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The Hidden Monopolies That Raise Drug Prices

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Re: The Hidden Monopolies That Raise Drug Prices

#121

Post by evgen »

dpark wrote: post #81
DarkKomunalec wrote: post #69

Earlier quoted context omitted.

> It's also keeping physicians up to date on the current science, applicability, and best practices of their products. I think it's a good thing for sales reps and MSLs to inform or remind physicians that there are alternatives to writing a script for Epipens, for example. There are many very cheap ways of keeping physicians up-to date, such as a conference presentation of the drug, followed by a Q&A session, with a…

> There are many very cheap ways of keeping physicians up-to date, such as a conference presentation of the drug, followed by a Q&A session, with a recording freely available online. Because most doctors are happy to spend hours watching recordings of drug presentations. For better or worse, doctors are just people and if you want them to understand the benefits of your new drug, it will fall to you to convince them.…

> Because most doctors are happy to spend hours watching recordings of drug presentations.

And yet somehow I am supposed to be overjoyed at spending hours watching conference talks, reading blog posts and documentation, and doing other things to evaluate new tech and learn new languages/libraries that are not my direct job just to keep up to date on my rapidly-changing industry?

Welcome to the 21st century doctors. I would unpack and play the worlds tiniest violin for you, but I have a few more confreaks youtube videos to plough through right now.

Re: The Hidden Monopolies That Raise Drug Prices

#122

Post by TheAdamAndChe »

e40 wrote: post #83
iamleppert wrote: post #55

I deal with Express Scripts and CVS Caremark. I have Hemophilia, a bleeding disorder condition I've been born with. By far, these are the most corrupt organizations in the medical/drug industry. At least the phrama companies actually make something at the end of the day and do research, and employ more than just business people. I am forced by whatever insurance plan I have, to deal with these companies directly beca…

So I read this and I'm horrified. And I know that no one in the coming years will make this or anything like it a priority in Congress. They give no shits about us. The media spends all day talking about tweets and Russian influence in our election and on our newly minted government officials. Yeah, the latter is important, but health care is really, really important. It's the reason our new POTUS was elected, accord…

Remember, Donald Trump was elected because people want change. Most people are aware at this point that the system is rigged, and are looking to change it. It's unclear currently whether populism or socialism will win in the long run, but don't lose hope yet.

Re: The Hidden Monopolies That Raise Drug Prices

#123

Post by vlunkr »

refurb wrote: post #2

It's interesting how the villains of drug pricing have gone from the drug companies to the PBMs. At any rate, I don't agree that PBMs cause drug costs to increase. PBMs are simply purchasing groups for insurance companies. They take advantage of bulk purchasing and offer that service to insurers. They also handle the all the complexities in setting a formulary which includes evaluating new drugs, negotiating with dru…

In this case I think there are several tiers of villains.

Re: The Hidden Monopolies That Raise Drug Prices

#124

Post by refurb »

kgwgk wrote: post #117
refurb wrote: post #107

Earlier quoted context omitted.

The price was too high. There are millions of untreated HCV patients out there that can't get treated because insurance companies won't pay for the drugs.

Now the prices are lower... and the profits as well.

Yes, but insurance companies haven't loosened the reins on these drugs. Even with the lower prices, patients are being denied.

Re: The Hidden Monopolies That Raise Drug Prices

#125

Post by refurb »

attaboyjon wrote: post #109
refurb wrote: post #42

Earlier quoted context omitted.

But that's their job! They are supposed to negotiate lower prices. They, in turn, can market their formulary to insurance companies by saying "If you use us, we can offer a lower cost pharmacy benefit." And if you're a smart insurance company, you do your due diligence and don't negotiate a contract where you have no transparency into the PBMs costs.

Well yeah that's the problem. They dont pass the discount on to me. I pay full retail price, and they keep the discount. This is why Express Scripts is a $100 BILLION company. And that's for managing Formularies you say? Express Scripts Holding Company is the largest pharmacy benefit management (PBM) organization in the United States,[20] with 2013 revenues of $104.62 billion.[21] In 2012 Express Scripts' $29.1 billi…

Well yeah that's the problem. They dont pass the discount on to me. I pay full retail price, and they keep the discount. This is why Express Scripts is a $100 BILLION company. And that's for managing Formularies you say?

The discounts are passed through via lower insurance premiums. You don't really see that since your employer pays the premiums.

And yes, ESI is a $100B per year company with $3.4B in net income.[1] A stunning 3.4%. Not that different than a grocery store.

[1]http://financials.morningstar.com/ratios/r.html?t=ESRX

Re: The Hidden Monopolies That Raise Drug Prices

#126

Post by replicatorblog »

Broken_Hippo wrote: post #80
replicatorblog wrote: post #54

Earlier quoted context omitted.

How much are you willing to pay the nine teams of scientists whose experimentation fails to yield any useful medications for every one that works? The problem is that most people only want to pay for the ones that work. Thankfully there are companies that manage that market risk taking on our behalf and take a fee for the service.

"How much are you willing to pay the nine teams of scientists whose experimentation fails to yield any useful medications for every one that works?" The same yearly salary that the folks on the "success" team make. I don't see why success is the issue here. I'd just make sure the failure is public information so that others can learn from it. After all, the things that don't work aren't valueless and the drug may be…

Should we have two teams or twenty researching drugs? How should we prioritize them? Focus on a couple diseases that are extraordinarily hard technically, but impact a small number of highly sympathetic, photogenic victims as with rare childhood diseases? Or problems that treat low intensity pains that could also be treated with behavior change like heartburn drugs and Type II diabetes meds?

What should we do if we find out that a heart disease is ineffective at reducing heart attacks, but seems to help treat erectile dysfunction as was the case with Viagra? Do we divert funds to commercialize that "breakthrough" or redeploy those research dollars back to primary research on heart health?

"Big Pharma" might not be optimal, and I have eaten in their mahogany-paneled executive dining rooms so I know there are healthy profits. But at the end of the day, they have turned death sentences like Leukemia into highly curable conditions. Are there examples of similarly impactful breakthroughs coming out of centrally-planned economies? Until then, I'm happy to pay high insurance premiums and deductibles for methotrexate, vincristine, dexamethasone, and the dozen other drugs I give my daughter to keep her alive.

Re: The Hidden Monopolies That Raise Drug Prices

#127

Post by e40 »

chimeracoder wrote: post #91
e40 wrote: post #84

Earlier quoted context omitted.

As I and other have mentioned before, the easiest way to fix this would be to permit re-importing drugs that were manufactured within the US. The easiest way to fix this is to have cost controls like every other 1st-world country in the world on drugs and medical procedures. Unfortunately, this is treasonous to Republicans and Democrats are spineless. The current system will be upheld until people get fed up enough t…

> The easiest way to fix this is to have cost controls like every other 1st-world country in the world on drugs Ignoring the incredibly loaded term "first world country", that's not true. Not all other "first-world" countries implement price controls on drugs. Secondly, as explained below, the only reason that works for them is that the single largest consumer of patent-protected drugs (the US) does not, and thereby…

I took that statement directly from this Frontline episode:

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

It was clearly stated, over and over again.

"First world country" was the phrase they used, as well.

Re: The Hidden Monopolies That Raise Drug Prices

#128

Post by xadhominemx »

spangry wrote: post #111
xadhominemx wrote: post #102

Earlier quoted context omitted.

Less than half of JNJ's revenues is pharmaceuticals, so not a great example to be honest.

Actually it's a pretty good example. In Australia, medicines and medical devices (i.e. 81% of J&J revenue) are regulated by the same body (the TGA) using the same approach, craftily reasoning that sick people need both. I realise you might see thing differently (i.e. better) in the USA, but I guess that's just part of what makes you exceptional!

Medical devices and pharmaceutical companies have different cost structures, so I maintain my point that J&J is not a good example of a pharmaceutical cost structure.

But you did 10 minutes of Googling so I defer to you I guess.

Re: The Hidden Monopolies That Raise Drug Prices

#129

Post by spangry »

maxxxxx wrote: post #92
novalis78 wrote: post #62

Earlier quoted context omitted.

Absolutely agree. Something long the lines of what pricepain.com had in mind. This "market" is so ripe for disruption like no other. Sadly, its guarded by a lot of lobbying power and artificial regulations. I think they get away with it "because health".

Americans are now so used to this insane system they can't even conceive that it actually doesn't have to be that way.

I see you're getting downvoted, but you're right. This whole thread is filled with utter lunacy. Just look at the top post. It's some middle-man explaining how his company is innovative because they've figured out how to take a cut of the massive economic rents, and everyone seems to just be nodding along sagely.

What really gets me is this idiot notion that the US is somehow subsidising everyone else's healthcare. In actual fact, pharmaceutical / medical device companies will simply charge whatever the market will bear, and it just so happens the US market will bear almost any price. If some market won't bear a profit making price, pharma companies simply won't sell into it.

It makes utterly no sense to sell at a loss and then cross subsidise using the massive rents extracted from US markets, yet that is exactly what most people here seem to believe is happening. Then again, maybe basic economics somehow doesn't apply to these super exceptional markets in the super exceptional USA.

Re: The Hidden Monopolies That Raise Drug Prices

#130

Post by jobu »

chimeracoder wrote: post #3

> Americans pay the highest health-care prices in the world, including the highest for drugs, medical devices, and other health-care services and products. Our fragmented system produces many opportunities for excessive charges. But one lesser-known reason for those high prices is the stranglehold that a few giant intermediaries have secured over distribution. The antitrust laws are supposed to provide protection aga…

I've been buying albuterol inhalers from Mexico for a several years now. Most of my life these inhalers cost a few bucks, but a few years back (2010?) they started costing me $50 for just the copay.

It turns out the pharma lobby was able to get congress to ban CFCs from inhalers (even though the amount of CFCs in these is trivial). Because of that they were able to re-patent them and start charging more. Now I go to Mexico every couple years and buy a bunch of them for less than $1 each. It's the same medication I've always used, now with spanish on the package.

EDIT

Here's a link that talks about the pharma lobby shenanigans for albuterol inhalers: http://www.motherjones.com/kevin-drum/2013/10/heres-why-your...

And here's another that talks more about medical patent evergreening: http://www.nytimes.com/2013/10/13/us/the-soaring-cost-of-a-s...

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