US Patients Battle EpiPen Prices And Regulations By Shopping Online (cnn.com)

"The incredible increase in the cost of EpiPens, auto-injectors that can stop life-threatening emergencies caused by allergic reactions, has hit home on Capitol Hill," reports CNN. Slashdot reader Applehu Akbar reports that the argument "has now turned into civil war in the US Senate": One senator's daughter relies on Epi-Pen, while another senator's daughter is CEO of Mylan, the single company that is licensed to sell these injectors in the US. On the worldwide market there is no monopoly on these devices... Is it finally time to allow Americans to go online and fill their prescriptions on the world market?
Time reports some patients are ordering cheaper EpiPens from Canada and other countries online, "an act that the FDA says is technically illegal and potentially dangerous." But the FDA also has "a backlog of about 4,000 generic drugs" awaiting FDA approval, reports PRI, noting that in the meantime prices have also increased for drugs treating cancer, hepatitis C, and high cholesterol. In Australia, where the drug costs just $38, one news outlet reports that the U.S. "is the only developed nation on Earth which allows pharmaceutical companies to set their own prices."

Comments

Logic Says It Should Be Legal

[pubwvj]

It should be legal to order the same product from another country. They're both made by the same company. Stupid trade protectionism.

Re:Logic Says It Should Be Legal

[Impy the Impiuos Imp]

Many on the left love protectionism...except when they don't.

The FDA is no prize -- by being so tightfisted, they prevent politicians from having to explain why a drug hurt people, but this ends up delaying new drugs (and generics, as TFA shows) that trivially causes a lot more harm than they save being overly cautious.

But you know, a death or two in front of the camera is a tragedy the likes of which 10,000 offscreen because of delayed drugs is not.

Re:Logic Says It Should Be Legal

[ArmoredDragon]

Your resident crazy libertarian here:

Indeed there doesn't seem to be any good reason to prevent importing anything from international editions of books (save money for college students) to pharmaceuticals. There may be some merit to that argument for places like Mexico where quality controls are quite poor, however that should be a judgement call left up to the consumer. Likewise, I think the idea of tariffs, embargos, and other forms of mercantilism ultimately cost a domestic economy much more than they supposedly preserve.

Nevertheless, I don't think that's quite the root of the problem. This isn't, by any definition whatsoever, a free market. This is in fact a government granted monopoly. You cannot have both a free market AND a monopoly in most cases. That said, I don't quite understand why we give i.e. patent holders, copyright holders, etc free reign on how, when, where, and how much they can charge for anything with the sky being the limit. There probably should be some system in place whereby if they opt for government protection, then they must follow certain pricing and trade rules in order to keep that protection.

Re:Logic Says It Should Be Legal

[ArmoredDragon]

Yeah, on account of the FDA, I had to wait 16 years for corneal crosslinking to finally become a thing in the US even though it's been in use safely elsewhere for longer than that.

Re:Logic Says It Should Be Legal

[Anonymous Coward]

>Many on the left love protectionism...except when they don't.
Many on the right love protectionism...except when they don't.

Re: Logic Says It Should Be Legal

[Anonymous Coward]

McDonalds is surprisingly consistent in foreign countries...

Re:Logic Says It Should Be Legal

[jenningsthecat]

Many on the left love protectionism...except when they don't.

Many on the right hate protectionism...except when they don't.

Corporations just love having unfettered access to other markets for their products. They also love unrestricted access to supplies of (cheaper) materials and labour in other countries; but let their customers demand the same, and all of a sudden the hypocritical bastards lobby for protectionism, and start spreading FUD about the supposed dangers of products from other countries. Their idea of a 'free market' is really a 'captive market' - one that is kept captive by the legislation they buy, the lies they spread, and the dirty deals they strike with their counterparts in other countries.

Re:Logic Says It Should Be Legal

[jedidiah]

> Yeah, on account of the FDA

There are other things that are common here that aren't done in "more civilized" part of the world. That goes both ways.

Plus it gets even worse than that. However restrictive and bothersome you might view the FDA, Medicare and Medicaid are even worse.

Re: Logic Says It Should Be Legal

[currently_awake]

You can buy a new release DVD in China for $5, or in the USA for $25. The difference in price is not shipping and handling, it is regional prices (higher profit margins in the richer countries). Copyrights, Patents, Trademarks. They set the prices as high as they can in each market. Is this not the very definition of free trade, that you can buy what you want where you want? Instead of extending copyright on the next trade deal, we need the right to import IP products with nothing more than taxes added.

Re: Logic Says It Should Be Legal

[Anonymous Coward]

When my wife was on a particular medication, we used CanadaDrugs dot com to get it vastly cheaper than we could through any USA based pharmacy. The funny thing was, the drug was made in the USA and shipped from a USA warehouse.

The medication was never outside the US borders at all -- but the only way to get a good price was to order it via an international pharmacy.

Re:Logic Says It Should Be Legal

[AthanasiusKircher]

This isn't, by any definition whatsoever, a free market. This is in fact a government granted monopoly. You cannot have both a free market AND a monopoly in most cases. That said, I don't quite understand why we give i.e. patent holders, copyright holders, etc free reign on how, when, where, and how much they can charge for anything with the sky being the limit.

Since there seems to be a lot of confusion in the media about the real issue here, the EpiPen problem (1) has nothing to do with drug patents, and (2) has relatively little to do with patent protection in general.

Just to be clear, the drug here (epinephrine) has been around for many decades and is patent-free. You can easily get a dose of it for a few cents: hospitals directly inject the generic all the time. And the EpiPen is basically out of patent protection. There apparently is still an active patent for some aspect of the device, but the manufacturer settled a lawsuit already that would allow generic manufacture.

So what's the real problem here? There are two. The first is the FDA. Epipens fall under the category of both "drugs" and "medical devices" for approval purposes, and the byzantine set of processes necessary for approval take forever. They also require standards for effectiveness that are probably impossible to meet in this case, because of the high rate of EpiPen (and generic autoinjector) user error. There were supposedly 26 incidents of "incorrect dosage" from Auvi-Q before the recall, but none were actually confirmed and the devices involved did not seem to be malfunctioning. So why the wrong dose?

This is the dirty secret of this whole autoinjector business -- people actually screw up using them quite a bit. (The second issue.) The most common user errors: (1) forget to take safety cap off, (2) use wrong end, (3) don't inject for adequate time (usually recommended for 10 seconds). You introduce a slightly different procedure (with another cap, oh gosh!) and that makes alternatives like Adrenaclick even more likely to be misused.

This whole discussion in the media, to my mind, has been highjacked by people who want to draw attention to the high prices of drugs in the U.S. And that's a very noble goal, because it is ridiculous.

But in this particular case, there is a simple, viable, CHEAP alternative -- a syringe with epinephrine. The primary objections are that people could draw up the wrong dose in a panic or whatever -- but this is solved simply. Have your syringe prefilled by a doctor, nurse, or pharmacist. You'll also hear misinformed doctors saying, "But it isn't guaranteed to be sterile" or "it will degrade." Again, we have research on this issue -- see here and here. Basically, as long as the syringe is stored in darkness (e.g., in a simple tube or something), it's sterile and stable for at least 3 months.

And guess what -- you don't have any of those annoying problems with people screwing up using their autoinjectors. (1) forgot to take safety cap off? Nope -- you actually see the drug go in, so if there's some sort of safety put on the needle to prevent accidental discharge, it'll be clear if you didn't take it off. (2) Used the wrong end? Nope -- even a 4-year-old knows which end of the syringe has to go in. (3) Don't inject long enough? Nope -- again, you see the stuff go in. You push the needle until the pre-measured dose is completely out.

Giving yourself or someone else an injection is not rocket science, and with pre-filled syringes it's probably less error-prone than "autoinjectors." And here's the best part: the total cost is probably about $5 for one (including the syringe and the pre-filling to correct dose). If you were willing to buy syringes and a larger bottle of epinephrine yourself, you could make it even cheaper, but we're already down to $20/year with replacements every

Re:Logic Says It Should Be Legal

[gordguide]

It should be legal to order the same product from another country. They're both made by the same company. Stupid trade protectionism.

Actually, they're not, they are all made under license by someone other than Mylan.

The Canadian EpiPen, for example, is manufactured and sold by Pfizer. It's the same everywhere else. Only in the US are they made by Mylan.

Re:Logic Says It Should Be Legal

[Anonymous Coward]

The fantasy you have is that the single payer system won't immediately be hijacked. Anything more important than a twinkie shouldn't be left up to corruptible governments
There, I fixed that for you.

Re:Logic Says It Should Be Legal

[geoskd]

>Many on the left love protectionism...except when they don't. Many on the right love protectionism...except when they don't.

As both sides wake up and realize that nobody thinks the idea is any good. Both ends of the spectrum have had the wool pulled over their eyes by corporate interests for the benefit of maybe a few thousand extremely wealthy individuals. Those same 100 families own 75% of everything, and have us so busy fighting each other we don't realize that they already snuck off with the loot...

Re:Logic Says It Should Be Legal

[whoever57]

While they are making this legal, how about funding the FDA so that it can get through its backlog of generics waiting for approval?

All this "small government" claptrap is really "dysfunctional government". Guess who benefits from a dysfunctional government?

Re: Logic Says It Should Be Legal

[HBI]

I've been injecting insulin and other drugs for 16 years now. No fuckups. No reactions. Nothing, and i'm no one special in this regard. It sounds like epinephrine is less stable than insulin in storage, but I could work with that - I used to carry my drugs in a sealed metal thermos on travel. Deployed to Iraq and back that way in 07-08.

Re: Logic Says It Should Be Legal

[HBI]

A free market cannot exist,because freedom only protects the criminal. Coercion is what protects the virtuous.

People herded into Gulags and concetration camps would beg to differ.

Re:Logic Says It Should Be Legal

[chriswaco]

Thank you for posting this. I've been trying to convince people they can do this for the last week and they look at me like I'm insane. They can even buy an insulin syringe carrying case for a few dollars if they need something robust.

Re: Logic Says It Should Be Legal

[Applehu Akbar]

"Can you imagine if this crap happened with something far more common like insulin injections? "

Actually this same sudden price jump is taking place for insulin, which has been generic for over fifty years. Like Daraprim, insulin is made and sold cheap all over the world - except in the US.

Re:Logic Says It Should Be Legal

[ArmoredDragon]

Since there seems to be a lot of confusion in the media about the real issue here, the EpiPen problem (1) has nothing to do with drug patents, and (2) has relatively little to do with patent protection in general.

IIRC doesn't the patent in this case apply specifically to the mechanism? And yes, epinephrine, for those who don't know, is commonly called adrenaline, which is the name brand of synthetic (but is chemically identical to the endogenous source, and thus no different from it) epinephrine.

And indeed, in many cases when there's a drug monopoly, it doesn't involve a patent. Because I have stage 4 CKD, I have problems with gout. The only medication that effectively treats it in my case is a drug called colchicine. That particular drug has been in use for a few centuries now, but a company presently has market exclusivity. Why? Well, when the Food and Drug Act was passed in 1934, any drug made from that point forward had have its efficacy proven before it could be prescribed, however old medications were "grandfathered in" until a few decades ago (I don't remember the exact year) when the FDA said they needed to pass scientific scrutiny, go through clinical trials, etc, to have their efficacy empirically proven. Colchicine was one of these drugs, and before this happened it was about 10 cents a pill, until the company that put it through its paces was granted market exclusivity as part of their efforts to prove that it works. They then trademarked it under the name Colcrys and raised the price to about $6 per pill.

And again, there is no intellectual property involved here, just the FDA granting market exclusivity. And to a point, I agree with this; they put in the effort to make sure that a drug that's actually by all definitions of the word toxic (it comes from a highly toxic plant) actually works and won't kill you, which isn't a cheap thing to do, they should be able to see a return on investment. But allowing them to raise the price of a drug that is super cheap to produce to a price that's just flat out extortion is ridiculous.

About the only rationale I can figure for avoiding the syringe issue is people's fear of needles

Actually believe it or not I'm less scared of a syringe than an autoinjector. Why? Because in the Army we were issued an autoinjector in case of exposure to some kind of gas (I don't remember which one) which you were supposed to inject into the muscle in your butt cheek. The scary part was how I saw one of these stick right through a 2x4 piece of wood. Imagine if you accidentally stuck your hip bone or your hand...oww...I'll stick with the syringe, thanks.

Re:Logic Says It Should Be Legal

[belmolis]

There's also no reason that autoinjectors could not be modified to have some of the useful properties of regular syringes. For example, if part of the case of the autoinjector were transparent, users would be able to see how much of the drug remained just as with a syringe and thereby avoid partial doses.

Re: Logic Says It Should Be Legal

[belmolis]

Active service is possible for diabetics if their diabetes is considered sufficiently well controlled.

Re:Logic Says It Should Be Legal

[BradMajors]

Your resident crazy socialist here:

Just implement single payer already and fund the FDA enough that they can get generics approved. Problem solved (and in exactly the same way it's solved in the rest of the civilized world).
 

You are about to get what you are asking for! As a result of Obamacare many states will in 2017 become single payer!

http://www.zerohedge.com/sites...

Re:Logic Says It Should Be Legal

[BitterOak]

They don't just sell empty syringes over the counter and most schools here in the US would probably freak out over "drug paraphernalia" if they spotted your kid with a bag of pre-filled syringes.

So kids with diabetes aren't allowed to go to school then?

Re:Logic Says It Should Be Legal

[currently_awake]

I would love to see a left wing political party in the US. Having the right wing Democrats falsely claim to be on the political left side of Ronald Reagan is a joke.

Re: Logic Says It Should Be Legal

[HBI]

You're technically correct but I got a full bird colonel Army doctor to say I could deploy. It got up that high. The G6 of the unit in question wanted me to deploy _really_ bad and pushed it to that extent.

Re: Logic Says It Should Be Legal

[thesupraman]

You think so?

Name one. Just one.

Perhaps use the nice small country of South Korea for comparison.

Find a single medical procedure that is available in the USA and not in south Korea and is not some archaic leftover the rest of the world has already abandoned.

There are certainly many procedures available there that are next to impossible to obtain in the USA.. And pretty much every procedure is available privately for significantly less cost and at lower failure rate.

Re: Logic Says It Should Be Legal

[thesupraman]

So.. You think funding is the reason the FDA cannot pass these exactly identical compounds (that is what a generic is remember.. And the FDA doesn't do quality control..)?

How cute.

Re:Logic Says It Should Be Legal

[arth1]

There are other things that are common here that aren't done in "more civilized" part of the world.

Male circumcision, you mean?

When are drugs like flupirtine going to be available in the US? When I moved here back around the turn of the century, I was rather flabbergasted that all the doctors could prescribe was opioids (except for the one opioid painkiller that isn't very habit forming, buprenorphine, which is only approved for treating drug addiction in the US).
Now, 17 years later, the situation is still the exact same.
The US is a 3rd world country compared to what Europe was a generation ago. But at immensely higher prices.
Americans think they get the world's best health care because they pay so much. But a quick look at statistics like life expectancy and mortality from diseases shows otherwise. It's a backwater.

Re: Logic Says It Should Be Legal

[ArmoredDragon]

Insulin is harder to fuck up than epinephrine, and if you do fuck it up the symptoms are easier to correct. Epinephrine, by the way, is the hormone secreted by the glands that sit atop your kidneys; most people know it as adrenaline after the name brand of the first synthetic version of it. Also, if you inject a dose of epinephrine standard for prophylaxis treatment into a vein, it'll cause a hypertensive surge that will kill you fairly quickly.

Re: Logic Says It Should Be Legal

[Anonymous Coward]

I don't know if this is the same product but it says Epipen and they're US$113 each in Canada.

https://www.canadadrugs.com/products/epipen/0-3mg

Re: Logic Says It Should Be Legal

[whoever57]

You think that generics are identical to brand-name drugs. How cute.

Yes, the "active ingredient" is identical, but the fillers, binding agents, etc. differ and this can have an effect on how the drug works.

Re:Logic Says It Should Be Legal

[nbauman]

I looked up your Pubmed citations in the hope that they would show that it was practical for people to use epinephrine injections rather than auto-injectors.

Unfortunately they didn't say that. Those were just lab tests of stability and sterility. In order to be convinced, I'd have to see a study of actual patients who successfully learned to do their own epinephrine injections. That would be a hard study to do, since anaphylaxis is relatively rare. Consumer Reports had an article about alternatives to the EpiPen, and their medical experts said that epinephrine would require more training than the EpiPen. You'd need a product that could be used by a bystander, such as a teacher, with minimal or no training.

If as you say people screw up the autoinjectors, it seems that they would be even more likely to screw up epinephrine. I'll believe it when I see the data.

(The other problem was that ephinephrine degrades after 3 months, while the EpiPen lasts 12 months.)

My basic reaction to your post is, you can't know that something is going to work until you've done a well-designed study in the real world.

Re:Logic Says It Should Be Legal

[AthanasiusKircher]

1. The school nurse and teachers were trained to use the EpiPen, not your homebrew syringe kit, when your kid has an emergency reaction to errant peanut butter in the lunch area.

Syringes are just as easy to use with 5 minutes of training. Particularly a licensed school nurse should certainly be able to handle that without extra training.

2. Syringes are typically controlled medical supplies here in the United States because they can also be used to inject illegal drugs. They don't just sell empty syringes over the counter and most schools here in the US would probably freak out over "drug paraphernalia" if they spotted your kid with a bag of pre-filled syringes.

Most states do in fact sell syringes over the counter, e.g., for diabetics. Some do put limits on sales to prevent drug use. But all of this is solved by -- ya know -- a prescription, just like you'd get for an EpiPen.

By the way, I guess you just proved my point. Our insane "war against drugs" nonsense is likely why we want to suck hundreds of dollars out of families for no good reason to force them to get the "EpiPen" while refusing to tell them about a cheap, reasonable alternative. Or, worse yet -- the families who go without an EpiPen because of expense or hope that an expired one still works... how many kids are we willing to kill or rush to the hospital with a severe allergic reaction because "ACK NEEDLES!!"

3. Emergency medical personnel are not troubled by the first two problems, but they aren't there when your kid needs them.

If you need someone to actually withdraw a dose from an ampule or vial, be sure to get the proper dose, be sure there's no air bubbles, etc. -- sure I'd agree that paramedics with experience will be better at it in a tense scenario.

But you put a pre-filled syringe in a kit, and it's ready to go. There are some things you need to know (e.g., do NOT inject into a blood vessel, but that's true of EpiPens too), but again that can be covered in 5-10 minutes of training... not significantly more than an EpiPen.

Re: Logic Says It Should Be Legal

[Zontar The Mindless]

If you ever emerged from your basement long enough to visit some other country, you'd very rapidly discover that the US political "spectrum" ranges from Center-Right to Batshit-Crazy-Far-Right.

Re:Logic Says It Should Be Legal

[Zontar The Mindless]

That sort of globalisation is intended to provide for unrestricted movement of capital while keeping labour and consumers locked down as tightly as possible.

Re:Logic Says It Should Be Legal

[Dahamma]

There may be some merit to that argument for places like Mexico where quality controls are quite poor

This is in fact a government granted monopoly.

HAH! This is one of my favorite hypocrisies of the Libertarian. So, do you want the government to ensure your drugs are safe, or do you want to let anyone make and sell any drugs as cheaply as possible?

Because the only "government monopoly" in this case specifically or in many others generally is that other companies feel that it costs to much to test their drug to make sure it's safe. Is the system maybe a bit too careful? Probably. But when it's a life saving drug (that can be dangerous, as you said, without proper quality controls) it's hard to justify cutting corners to safe money.

You cannot have both a free market AND a monopoly in most cases.

This is even more amazing! If that were true, anti-trust laws wouldn't be necessary. Wow. There are SO many examples that disprove this I wouldn't even know where to start. Thank you, it's been a long day so it was nice to have a good laugh...

Re:Logic Says It Should Be Legal

[Zontar The Mindless]

Ever had a big-mac in another country? Not the same... Heartbreaking shit : (

No. I've had many Big Macs/Whoppers/etc. in about 20 countries.

In many of these places, the food's actually *better* than at the same chains in the US due to local food safety/quality regulations.

The lone exception being that I've yet to find a KFC outside the US that serves biscuits instead of replacing them with bread rolls. *snif*

Re:Logic Says It Should Be Legal

[DamnOregonian]

Many on the left

You lost all legitimacy the second those words spewed from your neurally neocortex-disjointed fingertips.

(-1: Post disagrees with my already-settled worldview) is not a valid mod option.

Christ, I need to go clean the dripping irony off of my computer screen.

Re:Logic Says It Should Be Legal

[AthanasiusKircher]

Unfortunately they didn't say that. Those were just lab tests of stability and sterility. In order to be convinced, I'd have to see a study of actual patients who successfully learned to do their own epinephrine injections. That would be a hard study to do, since anaphylaxis is relatively rare.

I never claimed my links said that. They only proved that pre-filled syringes are a viable choice for those people who claim "We can't use syringes because of dosage concerns or worries that people won't fill them correctly or they'll lose time in doing all that for people inexperienced with them." Those things are the reasons always trotted out for why syringes aren't a reasonable alternative, but most of them are solved with a pre-filled syringe... which my links note is a viable way to store the drug until use.

Anyhow, you seriously want a STUDY showing normal people can successfully do an injection?? There are THOUSANDS of diabetics who inject themselves every day in the U.S.

(The other problem was that ephinephrine degrades after 3 months, while the EpiPen lasts 12 months.)

No, do you think the epinephrine in the EpiPens is "magic" or something? It doesn't degrade as fast because it's sealed. Epinephrine in a sealed vial or ampule would generally also last 12 months. Trained medical personnel who are used to drawing syringes quickly in emergency scenarios would have no problem with that stuff. So yes, putting in a pre-filled syringe cuts down the guaranteed stable lifespan. Anyhow, it's easy enough to swap out the syringes on a schedule. Is it less convenient and possible people will forget? Sure. But I think it's also likely some other people are more prone to forget to get a new EpiPen every year, since there's a much longer time between replacements.

My basic reaction to your post is, you can't know that something is going to work until you've done a well-designed study in the real world.

I never said it was guaranteed to be BETTER than an EpiPen -- and for that, I agree it would require a proper study. What I'm saying is that it's a reasonable, inexpensive, and reliable alternative that should be offered to patients who might want to consider alternatives.

Obviously an EpiPen -- used properly -- is probably less fuss and easier. However, I think it's irresponsible for physicians, pharmacists, and the news media to not mention the cheap, simple alternative that is clearly available.

(You also mentioned something about a media source claiming syringes require "extensive medical training" or something... I call BS. Again, diabetics deal with this all the time. There are some precautions, but most are similar to EpiPens, and the additional warnings can easily be explained in a few minutes. You also may want to check into the credentials of that medical professional -- I've seen some media quotes in stories in the past few days saying similar, but it turns out they work for allergy societies that get a huge amount of support from the manufacturer of EpiPens, which at a minimum presents a significant conflict of interest. Please note that many of the major allergy societies have been relatively silent in the past weeks as the EpiPen controversy has grown -- they get a lot of funding from the EpiPen company, so they haven't really been speaking out about what is clearly a patient advocacy issue. Horrifying all around.)

Re:Logic Says It Should Be Legal

[DamnOregonian]

The US is a 3rd world country compared to what Europe was a generation ago.

I don't know about that. I will concede that I do not live in Europe, I do however have a lot of European friends.
In the US, I can't collect 5 friends of mine, with this particular set of stories:

Ending up with an deep muscle infection in their leg after being given a shot. (Do these massively civilized Europeans not clean their needles?)
Having a crown placed on a tooth with an infection, and prescribing "Neural Therapy" (Fuck, I wish I were joking.) to handle the problem (Apparently, German dentists aren't keen on clean environments, either)
Having a breast reduction done.. and then again- with the fucking infections- spending 6 months trying to get an antibiotic-resistant infection cleaned out of their tit. Being advised by their doctor to take colloidal silver.
Literally being unable to communicate with their doctor, who literally does not speak their language.
Having opioids prescribed for a headache.

I'm pretty critical of America... But if I've learned one thing- it's that you eurocentrists are oozing with bullshit.
Europe is full of some really fucking stupid people, with some really fucking stupid ideas- without intended offense to the not stupid individuals.

Re:Logic Says It Should Be Legal

[DamnOregonian]

Americans think they get the world's best health care because they pay so much. But a quick look at statistics like life expectancy and mortality from diseases shows otherwise. It's a backwater.

I wanted to comment on this pile of bullshit as well- You're certainly right that we pay *way* too much for our healthcare.
In most instances where we "score dead last" It's always cost and access that screws us.

That being said- we consistently outscore European health care in survival outcomes for just about every major life-threatening disease. In fact- we're top 5 *in the world* in just about every outcome related study.
Don't blame the fact that we're a bunch of fat fucks who eat terrible food and live ultra sedentary lives on our healthcare system. I think if Europeans had our health care, they'd live to be 800.

Re: Logic Says It Should Be Legal

[AthanasiusKircher]

Insulin is harder to fuck up than epinephrine

[Citation needed]

Also, if you inject a dose of epinephrine standard for prophylaxis treatment into a vein, it'll cause a hypertensive surge that will kill you fairly quickly.

And if you inject a dose of insulin directly into a vein, it can cause blood sugar to plummet sending you into a diabetic coma.

Yes, the danger of intravenous injection for epinephrine is greater, but there can be dire consequences in either case. In any case, it IS possible to inject accidentally into a vein with an EpiPen too, probably not as likely as with a syringe, but both are perfectly safe if injected into a standard area (most commonly large outer muscle of thigh).

Re:Logic Says It Should Be Legal

[DamnOregonian]

They don't just sell empty syringes over the counter

Actually... They do.

Re: Logic Says It Should Be Legal

[DamnOregonian]

with equivalent outcomes

Not entirely true- but I don't believe that has anything to do with the healthcare *system*.
I'm absolutely on-board with single-payer healthcare, but US healthcare offers better outcomes than healthcare in most single-payer countries.

In Germany a dentist who caps your tooth with an infection in it can tell you to get "Neural Therapy" (novocaine injections) to manage the "neuropathic pain" until you become septic and nearly die. That may have something to do with it.

Re:Logic Says It Should Be Legal

[ChrisMaple]

By your own rule, you should be left to the free market.

Re:Logic Says It Should Be Legal

[ChrisMaple]

The FDA should be defanged. Its only powers should be to measure the weight and purity of foods and drugs, publicize the results, ban the import of impure products and sue the manufacturers and distributors of impure products. No testing for efficacy or safety. The manufacturers of products that are both unsafe and do not have their risks printed clearly on the products should have their responsible employees criminally liable.

That puts liability where it belongs, and eliminates the deadly delays caused by government foot-dragging. Costs come down, lives are saved, and government shrinks. (Note that I said "costs come down", not "prices come down.")

Re: Logic Says It Should Be Legal

[dunkelfalke]

People generally can tell a lot of things. In this case the patient should tell the dentist to suck it up and remake the crown under warranty.

Re: Logic Says It Should Be Legal

[dunkelfalke]

Well, there is the Green party and also the CPUSA, both are actually left. Not that they play any role in US politics, though.

Re:Logic Says It Should Be Legal

[arth1]

Having a crown placed on a tooth with an infection, and prescribing "Neural Therapy" (Fuck, I wish I were joking.)

He probably was, and you missed the punchline that he had to transcend dental medication .

Re:Logic Says It Should Be Legal

[Applehu Akbar]

" Because in the Army we were issued an autoinjector in case of exposure to some kind of gas (I don't remember which one) which you were supposed to inject into the muscle in your butt cheek."

This exact Army device is the autoinjector used in Epi-Pen. The patent was wrongly issued because of this government-developed prior art, but Merck and later Mylan have been making billions off this error ever since.

Re: Logic Says It Should Be Legal

[ganjadude]

the batshit side is the one wanting "safe spaces" and people to use the pronoun "xe" THAT is batshit crazy

Re:Logic Says It Should Be Legal

[ganjadude]

so because people are stupid and school nurses cant figgure out how to inject a needle..... and because the failed drug war.... we cant have nice things ??

maybe we could you know, train a nurse to inject? i mean thats one of a nurses main jobs in the real world. as for the drug war part, the clear answer to that is thats a copout and not a real excuse to prevent cheaper life saving measures

Re:Logic Says It Should Be Legal

[ganjadude]

if the first thought that crosses someones mind is heroin that is the real problem

Re:Logic Says It Should Be Legal

[ganjadude]

the sad thing is people actually believe as you do

Re: Logic Says It Should Be Legal

[ganjadude]

and yet when push comes to shove its still people coming here for their major issues

Re:Logic Says It Should Be Legal

[slashrio]

Europe is full of some really fucking stupid people, with some really fucking stupid ideas- without intended offense to the not stupid individuals.

Hahaha, that's funny. If Europe is full of stupid people, you surely don't leave much room for the not stupid individuals. :)

Re:Logic Says It Should Be Legal

[ganjadude]

i say let it all through and let the individual make up their mind.

Re:Logic Says It Should Be Legal

[slashrio]

...we consistently outscore European health care in survival outcomes for just about every major life-threatening disease... Got any link to back this up?
With regard to the lifestyle you're absolutely right.

Re:Logic Says It Should Be Legal

[ganjadude]

id wager it has more to do with the fact that (in this case) the CEO is the daughter of a congressman, and this is nothing but pure and simple corruption

Re:Logic Says It Should Be Legal

[Applehu Akbar]

Slapdash procedure like this is a hallmark of socialized healthcare systems. Such systems are good at delivering basic care to the masses at low cost. You just have to forgiving about such things as queuing up for heart surgery and having your hospital bed be out in the hallway because of overcrowding. Complainers will be reminded of Grandma's stories about the Blitz, and how much conditions have improved since then.

Re:Logic Says It Should Be Legal

[russotto]

If you give the FDA more money, they will spend it on things like enforcing rules against importation of epi-pens rather than going through the backlog of generics. They will then claim they need more money to go through the backlog of generics. Basically the last thing a government agency will spend money on are the things people want, because not doing those things is the best way for it to get additional funding. (This is a generalization of the famous Washington Monument strategy)

Re:Logic Says It Should Be Legal

[Qzukk]

When are drugs like flupirtine going to be available in the US?

When the DEA can figure out the correct amount of Tylenol to require to be added to every pill to ensure that anyone taking enough to get high will die. Just because it's not an opioid doesn't mean it doesn't make people feel good, and our government cannot allow that under any circumstances.

Re: Logic Says It Should Be Legal

[mikabreto]

Dude, so on point. I wish for mod points.

Re:Logic Says It Should Be Legal

[nbauman]

You also mentioned something about a media source claiming syringes require "extensive medical training" or something... I call BS. Again, diabetics deal with this all the time. There are some precautions, but most are similar to EpiPens, and the additional warnings can easily be explained in a few minutes. You also may want to check into the credentials of that medical professional -- I've seen some media quotes in stories in the past few days saying similar, but it turns out they work for allergy societies that get a huge amount of support from the manufacturer of EpiPens, which at a minimum presents a significant conflict of interest.

That "media source" was Consumer Reports. I have checked into their credentials. Their medical reviewers are probably more qualified in each of the specialties than some of the reviewers in the second-string peer-review journals. And they take no money from industry.

Diabetics do inject themselves with insulin, however there are differences between them and people with anaphylactic reactions so you can't equate the two. The most obvious difference is that insulin-dependent diabetics inject regularly, several times a day, so they're used to the equipment and familiar with it. People with anaphylactic reactions might a reaction once in their lives, once a year, or once every few years (according to a friend of mine who did have an anaphylactic reaction to bee antigen in a doctor's office), so they can forget how to use it.

You want to say that it makes no difference. I don't accept that. In a matter of life or death, you need better evidence than your own personal feeling. You seem to know enough about medicine to be able to look up articles on PubMed, but I'm certain that you're not a medical doctor or medical student. The standard of evidence for pharmaecuticals is a lot more rigorous than, say, the flavors and fragrances industry. I'd rather follow the advice of an MD.

It's not good enough to say that diabetic injections are sort of like epinephrine injections, so if it works for diabetes it seems like it should work for epinephrine. The only thing that will tell you what kind of problems come up when people use manual epinephrine injections is a well-designed study of people who use manual epinephrine injections, preferably with a comparison group of people who use the EpiPen. But that would be hard to do, because an anaphylactic shock is such a rare event.

And contrary to what you say, there is nothing in those studies that addresses the claim that "people won't fill them correctly or they'll lose time in doing all that for people inexperienced with them." Those were just lab studies of 2 narrow issues -- stability and sterility.

If you want to understand the design of medical studies, you could read the NEJM, BMJ, and JAMA Internal Medicine (my preferences) over the last few years. If you want to get a summary of what it's all about, you can look in http://www.healthnewsreview.or...

http://www.consumerreports.org...
Can You Get a Cheaper EpiPen?
You could save about $400 per two-pack with generic Adrenaclick and still protect against life-threatening allergy attacks
By Ginger Skinner
August 11, 2016

The DIY Syringe Method

To further cut costs, some have turned to using manual syringes and buying vials of epinephrine to fill them. The drug costs a few dollars per vial. But experts caution that switching to a do-it-yourself syringe is more complicated and can result in getting too much or little epinephrine. What’s more, you’ll need to be trained by a doctor or pharmacist on how to inject the drug quickly and accurately before attempting to try it during an emergency.

And because there are different concentrations on the market, getting the proper dose is critical, especially for children.

Re:Logic Says It Should Be Legal

[whoever57]

And the next thing that will happen is that pharmacies will require you to sign an arbitration agreement before selling you any drugs, so that you cannot effectively sue a drug company that sells bad drugs.

You think that, if you eliminate the powers of the FDA, you will be able to replace that with criminal liability on Big Pharma and its employees? Well then, I have a nice bridge to sell you.

You are so naive. It's saddening.

Re:Logic Says It Should Be Legal

[Dahamma]

How can the individual make up their mind when they are being sold fake (or even worse, adulterated) prescription drugs (as happens all the time in countries that don't regulate them carefully)? Unless everyone has their own home gas chromatograph that's just not going to work... nice troll, but no thanks.

Do you know WHY Canada, Europe, Australia, Japan, etc all have drugs at 1/10th (or less) of the cost of the US? Because they are single-payer. In a monopsony the buyer has a lot of control on the price, as opposed to the US where the drug monopolies have free reign.

Re:Logic Says It Should Be Legal

[rpstrong]

And it's overcrowded as well.

Re:Logic Says It Should Be Legal

[rpstrong]

They do have a window where you can monitor the drug's condition, and they caution you that there will be some left after the injection. Apparently, partial doses are not an issue if they are used correctly - which means holding them in for ten seconds.

Re:Logic Says It Should Be Legal

[rpstrong]

I've bought syringes (intended for insulin) over the counter several times at my local pharmacy - I toss the needles out, but the 100 cc size is perfect for measuring out and administrating my dogs' home-brew heart worm medicine.

[And there is another absurdity - in the US you can buy the active ingredient (ivermectin) over the counter for horses or swine, but not for pets. A $50 investment in a 50cc bottle of 1% solution + pharmaceutical grade propylene will provide on the order of one to three thousand doses.]

Re:Logic Says It Should Be Legal

[rpstrong]

HAH! This is one of my favorite hypocrisies of the Libertarian. So, do you want the government to ensure your drugs are safe, or do you want to let anyone make and sell any drugs as cheaply as possible?

Actually, I want both. I'm willing to fund the FDA as an advisory agency, but not a regulatory one. Let me make the decision of whether to use only FDA approved drugs or not. In fact, a few years ago, when I was buying prescription meds from Canada, I once faced a shortage of the Canadian approved version and was given the option of getting it sourced from Europe - which I did.

So where's the hypocrisy? In fact, we (Libertarians) are generally opposed to having the government in charge of what we do.

Re:Logic Says It Should Be Legal

[penix1]

I live in WV where Mylan CEO Heather Bresch (and her Senator father Joe Manchin are from) and they had on the local news just what you are describing. They said that the local ambulances stopped carrying the EpiPens because they were rarely used and tended to expire more often that they were used. It's a cost/benefit analysis the county did and they quickly came to the same conclusion as you did just now. Lastly, the schools here in WV all have trained nurses on staff that can administer the drug WITHOUT issues. In fact, just like Insulin, students have to surrender their drugs to the nurse upon entry into the school with a doctor's verification of the prescription. So I don't see the problem either with using a syringe.

Re:Logic Says It Should Be Legal

[dave420]

Yet when we compare outcomes, the US doesn't do that well. Clearly something is up. If you just want to focus on some unsubstantiated claims on Slashdot and ignore the actual statistics, I can understand why you'd be so confused.

Re: Logic Says It Should Be Legal

[dave420]

You keep posting these anecdotes as if they have any bearing on the subject what-so-ever, which they clearly don't. In Germany if your dentist screws you over for whatever reason, you can talk to your insurance company or talk to the state. The dentist will get shafted, and you'll get your treatment for free. Now my anecdote has cancelled yours out, you don't have to keep trying to ram it in to the discussion whenever you feel your argument is losing its teeth, and instead you can focus on constructing a real argument based on demonstrable fact.

Re:Logic Says It Should Be Legal

[dave420]

I think I love you.

Re: Logic Says It Should Be Legal

[DamnOregonian]

You call it an anecdote, and sure you're correct it is. And sure, the plural of anecdote is not data- however there is plenty of data displaying European anti-science views. Does your health insurance cover "Neural Therapy?" Mine doesn't either.
Look it up.
Germans' do. They're all about voodoo medicine and pseudoscience over there.
I'm terribly sorry for the cognitive dissonance you're suffering over there.
Get to know some of them. Fascinating people. They're ripe and ready to elect another Hitler over there. Their brain trust is emigrating in numbers high enough to cause existential worry for the government. Negative population growth- and its not because of a lack of children.
They're significantly further along the path to an idiocracy than the US is.

Re:Logic Says It Should Be Legal

[phorm]

The problem with a simple syringe is that - depending on the medical scenario - it can be quite difficult to inject somebody who is in the middle of an allergy attack (or near impossible for the person to inject himself/herself). I'd imagine that it's also a *lot* easier to do things like flying with a recognised device such as an epipen as opposed to a prepped syringe.

But yeah, it's nice to have high standards for devices but sometimes perhaps we need "not 100%, but good enough given the need".

Re:Logic Says It Should Be Legal

[Chrontius]

Actually believe it or not I’m less scared of a syringe than an autoinjector. Why? Because in the Army we were issued an autoinjector in case of exposure to some kind of gas (I don’t remember which one) which you were supposed to inject into the muscle in your butt cheek. The scary part was how I saw one of these stick right through a 2x4 piece of wood. Imagine if you accidentally stuck your hip bone or your handowwI’ll stick with the syringe, thanks.

A single autoinjector? It was probably the ATNAA (Antidote Treatment Nerve Agent Auto-Injector). If it was a pair of them in a black sleeve, it was the Mk.1 NAAK (Nerve Agent Antidote Kit). You may have gotten a third, with diazepam, to be used to treat seizures long enough to stick the atropine and pralidoxime chloride into the victim, if they were convulsing.

The reason they give you autoinjectors, though, is because under stress fine motor skills evaporate, leaving you with gross motor skills. Using a syringe is a fine motor skill, and trying to do that while your adrenaline is spiked, you’re starting to convulse, and you’ve got a needle phobia? Sorry, you’re going to die. The military spends money on kit when the cheap gear doesn’t cut the mustard, so I’m inclined to think they switched to autoinjectors for a reason.

Re:Logic Says It Should Be Legal

[Dahamma]

I'm willing to fund the FDA as an advisory agency, but not a regulatory one.

Hmm, how can I put this to a Libertarian... "I'm willing to sell anyone guns, but completely outlaw bullets".

I understand your frustration with overly expensive prescriptions, but of course you are NOT using unregulated drugs, you are buying cheaper generic versions of drugs from other countries because we are ALLOWING the drug companies to sell the SAME SHIT in the US for MUCH HIGHER cost.

What you are being fucked over by is the lack of single payer buying power of a universal healthcare system, not FDA regulations. You are effectively taking advantage of Canadian and European universal healthcare drug negotiation policies by buying "grey market".

Re:Logic Says It Should Be Legal

[beastofburdon]

You really hit the nail on the head there. Tylenol is added to all the opiates for the sole purpose of making them poisonous. This is done by government mandate. For those reading this who are not the parent, yes, the government mandates that our drugs are made less safe in order to allow them to be prescribed. And people wonder why marijuana is illegal still. The feds have not yet figured out how to make marijuana deadly, that is why it is still illegal.

Re:Logic Says It Should Be Legal

[ArmoredDragon]

Yeah it was for nerve gas, and yeah there were three of them. I'm not saying that the choice of autoinjector was wrong, just that autoinjectors scare me more than a syringe does.

Re:Logic Says It Should Be Legal

[lars_stefan_axelsson]

Syringes are just as easy to use with 5 minutes of training.

Having had to use two Epipens in anger, and another two in training (live with Epinephrin) I beg to differ.

In my case its complicated by the fact that the user was afraid of needles (really, really afraid), but could be coaxed into learning to use, and then use the Epipen. So call me sceptical. I'll take the autoinjector every time, and all the time.

The main problem is that you let yourselves be gouged on price. The Swedish pharmaceutical purchasing agency buy the exact same Epipen here in Sweden for $50. It cost me something like $45, to buy, before insurance, and since children were involved it's actually free on the states dime.

How on earth you can accept a system that charges several times that price, when the company is clearly willing to sell it for a lot less to a much, much smaller player, is completely beyond me.

You don't need syringes, you need a different system. Badly.

Free market is great

[Anonymous Coward]

As long as it doesn't interfere with some rich and powerful company!

Re:Free market is great

[LynnwoodRooster]

...that is headed by the daughter of a sitting Senator (interesting they didn't mention his party affiliation in the summary - Democrat).

Re:Free market is great

[Applehu Akbar]

There's nothing 'free' about this market.

For an example of a free market that has the same large research component and the same indirect marketing (as in "Intel Inside") as medicine, I give you electronics. This is what US medicine could look like if it were a free market.

Free market

[AK Marc]

Free Market, unless you want to buy medicine, then we don't let you. Funny how, in this, like so many other issues, the "conservatives" are against a free market, and the "liberals" are for the free market.

Re:Free market

[Anonymous Coward]

You're aware that the senator whose daughter is CEO of Mylan is a Democrat, right? Greed isn't a left nor right issue. It's not a conservative nor liberal issue, it's a people issue.

Re: Free market

[glomph]

Exhibit A: Comcast.

Re:Free market

[JaredOfEuropa]

This is not a free market. In a free market you'd be free to buy from overseas companies.

Re:Free market

[kenh]

Funny how, in this, like so many other issues, the "conservatives" are against a free market, and the "liberals" are for the free market.

So Republicans are fighting for price controls and the Democrats are letting the market set the price?

I think you and I have different definitions of what a "Free Market" looks like...

Re:Free market

[_Sharp'r_]

Yeah, the Obama FDA, that hotbed of conservative activism!

Also, since when was price fixing by governments a "free market" solution?

You make it sounds like the Democrats are in favor of free trade from online pharmacies, when a quick Google search and clicking on the first link is enough to dispel that.

I'm not saying there aren't government-lovers on both sides in this area, but to cast it as 'the "conservatives" are against a free market, and the "liberals" are for the free market.' when it's more the opposite is quite a stretch there...

Re:Free market

[misexistentialist]

Not really, they just want government to control the price as well as access to medicine. The FDA shuts shuts down internet pharmacies at Obama's order

Re:Free market

[93 Escort Wagon]

Both conservatives and liberals love their broad, simple talking points - but, in the end, there are lots of things that don't fit neatly into just one box. Many, many issues in life are just inherently complex. So, when there's conflict, a person has to weigh which conflicting principle Is more important to them.

Plus it's only natural that we are predisposed to be more sympathetic towards a position which either impacts us directly or affects someone we care about.

Re:Free market

[geekpowa]

Even if you are allowed to buy from overseas, you are not, strictly speaking, operating in a free market. You are relying on 'anti free-market' government measures and protections in the target jurisdiction. Carry idea of free market to it's ultimate logical conclusion, medicine from overseas will still be expensive if certain people had their way and this loophole would definitely be closed to you. Using Australia as an example, it is actually illegal to export government priced/subsidised medicines from Australia. It is supposed to be for Australian citizens only. Citizens leaving australia need to demonstrate any medicine they are carrying is for their own personal use.

All this reveals one of the many faults and limitations of libertarian-ism / small government ideology. It assumes that in all transactions all parties have equal agency. Which is never ever the case when your life and health are part of that transaction. Sometimes people need to organise help protect themselves from the ruthless practices of greedy arseholes. At least as far as medicine is concerned, the rest of the developed world gets it...

Re:Free market

[guruevi]

Price fixing happens for most monopolies, a free market wouldn't allow for many monopolies on high margin products. A truly free market wouldn't have licenses, FDA, copyright or patents. Price fixing protects the poor from abuse by government granted monopolies.

Re:Free market

[KiloByte]

There's no market when only one company is allowed to sell the good.

Re:Free market

[jedidiah]

That's all fun until people start dying.

Re:Free market

[Applehu Akbar]

"So Republicans are fighting for price controls and the Democrats are letting the market set the price?"

No, mainstream Never-Trump Republicans are paid for by pharma, and are in favor of doing nothing. Democrats will use price controls and rationing to 'solve' the problem. In Venezuela, these techniques have been great at eliminating patients.

Re:Free market

[jaa101]

Just because she's the daughter of a Democrat doesn't mean she's a Democrat. Does anyone know which party Mylan supports?

Re:Free market

[Hognoxious]

Many, many issues in life are just inherently complex. So, when there's conflict, a person has to weigh which conflicting principle Is more important to them.

So basically we're totally fucked and it's not a question of *if* the ants take over, it's a question of *when*?

I'd bet on early December, but I doubt I'll be around to collect.

Re:Free market

[BlueStrat]

You're not as educated on the matter as much as you think you are friend.

He has demonstrated at least a minimal effort towards self-enlightenment which is more than can be said for your snark.

Re:Free market

[ChrisMaple]

Price fixing protects the poor from abuse by government granted monopolies.

"Price fixing" refers to an agreement in an oligopoly to sell a particular product in a price range. It is illegal in the US, under antitrust laws. Monopolies don't engage in price fixing because there's nobody to make an agreement with.

Price fixing, being an agreement among suppliers, raises prices. In no way does it protect the poor.

Perhaps the phrase you are looking for is price controls, such as the disastrous Nixon policy that led to gasoline shortages in the 1970s.

Re:Free market

[AK Marc]

You make it sound like i ever used the words "democrat" or "republican" in my post. I note how every political post becomes ana rgument over words. Any argument on facts becomes a "no true Scotsman" or strawman. And nobody ever actually discusses the issue, just how it's discussed.

but to cast it as 'the "conservatives" are against a free market, and the "liberals" are for the free market.' when it's more the opposite is quite a stretch there...

I'm just looking at the work Reagan did to punish gays. He tightened enforcement of US-made drugs being re-imported to a level never before seen (to keep the "God hates fags" christian conservatives happy), and (Arguably) not seen since. Clinton kept the status quo of bans on re-imports, but there was no presidential pressure to prosecute, and so the Canadian mail-order drugs came back. At least until Bush II. Or do you recall the presidencies differently?

Re:Free market

[AK Marc]

The liberals want to set drug prices in the US, the whole "allow people to buy drugs from foreign nations" is just the whip they're using to pressure the other lawmakers to allow them to set prices to avoid opening the US pharma market.

So the whip to pressure the conservatives is a free market, and the conservatives run from that idea.

Exactly what I said. The conservatives are regressive (wanting change back to some previous ideal, real or imagined), and the liberals are conservative on many gains, and progressive on a smaller number of things (being pro-gay marriage is a conservative stance - it's the law of the land, so someone trying to change it is progressive, and someone trying to keep it the way it is now is conservative, though actions have been confused with ideology, and both have been confused with cheap political labels to where no words have any meaning when used in, or near, politics or politicians.

Re:Free market

[AK Marc]

Dying from what? US made drugs, made to US specifications that were distributed in Canada, before being re-imported into the US at 1/10th to 1/100th the price of US retail? Yay, conservatives, restricting personal freedom to protect us from ourselves.

Re:Free market

[BlueStrat]

The liberals want to set drug prices in the US, the whole "allow people to buy drugs from foreign nations" is just the whip they're using to pressure the other lawmakers to allow them to set prices to avoid opening the US pharma market.

So the whip to pressure the conservatives is a free market, and the conservatives run from that idea.

Wrong.

Pharma is anything but a 'free market', it is one of the heaviest-regulated US industries. This would simply be allowing in competition that can easily undercut prices as the competition doesn't have the expenses incurred by US pharma companies to research, develop, and eventually, after up to decades, possibly bringing them to market. Many shady foreign companies copy US patented drugs that cost US pharma companies many millions at each step along the way and sell the knockoffs for a fraction.

This would put pressure on US pharma research, development, and sales to leave the US and cripple what remains.

If the goal is to globalize pharmaceuticals then US pharmaceutical regulations, laws, and procedures for testing and certification in the US will have to be lowered/reduced/softened to more closely match the global markets like Indonesia or they will cease to exist (in the US, at least).

I too want reasonable pharmaceutical costs and robust research and development of new drugs and treatments, etc. I just don't think loosing the foreign competition on US pharma that's effectively hamstrung by a cumbersome, inefficient, and achingly-slow regulatory structure seems wise.

I believe much more could be gained all around if serious reform, downsizing, modernization, and streamlining of the current US pharmaceutical regulatory structure could be accomplished. At that point opening US pharma markets to foreign competition would not matter as US companies could easily compete.

Competition is great. It drives innovation and keeps prices low. Having one competitor deliberately hamstrung is not competition or a 'free market'. In this case it amounts to targeted economic destruction of a nation's particular industry.

Strat

Re:Free market

[ganjadude]

its not the conservatives against a free market here, how in the world can you even come to that conclusion???

Re:Free market

[guruevi]

Price fixing by the government which what parent post was referring to.

Re:Free market

[AK Marc]

Pharma lobbied for the regulations. It creates a markey where one monopoly drug after another is the hot thing. The cosp of pharma isn't in R&D, as you imply. Pharma spends more on marketing than R&D. If we want to make pharma cheaper, we should do what many other countries have done, and make advertisment illegal. The costs will go down, so the drugs should get cheaper, right? Oh wait, that's not how the monopoly big pharma worked so hard to build works.

The irony is that big pharma worked so hard to create a monopoly system, to then, while directly supporting it, claim it's holding them back from providing affordable drugs.

and procedures for testing and certification in the US will have to be lowered/reduced/softened to more closely match the global markets like Indonesia or they will cease to exist (in the US, at least).

Indonesia? Why that? You should have picked Somalia or Canada. Do you really think drugs are significantly more dangerous in Canada than the US? Most of the world already has much more lax standards that work. The US somehow believes they are the only exception to every rule. People in Australia aren't dropping like flies, yet the costs are much lower than the US. Even in Indonesia, do you know of any specifics of unsafe drugs in Indonesia?

Re:Free market

[AK Marc]

The conservatives are the ones fighting to protect big business with protectionist measures that block the free market. It's reality that makes me come to that conclusion. What reality are you visiting today?

Re:Free market

[AK Marc]

"No civil rights legislation for lesbian or gay individuals passed during Reagan's tenure." And he requested 26M, a number so low, that Congress ignored it and funded it almost twice that. The funding increases were by Congress under him, not by him. He gave passing mention when personal friends like Rock Hudson died from it, but didn't *do* anything about it. Bush (Sr.) pushed President's Council on Physical Fitness and Sports 1,000,000 times more than Reagan did AIDS awareness or support. Dallas Buyer's Club was shut down by Reagan. He made sure that while he funded a trickle of funding, to make sure he didn't go down as the most evil president ever, he did, and is the point of this pharma article:

President Ronald Reagan pushed for enforcement of DEA laws, and did so in a way that resulted in the deaths of Americans, for the benefit of the profits of big phama corporations, against the interests of the citizens (and, of course, the free market).

Whether you think he did or didn't do enough for gays, is irrelevant to whether he did or did not push for the weakening of the free market to boost big pharma profits.

Re:Free market

[BlueStrat]

Indonesia? Why that?

Because you wanted foreign competition? That 'free market' you were on about the conservatives fearing?

Wait, do you now want to pick and choose who gets in? What happened to 'free markets'? In a 'free market' US pharma would compete with Canada and Somalia...and Indonesia, India, Pakistan, Hong Kong, China, Turkey, Israel, Russia, etc etc.

Don't want that? Maybe 'them evul conservatives' are onto something in opposing it?

Strat

Re:Free market

[AK Marc]

Ah, so you were deliberately picking a "bad" example. And when that's pointed out, you get all aggressive. In a free market, one could choose whether they want to import Canadian, UK, or Somalian drugs. A "free market" doesn't mean you can only buy the cheapest supplier, but that you have choice.

Learn what "choice" means, then try again. Or is that the real reason the conservatives hate a free market? "Choice" is a bad word, so any "choice" must be ended at all costs.

Re:Free market

[BlueStrat]

Ah, so you were deliberately picking a "bad" example. And when that's pointed out, you get all aggressive. In a free market, one could choose whether they want to import Canadian, UK, or Somalian drugs. A "free market" doesn't mean you can only buy the cheapest supplier, but that you have choice.

Learn what "choice" means, then try again. Or is that the real reason the conservatives hate a free market? "Choice" is a bad word, so any "choice" must be ended at all costs.

That there will be choices is exactly what I was pointing out. People would be free to choose Canadian or Somalian, Indonesian, Pakistani, or any other nation's pharmaceuticals. The point is that it's a pretty good bet that not all those nations' pharma regulations & standards will meet or match those in the US. As a matter of fact many drugs would be imported which are restricted or banned in the US on top of bad batches of low quality pharmaceuticals. Even with current restrictions regarding importation of pharmaceuticals, literally tons of both 'legitimate' prescription-only and 'illicit' recreational pharmaceuticals are illegally shipped by foreign suppliers to people in the US from online orders every year and results in many overdoses, poisonings from bad batches, and deaths/crippling disabilities.

There has to be restrictions on importations of pharmaceuticals because all the various national standards are not the same and neither are laws regarding banned/restricted drugs. Opening foreign online drug purchase will also throw the door open wide to recreational designer-drugs with little or no quality standards or safety testing.

Strat

Re:Free market

[AK Marc]

So we should ban US made drugs, made to US specifications, from being re-imported, because someone could sell Somalian cocaine by labeling it Aspirin?

Never mind. What little mind you have is irrationally made up, and there exist no words that could force your tiny mind to have a thought.

Ban drug ad's like most developed nations do!

[Joe_Dragon]

Ban drug ad's like most developed nations do!

Re: Ban drug ad's like most developed nations do!

[glomph]

But my erection only lasted three hours!

Re:Ban drug ad's like most developed nations do!

[Anonymous Coward]

I left the US right about when they were starting to be allowed. Now when I go back it's pretty disconcerting, bordering on revolting, to see how much tv space is taken up with drug ads.

There is no reason for drug ads. Period. Drugs should be allowed by efficacy and safety, priced honsetly and prescribed by qualified unbiased doctors for the conditions they treat best. None of that is true in the modern US of A

Re:Ban drug ad's like most developed nations do!

[jxander]

While your point is valid, it's entirely unrelated to the issue at hand.

No one is going out and buying an EpiPen because they saw an advert for one. This is fundamental life saving medicine.

The problem is that a single company has a monopoly on that medicine

That's the issue we should be addressing. Letting a company maintain an iron grip on life saving medicines.

Re:Ban drug ad's like most developed nations do!

[LynnwoodRooster]

Patents on epinephrene expired a LONG time ago. This is simply the FDA restricting other manufacturers from selling a generic, out-of-patent drug delivery system - a spring loaded syringe.

Re:Ban drug ad's like most developed nations do!

[kenh]

The problem is that a single company has a monopoly on that medicine

No, they don't - they hold a patent on the fool-proof spring-loaded syringe.

Doctors use epinephren on a regular basis, they just have to draw a dose from a medicine bottle and inject it properly. The EpiPen allows anyone to slam a dose into the leg of someone suffering without any training.

Re:Ban drug ad's like most developed nations do!

[TroII]

No one is going out and buying an EpiPen because they saw an advert for one. This is fundamental life saving medicine.

Why are there commercials for EpiPen, then? They've been advertising pretty heavily in recent months, I see that commercial with the teenage bass player pretty much every day. Considering it's a life saving medicine and they're apparently the only source for it, why bother advertising? The obvious answer is it must drive sales, which means people do see the commercial and "ask their doctor if EpiPen is right for them."

Re:Ban drug ad's like most developed nations do!

[sjames]

If we're being honest, it doesn't take a lot of training to do an intramuscular injection to the thigh.

Many people with life threatening allergies are carrying pre-loaded syringes now since they can't afford the EpiPen.

The EpiPen came out in the mid-70s. That means the patents are expired.Their monopoly primarily exists now because the FDA has an extreme fear of insignificant differences. Otherwise, it shouldn't actually cost much over $40 by now for two.

Re:Ban drug ad's like most developed nations do!

[ChrisMaple]

Doctors are not omniscient. The number of drugs and diseases and their interactions is beyond any person's knowing. Take a look at Life Extension magazine, where the citations on a single article frequently exceed 100.

Drug ads bring the attention of consumers and doctors to potentially beneficial products. And they annoy the rest of us.

What's a drug? If you have the wildflower foxglove in your garden is it a drug? Is it a drug when you pick the plant? Are the digitalis-containing leaves a drug? Or is it only a drug when you extract digitalis (digitalin, whatever) from the leaves? These are important questions, because they determine the legality of many innocent actions. The FDA has long attempted the overreach of restricting the production and availability of food and herbal extracts, claiming that those things are drugs and subject to the FDA's powers.

Hooray for overseas mailorder

[glomph]

My Telmisartan (technically generic now, but Big Pharma is delaying it) is 6x cheaper overseas. Fuck the corporate kleptocracy and their politcal enablers with a rusty rake.

Re:Hooray for overseas mailorder

[AnAlchemist]

Where do you order from? Any advice on which overseas pharmacies are legit?? I have trouble separating the good from the bad. :(

Re: Hooray for overseas mailorder

[glomph]

Canada-drugs-dot-com (remove hyphens). Honest, reliable, good prices. You still need to provide a prescription.

State of Minnesota reccomends Canadian Pharms

[laughingskeptic]

They even had a state website that pointed directly to Canadian pharmacies for several years: http://www.amednews.com/articl... . I used their list to choose my Canadian pharmacy and still use them when it makes financial sense.

Just wait for the jail / prsion bill for the durgs

[Joe_Dragon]

Just wait for the jail / prison bill for the drugs + the cost of locking people up. as some people may trun to local jail as there last resort. also their doctors do more then the ER.

Who's stopping you...

[kenh]

Is it finally time to allow Americans to go online and fill their prescriptions on the world market?

What prevents an American from buying EpiPens (or any pharmaceutical) on the international market?

Re:Who's stopping you...

[Anonymous Coward]

It's illegal. You may not get caught, but still.

Re:Who's stopping you...

[ArtemaOne]

Possibly customs if they catch you breaking the law with the illegal import.

Re:Who's stopping you...

[kenh]

Yet somehow an entire industry of Canadian on-line pharmacies exist to service the American drug market...

Re:Who's stopping you...

[Applehu Akbar]

"What prevents an American from buying EpiPens (or any pharmaceutical) on the international market [webmd.com]?"

It's illegal, but do it anyway. Break the system by massive noncompliance. That was how we got out of Vietnam.

Re:Who's stopping you...

[rpstrong]

In which case, they'll confiscate the shipment and do nothing more (unless you're importing 'recreational' drugs - but you still need a prescription and a phone interview with a Canadian doctor). Some of the Canadian providers will reship (for free) if you don't get your order.

Do you really think customs gives a tinker's damn if you're importing blood pressure meds? (That was my own particular 'crime', till it went generic).

Re:Who's stopping you...

[ArtemaOne]

Care? No. Stop it if they find it? Yes. That is a direct answer to the question asked.

Re:Who's stopping you...

[rpstrong]

Another equally valid answer is that the package may be lost in the mail, or mis-delivered - possibilities that rank right up there with Customs interference. But in the Real World (TM), none of these potential issues prevent a person from buying on the world market - which was the original question. In all cases, a delayed re-shipment is about the worst possible outcome.

Re:Who's stopping you...

[ArtemaOne]

I'll agree to that. Is customs supposed to stop all contraband? Yes. Is taking government inefficiency into account at all points valid? Completely.

LMGTFY

[Tailhook]

Someone look up the D's and R's please. Since they were omitted I'm betting the father of the CEO is a (D).

Re:LMGTFY

[Knetzar]

Good catch.

From the article: One Democratic senator whose daughter has allergies has called for action and another Democratic senator's daughter is CEO of the company responsible for the price hike.

Asthma Inhalers did a Similar Money Grab

[Anonymous Coward]

This is similar to the price hike for asthma inhalers.
The excuse was to eliminate CFCs and save the ozone layer.
There is not even an attempt at government control.

All these pharma/insurance stories

[fustakrakich]

And still insufficient demand for universal health care. And don't blame the politicians. With the upcoming 95% reelection rate (and 100% republican/democrat monolith), there is no incentive for them to change anything. The only issue monopolizing the media is *he who shall not be named*

Re: All these pharma/insurance stories

[Anonymous Coward]

Bullshit.

What the fuck is it with you idiots ? Are you all truly incapable of opening your fucking stupid eyes ???

Universal healthcare delivers better outcomes at lower costs than the US system of third world medical care.

The rest of tje developed world laughs at you. They are healthier and live longer than you and dont go broke for having the temerity to get sick.

I have American friends who schedule health care during their trips to Australia as even paying full price it's vastly cheaper than the US, of superior quality, and they're not turfed out of the hospital after one day to free up a bed.

Wake up to yourselves. You're paying new BMW prices for a smashed up 1995 Taurus.

Re: All these pharma/insurance stories

[inode_buddha]

Bill shot and fud. Tell me why the Scandinavian countries and the Germans have probably better outcomes for less, with none of the scare points you're so sure of. Yo do realize that everyone can get paid just fine working at a non profit right? And no, Obamacare isnt even close to universal healthcare unless you're a tool of Fox news. Do you really believe Obama is socialist or something? His whole healthcare plan was a right wing gimme be cause he is fundamentally right wing regardless of the D after the name.

Re: All these pharma/insurance stories

[Anonymous Coward]

Because I have a dozen friends in Canada who all have horror stories of waiting for years for operations and treatments that would take weeks, if not mere days, to get done in the US.

Sucks to be them. It also sucks to be one of the hundred people in the US who can't afford even basic medical care for every one of the Canadians who have to wait for an operation.

Universal healthcare means everyone has to wait for treatment, paid healthcare means some people don't get treatment at all. The question of which one is preferable is a matter of conscience and an exercise left to the reader.

Re:All these pharma/insurance stories

[thegarbz]

Universal healthcare will get you rationing instead. Add to that shortages, long wait times, and just plain inferior care.

Yep everything is black and white, and all the countries with universal healthcare are inferior. Except for the countries with universal healthcare that rank above the 37th place the USA has on WHO's rating. Like Australia mentioned in the article coming in at 32 where I have never been out of pocket for a single cent for healthcare (excluding dental).

But back to the black and white thing, in the world that exists outside the USA, black and white is a bit like Michael Jackson. You get to chose that colour. I was put on a 6 month waiting list for an operation on a non life threatening hernia in Australia. ... So I went to a private hospital and was given the option of being operated on 3 days later for $2800 of which my private insurance would have covered $2000. So I'm out of pocket $800, or $0.... I chose the $0

2 months later I get an opening on a waiting list and I go in to get treated by ... a surgeon from the USA who left the USA because he was sick of the shit he had to put up with as a medical professional there.

The only people who think you get inferior care are those who have never left the USA.

I mean these are just anecdotes but doctors visits $0 no waiting.
Heat stroke, got picked up in an ambulance $0 no waiting.
I've broken bones about 4 times $0 no waiting.
Girlfriend broke her arm, drove her to hospital, $0 1hour wait but they already administered pain killers while she was in triage.
Car accident with whiplash injury, $0 no waiting.
Hospitalised with bad food poisoning $0 no waiting.
Got really sick 10 years ago, had blood screen and the works to find out I had mononucleosis, $0 no waiting.

But this is just my experience. I'm sure if you find other anecdotes eventually you'll have enough to start calling it data.

Re: All these pharma/insurance stories

[Anonymous Coward]

Really? Because I have a dozen friends in Canada who all have horror stories of waiting for years for operations and treatments that would take weeks, if not mere days, to get done in the US.

Are these anything like the stories you told us about your girlfriend in high school?

I hate the US system, but to pretend that the rest of the world has this 100% figured out is a pretty big lie on your part.

I'll settle for not causing bankruptcies, not wasting money on massive overpayments, and not having a useless set of trouble causing insrance companies.

Re:All these pharma/insurance stories

[BradleyUffner]

Universal healthcare will get you rationing instead.

We already ration healthcare. It's just done based on how much money the patient has, instead of by need.

Re: All these pharma/insurance stories

[DamnOregonian]

Tell me why the Scandinavian countries and the Germans have probably better outcomes for less

Mostly, they don't. Overall, on a massive list of medical outcomes for major diseases, they score significantly below us on survival in the majority of illnesses. They do completely destroy us on a few though, interestingly (wtf, cervical cancer?)

I don't think it has anything to do with their *system* though. I think it has more to do with the people and their love of holistic medicine.

Re:All these pharma/insurance stories

[Zontar The Mindless]

My daughter was born via emergency C-section in Australia. I think we ended up paying roughly a thousand dollars. Had this happened to us in the US, her mother and I would have been bankrupted.

Re: All these pharma/insurance stories

[ChrisMaple]

Obamacare was designed to fail, so that government-controlled healthcare would be inevitable.

Obamacare was sold to the insurance companies as "look at all the money you can grab now" and they fell for it.

Obama hates America, and Obamacare is a major part of his plan to impoverish the country.

Re:All these pharma/insurance stories

[ChrisMaple]

You are distorting the language.
Rationing refers to fixing a portion. In this context it refers to the fixing being done by an external entity, the government. Being limited by what you are willing/able to pay is not rationing, and it is dishonest to claim otherwise.
If you can't afford a Rolls Royce, it's not because of rationing.

Re:All these pharma/insurance stories

[thegarbz]

I hear these stories all the time mainly because I work for an international company with lots of movement of people between sites, half of which are located in America. One of our American colleagues immigrated to Australia and scored a trifecta:

1. He had a car accident from which he walked off. When his neighbour found out he called an Ambulance to take him to hospital for neck x-ray. He didn't think of calling for it himself because apparently that's expense rather than free. He spent the next few months in a neck brace.

2. His first born at a young age fell off a trampoline and split her skull open on a rock. Ambulance and a few hours in surgery to install a metal plate in her head.

3. His second born was born with TGV (transposition of vessels in the heart) which basically meant her body started dying from lack of oxygen the moment they cut her cord. She went into emergency open heart surgery.

The cost of 1 and 2 were zero. The cost of 3 was a trivial amount ($300) for neonatal care post surgery and this was voluntary but recommended. He was a pretty well off person so he wouldn't have been bankrupted if this happened in the USA. But he wouldn't have his house anymore either.

I'm interested to know what the $1000 came from? Were you residents or citizens in Australia, or was it additional specialist care? A friend of mine had her baby forcefully delivered via C-section and that didn't cost her a cent, though I'm not sure if this was due to her husband being out of work with a workplace injury, a lot of elective costs go to zero in such cases.

Re:All these pharma/insurance stories

[rpstrong]

He was a pretty well off person so he wouldn't have been bankrupted if this happened in the USA. But he wouldn't have his house anymore either.

Why wouldn't he? If he was 'pretty well off', he'd have been paying monthly health insurance premiums instead of higher taxes. He would be providing for his family, not for others. You may find this to be selfish - that's your right. But if he lost his house over it, he just wasn't planning ahead.

Does he carry fire insurance? Or would the government replace his house if it burned down?

Re:All these pharma/insurance stories

[thegarbz]

He would be providing for his family, not for others. You may find this to be selfish

Not at all. You look after your family first.

he just wasn't planning ahead.

The notion that people need to plan ahead for life threatening medical emergencies that also depend on a persons wealth is why the entire world laughs at you. We really really do. We do so even more when you claim it's the best medical system in the world when the reality is you rank down in the low 30s high 40s.

Does he carry fire insurance?

Of course he does. It's costs less than 1/5th of that of your medical insurance. Having your stuff replaced in a fire in Australia is not reserved for the rich, unlike being secure from medical emergencies in America, or non emergencies for that matter.

Re:All these pharma/insurance stories

[rpstrong]

Of course, none of the above addresses your claim that he would have lost his house - essentially claiming that couldn't afford coverage sufficient to cover his assets. In fact, such coverage has practically always been available, but at a price. And a "well off" family man (my dad fit that category) was in the class of those who either received it as an employment benefit or were able to afford it. (By the way, uncapped emergency care was a common benefit.)

Of course, this is your story, not mine. Perhaps you can provide a bit more info on what his coverage in the US would have been, and why he would have lost his house - my original question.

--

Please check your straw men at the entrance.

Epinephrine cost per dose in about 50 cents

[ITRambo]

Epi-pen dosage is 0.3 mg of epinephrine. One dose from a Primatene mist inhaler releases 0.22 mg of epinephrine, exactly the same active ingredient as an Epi-pen. There are over 60 doses per Primatene mist inhaler. at a cost of about 50 cents per dose. Several years ago Primatene Mist was removed from the market. Our health care system is now fully controlled by corporations that don't give a rat's ass if we live or die as long as their profits continue to skyrocket, at any cost. Health insurance companies could fight back. But they don't appear to care, as they just raise their rates to cover the excessive and escalating cost of life saving prescription drugs. Having asthma, and having worked with suppliers of delivery mechanisms during my career, I estimate the cost of goods sold per Epi-pen is about $2 to $3 each. Any figures beyond that are profit. Any higher CGS presented by Mylan, should they choose to do so, are likely accounting techniques where they move ongoing R&D costs onto old and fully paid for products. The retail price of Mylan's Epi-pen is legalized theft such that Al Capone would be proud.

Re:Epinephrine cost per dose in about 50 cents

[Dorianny]

The biggest problem is that Medicare the largest insurer in the country is bared from both negotiating prices with Drug manufacturers as well as weighing its cost when considering approval of medication

Re:Epinephrine cost per dose in about 50 cents

[hey!]

Well, it's the very fact that the alternative is, possibly, death that makes it possible for a company to do this. This thing occupies a peculiar corner case where the demand is modest, but inelastic.

This means a monopolist can milk the market by raising the price to insane levels, but because the market is small no competitor wants to enter it. Were the market to become competitive it is so small that the newly entered competitors wouldn't make much off their efforts. This is contrasted with statins, which are blockbuster drugs. You don't need a very large slice of that pie for the slice to be very large indeed.

The same thing happened last year with Duraprim. If you have toxoplasmosis, you absolutely have to have it. But how many people get toxoplasmosis?

Re:Epinephrine cost per dose in about 50 cents

[JBMcB]

Several years ago Primatene Mist was removed from the market. Our health care system is now fully controlled by corporations that don't give a rat's ass if we live or die as long as their profits continue to skyrocket, at any cost.

Primatene Mist was banned by the FDA in 2011 because it contained CFCs.

http://hubpages.com/health/Wha...

Do you have evidence that Primatene wanted the FDA to pull their product off the market?

Re:Epinephrine cost per dose in about 50 cents

[jedidiah]

We have a Pharma CEO with a father that's a Senator. We have a set of conditions that seem terribly beneficial to a particular corporation. We have that corporation and it's CEO profiteering and acting like an old school robber baron.

Follow the money.

It looks as corrupt as hell.

Yeah, CFCs are a nice excuse to create a monopoly out of thin air.

Re:Epinephrine cost per dose in about 50 cents

[sjames]

Quite the contrary. The Mob was pretty hard core, but they always had their limits. For example, they wouldn't be at all OK with endangering the lives of children.

Re:Epinephrine cost per dose in about 50 cents

[Wrath0fb0b]

I estimate the cost of goods sold per Epi-pen is about $2 to $3 each. Any figures beyond that are profit. Any higher CGS presented by Mylan, should they choose to do so, are likely accounting techniques where they move ongoing R&D costs onto old and fully paid for products. The retail price of Mylan's Epi-pen is legalized theft such that Al Capone would be proud.

Al Capone and his bootleggers were largely in favor of prohibition ($$$) and opposed to its repeal. They were also (violently) opposed to their competitors trying to move alcohol outside their protection racket. You want to fuck Mylan over, stop making it difficult for their competitors to compete with them

Last year Sanofi withdrew an EpiPen rival called Auvi-Q that was introduced in 2013, after merely 26 cases in which the device malfunctioned and delivered an inaccurate dose. Though the recall was voluntary and the FDA process is not transparent, such extraordinary actions are never done without agency involvement. This suggests a regulatory motive other than patient safety.

Then in February the FDA rejected Teva's generic EpiPen application. In June the FDA required a San Diego-based company called Adamis to expand patient trials and reliability studies for still another auto-injector rival.

The only shocking thing is that the price didn't go up more when a field of three competitors was narrowed to only one that's given a legal monopoly over the whole market.

Re:Epinephrine cost per dose in about 50 cents

[thegarbz]

No the biggest problem is that apparently your drug prices are set by negotiations between two parties who wish to part you with your money and then divide up the results. This is ludicrous. I actually heard from an American that after going to get healthcare (nondescript because Americans don't like sharing what was wrong with them) she got a bill, forwarded it to her insurance company and then they argued and negotiated the price.

This is medical. Why is the price negotiable at all? As someone who has never paid an after tax cent for anything medical other than some seriously cheap drugs ($38 as in the article) I don't understand.

Re:Epinephrine cost per dose in about 50 cents

[Anonymous Coward]

You are correct that Primatene was removed from the market due to the CFC ban, but the parent is correct that certain corporations, although not the one(s) that manufactured generic inhalers, like Primatene, profited handsomely from the situation. Here is what happened. The phaseout of CFCs happened gradually over a long period of time following the signing of the Montreal Protocol in 1985 and it's effective date of 1989 after 11 of the signers had ratified the treaty. At that time, the general public, politicians and environmentalists weren't much concerned with potential side effects from their arrangement to ban CFCs. However, certain shrewd persons in big Pharma spotted an opportunity to take advantage of the phase out and began redesigning (and patenting) the mechanics of inhalers designed to use different propellant gases or, in the case of EpiPen, alternative delivery systems. By the time anyone outside of big Pharma understood the problem, it was already too late and the potential generic competitors had been out-maneuvered and caught out of position for the CFC phase out by the EPA. Meanwhile it would take years for the FDA to approve any new inhaler design, now that the CFC ones were effectively banned (the Montreal Treaty made no allowance for any permanent CFC use, including critical medical devices), and many of the obvious new delivery systems had already been patented anyway. To summarize, big Pharma shrewdly played an environmental issue, the slow motion CFC ban, to masterfully re-capture the previously generic market for rescue inhalers and begin another 20 year run of big drug profits on what essentially amounted to the same thing that was sold before except with a different propellant gas.

Re:Epinephrine cost per dose in about 50 cents

[Applehu Akbar]

Did you know that the excuse the FDA gave for pulling Primatene Mist off the market was because the propellant was the type that damages the famed ozone layer? Nothing to do with the epinephrine in it.
http://asthmaallergieschildren...

Re:Epinephrine cost per dose in about 50 cents

[alw53]

According to divine doctrine of capitalism, the company's first duty it to its shareholders and the company takes care of its customers and employees only to the extent that a lawsuit or lost sales might hurt its bottom line. Fortunately for this company, it has the FDA and the customs service as its enforcers.

Re:Epinephrine cost per dose in about 50 cents

[ITRambo]

I am aware of the CFC excuse. HFC's, currently in use in prescription inhalers, could have been substituted. I don't believe for a minute that it could not have stayed on the market with a propellant sub.

Re:Epinephrine cost per dose in about 50 cents

[Zxern]

Oh there are plenty of costs behind the Epi-pen price. It's just that most of them have nothing to do with actually making it. The highest costs are in marketing and lobbying.

Lobbying for purchase requirements, Lobbying for generic fda rejections, marketing to create extra demand. That doesn't come cheap.

Re:Epinephrine cost per dose in about 50 cents

[Zxern]

They were going to put in an exception to the CFC bans for inhalers, but Pharma lobbied to have it banned since the replacement devices would all have brand new patents and therefore exclusivity and higher prices for years.

Re:Epinephrine cost per dose in about 50 cents

[Zxern]

It could if not for the fact that they've all been patented. They'd have to design a new delivery device, or license one, good luck with that.

Re:Epinephrine cost per dose in about 50 cents

[DamnOregonian]

They were going to put in an exception to the CFC bans for inhalers, but Pharma lobbied to have it banned

False. Amphastar lobbied for *years* fighting the ban. The FDA fought back... for years to go through all the loopholes it has to go through before banning something that's contested.
There was no vast conspiracy here, just the FDA trying to follow our obligations under the Montreal Protocol, and big pharma not wanting to spend any more money making a new product when it could continue reaping the profits from the drug who's R&D was paid for 10x over every single year it was at market.

Re:Epinephrine cost per dose in about 50 cents

[mpercy]

" The highest costs are in marketing and lobbying."

And litigation. Don't forget the lawyers getting rich off of 1-800-BAD-DRUG lawsuits.

Frankly, I'm shocked that anyone would even try to bring a new drug or medical device to market without allocating several billion dollars to litigation costs, which has to be recouped before lawsuits shutdown sales of the new drug.

I'm pretty sure that if someone invented a 100%-effective drug that cures cancer (all kinds) that cost $10 per dose and only one dose was needed to cure cancer...but 1 in 100 patients would have orange pee for the rest of their life, the company would be run out of business by lawyers.

Re:Epinephrine cost per dose in about 50 cents

[mpercy]

So Big Pharma, being a scorpion, did what scorpions do. Was completely foreseeable and expected. But it only works when Government provides the monopoly.

"A scorpion asks a frog to carry it across a river. The frog hesitates, afraid of being stung, but the scorpion argues that if it did so, they would both drown. Considering this, the frog agrees, but midway across the river the scorpion does indeed sting the frog, dooming them both. When the frog asks the scorpion why, the scorpion replies that it was in its nature to do so."

Government Enforced Monopolies

[Anonymous Coward]

Epipen has no domestic competitors because the FDA (government) says so. It can't be bought from abroad because the government (FDA) says so. The solution isn't to mandate pricing, it is to streamline the process of delivering a well understood drug (adrenaline) at a well known dose, in an exactly known situation. It would be trivial to bring generic competitors to market if this were a reasonably governed area, and there would be no price gouging allowed because they couldn't sell it at even what the price was before the jacked it up. (Adrenaline aka epinephrine is trivially cheap, and the injector is quite cheap to make as well.)

I don't normally swear online

[Kobun]

But why in the FUCK are companies being granted effective monopolies on generic drugs?!?!

Nice to know our 'representatives' don't feel the need to hide it anymore. They've been in bed with the drug companies for a long time. But seriously, this takes it to the level of Muppets-style puppetry. No one believe that Kermit is a real frog; we all know that he's got an arm buried up his backside. Do you think Congress gets a bulk discount on shoulder length calving gloves and jugs of lube?

Re:I don't normally swear online

[SuricouRaven]

The drug is generic, but the delivery mechanism isn't. The EpiPen is is a specialised injector designed so that a person can use it safely upon themself, with one hand, and minimal training, possibly while writhing in pain. The FDA has only approved one such injector, and it is patented.

Re:I don't normally swear online

[LynnwoodRooster]

Invented in the mid 1970s, any patent on it expired in the mid 90s at the latest. It's 20 years past that. Oh, and it was invented for the US Military (meaning it probably had Government investment to create it - meaning it is open technology now).

Re:I don't normally swear online

[SuricouRaven]

Yes, and the the FDA has only approved on such injector. Those 1970's designs are no longer approved. Only the latest revision, which is patented. This is a common practice in medicine: Companies introduce a new variation, which needs a specific recent patent, just so they can discontinue the previous version and so prevent it going generic.

Re:I don't normally swear online

[Solandri]

Invented in the mid 1970s, any patent on it expired in the mid 90s at the latest

Which brings us right back to the FDA only having approved one such product. The patent (and its expiration) is mostly irrelevant. Given that an EpiPen is frequently used in a life-or-death situation, no other manufacturer wants to assume the product liability associated with such a device unless the can shield themselves with the "FDA-approved" label. And the FDA is glacially slow at approving these things; so slow that manufacturers probably figure it's not worth the investment to even bother trying. Thus leaving one company with a government-granted monopoly (just like cable Internet service, whee).

Re:I don't normally swear online

[LynnwoodRooster]

And I'm sure the CEO of the company being the daughter of a well-connected Senator has nothing to do with the slow operations at the FDA... ;)

Conflating several issues here

[Etcetera]

Arguably "the same drug" will be the same everywhere, but if you're ordering online drugs from somewhere outside the FDA inspection regime, you don't know what your chances are that it's in fact actually "the same drug". Really, you don't know what you're getting.

That's still a possibility here, of course, but when a US producer commits fraud you'd better believe you'll have an army of lawyers beating down your door to help sue them into oblivion for it. Random Joe Bob's Discount Drug Shack operating in Singapore? Good luck.

Secondly, the FDA approval process itself. For better or for worse, having a complex medical trial and many layers of approval is probably better that not having it, in terms of protecting US consumers from unsafe foods and drugs. There's a fast-track process for promising drugs and devices to prevent dangerous conditions, and there registered experimental treatments, but all other things being equal, I'd prefer to know that some basic level of testing was done.

Drug IP process. People in other countries like to point out that they can purchase drugs for $20 that are charged higher processes here. You can thank us (the American Consumer) for that. Not everyone gets to be a marginal consumer.. and part of the reason we're paying full price for drugs is so that the market incentive allows those drugs to be developed in the first place. Without market incentive, you're only going to proceed in research as fast as centrally-planned authorities dictate you will. Or you're a charity, funded by donations.

None of those things directly deal with device IP, but to be honest cases like this (where someone is being an abject douchebag) are rare, and tend to get discovered, highlighted, and corrected through social pressure. (EMT's have been talking about the cost of EpiPens for years, and there were already initiatives under way to allow EMT's to inject Epi directly: http://thesouthern.com/news/local/govt-and-politics/new-state-law-will-allow-emts-to-inject-epinephrine/article_42dbddd9-a035-509b-b99a-7f720c7411b0.html

The measure, sponsored by state Sen. Chapin Rose, R-Mahomet, and signed into law by Gov. Bruce Rauner late last week, comes as the maker of the EpiPen is facing increased scrutiny from the federal government over dramatic price increases for the lifesaving drug. The cost of a two-dose package of EpiPens, made by pharmaceutical company Mylan, jumped from less than $100 nine years ago to more than $600 in May, The Associated Press reported Wednesday.

While the timing is a coincidence, Rose said recent attention from Congress has attracted the public eye to an issue that was first brought to him by a rural fire protection district he represents.

If there's a justifiable reason for a price hike, it'll become public as well. Often there is. E.g., a critical component has restricted availability.

Re:Conflating several issues here

[Anonymous Coward]

Canada isn't a third world nation, buying from a reputable seller there and you are getting merchandise manufactured from the same source the US gets.

Re:Conflating several issues here

[currently_awake]

Are you actually suggesting that Canada doesn't monitor and approve their drugs? How about England? Americans should be able to buy legal drugs over the internet from any country with an equivalent drug control system.

Re:Conflating several issues here

[sjames]

Canada isn't some third world mud hole. They have a regulatory process as well. I have every confidence in the drugs sold there. Same for the EU.

The FDA has gone well past the sweet spot and is now killing people rather than saving them. Their desire to have their asses kissed has gotten to the point that they are 're-evaluating' drugs with centuries of proven safety just because they pre-dated their authority. The result is that the prices jump by a factor of 100.(Yes, literally the price is now 100 TIMES what it was before).

Drugs people can't afford might as well not exist. It seems that health care is one of those things where a free market just won't work.

Re:Conflating several issues here

[thegarbz]

Random Joe Bob's Discount Drug Shack operating in Singapore? Good luck.

Random Joe would be bound by the inspection rules of the Singapore Health Sciences Authority (HSA) which serve a similar purpose as the FDA as well as be registered with the Singapore Pharmacy Council (SPC). Now if these sound like shady organisations it's because the FDA has a formed a joined working group with the HSA to ensure that all drugs available in Singapore and the USA meet the requirements of both countries as required by the trade agreement that is in place. i.e. Your government's agency charged with protecting you think that their government's agency charged with protecting them are equally capable and do the same job.

I'm glad you chose Singapore. It shows both your prejudices against the east as well as your complete ignorance of the pharmaceutical industry outside of the USA where, not only are the drugs of comparable quality but people are less likely to die as they can afford them too.

Re:Conflating several issues here

[Applehu Akbar]

The pharma argument that high US prices subsidize lower prices in other countries is bullshit. Drugs are sold at a profit in every market, except for charitable giveaways in Third World epidemic emergencies. Each market is assessed for what price it will bear.

The other often-repeated myth is that Canada imposes price controls. It doesn't. Its single-payer organization bids for the medications it wants, attracting low prices because it buys a nationwide supply of each device and compound at once, handling its own distribution. Those products it deems to be too expensive are just skipped.

Re:Conflating several issues here

[mpercy]

" vast majority of money spent by drug companies goes to sales and marketing, not research and development."

Don't forget lawsuits. Billions and billions of dollars go into the pockets of plaintiffs bar attorneys and their 1-800-BAD-DRUG litigation.

" The various owners of the device have fought other company's attempts to bring generics to market. This saga is pure profit taking my Mylan. Without effective competition they can do what they want unless the government finally implements price controls in the health care sector like every other developed nation."

Pretty much the FDA has done the bidding of the manufacturer and prevented alternatives from coming to market. So it was government regulation that caused the problem by putting the FDA in the role of gatekeeper for all drugs. A little corruption there can go a long way, and it certainly can't hurt to have the CEOs daddy be a Senator from WV.

really

[Anonymous Coward]

So its illegal to buy it from overseas, but its not illegal to take the profits overseas ????

Quit whining - your doctor can prescribe epi

[lightperson]

A 1 ml ampule of epinephrine costs about $5. An insulin syringe about 25 cents. That is enough for three normal epi-pen doses - more than enough for any emergency. Sensitive hikers carry this. Folks working around bees and wasps too. If your doctor won't prescribe it, find a doctor who will. Of course you will have to learn to break the top off the ampule and fill the syringe up, getting rid of little bubbles. The rest is the the same. The only reason epi-pens are an issue is because many, perhaps most people are accustomed to Big Pharma and insurance companies leading them to believe that they will take care of them, but only if they stop thinking for themselves.

Monopolies

[markdavis]

>"the U.S. "is the only developed nation on Earth which allows pharmaceutical companies to set their own prices."

There is nothing inherently wrong with a free market..... as long as the market really is free and isn't being controlled by unregulated monopolies. That is what we are seeing happen with things like the Epi-Pen. And in cases where patents are creating artificial monopolies, we have to examine if there should be regulation (as we rightfully regulate all other monopolies).

As for the backlog at the FDA for generics- that is just inexcusable.

Oh, and yes, I am one of the people that must have an Epi-Pen or risk losing my life if I accidentally eat a nut (which happened once and nearly did so). So yes, I have a horse in this race...

Re:Monopolies

[mpercy]

"That is what we are seeing happen with things like the Epi-Pen. And in cases where patents are creating artificial monopolies, we have to examine if there should be regulation (as we rightfully regulate all other monopolies)."

The FDA created this monopoly through their regulations. But the answer is more regulation?

The real question is whether there has been any quid pro quo or unethical behavior between the Senator from WV, whose daughter is the CEO, and the FDA and/or the Administration.

Also,

"I am one of the people that must have an Epi-Pen or risk losing my life"

No, you probably don't need an Epi-Pen (TM). You'd probably be just fine with an equivalent auto-injector made by another company. Or even with ampules and syringe. If you insist on the brand name item, then expect to pay brand-name prices.

UK Cost of EpiPen

[gb7djk]

The cost to the NHS is ~£26 each. You can buy them from registered UK online pharmacies for ~£45 each. Given that the £ has devalued rather more than somewhat against the US $, this may give you some sense of scale as to just much of a ripoff the price of $300 each is. It also makes rather a nonsense of the 8% profit margin mentioned in the article although - to be fair - it isn't made clear as to whether this is the overall margin for the company or the pens.

Re:UK Cost of EpiPen

[nnull]

8% margin, I'd rather shut down my business. Enjoy having nothing!

Re:UK Cost of EpiPen

[gb7djk]

You may find this manufacturer's comparison page useful.

Re:UK Cost of EpiPen

[jedidiah]

There is a government supplier of Epipens. The tech was originally developed for the military. So they have their own license. Epipens made for the Army are $50.

The private market supplier isn't just making a slight bit more profit. They're making 10x for a product that has been around for about 20 years already (if not longer).

This is more like aspirin than Gleevec.

So basically, nothing will happen to Mylan?

[sethstorm]

How about taking care of Mylan first instead of letting them off the hook?

Re:So basically, nothing will happen to Mylan?

[SuricouRaven]

How? Their high prices may by unethical, but they haven't done anything that's actually illegal.

Re:IP law has nothing to do with logic.

[Calydor]

No one said the company isn't allowed to turn a profit - but as a patient, do you want the sole supplier of medication that keeps you alive to suddenly realize they are the ONLY REASON YOU ARE ALIVE and bumping your daily expense up to a million dollars?

Re: IP law has nothing to do with logic.

[Anonymous Coward]

Oh, I agree. If you ever find anyone at your mercy, you should extract as much money and advantage from them as the market will bear. And believe me, the market will bear a lot when it comes to matters of life and death. Some may not be able to pay the cost but let them fall by the wayside - do not lower your optimized price.

Re: America = lame

[jedidiah]

That's all fine until you're put on a waiting list for an operation or aren't given the same standard of care that an American would expect.

Re:Just wait for the jail / prsion bill for the du

[jedidiah]

A big splash happened recently when a cancer patient was jailed for being a "deadbeat". He did NOT get his meds while in jail.

Re: IP law has nothing to do with logic.

[Anonymous Coward]

Um. Dude. You might want to look around, this site is largely due to the existence of free software. FREE. People do it and give it away for FREE.

You just can't fathom value being non-monetary which makes your economic-fu weak. Homo econicus ain't no fool, Homo Economicus has gradients of preferences, in relation to and driven by a variety externalities, which regardless of your mental capacity to comprehend them exist. Right now. In you, your inner homo economicus, is erupting with complex value calculations that you are probably to ignorant to clearly understand.

You should stop being so hung up on money, and let your inner homo economicus run free. Enjoy all your preferences, not just the ones society shows you will satisfy you.

A big secret I learned a long time ago, that sort of makes this all work, is that by helping each other (think free shit) we get along better in the universe. It actually makes us happy and fulfilled. What?! That is our most selfish center is, is best satisfied by caring about helping other humans?

That sounds fucked up. Real fucked up... But shit that does make some fucking sense. It's probably our evolutionary edge, because there ain't no fuckin way we out predator'd everything else on this planet lone wolfing it for a few million years... That and thumbs.

Thumbs are no fucking joke.

Marketing, not monopoly

[Goldsmith]

There are other epinephrine auto-injectors on the market in the US, cleared by the FDA. A simple Google search will show Adrenaclick at the top of page 1 (FDA cleared, available, and cheaper than EpiPen). It's not hard to find.

The problem here is that people want an "EpiPen", which is a BRAND, not a drug. These guys do not have a monopoly on epinephrine auto-injectors (the thing people need), they have a trademark on "EpiPen" (their product name), which is totally reasonable.

This is not an FDA issue, a generic drug access issue, or an issue with the pharma industry's reduction of effective R&D everywhere but the US. This is about people being susceptible to marketing and branding.

Re:Marketing, not monopoly

[badcodinghabits]

News Flash! If Medicaid is paying for this Brand Name Drug then it is because there is nothing else available (no generics). Therefore they are the only game in town. They shouldn't be but it has turned out that way.

Re:Marketing, not monopoly

[Goldsmith]

http://adrenaclick.com/

Maybe you should look at that a bit. Also, you may want to actually find out how Medicare and Medicaid work.

Medicare pays for nearly all drugs, generic or brand name. The catch is that Medicare pays what it wants, not what the companies charge. Epinephrine (the drug used in EpiPen) is a generic. The delivery mechanism (the pen) is a device with a separate set of rules. The competition in the market is about the pens, not the drug.

Medicaid has formularies that are managed by plan (i.e. by local committees or a company running a plan). Not all drugs/devices end up on the formularies. There are many reasons for this, not the least of which is people asking for brand names (i.e. "My patient needs an EpiPen." rather than "My patient needs an epinephrine auto-injector.") Depending on your local plan, Medicaid may (North Carolina) or may not (Colorado) include an alternative to "EpiPen".

So, yes. "Medicaid" does have a generic alternative to "EpiPen", you just may not be able to get it where you are.

Now, I pointed out in my original post that a simple Google search would find this information for you. It is telling that the "EpiPen" brand is so strong that people (you, for example) continue to assume a real monopoly even when told how to prove to yourself that this is not true.

Re:Marketing, not monopoly

[badcodinghabits]

If we can't get it where we "are" then it doesn't exist. Example, I'm stranded in a desert and need water. I know water exists but I don't have any. So for me water does not exist. Medicaid doesn't pay for every drug that their member is prescribed. If the prescriber insists that their patient must have the drug then they can appeal the denial just like they can with every other denied service. The "EpiPen" brand is strong because they can supply the product. There's no Jedi Mind Trick going on here. If my only choice is one product and there's only one entity that produces that product then ... that's a monopoly. It's real. It exists.

false statement

[bloodhawk]

"is the only developed nation on Earth which allows pharmaceutical companies to set their own prices."

this statement is simply not true. Even in Australia they set their own prices and drugs not listed as being subsidised by government can truly have insane prices. The only thing we have is the government rejects drugs for the program subsidies if the pharma companies aren't reasonable in price. Being a government subsidised drug is far more beneficial than a limited market at high prices in most circumstances.

Poster Children

[nehumanuscrede]

It seems Big Pharm companies are taking turns on who is going to be in the spotlight this week for their unregulated ability to gouge the shit out of folks who need the medications just to survive.

What needs to happen is the whole fucking industry needs to be regulated with price caps on everything they sell. If they give any shit about it, simply open up the overseas markets and tell Big Pharm to go screw themselves.

I know someone who was just informed their cancer treatment is going to cost $240,000. This is at least 3x times their yearly salary. Who the f*ck can afford this other than the 1% types ?

I think I would just take death instead. At least my beneficiaries would have a decent nest egg instead of giving it to those who profit by screwing everyone over.

I understand they need to make a profit to remain operational, but the profits they're making is absurd and it comes at quite a cost for everyone else.

Regulate it and stop the monopoly in its tracks. If they can sell the product overseas for a fraction of the cost, then they can do it here as well. If not, they can GTFO.

There's plenty of demand

[rsilvergun]

the right wing in our nation spent billions wining local elections so they could take the state senates and then gerrymandered their way into the national house & senate. Progressives won the popular vote in the last 3 elections but still lost because of this. If nothing else that's why I want Hilary. She's likely to stack the Supreme court with left leaning candidates that'll shut gerrymandering down. Trump/Pence will do the opposite. Imagine a court with 3 Clarence Thomases on it...

IP law is not involved in this case

[Anonymous Coward]

The patents on this expired long ago.

This is the big ugly hand of the regulatory super-state at work. No drugs can be sold in the USA without approval of the FDA (Food and Drug Administration) and they have a decades-long well-earned reputation for dragging their feet on approving drugs and manufacturers.

Sometimes their caution is GREAT, as when they never approved Thalidomide and American children were spared from severe birth defects that occurred in the US and Europe. They have also spared uncounted numbers of Americans from getting counterfeit drugs and being severely harmed or killed while thinking they are obeying their doctors instructions.

Unfortunately, the flip-side of that caution is that it takes mountains of money and years to get each drug approved at each manufacturer, so it a drug is not going to make enough money to justify those regulatory costs a company is not going to bother. This means there are currently only 3 vendors approved to produce the EpiPen in the US and 2 of them are offline right now (one halted by the FDA). The only company currently producing is doing what monopolies love to do: charging what the market will bear. Their executives convince themselves that it's OK to do it because insurance companies are the ones being bilked. Unfortunately for their PR deprtment, in the real world, and particularly now with Obamacare's high-deductibles, average people are the ones eating the price hike.

The solution: Change the FDA. Make it cheap and fast for a drug manufacturer to get approved to make any drug if they can prove that they are using industry-standard (or better) processes for quality control and if they are producing a chemically-identical product. Once the basic drug is approved, and the patents are expired, no other company should have to prove the efficacy andsafety of the same drug over and over again, they should only have to prove they are making the same drug and making it just as safely. Don't end patents (the stupid and simplistic faux-solution). That would destroy the sources of cash for most drug research by eliminating potential returns from long-shot R&D investments.

Re:IP law is not involved in this case

[nbauman]

The solution: Change the FDA. Make it cheap and fast for a drug manufacturer to get approved to make any drug if they can prove that they are using industry-standard (or better) processes for quality control and if they are producing a chemically-identical product.

And exactly how do you propose to change that? Do you want FDA employees to work longer hours? Or do you want them to work twice as fast in the same hours? Can you speed them up like a tape recorder?

Actually, the FDA does a pretty good job right now. They approve drugs faster than European regulators. They had a backup several years ago when Congress (actually, Republicans) thought it would be a great idea to cut taxes and cut the budgets of government agencies.

I remember the CEO of a biotechnology company (I think Centicor) complaining that the FDA inspector couldn't come to his plant because they didn't have the budget for the train fare on Amtrack.

FDA regulation has little to do with why drugs cost so much money. More important is the Republicans refusing to let the government negotiate prices with the drug makers. https://en.wikipedia.org/wiki/...

In the UK, they have an agency, NICE, which decides how much the drugs are worth, which is often half or a third as much as the US price.

Re:IP law is not involved in this case

[ganjadude]

it would be nice if we stopped blaming the republicans for the government shut down because its frankly unfair as if we remember why the government shut down it was because obama refused to delay they obamacare website because it was not ready to roll out..... obama refused to do so and threatened shutdown if he didnt get his way

the website went live and it failed and had to be pulled offline anyway because surprise!!! it wasnt ready!

the concept of this being a republican shutdown and not all on obama for not listening to the facts is laughable

Re:IP law is not involved in this case

[silentcoder]

>And exactly how do you propose to change that? Do you want FDA employees to work longer hours? Or do you want them to work twice as fast in the same hours? Can you speed them up like a tape recorder?

The first half of his post is classic repulican/libertarian "the state is too big and it's all government's fault" - so I conclude his plan is to do it by cutting the FDA's budget by 60% and firing 80% of their employees. You know because any time any aspect of government is in any way imperfect it's because it's too big and 'starve the beast' will somehow magically make it work better (as opposed to what actually happens which is that ordinary people who rely on public services get viciously fucked over... again).

Re:IP law is not involved in this case

[silentcoder]

Erm... based on your username, I'm going to assume you were completely high when you wrote that piece of utterly ahistorical crap.
Sorry the shutdown was the republican's fault and their demands had NOTHING to do with the Obama-care website, they were demanding the defunding of the entire Obamacare law (effectively repealing it without a repeal).

No president would ever agree to terms that means shutting down his signature legislation because congress is trying to blackmail him - Obama called their bluff believing they were not actually *insane* enough to go ahead with the crazy shutdown plan.
What he didn't plan on was that, at this time, the so-called "freedom caucus" (teaparty anti-government nutjobs who somehow got into government as opposed to the backwoods dumptruck graveyards they belong in - these guys made Ron Paul look like a fan of big-government) had enough power over the rest of the republicans to force them into it. Those nutjobs genuinely believe the very existence of the federal government to be an unholy satanic crime against god (no, I'm not exagerating) so they were quite happy to see it all shut down since that was literally the purpose for which they ran: they ran in ORDER to be able to shut down the government. Their only regret about the shutdown is that it ended, they wanted that to be permanent and saw the budget fight as an opportunity to show that it can be done and thought everything would work so much better with it down that voters would demand it become permanent... their experiment failed, it was an unmitigated disaster for the country and the republican party rightfully got blamed.

What really makes this stand out is that the entire freedom caucus at the time was only 44 members - that's about 10% of congress who somehow managed to get all the rest of the republicans so scared that they went ahead with the shutdown despite being relatively sane humans who knew it was a crazy idea. A bit like Paul Ryan "supporting" Trump now.

Sorry pal, you can't just rewrite history to make everything Obama's fault. I know republicans blame him for everything bad that ever happened up to and including 9/11, Hitler and original sin but it just doesn't make sense to blame a president for things that happened before he was elected or against his wishes. You want to be mad at Obama - blame him for the actual bad stuff that DID happen on his watch. Blame him for the extralegal and unconsttutional fuckup known as the drone war, blame him for the expansion of NSA spying on his watch - blame him for having a penis so much bigger than Trumps that he never once felt insecure enough to make it a subject of political debate... but don't make shit up.

Re:IP law has nothing to do with logic.

[geoskd]

Without personal gain, shit just doesn't get done.

People managed to make money (even obscene amounts) before patents and copyrights existed. They will be able to make money (even obscene amounts) after patents and copyright are given the boot.

Or put another way, if nobody is making something, someone will come along and make it. If there are too many people making copies of something, then some of those people will go out of business. The idea that without patent and copyright protection, nobody will build anything, is without merit and stands in contrast to 10,000 years of commerce.

Last note: copyrights and patents are artificial *monopolies*. They exist in direct contradiction to the concept of a free market. One cannot be in favor of unregulated free markets and be in favor of copyrights and patents: They stand at odds to one another. If you believe they can co-exist then you either do not understand what patents and copyrights are, or you do not understand what free markets are...

Re: IP law has nothing to do with logic.

[riverat1]

Without personal gain, shit just doesn't get done. You don't work for free. Why do you expect anyone else to.

As a real patient, I would rather the entire the entire industry not be destroyed either by crass idiots or morons with "good intentions".

The issue isn't that simple and there's a lot at stake that you're blissfully unaware of.

Sheesh! The Epi-pens cost less than $50 in materials to make and yet the maker wants to charge over $300 apiece for them. The only way they can get away with it is by having an exclusive license to sell them in the USA. The only reason they can get away with it is they have no competition.

Re:IP law has nothing to do with logic.

[JoeMerchant]

Back when air-travel was a regulated industry, the profit margins were absurdly high - at least compared to today.

Deregulation has not led to an increase in crashes, and if you like to bitch about economy class - you can still purchase business class service for about what economy class used to cost.

Point is, while I usually consider libertarians to be deserving of the label libertard, pharma is one industry that would benefit from some deregulation - open the trade barriers, license the generics more quickly, and maybe make it a little less costly to get new drugs approved. However, as with any status quo - there are plenty of people who would be disadvantaged by a change, so those people fight to keep the status quo. As a democracy, it's time we started standing up for what benefits the voting public, rather than the entrenched special interests.

Re:IP law has nothing to do with logic.

[godel_56]

Without personal gain, shit just doesn't get done. You don't work for free. Why do you expect anyone else to.

As a real patient, I would rather the entire the entire industry not be destroyed either by crass idiots or morons with "good intentions".

The issue isn't that simple and there's a lot at stake that you're blissfully unaware of.

According to a US TV report the drug contents of the pen are worth just a couple of bucks and the pen itself is out of patent protection. There is a competitor but it had a safety recall some time ago and that put some people off buying them. Also the name "Epipen" has become like "Bandaid" in that people think that's the only official option.

Make no mistake, this is just a blatant rip-off to help pay for the CEO's US$19 million annual paycheck.

It's fine to let companies set prices

[SuperKendall]

What is not fine is to give a very long monopoly to only one company to make them... without competition the price will not naturally fall.

You have to allow some time let companies have some profits on research, but how long has the Epi-Pen been around? Long enough there should be more than one company making hem now.

Re:IP law has nothing to do with logic.

[HiThere]

It's not really that simple, and in a restricted market well designed patents can encourage trade secrets to be replaced by a limited monopoly combined with publication in sufficient detail to allow others to replicate the invention.

Unfortunately, that doesn't describe the current situation, where things would be improved if all patents were canceled and declared void and invalid from the beginning.

Also read Spider Robinson's "Melancholy Elephants" for an insightful take on copyright law by an author. (Short of it: Copyrights last much too long.)

Both patents and copyrights have a valid place in a good legal system. But the current laws for both are worse than not having any laws about them.

I told you so

[Applehu Akbar]

As the medical monopoly prices itself out of the market, capitalism busts through with the same irresistible force it does whenever this happens.

They call it the black market, and we call it the real market.

Re:IP law has nothing to do with logic.

[Applehu Akbar]

"Current IP law has little to do with logic"

This is not the same problem as the high price of newly branded medications. This is a product that has been on the market for more than a generation, price steadily sliding down the learning curve as competing products came onto the market. Then, suddenly, there are no more competing products because Mylan, by influencing the FDA, is using governmental power to force out its competitors.

It has been pointed out that Mylan's CEO is a donor to the Clinton Foundation, but ultimately we can't blame Mylan for taking advantage of the legal power the government has handed it any more than we can blame a hungry whitetip shark from eating people. The real blame should fall on the FDA and its locking out of the competition, and only when we strip it of that power will there be any hope of bringing prices back to earth.

Re:IP law has nothing to do with logic.

[Applehu Akbar]

"Point is, while I usually consider libertarians to be deserving of the label libertard..."

Hi, I'm a libertard. The vital business of the FDA is getting compounds and products tested. Let that be its only business. Everything submitted to the agency would get a label, indicating whether or not the product was approved. The label would contain a QR code pointing to online detail about what the testing revealed about the product. My version of the FDA would have no other powers. Doctors, patients and insurance companies would be able to make up their own minds on whether to take FDA recommendations as a gold standard or whether to accept, say, the approval of European or Asian testing organizations as being equally authoritative.

In the Epi-Pen case, Sanofi and Teva submitted their own epinephrine autoinjectors. Sanofi's product has a problem with dosage control, and was recalled. The FDA rejected Teva's product for reasons that have never been made clear. Under my system, GDA would have to explain exactly what it didn't like about the Teva product, while at the same time allowing users to make up their own minds about the importance of the FDA's objections when weighed against how much they need the product and the price of alternatives..

CEO of Mylan

[seven of five]

If daughter is CEO of Mylan, the senator is in clear conflict of interest by voting on or discussing the issue.
Or does ethics matter at all?

Company town, ...

[PPH]

... company store. Face it, every regulatory agency from the FDA to US Customs exists for one reason: To keep us funneling our paychecks back to our masters. Screw them. The FDA says I need their 'protection' to ensure my safety. But what if I'm willing to accept the judgement of Health Canada and buy products certified to their standards? Or those of the EU? Or the Good Housekeeping seal of approval? We don't see Canadians dropping dead from poor drug quality control and that's good enough for me. The only people the FDA is protecting are their friends on the other side of the revolving door.

Same thing applies to NHTSA. If I want to drive a car built to EU standards, I should be able to ship one over*. And the crappy US manufacturing and dealership mafia can go straight to hell with their regulatory buddies who try to tell me who I should be doing business with. It's no different than what the mob used to do in NYC with garbage collection. Those responsible at the regulatory agencies need to be shuttled off to John Gotti's old cell ASAP.

*But muh safety! I can legally import USED European vehicles into this country. And non-EPA compliant as well, so long as they are old enough. So evidently, bringing in a smoke-belching death trap isn't the issue. It's me having money for a new vehicle but not spending it at the local dealership.

</rant>

This is where it ends...

[irving47]

This CEO lady is going to be the proverbial straw... "Daddy, 'pass a law against those evil Canadian pharmacies!"

And judging by what's happened with Hillary, he will, and not a damn thing will be done about it on our behalf.

Re:This is where it ends...

[irving47]

By the way, I goofed up a bit on this...not "pass a law against" but "fund / push for enforcement of the laws on the books prohibiting the use of..."

Re: America = lame

[currently_awake]

One third of Americans have effectively NO medical coverage, so I expect they have low expectations of medical care.

Re: IP law has nothing to do with logic.

[Midnight Thunder]

So you would prefer a form of indentured servitude due to overpriced medicine, so that the CEOs can buy their super yachts?

Re:IP law has nothing to do with logic.

[JoeMerchant]

Well, libertard (please take that in fun, as it was intended) your real problem in this world isn't actually the FDA, it's the insurance industry. The FDA may be able to shut down businesses which don't comply, but, by and large, they let an awful lot of stuff get through. It's the insurers who are deciding what actually gets used in our medical system - drugs, devices and procedures they are willing to pay for are widely used, those they do not are relegated to a tiny fraction of the market. FDA doesn't actually "approve" anything, they give "permission to market." It's insurers that "approve reimbursement," and insurers who have built up a system so corrupt that when it is studied in history, people will not believe the ratios between private pay price and insured reimbursement. It simply won't make sense that a society that supposedly had a free and open competitive market, with laws against monopolistic behavior, could ever allow billing $15 for a 500mg Tylenol pill, or $15,000 for a device with 30 year old technology inside that costs $500 to make.

The only other time I ever encountered "prices" that were so crazy was in former East Germany, just after the wall fell 1990: Bread: $0.05 per pound, nice 3 bedroom flat in town: $12 per month, bicycle (luxury item) $15,000, color TV $45,000. It turns money into a sick joke. Just like in the USA today, when you get really sick, the money involved is beyond crazy, all you can do is laugh and shake your head, oh, and pay the man if you want a chance to live.

Re:IP law has nothing to do with logic.

[Applehu Akbar]

No, the FDA's power to keep products off the market is the problem. The health insurance industry only has the power it enjoys now because it's the patient's only bulk bargaining agent in the current monopoly environment. Except for major medical like heart problems and cancer, the industry isn't even functioning as true insurance - it's just a prepayment system with bargaining power.

The real price of any medical procedure, device or compound is the contract price the insurance company pays for it. Unless you're on Medicare and get a regular EOB statement of payments, patients never even know what this contract price is. As an example, my wife's kidney dialysis sessions are billed out at $3,925 each, for a total of about $600,000 per year. The insurance company's "real price" is $290 per session.

If we had a competitive market in medicine the importance of insurance companies would diminish. Health insurance would go back to being the "major medical" it once was, indemnifying us against hospital stays and catastrophic diseases. The governments and charities which pay for medical services now would save correspondingly, which alone is why competition will be forced on the industry as prices become intolerable.

Re:IP law has nothing to do with logic.

[nbauman]

Without personal gain, shit just doesn't get done. You don't work for free. Why do you expect anyone else to.

You mean like penicillin? Or polio vaccine? Or insulin? Which were invented by people who refused to take patents and didn't try to make money out of it? The history of medicine is full of people who came up with important breakthroughs and weren't particularly interested in money.

Once you get a certain level of income, enough to raise a family in comfort with all the requirements of a good life, you don't really need more money and a lot of people will work for free just because they want to do something useful for the world.

A lot of doctors who are specialists make $300,000 a year. That should be enough for anybody.

Some of the most important work in medicine gets done free -- peer-reviewing journal articles and grant applications.

Heather Bresch, the CEO of Mylan who raised the price of EpiPens to $600, is making $16 million a year. Couldn't she get by on $1 million? Even Adam Smith would say that's excessive.

And yes, I've done some of my best work for free.

Re: IP law has nothing to do with logic.

[nbauman]

It's not just an exclusive license. They passed laws requiring schools to buy them.

Heather Bresch, Mylan's CEO, whose father is a congressman, managed to get Congress to pass a law effectively requiring every school in the country to stock an automatic injector, of which EpiPen is the only one readily available.

Re:IP law has nothing to do with logic.

[nbauman]

As an example, my wife's kidney dialysis sessions are billed out at $3,925 each, for a total of about $600,000 per year. The insurance company's "real price" is $290 per session.

Well, the original intention of Congress was to have free market competition in kidney dialysis, to bring the price down, but that didn't work. There were a lot of small providers but a couple of big companies took over the industry and turned it into a monopoly. You can't negotiate prices with a monopoly.

It seems that in the modern economy, the free market doesn't last long as many industries turn into monopolies. Amazon is a book-selling monopoly. Google is an internet advertising monopoly.

If we must have a monopoly, we might as well have the government running it.

Re:IP law has nothing to do with logic.

[Zontar The Mindless]

...[Y]our real problem in this world isn't actually the FDA, it's the insurance industry. The FDA may be able to shut down businesses which don't comply, but, by and large, they let an awful lot of stuff get through. It's the insurers who are deciding what actually gets used in our medical system...

Tell me about it. My mother has cancer. Her physician-recommended treatment isn't covered by insurance because they consider it "experimental", despite the fact that it seems to have worked quite well for Jimmy Carter.

Re: America = lame

[Zontar The Mindless]

Jedidiah, you're normally pretty astute, but on this issue I must inform you that with all due respect you have not got a single fucking clue.

*Neither* of those things happened to me when I was hospitalised in China a couple of years ago.

What I did get was prompt, professional, and effective treatment by very qualified doctors and staff using the latest equipment in a very modern and well-maintained facility.

I also received a bill for 1600RMB, because I'm not a Chinese citizen and I informed them that I was able to pay.

Can you remind me which US hospital it is that only charges $250 for ER admission + overnight stay? I can't seem to recall...

Re: IP law has nothing to do with logic.

[Anonymous Coward]

Some may not be able to pay the cost but let them fall by the wayside - do not lower your optimized price.

That's what coupons are for. If your customers start dying, you start up a need-based rebate program, where your accountants can review each customer's financial situation and determine the actual maximum amount they can pay. You do this as discounts from high price, because people will be grateful for the special consideration and charity.

Re:IP law has nothing to do with logic.

[tburkhol]

The health insurance industry only has the power it enjoys now because it's the patient's only bulk bargaining agent in the current monopoly environment.

Except that the insurance industry has no motivation to control costs. They run, essentially, as a cost-plus provider, meaning that their profit margin is some percentage of whatever the cost of care. If the cost of drugs goes up, the insurance company doesn't "eat" that cost, they raise premiums.

Re:IP law has nothing to do with logic.

[tburkhol]

Some of the most important work in medicine gets done free -- peer-reviewing journal articles and grant applications.

To be honest, peer review is not done for free. The people who do it don't have their salaries docked for time spent on these third-party activities, because they're considered part of the job. (NIH reviewers even get a small stipend for the days they spend in Bethesda) When professors go up for tenure and promotion, they list the journals and agencies they review for - they're badges of academic legitimacy. While it is true that time spent reviewing grants is time not spent preparing lectures, grading papers, or doing your own experiments, peer review is definitely something that a university considers its faculty paid to do. Just not paid by the journals that benefit.

Re:IP law has nothing to do with logic.

[SuricouRaven]

I must make a small correction in their defence: Unless the price has changed in the last couple of days, it's $300. They are usually sold in boxes of two, for a total price of $600.

Left Unsaid

[Anonymous Coward]

During this incredibly contentious Presidential elections with accusations of rampant corruption and accusations of immoral actions in return for money, it is appropriate to point out that this company is run by a Democrat, who is the daughter of a Democrat Senator, and that the company gave money to Hillary's "Foundation". The very same Hillary who climbed on her high horse about the cost increase but has now fallen silent, even though the cost increase is still $300 from $100.

So the lesson we learn here is that Democrats are against high Drug Prices...unless they are profiting.

Profiteers on death

[ZipK]

Harry Lime: Nobody thinks in terms of human beings. Governments don't. Why should we? They talk about the people and the proletariat, I talk about the suckers and the mugs - it's the same thing. They have their five-year plans, so have I.
Martins: You used to believe in God.
Harry Lime: Oh, I still do believe in God, old man. I believe in God and Mercy and all that. But the dead are happier dead. They don't miss much here, poor devils.

Martins: Have you ever seen any of your victims?
Harry Lime: You know, I never feel comfortable on these sort of things. Victims? Don't be melodramatic. Look down there. Tell me. Would you really feel any pity if one of those dots stopped moving forever? If I offered you twenty thousand pounds for every dot that stopped, would you really, old man, tell me to keep my money, or would you calculate how many dots you could afford to spare? Free of income tax, old man. Free of income tax - the only way you can save money nowadays.

You don't "have" to carry the epipen!

[p51d007]

Just carry the small injection package, small tin box with a needle, syringe, bottle of Eppie and it's just a couple bucks. The epipen is a CONVENIENCE item. I don't know why everyone is making this out like it's a frigging big deal! It's a CONVENINCE ITEM. No one is pricing this medicine OUT of your price range. It's a CONVENIENCE item. Just use the regular stuff for a couple bucks. If most people did that, they would either drop the price, or go out of business.

As usual, if its a (D) senator, no mention is made

[Tulsa_Time]

of the party affiliation.....

Re:IP law has nothing to do with logic.

[JoeMerchant]

It's not just Medicare, we have Blue Cross (of Florida, California, Texas and Minnesota - over the years), we get EOBs, the ratios are similar - wildly varying but generally around 10:1. Tourist bartering in souvenir markets usually starts at 2:1, but these jokers have really upped their game. We've also had periods of private pay, and when you're private pay (not shelling out $12K+ per year per person to the insurance industry), then those 10x prices - sure, they're willingly negotiated down for private payers - to 9x. It's worse than mob protection racketeering - and they're using a combination of threats on your health and welfare, and anti-competitive collusion in their business practices to get paid.

Re:IP law has nothing to do with logic.

[JoeMerchant]

If we must have a monopoly, we might as well have the people being served, served according to their best interests - not the interests of the monopoly owners. Call it private, call it free market, call it regulation, call it government run, I don't care. What it needs is transparency, oversight, and an early Ben and Jerry's style compensation cap in the system. When ANYONE in the organization starts making more than 5x the national MEDIAN income, it needs a restructuring to increase wages at the lower tiers, and/or lower prices to the consumers.

If that's Communism, sign me up.

Re: IP law has nothing to do with logic.

[JoeMerchant]

Tell me about it:

https://thesocietypages.org/so...

Economics of intellectual property

[RobertJon]

Provocative line: “The US is the only developed nation on Earth which allows pharmaceutical companies to set their own prices.” Of those 18 provocative words, the most egregious is “allows.” http://www.abc.net.au/news/201... That presumes government owns all property, real and intellectual, in which it magnanimously “allows” us a share, but only as it, government, please. That further presumes that government itself is not the cause of the problem in the first place. Both of those presumptions are wrong, to our great harm. To make this simple, I lay the matter out in clear terms below. That way we can begin discussions wherever it is that you first disagree. Free markets work best to allocate scarce resources. For free markets to work, certain premises are required: many small, independent agents; free flow of information; no distortions such as tariffs, barriers, monopolies The proper role of government is to ensure those premises. Instead, government chooses to meddle directly, and inevitably makes things worse. This is known as iatrogenic disease. In particular, private monopolies are not an issue today. All private monopolies fail: someone always cheats, or defects; substitutes arise; technology advances; fashions change. And if a monopoly should arise, we have a vast apparatus in the US, between the Department of Justice and Federal Trade Commission. (Not that those folks have a good track record, viz. AT&T, IBM, Microsoft, Apple, Amazon Indeed when he was six, my son asked a challenging question, “how can it be a monopoly if it’s something you don’t need?” I wonder.) Today, private monopolies cannot arise. With modern technology, international trade and global markets, they are simply infeasible. No, the only durable monopolies are those imposed by government, because government first holds the monopoly on violence. Now some government monopolies are good, and temporary. Copyrights, trademarks, and patents are in the US Constitution. Others, not so much. That latter includes all the frauds amongst cronies and politicos. That category is the worst violation of free market premises ever, and the one most perpetrated. Cronyism has done orders of magnitude more damage to the US economy than any other violation, including insider trading. As to patents, a primer on the economics. Invention, like any other good or service, must be rewarded in order for it to be produced. Unlike goods and services, intellectual property is peculiarly subject to theft. So government gives inventors standing (term limited) to protect their property with civil remedies. That patent is like a lottery ticket. The inventor tried 10 things. Lost his investment of time, effort, and cash in nine of them. The tenth thing seems to work. Now he must make enough on that tenth thing not only to reward that effort, but to recompense him for the other nine as well. Say the 10 ventures cost $100,000 each. That means the tenth winner must return AT LEAST $1 million. Quite a bit more, in fact, because government comes around to seize its taxes first, and after that, the inventor must do more than break even. That’s the social contract. Before the fact, the politico promises the productive person if he takes risk and makes something that works, he can cash in that lottery ticket.” But after the fact, the politico hypocritically turns all populist and say “I don’t feel that $1,000,000 is merited. I feel $500,000 is more than enough” Who the (trigger warning) is that politico to decide market value? How dare that politico feel it’s up to him to “allow” one price rather than another? Is the patent valid? Then do not violate the terms of the deal. Is there no other competition? Then tell the (trigger warning) FDA to do its job. Is the IP such that people really do need it, as my son asked?

Re:Reading comprehension failure

[nbauman]

The US pharmaceutical industry tried some of the short-cuts you recommended and ended up with several disasters, such as the New England Compounding Center disease outbreak, which caused 64 deaths.

The Chinese pharmaceutical industry also tried it with the same results.

Pharmaceutical quality control and manufacture is a lot more complicated than making artisinal beer.

hey Big Pharma

[Ol Olsoc]

Do you want single payer socialized medical care?

Because this is exactly how you get socliazed single payer medical care.

Re:IP law has nothing to do with logic.

[rpstrong]

I joined the 'libertard' party around 40 years ago, when I was 20. Thank you for highlighting the fact that our belief in legalizing drugs extends across the entire spectrum of drugs, both 'recreational' and therapeutic.

And I completely agree - the FDA would be far more useful if there conclusions were along the line of a UL approval, not regulatory.

Re:As usual, if its a (D) senator, no mention is m

[Ol Olsoc]

of the party affiliation.....

Don't be a Republican memeist. Every article I have read so far says specifically that she is the daughter of the Democrat Senator from West Virginia.

Tell me is that supposed to mean that she is a Democrat? And everyone from West Virgian is a Democrat, And BENGHAZI! And just to burst another bubble, I'll be that he is a big fan of Coal mining.

Aww hell, I might as well expose that you are lying From the link to the article:

One Democratic senator whose daughter has allergies has called for action and another Democratic senator's daughter is CEO of the company responsible for the price hike.

O hell, lookie here Right here in River city from the Slashdot summary!

One Democratic senator whose daughter has allergies has called for action and another Democratic senator's daughter is CEO of the company responsible for the price hike. And just to make certain you see it - I know some of you folks need a lot of repetition for the hard stuff to sink in.....One Democratic senator whose daughter has allergies has called for action and another Democratic senator's daughter is CEO of the company responsible for the price hike.

Any questions?

Re:IP law has nothing to do with logic.

[badcodinghabits]

You get your script. You go to the pharmacy. They fill it. They tell you your part is $200. Insurance pays "$400". Then Monthly, Quarterly, Yearly (whatever) the insurance company gathers up all scripts it has paid for and goes to the drug company. They tell the drug company we paid $400 on this script. We want a rebate. Drug company gives a rebate to the insurance company. Your don't see any of it. Insurance company doesn't care how much the drug costs because they know they will get a rebate on the drug. How much is the rebate? You don't know because nobody talks about it. Why give a rebate at all? Why not just lower the cost? Well that would hurt the insurance company. They make money on drug rebates. Drug manufacturers get to make money on high priced drugs. If you buy this out of pocket you won't ever get a drug rebate. You can't negotiate with them. It's nothing but a big accounting scam. You're not supposed to be able to figure this out.

Re:IP law has nothing to do with logic.

[Applehu Akbar]

If you have no idea what the negotiated price of the item you're buying is, you are not part of the market for it. Someone else is negotiating for you, in this case your insurance company.

Re:IP law has nothing to do with logic.

[badcodinghabits]

Oh, I only look at the data. The rules on pricing are the lowest price among a few choices (awp, and some other stuff). The point is when this story came out I ran some analysis back to 2007 and looked at: number of scripts, number of people, total paid. This was month by month. No one asked me to do this. I figured since it was political that eventual the state legislature was going to throw a question our way (which they did). The CFO got my report and said "thanks! I sent it over to the pharmacy department to see what rebates we got on this so I would know what our actual costs were." Get my point? We get rebates. If you have insurance then the insurance company gets the rebates since when you signed up for coverage there's a clause that says they are entitled to all rebates. You probably didn't read that. There's also a clause about subrogation. Look it up. If you don't have insurance? Well you get to pay full price, no rebate, no coupon, nothing unless the drug company is shamed into handing it out. My point is: If they are going to give rebates or coupons then why not just lower the price? It's a simple formula, everyone gets the same fair treatment. What's the incentive to keep the price high? What's your guess?

Not so much that they're "allowed" to set prices

[sabbede]

Technically, it is the market that sets prices. It just happens that the market has been slowly beaten out of shape by regulatory backfire, the AMA, and the drug industry.

It's also possible that part of the reason our drug prices are so out of whack is because everyone else is regulating prices, causing the industry to seek higher profits in the US. Kind of a douchebag maneuver, but is it something that can be fixed without backfiring? It seems like everything we've tried for a century has only made the cost issue worse.

What made the monopoly? Government.

[mpercy]

The question that has to be addressed is what created the monopoly that fosters the "price gouging" (no such thing by the way)?

Always, always, always there is government involvement that creates the situation where consumers have no choice. Corporations can't really be held to blame, they are simply scorpions doing what scorpions are going to do (q.v. parable about scorpion and frog). If the government said that ACA plans must cover a monthly pint of Ben & Jerry's, I have zero doubt that the cost of a pint of Ben&Jerry's would rise significantly no matter how crunchy the CEO might be.

Situation is even worse when government creates a monopoly. Why is there no generic form of EpiPen costing $25 per? I had my first epi-pen 30 years ago. Surely their patents have expired? Search and you will certainly find some government regulations propping up the monopoly. See https://mises.org/blog/lack-ep...

(from the Mises link above)

"As it turns out, Mylan has a great friend who keeps would-be competitors out of the market...That friend is the FDA.

"Just this year, Teva Pharmaceutical’s attempt at bringing a generic epinephrine injector to market in the US was blocked by the FDA. Adrenaclick and Twinject were unable to get insurance companies on board and so discontinued their injectors in 2012.

"Adrenaclick has since come back...and the FDA has made it illegal for pharmacies to substitute Adrenaclick as a generic alternative to EpiPen. Another company tried to sidestep the whole auto-injector patent barrier by offering prefilled syringes, but the FDA has stalled them, too.

"Mylan has been repeatedly protected from competition, and it has repeatedly (and predictably) increased the price of EpiPens in response.

"One thing is for sure: capitalism is not to blame. Government regulations have choked this market and many others. What we need is a big dose of freedom.

It has been pointed out that the CEO is a Democrat, the daughter of a Democrat Senator from WV so all of Hillary's bluster on the issue rings hollow.

The solution is not *more* government, as it was more government that caused the problem in the first place.

solution

[micahraleigh]

If they dismantled the FDA the government couldn't stop more affordable options from popping up -which is what happened with the epipen situation.

Private F&D monitoring and rating agencies would pop up like expedian and the other private credit reporting agencies ... except they wouldn't be funded out of your back pocket on April 15th like right now.

Also if you were dying and needed an experimental drug you could just enlist yourself in a trial.

Come on now! When Democrats owned Congress and WH

[mpercy]

They could have changed this. Instead we got the ACA, which pretty much doubled down on the whole deal.

Re:Reading comprehension failure

[nbauman]

the core problem created by our "friends" in places like the UK and Canada who do it. Those foreign governments doing it for their socialist medical services are what forced the American consume to bear all the R&D costs and drove-up OUR drug prices; they threatened to break the patents and let the American companies get ripped-off if the American companies did not sell at prices too low to cover all the costs. The result was that the companies lowered the prices over there to a level that allowed a profit on the manufacturing costs but no margin to cover the R&D costs which went entirely onto the US customers and their insurance companies.

I take it from your comment that your expertise is not in pharmaceuticals.

Did you ever hear of insulin (Canada), statins (Japan), penicillin (England), cancer chemotherapy (Italy) or monoclonal antibodies (Argentina/Switzerland)?

I am leaving the Wikipedia search as an exercise for the reader.

Re:Reading comprehension failure

[nbauman]

If some FDA exec is denying a trip for an inspector becase an AMTRAK ticket cannot be afforded, FIRE the exec and buy some tickets with the savings. Obama and the Democrats have been running the FDA for over 7 years. Priorities????

That happened during the Reagan Administration.

Re:IP law has nothing to do with logic.

[nbauman]

It's amazing (and hopeful) how human beings evolved to be cooperative and work together for the benefit of the group.

There's lots of research on that, in anthropology, biology, behavioral economics, etc.

I read the Wall Street Journal editorial page for 30 years. Milton Friedman was wrong. Ayn Rand was really wrong.

People aren't motivated by money, once they're financially comfortable. In published studies, they will sacrifice real money in order to satisfy their sense of justice. Look up behavioral economics.

Re:Reading comprehension failure

[slashdotwannabe]

Tell the FDA to stop requiring the same drug to be re-approved by each vendor in a very expensive and years-long process and instead switch to the presumption that THE DRUG ITSELF

They already do this; it's called the Abbreviated New Drug Application. This process was created as a result of an act of Congress, so if you have a problem with it, talk to Congress.

It was a further government encroachment and step to even further government meddling that keeps making things worse, and would only exacerbate the core problem created by our "friends" in places like the UK and Canada who do it.

lolWUT??? Every corporation in the world that negotiates prices is an efficient enterprise, but when a government agency does it, it's "meddling in the free market"? What the fuck kind of idiocy is this? Do you honestly expect people to be stupid enough to believe that if foreign governments were as stupid as we are in drug pricing policy, that the pharma companies would lower our prices? Do you honestly expect people to be stupid enough to believe that the prices charged have ANY relation to R&D costs? Have you seen the Pfizer, Novartis or Roche P&Ls?