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Hospitals and universities repurposing drugs at lower cost

kcl.ac.uk

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Re: Hospitals and universities repurposing drugs at lower cost

#91

Post by lotsofpulp »

tyre wrote: post #83
dabinat wrote: post #77

I’m currently on Spravato, which is fully emblematic of how broken the incentives in the US healthcare system are. Spravato is esketamine - a modified version of ketamine. Ketamine is made up of mirror image molecules and esketamine is the right-handed molecule. They did this because ketamine is off-patent so they needed to modify it in order to patent it, however there is evidence that esketamine is a less effective…

> It would be in the insurance companies’ interests to band together to fund the research so they can save huge amounts of money in the long term but they do not do this. Insurance companies do not want cheaper care. In the US, insurance companies must spend 80% of premiums on care. So if you pay $1k/mo, they have to pay out at least $800/mo in care. (Not to you specifically, but averaged out across all subscribers.)…

>Insurance companies do not want cheaper care.

Why is there a continuous stream of healthcare providers threatening to or becoming out of network for various managed care organizations because they cannot come to an agreement on healthcare prices?

Re: Hospitals and universities repurposing drugs at lower cost

#92

Post by lesuorac »

tyre wrote: post #83
dabinat wrote: post #77

I’m currently on Spravato, which is fully emblematic of how broken the incentives in the US healthcare system are. Spravato is esketamine - a modified version of ketamine. Ketamine is made up of mirror image molecules and esketamine is the right-handed molecule. They did this because ketamine is off-patent so they needed to modify it in order to patent it, however there is evidence that esketamine is a less effective…

> It would be in the insurance companies’ interests to band together to fund the research so they can save huge amounts of money in the long term but they do not do this. Insurance companies do not want cheaper care. In the US, insurance companies must spend 80% of premiums on care. So if you pay $1k/mo, they have to pay out at least $800/mo in care. (Not to you specifically, but averaged out across all subscribers.)…

> So, no, paradoxically, it is not in the interest of people paying for the treatment to save money. Quite the opposite.

I'll assume they're on company insurance. Which is often "self-insured" in that the company actually foots the bill as opposed to the insurance company.

Why don't corporations just drop insurance companies that decide to not allow cheaper medicines?

Re: Hospitals and universities repurposing drugs at lower cost

#93

Post by lotsofpulp »

ItsMonkk wrote: post #69
simiones wrote: post #60

Earlier quoted context omitted.

The maximum libertarian alternative to patents isn't free-for-all copying, it's trade secret formulas - e.g. Coca Cola. Drug patents actually exist as a compromise given the clear need for the state to force companies to publish their drug formulas for research. Allowing companies to just keep their drugs secret would be even more capitalistic, and would increase drug prices even more.

This is where prizes come in. If you create a drug and keep it secret, the government can grant you a large prize as an offer to reveal your secret. This is a much better compromise. The company will end up with more money(and faster!) as a result of this prize than under a patent system - since the patent system induces dead-weight losses, and the government will end up with more lives saved.

That is just an inefficient way to spend taxpayer money than straight up paying researchers from the government’s accounts.

The US has an enormously large higher education system with all the expertise and manpower to facilitate large trials of novel medicines. The only thing missing is political will to spend the money, so instead, Eli Lilly or Novartis or Pfizer etc spend investor’s money to do it.

And then taxpayers pay for it in a super convoluted way.

Re: Hospitals and universities repurposing drugs at lower cost

#94

Post by bit-anarchist »

simiones wrote: post #64
Aurornis wrote: post #37

Earlier quoted context omitted.

> This is interesting because the USA claims to pursue a maximum capitalistic society I don’t know why you think this. The US is not a maximally capitalist society. The reason drug prices are so high is due to regulations restriction who can manufacture them due to government-granted temporary monopolies through patent law. If the US was maximally capitalist it would be a free for all with no patent protection.

> If the US was maximally capitalist it would be a free for all with no patent protection. The much more likely alternative in a maximally capitalist / free market maximalist society would be keeping all drug formulas as trade secrets, and thereby having all drugs as branded, no generics whatsoever (or few - perhaps some substances could be reverse engineered). In such a society, having the state force companies to p…

I'm not convinced about trade secrets being the capitalistic route here, specially since, as pointed out somewhere else, the current system is basically like trade-secrets already, which suggest inverted causality.

In a pure free market, someone could try to keep the formulas secret, but others can just reverse engineer it into being public, which is basically guaranteed to happen if there's sufficient demand. Given that they aren't wasting money trying to obfuscate the recipe nor the formula, these competitors do have an advantage over the original. As such, I posit that free-to-copy will be default behavior in a pure free market, with trade-scerets being resteicted on niche sectors.

The reason we can't do this today is primarily that reverse engineering is heavily restricted by IP laws.

Re: Hospitals and universities repurposing drugs at lower cost

#95

Post by atourgates »

I have a little insight here from working with ophthalmologists.

When the article mentions "using a cancer drug to treat a leading cause of blindness" it's talking about using Bevacizumab (brand name Avastin) to treat macular degeneration.

Avastin and Lucentis are molecularly the same drug. The difference is that Avastin isn't packaged to be injected into eyeballs, and Lucentis is. Also, Avastin costs about $50/dose, and Lucentis costs around $1,500/dose.

There are compounding pharmacies that will repackage Avastin into a format that can be injected into eyeballs.

However, many ophthalmologists are hesitatnt to use Avastin because that process introduces the potential for contamination. Not that it happens frequently, but every ophthalmologist I know lives in fear of introducing an infection into their patient's eyeballs. And what level of risk is worth saving $1,450 per dose on an injection? 1/100? 1/1000?

I know at least one ophthalmologist who would use Avastin, but would culture a sample from every batch she got from the compounding pharmacy, and had at least one batch that cultured bacteria.

Assumedly, if she hadn't, every patient she injected with that batch would have been at risk of contracting endophthalmitis, and endophthalmitis is no joke. Not infrequently, it can mean losing vision.

I know several of that ophthalmologist's colleagues who had been using compounded Avastin to try and save their patients money, stopped after that incident.

I don't really have a conclusion beyond "drug pricing is insane and the issue is complex for providers."

Re: Hospitals and universities repurposing drugs at lower cost

#96

Post by rirze »

indoordin0saur wrote: post #84
toomuchtodo wrote: post #51

Earlier quoted context omitted.

The Price of Remission - https://news.ycombinator.com/item?id=43925396 - May 2025 (93 comments)

This was a good read, thanks for sharing. I feel like the best way to fight this, if I was the government, would be to stop enforcing laws preventing patients and even doctors or hospitals from importing the overpriced pharmaceuticals from overseas generics manufacturers. Like the article points out, each pill costs no more than $0.25 to make. The goal wouldn't necessarily be to get everyone using overseas suppliers…

It's too late for this. Many government regulations and policies can be solved with money and this would be one of those squashable problems.

Maybe if Pharma companies didn't get so rich already, this could've been possible.

Re: Hospitals and universities repurposing drugs at lower cost

#97

Post by ItsMonkk »

lotsofpulp wrote: post #93
ItsMonkk wrote: post #69

Earlier quoted context omitted.

This is where prizes come in. If you create a drug and keep it secret, the government can grant you a large prize as an offer to reveal your secret. This is a much better compromise. The company will end up with more money(and faster!) as a result of this prize than under a patent system - since the patent system induces dead-weight losses, and the government will end up with more lives saved.

That is just an inefficient way to spend taxpayer money than straight up paying researchers from the government’s accounts. The US has an enormously large higher education system with all the expertise and manpower to facilitate large trials of novel medicines. The only thing missing is political will to spend the money, so instead, Eli Lilly or Novartis or Pfizer etc spend investor’s money to do it. And then taxpaye…

Prizes pay for working results. Grants pay for possibilities. Grants are therefore riskier, and thus we allocate less resources to them.

Since the people with the money don't understand the science, these possibilities must then be assessed by bureaucrats, and this causes our best to spend half of their time writing proposals instead of working and researching. A complete waste of time. Let the people who know the most about their subject freedom to take risks, and then they are given the spoils of their rewards if they are proven correct.

Prizes are much more efficient than grants. Prizes should be given to academics according to the value they produced. I have no issue if the academics choose to spend some of the windfall profits of their prizes on trials.

> https://en.wikipedia.org/wiki/Innovation_prize_model

Re: Hospitals and universities repurposing drugs at lower cost

#98

Post by doctorpangloss »

lesuorac wrote: post #92
tyre wrote: post #83

Earlier quoted context omitted.

> It would be in the insurance companies’ interests to band together to fund the research so they can save huge amounts of money in the long term but they do not do this. Insurance companies do not want cheaper care. In the US, insurance companies must spend 80% of premiums on care. So if you pay $1k/mo, they have to pay out at least $800/mo in care. (Not to you specifically, but averaged out across all subscribers.)…

> So, no, paradoxically, it is not in the interest of people paying for the treatment to save money. Quite the opposite. I'll assume they're on company insurance. Which is often "self-insured" in that the company actually foots the bill as opposed to the insurance company. Why don't corporations just drop insurance companies that decide to not allow cheaper medicines?

UNH is so big because its customer Apple has its own pool. Apple deducts $24k/y for your healthcare. Healthy 29 year old male doesn't use anything. UNH denies the claims anyway. It gives that money back to Apple, which doesn't give it to you.

The 80% rule has a lot of loopholes. It doesn't apply to employer funded plans. There's a reason UNH is so big!

Re: Hospitals and universities repurposing drugs at lower cost

#99

Post by functionmouse »

adityamwagh wrote: post #75
functionmouse wrote: post #31

Related, one of my all time favorite articles: https://www.propublica.org/article/revlimid-price-cancer-cel...

This was so hurtful and blood boiling to read. How is stuff like this allowed to happen?

lack of disincentives to do this

Re: Hospitals and universities repurposing drugs at lower cost

#100

Post by refurb »

dabinat wrote: post #77

I’m currently on Spravato, which is fully emblematic of how broken the incentives in the US healthcare system are. Spravato is esketamine - a modified version of ketamine. Ketamine is made up of mirror image molecules and esketamine is the right-handed molecule. They did this because ketamine is off-patent so they needed to modify it in order to patent it, however there is evidence that esketamine is a less effective…

Blame the FDA on that one.

The FDA's policy for the last couple of decades is that mixtures of mirror images will not get FDA approval unless there is a strong rationale for it.

Racemic mixture of ketamine was approved decades ago. If you want a new indication for ketamine, you will need to get approval for a single mirror image, as the FDA won't approve the old drug.

They did this because there are numerous examples of racemic mixture drugs having increased side effects from the less active mirror image, so the FDA decided no more racemic approvals.

My guess is your insurer would be happy to pay for the old version, but your doctor is heavily incentivized to use the new version as the markup on the drug is much, much higher.

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