Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

nbc15.com

Post reply on HN
Print view View original

391–400 of 422 posts

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

#391

Post by tptacek »

jahaja wrote: post #381
tptacek wrote: post #377

Earlier quoted context omitted.

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.

I'm not sure what straw man that would be? I haven't suggested that either. What I'm implying is that Europe have regulations too, and that the price difference is not in proportion to the difference in regulatory strictness.

You have presented no evidence to support that argument, which has appeared late in your discussion, out of the blue, which discussion you opened with a snarky, dismissive one-liner.

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

#392

Post by vkou »

malandrew wrote: post #378
vkou wrote: post #318

Earlier quoted context omitted.

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…

> 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.

If it's an orphan drug, treating a rare condition, the economics of it are by nature difficult, because of the high fixed costs, and the low maximum revenues.

Since international medicine does not follow the same model as international aviation, it's not surprising that the high fixed costs (In time, research, and money) of adopting a new medicine + low, variable returns (Most countries are much smaller, or much poorer than the US), it's not surprising that the world isn't jumping on this head-over-heels.

Do you need this drug to live? If not, is it a marginal or significant quality of life improvement? If one of the latter, its possible that the cost/benefit analysis for it isn't great, and its manufacturer hasn't even bothered to go through the approval processes for other countries.

> 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.

I'd like to decide how my military, policing, and grade school education dollars get spent, too, but there turn out to be exceptionally good reasons for why they should be spent collectively.

> 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.

Everyone will at some point need healthcare, so yes, I do pay the price, and I'd like a system that does its best to get good results for money spent.

And if your insurance is paying for this drug, keep in mind that some unelected insurance-company bureaucrat has done a cost-benefit analysis on it, and decided that they were going to pay it. They could have gone the other way with it, and decided that it was not covered by insurance. As someone who buys into health insurance, but does not consume much healthcare, I can use your same argument to argue that my hard-earned insurance money should be spent on me, not you.

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

#393

Post by michael_j_ward »

kkreamer wrote: post #376
cgiles wrote: post #370

Earlier quoted context omitted.

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.

Are you 100% certain that it's the exact same vial? This [1] article claims that Humalog's patents expired in 2013 and 2014.

If you're right, do you know why no generic producers of the drug were able to enter the market by 2017?

[1] https://www.pbs.org/newshour/health/insulin-market-shakeup-p...

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

#394

Post by jahaja »

tptacek wrote: post #391
jahaja wrote: post #381

Earlier quoted context omitted.

I'm not sure what straw man that would be? I haven't suggested that either. What I'm implying is that Europe have regulations too, and that the price difference is not in proportion to the difference in regulatory strictness.

You have presented no evidence to support that argument, which has appeared late in your discussion, out of the blue, which discussion you opened with a snarky, dismissive one-liner.

I should be the one providing evidence that the following example is disproportionate with regards to regulatory differences between US and Europe?

"West, 30, has had type 1 diabetes since she was three years old. Back in Seattle, where she used to live, she typically paid $70 per month for insulin and another $130 for pump supplies. That was a relative steal in the U.S., made possible by her excellent health insurance, which she got through her employer. But still, it was a financial strain.

In Germany, she pays about €10, roughly $11. Every three months."

The extraordinary claim is that that vast price disparity is in proportion, so the burden of evidence rests on you.

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

#395

Post by conanbatt »

dopylitty wrote: post #17

Ultimately non profits or the government should produce insulin and other medicines to sell at cost. This sort of law will hopefully be a step in that direction.

And who would decide what the cost is if the government makes it?

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

#396

Post by conanbatt »

vmchale wrote: post #293
jwbwater wrote: post #238

Earlier quoted context omitted.

The politicians solution: create another law. The economists solution: create more competition, probably by getting rid of some laws. I guess JB Pritzker knows more about politics than about economics.

> The economists solution: create more competition, probably by getting rid of some laws. Or just set price controls (in the case of insulin)

Economics is strongly against price controls. It's very much against the core mechanics of micro-economics. If you put a price control, you limit supply.

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

#397

Post by conanbatt »

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…

> Step #1 should be to give a huge wad of money to the FDA. Say $1B/yr. Then you tell the FDA: every year, pick the 50 most promising drug candidates. Publicly fund the clinical trials, and the public will own the patent. Give some cash to the inventor and the institute to incentivize them to do this scheme and not sell to pharma.

I think the FDA is whats making drugs prohibitively expensive. First by disallowing the importation of drugs, second by putting a very conservative standard on the commercialization of drugs.

You are right about something, the policy is unappealing for either side. The right doesn't want to give more money to the FDA, and the left doesn't care about giving a gov institution pocket money, they want to outright outlaw profits as a whole.

Call yourself Elon because you are on Mars :)

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

#398

Post by conanbatt »

charwalker wrote: post #364
rhino369 wrote: post #317

Earlier quoted context omitted.

>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…

> 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?

Because it requires time and effort to educate providers on state-of-the-art medications and the marketing that goes to them is often educational.

I understand the frustration around the healthcare situation in the US, but the argument that marketing is bad, or that profits are bad, or that the private market cant service are frankly trying to reinvent the economic wheel.

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

#399

Post by kkreamer »

michael_j_ward wrote: post #393
kkreamer wrote: post #376

Earlier quoted context omitted.

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.

Are you 100% certain that it's the exact same vial? This [1] article claims that Humalog's patents expired in 2013 and 2014. If you're right, do you know why no generic producers of the drug were able to enter the market by 2017? [1] https://www.pbs.org/newshour/health/insulin-market-shakeup-p...

Yes, I am 100% certain.

Insulins are biologic medicines, so once patents expire you might get biosimilar drugs which also require FDA approval, not generics as with other drugs. Admelog is the biosimilar for Humalog, approved by the FDA in early 2018.

As I understand it, Sanofi (Admelog's manufacturer) sets the price to be only slightly below that of Humalog.

Eli Lilly, Novo Nordisk, and Sanofi manufacture substantially all of the insulin, and they more or less follow each other price-wise. There's not the competition you would expect that would drive down prices.

EDIT: they compete by offering varying discounts to particular insurance companies to only cover their insulin at the exclusion of the other company's insulins. This often leads to a letter to patients near the end of the year telling them that the insurance company has decided that their treatment plan has now changed, decisions of their doctor be damned. (Yes, you can appeal and what-not, but it's still fundamentally the insurance company's decision, not your doctor.) This, of course, also screws anyone without insurance who is expected to pay list price.

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

#400

Post by refurb »

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…

Say $1B/yr. Then you tell the FDA: every year, pick the 50 most promising drug candidates. Publicly fund the clinical trials, and the public will own the patent.

What do you think the FDA knows about running clinical trials? They are obviously experts when it comes to regulatory aspects, but what about trial recruitment, monitoring, supply chain, etc? And what about the educational side? Doctors need someone to talk to, to explain the data, to answer a multitude of questions.

It would take FAR more than $1B per year to have the FDA so all that. The Pharma industry spends $70B plus on R&D each year and they already have all the infrastructure.

And don’t for one second believe that getting a drug to market is as simple as funding clinical trials. There is a ton of upkeep once approved - phase 4 trials, manufacturing tweaks, educating physicians and customers.

2019 FDA budget was $5.7B. I’d guess you’d need closer to 20x to replicate the work the pharma industry is doing, just on the R&D side, let alone everything else.

Post reply on HN