Note: this is less than one half of one percent of total Medicare spending.
But the study is only for a small subset of that spending.
For that subset the computed saving is $9.6b -> $6.0b.
Medicare Could Have Saved $3.6B on Generic Drugs
21–30 of 86 posts
Re: Medicare Could Have Saved $3.6B on Generic Drugs
#22Re: Medicare Could Have Saved $3.6B on Generic Drugs
#23I don't know the specifics of the USA, but in Europe some generics are sold out, because they are imported usually from India, and the supply chain is heavily broken
Re: Medicare Could Have Saved $3.6B on Generic Drugs
#24Not just generics. Ever get a coupon from a drug manufacturer that drops your copay from hundreds of dollars to $10 or $20? Ever wonder why? It’s because Medicare gets an automatic discount (I think 20% these days but I’m no longer in the biz) from the manufacturer’s official price. So they simply set the official price at some huge figure and rake in huge bucks from the largest buyer, Medicare. Then they negotiate w…
> It’s a huge rip off. Medicare should be paying a discount to the median price actually paid on the open market. But apparent nobody has an incentive to fix this. Then they start issuing rebates instead of discounts? Or yeah, sure, everyone's definitely paying $100 for this quantity of this drug, then we kick insurance back $80 for advertising for every unit that makes it to an end consumer through them. There's no…
The Federal government and government in general is really good at commodity procurement. The processes and legal requirements give them the ability to price and fairly procure even single source commodities.
I’ve done scaled procurements at a very large, not federal level. We were almost always 10-20% lower unit cost than large corporate, and sometimes even better. At the Federal level, the law gives them “most favored” status, and they will sue vendors for fraud if they offer lower prices for the same commodity without lowering the federal cost.
“It’s hard” is a common refrain for policy discussions. “That’s bunk” is my reply. Policy without graft isn’t much harder than using high and mighty principles to enrich people at taxpayer expense.
Re: Medicare Could Have Saved $3.6B on Generic Drugs
#25Earlier quoted context omitted.
Yeah no. Generics -are- equivalent and regulated to be as such. [1] If you are hearing anything different it's just BS. [1] https://www.fda.gov/drugs/questions-answers/generic-drugs-qu...
Yes but no. Generics are not 1-1 substitutes because the FDA allows some (a lot) of wiggle room when it comes to bioequivalence. A really good example where this fails miserably is Adderall for ADHD. The generics are absolutely miserable . And if you actually find a generic you tolerate you can never switch pharmacies because they’ll be different. I’m no pharmacological expert but when I asked my pharmacist they expl…
The rules aren't strict enough IMO but the observed variation is very low in practice.
Australia allows very similar amounts of wriggle room in theory [1].
Most people I know in Australia with ADHD are treated with generics (very common among my friend group for some reason) and none that I am aware of have noticed any substantial differences between generics and brand name equivalents but I couldn't quickly find any studies that have investigated this.
I wonder if that is due to variation in balance of the included amphetamines (as most of these are multiple active ingredients) though as I doubt that the inactive ingredients would play a significant part.
[1] https://www.nps.org.au/assets/fc20fd821a02cf80-8d2289edb5e3-...
Re: Medicare Could Have Saved $3.6B on Generic Drugs
#26Note: this is less than one half of one percent of total Medicare spending.
But the study is only for a small subset of that spending. For that subset the computed saving is $9.6b -> $6.0b.
assuming that held true across the board, that's a ~35% reduction. What if it was only half that? Round down, and say generic policy might 'only' save 15%. 15% of 10s of billions of dollars (hundreds? can't find full numbers right now) is significant.
Re: Medicare Could Have Saved $3.6B on Generic Drugs
#27Earlier quoted context omitted.
Yeah no. Generics -are- equivalent and regulated to be as such. [1] If you are hearing anything different it's just BS. [1] https://www.fda.gov/drugs/questions-answers/generic-drugs-qu...
Yes but no. Generics are not 1-1 substitutes because the FDA allows some (a lot) of wiggle room when it comes to bioequivalence. A really good example where this fails miserably is Adderall for ADHD. The generics are absolutely miserable . And if you actually find a generic you tolerate you can never switch pharmacies because they’ll be different. I’m no pharmacological expert but when I asked my pharmacist they expl…
ADHD medication is an excellent example illustrating the potential "wiggle room" differences between generics and brand drugs. The composition is similar enough to meet FDA generic drug standards, but the rate at which the generic drug mechanisms distribute the drug differs and potentially decreases treatment efficacy for many patients.
Though, I do wonder if Vyvanse becoming a generic brand will help solve this dilemma, because the release mechanism is tied closer to the individuals metabolism via hydrolysis of an amino acid rather than relying on release rates set by minor manufacturing differences.
Re: Medicare Could Have Saved $3.6B on Generic Drugs
#28This is comparing to generic drugs from one specific company, based on the notion that the specific company is capable of providing a cheaper generic drug in a situation most favorable to the drug maker (a bulk purchase). It doesn’t actually go into if the generic will actually be a suitable replacement for each patient. For people with complex health needs, like the over 65+ folks on Medicare, it makes total sense t…
Generics are literally identical to the original drug.
Bioequivalent as judged by the FDA does not at all mean identical.
ETA: The fact that generics are not “literally identical” is probably the most important scientific, policy, and commercial consideration in that industry. FDA has to determine whether the benefits of lower costs justify the potentially lower efficacy, and set bounds for how different a generic can be and still count as “bioequivalent.”
Re: Medicare Could Have Saved $3.6B on Generic Drugs
#29Not just generics. Ever get a coupon from a drug manufacturer that drops your copay from hundreds of dollars to $10 or $20? Ever wonder why? It’s because Medicare gets an automatic discount (I think 20% these days but I’m no longer in the biz) from the manufacturer’s official price. So they simply set the official price at some huge figure and rake in huge bucks from the largest buyer, Medicare. Then they negotiate w…
It’s by design. The republican position was that allowing Medicare to negotiate drug prices would amount to price controls. They also forbade the using of Federal funds to reimport drugs from countries like Canada who negotiate prices. It’s a specious argument with predictable outcomes that were in fact predicted and widely discussed at the time the legislation was enacted.
Part D plans are privately administered by companies that are supposed to compete with each other. The prices aren't just whatever the drug companies want.
Re: Medicare Could Have Saved $3.6B on Generic Drugs
#30Earlier quoted context omitted.
It’s by design. The republican position was that allowing Medicare to negotiate drug prices would amount to price controls. They also forbade the using of Federal funds to reimport drugs from countries like Canada who negotiate prices. It’s a specious argument with predictable outcomes that were in fact predicted and widely discussed at the time the legislation was enacted.
Part D plans are privately administered by companies that are supposed to compete with each other. The prices aren't just whatever the drug companies want.
Interesting how there doesn't seem to be much competition.