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Fed Up with Drug Companies, Hospitals Decide to Start Their Own

nytimes.com

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Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#171

Post by refurb »

AstralStorm wrote: post #162
refurb wrote: post #148

Earlier quoted context omitted.

Not being able to get a sample to prove bioequivalence is typically very easy. There are a handful of drugs that have a REMS program whereby the manufacturer is required to restrict access. We're talking maybe a few tens of drugs. And yes, drug companies playing the game of "I'm not allowed to give you a sample" is super shady and ridiculous. Wouldn't surprise me if this gets fixed super fast.

FDA could give overriding authority to oblige manufacturers to provide a sample to the generic manufacturers for drugs older than . Of course this is bad for business. Alternatively the generic manufacturer would have to run a phase 1 and 2 trial. (Skip requirement for phase 3) Expensive, but much less than full R&D.

My understanding is that's the plan. Right now branded drug companies say "REMS regulations mean we can't provide a drug for anyone but a patient."

All the gov't has to do is say "no, if a generic company requests a sample you can provide de it without violating REMS regulations".

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#172

Post by Maarten88 »

manmal wrote: post #154
Symbiote wrote: post #144

Earlier quoted context omitted.

"Due to generic drug manufacturer monopolization, flucytosine currently costs approximately $2000 per day in the United States, with a 2-week flucytosine treatment course costing approximately $28 000. The daily flucytosine treatment cost in the United Kingdom is approximately $22." Would it be permitted to travel to the UK (or somewhere closer) and buy the medicine, then bring it back? Or even order online, there's…

Why not just go on a 2 week holiday :)

I was in San Diego some time ago, and went for a walk to Tijuana, Mexico. I noticed a flourishing pharma business there ;-). Not only Viagra but also seemingly normal pharmaceuticals and services like dentists and doctors. They seem to have found a market there...

Getting through the border and back on foot was a bit of a hassle, and it's probably not a good idea to "bring" too much stuff, but it was a fun experience anyway :-)

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#173

Post by refurb »

phaemon wrote: post #159
refurb wrote: post #150

Earlier quoted context omitted.

Why would a pharmacy care? They typically make a margin on each drug they fill. The more expensive the drug, the more money they make.

I think you misread that comment. He wasn't talking about the pharmacy making anything cheaper. Quite the contrary.

You're right I misread it.

As for the exclusive pharmacy arrangements, that already happens. Some drugs are only available at one pharmacy. That may mean more business for the pharmacy, but manufacturers also extract more concessions because of it.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#174

Post by refurb »

thatcat wrote: post #110
toomanybeersies wrote: post #77

Earlier quoted context omitted.

In New Zealand, Pharmac [1] is a government run entity that bulk negotiates bulk contracts for supplying the entire country with prescription drugs. It's not quite the same as manufacturing it themselves, but the bulk buying does bring the price down quite substantially. [1] https://en.wikipedia.org/wiki/Pharmac

This is common, the US is alone in its legislation against negotiating as a group for prescription prices.

That's an over simplification. Sure Medicare and Medicaid don't negotiate directly. Instead they impose discounts by fiat (no discount, no gov't business).

Look up the 340B program and mandatory Medicaid rebates. They add up to huge discounts.

In most cases Medicaid pays the lowest price of any customer and Medicare often pays the same as private insurers.

It's a fallacy to say the gov't is getting screwed over by not negotiating over drug prices.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#175

Post by Clubber »

phillc73 wrote: post #121
Clubber wrote: post #72

Earlier quoted context omitted.

I they seem to be explicitly targeting generics, so R&D doesn't come into play. It's really just find someone who can build a known compound and press it into a pill. This has the potential to be massively disruptive.

There is still a significant R&D element in that "press it into a pill" step. This is manufacturing and process R&D. For example, continuous (rather than batch) manufacturing is the big hotness at the moment. Also new techniques, such as 3D printed pharmaceuticals, involve plenty of R&D effort.

Yes, but compared to R&D for creating a new drug, it's a fraction of the cost. Also, I would think to save costs, they would do it the cheapest way that is proven and reliable.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#176

Post by pas »

dragonwriter wrote: post #157
thaumaturgy wrote: post #128

Earlier quoted context omitted.

Contrary to your comment, yes, they generally are; they're just using Hollywood accounting and referring to their profits as "excess earnings". "A study published in the May issue of Health Affairs revealed that in 2013, seven of the top ten most profitable hospitals in the United States were nonprofit hospitals, with each earning over $163 million in profits from patient care." https://www.forbes.com/sites/brucelee/…

> Contrary to your comment, yes, they generally are; No, they're not. > they're just using Hollywood accounting and referring to their profits as "excess earnings". No, they aren't. Excess earnings are the correct technical term. Non-profit status, even in theory, has nothing to do with whether you earn more in revenue than you expend in costs , it has to do with whether there are stockholders or others who have a cl…

So why aren't for profits the most profitable then?

And the simple fact that a non profit can spend 6M USD on compensation to its CEO loudly advertises the healthcare provider market inefficiency.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#177

Post by reacweb »

iagovar wrote: post #160
Symbiote wrote: post #144

Earlier quoted context omitted.

"Due to generic drug manufacturer monopolization, flucytosine currently costs approximately $2000 per day in the United States, with a 2-week flucytosine treatment course costing approximately $28 000. The daily flucytosine treatment cost in the United Kingdom is approximately $22." Would it be permitted to travel to the UK (or somewhere closer) and buy the medicine, then bring it back? Or even order online, there's…

There are multiple south american and european generic manufacturers, but I guess is not thay simple to ship drugs.

Maybe easier to ship patients ?

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#178

Post by AndyMcConachie »

icantdrive55 wrote: post #95
shykes wrote: post #86

This article makes it seem like drug companies alone are responsible for predatory pricing in US healthcare, with hospitals being somehow on the consumer's side of the issue. In reality US hospitals are just as guilty of predatory behavior. If they do achieve lower costs through a new generics company, I do not trust them one bit to pass on the savings to patients. Why would they?

Never forget being charged 14.99 for one Acetaminophen while in a hospital, and this was years ago. My father had good insurance. He went in for a spider bite. He needed to stay the night. I arrived and he thanked me for Teddy Bear, and flowers. I told him I didn't send you anything. He said, "Well someone did?" Weeks later he called me up, and said the gift shop on the hospital send the gift, and charged the Insuran…

Is there a website where people can post their annotated hospital bills and talk about them? If not, someone should make one.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#179

Post by GeekyBear »

mft_ wrote: post #165
eksemplar wrote: post #151

Earlier quoted context omitted.

Drug prices is an increasing problem everywhere. Now I’m European so bare with me and my “Stalinist” ways, but I don’t see why something so essential to society is in the hands of corporations rather than the public. Research? You could buy a lot of research for the amount of money we’re currently spending on medicine in healthcare and right now we’re really just paying a corporate tax to save lives so that some 1%’e…

Assuming you're referring to the general development and supply of all drugs (in particular new drugs, as well as generics) the simple answer is that the process of discovering and developing new drugs is both high-risk and also heinously expensive. As such, whoever approaches it needs to have many billions to spend and --very likely-- lose. The current capitalist Pharma model has developed to suit: investors in Phar…

Research from the Pew Charitable Trusts shows that in 2012 alone 27 Billion dollars was spent by US Pharmaceutical companies to promote their drugs to doctors and patients.

http://www.pewtrusts.org/en/research-and-analysis/fact-sheet...

This is money that could have been spent on R&D instead of advertising if we moved to a non-profit pharmaceuticals model.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#180

Post by maxerickson »

rtpg wrote: post #125
tacon wrote: post #103

For a fantastic discussion about the Byzantine process for generic drug approval, I recommend a recent episode of EconTalk[0]. The guest wrote a book called "Drug Wars: How Big Pharma Raises Prices and Keeps Generics off the Market"[1]. When up to half a billion dollars of revenue is at stake, the drug companies have incredible incentives to delay or prevent generics coming to market. Believe or not, they often simpl…

Is this a worldwide problem? Or is this really an American failing?

I think it is worse in the US.

India goes as far as waiving patents if a drug is too expensive.

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