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

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

#101

Post by cmdrfred » Fri, Sep 16, 2016, 4:54 PM UTC

Retric wrote: post #83

rayiner wrote: post #81

Earlier quoted context omitted.

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.

I work for a medical group that does just this. It is indeed possible and profitable. You just have to pay taxes on earnings.

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

#102

Post by vonmoltke » Fri, Sep 16, 2016, 4:55 PM UTC

bradleyjg wrote: post #39

pravda wrote: post #32

Earlier quoted context omitted.

>How can any article about this issue not mention the word "patent" anywhere? Because there is no patent here. That is why.

Patents do play a role here, though not the largest role. Both Teva Pharmaceuticals and Sandoz were sued when for patent infringement when they announced plans to introduce competitors to Epipen. [1] https://www.bloomberg.com/news/articles/2012-04-26/mylan-pfi... [2] http://www.law360.com/articles/181459/king-pharma-sues-sando...

They were, if I understand the background correctly, trying to make a workalike competitor, which King/Mylan asserts they cannot do without violating a patent on the current EpiPen injector. The only thing stopping them from making a non-workalike is getting doctors to prescribe it instead of EpiPen, since pharmacies can't autosubstitute in that case.

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

#103

Post by mindslight » Fri, Sep 16, 2016, 4:55 PM UTC

rayiner wrote: post #77

codegeek wrote: post #70

Earlier quoted context omitted.

It is not possible in the current setup, yes. But if there was no insurance company to deal with for little things like X-Ray, that's the question. Why is transparent pricing so difficult for a hospital management to come up with if they don't have to answer to an insurance company OR even the Govt. for that matter ? Private Hospitals are mostly run like a business anyway so why not this part ? The status quo is not…

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.

Those hospitals' standard rates should be paid by direct reimbursement from the government at their set rate. In the event they're out of line with the expected market (no idea what that distribution looks like, but obviously there would be one), then the hospital would be investigated for price gouging all their customers (as customers of this industry are less able to shop around).

The problem we have here is the exact same problem as with taxis/Uber (and telcos somewhat. and actually that public code thread we argued about the other day, too). Rather than just directly subsidizing infrastructure for poor people, governments enticed businesses to provide some service at a loss by giving them special privileges across the board. As the market finds more efficient solutions, the reality disconnect becomes painfully apparent. Market consumers grow sick of the incumbents' overhead, while simultaneously the businesses gradually renege on their unprofitable obligations.

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

#104

Post by convolvatron » Fri, Sep 16, 2016, 5:01 PM UTC

mhb wrote: post #71

fjejfjrjdjc wrote: post #66

I've been waiting to see a neurologist for a serious and worsening vision problem since May. For those keeping track, that's four and a half months. So between these high drug prices and low healthcare availability, why exactly are we so afraid of single payer again?

How does single payer create an incentive for increasing the neurologist supply?

I don't think anyone is suggesting that the doctors are making out like bandits here. Of course they do quite well, and since they are providing most of the value in the equation, every seems to be pretty happy about that.

Insurance companies don't practice neurology.

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

#105

Post by rayiner » Fri, Sep 16, 2016, 5:03 PM UTC

criddell wrote: post #98

rayiner wrote: post #65

Earlier quoted context omitted.

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.

It's very relevant. With the incentives in place now, the most profitable thing a drug company can do is alter an existing drug enough to extend patent protection for as long as possible. It's sleazy. Are you not bothered at all about the EpiPen situation? Martin Shkreli doesn't make you angry? A pharmacologist friend once told me that the best way for a drug company to get a customer for life is to make sure they do…

They can't "extend patent protection" for the drug. Only the improvement. The existing drug loses patent protection.

And no, the Epipen thing doesn't bother me. It's narrow minded to think about issues one crisis at a time. The only question is: how do you create a system with the proper incentives? At the end of the day, Mylan runs a very capital intensive business and has a profit margin about half what Google or Apple do. I think it creates perverse and absurd incentives for it to be more profitable to be in the advertising business than to be in the business of saving lives. That's the bottom line.

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

#106

Post by GordonS » Fri, Sep 16, 2016, 5:04 PM UTC

FireBeyond wrote: post #90

rayiner wrote: post #65

Earlier quoted context omitted.

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 alternativ…

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

I believe it's also allowed in New Zealand.

But I totally agree with you, it's a ridiculous practise

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

#107

Post by fjejfjrjdjc » Fri, Sep 16, 2016, 5:06 PM UTC

witty_username wrote: post #97

fjejfjrjdjc wrote: post #88

Earlier quoted context omitted.

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

So? Money is a representation of human effort. Nobody wants to work for free or invest for 0% gain. Is there a reason you think the price should be lower? (remember people working need money too)

If you had studied economics, you would know that profit and income are fundamentally different concepts. The existence of profit (rather than breaking even) implies a market failure.

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

#108

Post by unprepare » Fri, Sep 16, 2016, 5:06 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.

which would be completely solved by single payer would it not?

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

#109

Post by ceejayoz » Fri, Sep 16, 2016, 5:22 PM UTC

witty_username wrote: post #96

ceejayoz wrote: post #91

Earlier quoted context omitted.

> The government will spend more money, but the public will get it for free. You know where the government gets its money, right?

So what if taxpayers are paying for it? Companies need to make a profit. Is there a specific reason why the price is unreasonable? (don't anchor the previous price)

> So what if taxpayers are paying for it?

People are not getting it for free, as you argued.

> Is there a specific reason why the price is unreasonable?

It is a clear case of price gouging and a harm to public health.

> (don't anchor the previous price)

Do I get to forbid you from making arguments too?

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

#110

Post by sseagull » Fri, Sep 16, 2016, 5:31 PM UTC

bradleyjg wrote: post #100

JustSomeNobody wrote: post #89

Earlier quoted context omitted.

Honest question, how is Nexium a scam?

Omeprazole is a mixture of two mirror image molecules. One of the two versions is the active and the other isn't (for 97% of the population). When the patent was running out on omeprazole AstraZeneca patented esomeprazole, which is just the active isomer. In order to show improvement over omeprazole they did clinical trials that used a higher effective dose of esomeprazole than omeprazole. The FDA, for reasons unknow…

>One of the two versions is the active and the other isn't (for 97% of the population)

My understanding is that the inactive form is actually metabolized into the active form by the body.

There is some argument that this happens differently in different people. But if AstraZeneca knew this (which they almost certainly did), why didn't they release esomeprazole at the beginning? They released omeprazole first, then sat on esomeprazole until the omeprazole patent was about to expire. It's obvious why they would do that.