Foreign Impact on Healthcare

Blog post by Colin Hung

This past week there were two stories that captured my attention. One involved China and the US, the other Canada and the US. Given that the next #hcldr chat falls between Canada Day and US Independence Day, I thought it would be fun to explore them with the community.

US + Canada

A story broke late last week about a caravan of Americans who were planning on driving to Canada in order to buy insulin.

According to a story in the Globe and Mail, Kristen Hoatson, a mother of an 11-year-old son who as Type 1 diabetes, will be boarding a chartered bus in Minneapolis and heading to London, Ontario (865 miles away). While in Canada Hoatson plans to purchase NovoRapid, the Canadian equivalent of NovoLog which retails for US$824.79 for a five pen cartridge.

The price in Canada? CDN$61.23 which is about USD$50 at the current exchange rate. And it’s available without a prescription.

This gap in price has only gotten wider in recent years as the cost of insulin in the US has more than doubled since 2012. The price in Canada has remained relatively constant – due in most part to the Patented Medicine Prices Review Board, the federal regulator in Canada that sets maximums on drug prices.

The concept of putting a cap on the cost of certain medications is starting to garner some attention in the US, but faces stiff pressure from pharma companies who are naturally lobbying against it.

André Picard put it best in his op-ed on the insulin caravan:

“The solution to the problem is not for Americans to do drug runs to Canada, or for the U.S. to start importing drugs from Canada, as some federal and state legislators are proposing. The only viable solution is for the U.S. to legislate a cap on drug prices and to provide decent prescription-drug coverage to those who can’t otherwise afford their care, as every other Western country does. The insulin moms know this, and, to their credit, that is their goal.”

Picard also warns his fellow Canadians not to get an inflated head over the price of insulin:

“We also have to be careful not to be too prideful about our lower insulin prices. The continuing debate about pharmacare in Canada is a reminder that while our prices are lower than those in the U.S., they are still significantly higher than in other developed countries.”

Oh and why drive all the way to London Ontario to buy insulin? It just happens to be the hometown of Sir Frederick Banting MD, the co-discoverer of insulin.

US + China

Also in the news last week was the announcement that UnitedHealth had purchased PatientsLikeMe, the online service that helps connect patients with others who have similar health conditions. This sale was a direct result of the Committee on Foreign Investment in the United States (CFIUS) taking exception to the sale of a majority stake in PatientsLikeMe to China’s iCarbonX in 2017. Christina Farr and Ari Levy wrote an excellent article about this back in April.

“That deal has recently drawn the attention of CFIUS,” wrote Farr and Levy. “which is aggressively cracking down on Chinese investments in American companies, particularly when national security and trade secrets are at risk.”

Presumably the concern was over the potential for medical conditions of US citizens being exposed to the Chinese government.

Inadvertently, CFIUS drove PatientsLikeMe into the hands of a healthcare product/insurance company – UnitedHealth. The irony here is that many patients are uncomfortable sharing detailed health data with their insurance companies because they fear it being used against them (voiding coverage, raising premiums, etc).

To be fair, in the past several years, insurance companies have been actively looking for ways to do a better job at keeping their members healthy. PatientsLikeMe is a platform that can help UnitedHealth do that.

Chat Questions

Join me on #hcldr, Tuesday July 2nd at 8:30pm ET (for your local time click here) when we will explore  these stories in more depth:

  • T1 One argument drug makers use to justify high prices is that the $$$ are needed to fund research and the flow of new medications. How do you respond to that?
  • T2 It’s laughable to think about lobbying gov’t to set a max price for cell phones or cars. Why should/shouldn’t medications be different?
  • T3 Who would you least want to have easy access to your data – a foreign company, an insurance company that isn’t your own or a device company? Why?
  • T4 What can UnitedHealth do to ensure PatientsLikeMe continues to be helpful/useful for patients?

References

Sarashon-Kahn, Jane; Fox, Susannah and Suennen, Lisa. “A Matter of Trust, Perception, Risk, and Uncertainty – The Big Issues Raised by the Acquisition of PatientsLikeMe and Other Patient Data Transactions”, HealthPopuli, 1 July 2019, https://www.healthpopuli.com/2019/07/01/a-matter-of-trust-perception-risk-and-uncertainty-the-big-issues-raised-by-the-acquisition-of-patientslikeme-and-other-patient-data-transactions/, accessed 1 July 2019

Farr, Christina and Levy, Ari. “UnitedHealth buys PatientsLikeMe, which faced Trump administration scrutiny over Chinese investor”, CNBC, 24 June 2019, https://www.cnbc.com/2019/06/24/unitedhealth-buys-patientslikeme-after-cfius-forced-sale.html, accessed 29 June 2019

Farr, Christina and Levy, Ari. “The Trump administration is forcing this health start-up that took Chinese money into a fire sale”, CNBC, 4 April 2019, https://www.cnbc.com/2019/04/04/cfius-forces-patientslikeme-into-fire-sale-booting-chinese-investor.html, accessed 29 June 2019

Grant, Kelly. “Caravan of American parents, patients seeking cheaper insulin to arrive in Canada this weekend”, The Globe and Mail, 27 June 2019, https://www.theglobeandmail.com/canada/article-caravan-of-american-parents-patients-seeking-cheaper-insulin-to/, accessed 29 June 2019

Rauhala, Emily. “As price of insulin soars, Americans caravan to Canada for lifesaving medicine”, Washington Post, 16 June 2019, https://www.washingtonpost.com/world/the_americas/as-price-of-insulin-soars-americans-caravan-to-canada-for-lifesaving-medicine/2019/06/14/0a272fb6-8217-11e9-9a67-a687ca99fb3d_story.html, accessed 29 June 2019

Picard, André. “Desperate for lifesaving insulin, Americans head to Canada”, The Globe and Mail, 18 June 2019, https://www.theglobeandmail.com/opinion/article-desperate-for-lifesaving-insulin-americans-head-to-canada/, accessed 29 June 2019

Picchi, Aimee. “Price of insulin more than doubled over five years”, CBS, 22 January 2019, https://www.cbsnews.com/news/price-of-insulin-more-than-doubled-over-five-years/, accessed 30 June 2019

Image Credit

Photo by chuttersnap on Unsplash

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