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Implications of Inaccessible Insulin in US Markets

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The  Recent Telephonic Survey report conducted by the Staff of two  U.S  Senators i.e Elizabeth  Warren and    Richard  Blumenthal in the Month of Decembers 2019, is an eye-opener since three Market Leaders of  Insulin manufacturers   –  Sanofi, Novo Nordisk and  Eli Lilly controlling the  80% market share has failed to provide  Insulin to market despite their promises to ensure supply of the discounted authorized generic version of Insulin in the market to avoid shortage.

The report spells a cursory glance missing other market players who are equally involved making the report useful since it underpins loopholes which were neglected by only blasting only player –Eli Lilli. The reported outcome might have been very fruitful had the researches included other market players who are equally responsible in the issue those include manufacturer, insurer, doctors and pharmacies.

It was disgusting to know that despite using resources, the staff worked hard to conduct the research over the chain and no chain suppliers through the telephonic  survey  but the results unsatisfactory as the report targeted the only market player and provided safe passage to others deliberately providing safe cover to escape responsibility.  What the authors of the report did in their findings without analyzing the supply chain process, equally shows that they failed to substantiate their argument and threw all the burden to a single actor in the market – Eli Lilly.

It is also surprising that the report did not mention anywhere that the Pharmacy  Benefit  Manager is also  responsible including the National body  -Food and Drug  Administration whose responsibility has also been skipped in the report. Even  Legislators skipped their responsibility to legislate against the profiteers and how to ensure accessibility in the market.

The research methodology used in the survey was inefficient that failed to give desired results rather dropped the burden on a single actor. The Manufacturer has a limited role in the supply chain –all it could do to ensure production but other factors such as pharmacies, doctors and suppliers etc are equally responsible.

The survey results were alarming since  85% of the respondents confirmed that the promised authorized generic version of the  Insulin was not available in the market raising concerns for the people with diabetes that the situation was critical and abysmal. But the truth is that whether the company informed the doctors or patients about the authorized Generic insulin, Had any doctor prescribed any such drug for the patients  -the report is mum over the issue. 

The PBM is a great player to govern prices  but in this case Insulin prices, it shows that regulator has become beneficiary leaving patients at the mercy of profiteer who are playing with the lives of the people.

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It was high time the legislators, policymakers and Price regulators to be vigilant by taking initiatives against such criminal negligence that might cause serious consequences for diabetic patients in the US. The Report would have been comprehensive, had it discussed all the stakeholders without making any single player a scapegoat.

Despite pocketing millions of dollars by these  Pharmaceutical companies in the US,  the companies’  Up graph in the price increase, has not halted as these companies have market dominance, hence, they kept raising the prices making it impossible for Patients, Taxpayers to buy these Medicine at the relatively high price range.

The average prices were reported at $7 to $11 per patient per month.  There has been a significant price hike in overall drugs including the Insulin. Alarmingly, Over 30 million American living with Diabetes, Insulin is the essential medical treatment for Diabetes. Insulin helps the body to process the Glucose obtained from Food.

The Glucose is the essential part of the body to work properly but Diabetes disrupts the natural process, as a result, Insulin is used to control diabetes and process the glucose produced by food in the human body.

According to words of Diabetes Patient “They either use Insulin or they will die because of low or Excessive glucose present in the body.

The report  raised  the important concern  of  the  patients and caregivers in length   that  rising  prices  will affect the purchasing power parity of  people if the price  goes beyond the capacity of  Patients  risking their life  to death if  body glucose  is not processed  properly causing serious  health complications such as nephropathy( Kidney Disease Caused by Long Diabetes ), fainting   etc but failed  to make their argument defence by  sufficient evidence

The report heralds that given the growing public pressures, these Pharmacy companies promised to introduce the generic product Insulin to help decrease the out of pocket expenses of the Patients with Diabetes.

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According to the report, Insulin Producer Eli Lilly had announced in March  2019 that it will introduce a generic version of its Rapid Action Insulin  Humalog –to “Insulin Lisper” promising to keep its price lower to almost 50% to facilitate the people with Diabetes. It had also clarified that the “Insulin Lispro” will be used diabetes unlike Humalog as both drugs are same.

While going through the report, one wonders that the report is only revolving around Eli Lilly the only manufacturer while other players are absolved or not held responsible for  Insulin prices hike or subsequent unavailability in the markets.

It is also debatable that authorized generic is the actual substitute of original product Humalog or not.

Furthermore, why researchers or staffers have not referred to other market players. Whether the other players have ensured the supply of Insulin to market or not just remains unanswered.

Whether the essential drug is available or not -a point that is supposed to be missing in the report.   Such exceptions or omissions have made the report questionable or targeting a single market player and shifting the responsibility seems to be unjustified since Telephonic Survey seems to have fallen apart as random physical verification of the medicine may have different results as compared to telephonic survey research.

The report makes the respondents as anonymous raising doubts that whether actual respondents were taken aboard while preparing the report or not, also remains ambiguous. The report does not follow the research methodology or specific tools that might have multiplied its credibility since it missed important details.  Though the report has drawn the attention of the legislators towards the key issue of availability and affordability of medicines including insulin.

By far, responsibility does not fall upon single insulin producer Eli Lily when there are three to four other Market players come under the domain of oligopoly. The excessively and expedient mention of  Eli Lilli several times giving the impression that it had monopolized the insulin market. As a  researcher, one must be aware that research does not allow any personal prejudice or obsession with any market player.

Drugs, especially of diabetes, often have elastic demand thus the manufacturer is under pressure to double the production to supply the elastic demanded products in Market.

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Moreover, patients with cardio or diabetes are very particular to use the medicines of specific pharmacy or specific brand since they fear that if they changed the drug brand, they may have serious complications or its efficacy may be much lower as compared to the brand they have been using for a long time.

It was ironic that such negligence on the part of  Insulin manufacturers, Doctors, insurers and pharmaceuticals warrant a strong legislation against Pharmaceutical companies and strict laws to govern their operation and regulate their pricing and supply chain strategies so that situation may not get out of control given the serious and essential nature of Insulin for diabetic patients.

Moreover, It was unjust on the part of respectable senators i.e Elizabeth Warren and Richard Blumenthal to blast  Eli Lilly by holding it responsible for the failure to make the discounted version of authorized generic of Insulin availability and affordability issues, while absolving other market players. Since doctors advise multiple pharmacies not just stuck to singe manufacturer i.e Eli Lilly. Even the role of  PBM is not referred to in the report.

All the doctors having specialization in diabetes advise insulin manufactured by various manufacturers to discourage monopoly in the Pharmaceutical Industry because it will be too difficult for policymakers to regulate and restrict the prices at approved rates. The subsidies will also help lower drug prices.

The Legislators should empower the Food and Drug Administration  (FDA) to regulate prices so that  people may not bear the burden of  skyrocketing prices  which are slipping out of consumers reach especially the essential drug  “The Insulin”

FDA should bound the pharmaceutical companies to carry out mass awareness campaigns through  TV, Radio and Newspapers so that people may have updates regarding drug recalls, replacements, renaming or stock availability so the inconvenience caused to both the patients and caregivers may be averted.  Laws should apply to all not just apply to a single individual.

The survey indicators show the ratio of availability and unavailability as  15% and 85% which is alarming and calls for immediate measures to address the inaccessibility issues of an essential drug “The Insulin”  but at the same times, results of results are misleading and skipping some key market players.

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The Right-Wing Politics in United States & The Capitol Hill Mayhem

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The radicalized right-wing politics during the Trump Administration is responsible for creating severe unrest in the US, and subsequently, in the global community. There is a dire need to change the political structure in the US to safeguard the true spirit of democracy.

The US witnessed one of the tumultuous transitions of power as the republicans shook the very roots of a model democracy in the US after the Capitol Hill mayhem.

Trump administration during the four-year Presidential Term has been worst on all fronts -be it Internal Policy, Health Policy, unemployment, Governance, Foreign Policy, security and Trade policy.

Trump, being afraid of defeat resorted to inciting voters, supporters and workers to attack Capitol Hill, and his racial tirade and overtures drowned him in last year’s most trumpeted Presidential Elections when the country appeared divided between the rightist and leftists.

Trump and his attack on democracy

The elections witnessed the bloodshed, torture, violence and sheer violation of legislative laws that warranted immediate legal action. From his election to the Presidential slot, Trump behaved like an amateur.

He ran the political affairs as a personal business rather than a statesman. He, being an actor, took the job as a mere role but the presidency demands prudence and sensible decisions to avoid any worst repercussions.

Trump’s aggressive response to matters of importance further exacerbated the situation, especially with China and Iran.

The leftists or change agents wanted a people-friendly government where the rights of people should be protected regardless of their political affiliation or association, caste, colour, creed, religion, ethnicity.

For the years, US democracy has been a model for many developing countries owing to its non-radicalized and people-friendly Governments.

All the democratic forces were stunned over the unfortunate incident of  Capitol Hill mayhem and were shocked that even developed nations like America can be enthralled, enticed and incited to the level that will shake the very roots of  Democracy i.e  Capitol Hill.

The world responded with regrets that it was unfortunate that Trumpism radicalized supporters to the extent that they were instigated and incited to influence the Presidential Elections results so that Biden’s Victory may not be validated.

America in disgrace

The world might have moved to tears when Trump supporters and workers ransacked Capitol Hill and brought disgrace for America around the world.

All experts, analysts and pro-democracy leaders condemned such act since it was against the norms of civilized nations of the world.

All the mayhem that stormed the US was orchestrated and masterminded by a Business Tycoon, Actor turned Politician Donald Trump who already lost his credibility for his election to the office of President since he was facing rigging and horse-trading charges in his first term that led to his impeachment Trial but luckily he was set free twice from impeachment during his presidency.

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Furthermore, his complete failure to tackle the issue of pandemic also contributed to his humiliating defeat since he ridiculed the pandemic by terming it China Virus owing to trade war with China.

Later, when the pandemic went out of control, he took initiative but it was too late to restrict the covid-19 infections since the US had the highest ratio of infections in the world.

Diplomatic relations ruined by Trumpism

Trump escalated the situation with Iran by killing General Qassem Suleimani in Iraq. Later, Iran attacked American Military bases in Iraq but there were no causalities reported for the incident. Iran also shot down a passenger plane by mistake and all passengers were killed.

Trump’s diplomatic relations with China worsened due to the Trade war. American relations with North Korea did not improve though both Trump and KIM met in Singapore to reach a possible peace agreement.

His amnesty or pardon for his friends also came under heavy criticism since he was afraid that they might be prosecuted as his term ended.

His blunders contributed a lot to his worst defeat though, being stubborn did not accept defeat but later, Supreme Court rejected his claims of any rigging in elections.

Republicans being a right-wing party radicalized the political workers and community to that extent that people violated law without any fear as they enjoyed the support from the white house.

The right-wing politics of Donald trump sowed the seeds of hatred and hostility that will have serious repercussions in the long run as long as the Trumpism pandemic exists among the people.

His failure to implement a deal of the century plan in the Middle East that was aimed merely on supporting Israel by giving a greater share of settlements. The deal came to a logical end as it was heavily criticized and Palestinians called it to suicide if accepted.

Despite signing the deal with the Afghan Taliban with the help of Pakistan to end 20 years longest war on terror and paving the way for US troops’ withdrawal, the law and order situation has not improved so far as the peace dialogue between the Afghan Taliban and Government yet to take place.

Biden as a saviour

Right-wing politicians led by Trumps have serious implications that will ultimately create problems for Biden to cope with during his presidency.

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Biden has to overhaul the whole system to restore the Trust and reputation in the world and strengthen the US through unity by abolishing the discriminatory approach.

The Selection of an Afro-American lady as Vice President has already laid the foundation to put the country on right track and building the trust of all the communities whether voted for him or not as he called himself the president of all Americans rather than of those who voted and supported him during his victory speech.

The Vote is the great tool of people to bring in the choice of leadership as it is the constitutional right of every American and can be exercised on free will without any pressure

The Afro-American community still recalls the cold-blooded murder of George Floyd by Police, supported Joe Biden after he chose Kamala Harris as Vice President candidate.

On the other hand, though Trump was given clean chit in impeachment since he was charged with inciting the supporters to attack Capitol Hill that will be marked as a black day in American history, yet he has sown the seeds of intolerance, political victimization and radicalizing the peaceful Americans.

This aspect of populist or right-wing politics always plagues the peaceful and vibrant societies in a developed nation like the US, UK, France and Germany.

Trump promoted racism through his flowery speech that incited and enthralled mob violence to exert pressure through street power as practised in Asian states such as India, Pakistan, Bangladesh, China and Japan.

How will Biden make America ‘great’ again?

Political analysts term Trump as an existential threat for Biden as he still enjoys the second largest votes in key states and may create problems especially the legislation for key issues.

Biden will have to fix diplomatic relations with all nations of the world especially Tehran and Beijing as Former President Donald Trump escalated the diplomatic relations with these countries with his insensible and aggressive attitude.

He will have to take immediate steps to clear the mess that was stalled by Trump’s radicalized and extremist approach to right-wing Politics whose price is being paid by citizens through isolation and hatred.

Biden and Kamala Harris will have to chalk out such policies that deal with communities with equality and justice and especially deal with the pandemic situation through vaccination drive to minimize the covid-19 infections. The causalities have surpassed thousands whereas long lockdowns have created unemployment and an economic crisis impacting many industries.

They need to sit with health experts and Economists to get the country out of the crisis. It will be better to take help from the nations that managed to defeat this pandemic with SOPs and measures.

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Beyond ego, the US may seek help from Russia, China, Singapore and the UK to win against the pandemic situation, though the ratio of the infections dropped worldwide as the cold winter departs.

Joe Biden will have to support Kashmiris against the unilateral move of India as he had promised in the election campaign.

He should play his role for the Middle East peace plan of the two-state solution so that Palestinians may have a state as per their wishes and the map they have in mind.

It was the sensible decision from him that troops’ withdrawal option was postponed, given the critical situation in Afghanistan. Rather, he should not jeopardize or sabotage the peace deal with the Taliban.

Biden should engage person like Zalmay Khalilzad to strengthen the dialogue process between the Afghan Taliban and other stakeholders including the existing Government of Ashraf Ghani so that peace could be restored as it will benefit all the countries and play a pivotal role in regional stability and prosperity.

The pandemic has united the world as human conscience has roused again.

Republicans and Democrats

Finally, Democrats have always saved America and promoted justice, equality and opened doors for the world for immigration but Trump wreaked havoc with all the social norms and promoted intolerance, racism and inequality that shook the very roots of the country and gave birth to happenings of Capitol Hill and distrust on the electoral system.

Biden Administration is expected and mandated by the masses to clear that mess and pave the way for his second term if he succeeds to bring change to the country.

Right-wing politics has its pros and cons but the version introduced by Republicans radicalized the whole system and divided the country even in times of emergency.

Populist leaders all around the world have impacted various governments, especially in the Asian States as they are elected on popular vote.

The version introduced by Trump may give birth to the dissent voices as left-wing whose critique may be beyond rectification whereas the ethnic divide, will promote separatism as happened in the UK, Spain, Russia and the Subcontinent when people’s rights were compromised and the freedom of expression was annulled.

The US cannot afford further isolation and division of communities on the basis of ethnicity, colour or radical thoughts since it has already paid the price during the Trump regime.

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Development

The Development of microfinance industry depends upon the resilience and risk management: SECP Chairman Amir Khan

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Islamabad : SECP Chairman, Aamir Khan emphasized that in these challenging times the development of microfinance industry depends upon the resilience and risk management, achieved through quintessential pillars of liquidity-tapped through private capital and technology embracement. Khan was addressing the Non-Bank Microfinance Companies Stakeholders Forum organized by SECP to devise a way forward and collaborate strategic response to cope the challenges posed by COVID-19 pandemic and ensuing lockdowns.

The SECP Chairman Amir Khan, along with Commissioner Specialized Companies Division, Farrukh Sabzwari chaired the session. Representatives of Pakistan Microfinance Network (PMN), State Bank of Pakistan (SBP), National Bank of Pakistan (NBP), Pakistan Poverty Alleviation Fund (PPAF), Pakistan Microfinance Investment Company Limited (PMIC), Karandaaz Pakistan and multilateral donor agencies including the World Bank, International Finance Corporation (IFC) and Department for International Development (DFID) attended the session.

 The Chairman SECP advised NBMFCs to go far product diversification to insurance solutions and saving products and build capacity of their workforce to attain business development and operational efficiency. He endorsed formation of a working group consisting of nominees from SECP, PMN, PMIC and NBMFCs to further analyze the situation. The working group will also take up the matters with relevant forums including ministry of finance, SBP and multilateral donor agencies for possible solutions.

Khan expressed SECP’s firm commitment to providing all possible support to industry not only during the current pandemic times but also in developing the industry on a strong footing. SECP Commissioner, Sabzwari highlighted the measures taken by SECP to provide relief and flexibility to the NBMFCs and their wholesale lender in managing funding requirements. He also talked about SECP’s advice to NBMFCs to defer and reschedule borrower loans.

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Participants acknowledged SECP’s timely intervention to provide regulatory relief to NBMFCs in managing their credit lines and funding requirements. However, industry representatives expressed their concerns on potential defaults by borrower and liquidity crunch that may lead to capital crisis in the industry.

They raised the need of new money injection into the industry through collaborative efforts of microfinance regulators and the government. Representatives of international donor agencies attending the Forum expressed their resolve to extend fullest possible support to Pakistan’s microfinance sector.    

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Development

Gov’t releases Rs 533.33 billion for various development projects so far

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Islamabad: The federal government has so far authorized release of Rs 533.33 billion for various ongoing and new social sector uplift projects under its Public Sector Development Programme (PSDP) 2019-20, as against the total allocation of Rs 701 billion.

Under its development programme, the government has released an amount of Rs 230.3 billion for federal ministries, Rs 175.65 billion for corporations and Rs 43.46 billion for special areas, according to a latest data released by Ministry of Planning, Development and Reform.

Out of these allocations, the government released Rs 38.5 billion for security enhancement in the country for which the government had allocated Rs 53 billion during the year 2019-20.

An amount of Rs 81.37 billion has also been released for the blocks managed by finance division under the government’s 10 years development programme.

Similarly, for Higher Education Commission, the government released an amount of Rs 27.07 billion out of its total allocation of Rs 29 billion while Rs 301.47 million were released for Pakistan Nuclear Energy Authority for which the government had allocated Rs 301.48 million in the development budget.

For National Highway Authority, the government released Rs154.94 billion. Under annual development agenda, the government also released Rs 10.7 billion for Railways Division out of total allocation of Rs16 billion, Rs 7.7 billion for Interior Division, and Rs 8.38 billion for National Health Services, Regulations, and Coordination Division.

Revenue Division received Rs 4.3 billion whereas the Cabinet Division also received Rs 30.18 billion for which an amount of Rs 39.986 billion has been allocated for the year 2019-20.

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The government also released Rs 26.9 billion for Azad Jammu and Kashmir (AJK) block and other projects out of its allocations of Rs 27.26 billion and Rs 16.54 billion for Gilgit Baltistan (Block and other projects).

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