EpiPen Price Rise Sparks Concern for Allergy Sufferers • Hacker News Board

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#341

Post by grandalf » Tue, Aug 23, 2016, 10:01 PM UTC

vibrio wrote: post #315

grandalf wrote: post #297

Earlier quoted context omitted.

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 formu…

> i'm not sure why the price will stand in the long term.

I think the system we have leads to partial collusion, since all firms have an incentive to keep prices high and share the market two or three ways. If there were 30 or 40 pharma companies competing it would be a different story.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#342

Post by tcbawo » Tue, Aug 23, 2016, 10:13 PM UTC

skywhopper wrote: post #281

usefulcat wrote: post #278

Earlier quoted context omitted.

> 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...

You can be sure that Wellpoint has also negotiated a good rate on Epi-pens. This price-gouging affects people who don't have prescription drug coverage or those who are enrolled in HSA plans that force you to pay for the first few thousand dollars worth of prescriptions at retail prices. And there are a lot of people being funnelled into HSAs by their employers.

My children have a need for epipens. With our insurance, it is still prohibitively expensive. After hearing about the cost in GB, I'm considering making a trip to London to stock up

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#343

Post by tcbawo » Tue, Aug 23, 2016, 10:21 PM UTC

clarkmoody wrote: post #310

norea-armozel wrote: post #264

Earlier quoted context omitted.

You know what's weird about this situation is that often I've been told by people here in the US that the price NHS and other single payer systems pay is only possible because we here in the US supposedly pay for it at the free market price. I don't believe that myself since it wouldn't make much sense to say that the prices would plummet to such a degree as to be unprofitable. But I do wonder how much of the price w…

> we here in the US supposedly pay for it at the free market price The free market price system does not work in American healthcare because we do not have a free market. Healthcare is one of the most heavily regulated industries and the third-party payment system means that consumers are divorced from the price mechanism.

As a consumer of epipens, I can assure you that we are not divorced from the price mechanism. We are talking about $300+ a unit for a dispenser (the drug itself costs pennies). The time needed for competition to manifest in the market will cause much suffering.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#344

Post by tcbawo » Tue, Aug 23, 2016, 10:31 PM UTC

radu_floricica wrote: post #317

clavalle wrote: post #305

Earlier quoted context omitted.

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.

Are there any cases of a small company attempting this? Since the drug is well known and cheap, I was hoping to read about hackers designing an open source 3D printed dispenser.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#345

Post by tcbawo » Tue, Aug 23, 2016, 10:39 PM UTC

clarkmoody wrote: post #301

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…

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)

Our entire medical system was founded as a reaction against snake oil salesmen and quacks who preyed on desperate people. If you support capitalism and the free market in medicine, you must acknowledge that monopolies can and do arise.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#346

Post by maxerickson » Tue, Aug 23, 2016, 10:42 PM UTC

gwright wrote: post #339

maxerickson wrote: post #304

Earlier quoted context omitted.

I don't think it is a massive regulatory failure to have the pharmacy dispense a product with matching use instructions to the product that is prescribed. So it's the market that has doctors prescribing $600 Epipens instead of the $150 alternative (that has different use instructions and thus cannot be used to fill a prescription for an Epipen).

Isn't this just another example of a problem created by the rules/regulations? A pharmacist is forbidden from providing the $150 alternative even if the customer specifically requests it (because of the prescription requirement and rules). For those who need epinephrine injectors, can't they just ask their doctors to prescribe Adrenaclick? What prevents that from happening? I'm guessing it is insurance guidelines tha…

It's marketing. I saw some discussion on social media, people expressed a preference for the Epipen because they expected other people to be more aware of how to use it.

Same with parents, they expect the school nurse to be more familiar with the Epipen (and I guess the other way around, the nurses prefer Epipen because they are familiar with it).

If asking the pharmacist for a specific type of injector isn't onerous then neither is asking the doctor.

I'm willing to concede that US medical regulation has lots of problems, but there is also clearly some problems with the way people in this market are behaving. Patients should care about saving $1000-$1500. Doctors should care about saving their patients $1000-1500.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#347

Post by tcbawo » Tue, Aug 23, 2016, 10:50 PM UTC

hkmurakami wrote: post #50

mikeash wrote: post #35

Earlier quoted context omitted.

Dying because you can't afford a device you need is also not something to take lightly. It may not be a good idea, but blame should lie with the manufacturer for raising the price to such ridiculous levels.

Not condoning this behavior at all, but don't we see this with the lack of equal access to drugs all the time? :(

It seems especially egregious when we are talking about a dispenser versus the drug itself.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#348

Post by gwright » Tue, Aug 23, 2016, 11:09 PM UTC

maxerickson wrote: post #346

gwright wrote: post #339

Earlier quoted context omitted.

Isn't this just another example of a problem created by the rules/regulations? A pharmacist is forbidden from providing the $150 alternative even if the customer specifically requests it (because of the prescription requirement and rules). For those who need epinephrine injectors, can't they just ask their doctors to prescribe Adrenaclick? What prevents that from happening? I'm guessing it is insurance guidelines tha…

It's marketing. I saw some discussion on social media, people expressed a preference for the Epipen because they expected other people to be more aware of how to use it. Same with parents, they expect the school nurse to be more familiar with the Epipen (and I guess the other way around, the nurses prefer Epipen because they are familiar with it). If asking the pharmacist for a specific type of injector isn't onerous…

Well in a perverse sort of way, the $600 price tag is certainly one way to motivate patients to demand alternatives from their doctors and insurance companies.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#349

Post by vonmoltke » Wed, Aug 24, 2016, 1:06 AM UTC

ascorbic wrote: post #316

usefulcat wrote: post #278

Earlier quoted context omitted.

> 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.

Actually, the big problem in the US is that there are no alternatives. The last Mylan competitor making a similar product folded six months ago. If you want to blame anything about the US system for the current situation, blame the regulatory capture that is generic drug approval.

What does the NHS do about drugs that are sole source?

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#350

Post by vonmoltke » Wed, Aug 24, 2016, 1:28 AM UTC

infinite8s wrote: post #237

toomuchtodo wrote: post #29

Earlier quoted context omitted.

Scarcity demands innovation. I don't think its being taken lightly; more like, "a private company is gouging medical users and the government won't step in". Not left with many options when your life depends on it. EDIT: Alternatively, a "better" temporary solution would be to arrange for the import of these from Canada, where the price is fixed by the government.

Well the cheaper and more effective solution would be to carry around a syringe and a small bottle of epinephrine.

That's an alternative, but is more complicated and the vials of epinephrine only have a shelf life of three months vice twelve to eighteen for the EpiPens.