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EpiPen Price Rise Sparks Concern for Allergy Sufferers

well.blogs.nytimes.com

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Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#351

Post by vonmoltke »

maxerickson wrote: post #284
grandalf wrote: post #270

Someone might reasonably wonder why a federal task force is required to investigate "price gouging" for an item that contains under $10 of materials and is not mechanically complex. Why wouldn't an entrepreneur simply introduce a competing epi-pen design and bring it to market for $300 (for example) and undercut the price being charged by Mylan? We're told to hate the Martin Shkrelis of the world, and to resend the M…

There's a $150 alternative available. http://www.goodrx.com/adrenaclick

It's an alternative that a) requires a doctor to specifically prescribe and b) is not covered by most insurance plans. There is a good reason the articles on this subject are saying there are currently no alternatives, since there were drop-in replacements until earlier this year.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#352

Post by dang »

Ironchefpython wrote: post #307
eropple wrote: post #204

Earlier quoted context omitted.

> I assume at this point that you're being paid to shill some political viewpoint on the internet I don't agree with Walter on this issue, but a cursory Google of who you're talking to should indicate how ridiculous this statement is. You are profoundly out of line and you owe him an apology. (You'd owe anyone an apology, but this is particularly silly of you.)

> but a cursory Google of who you're talking to Right, there's more than one person on the planet with that name, and surely the actual inventor of the D language has better things to do with his time than go all Liberatard on the Internet arguing economics with strangers.

You've been an HN user for a few years, so we won't ban you for this, but the way you've behaved in this thread is bannably offensive, so please don't do it again—to anybody.

Specifically: no accusations of shillage to score points in an argument; no name-calling; and respect toward your fellow users, please, from now on.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#353

Post by dang »

Ironchefpython wrote: post #200

> selling service contracts, [...] The price is still $0 and there are still no regulations on it. I assume at this point that you're being paid to shill some political viewpoint on the internet, because you just explained that the price of software isn't actually zero, because it's unusable (to the customers that buy a service contract) without a service contract, and creating a company that employs the developers t…

Accusations of astroturfing or shillage without evidence are not allowed on Hacker News. An opposing view does not count as evidence.

Please also read my reply to you at https://news.ycombinator.com/item?id=12344369, because you've broken the HN guidelines badly in this thread.

We detached this subthread from https://news.ycombinator.com/item?id=12341638 and marked it off-topic.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#354

Post by hackuser »

incongruity wrote: post #247
hackuser wrote: post #102

Earlier quoted context omitted.

Consider also reliability: What if some 3D-printed part breaks? What if it sticks when it gets hot or cold, or after a few hot/cold cycles, or after some flexing in a pocket? The first 90% of quality is easy ... Think of the difference between the quality needed for a mobile game app and the software that flies airplanes.

If they're significantly cheaper, carry 2 or 3. If you're at a 90% level, you will be almost assured of cheaply having one work, assuming the error/failures are random. Yes, this is sub-optimal in a life or death situation, but it's a reasonable counter to unreasonably high EpiPen pricing. Moreover, if this becomes common practice or if it's even feared as plausible, it could help reduce EpiPen pricing.

> this is sub-optimal in a life or death situation

I think that rules it out. Imagine a family member, or anyone, dying because of your sub-optimal solution.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#355

Post by schmidty »

rdtsc wrote: post #192
Tiksi wrote: post #169

Earlier quoted context omitted.

Because then no one will manufacture it. You can't just will things into existence with unrealistic feel good rhetoric.

If the cost is $5 why wouldn't someone manufacture it then? > You can't just will things into existence with unrealistic feel good rhetoric. Why not? We've willed wars and consequent huge handouts to the military industrial complex. I am sure if we tried a bit we can will into existance some $30 EpiPens.

You might be able to coerce (by force) the world to give you what you want at the price that you want. But that doesnt mean it comes without a price. There is always a cost and many times, with governmental interference much of it is unintended consequences not immediately seen.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#356

Post by clavalle »

clarkmoody wrote: post #333
clavalle wrote: post #323

Earlier quoted context omitted.

>The free market ruthlessly punishes businesses that do not meet consumer demands. True. But only as ruthlessly as the market approaches the free market ideal (readily available and accurate information on products, other users, choice at time of purchase etc). And we know there are no true free markets and that markets can drift far from the ideal even absent of government interference. Who is the first to try out a…

> markets can drift far from the ideal even absent of government interference But only government interference can lock the market in that state in perpetuity, eliminating the corrective forces of price and competition. > Are we to believe that information asymmetry is all rooted in government interference? Of course not. But businesses that are able to satisfy more consumers through better transparency are going to…

>But only government interference can lock the market in that state in perpetuity, eliminating the corrective forces of price and competition.

Again a very strong statement with only faith that government is bad to back it up. Market power can become dominant in such a way that it can lock market distortions in as well. See: monopoly

>But businesses that are able to satisfy more consumers through better transparency are going to win market share and increase profits.

What about businesses that poison the environment in secret? This is also an information asymmetry that can exist that will earn greater profits right up until they are caught, if that day ever comes. I was using information asymmetry as one unavoidable aspect of pure markets that can lead to severe distortions completely apart from any kind of government interference since you asserted that only the government can sustain negative market distortions.

>> abundance of sustained profits is also a signal that the business is doing something wrong >What? Please explain.

If there is a great profit being made in a theoretical market approaching perfection then theory says competitors will enter that market, chipping away at that enormous profit until it is at a level that is still profitable but only so much as it is not worth it to further competitors to enter that market to capture even more. In other words, in a well functioning market profits tend toward (but never reach) zero.

If this is true then an abundant profit sustained over time is an aberration and evidence that the business is doing something wrong in terms of the health of the market (threatening or buying off potential competitors, for example).

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#357

Post by tqi »

grandalf wrote: post #340
seanp2k2 wrote: post #335

Earlier quoted context omitted.

Do we really expect every person to conduct such personal research for every single treatment to every single ailment they have? I don't consider that a reasonable solution.

It would be more of a checklist. Chances are there would not be much disagreement. Tylenol, for example, is likely to be whitelisted by nearly any list maker. The scenarios where there was a mix of approval and disapproval probably do warrant taking some extra time, yet few of us are able to do it today because we assume (falsely) that just because something is approved by the FDA it is safe (or unsafe if not approve…

How would one vet which lists are "true" and which lists can be "sponsored"? What would prevent corps from taking their lobbying money and simply directing it at list makers? How would the non-sponsored lists make their money?

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#358

Post by retSava »

JshWright wrote: post #318
retSava wrote: post #217

Earlier quoted context omitted.

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.

EMTs are not the target customer of epipens. They work with life-threatening situations day after day. To a kindergarten teacher, if a child if having an anaphylactic chock, this is very far from a "very slight increase in complexity".

Just to ground the situation, the kindergarten teachers at my daughters place are already freaked out from the thought of having to administer an epipen. I can't even start to imagine how they would handle a syringe and a bottle.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#359

Post by JshWright »

retSava wrote: post #358
JshWright wrote: post #318

Earlier quoted context omitted.

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.

EMTs are not the target customer of epipens. They work with life-threatening situations day after day. To a kindergarten teacher, if a child if having an anaphylactic chock, this is very far from a "very slight increase in complexity". Just to ground the situation, the kindergarten teachers at my daughters place are already freaked out from the thought of having to administer an epipen. I can't even start to imagine…

There are thousands of people out there who carry IM Glucagon kits, an similarly time sensitive medication, intended to be administered by untrained bystanders. If it works for Glucagon, I see no reason it can't work for Epinephrine. In reality, there's no need for a vial, the syringe can be prefilled with the correct dose.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#360

Post by maxerickson »

vonmoltke wrote: post #351
maxerickson wrote: post #284

Earlier quoted context omitted.

There's a $150 alternative available. http://www.goodrx.com/adrenaclick

It's an alternative that a) requires a doctor to specifically prescribe and b) is not covered by most insurance plans. There is a good reason the articles on this subject are saying there are currently no alternatives, since there were drop-in replacements until earlier this year.

It's still obviously a reasonable substitute for (at least some) patients with out of pocket costs above $150 for Epipens.

I do understand that people are concerned about the different usage instructions (for example the school nurse not realizing it needs to be used differently) and that doctors may be hesitant to prescribe it.

The thing I think is really interesting about the $150 generic Adrenaclick is that it puts some sort of ceiling on the regulatory costs and costs imposed by the other players in the health system.

The Mylan CEO did an interview this morning where they hand waved and equivocated and so on, but it's clear enough (based on availability of a $150 substitute) that they are setting the price based on their advantageous position in the market. I don't see any reason not to call them out on any BS where they try to deny that.

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