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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

#401

Post by UnpossibleJim »

EpicEng wrote: post #116
UnpossibleJim wrote: post #103

Earlier quoted context omitted.

Which insulins? Not all insulins are equal or cost the same to produce.

https://www.businessinsider.com/insulin-prices-could-be-much... If you can find any variant that even approaches $100, please link a source.

I'm not arguing that they cost $100 to produce, but even in this article they cost more than the stated "<$5 to make". And this doesn't include any recoup of research cost. I'm not arguing for higher insulin cost, even though it seems like I am. I have to buy the stuff and take it or die. On the other hand, a consistent supply and further research into better fast acting and long acting insulins also matter to me, as they make a HUGE difference in the quality of life. It's a double edge sword, unfortunately. Until such time as profit motive is replaced (and I would be ecstatic if it were), those of us with type I diabetes have to thread that needle very carefully =\

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

#402

Post by nate_meurer »

jahaja wrote: post #389
nate_meurer wrote: post #382

Earlier quoted context omitted.

Regardless of how you want to redefine the phrase trickle down , your use of it here betrays a fundamental misunderstanding of the subject. If it's possible to reduce the regulatory burden of the approval process for biosimilar insulin so as to allow generic makers to compete more easily, this will REDUCE the monopoly power of the large incumbent drug companies. I don't know if you're being deliberately obtuse, but I…

> Regardless of how you want to redefine the phrase trickle down, your use of it here betrays a fundamental misunderstanding of the subject Care to explain how it doesn't fit the template I described? > this will REDUCE the monopoly power of the large incumbent drug companies This is at best naive. The approval process isn't the problem. Government granted monopolies are. > Which has exactly nothing to do with insuli…

> The approval process isn't the problem. Government granted monopolies are.

You're still not understanding. Overly burdensome approval processes are part of what creates government granted monopolies. In other words, those two things go together.

For example, if you're familiar with the approval pipeline for generics in the U.S., you'll remember that the main component of an ANDA filing is proving equivalence. Regulations require the evaluation to be based not just on the chemical description of the brand name medicine, but on actual physical samples. A separate regulation subjects any medicine with serious side effects to the REMS program, which restricts its distribution to narrow channels of the drug maker's choosing. Furthermore, the regulation allows companies to voluntarily subject a drug to REMS-type treatment even in the absence of serious side effects.

The result of these twisted regulations is that a large incumbent drug maker can easily deprive smaller generic makers from getting the samples they need to pursue approval.

This is just one example. REMS and other regulations allow incumbent drug makers other ways to block prospective generic makers. These abuses are common, and according to one study cited by the FTC, if we removed or reformed some these regulations, it would save Americans billions of dollars a year. [1]

Now read this slowly and carefully: these government regulations help to preserve big pharma monopolies. Read the citation below. Read the paper cited earlier. Read anything.

If you have any evidence of your own to support your positions -- studies, papers, anything -- I'd be interested to hear it. Otherwise I'm done with this.

1 - https://accessiblemeds.org/sites/default/files/2018-09/REMS_...

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

#403

Post by aladoc99 »

tialaramex wrote: post #237
monadic2 wrote: post #181

Earlier quoted context omitted.

I would imagine you’d need to draw a correlation between advertisements and quality of care and successful treatment rate; awareness and involvement aren’t positive or negative per se. Secondly, I see too many damn branded pens in my doctor’s office to be under the illusion that the marketing is only directed at the patients. I can’t count the number of times I’ve been prescribed medication just to have it swapped ou…

So, the reason they've got branded pens is that the drug reps are allowed to give them pens, so they do. Trivial low value gift. Historically the doctor wouldn't remember HealthyHeart brand beta blockers because of the 40 cent pen but because they paid for his two week safari. Most of the world banned that, but not so very long ago. My nurse friend didn't spend a penny of her own money on big birthday events when she…

Drug reps in the US quit giving away pens and coffee mugs in the US in 2008, in accord with PhRMA rules (that's the drug manufacturers' association/lobby). They got to say it was improved ethics, but it was also a mutual disarmament agreement of sorts. "We'll stop giving out sticky pads if you will."

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

#404

Post by nate_meurer »

jahaja wrote: post #394
tptacek wrote: post #391

Earlier quoted context omitted.

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 insuran…

I posted this citation a few comments earlier, but I'll put it here too for posterity:

https://accessiblemeds.org/sites/default/files/2018-09/REMS_...

It's a good summary of the costs of one type of overly burdensom regulation in the U.S. drug market, and was cited by the FTC in congressional testimony. There are other problems to be sure, but the anti-competitive effect of our over-wrought regulatory framework is widely recognized to be a problem by both liberal and conservative policy makers.

There's plenty more material out there you're able to use google for five minutes. At this point, though, I'm confident that you're interested only in polemics, rather than actually learning anything about the issue.

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

#405

Post by Aloha »

conanbatt wrote: post #397
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…

> 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…

The standard we have for drugs now was paid for in lives.

Elixir Sulfonamide, Profusion of Barbiturate use in the 50's, Thalidomide (which the US missed because of our more stringent rules), Phen-Fen - I can go on.

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

#406

Post by snapetom »

snapetom wrote: post #193
chimeracoder wrote: post #171

Earlier quoted context omitted.

> All these arguments for "look at Europe" doesn't fly in health economics. There are not subtle differences in the US legally, infrastructurally, and culturally. Not to mention: European countries wouldn't be able to negotiate those prices if the US market didn't exist. Pharmaceutical companies - many of whom are based in Europe - know that they'll make most of their revenue from the US, which is not only the single…

Yes, very true. Further, in general, the drug release schedules are US -> Europe -> Asia. This is primarily for two reasons - the FDA approval process is the most rigorous in the world. It would not be outrageous to classify European drug approval process as "rubberstamping" if the drug has already received FDA approval. Essentially, the US pays the R&D of the drug costs for the rest of the world. The second reason i…

Hey, if y'all are going to downvote instead of countering, go back to reddit.

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

#407

Post by ars »

throwaway_tech wrote: post #301
ars wrote: post #277

Earlier quoted context omitted.

If the Dr. wants to see the patient in 30 days then they setup an appointment for that. I don't understand why you think the length of a prescription controls the appointments. It doesn't, it has nothing whatsoever to do with that.

>It doesn't, it has nothing whatsoever to do with that Yes, the patient could pick up the phone and schedule another appointment, or the doctor could call to try to schedule another appointment in the meantime. You are missing the point...in practice those appointments don't get rescheduled. The Doctors and insurers know this, which is why the Doctor tries to do 30 day scripts for at risk patients so they can be clos…

> because they know the patient won't schedule an appointment

Such a patient isn't going to correctly take their medication either, 30 days or not.

> the other part you keep glossing over that is the insurer dropping doctors from their networks

Yah, because that's not actually true.

Insurance companies do a lot of bad stuff, but you seem to have invented a whole new class of things that they just don't do.

There is no bonus for 30 day to 90 conversion. There is only a lower co-pay for the member.

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

#408

Post by conanbatt »

Aloha wrote: post #405
conanbatt wrote: post #397

Earlier quoted context omitted.

> 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…

The standard we have for drugs now was paid for in lives. Elixir Sulfonamide, Profusion of Barbiturate use in the 50's, Thalidomide (which the US missed because of our more stringent rules), Phen-Fen - I can go on.

The standard you have now is also paid with lives. It's the people that can't get a drug in time or can't pay for it thats killing people.

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

#409

Post by conanbatt »

zip1234 wrote: post #127
fjp wrote: 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?

Competition drives down profits, not necessarily costs. If you passed a law that funds pharma startups to produce drugs, you would reduce profits and increase costs (through taxes).

Cost goes down with increased productivity. Competition sometimes brings that, sometimes it doesn't.

Economics can be complex!

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

#410

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.

Sorry, I realize those excerpts in my earlier comment don't really convey what I intended. The paper does talk about about how the various improvements over the years were changes in just a few (or even just one) amino acids in the molecule. It's a large molecule, nearly 6000 daltons (for reference, the limit for what we call small molecules is around 1500 da), so there's been a lot of opportunity for tinkering.

FWIW, the full paper is available at https://sci-hub.tw/10.1056/nejmms1411398

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