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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

#371
post #337

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…

>And with insulin specifically, there is another problem: diabetics won't take the generic insulin that has been off-patent for years now.

A huge reason I found is your doctor won't ever recommend it. Most diabetics may very well just be blissfully ignorant (I was until recently) that it's even an option, save for Wal-Mart very heavily marketing their "Reli-On" branded insulin produced by Novo Nordisk.

I wonder if PCPs (not endocrinologists) are even aware it exists. I've had many PCPs in the past few years, from one of the best health care centers in the US, never recommend it as an option, and seemed to forget it even existed. I guess when you recommend Eli Lilly's biologic-developed analogs for decades and decades, you damn near forget about the old school insulin out of habit.

I recently switched, WITHOUT a doctor's approval (none would recommend it). I have to be more careful, but my costs of using purely generic everything plummeted to below 1997-era insured levels Increasingly insurance co-pays have gotten far more expensive for the biologics, and increasingly plans don't even cover the biologic-process analogs anymore (where my costs would be $560/mo for just the insulins that aren't covered by my current plan, or $130/mo if I paid another +$230/mo for a better single-person insurance plan -- only a $170/mo net reduction).

My uninsured "no prescription required" OTC costs for all my diabetic supplies (two insulins, sharps container, lancets, test strips) are $69/mo, and $18/mo (prescription required) for generic syringes now. It required taking everything in my own hands and telling every PCP I had to #$%& their hat.

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

#372
post #303

Earlier quoted context omitted.

The market for food is not at all like the market for medicine. The main difference is that food is far more fungible than drugs are. If a patient is suffering an illness, there may be only one drug that will help, whereas if one needs calories, or vegetables, there are many more options. Having said that, there is a reasonable argument to be made that the FDA and the patent situation stifles innovation and that most…

Off patent drugs are fungible in the sense that if Tylenol starts charging too much I can buy acetaminophen from anyone. Drug patents only last about 10 years. Fix evergreening at the patent office and your concerns are taken care of. Fixing evergreening is a much smaller action than cannibalizing an entire industry, which should be a last resort.

Makes sense to me. If evergreening is fixed, then theoretically in ten years time every drug on the market right now could be available as a generic at generic prices.

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

#373
post #60

Earlier quoted context omitted.

"Markets" are poorly designed for health care/research investment in general. Just like roads, education, general science research, etc... It just doesn't play well with being largely run with a profit motive. That's not to say there's on place for the private sector there, but there is massive friction between a profit motive in drug research and you know, building a more healthy society. See the "new Adderalls" lik…

Competition is what drives down costs in a market. If costs are going out of control, perhaps there is something in the current system that is preventing competition? Lack of price transparency?

Lack of price transparency is an issue. There's waaay too many misdirections and misaligned incentives between the price a consumer pays for a drug and the manufacturer's pricing.

But again, market-based solutions are just not appropriate for essential health care. You would pay ANYTHING to not die - there's no price elasticity of demand.

Every other developed country has figured out that this is simply immoral.

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

#374

Earlier quoted context omitted.

>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.

You are saying that step (2) has no effect on patent X from step (1), and thus patent X still enters public domain in 2020, correct?

Note- I understood this to be your position from your other comments. I asked the clarifying question to understand `pdeuchler`'s idea of the `evergreening` process.

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

#375
post #259

Earlier quoted context omitted.

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…

Ah I see. So as long as we append the word "type", we're free to throw phrases into completely non-sensical contexts? How convenient. Kidding aside, your use of the phrase here indicates a fundamental misunderstanding. This isn't "similar" to trickle-down. This has nothing to do with it whatsoever. You might as well call it "fascist" or "colonialist". It's jibberish. Try this: You can find the Hopkins paper that Rayi…

The template of trickle down economics I'm referring to is the method where the already wealthy/profiting and so on, is given immediate benefits under the premise of vague and long-term benefits for the many. This method of upwards redistribution has been applied repeatedly time and time again, and tax cuts in the style of trickle down economics are just one instance of it.

> Just for fun, give me some examples of drugs that are merely "superficial/vanity related". I think you're trying to construct a straw man.

Once again, it was one example, I was mainly thinking about hair loss or other male things caused by men, historically and still, earning more.

My main point was that the profit motive causes this kind of skew:

"Scientific publications brought the evidence that there was a lack of news drugs for diseases that cause high mortality and morbidity among people living in poor areas. One showed that only 1.1% of new drugs were approved specifically for neglected diseases over a period of 25 years (1975 to 1999) despite the fact that these diseases represented 11.4% of the global burden"

> It's certainly true that the free-market does not guarantee alignment with the public interest. It's also true that over-regulation is one of things that causes such misalignments.

I would argue that "free-markets" is the exact reason for anti-competitive regulations, among others, in the form of regulatory capture, which is inherent with capitalism.

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

#376
post #370

Earlier quoted context omitted.

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…

I totally agree with you regarding drug prices overall, but insulin is different in this respect. A vial of Humalog cost $35 in 2001. The exact same size vial of the exact same insulin -- no refreshed patent, no reformulations, no improvements, no change whatsoever -- cost $270 in 2017. If the price would have only followed inflation, it would have been $48.50 in 2017.

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

#377
post #284

Earlier quoted context omitted.

The presumption is that the regulations add a major cost hurdle to delivering unencumbered insulin products at lower prices, because that is in fact what they do.

Are drug companies operating at a loss in Europe?

I think you're trying to construct a straw man. Nobody on this thread is suggesting that pharma be deregulated. Rather, Rayiner pointed to a specific regulatory problem that may be contributing to the price of insulin. Whether or not drug companies operate at a loss in Europe is immaterial to that point.

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

#378
post #318

Earlier quoted context omitted.

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 ac…

This drug is very effective and very safe with few side effects if not abused.

This drug costs more than $10,000 per year because it is an orphan drug. There's little to no money spent on marketing for this drug. None that I've ever seen and I'm the target market for it. The net margins for the pharmaceutical company that manufacturers the drug is now around 20-25%, but their net margin was very very deep in the red for the first ~6 years that I took the drug. Not sure if they have yet recouped the investment from the 7+ years that they were in the red.

> 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.

It's not foolish if you're the one whose life is bettered by the medicine in question. How my healthcare dollars are spent is my decision, not the government's decision. This is where the arguments for single payer healthcare break down because you're arguing to take away my choices that I've earned by being useful to society. You're not the one paying the price for putting the decision in the hands of a bureaucrat. I and people like me are paying that price.

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

#379

I think this is a naive approach. We could price cap anything. Homes in San Francisco for example. The result will be rationing and shortages. It won't solve the fundamental problem. They key to bringing prices down is to remove barriers of entry. We need to flood the market with more insulin, or with my SF housing example flood the market with many more houses.

> They key to bringing prices down is to remove barriers of entry. [sic] Or just set price controls

* to bring advertised prices down. Those may be superseded by black market prices or augmented with lines and waiting lists.
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