The Hidden Monopolies That Raise Drug Prices • Hacker News Board

Re: The Hidden Monopolies That Raise Drug Prices

#111

Post by spangry » Thu, Mar 30, 2017, 5:47 PM UTC

xadhominemx wrote: post #102

spangry wrote: post #77

Earlier quoted context omitted.

"Finally one of the challenges with moving to a centrally managed pricing solution like what works so well in Canada and most of Western Europe is right now R&D into pharmaceuticals is largely financed by the opportunity size available in the US market. If you were to just adopt the centralized model tomorrow R&D would grind to a stop, at least for some period of time until we found new ways to finance it." That woul…

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!

Re: The Hidden Monopolies That Raise Drug Prices

#112

Post by Retric » Thu, Mar 30, 2017, 5:48 PM UTC

brandonmenc wrote: post #70

DarkKomunalec wrote: post #53

Earlier quoted context omitted.

> And no, the sales and marketing in that article is not advertising alone. It's mostly sales people who go and visit medical professionals to talk about their products. That's advertising. You mentioned 20% of their revenue is R&D - do you have a source, ideally listing what the other 80% goes to? That's a lot of unaccounted revenue, especially given how many drugs were shown to be dirt cheap to manufacture.

> That's advertising. Anecdotally, a friend of mine was doing post-doctoral work researching and developing cancer drugs. He now works on a pharmaceutical sales team as a scientific liaison. "Advertising" a drug involves a lot more than running TV commercials - it also includes former scientists making the current research digestible for doctors who don't have the time or specialized knowledge to do that in between s…

There are only ~50 new drugs a year, and many of those are highly specialized. So, it's really not hard to keep up with new drugs. The hard part is actually staying fresh on all the existing knowledge that you don't use regularly and some changes to best practices.

Re: The Hidden Monopolies That Raise Drug Prices

#113

Post by rhizome » Thu, Mar 30, 2017, 5:49 PM UTC

tclAmockingbird wrote: post #94

galdosdi wrote: post #65

Earlier quoted context omitted.

FWIW the anecdotal experience of people I know in the health field in the US is that pharma sales reps know nothing about medicine, are hired for their sales / "relationship building" ability, and can't answer any question about the drug they are touting that can't be answered by looking at the brochure. Very disappointing. You can't expect to get unbiased, quality advice from someone with such a strong incentive. Th…

> FWIW the anecdotal experience of people I know in the health field in the US is that pharma sales reps know nothing about medicine, are hired for their sales / "relationship building" ability, and can't answer any question about the drug they are touting that can't be answered by looking at the brochure. Very disappointing. MSLs have advanced degrees in medicine or biomedical research. It's preferred that the tradi…

Not everyone here is in the industry, what's an MSL?

Re: The Hidden Monopolies That Raise Drug Prices

#114

Post by rhizome » Thu, Mar 30, 2017, 5:53 PM UTC

ch4s3 wrote: post #37

kellanem wrote: post #27

The article does a good job of starting to explain the forces, but it's actually even more complicated. A number of the PBMs are cross invested in pharmacies and insurance companies, and the incentives of 2-3 large pharmacies that control the majority of the market (and how they get paid) is very different than how small pharmacies get paid. Additionally the way the generic market works vs the branded (patented) meds…

> what works so well in Canada and most of Western Europe is right now R&D into pharmaceuticals is largely financed by the opportunity size available in the US market. If you were to just adopt the centralized model tomorrow R&D would grind to a stop This is really hard to explain to people.

Probably because saying something is "financed" by demand is counter-intuitive.

Re: The Hidden Monopolies That Raise Drug Prices

#115

Post by jonathankoren » Thu, Mar 30, 2017, 5:57 PM UTC

tclAmockingbird wrote: post #94

galdosdi wrote: post #65

Earlier quoted context omitted.

FWIW the anecdotal experience of people I know in the health field in the US is that pharma sales reps know nothing about medicine, are hired for their sales / "relationship building" ability, and can't answer any question about the drug they are touting that can't be answered by looking at the brochure. Very disappointing. You can't expect to get unbiased, quality advice from someone with such a strong incentive. Th…

> FWIW the anecdotal experience of people I know in the health field in the US is that pharma sales reps know nothing about medicine, are hired for their sales / "relationship building" ability, and can't answer any question about the drug they are touting that can't be answered by looking at the brochure. Very disappointing. MSLs have advanced degrees in medicine or biomedical research. It's preferred that the tradi…

I don't what you're talking about. The pharmaceutical salesmen I've known were retrained coal miners without college degrees.

You should never trust a salesmen to give you advice, because the advice inevitably is, "you need this thing I happen to be selling today."

Re: The Hidden Monopolies That Raise Drug Prices

#116

Post by [deleted] » Thu, Mar 30, 2017, 5:57 PM UTC

tclAmockingbird wrote: post #94

galdosdi wrote: post #65

Earlier quoted context omitted.

FWIW the anecdotal experience of people I know in the health field in the US is that pharma sales reps know nothing about medicine, are hired for their sales / "relationship building" ability, and can't answer any question about the drug they are touting that can't be answered by looking at the brochure. Very disappointing. You can't expect to get unbiased, quality advice from someone with such a strong incentive. Th…

> FWIW the anecdotal experience of people I know in the health field in the US is that pharma sales reps know nothing about medicine, are hired for their sales / "relationship building" ability, and can't answer any question about the drug they are touting that can't be answered by looking at the brochure. Very disappointing. MSLs have advanced degrees in medicine or biomedical research. It's preferred that the tradi…

[deleted]

Re: The Hidden Monopolies That Raise Drug Prices

#117

Post by kgwgk » Thu, Mar 30, 2017, 5:57 PM UTC

refurb wrote: post #107

kgwgk wrote: post #71

Earlier quoted context omitted.

How so? There are only so many patients to treat. Sales are eroding mostly because competition has brought prices down and improved drugs allow for shorter treatments.

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.

Re: The Hidden Monopolies That Raise Drug Prices

#118

Post by tclAmockingbird » Thu, Mar 30, 2017, 6:07 PM UTC

rhizome wrote: post #113

tclAmockingbird wrote: post #94

Earlier quoted context omitted.

> FWIW the anecdotal experience of people I know in the health field in the US is that pharma sales reps know nothing about medicine, are hired for their sales / "relationship building" ability, and can't answer any question about the drug they are touting that can't be answered by looking at the brochure. Very disappointing. MSLs have advanced degrees in medicine or biomedical research. It's preferred that the tradi…

Not everyone here is in the industry, what's an MSL?

Medical Science Liaison

Re: The Hidden Monopolies That Raise Drug Prices

#119

Post by tclAmockingbird » Thu, Mar 30, 2017, 6:10 PM UTC

jonathankoren wrote: post #115

tclAmockingbird wrote: post #94

Earlier quoted context omitted.

> FWIW the anecdotal experience of people I know in the health field in the US is that pharma sales reps know nothing about medicine, are hired for their sales / "relationship building" ability, and can't answer any question about the drug they are touting that can't be answered by looking at the brochure. Very disappointing. MSLs have advanced degrees in medicine or biomedical research. It's preferred that the tradi…

I don't what you're talking about. The pharmaceutical salesmen I've known were retrained coal miners without college degrees. You should never trust a salesmen to give you advice, because the advice inevitably is, "you need this thing I happen to be selling today."

This sort of hostility is why I keep quitting this damned site. Thanks for reminding me.

Re: The Hidden Monopolies That Raise Drug Prices

#120

Post by txmx2000 » Thu, Mar 30, 2017, 6:30 PM UTC

> The Pharmaceutical Care Management Association, the industry’s lobbying group, claims that PBMs will save health plans $654 billion over the next decade.

That's about $16 per person per month. Not a very compelling argument for keeping your drug monopolies: eliminating them costs little more than a Netflix subscription.