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EpiPen Price Rise Sparks Concern for Allergy Sufferers

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Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#311

Post by rangibaby »

cjbprime wrote: post #290
rangibaby wrote: post #209

Earlier quoted context omitted.

When the difference is $1 vs $600, I think a lot of people would be willing to take that risk, especially for something that is basically an unexpected expense; I doubt any allergic people are getting stung by bees on purpose. Most people I know couldn't handle a sudden $600 expense like a car repair without help from someone like their parents (I'm mid-20s living in JP).

> When the difference is $1 vs $600, I think a lot of people would be willing to take that risk, especially for something that is basically an unexpected expense; I doubt any allergic people are getting stung by bees on purpose. What probabilities are you assigning to needing the printed epipen to survive, and to it functioning correctly, such that it's worth that risk?

I get where you're coming from. I guess my point was that to most people $600 might as well be $6,000 or $6,000,000, since that's not something they can afford on their own. At that point, the dollar version is (hopefully) better than nothing.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#312

Post by grandalf »

clavalle wrote: post #309
clarkmoody wrote: post #301

Earlier quoted context omitted.

Thank you. This is a problem that starts and ends with government, not with the "free market" (which hasn't existed in the healthcare industry in a long time)

The problem is how does the free market test these kinds of things when there is every incentive to cut corners? We're not talking about toasters. How many people have to die before the market reacts? How much research into individual company's testing should a person do in order to buy an epipen?

> The problem is how does the free market test these kinds of things when there is every incentive to cut corners?

The same incentive that makes the iPhone or Model S such poor quality?

We don't know the name of the epi pen manufacturer because it does not need to develop a brand reputation, all it needs to do is reach a deal with regulators and collect profits.

There is much room for a combination of public and self-interested private watchdog groups. There is no reason why we must rely on only one quality control approach.

If things go poorly it can simply sell the patent to another firm who can repeat the same strategy, the only risks being that someone will come up with a better treatment or that regulators will take a dislike to the company... The second of these risks can be reduce through revolving door strategies and the standard regimen of fancy meals, etc.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#313

Post by clarkmoody »

clavalle wrote: post #309
clarkmoody wrote: post #301

Earlier quoted context omitted.

Thank you. This is a problem that starts and ends with government, not with the "free market" (which hasn't existed in the healthcare industry in a long time)

The problem is how does the free market test these kinds of things when there is every incentive to cut corners? We're not talking about toasters. How many people have to die before the market reacts? How much research into individual company's testing should a person do in order to buy an epipen?

Let's talk about a free market.

> every incentive to cut corners

Do you continue to patronize businesses that cut corners when you expect good customer service or a good product?

The free market ruthlessly punishes businesses that do not meet consumer demands. Only through government interference are substandard businesses sustained. Profits are the signal that a business is doing something right.

Ok, but the EpiPen is a life-or-death product. We must have coercive government regulation, right?

> How many people have to die

As far as a quick search could turn up, it looks like the discovery and isolation of epinephrine was entirely the product of private ingenuity -- in 1901. Government did not have some large project to find this wonder compound that could save lives. So private initiative already has saved countless lives without the direction of the government.

So here is a compound that has been around for 115 years, and somehow we're looking at $600 for a two-pack of injectors. There is no way that situation arises from free-market processes. Government has been heavily involved in healthcare for a while, granting monopoly privilege to favored parties, effectively eliminating competition.

Additionally, if a company sells a product purporting to save your life in a dire situation, shouldn't they be held liable if their product doesn't work? Not only will people cease to trust said company (forcing them out of business) but competitors will also arise -- and survive -- based on how well they serve consumers.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#314

Post by JoeAltmaier »

Cyph0n wrote: post #28
gmisra wrote: post #18

One of the early on-line responses was "maybe we can figure out how to 3D print these cases". It turns out that an Epi-pen is just a plastic safety housing around a normal syringe. Some discussions: https://www.reddit.com/r/news/comments/4y5481/cost_of_epipen... https://www.reddit.com/r/3Dprinting/comments/4y7f26/epipen_f...

That second discussion got heated quite fast. I agree with the downvoters though. 3D printing a medical device is not something to take lightly. Edit: Here's why I agree. You download this design from the internet, and 3D print the parts. You then assemble it. Awesome! Some time later, you get an allergic reaction. You use the pen, but it fails to work correctly. Who's responsible? The designer? You (if you're alive)…

Liability isn't (shouldn't be) the first concern in health discussions. Presuming an individual cannot afford the $600 version, surely the chance that a printed version might work is purely an improvement in their situation.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#315

Post by vibrio »

grandalf wrote: post #297
vibrio wrote: post #291

Earlier quoted context omitted.

First: I don't disagree with you about price gouging and the need for a solution. i spend time awake at night thinking about it. Considering COGS in Biologics drugs pricing is a logical fallacy. The $10 is irrelevant. You have to amortize in all the time, and expenses required to establish a sterile fill and finish facility, or the required capacity of a new product in an existing facility. A reasonable accountant wo…

Your point about R&D is valid, but in this case epi was first synthesized in 1895 and the R&D cost has long since been amortized and the IP is in the public domain. http://www.patent-invent.com/adrenaline_patent.html This article suggests that it was in fact a very shrewd business plan: http://www.bloomberg.com/news/articles/2015-09-23/how-market...

The relevant IP isn't the active pharmaceutical ingredient but the formulation and delivery method, and that appears to be out to 2035. http://www.accessdata.fda.gov/scripts/cder/ob/results_produc...

http://www.accessdata.fda.gov/scripts/cder/ob/patent_info.cf...

I agree it's a good business plan as a solo participant in the market, but as a second or third entrant, probably less so-- depending on IP around the formulation and delivery method. With the number of company with discontinued products in the Orange book, i suspect there is some economic burden.

that said there seems to be therapeptic equivalents available http://www.parsterileproducts.com/products/products/adrenali... so unless there is collusion, or a supply constraint, i'm not sure why the price will stand in the long term.

(also is don't have expertise in this specific disease/drug so my comments could all be wrong).

EDIT: i just realized i put int he IP links for PAR Pharma's product... i'm not sure what mylan's protection is but i have to get to work....)

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#316

Post by ascorbic »

usefulcat wrote: post #278
treebeard901 wrote: post #269

Earlier quoted context omitted.

It is possible that both can be true. The price for medicine is cheaper because you have a single entity, the NHS, negotiating for a large group of people. On the the other hand, it is possible that we subsidize the development of new medicine to an extent. An epipen would otherwise exist regardless because it is a requirement for many people. More advanced medicine that requires a large capital investment for resear…

> The price for medicine is cheaper because you have a single entity, the NHS, negotiating for a large group of people. Wellpoint and its subsidiaries insure more than 70 million people, which is slightly more than the current population of the UK. https://www.thebalance.com/the-big-five-health-insurance-com...

Their negotiating position is probably limited by the fact they can't say that they just won't buy it. NICE evaluates all treatments bought by the NHS for value for money. If it was too expensive they'd just not buy it. It's not like there are no alternatives.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#317

Post by radu_floricica »

clavalle wrote: post #305
grandalf wrote: post #292

Earlier quoted context omitted.

> a market trial and error approach seems a little barbaric. The average American earns less in a week than the cost of one epi pen. No, "nonfarm" statistics don't apply since people who work on farms still need epi pens. > It makes sense for the government to step in when something goes wrong. What has gone wrong in this case? The protected cronies of regulators are making a tidy profit after spending years cozying…

So, what is the market solution? All I see is a restatement of the problem.

There is no market solution because it's not a market problem. If you try to make your own epi pen and sell it, the nice men with guns come and take you to jail. Literally.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#318

Post by JshWright »

retSava wrote: post #217
JshWright wrote: post #154

Earlier quoted context omitted.

I don't understand why a prepackaged vial/syringe kit isn't readily available for epinephrine. It works just fine for glucagon... http://www.childrenwithdiabetes.com/d_0n_022.htm We're literally talking about $1 worth of epinephrine, a $0.50 syringe, and a couple cents worth of injection molded plastic case...

Probably because that is not what matters. With the epipen, I can just jam it into my daughters thigh, straight through thick winter clothing and all. I don't need to ensure she gets the dosage right, nor that the syringe doesn't break.

My point is that with a very slight increase in the complexity of the process, you could have a _dramatic_ reduction in cost.

New York State is actually in the process of transitioning EMTs from EpiPens to vial/syringe kits.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#319

Post by aianus »

makomk wrote: post #224
gwright wrote: post #128

Earlier quoted context omitted.

The non-trivial entry costs are there because of regulations and the legal environment regarding liability. You can view the high price as the free-market finding the intersection of supply and demand given the regulatory and legal constraints but that seems like a less than useful way of understanding 'free-market'.

Suppose there were no regulations and no liability for manufacturers. Would you really trust your life or your kid's life to some unregulated clone of the EpiPen that may or may not actually work properly when needed, knowing that if it went wrong the manufacturer wouldn't even have to pay one cent of your medical bills and didn't have to worry about liability for screwing up? I suspect not.

You would if you literally didn't have $600 for the brand name version.

Maybe $600 is an amount that everyone can get with some sacrifice but there are other drugs/devices/procedures that cost $10,000s or more where people just have to go without because they're not allowed to take a chance on an unregulated alternative.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#320

Post by grandalf »

clavalle wrote: post #305
grandalf wrote: post #292

Earlier quoted context omitted.

> a market trial and error approach seems a little barbaric. The average American earns less in a week than the cost of one epi pen. No, "nonfarm" statistics don't apply since people who work on farms still need epi pens. > It makes sense for the government to step in when something goes wrong. What has gone wrong in this case? The protected cronies of regulators are making a tidy profit after spending years cozying…

So, what is the market solution? All I see is a restatement of the problem.

It's not necessarily an all-or-nothing solution.

Consumers value accurate information about drug safety, so there is abundant incentive for a wide variety of different groups to offer a list of safe drugs.

Since most Americans also interface with a private health insurance company and often private medical groups or hospitals, it's not just the individual who determines which safe list to trust.

For example:

Ronald's cardiologist might trust a safe list produced by a professional organization of cardiologists. Ronald's wife may be from the UK and trust the UK's trusted list. Ronald may be a customer of Aetna which may use its own list.

If Ronald is prescribed a particular drug, he can verify that it's listed on any lists he cares about. Perhaps he's recently gotten interested in Anti-Vaxer lore, and the drug is blacklisted by his group. He can go back to his doc and request another option. The same would happen if Aetna hasn't added the drug to its formulary (for whatever reason).

Ronald may also be cost conscious and may also have a safe list of highly economical drugs, and may ask his doctor about the implications of choosing a far less expensive option that was popular in the 1970s. This drug may have been removed from Aetna's list due to influence from the pharma industry, but Ronald and his doctor can look at the available information and make an informed decision.

With pharmaceuticals we're talking about a very simple blacklisting or whitelisting scheme. Most well-known drugs are quite well understood. The "important" area for making the white listing (or blacklisting) decision lies mostly with brand new drugs. It's silly to think that a single entity can somehow merge the interests of young and old and derive a safe period of time for a drug to stay off the market. It's also important to recognize the intense pressure on regulators not to pull a drug that has already been approved and whose side effects may be a bit worse than initially understood (such as Vioxx).

So in a broad sense, the key is decentralization, to make corruption more costly, and focusing our trust at the local level to the docs who we trust with our care who can make an informed decision guided by whitelist/blacklist offerings from a variety of sources.

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