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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

#361

Post by kkreamer »

cgiles wrote: post #337
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…

I work in medical research and mostly agree with this, but there are two major problems I see preventing this from becoming a reality: 1) Academic medical research is simply not well tooled, right now, to do the later stages of drug development. What pharma does well and academia does not, is basically optimization of candidates. They do it through high-throughput screens and medicinal chemistry. Those things are ver…

Not going to respond on the rest of your comment, but on insulin, I want to rebut the idea that generics are the same as "fancy and more convenient" versions. They are completely different drugs with different (and far worse) clinical outcomes.

You might as well say "infected people won't have amputations like we've been doing forever. They must always have the fancy and more convenient antibiotics instead."

The fact is, because of intrinsic differences in the types of insulin, a regimen of NPH and/or R can not help but have a significant increase in diabetic complications (including amputations, as in my statement above) than a basal/bolus regimen of Lantus/Levemir and Novolog/Humalog -- all of which have been available for something like 20 years and all of which have seen predatory price increases.

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

#362

Post by lastpingstandin »

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…

I seem to recall that the reason marketing costs seem high relative to R&D is that large firms typically acquire much smaller firms, small firms which invested a ton of money developing a drug but without the means of distributing it.

When a company like Pfizer acquires said company, none of the R&D spending of the smaller company gets absorbed into Pfizer's balance sheet.

In 2006, the pharma entire industry spend 12 billion in marketing, but 58.8 billion on r&d. Simply looking at individual large companies' doesn't do this justice.

http://phrma-docs.phrma.org/sites/default/files/pdf/marketin...

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

#363

Post by jahaja »

rayiner wrote: post #343
jahaja wrote: post #262

Earlier quoted context omitted.

The presumption is that it's actually the regulations that prevents the competition, which haven't at all been made clear. How about patents for example? How about the cheap prices of Europe?

Drugs in Europe aren’t “cheap.” https://ihsmarkit.com/solutions/us-price-gouging-pharmaceuti... > Based on our analysis of prices in regulated markets, the United States paid on average more than 50% that other developed markets. Of course, that figure is before discounts: > Hence, while US pharmaceutical reference prices are typically higher than most counterparts, it does not mean that the US also ultimately pays h…

With regards to the topic, insulin. It's certainly cheap by comparison.

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

#364

Post by charwalker »

rhino369 wrote: post #317
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 char…

My doctor prescribes my medication, not my software. Why would anything more than a journal article with technical information released for the benefit of the medical community be needed?

The US is one of like 2 countries that even allow TV commercials for drugs, yet all those other countries (and their Not for Profit or universal healthcare systems) work better than the US.

If I'm told to ask my doctor if [DRUG] is right for me, shouldn't they already be aware of the option and if beneficial brought it up vs staying quiet and endangering my health? The marketing budget is way out of line.

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

#365

Post by nate_meurer »

rayiner wrote: post #315
pdeuchler wrote: post #296

Earlier quoted context omitted.

> 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.

The best answer comes from the paper you cited earlier:

> "New biologic drugs are orders of magnitude larger than small-molecule drugs, and it’s often impossible to know on an atom-by-atom basis whether one large-molecule drug is the same as another. Subsequent versions of off-patent biotech drugs are therefore called biosimilar rather than generic. Differences in the tissue systems that produce them can lead to differences in protein folding and glycosylation, which could theoretically result in efficacy or safety differences. But the FDA, the EMA, and the generic drug industry hope these issues can be addressed by new regulatory sciences of biosimilarity."

> "Although regulatory pathways for biosimilar insulin are being finalized in the United States and Europe, economists warn that the introduction of biosimilars may not lead to price reductions equivalent to those seen with typical generic medicines. Even an abbreviated approval process for biosimilars will require substantially more original data than the typical abbreviated new drug application required for small-molecule generics and will necessitate immunogenicity and other safety studies in humans."

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

#366

Post by kkreamer »

cgiles wrote: post #357
sterlind wrote: post #349

Earlier quoted context omitted.

aren't there some diabetics that need the newer types of insulin? is it really true that all diabetics could take the generic, classical insulin without any problems, and suffer no health consequences? I mean I doubt they pay hundreds of dollars just to sport the Mylan brand like like a Gucci purse..

To my knowledge -- keeping in mind this is not my area -- there are modest benefits for newer types of insulin. You have to dose less often. The variance in swings of blood glucose is lower -- newer types tend to be more "extended release". Some types can be inhaled instead of being injected, which is obviously preferable. But in my understanding, in general, there are no major health risks from using plain insulin,…

This depends on what you mean by "plain insulin". If you are referring to NPH and R, there's a massive world of difference going to, say, Novolog and Lantus. If you're comparing something like Lantus versus Tresiba, sure, it's more "extended release" Or yes, Afrezza is inhalable. But when people complain about the cost of insulin, they're referring to the cost, and especially the huge cost increases, of insulins like Lantus and Novolog (that have been out for a couple decades now), not the cost of new insulins like Afrezza or Tresiba.

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

#367

Post by TurkishPoptart »

amyjess wrote: post #249
umvi wrote: post #137

Earlier quoted context omitted.

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…

I'm a trans woman. It's widely acknowledged in the trans community that most of us have to teach our doctors what meds to prescribe, what starting doses are common, and how to interpret lab results to determine how to titrate the dosage. Most of us have read the Encdocrine Society's clinical guidelines for HRT cover to cover, because we have to be the experts. And half the time, it turns into a fight. At one point, I…

Q: If you say you are a trans woman, does that mean you are transitioning from MtF?

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

#368

Post by kkreamer »

cgiles wrote: post #357
sterlind wrote: post #349

Earlier quoted context omitted.

aren't there some diabetics that need the newer types of insulin? is it really true that all diabetics could take the generic, classical insulin without any problems, and suffer no health consequences? I mean I doubt they pay hundreds of dollars just to sport the Mylan brand like like a Gucci purse..

To my knowledge -- keeping in mind this is not my area -- there are modest benefits for newer types of insulin. You have to dose less often. The variance in swings of blood glucose is lower -- newer types tend to be more "extended release". Some types can be inhaled instead of being injected, which is obviously preferable. But in my understanding, in general, there are no major health risks from using plain insulin,…

To clarify, the IMMINENT DEATH possibility is also true, in the case of diabetic ketoacidosis, which is caused from lack of insulin. Yes, if it came to it, you could use Walmart's NPH/R to avoid DKA, but then you put yourself at a higher risk of severe hypoglycemia (extreme low blood sugar) due to the way those insulins work, which can also result in imminent death.

My comment previously was referring to the best case, where you only lose some toes or a foot in a decade or two.

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

#369

Post by rayiner »

michael_j_ward wrote: post #326
pdeuchler wrote: post #264

Earlier quoted context omitted.

It's quite telling what you excluded in your rendition of history. The original research for the synthesis of insulin was actually done in Europe by a private citizen (not a government entity). That research was followed up on by a surgeon with a private practice in Canada, and only after a time was it taken to the U of Toronto. The work leading to a manufacturable insulin process was done in collaboration with anoth…

>They prevent other companies from creating their own "generics" through a process called "evergreening" where they change patents in small, insignificant ways while still maintaining the patent on the core product. To be really clear: 1) A company receives patent X in 2000, which expires in 2020. 2) In 2018, that company gets a new patent Y that is really patent X but with "small, insignificant" changes. Are you say…

Not just the original patent, but every invention embodied in the original product will go into the public domain.

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

#370

Post by cgiles »

kkreamer wrote: post #361
cgiles wrote: post #337

Earlier quoted context omitted.

I work in medical research and mostly agree with this, but there are two major problems I see preventing this from becoming a reality: 1) Academic medical research is simply not well tooled, right now, to do the later stages of drug development. What pharma does well and academia does not, is basically optimization of candidates. They do it through high-throughput screens and medicinal chemistry. Those things are ver…

Not going to respond on the rest of your comment, but on insulin, I want to rebut the idea that generics are the same as "fancy and more convenient" versions. They are completely different drugs with different (and far worse) clinical outcomes. You might as well say "infected people won't have amputations like we've been doing forever. They must always have the fancy and more convenient antibiotics instead." The fact…

You are right, and I altered a comment below to reflect this. I was trying to make a more general point and phrased it poorly.

The general point is: the reason drug costs are high because of two things working together:

1) Pharma continually refreshes patents by making modest, but real, improvements to things that are generically available.

2) Patients will not accept any level of increased health risk, no matter how much the cost increases in exchange for decreased risk.

The result of these two things is that even though we have generics available for almost every major disease, they are rarely used, and we are always using the patented versions which are orders of magnitude more expensive. And then we have people wondering why health care is so expensive.

It would be absolutely bizarre if it were any other area of the economy. Imagine if every person insisted on owning a sports car because they go 20% faster. But because we (the public in general) continue on insisting that no price can be placed on marginal increases human life or health -- despite the huge logical contradictions that result from this -- we cannot have rational discussions about how to actually keep health care affordable.

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