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Sen. Sanders' Common Sense on HIV Drugs Would Save Money and Lives

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Common sense suggests that in a time of wringing blood from turnips, every member of the U.S. Congress would leap at the chance to save the nation billions of dollars.

Yet Sen. Bernie Sanders (I-Vt.), the most commonsensical man on Capitol Hill, was the only member of the subcommittee on Primary Health and Aging of the Health, Education, Labor and Pensions Committee that he chairs, to preside at a hearing on Tuesday to discuss an issue Sanders called "of monumental importance."

The issue is the current system for drug development in America, HIV drug development in particular, and how it leads to medications priced so high that the people who need them can't afford them.

Sanders pointed out that Americans are forced to pay the highest prescription drug prices in the world -- 85 percent higher than in Canada, and 150 percent higher than in France, Italy, Sweden and Switzerland.

He noted that one widely used HIV medication, Atripla, which combines three different drugs in one pill, costs $25,000 a year in the U.S. But an FDA-approved generic version of the same pill costs a mere $200 in the developing world.

Sanders has offered a bill, S. 1138, that would create a $3 billion fund to be awarded in prizes to drug companies for innovative new HIV drugs, instead of the long-term (usually 20-year) monopoly awarded under the current system.

Nobel Prize-winning Columbia University economist Joseph Stiglitz said at the hearing, "The patent system is a prize. It awards a temporary monopoly power."

That monopoly is why the sky is the limit for drug prices in this country, chemical compounds that cost mere pennies to produce. Of course the pharmaceutical companies claim the high prices are necessary to recoup their research and development costs.

Which is "curious," said Stiglitz. "The government pays for most research and development."

Harvard School of Public Health professor Suerie Moon said there has been an "unwritten political bargain" behind the high drug prices in the U.S. and Europe.

She explained that our side of the lopsided "bargain" is that we pay more than anyone else in the world for our medications to reward companies for their investments in research and development -- even though our tax dollars have already paid for most of the R & D, as Dr. Stiglitz pointed out.

The other side of the "bargain" allows people in the poorest countries to pay generic prices that are closer to the cost of production -- such as the $200 Atripla generic that costs us $25,000.

It may at first glance seem to make sense that a wealthy country like America should pay a proportionately higher price for its prescription drugs. These are the days, after all, when the so-called 99 percent are demanding the wealthiest 1 percent pay their fair share of taxes.

But there's the rub: Those most affected by HIV -- the 30 million estimated by the World Health Organization to be living with HIV worldwide, including 1.2 million in this country alone -- tend to be the least able to afford the extremely expensive drugs they need to save their lives.

Not only that, but our federal-state AIDS Drug Assistance Program (ADAP), which pays for HIV medication for low-income or uninsured HIV-positive Americans, is strained to the breaking point because of underfunding and ridiculous domestic HIV drug prices.

As of last week, 2,759 HIV-positive Americans who need medication couldn't access it because of the underfunded ADAP program. This is a big drop from the 2011 high of 9,217 in 12 states.

The prohibitive cost of medication has forced thousands of HIV-positive Americans who need treatment to wait, or be turned down altogether -- despite the fact that we know antiretroviral therapy saves lives and reduces the risk of HIV transmission by up to 96 percent.

"Treatment and prevention are linked," said Dr. Mohammed Ahkter, director of the District of Columbia department of health. "You can't do one without the other."

It makes no medical, moral or economic sense that Americans who need life-saving medication -- which is also a key to preventing new infections -- aren't provided access to antiretroviral therapy as soon after they test positive as their doctor recommends it for them, and in spite of their ability to pay.

Without a generous private insurance plan or public programs such as ADAP and Medicaid, few can afford the $25,000-plus it costs to manage HIV infection with antiretroviral treatment and the associated costs of lab work, specialists and additional medications needed to treat the side effects of the ART drugs.

Which makes it galling that, as Sen. Sanders noted, the President's Emergency Plan for AIDS Relief (PEPFAR), the U.S. government's AIDS program in the developing world, is able to purchase generic Atripla for under $200.

Our tax dollars are paying for dirt-cheap generic drugs for people with HIV in the developing world -- while Americans who need the very same drugs are forced to wait, suffer and die because they can't afford the outrageous prices charged for the same drugs in this country.

The Pharmaceutical Research and Manufacturers of America (PhRMA) naturally says the current patent system works. It certainly works extremely well for its member corporations.

But it's not working well at all for Americans who underwrite these companies' research and development costs -- and are then forced to cover the billions they spend to market their products in prices we can't afford and that are wrecking our entire health care system.

Sen. Sanders' proposed "Prize Fund for HIV/AIDS Act" could help to change this crazy situation. "It is designed to accelerate innovation and expedite access to its products at the same time," said the senator, "as if patients and their well-being are paramount."

People over profits. Now that is common sense.

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