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The Best Fix for American Drug Prices Is Already on the Books

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Re: The Best Fix for American Drug Prices Is Already on the Books

#31

Here’s the rub with developing something as important as a medicine. If it works, people often _need_ it to prolong their life or improve their health. What drug companies are selling... isn’t like what other companies are selling. We ought not look at it through our normal understanding of goods in a free market. Take, for example, Sovaldi, a drug which cures Hepatits C. After discovering this drug and confirming it…

> We ought not look at it through our normal understanding of goods in a free market.

This is the biggest flaw in how we think about many important issues. Market economics isn’t something you decide to apply or not based on public policy. Instead, its the framework of actions and consequences against which you must determine public policy. If your policy is to have private companies develop and commercialize medicines, then you need to ensure functioning markets from drugs. That means avoiding antitrust issues, but also avoiding free-rider problems that result for drugs being easy to copy.

You can, of course, do something else, such as having the government pay to commercialize drugs. What you can’t do is eat your cake and have it too, by deciding that you can somehow “opt out” of market dynamics for industries you deem to be of public importance. It’s like saying that “supersonic flight is important, so we ought not to look at it through our normal understanding of aerodynamics.”

Re: The Best Fix for American Drug Prices Is Already on the Books

#32
post #5

> Over time, Big Pharma learned how to game the law. As the patent for the original drug approached expiration, companies added wrinkles — a new coating for the pill, a time-release version, and so on — that they then patented. If the patents were approved, and they usually were, the exclusivity clock would start ticking all over again. This is so misleading. When this happens, only the new "wrinkles" are patented. T…

> Nobody wants to spend money on marketing. If drug companies could recoup their investment faster by spending less on marketing, they would. This doesn't pass my sniff test. The original article's point isn't that companies are marketing just so they can flush money down the toilet. Of course it's profitable. The article's point is that we as a society want them to spend more money on R&D; and our current strategy s…

Shortening exclusivity would increase the need for marketing, because companies would have to get the word out to consumers and doctors much more quickly.

Re: The Best Fix for American Drug Prices Is Already on the Books

#33
> Over time, Big Pharma learned how to game the law. As the patent for the original drug approached expiration, companies added wrinkles — a new coating for the pill, a time-release version, and so on — that they then patented. If the patents were approved, and they usually were, the exclusivity clock would start ticking all over again.

I don't understand how that would ever work.

Time-release version of X, now with new coating: patented

Old version of X, with no time-release and without new coating: patented expired, correct?

If so, what stops the generic manufacturer from just manufacturing the old version of X?

Re: The Best Fix for American Drug Prices Is Already on the Books

#34
post #4

One of the biggest reasons is that the US essentially subsidizes drugs for many other countries, such as Canada, that impose price controls, and threaten to allow other manufacturers to provide the drugs in their countries if the companies don't accept the imposed price. This enables these countries to get access to new medicine without paying the cost of developing the new medicine. Its time to end the trade war on…

Like that time US subsidized Ebola Vaccine? By buying rights for 200K from publicly funded Canadian Uni research.

Re: The Best Fix for American Drug Prices Is Already on the Books

#35

> Over time, Big Pharma learned how to game the law. As the patent for the original drug approached expiration, companies added wrinkles — a new coating for the pill, a time-release version, and so on — that they then patented. If the patents were approved, and they usually were, the exclusivity clock would start ticking all over again. I don't understand how that would ever work. Time-release version of X, now with…

There is nothing to stop them. The only reason why "evergreening" works is because doctor's write scripts for the "new" drug.

Sometimes it's worth it! If you need to take a drug three times a day and the new version is only once, that can improve patient adherence and outcomes.

However, sometimes the added value is minuscule. In that case insurance companies should just say "we're not paying for it since the added cost is not worth it".

Problem solved.

Re: The Best Fix for American Drug Prices Is Already on the Books

#36

Here’s the rub with developing something as important as a medicine. If it works, people often _need_ it to prolong their life or improve their health. What drug companies are selling... isn’t like what other companies are selling. We ought not look at it through our normal understanding of goods in a free market. Take, for example, Sovaldi, a drug which cures Hepatits C. After discovering this drug and confirming it…

> If it works, people often _need_ it to prolong their life or improve their health. What drug companies are selling... isn’t like what other companies are selling. It is very much like many other products. If you don't have food you will die of starvation, if you don't have shelter you will die of exposure, etc. The real issue is drug patents. Nobody is complaining about the price of ibuprofen any more than they com…

But drugs are produced in other countries, too, and they manage to do so without charging what US companies do.

Re: The Best Fix for American Drug Prices Is Already on the Books

#37
post #31

Here’s the rub with developing something as important as a medicine. If it works, people often _need_ it to prolong their life or improve their health. What drug companies are selling... isn’t like what other companies are selling. We ought not look at it through our normal understanding of goods in a free market. Take, for example, Sovaldi, a drug which cures Hepatits C. After discovering this drug and confirming it…

> We ought not look at it through our normal understanding of goods in a free market. This is the biggest flaw in how we think about many important issues. Market economics isn’t something you decide to apply or not based on public policy. Instead, its the framework of actions and consequences against which you must determine public policy. If your policy is to have private companies develop and commercialize medicin…

We most certainly do get out of market economics for some things we deem important. Think defense, water and electric utilities, and law enforcement.

Re: The Best Fix for American Drug Prices Is Already on the Books

#38
post #35

> Over time, Big Pharma learned how to game the law. As the patent for the original drug approached expiration, companies added wrinkles — a new coating for the pill, a time-release version, and so on — that they then patented. If the patents were approved, and they usually were, the exclusivity clock would start ticking all over again. I don't understand how that would ever work. Time-release version of X, now with…

There is nothing to stop them. The only reason why "evergreening" works is because doctor's write scripts for the "new" drug. Sometimes it's worth it! If you need to take a drug three times a day and the new version is only once, that can improve patient adherence and outcomes. However, sometimes the added value is minuscule. In that case insurance companies should just say "we're not paying for it since the added co…

> Sometimes it's worth it! If you need to take a drug three times a day and the new version is only once, that can improve patient adherence and outcomes.

For the moment, let's ignore that case by simply calling the improved drug a new drug.

> However, sometimes the added value is minuscule. In that case insurance companies should just say "we're not paying for it since the added cost is not worth it".

I'm still lost.

1. Doctor writes prescription for "B", which is really "A" with an insignificant change and a price bump.

2. Patient goes to pharmacy and looks at their copay for "B." Whoa! they say-- that is surprisingly high.

Wouldn't the pharmacist then have the responsibility to jump in with their expertise at this point? Say: "B" is just a slightly altered "A" to get you to pay more, so call your doctor and ask them if you can take "A."

Re: The Best Fix for American Drug Prices Is Already on the Books

#39
post #28

Earlier quoted context omitted.

> If it works, people often _need_ it to prolong their life or improve their health. What drug companies are selling... isn’t like what other companies are selling. It is very much like many other products. If you don't have food you will die of starvation, if you don't have shelter you will die of exposure, etc. The real issue is drug patents. Nobody is complaining about the price of ibuprofen any more than they com…

Pharmaceutical R&D spending isn’t all that high. It’s around $300 per capita in the US. The money is not coming from high insurance premiums.

That is around 90 Billion dollars. I'm not sure where you got that number exactly, but phrma member companies list their combined 2016 R&D expenditures at 65.3 billion[0] so it seems plausible. For context that is around the GDP of Slovakia or Sri Lanka. (65th and 66th biggest world economies)[1]

[0] https://www.phrma.org/press-release/randd-investment-by-u-s-...

[1] https://en.wikipedia.org/wiki/List_of_countries_by_GDP_(nomi...

Re: The Best Fix for American Drug Prices Is Already on the Books

#40
post #5

> Over time, Big Pharma learned how to game the law. As the patent for the original drug approached expiration, companies added wrinkles — a new coating for the pill, a time-release version, and so on — that they then patented. If the patents were approved, and they usually were, the exclusivity clock would start ticking all over again. This is so misleading. When this happens, only the new "wrinkles" are patented. T…

> Nobody wants to spend money on marketing. If drug companies could recoup their investment faster by spending less on marketing, they would. This doesn't pass my sniff test. The original article's point isn't that companies are marketing just so they can flush money down the toilet. Of course it's profitable. The article's point is that we as a society want them to spend more money on R&D; and our current strategy s…

If we take the somewhat liberal assumption that pharma's marketing budget is ecomically optimal at present - eg marginal costs equal marginal revenue, how is making marketing more expensive helping anyone? All it will do is decrease revenue/drug which will have a knock-on effect on marginal revenue of R&D: reducing gross R&D expenditure and thus approved drugs.

In the end, you can have more new drugs (new antibiotics, orpan drugs, etc.), or cheaper drugs(Less qualified, fewer, off label usage, not qualified for efficacy, etc.) There are different ways to make either happen but short of attacking an inefficiency in the system there's no free lunch. Equipment costs money and scientists need to eat.

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