Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

The Hidden Monopolies That Raise Drug Prices

prospect.org

Post reply on HN
Print view View original

171–180 of 199 posts

Re: The Hidden Monopolies That Raise Drug Prices

#171

Post by dikdik »

refurb wrote: post #150
dikdik wrote: post #146

Earlier quoted context omitted.

Yes, I know a TON of doctors and used to work very closely with about 50 of them. Well the solution to your problem is not to inundate them with misleading or false information from someone whose entire base of scientific knowledge comes from employer-led seminars. The solution would be to train more doctors, so they have more time with patients AND can be more effective physicians.

from someone whose entire base of scientific knowledge comes from employer-led seminars You forgot to add that the scientific information is limited to the FDA approved label.

While it should be, it's not. There has been lawsuit after lawsuit of pharma reps that promote off label uses of drugs among many more egregious acts (typically at the behest of the pharma companies).

Re: The Hidden Monopolies That Raise Drug Prices

#172

Post by vonmoltke »

spangry wrote: post #77
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…

"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…

> Marketing expense: $19.9bn

Here I go tilting at this windmill again...

"Selling, marketing, and administrative expenses" (SMA) is not just marketing or advertising. It is all the costs of operating the company that are not either R&D or direct costs of producing products sold.

Re: The Hidden Monopolies That Raise Drug Prices

#173

Post by dpark »

evgen wrote: post #121
dpark wrote: post #81

Earlier quoted context omitted.

> 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…

I'm kind of impressed that you managed to turn this into an opportunity to whine about your own continuing education.

Also, just FYI doctors already have to do continuing education to maintain a license, which cuts into the time they can spend researching new drugs.

Re: The Hidden Monopolies That Raise Drug Prices

#174

Post by DanBC »

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.…

There are only about 20 - 30 "new molecular entities" approved each year. These are the ones that need most focus.

How could that information be delivered to doctors without unduly influencing them or overwhelming them with junk info?

Re: The Hidden Monopolies That Raise Drug Prices

#175

Post by code_duck »

refurb wrote: post #140
code_duck wrote: post #89

Earlier quoted context omitted.

Unfortunately that process is a lot more complex than one might think, like everything else involving medicine, government, or even worse, a combination of the two. Safety and efficacy are not a binary condition, either. Questions you might ask are, how effective does a drug have to be to be approved? Is it better to have false positives or false negatives? Who pays for and conducts the studies, and who reviews them?…

Every drug is approved based on a risk vs. benefit analysis. The FDA can't know exactly what will happen when the drug is approved since you can't test a drug on every patient prior to approval (that would be unethical). No one should be surprised when a few drugs are pulled off the market post-launch. I would argue the FDA didn't make a mistake here and the system works.

All I was asserting was my original statement. Many drugs are on the market which are ineffective or harmful. As far as your conclusion there, like your other question it's dramatically over simplified. Whether it 'works' or not seems like a judgement so binary as to be useless. How well it works depends on many factors that we haven't discussed at all.

Re: The Hidden Monopolies That Raise Drug Prices

#176

Post by dpark »

DanBC wrote: post #174
dpark wrote: post #81

Earlier quoted context omitted.

> 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.…

There are only about 20 - 30 "new molecular entities" approved each year. These are the ones that need most focus. How could that information be delivered to doctors without unduly influencing them or overwhelming them with junk info?

I don't know, honestly, but hand waving and saying doctors should all take the initiative to self educate won't do it. Maybe they should, but many likely won't.

The only thing I can think is to make it mandatory continued education. But even that is iffy. Part of the problem is that there's just not that much additional data on new drugs. By definition the FDA thinks the drug is safe (relatively) and effective so what's the education going to look like and who's going to put it together?

Re: The Hidden Monopolies That Raise Drug Prices

#177

Post by refurb »

AstralStorm wrote: post #164
refurb wrote: post #136

Earlier quoted context omitted.

Ummm... the numbers reported by pharma companies has nothing to do with the estimate DiMasi's group did. The pharma numbers are SEC approved financial statements. That real cash going to R&D, not some pie in the sky estimate.

But no idea how much of that is going into new or more effective versions of the drugs, how much to manufacturing process research, how much on sales research etc.

Sales research wouldn't fall under R&D. That's sales.

And why do you need to know how much goes into manufacturing process research? That's as valid as any other R&D process.

Re: The Hidden Monopolies That Raise Drug Prices

#178

Post by refurb »

kgwgk wrote: post #163
refurb wrote: post #124

Earlier quoted context omitted.

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

Not completely true (the restrictions have been eased a bit) but how does this fact support your claim? ("If they had priced lower, they probably would have seen even greater profits.") Profits were higher when prices were higher.

Yes, access has gotten better, somewhat driven by discounts, but also driven by lawsuits against Medicaid.

Where I'm coming from is that there are 3.5M people in the US with HCV. Let's say 10% are in California (350,000). Many of them are on Medicaid. Medicaid estimates it will be spend $1B on these drugs in 2017[1]. Based on that article, it comes out to 14,300 patients. A small fraction of those with HCV.

I would imagine if Gilead had priced lower (maybe starting at $40K and discounting from there) they would have had much less payer pushback and likely a huge increase in numbers treated. Payers are still telling people "yes you have HCV, but no you're not sick enough".

[1]http://californiahealthline.org/news/medi-cal-to-spend-nearl...

Re: The Hidden Monopolies That Raise Drug Prices

#179

Post by refurb »

jellicle wrote: post #142
refurb wrote: post #38

Earlier quoted context omitted.

What a poorly written article. It looks like just lumped all the business expenses under "sales and marketing". I think it's absurd to assume that all of that spending is completely discretionary. Contrary to what people think, you need to do a certain level of sales support in the pharmaceutical market. The drugs don't sell themselves.

We don't want them to be "sold". We want them to be prescribed as needed by medical professionals.

Yes, but medical professionals can't prescribe if they don't know enough about the drug.

Here is an interesting example: People complain about direct to consumer advertising of drugs in the US. What an outrage!! Well, the FDA did some analysis and found out that when patients asked for the drug: (1) 87 percent actually had the condition the drug treats, (2) 6 percent of those DTC-generated visits, a previously undiagnosed condition was discovered, (3) Only 7 percent of doctors said they felt "very pressured to prescribe" a particular advertised drug - the real pressure was time pressure. More patients are coming in armed with more questions.[1]

Sounds like DTC is pretty good huh?

[1]http://drugwonks.com/blog/fake-dtc-news-mustn-t-drive-the-he...

Re: The Hidden Monopolies That Raise Drug Prices

#180

Post by guelo »

TheAdamAndChe wrote: post #159
ch4s3 wrote: post #157

Earlier quoted context omitted.

Socialism and populism are not necessarily mutually exclusive. Quite often socialism takes the form of populist socialism (think Bernie Sanders or Chavez). Also, I think anyone who voted Trump to generate populist change, are likely getting a raw deal. The administration is loaded with Billionaires and business leaders, the opposite of populism. And, they've already set about enacting changes that negatively affect a…

Thank you, I wasn't aware of that. I thought they were completely different. How would Trump's direction be described, then? Nationalism? Also, I agree that electing Trump was a raw deal. But between the two presidential candidates, Trump was the Change candidate and Clinton was the Status Quo candidate. From what I understand, a lot of studies show that Sanders would have won the election if he wasn't suppressed on…

I would say Trump is a traditional pro-big-business conservative, all about deregulation and cutting taxes, tough on crime, etc. mixed with an extra dose of xenophobia.
Post reply on HN