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Why drug prices in America are so high (2016)

economist.com

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

#111

Post by refurb »

dv_dt wrote: post #69
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…

The R&D argument would be much stronger if pharma companies didn't spend more in marketing than R&D in the US.

Marketing budgets pay for themselves. Why else would you market something?

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

#112

Post by vertex-four »

chimeracoder wrote: post #31
refurb wrote: post #19

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.[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…

To anyone interested in getting PrEP in the UK, you can buy it from £39/month upwards without a prescription from a number of online pharmacies. Do your own research, as with taking any medication.

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

#113

Post by chimeracoder »

refurb wrote: post #58
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…

There are a lot of problems with reference pricing. First off, if country A (300M people) references country B (30M people), then the drug company can simply chose not to launch the drug in country B if that reference price is too low. Second, drug companies can modify their launch sequence (this already happens today) so that they launch in the referenced countries after the price is set in the country doing the ref…

> Third, this may actually push up the prices in other countries.

That's the whole point. As mentioned in the article, the US disproportionately funds new pharamaceutical research. Other countries currently receive the benefits of this, but at a much lower cost.

So any system which reduces the prices in the US will either require other countries paying more for what they're already getting, or less research and development for the entire world.

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

#114

Post by refurb »

DanBC wrote: post #81
chimeracoder wrote: post #15

Earlier quoted context omitted.

> 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…

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.

That's not true at all. Kadcyla is superior to current therapies for HER+ breast cancer. NICE has decided not to fund it because it's too expensive.[1]

But the reality is that the price of Kadcyla is currently too high in relation to the benefits it gives for it to be recommended for routine commissioning in the NHS, even taking into account the end‑of‑life criteria and the patient access scheme.”

[1]https://www.nice.org.uk/news/article/kadcyla-too-expensive-f...

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

#115

Post by rayiner »

white-flame wrote: post #99
andmarios wrote: post #73

Earlier quoted context omitted.

But isn't free market, unregulated prices, etc the mandate of US? I don't judge, just making a remark.

It's not a free market if you're not allowed to import from cheaper suppliers elsewhere, so that's already broken.

Permitting imports also undermines the market if it extends the scope of the market to include areas where government intervention (e.g. aggressive negotiation by national health systems) drives prices below efficient levels.

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

#116

Post by maxerickson »

abfabry wrote: post #97

I work at Blink Health (www.blinkhealth.com) and we're working to solve this problem and offer patients a fair price for their medication, often saving patients up to 90% of list price. We negotiate with pharmacies and pharmaceutical manufacturers to get the lowest rates and improve price transparency in an opaque market. We have a kick-ass engineering team -- if you're interested in these problems and want to help u…

Why is an account with you better than no account at GoodRx?

I assume you are pretty much just a PBM?

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

#117

Post by refurb »

andrewla wrote: post #92

> 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…

The largest pharmacies do compete on price. It's common for CVS or Walgreens to get an additional discount on products.

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

#118

Post by whafro »

cowsandmilk wrote: post #13
whafro wrote: post #9

Earlier quoted context omitted.

It was politics from a couple decades ago. Medicare historically didn't cover prescription drugs, until Part D was enacted during the Clinton administration. A tactic to get Republicans to support the measure was to pledge that Medicare wouldn't interfere in the drug market by developing its own formulary – Medicare Part D plan providers would compete for members and negotiate with pharmaceutical companies themselves…

> until Part D was enacted during the Clinton administration. ???? Medicare Part D came into being in 2003, well into Bush's administration. The whole rest of your post is based around the notion that it was proposed by Clinton, when it was Bush....

Totally, and thanks. I was quick to write and submit my answer and was remembering some debate during the Clinton era.

But the noninterference provision was indeed targeted at market-oriented Republicans to get them on board. There were plenty who wanted to ensure that Medicare wasn't going to be eroding the businesses of established payers.

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

#119

Post by lumberjack »

chimeracoder wrote: post #61
dv_dt wrote: post #39

Earlier quoted context omitted.

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 valida…

> 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, Having 100% of the market is the definition of a monopsony. That's bad for both patients (in the long run) and pharmaceutical companies (in the short run). In any case, even an ostensible monopsony pharmaceutical purchaser can't really just "walk away", because so so many of the drugs…

>Having 100% of the market is the definition of a monopsony. That's bad for both patients

That's how the rest of the developed world does it.

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