In the last installment we started down the perilous rabbit hole of the presidential candidates’ respective healthcare plans. In this episode, we continue said journey which happens to lead us to the pharmacy where our life-saving medication is covered provided we pay the $18,325 deductible, the $57 copay and half of the acquisition cost of the drug which also happens to be $18,325. What are the odds?

Suffice it to say that prescription drug prices are a pressing health issue. As per the previous article, information on the candidates’ plans was extracted without anesthesia from their respective websites: and

Secretary Clinton plans to remove tax breaks for direct to consumer marketing. (I was not aware that was even an option). She will demand that drug companies invest more funds in research and development instead of marketing if they want to get any taxpayer support. She wants to create a “backstop” for excessively expensive drugs that do not have any competition. (Those types of drugs do tend to be more expensive). And she intends to clear out the FDA backlog of generic drugs.

Another shady pharmaceutical practice that Secretary Clinton is wanting to address is “Pay for Delay”. This is where a drug company that makes a brand name drug pays generic drug makers to hold off on making generic versions of the drug, thereby allowing the brand name drug company to rake in profits over a longer time period. If this practice seems shockingly corrupt and detrimental to patients, that’s because it is.

The one area where Secretary Clinton and Mr. Trump are in agreement is the importation of medications from other countries. They are both in favor of this practice. They both emphasize that the imported medications would be inspected for quality and safety. This is where Mr. Trumps plan to control prescription drug costs ends. He has not mentioned any other approaches on his website.

But Secretary Clinton does.

She wants to ensure that new drugs are more effective than established treatments. While this may seem like a no-brainer, the actual process of a new drug coming to market is anything but. A new drug only has to prove that it is better than placebo (i.e. nothing) to be approved by the FDA. It does not have to prove that it is better than the established medication.

For example, let’s say Drug company Moneybath has a drug, X, that treats depression better than placebo. It submits the research to the FDA and if the research is found to be sound, the drug is approved. Then drug company Moneybath sends sales reps to clinics and does direct to consumer advertising featuring black and white footage of a morose middle aged woman that turns into color after she takes drug X. Drug X sells for $319 per month. Meanwhile the established treatment drug A sells for $10 per month. Secretary Clinton wants to hold drug company Moneybath responsible for showing that drug X actually works better than drug A. Certainly from a provider and patient perspective that would be very helpful information.

Secretary Clinton’s plan will allow Medicare to negotiate directly for drug prices. This allow Medicare to leverage its large patient population to get a better deal from drug companies. Since getting a Medicare contract means a medication would be easily accessible to millions of seniors, drug companies have a strong incentive to strike a good bargain.

And finally, Secretary Clinton vows to put penalties on unjustified price increases. I’m guessing the recent case of the Epipen price surge and the not as recent example of the toxoplasmosis drug used for AIDS patients, Daraprim, price surge are examples of such unjustified price increases.

That concludes this brief tour of our presidential candidates’ plans for America’s healthcare. As always, the debate essentially boils down to whether we think healthcare is a public good like road works, drinking water and fire fighters that everyone should support so everyone can use it, or if we think healthcare is a private good like cell phones, cars, and paisley socks that people decide on their own whether they want to get it or not.

We’ll have a slightly clearer sense of America’s leanings on November 9.  

Dr. Ali Javanbakht is the UCSB Student Health Medical Director