr. Morie Gertz and you can view them if you CLICK HERE.

Good Luck and May God Bless OUR myeloma journey. For more information on multiple myeloma CLICK HERE and you can follow me on twitter at: https://twitter.com/grpetersen1

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We Can Overcome The #COVID19 Testing Failure! The German/MyelomaCrowd Template!

4/18/2020

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Riding The COVID19 Storm Out With A Little Help From A Friend!

Why do I call testing to date a failure? We are now 3 months into the pandemic and have just tested about 1% of the US population. 18% of those tested are virus positive with the in lab nasal or oral swab test. The one day total of newly diagnosed patients has gone from 3419 each day on 3/18 to 30,000 each day on 4/18. This is the highest rate of newly diagnosed to date. Testing has gone from around 15,000 a day to 167,000 tests daily. So at the current rate it will take another 63 Months to test the entire US population with the nasal swab test. We have a total of 43 FDA approved viral tests for COVID19. We MUST pick up the pace or far more people will die! The current system is slow and cumbersome, swabs are taken, sent to a lab and maybe just maybe you will get results in a week or two. Drive up testing was intituted in Jacksonville, FL but had only the capacity to complete 250 to 400 per day with the same wait. The present system and methods are overloaded and way over capacity. So what is the problem? I believe it is "Logistics Stupid!" My life has been in the field of operation engineering, distribution operations management, and supply chain management, and I am shocked and amazed at this supply chain management fiasco.

We have heard a lot about antibody testing from Dr. Fauci and Governor Cuomo. This antibody test will determine if we have or have had COVID19. It is their belief and many other people as well, that to open up the economy we need to have extensive testing with the cornerstone to be the antibody blood test. You would think the task force would have learned from the mistakes from the nasal swab testing nightmare. What would an expert in Supply Chain management do?

-Make the process easy for the most likely at risk. The old, feeble, those with cancer, asthma, pulmonary, respiratory, immune sensitivity, African Americans, those with commodities, and those in cities which rely on public transportation. Who wants to get on a bus, subway, or elevator in New York or any big city?

-Find a way for those who are most at risk and need to shelter in place to get tested given these limitations. These groups have been told to stay away from hospitals, labs, grocery stores, and drug stores and stay 6 feet away from anyone.

So if there was any learning from mistakes of the flawed implementation of the nasal COVID19 test, we would expect to see a major shift in implementation for the antibody test. BUT NADA, in fact it is far worse. We only have 3 tests approved by the FDA for the antibody test for COVID19. Two of which were approved on 4/16/20. Johns Hopkins has a list of 39 tests which are under investigation but yet to be approved. CLICK HERE for list. The three approved tests are only approved for use by a lab, vs the swab test which has 43 approved for lab use. Let me ask a question. If 43 tests for use in lab only a shows such poor results, why would we expect one with just 3 tests for use only in a lab to be anything other than a disaster 14 times greater? Denmark has tested 9 tests for accuracy and the Zuckerburg Chan Initiative (Facebook) set up a lab in 8 days and will test all current antibody tests with results scheduled for completion in a WEEK!

We could learn a lot from the German approach! Germany has one of the lowest death rates for COVID19 in the world, developed and is manufacturing its own antibody tests, and is conducting nationwide testing for COVID-19 antibodies, the first European country to do so. CLICK HERE Germany has conducts nearly 4 times the tests per day per 100,000 population than the USA.

A SOLUTION

Send nasal swabs or antibody test kits to the peoples' homes at the GP's request. Amazon, UPS, FedX(totaling 10's of Billions of packages each year)

With nasal viral test, have the doctor supervise the at home swab procedure by telehealth. Send into the lab for results. GP calls the patient with results.

For antibody test send it to the patient, have a telehealth visit with your GP to supervise the test and take a screen shot of the finished test and provide the data right then to the patient.

You can learn from the Myeloma Crowd(CLICK HERE) who is looking to use the antibody test to obtain data on why some myeloma patients have better outcomes when infected by COVID19, We have some centers who have had 20 to 40 COVID19 positive patients and no deaths and others which have shown 30% or greater death rates. They will use this SOLUTION to insure these very high risk patients get tested. Myeloma Crowd has found a way to meet the needs of an Ultimate Risk group. To all who are working on the Resurrection of the Country, please use the Myeloma Crowd example of how to provide telehealth and retail logistics to this healthcare problem!

Good Luck and May God Provide us with the guidance and leadership to weather this storm!

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The Bridge To A Cure For Multiple #Myeloma!

3/23/2020

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The American Society of Hemotology 2019 meeting may well be one of the most significant and productive ASH Conferences I have attended. Clinical trials using 4 drug combinations, and combinations with new drugs like Ventetoclax and Selinexor, and finally the clinical trials with CAR T, BiTE's, ADC, and BCMA as a target all look to be part of the Bridge to a CURE!

From the patient's perspective, it is always disappointing to see that the cure continues to escape us, but building new segments of the bridge to a cure is the second best possible outcome. What is the bridge to a cure? At two of the presentations I attended, Dr. Raji Vij of Washington University mentioned using combinations and the new drugs to bridge the patient to the next new treatment or a possible clinical trial. Dr. Sikander Ailawadhi of Mayo Clinic Jacksonville said the same thing about a drug he discussed called CLR131,(To view a Cure Talk 3/24 presentation on CLR131 CLICK HERE) and there was a poster on using SPd after failed CAR T as a bridge to the next clinical trial.

Although the cure is not apparent at this point, as long as we keep providing the next segment of the bridge we just may be able to live to see the CURE. In the past the segments of the bridge, even for breakthrough drugs like Daratumumab which had a ORR(overall response rate) of 24% with a PFS(progression free survival) of just 1.9 months, and Selinexor with a ORR of 26% and PFS of 3.7 months, improvements were marginal and not overly significant. The new clinical trials like the ADC(Anitbody Drug Conjugate) GSK2857916 (Belantamab Mafodotin) in patients who had previously been treated with daratumumab, the ORR was 38.5%; with a PFS of 7.9 months, and finally the most seasoned CAR T study bb2121 shows ORR of 84% and PFS of 11.8 months. The point here is the ORR and PFS continue to improve giving those in the later stages of myeloma a bigger window to find the next treatment. The BiTE's, ADC, and combination target CAR T(eg. BCMA and CD38) show even better initial results, but are just too early to call.

Another key we have found is if a drug like Daratumumab works in the heavily pretreated patients, when we move it to earlier in the disease progression and in combination, we achieve outstanding results! Who would have thought a drug which had a PFS of 1.9 months would be the biggest hit at ASH19. It is being presented as a combination with everything and shows improved results. It seems all “ Things Go Better With Darzalex!” What happens when we move a treatment with PFS of 11.8 months to earlier in the disease progression? Will it be all “Things Go Better With bb2121, or BiTE's, or ADC, or AWC, etc”?

The momentum has shifted to the patient from the disease! The game is not over, the bridge is not built, but an end is in sight!

Good Luck and May God Bless OUR myeloma journey. For more information on multiple myeloma CLICK HERE and you can follow me on twitter at: https://twitter.com/grpetersen1

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Affordable Access To American Healthcare - DEAL or BAD DEAL? Part 4 of 4

2/7/2020

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I want to qualify this headline by first saying this has nothing to do with the quality of health care services. The doctors, researchers, hospital facilities and personnel, patient advocates and organizations, and drugs are of the highest quality in the world. I have experienced this excellence with my own treatment of an incurable blood cancer called multiple myeloma. I was blessed to have medical and drug coverage from my wife's public school system union negotiated health care insurance, and secondary insurance of Medicare because the myeloma caused me to have end stage renal disease. With these two insurances I was able to obtain treatment at Mayo Clinic and UAMS. The prognosis for myeloma with dialysis dependent kidney failure was 3 MONTHS. Without access to this remarkable care provided by my excellent insurance coverage, I would not be alive 14 years later to write this post. So I do feel blessed to have this exceptional care, BUT for many of the most vulnerable, seniors, poorly insured, and lower income patients' this is not so! This post is about Affordable Access to these outstanding life saving health care services.

We spend more on healthcare than any other nation in the world. In fact we spend at least twice as much per capita than all but 4 countries in the world. With this tremendous financial commitment we would expect to have some of the very best results in the world, at least in the top 10. Two important measures of a countries' health care success are life expectancy and infant mortality rate- The start and finish to life.

The USA is ranked 46th in life expectancy CLICK HERE

The USA is ranked 54th in Infant Mortality CLICK HERE

Apparently we are not getting what we pay for, or maybe we do get what we pay for. To the extent the top 25% of income earners live for 87 years and the bottom 25% live just 77 years, maybe the graph below is not just a coincidence, but income dependent. The best life expectancy in the world is Hong Kong at 85.29 years. So money may not buy you love, but it may buy you life! High prices, under-insured, co-pays(medical and drugs), poverty, disability, retired, seniors, co-pays based on list not net pricing, PBMs, Medicare co-pays on drugs at list pricing always(no negotiation), insurance delay pays, etc..to me we pay more than anyone in the world and do not get the outcomes we should expect. This is the Art of the BAD deal!

Another Part of the BAD deal is where we do not negotiate Medicare Part D drug prices, and as a result we do not get the net price from drug companies which most other developed countries negotiate. These other countries negotiate a discount rate at 50% or more. The USA buys more drugs than any other nation, and based on the economy of scale(buy more get a better price) we should be getting a price lower than any other country not twice what they pay! Many countries therefore obtain drugs at half to a third of the price Medicare pays. To see government study CLICK HERE. Also, when drug companies increase the price by nearly 10% each year, the $ impact on these other countries is half of that which the USA will pay. So if a list price is $100, the new Medicare cost would be $110, but for the counties which negotiate a 50% discount, their cost would originally be $100 x .5 or $50 and the new cost would be $110 x .5 or $55, a saving of $5 this time and every time a drug price goes up.. In the President's outline for drug price reform,he provided the following data from his plan. To see the plan CLICK HERE

Combined, Medicare and Medicaid represent 40 percent of the U.S. drug market – we’re the largest purchaser of prescription drugs in the world, and even if you just look at Medicare, it is clear that our spending is growing. In 2012, Medicare spent 17 percent of its total budget, or $109 billion, on prescription drugs. Five years later in 2017, this had increased to $185 billion. We’re talking about an increase of $76 billion in just five years.

Over the last five years drug list prices have gone up by 9.5% on average, and list price increases represents $62 Billion of the $76 Billion increase in part D drug spending, or 82% of the total increase. So not only do we pay twice as much as countries which negotiate drug prices, but each price increase hits the USA twice as hard as for that of other countries. To me that really sounds like "The Art Of The RAW Deal".

To view the first three parts of this series CLICK HERE for Part 1, CLICK HERE for Part 2, and CLICK HERE for Part 3.

Good luck and God Bless your Healthcare Journey/ [email protected]
For more information on multiple myeloma CLICK HERE and you can follow me on twitter at: https://twitter.com/grpetersen1

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If We Take Away The Drug Companies' Government FREE LUNCH, THE SKY WILL BE FALLING! Part 3 Of 4

1/22/2020

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Let's set the stage by first establishing the logic behind not negotiating Medicare Drug prices. The first is this will limit the development of new drugs because the drug companies will develop fewer drugs. The other is that we will not have access to many of the current drugs for cancer which are currently available in the US but not in Europe or other countries. Some very good arguments if they were at all credible. But I would argue it is nothing more than Bogus Spin by Drug Companies and their lobbyists. The Drug Industries' efforts to Pettifog the Public! I will talk about each of these points in detail.

Before I begin the analysis of these arguments, I believe they all are in fact mute. If our government was a government which represented the people, one would think that if 9 out of 10 members of the public believe we should negotiate Medicare D prices, how on earth could it not be law NOW? Something is very wrong with our democracy, when just 10% of the people can DICTATE policy!

With all of this doom and gloom you would think the Medicare Part D was the vast amount of the global drug spending. However, in 2017 Medicare Part D spending was just $154.9 Billion of the total worldwide spending of $1135.0 Billion. This is 13.6% of the world spending. The Congressional Budget Office(CBO) projects a savings of $49 billion per year and at the average after tax profits of Pharma at 14%, the impact on the bottom line of the international drug industry would be $6.9 Billion or just 6/10 or 1% if I were to provide a liberal estimate of the impact to pharma. Let's just say, because we do not negotiate price the profit on Medicare is 3 times greater than the industry average or at 42%, then the impact would be just 1.8%. Someone seems to be trying to make a MOUNTAIN out of a molehill. The source of much of this information can be seen if you CLICK HERE! The CBO also estimates that the loss in revenue for drug manufacturers would lead to 8 to 15 fewer drugs coming to market over the next 10 years of the approximately 300 drugs expected to be approved during this period. To me drug companies will continue to do what they have always done to improve profits and that is to JUST RAISE PRICE. With drug increases of over 10% each year for 5 years and 2017 at 8.4%, any impact of lost profits would be offset by just one year of price increases.

The final point on the suggestion negotiating price will limit the development of new drugs. If you can make profits and your bonus by just raising the price of your existing drugs, why go though the heavy lifting to develop new drugs. If we take away this FREE LUNCH, major drug companies will have a greater incentive to develop new drugs to achieve improved profits. In addition, big pharma will more likely look to the small biotech companies who are a major incubator of drug development and help them to bring great ideas to the clinic. The process used to be these small inventive companies would develop ideas conceived at Universities, the NCI,, Teaching Hospitals and Labs, bring them to a level of development and then be taken over or funded by large pharma which had the financial might to spend the $2.5 Billion to get these drugs to market. This process has been disrupted when all you have to do is raise price to make bonus. The inventive, small biotech companies now are starved for funding, and are seen as easy targets for destructive stock manipulation, which can and does bankrupt these small vulnerable agents of invention.

The last argument is just preposterous! The US will not have fewer cancer drugs with Medicare drug price negotiation. New drugs are patented so drug companies can sell them as a monopoly for several years. For the European's they negotiate the price based on a value of $50,000 per year of life saved by a drug, and the US has a number from ICER which is a benchmark at $150,000 per year of life saved. Drug companies are not required as yet to follow even this more liberal US standard, so the USA will always be the first country to get drugs approved even if the ICER standards become mandatory in the US. The ICER standard has a much higher threshold for drug denial at 3 times that used in Europe.

Just as an aside, I recently attended the ASH(American Society of Hematology Meeting) in Orlando and was amazed at the explosion in new treatment developments.
With this new backlog of drugs in later stage development, the future of FDA new drug approvals looks outstanding.

The last important part is the graying of America and the world, which provides a HUGE tail wind to the growth in Pharma sales and profits. This has been reflected in the tremendous growth which we have seen in Medicare Part B and Part D spending.. In 2017 spending was $185.3 Billion of the total USA spending of $333 Billion. This was 56% of the total but just 15% of the US population over 65. The US population over 65 will increase to 21% of the US population in 10 years, 40% greater than today. Logic would therefore imply Medicare spending would increase by 40% or $74 Billion without a price increase by Pharma just due to the aging of the US population. A way to reduce Medicare costs are right here, without cutting Medicare funding at all. NEGOTIATE PRICE!

Good luck and God Bless your Cancer Journey/ [email protected]
For more information on multiple myeloma CLICK HERE and you can follow me on twitter at: https://twitter.com/grpetersen1

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Mayo’s Myeloma And You: A Day For Patients And Caregivers

1/14/2020

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When Pat Killingsworth started Pat’s Myeloma Survival School he wanted to develop something which focused on the Patient and Caregiver. He had attended many of the meetings like ASH and ASCO and found they were designed with a focus on the medical community, and lacked a patient focus. At the time these sessions were held in the Jacksonville area so Mayo had a big part to play in them. I got the same feeling at Mayo’s Myeloma And You Program as I had at Pat’s Survival School. This is why!

- The first 3 speakers were either patients of caregivers with lots of time for questions
- Doctor Asher Canaan Khan and Dr. Sikander Ailwadhi have an uncanny way of providing a patient friendly presentation with humor
- The second half of the program was all about supportive care
- Dr. Mohamed Kharfan-Dabaja and Dr. Sikander Ailwadhi discussed the new CAR T program at Jacksonville, and the work they are doing with several malignancies including myeloma.
- Dr. Ailwadhi discussed the many clinical trials which are currently available including AMG 701, BiTES, CAR T, ADC, Selinexor, and CLR 131.
- Dr. Asher Chanan Khan discussed breakthroughs and Immunotherapy. He highlighted a new vaccine therapy which he feels just may be the BREAKTHROUGH for cure we have been hoping for. Many vaccines have been tried and failed in the past but he feels he has finally found the key! I hope he has, he is usually right!
- This Mayo Myeloma And You Program is just 2 years old and the growth has been exponential and the cost at $20 per person is a deal. Over 200 participants this year. The drug companies like Takeda, Celgene, Sanofi, & Karyopharm helped to fund this program.

Knowledge is power and for myeloma it is LIFE! Thanks to all who helped to bring this patient and caregiver focused program to the myeloma patient population. To me more should be presented using the Pat Killingsworth Survival School Template.

Good luck and may God Bless your families cancer journey. For more information on multiple myeloma CLICK HERE and you can follow me on twitter at: https://twitter.com/grpetersen1

A few pictures from the meeting.

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If USA Healthcare Was Affordably Accessible, The Very Sick Would Love Drug Companies, Insurance Companies, Government, And Medicare! Part 2 Of 4

1/10/2020

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As a myeloma patient I feel blessed to have had great insurance through my wife who had great union benefits as a teachers aide. I had kidney failure so I could get Medicare coverage as a secondary insurance. In addition this coverage allowed me to be treated at Mayo and UAMS, two of the world's best Myeloma Centers. So personally I loved my doctors, hospitals, and drug companies because I had AFFORDABLE ACCESS to excellent health care. I, plus perhaps 50% of Americans, are equally blessed. This leaves the remaining 50% without affordable access to our system, and this makes all the sense in the world why the following statements are true, and all else is bogus spin.

We spend twice as much as the highest per capita spending of any other nation in the world. Over twice as much as the average of all other developed countries. We should have a healthier population than the rest of the world, but over and over on any measure life expectancy, child death rate, etc. we are seldom even in the top 10. We do not get what we PAY FOR !

Drug Prices are 2 to 10 times more expensive than in most other counties. All other nations and commercial insurance negotiates for lower prices, but Medicare does not. It is like everyone gets to buy a car at half price except the US which must pay list! Whatever drug companies give up to other great negotiators is made up by increasing list on Medicare!

Insurance companies, PBM's and Medicare base copays as a percent of List price, and not of negotiated price. If the insurer get a 50% discount you still pay the SAME % of List. Also as the price of drugs increase the copay cost goes up., The copay for generic drugs is low $5 to $10 per prescription, but Tier 4 and specialty drugs(like cancer drugs) far greater and can be as much as 30 to 35% of the list price or as much as $5000 per per prescription. The copays must be limited to $100 to $200 per prescription.

Medicare Part B has no out of pocket maximum, so 20% or $500,000 for a stem cell transplant is HUGE! A Medigap plan would be required at an additional $3000 to pick up this extra 20%.

The new laws in the House and Senate do not address the issue of affordability, but could with some key modifications. The following discusses most of the above and more.

For more information on multiple myeloma CLICK HERE and you can follow me on twitter at: https://twitter.com/grpetersen1

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Shouldn't We Be Improving AFFORDABLE Access To Life Saving Drugs! Most Else Is Just BS (Bogus Spin)! Part 1 Of A 4 Part Series

12/21/2019

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The major components of the new drug plans in the House focuses on Drug Pricing, and the Senate's bill on pricing really does not even confront the Elephant in the room, which is the lack of negotiation of Medicare Drug Prices. However, both bills have one thing which will improve ACCESS, which is the cap on out of pocket costs, the House at $2000 and the Senate at $3100. So what is the Bogus Spin? There are 3 major categories of BS (Bogus Spin)

- Reducing Negotiated Drug Prices will improve AFFORDABLE ACCESS to life saving drugs.
- New Drug innovation will be stifled if Medicare negotiates price.
- We have the BEST health care system MONEY CAN BUY.

I had planned to do a three part YouTube broadcast on these three elements, but everyone was focused on other government business(impeachment). I think it is only logical to start this series after the holidays. However, I believe I can outline some of the logic beforehand.

Reducing Negotiated Drug Prices will improve AFFORDABLE ACCESS to life saving drugs.

Most private and government insurance (eg. Medicare, Medicaid) base the copay at a percentage of the List Price, not the Negotiated Price. If the negotiated price goes down by 50% the list remains the same so the copay does not change one bit! Copay must be changed to a percent of net pricing.

The Insurance companies increase the copay % as the price of the drug goes up. They call it Tiers, and I think they need to change the spelling to TEARS. Tier 1 (preferred generic drugs)has a very reasonable copay of $5 to $15 per prescription, but in higher cost drugs in Tier 4 and the Specialty Drug Tier it is 25 to 33% For cancer drugs this can represent $3000 to $5000 per month. I have myeloma and the one drug which is used in most all treatment regimens is Revlimid, at an out of pocket cost of $14,000 per year. See the graph below.

Affordable is a major key to this entire argument. Is it affordable to all Americans? I say that is so much BS(Bogus Spin). It is not affordable to most seniors, nor the middle class, the needy, and minorities. Let me just talk for a minute about very sick seniors! The ones with heart disease or cancer. The number 1 and 2 killer of Americans. According to the Kaiser Family Foundation the average income of a Medicare Beneficiary was $26,200 in 2016. To be covered for the 20% copay of Part A & B, they would need to have Part G or F as well, and include Part D for drugs. Cost for these insurance premiums is $5000 each year and with one drug like Revlimid at a copay of $14000, it comes to a total of $19000. This is the equivalent to Senior Genocide, but with all cancers a slow agonizing death. Over 600,000 Americans die of Cancer each year! Just for comparative purposes this contrasts to the costliest war in US history, the Civil War, where 620,000 soldiers died over a period of 4 years.

New Drug innovation will be stifled if Medicare negotiates price.

If you were provided a free lunch everyday and it was excellent food, why on earth would you pay for your own? Not having to negotiate price is the "ART OF THE NO DEAL". Drug companies must negotiate prices with all major industrialized nations, and private insurance companies and PBM's(Pharmacy Benefit Managers), but for everything they lose in these negotiations can be made up by just raising list prices which Medicare will pay by law!

The NIH (National Institute of Health) provides billions of dollar to fund the development of new drugs, and academic institutions provide basic research for drug development. Frequently, this work is then developed by very small companies which do not have the capital to spend the billions to get FDA approval. If they have a great idea, they usually are purchased or license the drug to a large drug company, which has the funding to bring it to market. The two blockbuster myeloma drugs, Thalidomide/Revlimid(Celgene)and Velcade(Takeda) were developed by very small companies. Celgene was very small when it licensed the use of Thalidomide from Rockefeller University, and Velcade was first developed by a small biotech ProScript to treat muscle weakness and muscle loss associated with AIDS and muscular dystrophy and ultimately was purchased by Takeda.

To me the biggest barrier to new drug development is the lack of protections for small bio tech firms which have become the target of Illegal and criminal stock market manipulation. Small companies can easily be forced into bankruptcy by Capital Vultures who have found easy prey in small and vulnerable biotech firms. Many companies have been devalued by as much as 99% in just 5 years. How many life saving drugs have not made it to market because of these heartless and morally bankrupt animals who feed off the dead and dying? I explain this in a 3 part series and you can read it if you CLICK HERE. Two prior blog posts on this major problem are as below, just click on either of the following story headings.

What If The New Cancer Drug Pipeline Runs Dry? No New Cancer Drugs! Patients DIE!
The Proof Capital Vultures Are Destroying Baby Bio Tech Companies Before They Have Time To Create New Drugs!

The USA has the BEST health care system MONEY CAN BUY.

This one is very hard to argue with unless we look at the definition of the word BEST. If best is the one where you can get the best care in the world only IF you have all the money in the world or have a drug and health plan with affordable co-pays, then it is hard to argue against this statement. If best is defined by any other measure, best life expectancy, care for all citizens, care for the elderly and needy, most cost effective per citizen, non discriminatory, lowest infant mortality, ad infinitum, then we have a very long way to go.

Each of these points will be discussed in my 4 part Series titled "The Bogus Spin Report" or in short "The BS Report". Good luck and God Bless your Cancer Journey/ [email protected].

For more information on multiple myeloma CLICK HERE and you can follow me on twitter at: https://twitter.com/grpetersen1

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BIG #MYELOMA NEWS WEEK! #ASH19 Showed Excellent Progress Towards The CURE, & The House Passed A Drug Cost Control Bill!

12/15/2019

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Myeloma Had An ASH Kicking In Orlando This Year!

I had an opportunity to attend the ASH(American Society of Hematology) annual conference this year in Orlando from 12/6 to 12/10, and came away with the feeling the future of myeloma treatment is excellent! These are my top line takeaways.

- Myeloma has a tight knit community of researchers, myeloma specialists, patient advocates, drug companies, and myeloma organizations like the IMF, MMRF, LLS, and Myeloma Crowd.   They use Twitter and Facebook as communication tools which provides real time information to the myeloma patient community. There are more than 24 major categories of blood diseases represented at ASH, and myeloma was frequently listed in the top 10 of ASH twittter online influencers. Given myeloma is one of the the 24 major diseases, you would expect them to have less than one top influencer in the top ten, but they had between 6 to 10 of the top 10. Just remarkable!

- Each new class of drug which is approved has resulted in an increase of one year in life expectancy. We just had one new drug approved, Selinexor.   We also have 7 drugs which have a high probability of approval. These are the ones with at least two FDA designations like Orphan Drug and Fast Track. Effectively the ones the FDA finds fill an unmet need and have the most potential, kind of like the Teachers Pets of drugs. CAR T, BiTE's, ADC's, AWC, melflufen, multi target CAR T, CLR131, allogeneic CAR T and many more, are all new classes of drugs which bodes well for current and future patients life expectancy. I estimate a minimum of 6 new classes of drugs approved for myeloma which, if history repeats itself, would take the current NCI, national average life expectancy, for all patients from 6 years to 12 years. The 15% who consult or see a myeloma specialist which now have a life expectancy of 10+ would likely to exceed 16+ years.

- When Daratumumab was approved in RRMM(Relapsed Refractory Myeloma) it had been approved with an ORR(overall response rate) of 24% and a PFS of just 1.9 months. Daratumumab has been moving to early stages of the disease, and in combinations with EVERYTHING! It seems "Things Go Better With DARA"! These new combination with Darzalex are exhibiting exceptional resultsl. At this year's ASH we have new drugs which have shown better initial results in heavily pretreated patients who have also failed Darzalex. The newly approved Selinexor had an ORR of 26% and twice the PFS at 3.7months. A drug in clinical trial, GSK2857916 has an ORR of 38.5% in patients who had previously been treated with daratumumab, and a PFS of 7.9 months This is 4 times more effective than the Darzalex PFS! The big question is how will these and all the new classes of drugs perform when moved to earlier in the disease process. I think the sky is the limit!

- A big finding for me was a repeated use of the phrase "treatment used as a Bridge".   At end stage myeloma, patients are often too sick to qualify for clinical trials. If treated with one of the end stage drugs like Panobinistat, Selinexor, or many other combinations the disease may be able to be controlled enough to make it into available clinical trials.

- Treatments for early stage myeloma have shown excellent results, For example high risk smoldering myeloma has a 50% chance of progressing to full blown myeloma each year, however an all oral clinical trial of IRd (Ninlaro, Revlimid, dex) had a 0% chance of progressing in the first 30 months or 2 1/2 years. Many such trials for high risk smoldering myeloma are in process. Soon the question will be how do we screen the population to catch myeloma in the precursor stages. This may reduce or eliminate the devastating end organ damage associated with finding myeloma in the later stages of the disease progression. The future looks bright!

The House Has Passed A Bill Which Should Help Patients To Get Access To Life Saving Drugs! BUT!

This is great news for the myeloma patient community. Cost is important, however the critical feature to the patient is ACCESS TO LIFE SAVING DRUGS!

The Congressional Budget Office estimates that the proposal would reduce Medicare drug costs by $500 billion over 10 years in three major ways:

· It would allow Medicare to directly negotiate prices for up to 250 of the mostly costly drugs that have no competition from generics or biosimilar drugs. Companies that don’t negotiate would be subject to an excise tax of up to 95 percent on gross sales.

· The US prices of those drugs would be tied to a benchmark index of prices in other developed countries.

· And, for all drugs, manufacturers would have to rebate back to Medicare any price increases that exceed the rate of inflation.

The most significant element of the bill for drug access is the capping of out of pocket and co pay for Medicare at $2000 per year. Currently there is no out of pocket maximum limit. Most all newly diagnosed myeloma patients usually have a treatment regimen including Revlimid, and the copay would be $2600 for the first month. Under the House plan it would be limited to $2000. Great news, if is was not for the fact 50% of prescriptions with a co pay over $2000 are abandoned at the pharmacy. I believe Senate bill allows this to be spread across the entire year. So what is the BUT?

The BUT is the house passed it on Party Lines, and President Trump, who supported the idea of negotiating drug prices during his presidential campaign, now strongly opposes the House Democrats’ bill for part D. The measure will likely die in the Senate, where Majority Leader Mitch McConnell (R-KY) may block it from ever coming to a vote.

The Senate has a bill which the president will likely back BUT is absent one of his initial major objectives to negotiate Medicare, and Medicaid oral drug prices. This bill well likely be rejected if voted on in the House. The concern in the Senate has to do with the thought this would limit new drug development. Private insurance companies negotiate prices now, as do all single payer programs throughout the industrialized nations of the world. It is also the talking point all the drug lobbyists are spinning!   It is known that 8 in 10 American's feel Medicare should be able to negotiate drug prices. BUT the measure does not address the problem copays are always computed as a percentage of the list price and should include provisions to make copays a percentage of the negotiated price. Under the existing system if the cost of a drug is negotiated down by 50% the copay would remain the same. Our entire economy is based on negotiating price and trying to get a better deal by leveraging buying power or "The Art Of The Deal". The USA has 4.3% of the world's population, but is estimated to be 45% of the world's total prescription drug spending by Reuters in 2021. As President Trump has noted the world gets a free ride or better said the US pays way too much! Like China's predatory trade practices, this must STOP!

This is a very complex problem which requires far more of a discussion than I can discuss here. I plan on providing a multi part You Tube broadcast which I will title "The BS(bogus spin) Report".

Good luck and God Bless your Cancer Journey/ [email protected]
For more information on multiple myeloma CLICK HERE and you can follow me on twitter at: https://twitter.com/grpetersen1

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