EpiPen Maker Quietly Steers Effort That Could Protect Its Price • Hacker News Board

Re: EpiPen Maker Quietly Steers Effort That Could Protect Its Price

#81

Post by rayiner » Fri, Sep 16, 2016, 4:01 PM UTC

bradleyjg wrote: post #79

rayiner wrote: post #77

Earlier quoted context omitted.

Are we going to allow doctors and hospitals to turn away anyone who can't pay the advertised rates? Like we allow every other business to do? And will we require Medicare and Medicaid to pay those advertised rates, without the discounts they currently get? Jose are the things that force cross-subsidization.

The hospitals that are covered by EMTALA (duty to treat) are those that "receive federal assistance, maintain charitable nonprofit tax status, or participate in Medicare". A hospital is free to get off the federal government gravy train if it thinks it can make more money that way.

You can't have the government distorting the market by bringing half of all potential customers under a single taxpayer-funded system then pretend that hospitals have a real choice in whether to participate in those programs.

Re: EpiPen Maker Quietly Steers Effort That Could Protect Its Price

#82

Post by astockwell » Fri, Sep 16, 2016, 4:05 PM UTC

rayiner wrote: post #64

codegeek wrote: post #50

Earlier quoted context omitted.

This. Exactly This. I am sick of hearing "oh you just pay $20 co-pay". No we don't. The real cost is much more and these pharmas and insurance companies know it. I know because I paid it for a family of 4. It costs $1500/Month for a decent plan that does not have high "out of pocket" costs (Read capped at $5000). So you pay $1500 per month and in worst case scenario, you can still pay $5000 out of pocket for a year I…

Transparent medical pricing is not possible so long as hospitals have an obligation to treat sick people whether or not they can pay. Hospitals heavily cross subsidize between insured, uninsured, and Medicare/Medicaid patients. As long as we put expectations on doctors and hospitals that compel them to do that, they cannot provide transparent pricing.

THIS. Many Americans don't seem to realize we already have a "socialized" medical system - everyone paying into everyone else's costs - it's just that it's brokered by private companies instead of the gov't. Which means that it's less transparent, less regulated, and subjected to a bigger rake [1] than if it was run by the gov't.

[1] https://en.wikipedia.org/wiki/Rake_(poker)

Re: EpiPen Maker Quietly Steers Effort That Could Protect Its Price

#83

Post by Retric » Fri, Sep 16, 2016, 4:07 PM UTC

rayiner wrote: post #81

bradleyjg wrote: post #79

Earlier quoted context omitted.

The hospitals that are covered by EMTALA (duty to treat) are those that "receive federal assistance, maintain charitable nonprofit tax status, or participate in Medicare". A hospital is free to get off the federal government gravy train if it thinks it can make more money that way.

You can't have the government distorting the market by bringing half of all potential customers under a single taxpayer-funded system then pretend that hospitals have a real choice in whether to participate in those programs.

Many are not part of the system, so they really do have a choice. Granted, location is a big part of this, and it's much simpler to operate this way when population density is high and there are other hospitals in the area.

Re: EpiPen Maker Quietly Steers Effort That Could Protect Its Price

#84

Post by warfangle » Fri, Sep 16, 2016, 4:08 PM UTC

maxerickson wrote: post #41

warfangle wrote: post #40

Earlier quoted context omitted.

Forbes trots out an interesting figure: $2.6bn to win FDA approval for a new drug. That sounds like a lot! It also sounds like a number pulled from a hat. So I went looking. It's from a Tufts Center for the Study of Drug Development study published in 2014 [0]. Which is, incidentally, supported financially by the pharmaceutical industry [1]. Even the published pdf is pretty lacking on actual data [2]. Because it's a…

The studies of marketing spending are usually just as disingenuous, reporting the "Selling, general and administrative" line item from annual reports as the amount spent on marketing. But that line item includes things like salaries and office space and such, things that the company has to do to sell products which are not advertising. Marketing spending is huge, but it undermines their message when they do that.

And the US is the only developed country where pharmaceutical companies are allowed to advertise specific drugs.

Re: EpiPen Maker Quietly Steers Effort That Could Protect Its Price

#85

Post by draker » Fri, Sep 16, 2016, 4:08 PM UTC

mrb wrote: post #23

lettergram wrote: post #5

Having multiple deadly allergies and needing to purchase EpiPens regularly, their price doesn't seem outrageous to me. I pay about $10 a pen, insurance pays about $100 per (even after the price increase). That being said, people rarely use this drug. $100 to save your life once a year or so kind of seems like a fair trade. This seems more like the media is outraged as opposed to the country. All my friends don't even…

"I pay about $10 a pen, insurance pays about $100 per (even after the price increase)." You don't have your facts straight and seem unaware of the more recent increases . The price for a set of 2 pens was: $103.50 in 2009 $264.50 in July 2013 $461.00 in May 2015 $608.61 in May 2016 Source: http://well.blogs.nytimes.com/2016/08/22/epipen-price-rise-s... You say you + your insurance pay $110 per pen, so $220 for a set,…

>you seem to be paying the price as of right before May 2015, and you haven't bought a pen since then. You might be in for a big surprise next time you have to buy one.

Express scripts co-pay has only gone up $0.45 in that time.^1

>Express Scripts says it has been able to hold costs steady for its members: its commercially insured population has seen their co-payments for EpiPen go from $73.05 in January 2015 to $73.50 in July 2016, even though the price of EpiPen rose by 51% over that period of time.

[1]http://www.forbes.com/sites/matthewherper/2016/08/30/the-con...

Re: EpiPen Maker Quietly Steers Effort That Could Protect Its Price

#86

Post by davidf18 » Fri, Sep 16, 2016, 4:11 PM UTC

The solution to the cost problem is for competition to enter the market. It is my understanding FDA has in some way restricted market entry as competing firms (eg, generic giant Teva) come up with a device acceptable to the FDA.

Re: EpiPen Maker Quietly Steers Effort That Could Protect Its Price

#87

Post by anexprogrammer » Fri, Sep 16, 2016, 4:16 PM UTC

a_humean wrote: post #63

gizmodo59 wrote: post #43

Earlier quoted context omitted.

One of the things I do not understand is, the explanation given is that Obamacare fixes the donut hole where people who are not enrolled in company sponsored/medicare could get insurance. This has just let the drug companies to raise the price without any backslash because the end user is "not" paying the price. However, the rising premiums and plans with high deductibles meant that the drugs are still not affordable…

What literately every other country does: Old fashioned price controls. Government as a buyer or as a regulator puts a cap on the price through a process of negotiation, and be willing to say no when the price is too high and the benefits are too low. The UK's NICE body regularly rejects new products if they don't represent value. New cancer drug that extends life by two months but costs £10k per pill with a course o…

There was a programme on R4 about NICE, drug companies and finance in health care a month or two back. I discovered two new (to me) things. First it's common for drug companies to tweak patent protected items suspiciously near end of patent - to find a new use, or reformulate a tablet as a capsule - to buy more patent period.

Second in the case of off patent medicines, some are harder to make or not prescribed widely enough for the generic makers to bother with. These seem to be the things at risk of price gouging. There was an example of something off patent sold by Pfizer to another company who now charge 10x more, as there is no generic alternative. That's now at the competition authorities.

So we mitigate a lot of this, but we apparently don't avoid it entirely.

EDIT: Programme page with mp3: http://www.bbc.co.uk/programmes/b07j7j6m

Re: EpiPen Maker Quietly Steers Effort That Could Protect Its Price

#88

Post by fjejfjrjdjc » Fri, Sep 16, 2016, 4:17 PM UTC

rayiner wrote: post #78

fjejfjrjdjc wrote: post #73

Earlier quoted context omitted.

By turning healthcare into a humanitarian mission instead of a business venture. My local clinic is for-profit and found that it made better business sense to only have the most rudimentary neurology department possible since it tends to be expensive. Instead they focus on their financial bread and butter like flu shots and annual checkups.

Humanitarian missions and charity are notoriously ineffective at achieving real change. See, for example, the utter failure of aid organizations to achieve any fundamental changes in Africa. Meanwhile, big drug companies and their anti-retro viral cocktails changed the course of the AIDS epidemic there almost overnight.

And yet I continue to go untreated thanks to the profit motive...

Re: EpiPen Maker Quietly Steers Effort That Could Protect Its Price

#89

Post by JustSomeNobody » Fri, Sep 16, 2016, 4:22 PM UTC

bradleyjg wrote: post #17

maxerickson wrote: post #4

Does the FDA have the authority to deny marketing approval for minor improvements? Mylan pushed generics off the market by making a better cap or something, the FDA should just say no, that improvement is nice but it isn't enough to give you exclusive marketing rights. If you want to incorporate it into your product, license it to your competitors for cheap.

>> Does the FDA have the authority to deny marketing approval for minor improvements? They certainly don't. Look at Nexium, it is something close to a blatant scam but the FDA approved it and between Medicare and Medicaid alone the federal government has rewarded the scammers (AstraZeneca) with billions of dollars never mind private insurance companies.

Honest question, how is Nexium a scam?

Re: EpiPen Maker Quietly Steers Effort That Could Protect Its Price

#90

Post by FireBeyond » Fri, Sep 16, 2016, 4:23 PM UTC

rayiner wrote: post #65

criddell wrote: post #60

Earlier quoted context omitted.

Maybe they should fold the R&D department into the marketing department. That's where all the drug company money is spent.

The fact that companies often spend more on marketing than R&D is irrelevant. The fact is that they spend billions on R&D. They have to recoup that. Presumably they don't spend money on marketing for shits and giggles--they spend how much they need to maximize revenue.

Ask yourself, why is the United States the only country in the world where advertising prescription medicine to consumers is allowed?

Why is it even needed? I know some people say "education", but that's backward.

You have a problem. You go to your physician. He works out a treatment plan for you.

For drugs advertised for specific conditions? To enlighten you to alternatives? You can oftentimes assume that alternatives exist, for most common complaints.

For those that don't? Those ads are such a dragnet of wide ranging and vague conditions that oftentimes, the majority of the population would qualify ("Are you feeling run down? Do you have trouble getting to sleep? Ask your doctor about trying XXX". No. Ask your doctor about your conditions. Let them decide whether to try XXX. Or YYY. Or just to get more sleep).

There's no justifiable need that I can see that prescription medication need be advertised to anyone other than physicians and practitioners.

Oh, and it's not "often" that they spend "more". There is not one of the top ten pharma companies that spends more on R&D than marketing. Every one outspends on marketing. And by "more", the smallest gap is "four times more" leading up to "seventeen times more".

And we wonder why healthcare is so expensive here...