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The Cost of Drugs For Rare Diseases Is Threatening the US Health Care System (hbr.org)
An anonymous reader shares an article: There are 7,000 rare diseases affecting 25 million to 30 million Americans. The average drug approved under the Orphan Drug Act of 1983 (ODA), which governs rare disease approval, costs $118,820 per year. Assuming a similar cost, if a single drug were approved under the ODA for 10% of rare diseases, the total would exceed $350 billion annually -- more than 10 percent of the total amount that America spends on health care and much more than the health care costs attributable to either diabetes or Alzheimer's disease and other forms of dementia. If this seems far-fetched, consider the two drugs for treating Duchenne muscular dystrophy that the FDA approved in the last six months: eteplirsen, which is sold by Sarepta Therapeutics and costs $300,000 annually per patient, and deflazacort, which is sold by Marathon Pharmaceuticals and costs $89,000 annually per patient. However, approval of such costly drugs exposes an uncomfortable truth: scientific discovery has outpaced health care economics. [...] In the United Kingdom, the National Institute for Health and Care Excellence (NICE) determines the cost effectiveness, or value, of newly approved drugs based on their impact on quality-adjusted life years. These determinations inform the National Health System's (NHS) treatment-coverage decisions. In contrast, the FDA is prohibited from considering cost or value in its decision making, and there is no U.S. governmental equivalent of NICE.
I wonder what's the markup on those drugs.
Are they that costly to produce?
...gis sdrawkcab (usually not responding to ACs; don't bother posting as AC)
Just how many Martin Shkrelis are there in the (supposedly) (legal) drug business?
Pain is merely failure leaving the body
The average drug approved under the Orphan Drug Act of 1983 (ODA), which governs rare disease approval, costs $118,820 per year. Assuming a similar cost, if a single drug were approved under the ODA for 10% of rare diseases, the total would exceed $350 billion annually
In this chain of healthcare, who is making the money?
To be more precise, who is making a killing?
It's a fact that some entity (cabal) is making big cash, but find it hard to come to terms that this cabal or cabals are profiteering over the misery of others in these United States.
We have a culture built around the concept that human life is worth any amount of money. At the end of our lives we spend and spend to pry out another 2 weeks of lifespan.
Instead maybe we should realize that with 7.5 billions of people, the value of any given human life is very close to zero. It sounds harsh, but it is also the truth. If people want to pay to save themselves, great have a go, but we should not be foisting that cost onto society when there is no rational reason. Spending those sums is absurd.
We don't even treat our pets in that way: we realize that life is finite, and we try to keep them comfortable at the end so they do not suffer, but we are willing to acknowledge that there is a time when it is best to let them go. Ease their passing so they can go in peace and as much comfort as possible. We need to adopt this attitude for people as well.
We're not a scattered band of 10K hunter-gatherers on the brink of extinction any longer. A random human life is simply not valuable.
What's threatening the US health care system is putting profit ahead of lives.
Good luck. You poor saps are going to need a lot of it.
Log in or piss off.
Our society is so corrupt that we do not regulate the costs or profits made by drug producers. There are drugs that are dirt cheap to produce that cost a king's ransom. I suppose that the right wing will consider that as a freedom issue which is nonsense. Do they mean free to die in agony?
It's not a free market. By law, US consumers cannot import drugs from other countries. The $50,000+ dollars for hepatitis drug is under a thousand in India.
love is just extroverted narcissism
The cost of Sovaldi and Daklinza (used together) to treat Hepatitis C (which infects 3.5-5 million Americans), is $336,000 for the 24-week course of treatment. $1000 for each pill. The cure rate of Sovaldi and Daklinza is approximately 90%. The same drugs in India cost about $4 per pill.
Hepatitis C currently kills more Americans than any other infectious disease.
https://www.cdc.gov/media/rele...
You are welcome on my lawn.
A little known secret: Most countries' governments arbitrarily set the price of drugs and medical devices during negotiations and force pharma and medical device manufactures to sell it at a loss (or simply not have access to that market). To make up for the R&D and marketing, they have to jack the price up in the US to make up the loss. http://www.ibtimes.com/how-us-...
With the upcoming collapse of Obamacare, the rest of the world should be afraid of the US doing the same to the drug and med device companies. The cost of healthcare for the rest of the world will go up while it goes down for the US. I shudder to think about the hoards of angry folks when NHS starts becoming moderately expensive.
Do you mean produce as in to manufacture. Or do you mean to research and development and manufacture? If it's a rare disease then it by definition doesn't achieve economies of scale.
Some rare diseases, if untreated, will lead to a person's death. That's bad of course.
Other rare diseases primarily impact quality of life and treatment can turn an sick unproductive person into a functional productive one. That's good for society, although you will probably have trouble justifying it by the numbers alone if you treat healthcare as an ROI problem. (return on investment)
“Common sense is not so common.” — Voltaire
Bristol-Meyers Squib has a 75% margin on their drugs. And almost 30% return on equity.
They like to blame R&D but one Summer I worked at one of their research labs. It was a very very nice place. Parts could have been from a country club. The head of the place helicoptered in from NY every morning - which is all considered R&D "costs". The cafeteria food was 5-star but cost as much as a McDonald's meal.
The only sucky part was the animal section.
I miss that place.
NICE." It's true, there isn't - but insurers handle this in the private sector.
The problem is not that we aren't spending enough money. The problem is the combination of the pharmaceutical and insurance industries getting all of the money they can out of anything they have with no limits. Even generic drugs that aren't under patent production are many, many times more expensive in the US than in other countries (one example my wife gave me last night is $0.18 per pill abroad, versus $30 per pill here - for a generic medication). If the pharmaceutical companies are not actively engaged in collusion and price-fixing for generic medications then I would be shocked. Additionally, they spend so much money buying legislators that it is effectively impossible to get any legislation passed which would force a resolution to this issue by capping the price of medications or making it easier for additional companies to manufacture generic medications and compete with the established players. The free market is obviously not working correctly when every company making a certain generic medication sells it for the same amount, or when generic drugs which are readily available in other countries are not available here because they would compete with products from established companies. There is an opportunity there for a competitor to sell it for less and undercut the competition and make money, but for some reason that doesn't happen. If the free market is not allowed to work, and instead there is price gouging going on, then it sounds like legislation is required to correct that issue and bring drug prices down as a matter of law. If anyone thinks that such a thing would limit development or force companies out of business then I would invite those people to look at the P/L statements for the major pharmaceutical companies. A good start may be to outlaw advertising to consumers for pharmaceuticals, followed by a way to cap prices on medication based on metrics similar to those used by NICE.
"Our two-party system is like a bowl of shit looking at itself in a mirror." - Lewis Black
We all know these drugs have an insane markup. The drug companies are getting rick because they set astronomical prices for drugs the might help people, even a little. And they get it because insurance is forced to pay for it, not individuals who could never come up with the money on an individual basis. We have created the problem by mandating insurance and then letting the drug companies pilfer it blind.
This is just another facet of the problem that drug companies use U.S. public funding for the research to help develop most of these drugs, then turn around and charge the American taxpayer more for the drugs than they sell them in other countries, both third world countries like the African nations and first world countries like Canada. And, of course, they spend a lot on expensive lobbying to buy politicians to make sure we in America don't get access to those drugs they sell in Canada.
I'm an American. I love this country and the freedoms that we used to have.
Right, medical liberty. The freedom to either pay $300k per year for treatment, or die. Give me liberty and give me death, right?
"Our two-party system is like a bowl of shit looking at itself in a mirror." - Lewis Black
Common statin's (for lowering cholesterol) can cost more than $700 for a 30-day prescription if you don't have insurance. I think the cost issue goes well beyond prescription drugs for rare diseases, and in fact, is more detrimental in a broader sense.
But, when we as citizens don't insist our politicians address campaign finance reform, policies favoring corporations will continue to guarantee price gouging will continue. Campaign finance reform should be made the top issue... Every. Single. Election.
There is a far bigger systemic problem behind this than market gouging. Governments poor billions into medical research: the salary for medical researchers is 2-3 times that of scientific researchers and the government budgets for medical research far outpace those for science in many countries because it is politically easy to justify developing a new drug or a new treatment.
This is the long term problem behind spiraling medical costs. Money spent on developing new medical treatments end up costing society more and more money. In the past these costs were offset by scientific advances which lead to improvements in productivity which generate money for society. The long term solution is to spend less money on developing new and more expensive treatments and spend more money on the fundamental sciences which will give us the ability to pay for them. However I see little chance of this happening because nobody wants to hear about cuts in medical research funding.
The industry doesn't do much research. Not the expensive kind. They do a few clinical trials after the government has done the really expensive stuff (what's called "Basic Research", IIRC).
Also, what you're seeing here with these rare disease drugs is the style of capitalism popularized by Bane Capital: Find something undervalued and buy it up then extract the value for yourself. Usually this takes the form of liquidating the company. But in these cases they're selling life saving medicine. It's literally a matter of life or death (or a life worse than death). These are small markets with a high barrier to entry where the customers depend on the product to live. This is exactly the sort of thing no decent society would leave in the hands of unregulated capitalism. American on the other hand...
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for someone's medicine? I said "Force" there. Because if you're getting into single pay with taxes funding health care then you are effectively forcing me and everyone else to pay for their medicine. Maybe I want to, but shouldn't that be my choice? Shouldn't I decide if I'm going to give that money to a charity or not? What if I oppose the medicine being give (like the "Morning After Pill")?
I'm asking loaded questions here. I'm in favor of single payer because it's part of civilization. And I'm in favor of forcing people to join civilization for the same reason I'm in favor of vaccinations. But I've yet to hear a compelling argument for all of this. I've yet to hear anyone give an answer to the age old "Tax and Spend Liberals". Maybe "Slash and Burn Conservative"? But even that's not as catchy or "Truthy"...
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"As Interim Chief Executive Officer, and Senior Vice President, Chief Medical Officer at SAREPTA THERAPEUTICS INC, Edward M. Kaye M.D. made $4,396,696 in total compensation. Of this total $494,585 was received as a salary, $249,704 was received as a bonus, $1,694,678 was received in stock options, $1,939,532 was awarded as stock and $18,197 came from other types of compensation. This information is according to proxy statements filed for the 2015 fiscal year." So the people that need the medicine are dying, or going into absurd debt, or paying out of their ass for this medicine. All while the CEO of the company gets a $250k bonus and makes $500k/year....
Could you cite a few examples of where the government proved to be more efficient at producing a product or delivering a service, than a privately-run firm?
The hate towards the drug companies is misplaced — and whether they are sinfully greedy or not is irrelevant. The simple fact is, had they not existed, the drugs would not have existed — unavailable at any price.
If only K of something — anything, from LeBron's sneakers to life-saving medicines — is available despite there being N people desiring it, then whichever way you pick to distribute it:
N-K people will still not receive it — and no amount of "outrage" will help.
The only hope for the rest is that the second method — charging whatever the market will bear — will be chosen, because then the profits (however "obscene") may be used to produce more of the stuff... Incidentally, Capitalism is all about the second method and that is why we tend to enjoy an abundance of most things — to the point, where some people are already talking about "post-scarcity".
In Soviet Washington the swamp drains you.
The cost of healthcare for the rest of the world will go up while it goes down for the US.
Nope, but we might see reduction in research and development of new drugs...
But in fairness, there is value to balancing how much money we spend on researching new drugs and how much we spend on treating people with existing drugs..Clearly, it's not cost efficient to develop drugs for rare diseases..
Or, maybe the end result is higher government subsidies for research and development, which probably could be more efficient economically than financing drug research and development through the stock marked.
Lower the production and compliance costs or increase the number of people with the rare diseases. The second one isn't possible so the first one is mandatory. That is within the FDA's control.
Bureaucrats will tend to want to do neither and to make everybody else pay for their phoney baloney jobs but that does nothing to improve market incentives and only winds up increasing costs further.
My God, it's Full of Source!
OUTSIDE_IP=$(dig +short my.ip @outsideip.net)
A little known secret: Most countries' governments arbitrarily set the price of drugs and medical devices during negotiations and force pharma and medical device manufactures to sell it at a loss (or simply not have access to that market). To make up for the R&D and marketing, they have to jack the price up in the US to make up the loss.
Yes, this sounds like something the US would be OK with :-)
Many of the big pharmas are European. https://www.tharawat-magazine....
The US treats drugs as commodities, subject to supply, demand, and buyer desperation. That's all. Europe does not, at least not as much as the US would like. If the US imposes a limit on prices what will happen is that companies will be forced to be more efficient, make less money, or let new players take their place in the market. All of those options are fine by me.
You understand that the American Revolutionaries never intended to set up a system where every single person had to opt-in for a tax. The issue was to have taxation with representation. You live in a representative democracy, which means that the obligation is that a majority of the elected representatives agree to the tax.
Trying to turn this into a moral issue is bizarre, since essentially your position boils down to "I want the right to abrogate any moral obligation I have to my fellow man, and that's totally moral!"
As it is, overall, the US has some of the worst overall health outcomes in the industrialized world, while it's health care system actually produces a larger overall drag on the national economy. So, if we're going to talk morals, you think it's somehow moral that overall people are more poorly served at greater overall cost, just because maybe you personally get to pay less?
The world's burning. Moped Jesus spotted on I50. Details at 11.
The real reason why healthcare is so expensive in the US is because Americans want the "freedom" to have everything they want, but expect that someone else should have the responsibility of paying for it. This leads to attitudes such as:
"I want to eat the cheapest and unhealthiest food and drink as much soda as I want, and expect my health insurance to pay for my diabetes, heart disease, morbid obesity, and metabolic syndrome, because it's my right to decide what to eat."
"It's my right to feed my children whatever food I want. How dare the government suggest guidelines for what my kids should and should not eat. How dare they suggest I'm setting them up for a lifetime of poor dietary choices and health problems."
"I want the best health care possible, because I paid my insurance premiums and taxes for decades."
The broader issue here is not that orphan drugs are expensive--to be clear, they are very, very expensive--but that Americans are ignorant and uneducated, distrustful of science yet reliant on science for life-saving medications, smartphones, self-driving cars, nutritious food, clean renewable energy, and so on. They think vaccines are a government conspiracy, believe climate change is a hoax designed to prevent them from getting rich, and believe in a divine Creator that will grant them their wish to be personally wealthy if they simply have enough faith, and that if one does not have their material wishes granted, it is because they didn't give enough money to the televangelist who told them God would answer their prayers. These people complain that Obamacare is too expensive but when they get cancer, expect Medicare to pay for the chemo, radiation, and surgery.
In that context, is it any wonder that health care is expensive? Americans are hypocrites: they preach endlessly about "personal responsibility" but when it comes to actually being personally responsible, suddenly everything is Somebody Else's Problem And I Had Nothing To Do With It.
Drug development is expensive. It costs insane amounts of money to discover candidate compounds, then run through preclinical and clinical trials, then jump the pivotal Phase III hurdles. Orphan indications would never be addressed without giving the pharmaceutical industry an incentive to treat them. If one insists on applying a capitalist economic model to orphan drug development, this is how it looks. You can't claim to be in favor of free-market principles and in the same breath claim that this is the cause of crippling health care costs. This is what Americans ask for when they say that health care should remain a privatized system.
In the United Kingdom, the National Institute for Health and Care Excellence (NICE) determines the cost effectiveness, or value, of newly approved drugs based on their impact on quality-adjusted life years. These determinations inform the National Health System's (NHS) treatment-coverage decisions.
In other words, if it's too expensive to treat you and therefore not worth it, they decide you don't get the medicine. This is what folks in the US were referring to as "death panels". They're actually correct, but the reality is that in the US anybody who can't afford the drug is going to die, also.
Do you have ESP?
When someone will pay a price for a thing, that is the price of the thing. When that someone doesn't really care about the price, because they can just print more money, there is no downward pressure on the price.
It's math, kids.
There are people living in 'luxury apartments', paying 90% of their income into rent not because they want to live in high class apartments but because thats all that is available and its a choice between that and being homeless. Sometimes people are, literally, forced to pay through the nose for goods and services, are given no choice and have to pay the price that is demanded or face life-changing problems from which they are unlikely to recover (homelessness is a good example).
The downward pressure ultimately becomes massive civil unrest and crime, like when in the UK you'd be hung for stealing a loaf of bread and we have the saying "May as well be hung for a sheep as for a lamb".
In the free world the media isn't government run; the government is media run.
The whole global drug development system needs to be changed. As it now the U.S. develops and the U.S. population is saddle with paying for most of the new drug research and development in the world. Once developed a drug that cost $50,000 p/year in the US will cost $800 in some other part of the globe. The whole R/D and economic system needs to evaluated. The US population is being unfairly burden with the high cost of the drugs.
You claim that the current prices of drugs is a reflection of the free market failing to keep prices low. Here's a problem with your assessment, we don't have a free market with drugs.
One thing is that the FDA has declared that any drug sold in the USA must get their approval, and the approval process they have is long and expensive. If you want to see prices go down then we need to see reform in the approval process. What we are talking about here are people with extremely rare diseases that threaten their lives. If the FDA simply opened the floodgates on allowing the testing then we'd have all kinds of drugs getting tested and the cheapest ones would win. As it is now drug companies have to pick and choose which ones to submit for approval for testing placing very high costs on failure, so they will spend a lot of money on R&D. Once a drug is approved for a disease research stops because the profit motive is gone. The market is small, the costs are astronomical, so the ability to profit disappears. For prices to go down people need to be able to compete in these exceedingly small markets. Or, the market needs to grow by, as a possibility, treaties that allow testing in other countries to be recognized more universally.
Along that line of allowing drug tests to cross borders is that the FDA prevents importation of these cheap drugs without their prior approval. My sister has diabetes and was on vacation to India. She needed more insulin while there and she was able to walk into a pharmacy and buy a vial of insulin for something like 25 cents. Why does it cost something like $50 per vial here? I'm sure a lot of that has to do with FDA overhead.
Here's a few other things that drive up drug costs. Prescription rules, if you want even a common drug for a chronic condition you will need a permission slip from a physician. Why? Can't people figure this out on their own? My sister knows what kind of insulin she needs. Another thing about diabetes treatment, I remember when disposable syringes were sold by the hundred and were just sitting on the shelf at the drug store. You want to see medical costs go down? Then let people buy these things without a government permission slip. I'm not saying that we need to remove all regulation, only that they need to be rolled back to something more reasonable. If people can buy safe and effective insulin for less than a dollar in India but it costs 50 times that in the USA then we are doing something seriously wrong.
More laws will not fix this problem. The problem is too many laws. The drug companies would not be able to price gouge if the market wasn't so close. If you think that there is price fixing then I ask you to prove it. It takes only one drug company to step out of line to ruin the whole deal. If they are all in on the deal then the rules need to be changed to make it easier to start a drug company.
I am armed because I am free. I am free because I am armed.
Check out the net profit margins on many of the big Pharma companies. They're not obscenely high for the most part. Apple for example has had a profit margin of around 20% for the past few years.
Average profit margin in the last 5 years:
GSK=12%
Merck=9%
Abbot Labs=15%
Astrozenica 12%
Eli Lilly 13%
They're good for the most part, but not unbelievably amazing.
Bring back the old version of slashdot.
Sounds like you need a quick class on economics, because "If the free market is not allowed to work, and instead there is price gouging going on" are not mutually exclusive. Quite the contrary, a free market is pretty much required for price gouging to go on. You are only focused on one half of the equation (more competitors usually means lower prices), vs the other side which is anyone doing selling can (and almost always will) sell to make the most amount of profit, not necessarily the highest quantity.
I've seen multiple stories about how a small number of Americans are responsible for most of the healthcare costs in the last week or two. These weren't part of the general healthcare debate leading up to the failed Obamacare re-write (I refuse to call it a repeal, they didn't have the guts to do that). They started springing up about a week or two ago.
Yeah, these stories might be true and all, but what I find disturbing is how they keep showing up all of the sudden. Coincidentally right around the time Bernie & co have a bill on the Senate floor for Medicare for All. It's pretty obvious if you're looking that somebody is firing propaganda shots off. But if you're not a news hound like me with a google feed full of politics you probably wouldn't have noticed. I'm guessing it's the insurance companies buying stories to shut down single payer, since single payer should shut them down...
Anyway, I'd like everyone ehre to realize there's a difference between Bernie trying to talk you into single payer and somebody pushing a pro-insurance narrative on the sly. Whatever your opinion on the merits of single payer vs paid insurance just know that your actively being manipulated.
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On the other hand, if it wasn't for those for those paying $50k in the US, there wouldn't be a drug AT ALL. The reason it is $1k in India and $50k in the US is because of that's how it is set up to maximize the return on investment. The drug companies are simply selling the drug at whatever will make them the most money, and because of the way the insurances work in the US, there are a lot of people who can get that drug at $50k. They would make a lot less money if they sold it for $1k in the US (demand won't grow 50x). Yet if they sold it for $2k in India, they would likely sell less than half of what they do at $1k.
But your first statement is correct, it isn't a completely free market. It's a limited free market (within the US), and then limited by law (must have FDA approval), and restricted by patents. I would love to hear about a better way, but I've yet to hear one that would actually work. Most of the great "fixes" aren't well thought out and would fall apart.
With the upcoming collapse of Obamacare
You've been watching too much TrumpNews. The "collapse," if it happens, only refers to there being no providers on the ACA-created health insurance exchange marketplaces. We can use scary words like "explosion" but the fact of the matter is that unless and until there are ZERO policies sold on the exchanges in the ENTIRE country, we're a step ahead of where we were in 2010, and that leaves aside every other reform in the entire act.
No, it's greed over people pure and simple. cancer treatments that cost $100k per treatment in the US vs $3k in Canada for the same drug by the same maker.
Arsewipes like martin shkreli and Elizabeth Holmes are not poster children, but the norm.
The US FDA went on a war against imported Canadian drugs a few years ago to increase profit to the US pharma cartel and their paid for elected pawns to ensure profit continues to roll in.
UW, the University of Washington is developing a cure, a real cure, for leukemia. In order to raise money for research, the rights were sold to a VC (vulture capitalist firm) who giggle with glee believing they can charge $500K per dose. Here’s the piece most people don’t realize – most health care policies contain lifetime maximums; usually $1m, $2M for the better, more expensive ones. These greedy jerks are going to consume ½ of someone’s life time’s healthcare in a single injection. Think about those implications. This is not about making health care better, more affordable, or improving the lives of people, this is purely about extorting life and death so a very, very few can have bigger houses and private jets. Welcome to ‘Merica 2.0.
they're not doing the expensive part of that 2.5 billion. You are. With your Tax Payer dollars. Anyone who says they're spending that kind of money is just using clever accounting. Kinda like how Return of the Jedi lost money at the box office.
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Here's a problem with your assessment, we don't have a free market with drugs.
I know, that's my point. I said that if the free market was working, then we would see more competition and lower prices. The fact that we don't means that it is not working. The fact that no one is coming in to undercut prices on generic drugs that are not encumbered by patents is indicative of the fact that the free market is not working here. It might be evidence of collusion and price-fixing, or a situation making it impossible for competitors to enter the market.
Prescription rules, if you want even a common drug for a chronic condition you will need a permission slip from a physician. Why? Can't people figure this out on their own?
I understand that problem well. My wife is from Brazil, when we are there she can walk into any pharmacy and get whatever she wants, she can even consult with the people working there. There are certain limitations on what they're allowed to do, but they can sell her any of the drugs they have there. Many of those drugs are not even available in the US even though they do not have patents and are generic drugs. She can't get steroids that she needs for inflammation and other issues, and she can't even get the drug that works to get rid of her headaches without going to Brazil and getting it straight from the pharmacy without ever needing to see a doctor. She feels lied to after coming here and realizing that she cannot get the quality of care that she is used to from living in other countries, and the reason seems to be money, like so many of our other problems. So many people have their hands in the pie and what gets lost is actually providing good quality care to people who need it, even if it only means making drugs readily available like they are in other countries. She knows exactly what she needs, what works and what doesn't, and she simply can't get what she needs here. She feels lied to after hearing how great the US was supposed to be, and then getting here and realizing that it's all about money, and if someone can make money restricting access to health care then that's what they're going to do.
More laws will not fix this problem. The problem is too many laws.
Which laws do you think need to be removed in order to fix these issues?
If you think that there is price fixing then I ask you to prove it.
Really? You want evidence of a price-fixing scheme in a trillion-dollar industry? Well let me just hit Google, I'm sure there are signed documents online that will clear that right up.
"Our two-party system is like a bowl of shit looking at itself in a mirror." - Lewis Black
So you're suggesting that if everyone is selling a certain medication at $30 per pill in the US, and that this pill costs less than a dollar to manufacturer, then if someone enters the market and sets their price at $20 per pill, that they aren't going to start raking in cash? Why would anyone buy the exact same thing for 50% more? The fact that profits are so high on pharmaceuticals indicates that there is plenty of room for a competitor to set a lower price and make a huge amount of money on quantity. But, hey, obviously I don't understand economics. I do understand the difference in prices for drugs in the US and other countries though, I have plenty of first-hand experience on that.
"Our two-party system is like a bowl of shit looking at itself in a mirror." - Lewis Black
Haven't seen it mentioned yet, so I'll chime in. It only takes a bit of T.V. watching to notice that nearly every single drug commercial is actually TWO commercials. One to promote the drug and a follow-on spot to list every single side effect and remind potential customers they should tell their Dr. about their medical conditions prior to getting them to prescribe the drug. This seems to more or less double the cost of all drug-based advertising (even print ads must be larger to include all the disclaimers and fine print) while adding no value. You HAVE to talk to your Dr. to get the damn prescription and the Dr./Pharmacy has to inform you of the side effects. Imagine how much less they'd have to spend if the rules simply stated that all side effects and cautionary tales must be published on the company websites, rather than broadcast along side every advertisement.
That's a terrible example for this article as this was a drug that had been around for decades that just got approved in the US and is dirt cheap everywhere else. For the cost of doing trials and getting FDA approval, Marathon gets a 45x markup. Whereas previously, patients could buy this drug from overseas, now that it's approved by the FDA, they can no longer do that. So they have to pony up the $89K (minus whatever discounts Marathon offers to try and appease the mob). That's BS. The reform has to start at the FDA. If a drug is approved in a place like Canada, where I'm sure they're not just passing out hemlock and saying this might cure something, the process here should at the very least be shortened for approval and if the drug is already available from an existing company(ies), then they should not be handing out these sweetheart deals, like the one to Marathon, to essentially gouge all Americans with these ridiculous prices. The FDA and the Congress are complicit with the drug industry lobbyists for creating this environment where America pays far more for every drug than in the rest of the world. We're floating Big Pharma's profits and their marketing budgets because no one in Washington DC has the will to stand up and protect the American consumer.
You are suggesting drug prices in the US are related in any way to drug prices in other countries. The drug companies set their prices to maximize revenue, they make a profit in every country or they abandon that country.
Did you know that HIV transmission can be prevented with a pill?
Would it not be a good thing to HALT the spread of HIV (or at least slow its spread to below the threshold for it to remain in the population long term)?
Sort of like the effort put into to stopping smallpox and making polio rare?
Truvada PrEP is estimated to be greater than 99% effective.
Across the US border it costs about $70. But here? Something like $4,000+, unless your insurance covers it, then $600+.
Putting two generic medicines into a single pill warrants x50 price increase and a patent to cover that?
leather-dog muksihs
Blog: @muksihs
We build and maintain roads using taxes because it's expensive, has a large benefit to society, and is hard to pay for without destroying those benefits. We should do the same with drugs- all research, production, and distribution done by government. Doing so will eliminate the high risk to corporations (failed drugs=lost money), and ensure our healthcare dollars are only spent on costs not private helicopters.
show me your #s. I'm waiting... It's pretty easy to prove the point that they spend more on marketing than R&D with a google search. So show me a single, low user drug with 2.5 billion invested in it where the money came from the drug companies pockets.
Oh, and I've got family with cancer. The drugs that kept them alive were invented in Europe by the European governments because not a single US company would spend a dime on it.
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Poor pharmaceutical companies, they have to jack up the price! Otherwise they wouldn't have such fabulous profit margins, or be able to spend such an incredible amount of money in marketing! Imagine the horror!
entropy happens
$89,000/yr for deflazacort? Big Pharm clearly has the US health industry blindfolded, bent over and reamed but good doesn't it? My son has Duchenne's Muscular Dystrophy and is taking deflazacort for it. It hasn't been approved for general prescription here in Canada, but getting approval for it to treat DMD is a straightforward rubber stamp through the exceptional access program. Because it isn't formally approved, we have to pay for it and then get reimbursed for it, Also because it's an EAP drug, we're paying only a little over wholesale. Currently we pay 85$ for a three month supply, or 340/yr. That includes shipping from the pharmacy associated with the research and teaching hospital my son is being treated by.
I need a wheelchair van for my son. Help me get the word out. https://www.gofundme.com/wheelchair-van-for-jj
No, I am not suggesting that because it isn't that simple. I'm going to try and put this in a way that hopefully you will understand (with my very limited knowledge of lawyering, and I'll assume you are a lawyer based on your name). Presenting a case in trial should be free, because I have the choice of multiple lawyers, and it costs absolutely nothing to talk in front of a judge and in some cases you can get a public defender which is free. That doesn't happen for the same reasons drugs that cost $1 to manufacture aren't cheaper. Now this is the point where you step in and tell me all the reasons why you charge for your services, why it isn't free, why you cost more than the public defender...
As for drug companies, you can't make a pill for $1. You can't make a single pill for $1,000, or even $10,000. You can however, possibly make a million pills for 1 million dollars. There are set up fees, and QA testing, drug testing, packaging (and testing), and... so on and so on that all must go through the FDA. Even generic drugs. You have to prove that the delivery system is the same, at the same dosage, and delivers the active ingredients at the same rate as another generic, or the brand name product. You have to prove your manufacturing process is within a given tolerance (not every pill has the EXACT same quantity of active ingredient, even for brand name drugs). Then you have to market it, sign agreements with warehouses, and packaging companies, and eventually someone to put it where people can actually buy it.
So no, if it costs $2m to get all that stuff done, and then x% after that goes to other expenses, if you can only sell 10,000 pills per year, you will not make a killing at selling them for $20 each. It is complicated, and it is a long process (even when lawyers don't get involved), and there is significant risk in trying to bring even a generic drug to market, but there is so much "profit" to be made, then why don't you go do it yourself and become a bajillionaire?
Before Obamacare, US had 60% cancer survival rate. And even higher rates for some of the better understood and more frequently screened forms of cancer. Britain's cancer survival rate at the same time was 30%. So I would not use Britain as a model for how to deal with expensive rare treatments.
Any guest worker system is indistinguishable from indentured servitude.
Shouldn't the government have an obligation to limit the market price of such drugs? I'm sure the rapacious companies charging exuberant amounts for the drugs would yell "free market" to excuse their prices, but the truth is that a drug under anti-competitive patent protection does not exist in a free market. Since the government provides the protection against competition to the manufacturer, shouldn't the same government, whose primary obligation is towards its flesh and blood citizens, and not its corporate citizens, have the obligation to regulate the price of drugs used for the treatment of illness? To lose the price restriction, a company should be obligated to lose the protection against competition. That only seems fair, and a proper use of the patent system. Right now it seems to be broken and abused by the industry.
I like my dinosaurs feathery, and my pterosaurs hairy (or is it pycnofibery?)
No, I'm not a lawyer. I understand that it costs money to go through the process. I also understand that there are medications that cost $0.18 per dose in other countries, and $30 per dose here (or $89,000 for three months here, versus a few hundred dollars if you're in India or Egypt).
but there is so much "profit" to be made, then why don't you go do it yourself and become a bajillionaire?
If I had the resources to start that I would, believe me. I would find generic drugs that aren't under patent and I would go through the process to manufacture and market them and sell them for a price that is more on par with the rest of the world. I don't have the resources to do that right now, but even so, the goal would not be to become a bajillionaire, I would be happy to break even and see more people who need medications have access to them. In the US no one is going to do anything if they can't make a buck off it, and if they can make $1 then shit, why not crank up the price and make $10,000, right? How many stories have come out over the past few years of pharmaceutical companies raising drug prices by hundreds or thousands of percentage points? What happened, did it all of a sudden get so much more expensive to make them? Did they just get the lawyer bills?
"Our two-party system is like a bowl of shit looking at itself in a mirror." - Lewis Black
I have a similar story. I wouldn't say that the VA tried to kill me but they seemed to have little sympathy for my pain.
The VA isn't the only failure in government medicine. Look at the Indian Health Service, Medicare/Medicaid, and various state agencies. It's not just government but also the insurance agencies. I hear horror stories from people about not getting the medicine they need from hospitals because insurance won't pay what they charge, but they can go to a drug store and get the same stuff the shelf for pocket change.
Hospitals will charge $20 for a Tylenol because the insurance companies will pay it. That's not for a bottle of Tylenol, that's for a single pill. That's what happens when we create layers of bureaucracy between the patients and care providers.
I am armed because I am free. I am free because I am armed.
As multiple other people here have posted, the pharma industry spends at least $2.5B in R&D per new drug. Also, almost all of that is spent in the US, where the vast majority of new drugs are researched. To attract talent, pharma companies generally put their R&D in desirable places to live, have nice facilities, and pay good salaries. When you have a team of ~1000 scientists and doctors working for 5-10 years on a drug, you're going to spend a LOT of money. Just the cost of capital to develop a drug is staggering. The easy answer is to pay people less, and convince them to work in cheaper facilities... The rest of the world tried that and now virtually all the drugs are developed in the US.
One way to do fix this is to focus on spinning out R&D efforts as startup companies. This places the financial risk on the scientists doing the work, but also gives them much greater rewards for success, and an incentive to keep costs low. That's the giant problem with pharma development and marketing right now: no one has any real incentives to keep the costs down.
There are R&D grants for orphan drug development, and there are patient advocacy groups that help with clinical trials. We need to be able to get to a future where a "successful" small pharma effort is one with $5-10M of annual revenue.
Hate to say it, but people don't seem to realize that health care costs money, and it may even require not financially covering certain treatments, like organ transplants, rare diseases, and MRIs for diagnosis ass-covering. If the American public cannot concede to common sense, no form of nationalized health insurance program will be fiscally plausible.
There is no America. There is no democracy. There is only IBM and AT&T and DuPont, Dow, General Electric, and Exxon
Much of what costs isn't in advertising to the public
It's in fishing jaunts for Dr.'s, payola to Bureaucrats, "Free" medical symposia to peddle the latest nostrum and "Free" contributions to Legislators
That's irrelevant.
If you would have to pay a dollar extra per year to save some people, would you be willing to do it?
Besides, it's all a point-of-view discussion. If you're the one being sick, your view on how it should be radically changes.
...gis sdrawkcab (usually not responding to ACs; don't bother posting as AC)
She doesn't take opiates for anything, but she does have a genetic disorder and several other chronic conditions. But, hey, thanks for the internet diagnosis.
"Our two-party system is like a bowl of shit looking at itself in a mirror." - Lewis Black
Communist :) hehe
But yes, more government funding for research is the best way to keep drug costs down. IMO we don't have to do everything in the public sector, but finding a balance... Notably reducing the barrier to entry for new drug companies by making funds available, funding basic research with open publication, limiting patents, and using patents from publicly funded research to the benefit of the public.