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Valeant Pharmaceuticals' much-ballyhooed agreement with Walgreens includes an unusual inventory provision that helps explain why the pharmacy chain might have been eager to strike a deal...Valeant is buying back its drugs from Walgreens and selling them on consignment to the pharmacy, a provision that triggers an upfront financial hit. Walgreens won't physically return the drugs, just the title to them...It's just one out-of-the-ordinary feature of an out-of-the-ordinary pharmacy deal. Valeant announced last week that it had teamed up with Walgreens to distribute its drugs, discounting key skin and eye brands by 10% and another slate of meds by an average of 50%. Walgreens is taking the Valeant drugs on consignment and collects fees for filling prescriptions…The Walgreens partnership replaces Valeant's relationship with Philidor, a specialty pharmacy that was closely tied to the drugmaker until questions arose about its operations...The drugmaker is expecting a sales hit from the pharmacy shift, partly because of the mechanics of the Walgreens deal and partly because of lower demand for its drugs in the wake of the Philidor allegations.

I read the letter you recently published regarding pharmaceutical costs ["Pharma costs leave cures out of reach for many," Voices, Dec. 11], and have to ask in response: Where is the accountability of insurance companies?...It’s easy to blame pharmaceutical companies, especially given the recent issues with one very bad actor from Turing Pharmaceuticals. But what about insurance companies deciding what drugs they will and won’t cover? The fact is that insurance companies play a role in this issue, and they need to be held accountable...my quality of life shouldn’t come down to my insurance company deciding what they will and won’t cover.

As World Health Organization figures show China rising to the top of the list of countries with the most cancer cases, its people are facing increasing problems in trying to find ways to pay for their treatments. Healthcare costs are soaring in the nation despite the government's efforts to force drug prices lower...China spends $115 billion on pharmaceuticals annually, but stubbornly high prices mean some are having to make life-and-death decisions...China's cancer crisis takes an estimated 2.2 million lives each year...and the trials and tribulations of its people are exacerbated by the lack of insurance...cancer patients pay anywhere from 80% to 120% of U.S. prices for foreign medicines and also pay up to 77% of all private healthcare costs...China claims that it covers 95% of the healthcare coverage for its citizens, but costly foreign drugs for cancer treatments are often not covered. The country is undergoing a massive reorganization of its healthcare system that is expected to cost upward of $460 billion and is trying to cut drug costs and improve insurance coverage...China's efforts to slash spending on drugs is having a perverse effect on its public hospitals which rely on drug sales to add to their operating revenues.

Alongside the growing prevalence of chronic pain and prescription opioid use, drug-related overdose continues to claim the lives of 17,000 Americans each year...Deaths from unintentional opioid overdose have increased 56% since 2010. In 2013, 83% of the opioid overdoses were unintentional...In 2010, there were approximately 136,000 emergency room visits related to opioid-induced respiratory depression and overdose. Needless to say, opioid overdoses are...drastically increasing health care costs...When naloxone is administered by first responders outside an institutional setting, it can improve outcomes for emergency opioid reversal prior to a patient reaching the emergency department. There are currently 2 FDA-approved naloxone formulations for take-home use: the auto-injector...and the new intranasal formulation...

• Who Should Receive Take-Home Naloxone?
• The Risk Index for Overdose or Serious Opioid-Induced Respiratory Depression (RIOSORD)
• Risk Factors Associated with OSORD (opioid-induced respiratory depression)
• How Can I Use RIOSORD in a Community Pharmacy?
• Risk Mitigation and Patient Education
• Conclusion

With the availability of naloxone for take-home use, no one should lament over the loss of a loved one because a life-saving medication was not easily accessible...We can’t agree that naloxone availability will end opioid overdose deaths, but it certainly is our professional responsibility to ensure that we’ve taken every step to reduce risks...Pharmacists, physicians, and student clinicians have an excellent opportunity to mitigate opioid overdose risks by employing the validated RIOSORD tool. RIOSORD can aid opioid prescribers in identifying at risk patients, and it can also help encourage a candid dialogue among pharmacists, patients, and caregivers to reduce patient harm.

"Don’t Believe the Hype."...It’s good advice for people operating in the R&D side of pharmaceuticals. Many exciting things are happening today in the science, so it’s easy to get carried away. But this year’s market correction–driven in part by systemic concerns about drug pricing, a few clinical trial blowups and shenanigans—should serve as a vivid reminder. No matter how good the fundamentals are, biotech still hasn’t figured out how to carefully calibrate perceptions to keep the steam engine steadily chugging along, without letting things get too hot or too cold...Hype has always been part of biotech because investments must be made on glimmers of promise, otherwise known as incomplete data. Without hype and hope, the industry couldn’t exist...There’s no good way to quantify perceptions, and things change fast in biotech, but I do talk every day to lots of different people with their fingers on the pulse of different things. So I thought it would be fun to try again this year with plotting various biotech platforms and concepts along the Gartner hype curve.

Peak of inflated expectations

• CRISPR/Cas9 genome editing.
• Microbiome everything.
• Genomic wellness.
• Conquering antibiotic resistance.

Trough of Disillusionment

• Digital health.
• Stem cell therapies.

Climbing up the Slope of Enlightenment

• Immuno-oncology.
• Viral Vector Gene Therapy.
• Long-read sequencing.

Public programs such as Medicaid are a necessity – not only for low-income families but for all the public, which benefits from a healthier population...These programs need access to affordable prescription drugs to treat those suffering from diseases like hepatitis and HIV. Unfortunately, their services are threatened by recent price increases from pharmaceutical companies like Turing and Gilead...I worry that such prices for prescription drugs are driving up spending for critical public programs like Medicaid, Medicare, and Tricare at unsustainable rates. We need to be able to cure life-threatening diseases for the low-income, seniors and veterans. But at these prices, it’s simply not feasible. Clearly something needs to change...

Chatting with the public is not in pharma's comfort zone. Drugmakers are adept at the one-way communication known as direct-to-consumer advertising, and some of them deal well with the media. Some even know how to work with patient groups. Back-and-forth with doctors? Pharma's daily bread...But put your average, everyday drug company in the middle of a public conversation, and it freezes up. Worried it will say the wrong thing, sensitive to criticism, mindful of unintended consequences, drugmakers usually prefer to stand by the punch bowl and check their iPhones for messages...You could say pharma has social anxiety...Drugmakers' usual excuse for remaining social-media wallflowers is regulation, or lack of it. The FDA's guidance on the subject is piecemeal and tardy; the agency has slapped companies for overstepping bounds they didn't know existed.

1. Johnson & Johnson
2. GlaxoSmithKline
3. Novo Nordisk
4. Pfizer
5. Boehringer Ingelheim
6. Novartis
7. Bayer
8. Merck & Co.
9. AstraZeneca
10. UCB

Big Pharma has taken its lumps on a number of fronts this year. Election year rhetoric has battered the industry on drug prices. Politicians have also aimed their venom on U.S. companies that seek to move their headquarters to Europe to escape the U.S. high corporate tax rate...has...eroded the public’s trust in this industry...Yet, some recent events, that have gone largely unnoticed, show another side of Big Pharma.

• ...donation of Pfizer 500 millionth dose of Zithromax (azithromycin), an antibiotic that is especially effective in treating trachoma. Trachoma is one of the leading causes of preventable blindness in the world…
• Merck established the Mectizan (ivermectin) Donation Program to eliminate river blindness (onchocerciasis) in Africa and Latin America. 
• Novartis recently announced that it had delivered its 300 millionth dose of a pediatric malaria treatment to children in more than 30 malaria-endemic countries. 
• Beyond donating its medicines, Big Pharma companies are developing treatments for diseases that are unlikely to turn any profit, such as Merck’s Ebola vaccine and GSK’s malaria vaccine.

…all Big Pharma companies have major philanthropic programs in areas of neglected diseases. There are those who dismiss these efforts and some...are even critical of such altruism. Nevertheless, the resources and manpower devoted by Big Pharma are considerable – efforts for which they receive little credit and zero return on investment...In the coming year, we are likely to see more attacks on Big Pharma...The industry is a big target...not without its flaws. However, the industry does a lot of good beyond providing new treatments to treat the diseases of the world. It would be nice to remember that on occasion.

Prices for brand-name drugs are typically higher in the U.S. than other developed countries. The drug industry has argued it's misleading to focus on U.S. list prices that exclude discounts struck behind closed doors with insurers...A Bloomberg News analysis finds that even after these discounts, prices are higher in the U.S. than abroad. Seven of eight top-selling drugs examined still cost more in the U.S. than most other countries..."We can no longer sustain a system where 300 million Americans subsidize drug development for the entire world," said Steve Miller, chief medical officer for Express Scripts Holding Co...The drug industry sees it differently..."The entire health-care system in the United States is more expensive than other countries," said Robert Zirkelbach, a spokesman for the Pharmaceutical Research and Manufacturers of America trade group. "The difference in prices here in the U.S. compared to other countries is often vastly overstated," because comparisons don’t include all the discounts drugmakers give to various payers...In the U.S., list prices are just a little bit crazy, and even with discounts...

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