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

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

#311

Post by michael_j_ward »

tryptophan wrote: post #248
michael_j_ward wrote: post #173

Earlier quoted context omitted.

In addition to reducing regulatory barriers that prevent generic producers, why is no one suggesting altering the pharmaceutical intellectual property system? Twenty years to hold monopoly production rights is an obscene amount of time. Yes, reducing that twenty to say five will reduce capital investments in drug research, but it will also alter the structure of those investments. Investing in improvements at the mar…

Lowering drug patent duration would explode prices upwards. Its much easier to recover 1B investment over 20 years than 5. And this conspiracy that pharma is intentionally not funding cures to make more money is ridiculous. That would imply they know how to cure things, but just don't want to...

Explode prices for this first 5 years, maybe it would. But then, the improvement would have to be enough over the most recent generic that the consumer would actually pay the increase.

As to not investing in cures, I'm not saying they don't at all, but they allocate resources towards the best return on capital. And I'd ask you to apply your own reasoning, that "Its much easier to recover 1B investment over 20 years than 5" to which gives an easier return on capital.

Of course, implicit in that is that it's less risky to fund research in incremental improvements than on outright cures- but I'm open to being taught differently on that.

EDIT: fixing jumbled words

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

#312

Post by marriedWpt »

chimeracoder wrote: post #200
mattrp wrote: post #124

Earlier quoted context omitted.

Along similar lines, I read a study nearly twenty years ago and I wish I could find it for these very recurring government vs market debates. The study evaluated prices between single payer countries and found that it wasn’t the collective bargaining that reduced prices in those countries. They observed that there was no correlation between the size of the single payer and pricing. Rather, it was that the pharma adju…

> Edit: another thought comes to mind - has anyone compared the size of health insurers in the US and compared their purchasing power to government run single payers? I’d hazard a guess that United Health for example probably dwarfs entire single payers of some governments. Medicare alone covers more patients than NHS England does. (Very few countries in Europe actually have single-payer healthcare; the four UK count…

Medicare isn't one gigantic entity though.

You get a Medicare provider, with an insurance company that you work with.

Yeah there's lots of layers of bureaucracy.

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

#313

Post by Consultant32452 »

InvisibleCities wrote: post #310
Consultant32452 wrote: post #298

Earlier quoted context omitted.

Food is far more important for human survival than medicine. Somehow we're able to allow a free market with for profit food producers and distributors. Lots of research is done to make better/heartier foods. Prices are quite reasonable for food with stable inflation. Almost no one thinks it'd be a good idea to nationalize food research, production and distribution. The solution seems clear to me: take a look at the r…

This is a very disingenuous comparison. For any given food, there are a large number of both perfect and imperfect substitutes, which is very much not the cases for patented medicines. It is also much easier for individuals to grow their own food than it is to manufacture their own pharmaceuticals. But beyond that, food is one of the most regulated markets in modern society. Farm subsidies, food assistance programs l…

Drug patents only last about 10 years. So fixing the evergreening system at the patent office solves your concern about perfect and imperfect substitutes.

Take a look some time at the large list of drugs Walmart pharmacy offers for just a few bucks a month. Our model should be to get more drugs in such a state that a Walmart can offer them for such a low price.

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

#314

Post by michael_j_ward »

harryh wrote: post #198
michael_j_ward wrote: post #173

Earlier quoted context omitted.

In addition to reducing regulatory barriers that prevent generic producers, why is no one suggesting altering the pharmaceutical intellectual property system? Twenty years to hold monopoly production rights is an obscene amount of time. Yes, reducing that twenty to say five will reduce capital investments in drug research, but it will also alter the structure of those investments. Investing in improvements at the mar…

The vast majority of drugs wouldn't even make it out of the FDA approval process before the patent expired if you set the term to 5 years.

The number was merely an example. The alteration I proposed would be equivalently applicable to "5 years post FDA approval."

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

#315

Post by rayiner »

pdeuchler wrote: post #296
rayiner wrote: post #167

Earlier quoted context omitted.

> What's your solution for drugs that aren't out of patent? Wait for them to get out of patent? The average remaining patent term for newly approved drugs is 10-12 years. So drugs approved in 2008 will mostly be coming out of patent this year. All this stuff you here about “evergreening” is entirely the result of gaming the FDA approval practices. Patent law is categorical: once you make a thing publicly available, t…

> All this stuff you here about “evergreening” is entirely the result of gaming the FDA approval practices Evergreening has absolutely nothing to do with the FDA and everything to do with the USPTO and the specific chemical makeup of insulin, which has unique characteristics that make it very easy to engage in effective "evergreening". This also allows drug companies to manipulate pricing lists in deceptive ways that…

> Evergreening has absolutely nothing to do with the FDA and everything to do with the USPTO and the specific chemical makeup of insulin, which has unique characteristics that make it very easy to engage in effective "evergreening"

I’m very curious what you think these are.

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

#316

Post by marriedWpt »

vasilipupkin wrote: post #222

everyone tearing their hair out over this: the effect of the law is just that insurance overall will be somewhat more expensive in Illinois. There won't be any effect on research or innovation or anything else. Everyone will have to chip in a bit to make sure people with diabetes don't go without insulin. I don't see this is as a big disaster. Illinois has much bigger problems than this. If people foregoing insulin b…

This will either increase the price of insurance or cause people to take monthly trips to neighboring states.

Price ceilings don't work, I don't quite understand how people are elected when they don't understand high school level government/economics.

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

#317

Post by rhino369 »

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

In an industry with high fixed costs, marketing may in fact reduce the cost per consumer. Using software as an example, you can't just take the marketing costs per customer and subtract that from the price. If 1,000,000 in marketing brings in 3,000,000 in extra revenue, that marketing didn't cost customers anything. It could even allow the software company to charge less per copy.

There are some real differences between software and medicine. And I'm not sure increasing users of a drug is a good thing in many cases. But I doubt prilosec commercials are increasing the price I pay.

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

#318

Post by vkou »

malandrew wrote: post #287
vkou wrote: post #275

Earlier quoted context omitted.

> It seems like there is a perception by these companies that there is a discoverability problem. The rest of the world manages to 'discover' that these drugs exist on the market just fine, yet pharma advertising is banned in most of it.

FWIW, a medicine I have been taking since 2003 is still not available in all other countries except the US and Canada (and it's only recently become available in Canada). It's still the only effective treatment for my condition.

There's typically a couple of reasons for that, and awareness is not really one of them.

Just like the FDA reviews drugs for safety and efficacy, and just like your insurer reviews drugs for price, national health boards review drugs for safety, efficacy, and price.

Sometimes, the boards want to wait and see if the drug is actually effective in clinical use.

Sometimes the boards want to wait and see if the drug is actually safe in clinical use.

Sometimes, that equation does not swing in the drug's favour. If a drug is $10,000/year, compared to a $500/year, but provides someone taking it for 10 years, on average, with a month's extra life, it would be foolish to spend $100,000 on the better drug - if for that money, you can buy more than a month of life for other people, with another drug, or with surgeries, or better screenings, etc, etc.

Likewise, if a drug improves quality of life for someone, how do weigh that against saving someone's life? There's a limited medical budget, and there's some ethical calculus that you plug the numbers in, and determine which of those options is a better use of scarce resources. But in order to do that, you actually need to get the numbers. Clinical trials, in themselves, don't give all of those answers.

The FDA differs from the FAA, in that the world does not consider it the sole gatekeeper of medical efficacy, safety, and cost.

What will not solve this problem, is the drug manufacturer spending half a billion dollars on taking doctors, medical directors, and politicians on all-expense paid junkets to the Carribean. You're not going to get better awareness from this, you're going to get more corruption, and more expensive drugs. (The $500/year alternative can't compete with the $100,000/year alternative in this sense - as the manufacturer of the latter can trivially out-bribe the former.)

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

#320

Post by dreae »

ikeboy wrote: post #309
dreae wrote: post #300

Earlier quoted context omitted.

Are you suggesting when a new drug hits the market doctors should just try it out on a few patients to see if actually does what it says it does? If only there was some way this sort of trial and error could be performed before a drug was widely available, in a controlled environment...

" If only there was some way this sort of trial and error could be performed before a drug was widely available, in a controlled environment..." This is exactly how doctors determine what works, with or without the government. See the off-label discussion in the link above.

I'm familiar with the off-label discussion, but what number of these off-label uses were discovered by treating coinciding conditions in patients? How many were last ditch attempts when other treatment options either don't exist or failed?

I'm not suggesting that current regulation by the FDA isn't flawed, or that it doesn't need an overhaul, but I think it's clear that there should be some proof that efficacy studies were done before a drug becomes widely available, especially when the potential damage done by a failed treatment is so high. The current opioid crisis has completely eroded any faith that the pharmaceutical industry is capable or willing to regulate itself.

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