101–110 of 204 posts
> Private insurers do so instead, but the government binds their hands, for example by requiring them to pay for six broad categories of drugs, without exception I'd like to understand more of this -- it seems like there is hand-tying at multiple levels. In addition to insurance companies, why isn't it possible for pharmacies, for example, to compete on price directly -- CVS, or Walgreens, or potentially even Walmart…
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…
Earlier quoted context omitted.
> 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. You don't need a rule to enforce that. You just need to allow the US to reimport prescription drugs that were originally exported from the US. It would be far and away the simplest solution and would have the same e…
It's a nit pick but those prices would always be a bit higher after the effort to import them and source them etc. Of course this will never happen. No politician wants to have her name tied to the bill that allowed all those dangerous drugs into the country that killed kids. One mistaken import or a badly made counterfeit being imported would be a media frenzy.
That's what I said:
> The difference between the prices charged in the US and the prices charged in any other country could be no greater than the costs of reimporting the drugs from that country
As for:
> Of course this will never happen. No politician wants to have her name tied to the bill that allowed all those dangerous drugs into the country that killed kids.
That's not true at all. The Senate voted on this exact proposal on Jan 17th (not for the first time). The measure failed, but only by a few votes[0].
> One mistaken import or a badly made counterfeit being imported would be a media frenzy.
We're talking about importing drugs only from countries which recognize US patent laws, such as Canada. The risk of counterfeit drugs entering the supply from reimporting is no greater than the risk of counterfeit drugs entering the supply domestically in either US or Canada.
Besides, this is already done for other drugs, just not prescription drugs that are on patent.
[0] https://www.senate.gov/legislative/LIS/roll_call_lists/roll_...
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…
Earlier quoted context omitted.
> 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…
Sexual health is part of public health, and thus we'd expect PrEP to be funded by Public Health England, not the NHS. The target of your anger here should be local authorities (who hold responsibility for Public Health), not the NHS. https://www.england.nhs.uk/2016/11/update-on-prep/
First, PHE and NHS are both part of the DH, as is NICE.
Second, sexual health is one aspect of PrEP, but it's not the full picture (though of course, that's how the NHS press release you linked would be inclined to portray it. The lower court disagreed with that portrayal, even if the appeals court did not.)
Finally, the arbitrary delineation of responsibilities in which the NHS is free to wash its hands off of the matter and NICE has no incentive to hold the NHS accountable - leaving patients with no choice but to pay out-of-pocket - is exactly the problem. Meanwhile, PrEP has been generally available (and essentially free) in the US for four years, thanks (ironically) to the federation of power which forces insurers to remain somewhat competitive with each other, and which permits the pharmaceutical companies to pick up the slack when that fails.
If you want to point out that this approach has its shortcomings as well, then yes, I'm right there with you. But it's wrong to imply that what NICE and the NHS are doing is fundamentally different from the cost-benefit analyses done in the US, and it's also wrong to ignore the problems with the DH.
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The US is 8% richer than Denmark, 12% richer than Sweden and 40% richer than Germany on a per capita basis. https://en.wikipedia.org/wiki/List_of_countries_by_GDP_(nomi... If you had said Luxembourg, Switzerland & Norway I would have agreed with you. That's only about 14 million people though.
He still makes a point if for example country A is 8% poorer yet paying 40% less.
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…
I like this idea but it is probably difficult to implement. Can't drug companies make slightly different versions of drugs and work around this kind of arrangement? In that case the US would get the "best" version of the drug since it's paying the most, but that's not the solution you want (e.g. lower prices) because it's fighting the fundamental fact that the US will pay more for the same drug. I'm not a drug expert…
1) The potential free rider effect is huge. Drug companies would not invest billions into creating new drugs if after six months on the market they could be duplicated by a competitor and sold for a far lower price.
2) To avoid (1), we give drug companies a patent. But in the process, we make it much harder to use market mechanisms to regulate drug pricing, since patents inherently give drug companies monopoly power.
3) Moreover, in most of the developed world, we want to make a certain level of medical care accessible to everyone. That results in systems like Medicare, the U.K. NHS, etc. That too stymies market mechanisms, except in the other direction. Single-buyer markets are monopsonies, and unchecked result in driving prices below efficient level. (That is likely what has happened in Europe, and is the reason why Medicare is prohibited from negotiating drug prices.)
4) The pharmaceutical market is international, and thus rich in arbitrage opportunities for national governments. So long as the American market is willing to foot the R&D bill, other countries have enormous incentives to drive prices local below the efficient level for their own citizens.
5) Conceptions of morality also complicate things. We ordinarily accept the idea that companies are permitted to charge based on the value they create for their customers. We accept Apple charging $2,400 for a Macbook Pro and understand that people only buy it because they think they will get more than $2,400 of utility from it. What's the value to the customer of HIV anti-retrovirals? How much would you pay to extend your life by decades? Almost certainly more than what those drugs cost. There is an impulse to try and say "well, it's okay for Apple to charge based on value created, but not drug companies." That impulse is surely well-intentioned, but is counter-productive. It has the effect of driving talent and capital out of areas that have the greatest positive impact on humanity.
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This seems like something that shouldn't upset many Republicans. Remove artificial barriers and open the markets. This could apply to a lot more than just drugs. For example, it would be nice if region restrictions were removed from digital goods.
The problem is many Republicans claim to be proponents of open markets and less regulation. But when it comes down to voting on bills, they generally do the opposite.
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> 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). They consider everything in a wider context of opportunity cost of adopting a new treatment and budget constraints. For context, this is literally what risk-bearing entities in the US already do (both insurers and at-risk providers). I could get behind the st…
You're confusing two different things. When NICE decides not to fund something they have clear evidence that it is worse than current treatment, not just that it is more expensive than current treatment. See, for example, Abraxane, a chemotherapy for pancreatic cancer. To be accepted all it has to do is either: i) Be better than current first line treatment or ii) Have less side effects, and thus be usable as a secon…
No, I'm not confusing two different things, and I'm glad you picked cancer as an example.
Even if NICE has approved a treatment as "cost-effective", that doesn't mean that any specific patient will actually be eligible to receive it. For cancer treatments, there is a separate panel which reviews individual cases and provides the options available to that patient. It is not done on the aggregate; it's determined on the individual level. And, to make matters worse, if the patient decides to deviate sufficiently from the treatment plan (perhaps by delaying chemotherapy, or seeking treatment abroad first), those options can be rescinded, at which point the patient is required to pay out-of-pocket on the private market.
> It's incorrect to say that NICE has a profit motive. They very clearly - and this is the point of transparency - don't.
Every agency in every country, public or private, has a profit motive, and the DH is no exception. Transparency doesn't eliminate the profit motive; it just provides visibility into both the inputs and the outputs.