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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

#411

Post by mytailorisrich »

AdrianB1 wrote: post #276
mytailorisrich wrote: post #19

Earlier quoted context omitted.

If the law simply prevents prices higher than $100 in Illinois then manufacturers and distributors might stop selling in the state or only take orders from the state if they have surplus. Either of which might hit availability in the state, especially if the industry tries to make an example out of this. I guess it also depends on the profit margin at that price and how it compares with the "market price". Edit: Care…

The downvotes are because the opinion you have is not popular, not because it is wrong. You may be right, you may be wrong, that is less important these days.

I don't have an opinion, that's the point.

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

#412

Post by jahaja »

nate_meurer wrote: post #404
jahaja wrote: post #394

Earlier quoted context omitted.

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 wi…

This is why the neoliberal fantasy of "let's just remove regulations and let the "free-market" work its magic" is naive at best:

https://www.washingtonpost.com/business/economy/why-humiras-...

"Humira’s price has defied gravity — and been ensconced as a frequent rhetorical target on Capitol Hill — through AbbVie’s aggressive use of patents and deals with generic manufacturers to forestall competition."

"Humira was approved by the FDA in 2002 and its core patents expired in 2016, according to the Biosimilars Council, a division of the Association for Accessible Medicines, which represents generic manufacturers. But AbbVie won dozens of additional patents — what critics call a “patent thicket” — that extended the exclusive market for the drug to as late as 2034, the council said."

I'm not saying that there isn't high costs involved in the approval process, what I'm saying is that it is disproportionate to the price difference. What actually makes a difference is government regulations on another level, mainly price controls, like in Europe.

Just to make it clear, I'm very much in favour of generics, but the focus should be patents and price control, not small fish like REMS (from your link "consumers pay an extra $1.8 billion in out-of-pocket costs.", which furthermore is a number the authors have every interest to inflate) or removing burdensome, but appropriate, approval regulations, possibly threatening public safety.

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

#413

Post by jahaja »

nate_meurer wrote: post #402
jahaja wrote: post #389

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 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. Regul…

You couldn't make this up. The very group that ordered the report you are referring to, The Association for Accessible Medicines (AAM), is also appealing the introduction of a law in California that makes pay-for-delay deals with drug companies illegal. Do you understand why I'm calling it naive now? They clearly don't have the public interests in mind at all, just raking in profits, even if it's through mob-like protection fees with incumbents.

"The Association for Accessible Medicines (AAM), which represents generic drugmakers, is appealing a December 31 decision by a federal judge that allows California’s new law barring pay-for-delay arrangements between brand-name and generic pharma firms to go forward."

"AAM had argued that the law violated the federal government’s right to regulate interstate commerce and the scope of US patents"

https://www.centerforbiosimilars.com/news/lobbying-group-app...

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

#414

Post by michael_j_ward »

kkreamer wrote: post #399
michael_j_ward wrote: post #393

Earlier quoted context omitted.

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 substantia…

Gracias for the information. I had to look up biologic medicine to understand what the difference is with other drugs like say acetaminophen. This article from forbes laid it out [1].

TLDR:

1) Biologic / large molecule drugs (insulin) are much harder to produce than small molecule drugs like acetaminophen.

2) The FDA thus requires a lengthly, costly approval process to make generic large-molecule drugs. And since often these drugs are not atom-by-atom the same like small molecule drugs, they are referred to as "bio-similar"

3) Additionally- though least clear from the article, while the patent on a large molecule drug does expire after 20 years in the same way as small-molecule drugs, it appears that the larger-molecule gives a wider area to patents that can be applied to it. The article hints at, but does not make explicit, a mechanism for "evergreening" as I tried to clarify elsewhere in these comments.

Anyways, thought I'd write it up the TLDR because this background info would have been useful to know prior to engaging in this comment section.

Gracias again

[1] https://www.forbes.com/sites/theapothecary/2019/03/08/biolog...

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

#415

Post by throwaway_tech »

ars wrote: post #407
throwaway_tech wrote: post #301

Earlier quoted context omitted.

>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 n…

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

Exactly that is why the doctor specifically writes a 30 day so they come back in and can check their numbers.

>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.

When you hear the term consolidation of the healthcare market this is what they are talking about. There are numerous lawsuits right now by doctors against insurers for dropping them, illegally, from their networks and sending their patients to new providers/practices that are owned by the insurers. You can find any number of those lawsuits, if you cared, but here is an article on the practice of insurers buying providers (to control all aspects of their costs), you have insurance A, odds are you are only able to go to a doctor practice/hospital owned by the insurer.

https://www.modernhealthcare.com/article/20180602/NEWS/18060...

>There is no bonus for 30 day to 90 conversion

You are wrong, and it is clear you have never even heard of Medication Therapy Management (MTM) or OutcomesMTM. Walk into any big pharmacy (walmart, cvs, walgreens) and ask the pharmacist about OutcomesMTM and MTM generally. Or use this link to a OutcomesMTM report and learn about it http://www.outcomesmtm.com/wp-content/uploads/2018/02/2016MT...

>"Today, more than half of U.S. pharmacies are active in OutcomesMTM programs, earning revenue for their clinical services while helping healthcare payors reach their goals."

>Each year, OutcomesMTM recognizes pharmacies and pharmacy chain organizations with exceptional performance in delivering MTM services. Top MTM Center and Top Chain awards are based on the organization’s overall effectiveness in delivering CMRs and resolving drug therapy problems through TIPs

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

#416

Post by jotm »

patmcc wrote: post #306
jotm wrote: post #94

Earlier quoted context omitted.

> If I asked my GP for a specific medication they'd look at me like an alien. He shouldn't. They're not all knowing super genius specialists who keep up with all the drugs and research.

Sure, but neither is the guy who asks for a new drug based on the 30 second ad he just saw. If I go to my doctor and say "hey, for my condition XYZ I hear there's a new drug ABC, would that offer any benefits over what I'm on now?" that's one thing, but if I go in and say "hey give me that ABC" they'll correctly roll their eyes at me.

That's what I meant - you can use that first phrase and the doc's very likely to say "No." with no explanation. Even if your current drugs aren't working well.

I get it, they're nearly always overworked and tired, and most of their clients are idiots.

But people should be free to try something new without all this gatekeeping that keeps getting worse.

At the same time, place the responsibility on the user if they request something out of the ordinary, of course.

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

#417

Post by dang »

jahaja wrote: post #283
tptacek wrote: post #269

Earlier quoted context omitted.

Because in most markets, one of the more straightforward ways to make money is to deliver products more efficiently, split the reduced cost basis with the customer, and outcompete incumbents. You're not doing your argument any favors with this "typical HN response" stuff. Have a discussion with people on the thread or don't; it is fine for you to simply disagree and walk away.

And in many markets it's not. Well-run state companies, that exists, and have existed for a long long time, efficiency is not a problem and they can focus their efforts and money on what's important, not profits and marketing. Don't tone police me please. I find it rude to assume ignorance and go on explaining. Did you miss the whole mansplaining wave?

Would you please stop posting in the flamewar style to HN? It's not what this site is for, and we ban accounts that keep doing it.

https://news.ycombinator.com/newsguidelines.html

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

#418

Post by jahaja »

dang wrote: post #417
jahaja wrote: post #283

Earlier quoted context omitted.

And in many markets it's not. Well-run state companies, that exists, and have existed for a long long time, efficiency is not a problem and they can focus their efforts and money on what's important, not profits and marketing. Don't tone police me please. I find it rude to assume ignorance and go on explaining. Did you miss the whole mansplaining wave?

Would you please stop posting in the flamewar style to HN? It's not what this site is for, and we ban accounts that keep doing it. https://news.ycombinator.com/newsguidelines.html

Sure. However, given the rudeness in the replies I feel that I restrained myself decently with a few slips.

"You can't coherently and simultaneously believe"

"You might as well call it "fascist" or "colonialist". It's jibberish."

"it is fine for you to simply disagree and walk away"

"Right, so it was a bullshit distraction that can safely be ignored."

"You're still not understanding."

"Now read this slowly and carefully"

"You are completely misunderstanding the argument."

"I think you're trying to construct a straw man"

"which discussion you opened with a snarky, dismissive one-liner."

"[if] 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

#419

Post by specialist »

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…

If you can, I'd encourage you to find the care providers you need.

One friend moved to become a patient of the #2 Lyme disease specialist.

Another moved to become enrolled in a clinical trial. He was proclaimed terminal and went doctor shopping. (Still alive today.)

I've stayed anchored in my house for decades because I won't risk leaving my care providers (SCCA, FHCRC). I've had terrible experiences with noob doctors. As in life threatening.

I now better understand how doctors think. Recurring rounds of 20 questions time boxed to 15 minutes. Hopefully they've seen your condition before. If not, oops, too bad, out of time, take two aspirin and call me in the morning. Next!

YMMV.

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

#420

Post by rhino369 »

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…

A lot of the marketing budget is all expenses paid conferences for doctors and samples, etc.
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