Why drug prices in America are so high (2016) • Hacker News Board

Re: Why drug prices in America are so high (2016)

#31

Post by chimeracoder » Mon, Mar 27, 2017, 4:19 PM UTC

refurb wrote: post #19

Apfel wrote: post #6

Earlier quoted context omitted.

If anyone's interested, England's system of health technology assessment (HTA) for the NHS is extremely transparent and world-leading. It's one of the things that we Brits should be extremely proud of (although pharma-sponsored sob story campaigns in tabloid newspapers may suggest otherwise). All new technologies are investigated in terms of incremental quality of life gain (vs current treatment norms) and changes in…

I would argue HTA is not without it's problems. That's why the UK has a cancer drug fund. NICE has said "no" to those drugs, yet the public still clammers for them. So a separate funding mechanism was created to pay for them.[1] [1] https://www.england.nhs.uk/cancer/cdf/

> I would argue HTA is not without it's problems. That's why the UK has a cancer drug fund. NICE has said "no" to those drugs, yet the public still clammers for them. So a separate funding mechanism was created to pay for them.

See also: PrEP. PrEP is available in the US (and covered by almost every private insurer[0] with drug co-pays covered by the manufacturer[1]). And while it's less convenient, there are public clinics where you can get prescriptions to avoid paying the co-pay to a GP. In other words, absent the cost of your time, you can get it in the US for free.

In the UK, PrEP is not covered by the NHS. The National AIDS Trust had to sue the NHS just to get them to announce their decision not to cover it - before that, they refused to make a statement one way or the other, and kept kicking the can down the road. Now, you can only get it by paying a private doctor (out-of-pocket) for a prescription, and then fill that prescription privately, which can cost up to $13/pill.

(This is technically not HTA, but for the purposes of this discussion that distinction isn't relevant.)

[0] And, as an aside, on the rare case that your insurer does not cover it, Gilead (the manufacuter) offers assistance programs that provide it essentially for free.

[1] This is a separate program to enroll in; Gilead basically reimburses the co-pays that the insurers charge

Re: Why drug prices in America are so high (2016)

#32

Post by ferentchak » Mon, Mar 27, 2017, 4:19 PM UTC

doktrin wrote: post #20

> These high prices support innovation, they argue—not just for America, but for the world. I suspect this is in fact somewhat true, but how is it a coherent argument in favor of higher prices? The American people / American elderly (obviously) don't have some unspoken moral obligation to subsidize pharmaceutical R&D for the whole world. Governments around the world are able to negotiate affordable rates for their ci…

This. Do we need to subsidize Sweden and Germany?

I have wondered for a while why we don't make a law saying the highest price you can sell a drug for in the US is no higher than the lowest negotiated price that drug is sold to in other rich countries.

So if Canada negotiates a drug for $10 then that is the highest price you can sell it for here etc. That way they can set the prices however they want but collective buying agreements that are a part of socialized healthcare don't end up shifting the burden of cost to the US.

Re: Why drug prices in America are so high (2016)

#33

Post by prostoalex » Mon, Mar 27, 2017, 4:20 PM UTC

RcouF1uZ4gsC wrote: post #25

This has a very simple fix, and is a fix that would appeal to Donald Trump: Require that pharmaceutical companies do not charge Americans any more for their drugs than what they charge any developed country. This lets other countries do the dirty work of negotiating prices while reaping the benefits for the US. In addition, it goes along with his whole America is getting screwed narrative - ie that other companies ar…

Can't the manufacturers still inflate list prices by introducing heavy rebates?

Re: Why drug prices in America are so high (2016)

#34

Post by pascalxus » Mon, Mar 27, 2017, 4:20 PM UTC

RcouF1uZ4gsC wrote: post #25

This has a very simple fix, and is a fix that would appeal to Donald Trump: Require that pharmaceutical companies do not charge Americans any more for their drugs than what they charge any developed country. This lets other countries do the dirty work of negotiating prices while reaping the benefits for the US. In addition, it goes along with his whole America is getting screwed narrative - ie that other companies ar…

this sounds like a good start.

Re: Why drug prices in America are so high (2016)

#35

Post by jadell » Mon, Mar 27, 2017, 4:20 PM UTC

chimeracoder wrote: post #8

ThomPete wrote: post #2

"The simple answer is because they can. European governments control prices in various ways—Britain has the strictest system, refusing to pay for medicines that fail to meet a threshold of cost-effectiveness. But in America companies set whatever official price they like."

> "The simple answer is because they can. The easiest way to fix the fact that 'they can' would be to permit re-importating drugs that were manufactured within the US. Shortly before Obama left office, there was a bill that would have fixed that, but nine Democrats joined the Republicans in voting it down: https://www.senate.gov/legislative/LIS/roll_call_lists/roll_...

It wasn't a bill, it was an amendment to a budget resolution. Several of the Senators who voted against it said they did so because they didn't like the way it was being introduced, not because they are against the idea in principle.

Here's the same idea, introduced as a bill instead of an amendment, and being co-sponsored by several of the amendment's "Nay" votes: https://www.congress.gov/bill/115th-congress/senate-bill/469

Re: Why drug prices in America are so high (2016)

#36

Post by harryh » Mon, Mar 27, 2017, 4:21 PM UTC

toomuchtodo wrote: post #26

refurb wrote: post #21

Earlier quoted context omitted.

Please explain how that would work. If I'm Pfizer, why on earth would I dramatically increase my sales of drugs to Canada knowing they're just going to be reimported into the US? The answer is, I wouldn't. I would put a quota on Canadian sales. Sell them enough drugs for Canadians. This was actually done about a decade ago when reimportation was more popular.

That's how you get your patent broken.

Has the US ever disallowed a patent because the company holding it refused to sell a product to the government at the price the government wanted? It's hard to imagine SCOTUS allowing that sort of thing. The US gov't is subject to its own laws.

Re: Why drug prices in America are so high (2016)

#37

Post by pessimizer » Mon, Mar 27, 2017, 4:21 PM UTC

refurb wrote: post #19

Apfel wrote: post #6

Earlier quoted context omitted.

If anyone's interested, England's system of health technology assessment (HTA) for the NHS is extremely transparent and world-leading. It's one of the things that we Brits should be extremely proud of (although pharma-sponsored sob story campaigns in tabloid newspapers may suggest otherwise). All new technologies are investigated in terms of incremental quality of life gain (vs current treatment norms) and changes in…

I would argue HTA is not without it's problems. That's why the UK has a cancer drug fund. NICE has said "no" to those drugs, yet the public still clammers for them. So a separate funding mechanism was created to pay for them.[1] [1] https://www.england.nhs.uk/cancer/cdf/

People for whom standard cancer treatments have failed will always beg for more options, no matter how ineffective or absurd. It's good that there's a fund for that; hope adds to quality of life, and with continued testing there maybe some of the treatments will graduate.

Re: Why drug prices in America are so high (2016)

#38

Post by lcfcjs » Mon, Mar 27, 2017, 4:21 PM UTC

It's quite simple. The American Republican party is in the pocket of healthcare's biggest businesses. They accept "donations" if their policies are favorable to these companies. If these donations became illegal, the problem would be solved.

It really is as simple as that. Anybody who complicates it further has purely partisan reasons.

Re: Why drug prices in America are so high (2016)

#39

Post by dv_dt » Mon, Mar 27, 2017, 4:21 PM UTC

chimeracoder wrote: post #18

dv_dt wrote: post #7

Earlier quoted context omitted.

It was part of the Medicare part D program - and likely put in via lobbying of Drug companies to politicians: https://en.wikipedia.org/wiki/Medicare_Part_D#Criticisms https://en.wikipedia.org/wiki/Medicare_Prescription_Drug,_Im...

> It was part of the Medicare part D program - and likely put in via lobbying of Drug companies to politicians: The prices are still negotiated. They're negotiated by the plans that provide Medicare Part D, rather than determined unilaterally by Medicare itself (which is what happens for Medicare A and B reimbursement rates).

Any private drug negotiator is going to be in a terrible position because they don't have 100% of the market. They can't walk away, the drugs will just flow through another private drug body. The drug makers have no reason to give a discount if the drugs will be sold under plan distributor B vs distributor A.

When you compare prices in the US vs nations with governmental bodies controlling drug prices, you can validate that the US way is ineffectual for controlling drug prices.

Re: Why drug prices in America are so high (2016)

#40

Post by frgtpsswrdlame » Mon, Mar 27, 2017, 4:22 PM UTC

RcouF1uZ4gsC wrote: post #25

This has a very simple fix, and is a fix that would appeal to Donald Trump: Require that pharmaceutical companies do not charge Americans any more for their drugs than what they charge any developed country. This lets other countries do the dirty work of negotiating prices while reaping the benefits for the US. In addition, it goes along with his whole America is getting screwed narrative - ie that other companies ar…

Why would that appeal to Donald Trump? It would hurt the profits of the drug industry in America which will cost jobs, pharma execs will tell him how bad this is for America and how harmful it is to drug R&D, etc etc. Donald Trump may have campaigned as a negotiator for the common man but he identifies with CEOs, anything that hurts them is not something that appeals to him.