Illinois governor signs law capping insulin costs at $100 per month • Hacker News Board

Re: Illinois governor signs law capping insulin costs at $100 per month

#251

Post by bmelton » Wed, Jan 29, 2020, 6:31 PM UTC

baron816 wrote: post #23

outlace wrote: post #7

Has there ever been a price control experiment that hasn't resulted in even worse problems?

Price controls are usually really bad. But medicine is a different case for many reasons I don’t want to get into now. Lots of countries do control prices of medical care without restricting supply.

The obvious counter to that and (feel free to interject if I'm wrong) is that it's because other countries have instituted price controls on pharmaceuticals that companies have to make up their profits on the US market.

My worry here is that the price control seems to act as a disincentive for selling in the price controlled market. So long as there are 49 other states where margins are greater, it seems like those orders will be fulfilled first.

Re: Illinois governor signs law capping insulin costs at $100 per month

#252

Post by gdubs » Wed, Jan 29, 2020, 6:32 PM UTC

Someone1234 wrote: post #8

I'm really past the whole "pharma need to charge high prices to fund research" line of argument. Aside from being factually untrue (research funding is dwarfed by marketing for example[0]), it is also arguing for a continued unhealthy relationship with pharmaceutical care. A large amount of research is currently publicly funded. Either via public academic research or directly. When that research bears fruit it is oft…

The numbers don’t support their argument that r&d expenses drive the prices, so they’ve shifted to saying that prices reflect the drugs “value”. Even on this, the numbers don’t really agree.

But to jump on to your main point — people don’t realize just how much their tax dollars have already paid for the development of these drugs.

Having a healthy competitive market to take these things the last mile is good — but these companies are incredibly deceptive when it comes to how much they’ve benefited from public investment.

Re: Illinois governor signs law capping insulin costs at $100 per month

#253

Post by nokcha » Wed, Jan 29, 2020, 6:32 PM UTC

ptah wrote: post #42

Someone1234 wrote: post #8

I'm really past the whole "pharma need to charge high prices to fund research" line of argument. Aside from being factually untrue (research funding is dwarfed by marketing for example[0]), it is also arguing for a continued unhealthy relationship with pharmaceutical care. A large amount of research is currently publicly funded. Either via public academic research or directly. When that research bears fruit it is oft…

> research funding is dwarfed by marketing for example i really believe pharma advertising should be banned

Of potential relevance: The U.S. Supreme Court ruled on the constitutionality of a statute restricting the advertising of the prices of prescription drugs in Virginia State Pharmacy Board v. Virginia Citizens Consumer Council, 425 U.S. 748 (1976). (https://www.law.cornell.edu/supremecourt/text/425/748). The Court ruled that statute at issue was unconstitutional under the First Amendment.

Re: Illinois governor signs law capping insulin costs at $100 per month

#254

Post by ceejayoz » Wed, Jan 29, 2020, 6:32 PM UTC

ikeboy wrote: post #215

djpowell wrote: post #211

Earlier quoted context omitted.

The NHS pays £14 - £28 a vial for those newer formulations.

Good for them. Maybe if we fixed the patent system (government enforced monopoly) we'd be in a similar position.

The UK has a patent system.

Re: Illinois governor signs law capping insulin costs at $100 per month

#255

Post by AdrianB1 » Wed, Jan 29, 2020, 6:33 PM UTC

gruez wrote: post #16

outlace wrote: post #7

Has there ever been a price control experiment that hasn't resulted in even worse problems?

Other developed countries have price controls (more specifically, government negotiated prices) and it seems to be working well for them.

Real case: Romania. We put a price control in place, thousands of drugs are no longer available. My brother works for a distributor (they import and distribute, so they don't have any control) and told me the government report on 1200 drugs that disappeared from pharmacies in the past 3-4 years are the important ones, in total there are over 5000 they can no longer import because the controlled price is lower than the bulk price they can buy for.

Re: Illinois governor signs law capping insulin costs at $100 per month

#256

Post by Baeocystin » Wed, Jan 29, 2020, 6:34 PM UTC

umvi wrote: post #137

ollie87 wrote: post #76

Earlier quoted context omitted.

It is where I live, so weird visiting the US and seeing "ask your doctor for" adverts. If I asked my GP for a specific medication they'd look at me like an alien.

On the other hand, I hate the general attitude of "don't question your doctor or do your own medical research; the doctor knows what's best" Doctors are mortals too and can only have so much time to draw on info they crammed X years ago. Patients can quickly become more expert than GPs with regards to their own diseases, especially if they have months to research it. Anecdotal example - my sister had a wierd skin con…

>Patients can quickly become more expert than GPs with regards to their own diseases, especially if they have months to research it.

A couple of years ago my GI specialist put me on a medicine that had just been approved that was designed for my type of gut issues. We spent a lot of time talking about what we hoped to see, and he spent a lot of time listening to what my experience actually was. This has continued ever since, and he always spends a lot of time listening, because I am one of his few patients that takes that medicine. This patient / doctor feedback loop is incredibly important!

Re: Illinois governor signs law capping insulin costs at $100 per month

#257

Post by GordonS » Wed, Jan 29, 2020, 6:34 PM UTC

pkaye wrote: post #180

ollie87 wrote: post #76

Earlier quoted context omitted.

It is where I live, so weird visiting the US and seeing "ask your doctor for" adverts. If I asked my GP for a specific medication they'd look at me like an alien.

I have a lot of serious long term health issues and quickly found out you have to be the champion for your own health and research everything. But that doesn't mean just asking for the latest drug in the market. Its about asking the right questions. Unless you have a common well understood health issues, you will quickly reach a roadblock.

I agree that it's important to be informed, especially if you have a health problem that is remotely non-obvious.

Pharma TV and billboard ads are the last place I'd seek such information though.

Re: Illinois governor signs law capping insulin costs at $100 per month

#258

Post by throwaway_tech » Wed, Jan 29, 2020, 6:35 PM UTC

ars wrote: post #188

throwaway_tech wrote: post #149

Earlier quoted context omitted.

In the US, we have something similar (but evil) that people don't know or refuse to acknowledge. A Doctor writes a script, and then a pharmacist (not on their own, but at the direction of an insurance company) suggests a change typically to benefit the insurer (for example changing a name brand to a generic or changing 30 days to 90 days so the patient doesn't get seen by the doctor again for 90 days for additional t…

That's not something similar, and has nothing whatsoever to do with what you replied to. And there's nothing wrong with switching from brand name to generic, and most patients don't need to see their doctor every 30 days, and if they do, they can still make an appointment. The length of the drug prescription does not control the appointment - and anyway you can just call and they'll extend the prescription on the pho…

>And there's nothing wrong with switching from brand name to generic, and most patients don't need to see their doctor every 30 days, and if they do, they can still make an appointment.

For patients with chronic conditions if the doctor determines the patient should be seen to evaluate their condition in 30 days before a new script is written, insurers having pharmacists effect a change to 90, is a direct interference with the doctor's practice of medicine. The doctor should make the determination, because they have the relationship with the patient, they know if they are at risk or likely to adhere to the therapies better than an insurer making broad brush strokes based on the cost to insurers. You also skip over the part where doctors get dropped from the insurers network when they don't accept the insurers "recommendations."

>The length of the drug prescription does not control the appointment - and anyway you can just call and they'll extend the prescription on the phone.

Sure, but that is not how it works in practice, the patients won't set up another appointment until they need another script, which is cheaper for the insurer and worse for the patient outcomes. Nevermind the Doctor being in the best position to determine which patients should be seen every 30 or 90 days, the shorter duration and 30 day appointments lead to higher percentages of drug adherence...which is a major issue in the US leading to about 1 million hospitalizations per year.

Re: Illinois governor signs law capping insulin costs at $100 per month

#259

Post by jahaja » Wed, Jan 29, 2020, 6:35 PM UTC

nate_meurer wrote: post #233

jahaja wrote: post #187

Earlier quoted context omitted.

This is the classical "tricke down economy" type of solution. Give companies, who are additionally acting unethically, a guaranteed and direct profit increase and _hope_ that it solves itself in the long-term. Surely it depends on the barriers and how much of a cut those actually are in practice. Furthermore, private corps aren't the only way drugs can be invented.

No, trickle-down refers very specifically to tax breaks tailored narrowly to the wealthy, in hopes that they will in turn distribute their wealth via increased employment of capital and, ultimately, labor. Since its origins in Gilded Age populist political writing and depression era popular media, it has never meant anything else, and it has nothing to do with the subject at hand. > Give companies, who are additional…

Sigh, this is such a typical HN response, "I read everything literally and need to explain what it _actually_ means". I wrote _type_, as in similar. I know the origin.

> This is not a simple analysis, but I think the answer is more often than not, No.

Why not? Profit-driven drug companies will obviously focus on things that make money, e.g. superficial/vanity related things, not what's necessarily aligned with public interests.

Re: Illinois governor signs law capping insulin costs at $100 per month

#260

Post by RcouF1uZ4gsC » Wed, Jan 29, 2020, 6:37 PM UTC

ikeboy wrote: post #107

nradov wrote: post #95

Earlier quoted context omitted.

The testing regulations are not onerous. They are necessary to ensure that new medications are both safe and effective. I often see vague complaints about the regulations, but no one seems to have specific suggestions about how to lower drug development costs while still protecting patients.

https://www.fdareview.org/issues/theory-evidence-and-example... Specific suggestion: get rid of efficacy requirement, keep safety requirement. Let doctors decide what works, as they currently do for off-label uses just fine.

For many medicines, you really can't separate efficacy from safety. As an extreme case, take for example cancer drugs. They typically have high side effects and every year, a certain proportion of the people taking them, die from the side effects. That is an acceptable risk because there is evidence that they are efficacious in treating cancer. If they are not efficacious, that is a completely unacceptable risk.

Less extreme are antibiotics which can also have bad side effects, but are useful drugs because they actually kill bacteria. If they did not, the side effects would be unacceptable.