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Doctors Tried To Lower $148K Cancer Drug Cost; Makers Tripled Its Price (arstechnica.com)
Slashdot reader Applehu Akbar writes: Imbruvica, a compound that treats white blood cell cancers, has until now been a bargain at $148,000 per year. Until now, doctors have been able to optimize dosage for each patient by prescribing up to four small-dose pills of it per day.
But after results from a recent small pilot trial indicated that smaller doses would for most patients work as well as the large ones, its manufacturer, Janssen and Pharmacyclics, has decided on the basis of the doctors' interest in smaller dosages to reprice all sizes of the drug to the price of the largest size. This has the effect of tripling the price for patients, and doctors have now put off any plans for further testing of lower dosages.
The researchers are retaliating by urging clinical investigators to test whether the expensive pill could be safely given every other day -- and by calling on America's public health regulators to investigate the drug's pricing.
But after results from a recent small pilot trial indicated that smaller doses would for most patients work as well as the large ones, its manufacturer, Janssen and Pharmacyclics, has decided on the basis of the doctors' interest in smaller dosages to reprice all sizes of the drug to the price of the largest size. This has the effect of tripling the price for patients, and doctors have now put off any plans for further testing of lower dosages.
The researchers are retaliating by urging clinical investigators to test whether the expensive pill could be safely given every other day -- and by calling on America's public health regulators to investigate the drug's pricing.
Hang them
Much of what is wrong in the world is represented in this story. I get it.. recovery of R&D costs, profit, all of that. This seems to go far beyond the pale, though.
Beware of the Leopard.
...come into effect, expect wailing, moaning and cries of "How could it have come to this?!?". Well, dumb-asses, you just HAD to grab that extra dollar just because you could, right? Payback will be a bitch if we ever wake up in this country.
Lots of folks here are allergic to the idea of the public interest having any role in public policy. I understand where you're coming from - "if it isn't helping me now..."
But here's the thing - properly funding public research is WAY cheaper than these ruthless extortion tactics we've turned healthcare into for the past few decades.
I mean, it's crazy cheaper to prioritize a working public healthcare, and yes, research programs.
As in, most of the rest of the world would consider how we run things a complete joke.
But somehow, because it involves some sort of public interest at play... it's somehow seen as a threat(?)
But somehow, these stories after stories of business people deciding to extort folks, with such calculated corporate smiles on their faces are seen as not a threat.
Which is rather odd - those same folks would see Andy Griffith as a misty memory ideal don't see how basically that's exactly the kind of cruel selfishness personified that he ranted at in half of the episodes of his show.
It's just so bizarre to see what passes for debate and morality in discussions on Slashdot these days.
Ryan Fenton
...that so many Americans identify with and defend patriotically and decry anything else as Socialism/Communism/government overreach. This is the free market and minimal regulation at work, doing what it's supposed to do, regardless of anything except profits and share prices, and you vote for it like true patriots every few years.
Debate is a form of harassment. Do not question my truth.
I'm assuming this is because they are trying to get back the fixed R&D cost. Maybe the solution should be an incremental cost for the medicine and the fixed cost divided by the number of users. That way the more people who sign up, the lower the cost is to all. Or maybe the government should buy out the fixed cost and let the company collect the incremental cost.
Second, as far as I know, every pharmaceutical marketer has a drug affordability of some kind. In fact I think it might be a little known requirement under US FDA regulations. Here is the official drug affordability site for the drug: Imbruvica cost support Any one who needs this drug (or any other life saving medication really) should look into these programs.
I need a wheelchair van for my son. Help me get the word out. https://www.gofundme.com/wheelchair-van-for-jj
1. Kidnap a pharmaceutical company CEO.
2. Lock him up with a rabid raccoon until they become properly acquainted.
3. Offer the exec access to the anti-rabies vaccine for $30 million deposited in an untraceable numbered bank account.
4. Profit!
I've calculated my velocity with such exquisite precision that I have no idea where I am.
Barriers to entry in the US market?
Ezekiel 23:20
Check the bolded portion below:
It always blows my mind when I see users who constantly post pro-Trump free market posts on slashdot calling for the death and hanging of someone or some organization who is doing just that!
Geez. Either you want free market or you don't! At least be consistent.
I have suspected MOST Republicans actually want socialized healthcare, they've just been bamboozled by their party to think otherwise.
Mike @ The Geek Pub. Let's Make Stuff!
They need to get the generic approved by the FDA by doing expensive studies, even though itâ(TM)s the same chemical formula thatâ(TM)s already been approved. Itâ(TM)s an incredibly stupid law thatâ(TM)s only on the books because of lobbying by large drug companies.
I remember some very old people I new in the 80s were talking about how all the non-profit the hospitals were closing down and for profit hospitals were moving in. They said that prices for medical will skyrocket because if there is one thing sick people will do, is pay to live. They were hoping the government would make for profit medical services illegal. Well I guess we are there now.
It's not the only reason. If they use different ratios of delivery/carrier materials, it does need to be proven that they don't interfere with dosing and absorption. And if the patent only covers the active ingredient, can the composition of the tablet itself be kept as a trade secret or is it published with some sort of FDA document? Honest question, I don't know the answer to that.
and for England
https://www.youtube.com/watch?...
Politics is Treachery, Religion is Brainwashing
Here's an informative article from last year on U.S. drug patent law and the impact and implications, as well as a recommendation to alter it from 20 years from date of invention to 15 years from date of FDA approval.
https://www.upcounsel.com/how-long-do-drug-patents-last
Here is the horrible action the pharmaceutical company took:
But after results from a recent small pilot trial indicated that smaller doses would for most patients work as well as the large ones, its manufacturer, Janssen and Pharmacyclics, has decided on the basis of the doctors' interest in smaller dosages to reprice all sizes of the drug to the price of the largest size. This has the effect of tripling the price for patients,
So, previously there was a pricing anomaly in that 4x smaller pills were as effective as 1x large pill, so when they repriced the drug, each of the smaller doses cost as much as the larger dosages. Why would a patient keep taking several of the smaller dosage pills after the price change? Just take the 1x larger dose pill and it costs as much as the 4x smaller pils used to.
I would expect highly specialized medicines to retail at a price based on the amount of active ingredient in the container, if it is spread over 50 large dose pills or 200 small dose pills (small is 1/4th the large dosage).
Ken
The manufacturer of a generic drug still has to prove that their product is as equivalent to original.
The approval process for a new drug is more complex; they have to prove it is safe and that it is effective in rigorous clinical trials. For a generic, they merely have to demonstrate equivalent pharmacological effects (e.g. absorption into the bloodstream in similar quantities and in a similar time, etc.), which is much easier, and requires fewer test subjects, less complex follow-up, etc.
However, to do this sort of trial, you still require access to the original drug, because this type of trial will require head-to-head testing. One of the ways in which Shkreli aimed to stop this was to completely shut down all distribution of the drug. Instead, his company would employ their own pharmacists who would dispense a limited quantity of the dug only on receipt of a named patient's prescription sent directly to the company. By not selling the drug to wholesalers and pharmacies the intention was to make it impractical for other companies to purchase stocks of the drug against which to run trials.
Everytime I go there and go to a pharmacy to get a prescription refill while abroad, the price charged is usually even lower than my copay in the USA. It is an obscenity against US consumers. We should really be in the streets with pitch forks about this but we are not. The fact that most drugs are covered and only copay is needed obfuscates the real retail prices that would cripple anyone without insurance. I was shocked about the prices in europe. Most americans would not even need prescription coverage for most of those drugs as their street price is ridiculously low compared to what we pay in the USA
His candor doesn't make the foulness of his predatory actions ok.
His abuses of abusive laws are not ok. An "et tu" defense that others do it doesn't make it ok.
The entire US health care system is a scam run by doctors, hospitals, pharma, insurance companies. Prices for health care in the US are four to ten times that of the rest of the world. Other developed countries have universal care and better health indicators than the US and they spend less than half what the US spends to cover just part of the population.
We have the most expensive, least effective health care in the world.
No other civilized country would let pharma get away with these obscene prices for drugs. Other countries control prices. However, the US is run by a crony capitalist system where corporations, etc. buy congress to protect their profits.
I don't read your sig. Why are you reading mine?
Low volume of patients. High cost to invent the drug and pass the regulatory hurdles. And it has to subsidize all the drugs they researched that didn't work out. They need to make this money back over the lifetime of the patent or they go out of business.
A couple of researchers try to game that system and the company responds: Nope, prescribe the medicine the patient needs based on the medical evaluation only. We're going to make it cost exactly the same per patient regardless of the dosage you pick.
There are lots of facts here that I don't know. Do they need $150k per patient to break even? I don't know and neither do you. The part that I do know seems relatively reasonable.
Moderating "-1, Disagree" is simple censorship. Have the guts to post your opinion.
A New York Times article stated that this drug was developed with three other non-viable drugs for a total cost of $388,000,000. Dividing by the stated cost of $143,000 dollars, 2,713 patients have to be treated with this drug for 1 year to recover development costs.
This drug treats Chronic Lymphocytic Leukemia (CLL). Approximately 20,000 people are diagnosed with CLL each year, and those people have an average age of 71 years. Approximately 4,500 people die each year from CLL. Your lifetime risk of developing CLL is 1 in 175.
Cancer.org lists 5 other treatments (Obliersenn, Lumiliximab, HA22, Lenalidomide, 'standard' chemotherapy) for CLL , and mentions dozens of drugs are in testing for CLL treatment.
You now have more information to discuss alternative treatments, their costs, and why folks would choose one over the other, as well as a greater ability to evaluate the potential profitability of this drug (Imbruvica) at any price point.
Alcohol, Tobacco and Firearms should be the name of a store, not a government agency.
Most drugs have a bunch of patents, including ones for the active ingredient, the delivery mechanism, the coating, etc. The patents will have staggered expiration dates, which can maximize the time a drug remains on patent. Albuterol inhalers, for example, which used to be generic until they were reformulated to be ozone safe, has 4 US patents for one particular formulation (ProAir). That helps keep this 40 year old drug at $57-$70 an inhaler. Somehow, back when it was generic, it was $4 an inhaler. Albuterol was supposed to be going generic again any minute now for the past 2-3 years, but it's still hung up in court —all for a drug that probably ought to be over-the-counter. IMHO.
The drug was priced that way with a very simple formula.
Number of Patients X Dosage X Cost = Development Cost + Marketing + L. Insurance + Profit
The Dev and Marketing costs are already spent, or at least mostly, and kept at an absolute minimum anyways. The Insurance is probably not going to be negotiable, and the profits are almost certainly a set industry standard. So if the dosage goes down the company either has to increase the number of patients, the cost, or quit selling the drug and just try and take the loss or declare bankruptcy.
Troll is not a replacement for I disagree.
I'd rather die from cancer than give those motherfuckers a penny. Besides, who wants to live in a world like this anyway?
This is why monopolies used to be broken up - they could price like this. In addition, in this case, it's a life and death product. "How much is your life worth to you? That's how much it costs." Shkreli was was honest and transparent about the reprehensible actions he was taking. The people you need to worry about are the ones who are smiling and empathizing as they knife you. They don't slip out of character either. And they're still leading the industry.
Additionally, the government prohibited itself from negotiating with drug companies for prices for Medicare Part D. Politicians created the "safe space" that those with suitable mentalities could then operate in (and funnel some of the proceeds back to DC).
Dear America,
Fix your fucking healthcare system.
Sincerely,
The civilised world.
Dear Europe (and much of the rest of the "civilized" West),
Please start paying for your own national defense, the nuclear arsenals, standing armies, air forces, navies, etc to match Russia and China.
Then we can talk about us spending that money we currently spend to protect YOUR asses on healthcare instead.
The US is bankrolling your 'free' healthcare.
Just say "thank you" and STFU, 'mkay?
Strat
Progressivism (aka US 'Liberalism'): Ideas so good they need a police/surveillance-state to enforce.
... at the end of this phrase: "its manufacturer".
I'm not supporting the manufacturer here. But there are some factors to consider why drug prices like this are so high. It's not always just naked greed (though sometimes Shrkelis do happen).
Say you're a pharma company. You work on drugs for rare diseases like this cancer. It takes a lot of money to develop new drugs and bring them to market.
If you're lucky the initial research finding drug candidates will be funded with public grants at a university. But you still have to take those drug candidates from promising lead to actual treatment. That means finding the right dosage. That means figuring out how to make the drug efficiently. It means lots of clinical trials to prove safety and efficacy - not to mention animal trials before you even get to that point. It means lots of regulatory hurdles. Basically the D part of R&D.
All that costs money. Typically we're talking hundreds of millions to billions of dollars. And success rates are low. Something like 10% of potential new drugs make it through the entire process. So for every drug that works, you tried nine others that failed. That raises costs to develop a successful drug even more.
So you get through all that. You now have a treatment for this rare disease. It costs billions to develop, including all the unsuccessful drug candidates you tried that didn't pan out. But the disease only affects 5,000 people a year. If you charge each one $100,000 for the treatment, you get 500 million per year.
If you spent 2 billion to create the drug, then you won't recoup your investment and start making money until year 5. And that doesn't count ongoing costs like manufacturing, quality control, patient monitoring, physician feedback, etc. Your patent on the drug is at most 20 years, and usually closer to 7-8. So you only have a few years to make profit on the drug until generics come in and eat your market.
I'll be the first to say the system stinks. But it's not because of evil profit-seeking drug makers. It's the way the entire system is setup. More drug development costs should be publicly funded. The regulatory approval process should be streamlined. Drug advertising should be illegal. The profit motive is killing US healthcare. We're subsidising drug prices for the rest of the world, where strict price controls limit what drug makers can recoup.
There are a lot of problems with drug development in the US. But it's not primarily the fault of greedy drug makers. It's the economics of the entire system that lead to crazy results like this. Hate the game, not the player.
Democracy is two wolves and a sheep voting on lunch.
Pharmacyclics (the developers of ibrutinib/Imbrivica) is actually now owned by Abbvie, which is the pharmaceutical company spun off from Abbott Laboratories. Abbott achieved fame in 2003 when it increased the cost of their HIV medication, Norvir, 5-fold when it found that doctors were combining the smaller pill size version with other drugs. This is just history repeating itself.
Because the US bankrolling Europe is something that would fly with any politician in the US regardless of side?
Because the US bankrolling Europe is something that would fly with any politician in the US regardless of side?
Obviously so or it wouldn't have gone on for the last ~60+ years.
Did you have a point other than the one under your hat?
Strat
Progressivism (aka US 'Liberalism'): Ideas so good they need a police/surveillance-state to enforce.
Your right to life is goes down with your bank balance. Of course, dead patients cannot pay. The optimal path of for-profit medical institutions is to bankrupt you before you die. Companies have a fiduciary responsibility to their shareholders, not your life.
There is a solution to greed pharmaceutical companies. Only a couple of countries have ever invoked this, for HIV and Hepatitis C drugs. Lobby your congressperson to use international law to their constituents' advantage for a change, instead of pandering to their donors.
I think the real reason is that you have to have access to the drug in order to certify that your generic works as well, and he restricted access making that impossible
Rewrite patent laws so their duration is inversely proportional to the cost of the drug past some arbitrary number (say $1000 a year).
Companies who play these kind of games will discover that the government is not willing to subsidize their drugs while simultaneously providing unlimited protection from competitors.
I mean seriously- shooters kill over their youtube account being demonetized.
What about you dying?
What about your parent dying?
What about your child dying?
When is someone going to track down the people or corporation increasing the price?
It seems inevitable.
She was like chocolate when she drank... semi-sweet at first and then increasingly bitter.
Fuck you and your protection racket. All you do is destabilising countries, creating misery and causing refugees.
"It's such a fine line between stupid and clever" -- David St. Hubbins, Spinal Tap
Fuck you and your protection racket. All you do is destabilising countries, creating misery and causing refugees.
No, fuck YOU and your pathetic, dependent, infantile, Euro-trash asses!
Stop leaning on the US for your national defense and spend your OWN fucking coin and the blood of your own sons & daughters for your fucking protection, you fucking cheapskate whiny-ass cowards.
Strat
Progressivism (aka US 'Liberalism'): Ideas so good they need a police/surveillance-state to enforce.
Dear Europe (and much of the rest of the "civilized" West),
Dear Europe, because you do things I think are wrong, I am going to aggressively fight any attempt to fix things in America. #MAGA
-BlueStrat
SJW n. One who posts facts.
Reading comprehension is obviously not your strong suite.
Of course, that's assuming you *want* to correctly understand what was posted, instead of what your ego, your bigotry, and the voices in your head tell you.
Finally, I didn't vote for the Orange Wonder. "Another swing and a miss! Strike three, yer outta here!"
Strat
Progressivism (aka US 'Liberalism'): Ideas so good they need a police/surveillance-state to enforce.
Reading comprehension is obviously not your strong suite.
No it really is, it's yours that's lacking. Healthcare in America is a total fucking mess whether or not Europe has sufficient defensive military. Angrily pointing out flaws in European military spending won't fix your messed up healthcare system.
The only thing it serves to do is to make you have better feelings about it, so you feel less inclined to vote for someone who will fix it.
Finally, I didn't vote for the Orange Wonder.
I didn't claim you did, I claim that you're espousing the same ideology, in as much as #MAGA can be an ideaology.
SJW n. One who posts facts.
You dont't hear how ridiculous your idea is? There is not a single administration nor makeup of congress that would allow the US to bankroll Europe since that would be seen as being Socialists. A single senate hearing of a CEO from any Pharmaceutical company where he/she would say that the price in the US is high so that they can sell it for less in Europe would lead to immediate consequences by both the public at large and the sitting political administration.
The reality is that the pharma industry (like any other industry) sells their products at the price on each market they they determine that the market is willing to pay, this is basic capitalism. The pharma companies also have a very high profit margin (among the highest among the various industries) so they are definitely not in need to subsidize the price in one market by increasing it in another.
No it really is, it's yours that's lacking. Healthcare in America is a total fucking mess whether or not Europe has sufficient defensive military.
Healthcare in America would have a lot more money available to fund it along with a host of social programs to match if America could shirk it's responsibility to protect itself and it's citizens like Europe does by having the US provide the majority of their military protection.
European nations with universal healthcare and other social safety-net programs are only able to afford it because they spend money they would otherwise need for a strong military force that they have depended on America for since WW2.
Anyway, Europe is going to soon get a taste of reality.
With the American economy heading for a fall, Europe will have to decide between funding their own military or Russian and Chinese language lessons for those of their citizens left alive after Russia and China take over your nations, as America will be too broke to, once again, come riding o Europe's rescue after they shit the bed...yet again.
Strat
Progressivism (aka US 'Liberalism'): Ideas so good they need a police/surveillance-state to enforce.
Anyone who assisted Janssen and Pharmacyclics in jacking up the price should be exterminated. Marketers, executive staff, etc etc., they should all be executed for their inimical, profit-driven actions.
Just cruising through this digital world at 33 1/3 rpm...
Healthcare in America would have a lot more money available to fund it along with a host of social programs to match if America could shirk it's responsibility to protect itself and it's citizens like Europe does by having the US provide the majority of their military protection.
I wold qualify that as "not even wrong". America doesn't need more money to spend on healthcare. America needs to scrap the system where its healthcare costs about ttwice that per capita of the major European economies while giving worse outcomes in most areas.
European nations with universal healthcare and other social safety-net programs are only able to afford it because they spend money they would otherwise need for a strong military force that they have depended on America for since WW2.
Demonstrably false. Several European countries are spending to maintian a nuclear deterrant, have better healthcare outcomes in most areas and spend HALF what the US spends per capita on healthcare.
Thing is you're so stuck on #MAGA that you can't even see where the problems are.
The main problem is the massively profitable healthcare insurance industry, and the republican party who back it.
SJW n. One who posts facts.
Pill-splitter.
There's no time like the present. Well, the past used to be.
Healthcare in America would have a lot more money available to fund it along with a host of social programs to match if America could shirk it's responsibility to protect itself and it's citizens like Europe does by having the US provide the majority of their military protection.
I wold qualify that as "not even wrong". America doesn't need more money to spend on healthcare. America needs to scrap the system where its healthcare costs about ttwice that per capita of the major European economies while giving worse outcomes in most areas.
European nations with universal healthcare and other social safety-net programs are only able to afford it because they spend money they would otherwise need for a strong military force that they have depended on America for since WW2.
Demonstrably false. Several European countries are spending to maintian a nuclear deterrant, have better healthcare outcomes in most areas and spend HALF what the US spends per capita on healthcare.
Thing is you're so stuck on #MAGA that you can't even see where the problems are.
The main problem is the massively profitable healthcare insurance industry, and the republican party who back it.
Well thankfully it doesn't matter how wrong and delusional you are, reality will be your wake-up call after the US collapses economically and Europe is faced with either having to pony-up the wealth for more than a small handful of nukes and tiny jokes for military forces, or else watch Russian tanks roll into Poland, France, Germany, and the rest of the EU & UK as well.
Japan already sees the writing on the wall you are so determined to ignore and is building up it's military and a nuclear deterrent force against China whom the US soon won't have the means to deter militarily.
Do svidaniya, Comrade!
Strat
Progressivism (aka US 'Liberalism'): Ideas so good they need a police/surveillance-state to enforce.
Well thankfully it doesn't matter how wrong and delusional you are, reality will be your wake-up call after the US collapses economically and Europe is faced with either having to pony-up the wealth for more than a small handful of nukes and tiny jokes for military forces, or else watch Russian tanks roll into Poland, France, Germany, and the rest of the EU & UK as well.
It's amazing: you're so desperate for excuses that you'll do anything but accept the actual facts.
What may or may not happen in fugure is irrelevant to the fact that right now America spends twice what Europeans spend on healthcare with worse outcomes.
Deflect all you like, it makes that no less true.
As for the Russian tanks. Well, Russia spends more than the UK on its military, and more than France on its military, but substantially less than the combination of the two. Then add the rest of Europe.
And you don't really understand what a nuclear deterrant is to you? The UK and France don't need enough nukes to bomb the entire world into the stone age. All we need is enough nukes to make us not worth attacking.
The Us might not be on the ascendance, but neither Russia nor China have the means to project power. I mean sure Russia has an aircraft carrier, except apartf from being vulnerable to subs on the move, it's so unreliable it has to by shadowed by a tug everywhere in case it breaks down.
SJW n. One who posts facts.
This kind of shit should be 100% illegal.
The makers should have their patent confiscated and given freely to another party who will price it more reasonably.
Despite
https://en.wikipedia.org/wiki/... why/how Corruption prevails in USA?
Casteism
Free market at work eh? Fucking suckers.
Wanna buy a shirt?
https://www.redbubble.com/people/stealthfinger/shop?asc=u
You seem to be under the delusion that US health care costs are reasonable. Last I checked, we paid about 50% more per capita than the next most expensive, and twice what lots of very healthy countries pay.
If we were able to reduce health care costs per capita to be only tied for first, we'd be able to more than double the defense budget or whatever we wanted to do. Two years of those savings would more than pay for the entire F-35 project.
So, it's not that Europe saves money on the military so it can afford universal health care. It's that their health care systems are relatively inexpensive.
There's also the question of how much defense Europe actually needs. I don't trust the US to judge European needs.
"When you have eliminated the unacceptable, whatever is left, however improbable, must be the truthiness" - Holmes
You seem to be under the delusion that US health care costs are reasonable.
It is for the leading nation in medical research.
The costs are mostly because of all the R&D and the need to recover those costs and the costs of the decades of federally required testing, although a significant fraction is also because of government over-regulation along with the obligatory barriers to entry to shut out new competition set up by lawmakers for their lobbyist buddies. The ACA has also contributed greatly to recent cost increases. Why not raise your prices if the law says people must buy what you sell to not be a criminal?
Strat
Progressivism (aka US 'Liberalism'): Ideas so good they need a police/surveillance-state to enforce.
"Leading" in terms of expenditure? Shocking that, when that's exactly what we're pointing out - it's easy to spend more when you're charging twice as much.
P.S. China and then Europe are not significantly behind the US in terms of spending in those areas. But we don't have a healthcare system predicated on charging the patient.
Honestly... give it up. You're trying to conflate so many issues into one to make your America great, rather than do the sensible thing and say "Yeah, paying for healthcare sucks, but we have other advantages".
P.S. For all that research, you're 31st on the list for life expectancy (not helped by going into battle on a regular basis, I hasten to add). Below South Korea, Slovenia, most of Europe, etc.