The Cost of Drugs For Rare Diseases Is Threatening the US Health Care System (hbr.org) 311
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.
Wait! (Score:5, Insightful)
I wonder what's the markup on those drugs.
Are they that costly to produce?
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You could perhaps spread research costs around to all projects. Such as in the olden days when major corporations had research arms out of which a few major advances and profit engines would arise as well as lots of smaller advances that would contribute much less to the bottom line. But then this really messes up costs for the commonly used drugs as well. This would make drugs for rarer drugs cheaper, but the drawback is that it makes the common drugs more expensive. The profits from Viagra are not paying
The invisible hand of the free market (Score:2)
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
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I picked the train of logic AFTER the question of whether it makes sense to spend X billions of dollars on research for disease Y and save Z amount of people, where Z is under 1000 and the positive economic impact is near zero.
R&D is tricky to measure, a study costing a million dollars can yield 10 billion dollars, while another study costing 500 million dollars might yield 5 million. therefore one R&D could cover another.
Hell, a simpler solution would be to ever-so-slightly raise the price of commo
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Having some people pay more in order to support the needs of other people sounds like socialism.
Re:Wait! (Score:5, Insightful)
The real problem is that we have buyers (insurance and government) who will pay that price regardless of whether the drug actually provides that much value to the patients. It's a noble sentiment to believe that every life is worth saving. But practically, when you try to do that you just end up burdening society with costs which give you a negative return on investment (you're throwing away money - people's productivity that they've sent in good faith to government and to insurance companies).
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...a 90% return is ludicrous over 10-years is unlikely and since its not all spent at the start of 10-years the supposed rate of return is more like 180%.
One word: compounding
The reality is that using the doubling formula [ time-to-double = log(2) / log(1 + r) ] with a 7% annual interest rate gets you to 10.25 years. As far as estimated rates of return go, 7% is pretty average in terms of investment planning. Nothing ridiculous there.
The Wikipedia article on internal rate of return [wikipedia.org] has some examples of how the rates of return on capital projects are calculated in terms of cash flow.
75% Margins (Score:5, Interesting)
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.
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The question is: what fraction of the cost did that overhead reflect? I've seen gross-mismanagement, and I've seen stuff that's so damned expensive that a 0.5% extra expense is... a lot.
Executive salaries are typically interesting in that respect: the actual cash compensation for most executives amounts to pennies per hour. The CEO of Ford gets, from revenue, about 1.05 cents per employee per hour, or $21 per year; stock and options compensation come at the expense of diluting stock--basically the bus
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Then introduce competition. Bristol-Meyers can get away with paying for a helicopter ride very day because the FDA has created rules that makes getting into the drug business nearly impossible. Someone could bring this all to a screeching halt by bringing in a competitor that offers products for less because they aren't paying for aviation fuel and a helicopter pilot.
Government Research Priorities to Blame (Score:2)
This is the long term problem behind spiraling medical costs. Money spent on developing new medical treatments end up costing soci
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"I wonder what's the markup on those drugs. Are they that costly to produce?"
Most certainly, when you factor in the cost in R&D the cost per pill over a given period of time, the cost of FDA approval -- basically everything it takes to bring medication to market. Most people don't consider any of that -- just that when they put the powder in one end and the pill comes out the other end how much is the pill?
By definition, rare diseases are RARE and they wont be making huge numbers of pills to spread ou
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By definition, rare diseases are RARE and they wont be making huge numbers of pills to spread out the total cost.
Rare and yet ten times more Americans suffer from them than the margin by which Hillary 'won' the popular vote.
And yet Democrats still whine about that so much you'd think it was a really significant portion of the US population.
If 3 million people is enough to consider that Hillary 'really won' the election then is 30 million people enough to consider these diseases worth fighting?
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If 3 million people is enough to consider that Hillary 'really won' the election then is 30 million people enough to consider these diseases worth fighting?
That's 25-30 million people with 7,000 different diseases. That's about 4k people per disease. They're not researching a single cure for all those 30 million people.
WTF does this have to do with the election or number of votes cast? There's only one person still obsessed with the election results and TFA isn't about him.
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Gross margin? Huge.
Net margin? It costs several billion to get drugs to market. All that FDA safety and efficacy stuff is about $310 million, from lab rat studies over 3 years to a 3-year follow-up with patients to document side-effects and efficacy once the drug is out in the market. Only about 10% of new drugs make it to market, and a lot goes into the pipeline and doesn't even make it to being a "new drug". The sunk research costs are $3-$5 billion per drug.
For these drugs, they have to recover
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The costs involved in their development.
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There is nothing much we can do about the new, branded medications in this list other than wait for the patent to expire, but compounds like Daraprim, the one Martin Shkreli wants $750 per pill for, are off patent and sell for pennies on the world market. If Trump wants to be taken seriously on this whole populism thing, it's time to strip the FDA of its power to prevent us from freely importing these long-since-approved ompounds.
Re:Wait! (Score:4, Interesting)
Quite late in the discussion, but yes. I work as a sysadmin in a big biotech pharma company where we make special treatments for a specific rare disease that will kill the people who have it if they don't get it. It cannot be cured, because it is due to a genetic defect. The only option is to supply the patient with enzymes that their own body doesn't make.
The medicine itself is 'reasonably' easy to make. But not when you have to comply with the regulatory requirements of various countries.
All research, marketing and other costs aside, we have a half a billion dollar plant, with over 500 employees, to make a drug for only 2500 patients worldwide, give or take. You can do the math on that. The reason we need that many employees is because the rules surrounding biotech drugs is incredibly strict. We are audited several times per year by various agencies, and things like change control, exception and deviation management, etc, are gruesome. Top heavy and very labor intensive.
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While this will be cheaper, it isn't THAT much cheaper.
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Re: Wait! (Score:3, Interesting)
In other words, somebody who will work at a fraction of the price. I'm not an economist, but I suspect that kind of mindset won't attract new talent into that industry. But maybe I'm wrong.
Though I read somewhere that 90% of these (and other) drugs are made in the US, and then sold elsewhere as an afterthought to drive additional revenue. So in other words, European health care systems get a (mostly) free ride.
That said, it would be interesting to watch what happens internationally if the FDA was allowed to
Re: Wait! (Score:5, Interesting)
Welfare starts at the top
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After the election in 2016, and the following riots from anyone who disagreed with the election in 2016, do YOU want the average tax payer to be in charge of what top-tier researchers are actually researching?
Re: Wait! (Score:5, Informative)
The various drug companies spend 3 1/2 x as much on advertising and marketing as research
The actual ratio is about 1.8 to one [washingtonpost.com], but still an unreasonable amount considering all the taxpayer subsides that these companies receive. Much of that is spent marketing directly to doctors in ways that are nearly indistinguishable from just bribing them to write prescriptions.
profit margins (Score:3)
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.
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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.
Don't forget, that's after throwing away 20-40% on advertising.
So, yes, they are unbelievably amazing.
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Though I read somewhere that 90% of these (and other) drugs are made in the US, and then sold elsewhere as an afterthought to drive additional revenue. So in other words, European health care systems get a (mostly) free ride.
Sure, they're just giving a first-world market more than twice the size of the US a free ride. Reality is that they don't make that much money in Europe because we don't let them. It's my impression that in the US the doctors do pretty much as they please, if it's "in" to use a certain brand of medicine they just do. The insurance companies aren't going to tell them you could have saved $100 here and $200 there by using cheaper generics, the hospital would just tell the bean counters to stick to what they k
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rather than look for someone who will create cures at a more sustainable cost.
If you are offering BILLIONS of dollars, you don't need to "look for someone". They will find you. The fact that no one else is offering to undercut the pharma companies producing these drugs most likely means there is no excessive profit margin. The development costs are enormous, and since the diseases are rare the market is tiny, that means a high unit price.
No it won't (Score:5, Insightful)
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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They do a few clinical trials after the government has done the really expensive stuff (what's called "Basic Research", IIRC).
This is simply wrong. The development process (which includes a lot more than just clinical trials) is far more expensive than the basic research component - and that's without even counting how many projects simply fail without anything to show for it.
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This is common knowledge to anyone who has worked in the field - it's like asking for a citation for the claim that eating too much junk food leads to obesity. But here are two data points:
http://blogs.sciencemag.org/pi... [sciencemag.org]
https://en.wikipedia.org/wiki/... [wikipedia.org]
So that's less than 20% of approved drugs that are discovered in academia to begin with. Academic labs aren't large-scale operations - a single-investigator R01 grant from the NIH might be $5 million over 5 years, and most investigators won't have more th
Re:No it won't (Score:5, Informative)
Read my post again (Score:2)
Government to the rescue; post-scarcity (Score:4, Interesting)
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 [dailymail.co.uk] 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" [blogspot.com].
Re:Government to the rescue; post-scarcity (Score:4, Interesting)
The USPS. Providing libraries. Electricity (either government run or price set). Some would probably say healthcare in general (ex. Medicaid vs. private insurance).
Most drug companies purchase completed drugs (often funded by the government), not develop them inhouse.
That's quite simply wrong across multiple dimensions. First, the highest price where there are still willing buyers is no where near proper profit maximization. Secondly, marginal costs on drugs are almost nothing, they're almost all fixed costs. There's no reason that there are a limited amount of pills any more than there are a limited number of CDs. Third, that "may" is troubling. Sure, it may be used for that, or simply pocketed. Since money is fungible, there's no real cause to suggest that it will directly fund the next round
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efficient
Efficient? No. Cheaper to the end user? Plenty. In many cases the lack of efficiency of a process is offset by the desire to make CEOs and corporate shareholders rich in private institutions.
It's likely the PRICE, not the cost (Score:3)
Just how many Martin Shkrelis are there in the (supposedly) (legal) drug business?
Re:It's likely the PRICE, not the cost (Score:4, Interesting)
Plenty. It's because we allow sociopaths to run companies. Sociopaths should be banned from all management positions, should be outlawed under pain of horrible death from having any power over any finances. They should be permitted, under heavy surveillance, to work flipping burgers at McDonalds or cleaning streets, but they should never ever be put in a position where they can affect a market or a pension fund or any significant transaction, and if they're caught trying to fuck around with their coworkers, they should be removed permanently from society.
Re:It's likely the PRICE, not the cost (Score:5, Insightful)
You sound like a sociopath
Re:It's likely the PRICE, not the cost (Score:4, Insightful)
..and who decides who's a sociopath? The Local People's Social Justice Friendship House, which of course has absolutely no ideological bias against private business? I'll pass. It's just replacing one form of tyranny with another.
There might be other solutions that could help. For example, if it is true that those companies are squandering large percentages of money on things like advertising, perhaps only allowing it to be funded from a set percentage of profits from sold product would be enough. This would hopefully limit the waste of research money on irrelevancies. While still not perfect, this is better than the witchhunt you suggested. Those never end well.
Re:It's likely the PRICE, not the cost (Score:4, Funny)
Maybe a pharma company could develop some sort of test.
The question to ask... (Score:2)
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.
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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.
Without the profiteering, many of the drugs would not exist. It is difficult to conceive of a different model that maintains the current level of R&D.
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The researchers in lab coats are making big money. A lot of it is their wages. The wages of people at chem synth companies, mining facilities, and other supply chain services is also a big part of the majority cost.
value of human life (Score:3, Insightful)
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.
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Re:value of human life (Score:5, Insightful)
That's just not true. We value human lives very little. What we value is the lives of our friends and families.
If your brother gets shot in Iraq, its a tragedy to you personally. If an Iraqi's brother gets shot, its a statistic to you. And the Iraqi thinks the exact same thing except in reverse.
This is a good part of why Americans are so resistant to a decent healthcare system.. Joe is happy to spout off things like "well I'm not sick and nobody I know is sick so why should I be paying for Jane from 6 miles down the road?" But of course if Joe gets sick himself a year later, suddenly he's bitching about the cost of doctors and medicine. Because now it actually matters to him personally. His life is worth paying for but Jane's isn't. And Jane thinks the same way about Joe.
Basically it all comes down to that "Monkeysphere" concept we hear about, combined with "greed solves everything" capitalism and some American-dream style eternal (if unfulfilled) optimism about a person's own potential.
Nonsense (Score:5, Insightful)
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.
Re:Nonsense (Score:4, Interesting)
If there is no profit in saving lives then it cannot go on for long. If drug companies cannot profit making drugs then their won't be any drug companies. If a brain surgeon gets paid as much as a truck driver then you aren't going to have many brain surgeons, at least not many that's any better trained than a typical truck driver.
This is not a choice between lives and profit, we can have both.
What a lot of nations chose to do is, out of "compassion", put government in charge of providing medical care. This has been and will always become a disaster. The people that provide care may be the best people at the start but without competition, which requires a profit motive, the quality of care will fade. People need motivation to improve, provide quality care, and profit provides that.
It sucks that labor and materials cost money but that is the world we live in and that cannot be changed. Removing the profit motive to providing quality medical care and people WILL die needlessly.
Even the most compassionate person needs resources to provide medical care to those in need. The best, and perhaps only, means to make sure that the compassionate have those resources is with a free market. A free market means people will profit.
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It is coming to the rest of the world, one way or another.
I've been hearing about the nightmares of healthcare in Canada and the UK. One thing was a Canada court ruling that denying people the ability to seek medical care on the private market was a human rights violation. This opened the gates to what Canadians call "super hospitals" but we in the USA call "hospitals". Canada had made it illegal for people to buy private insurance or seek care from private care providers. This caused the government run
Re:Nonsense (Score:4, Insightful)
The problem is not that we put profit ahead of lives but rather that we haven't fixed health care so it properly comes under traditional market forces.
When are you braindead idiots going to get it? When the choice is pay or die, there is no market! Goddamnit, how stupid can you possibly be? Markets require choice. Healthcare is not optional. End of discussion. Healthcare can not be managed via a market.
If you've fallen off your roof and broken your leg and nicked your femoral artery, do you:
a) Methodically call up each of the six independent healthcare providers in your area and ask them for their up-front pricing for repairing your artery and setting your broken leg, then carefully research their quality of care online, paying appropriate attention to their average outcomes specifically for treating a broken leg before calling back your provider of choice and making a reservation for them to come and get you; or
b) Dial 911, frantically convey your situation, and pray the EMTs get to you before you bleed the fuck out?
I'm gonna guess option b). And if in some fever dream, you really think you'd pursue option a), I hope you fall off your fucking roof.
God DAMN I'm sick of you anonymous, cowardly fucks. You know your psychopathic ideas are wrong, or you'd post with an account and accept the downmods you deserve.
No LIMITS (Score:3)
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See, here's the issue.
NHS and other non-US markets negotiate prices with drug companies, often forcing them to sell those medications at a loss or lose access entirely to that market. In order to make that loss back, they have to shift the cost of the drug to markets who do not force pricing - especially the USA. That's one big reason why the US has jacked up prices - we are effectively subsidizing medical treatments for the rest of the world.
When you implement price controls and force a producer to sell
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That's precisely their argument. They'll tell you that if you don't like the price of drugs, you should refuse to buy them and let the free market decide. There are always [technically] alternatives, because the was a time before the new drugs existed. But the old treatment may have been to lay in bed doped up on morphine while you wait to die.
Not just "rare" diseases (Score:5, Informative)
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... [cdc.gov]
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Re:Not just "rare" diseases (Score:5, Informative)
However, in the United States, price negotiation for medicine doesn’t exist. Medicare is required to accept the price given by the pharmaceutical company. Federal law doesn’t even allow Medicare to bargain or negotiate bulk discounts. It is only logical that under these circumstances the prices skyrocket, and it becomes the norm to pay high prices for medication.
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Because in India, medications can't be patented. The public policy reason behind this is that their society sees attempting to keep 1 billion people reasonably healthy as a more worthy endeavor than lining the pockets of unscrupulous pharma execs.
Well, that right there is probably why all the funding that went into developing them went to New Jersey and not New Delhi. The US healthcare system is subsidizing the drugs for India.
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Well, I've never wanted to travel to India, but a nice long vacation there seems like a no-brainer if you get Hep-C and aren't extremely wealthy.
I could just do a quick round trip to get the drugs and not even worry about missing work or having to pay for a hotel room.
Customs would probably steal the drugs from me at the border, I suppose, and maybe lock me up as a mule.
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Unfortunately, that doesn't work any more. India has placed limits on pharmaceutical tourism. They're probably worried about Big Pharma launching a Tomahawk missile strike on them or something.
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It's OK, I have a fallback plan... I just continue to live in Canada.
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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.
Honest question: If the US had the same laws as India, would the drugs exist? If everything were government funded or if wild success did not necessarily mean wild profits, do you think we'd get the same quality results?
Both drugs were developed in New Jersey.
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A better question might be, "If the drugs were developed in New Jersey, then why does a smaller percentage of Hepatitis C patients in the US have access to them than Hepatitis C patients in India?"
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citation: http://www.huffingtonpost.com/... [huffingtonpost.com]
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And what would India have to pay if the US consumers weren't subsidizing that price?
Fundamentally, the Western (and increasingly the rest of the world) has a problem with medicine: we are capable of amazing feats of medicine and healing. At what point do we have the courage to start deciding what human lives are worth?
1) Yes, we can save that hemophilic fatally allergic-to-everything crack child. It'll only cost $300,000 a year in constant hospitalization, therapy, and treatments. And if we're lucky, the
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India has started limiting access to these drugs to Indian citizens.
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The US subsidizes healthcare for the rest of the w (Score:5, Informative)
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-... [ibtimes.com]
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.
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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
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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.... [tharawat-magazine.com]
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.
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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.
I'm shocked the drug companies are so greedy (Score:5, Insightful)
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.
The cost of drugs for rare diseases? (Score:5, Insightful)
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.
Is it morally right to force other people to pay (Score:2)
I'm asking loaded questions here. I'm in favor of single payer because it's part of civilization. And I'm in favo
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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 tot
Arithmetic (Score:2)
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.
Americans want everything for nothing. (Score:2)
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
Hello, death panels (Score:2)
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.
Who's pushing this narrative? (Score:2)
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
Corporate Greed is the root (Score:2)
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
what the unholy &^%$#!!!! (Score:3)
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Right, medical liberty. The freedom to either pay $300k per year for treatment, or die. Give me liberty and give me death, right?
Re:Stupid summary is STUPID (Score:4, Interesting)
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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
Re:Attn Americans (Score:5, Interesting)
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.
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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 th
Re:Attn Americans (Score:5, Interesting)
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.
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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.
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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.
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So the answer is simple. TAx the living fuck out of the man. Set a base rate where taxes are progessive, but anything over that, and the tax rate goes up to 99%.
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You mean tax rates before Reagan broke things? Where the economy was still great and we didn't have nearly the wealth disparity we do now? Not possible
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So if Edward M. Kaye made something you think is more reasonable, like...$20,000 a year ($10/hr), and your $50k drug is now let's see... (($4,396,696 - $20,000) / 7,100,000,000) is $0.0006, so it's now $49,999.9994 then you'll be happy?
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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 ultim
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Yes. People in the USA are being forced to subsidize the development of drugs for the entire rest of the world.
How can a drug that sells for $800 in one place cost $50,000 in the USA? Because the U.S. federal government makes it illegal to import or re-import that drug, or any prescription drugs. Repeal this ban and the price discrepancies disappear. Drug prices in the USA would fall quickly and dramatically.
The problem isn't with the development model. The problem is government.