New price on an old medication

Most people don't realize that toxoplasma gondii are interdimensional invaders (see my recently completed novel, A Dancer in the Infinite for more information--once it's pubbed) out to enslave the world. This was an obvious move on their part.

ErezMA said:

Sulfadiazine is an alternative. There also likely exists generics.

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Sulfadiazine is a sulfonamide antibiotic. Sulfonamides are bacteriostatic, which means they don't destroy bacteria, but they stop it from growing. Clindamycin is also bacteriostatic. Bacteriostatic antibiotics are usually prescribed with other antibiotics that are bactericidal.

Toxoplasmosis is an AIDS defining illness, which means that it doesn't effect people who have a healthy immune system. So people who need treatment for it will likely need treatment for a lot more.

Drugs are expensive, though. You would be very surprised how much most brand name drugs cost without insurance.

c.e.lawson said:

Seriously, how many of us would be able to pay for this?

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I don't think that's the real angle here. I watched his Bloomberg interview and I think he's serious about providing the medication for almost nothing to people who can't pay. That said, he's still a slimy predator imo. But he's targeting the insurance companies. They are the ones who will have to pay for all their patients with the upper tier plans. Because if I understand the ACA correctly, this drug--being the only one in the game for what it treats--will have to be covered. So, upper tier plans with no deductible, well people with those plans will be shelling out $50 or less for a bottle of pills and the insurer will pay the rest.

Again, still slimy. Maybe even moreso insofar as the gouging will be somewhat hidden...

I'm not sure how serious he is about helping patients, given his past history. I've no doubt he's trying to gouge the insurance companies, though.

Liosse de Velishaf said:

I'm not sure how serious he is about helping patients, given his past history. I've no doubt he's trying to gouge the insurance companies, though.

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Sorry if I wasn't clear. I don't think he's actually concerned with the patients at all. But I believe that he will allow the drug to be distributed for almost nothing to those who can't pay. It's part of the model and is what--he thinks--will allow it to go forward. We'll see if he's right, I guess, in a month or two, if the he doesn't back down on the price hikes.

This genius drew people's attention to a very real problem. Now, the politicians have to speak on it. And what happens to the when the politicians speak? Unintended consequences.

They'll bounce back, but I'm guessing he's not getting a fruitcake at Christmas from those CEOs. Of course, he doesn't seem to be very good at this type of business.

robeiae said:

I don't think that's the real angle here. I watched his Bloomberg interview and I think he's serious about providing the medication for almost nothing to people who can't pay. That said, he's still a slimy predator imo. But he's targeting the insurance companies. They are the ones who will have to pay for all their patients with the upper tier plans. Because if I understand the ACA correctly, this drug--being the only one in the game for what it treats--will have to be covered. So, upper tier plans with no deductible, well people with those plans will be shelling out $50 or less for a bottle of pills and the insurer will pay the rest.

Again, still slimy. Maybe even moreso insofar as the gouging will be somewhat hidden...

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Well, no doubt the insurance companies aren't just going to take the hit. They'll make up for it somewhere, and it will be coming out of our pockets in higher prices for insurance policies. And I wonder how this will affect hospital pharmacies in terms of stocking it/patient access to it in a timely fashion.

One step in the right direction....

They have the details on how this happens over at HuffPo. It's not really a patent issue afterall.

By various means, old generic compounds have ended up as protected species, and several companies have made it their business to take advantage of these situations to the maximum extent possible. The FDA grants market exclusivity to companies that are willing to take "grandfathered" compounds into compliance with their current regulatory framework, and that's led to some ridiculous situations with drugs like colchicine and progesterone."

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It's still a government-granted monopoly, but not by the patent office.

OK. I get it now. It's basically a bunch of sleazy sharks like this guy taking advantage of a government program to try to keep low volume generic drugs available for the people who need them, since the volume is so low, no one would produce them otherwise.

clintl said:

OK. I get it now. It's basically a bunch of sleazy sharks like this guy taking advantage of a government program to try to keep low volume generic drugs available for the people who need them, since the volume is so low, no one would produce them otherwise.

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Yep, Crony Crapitolism at its finest.

Don said:

Yep, Crony Crapitolism at its finest.

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Not really. It's more a case of market failure because the demand is too low for multiple competitors to want to make the product.

CrastersBabies said:

One step in the right direction....

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From that article...

Mr. Hasler, a former Lilly executive, said the Chao Center had lost about $10 million on the drug [Cycloserine, not Daraprim] since 2007 because of the small number of patients and high regulatory costs. [SNIP]

A patient with multidrug-resistant tuberculosis might take two capsules a day of cycloserine, along with other drugs, for 18 to 24 months, according to the Centers for Disease Control and Prevention. Under the price Rodelis planned to charge, a full course of treatment would have cost more than $500,000 for cycloserine alone. With the new price from the Chao Center, it will be closer to $50,000. The drug made by generic companies abroad costs only about $20 for 100 capsules. [SNIP]

it would have made much more sense to just import the drug from abroad, rather than have it produced in America for so few patients at such high cost.

Mr. Hasler said this was probably not done because foreign manufacturers were not willing to bear the expense of applying for regulatory approval in the United States.

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I might be missing something, but why does it cost so much more money to manufacture drugs in the US as opposed to, say, EU or UK? Having lived in both England and the US, I don't understand why OTC drugs like generic paracetamol (acetaminophen in the US), for example, costs me £0.03 per pill whereas in the US it costs about 10 cents per pill. Even taking into account the exchange rate, that still means that in the US, generic paracetamol costs...200 times the amount it costs in the UK. (Unless I did the math wrong. DID I DO THE MATH WRONG.) I'm pretty sure the UK has tight regulations regarding drugs too...I certainly haven't experience a lower quality in terms of drugs there, but why are the regulatory costs so crippling in the US?

ETA: As it turns out, I did do the math wrong. Thanks Xelebes for pointing out that it's 200%, not 200 times.

Putputt said:

From that article...



I might be missing something, but why does it cost so much more money to manufacture drugs in the US as opposed to, say, EU or UK? Having lived in both England and the US, I don't understand why OTC drugs like generic paracetamol (acetaminophen in the US), for example, costs me £0.03 per pill whereas in the US it costs about 10 cents per pill. Even taking into account the exchange rate, that still means that in the US, generic paracetamol costs...200 times the amount it costs in the UK. (Unless I did the math wrong. DID I DO THE MATH WRONG.) I'm pretty sure the UK has tight regulations regarding drugs too...I certainly haven't experience a lower quality in terms of drugs there, but why are the regulatory costs so crippling in the US?

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See the final sentence in what you quoted. The process of getting FDA approval is long, onerous, and expensive as hell. In addition, companies in the U.S., where there isn't the same kind of price regulation as in countries with national healthcare, can make back R&D money through pricing. The R&D is phenomenally expensive, and mostly private, because it can generate huge profits if you hit on something.

I'm not sure on this part at all, but I'd guess in countries with national healthcare and easier steps to market, there may be more research going on at a non-profit level than there is in the U.S. w/re pharmaceuticals, or more government subsidies helping fund private research. Or maybe they just figure they'll sell anything in the U.S. at higher cost than where it's developed and sold for less.

Putputt said:

From that article...



I might be missing something, but why does it cost so much more money to manufacture drugs in the US as opposed to, say, EU or UK? Having lived in both England and the US, I don't understand why OTC drugs like generic paracetamol (acetaminophen in the US), for example, costs me £0.03 per pill whereas in the US it costs about 10 cents per pill. Even taking into account the exchange rate, that still means that in the US, generic paracetamol costs...200 times the amount it costs in the UK. (Unless I did the math wrong. DID I DO THE MATH WRONG.) I'm pretty sure the UK has tight regulations regarding drugs too...I certainly haven't experience a lower quality in terms of drugs there, but why are the regulatory costs so crippling in the US?

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200%, not 200x.

One of the things those onerous regulations do is to prevent companies from selling and marketing drugs that are worthless and in some cases actively dangerous. Not that any of them would do that of course, just to make a buck.

As for the billions spent on research and development, it's worth noting that pharmaceutical companies spend a great deal more on sales and marketing than they do on research. I have yet to see them claim the reason drugs are so expensive is that they have to recoup their huge marketing budgets, but I wouldn't be surprised if they tried.

The biggest spender, Johnson & Johnson, shelled out $17.5 billion on sales and marketing in 2013, compared with $8.2 billion for R&D. In the top 10, only Roche spent more on R&D than on sales and marketing.

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http://www.washingtonpost.com/news/...spending-far-more-on-marketing-than-research/

I'm not against regulation or safety controls, at all. If the FDA did what they do well, it'd be one thing. How many drugs get approval and then get pulled or end up in class-action suits because of side effects or the like? How many drugs end up pulled due to stuff like mold in the manufacturing facility contaminating the product?

There are many other countries with higher standards of living, better healthcare for all, and drugs that get to market sooner without a lot of issues.

buzhidao said:

I dunno; how many people can pay for a $15,000 appendectomy....

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That's why they have socialized medicine in most countries, and it's why we're "supposed" to get health insurance from our employers in the US. Except not everyone does, and even with the ACA, some people fall through the gaps (and coverage for prescription drugs are often the weak link in many health plans).

Medical bills are a leading cause of bankruptcy in the US. Go us.

rugcat said:

One of the things those onerous regulations do is to prevent companies from selling and marketing drugs that are worthless and in some cases actively dangerous. Not that any of them would do that of course, just to make a buck.

As for the billions spent on research and development, it's worth noting that pharmaceutical companies spend a great deal more on sales and marketing than they do on research. I have yet to see them claim the reason drugs are so expensive is that they have to recoup their huge marketing budgets, but I wouldn't be surprised if they tried.

http://www.washingtonpost.com/news/...spending-far-more-on-marketing-than-research/

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But surely they have tight regulations in the UK to prevent companies from selling dangerous or worthless drugs. I'm just wondering why drugs are so much cheaper in the UK. Even OTC drugs which are not covered by the NHS are cheaper in general. Don't UK pharmaceutical companies spend just as much on R&D and marketing? Unless, like cornflake said, they get subsidized by the govt, which would make sense.

I also Googled the cost of Daraprim in the UK and found sites selling them for around 60p per pill. Even before Martin Shkreli's price hike, they were charging $13.50 per pill in the US. It is entirely possible that the sites I found are shady as hell and are selling fake Daraprim, but I doubt that. And this is the price if you're not going through the NHS. On the NHS, all prescriptions cost £7, which is a separate matter entirely. This is the cost to buy pills out of pocket. So what gives? I'm so confused by the massive difference in price between both countries.

rugcat said:

I have yet to see them claim the reason drugs are so expensive is that they have to recoup their huge marketing budgets, but I wouldn't be surprised if they tried.

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Oh, for God's sake, you don't really expect they'd admit this, do you?

caw

Other countries do a much better job of regulating drugs. The approval process in the US is onerous, vastly expensive, and takes years, which provides great protection for drugs already approved but holds back medical progress compared to many other countries. Importing most drugs is illegal, so competition is restricted, which helps pay for that approval process, although it doesn't account for the lives that are lost in the intervening years. The FDA is a prime example of regulatory capture by entrenched interests who raise barriers to entry at the cost of the consumer and their competitors. After all, the drug companies have to be able to pay for all that advertising, and they couldn't afford that if they couldn't keep the competition down. Patents can be extended and exclusive marketing granted for drugs that have expired patents, as is the case with Daraprim.

As has been pointed out, these drugs are readily available at ridiculously lower prices elsewhere. The quote by Putputt in #64 notes both of the drugs under discussion are available at a tiny fraction of the cost in other countries. Ending import restrictions by recognizing other countries' ability to successfully regulate would save consumers billions and cost Big Pharma billions in profits and a whole bureaucratic infrastructure here in the US their jobs, so don't hold your breath on that one.

And for all that "protection" money, we get approved drugs for rough skin that cause cancer, while the medical benefits of marijuana are disclaimed.

The FDA ranks right up there with the UN as great organizations go.

We like to yammer on about how "free" we are, but other countries are far more free in some areas, and healthcare, and particularly pharmaceuticals, is one of those areas. Consumers pay the price in healthcare and in dollars.

Apparently that little boy behind the hike who hasn't been alive long enough to get laid half as often as I have, believes the measure is reasonable and not at all drastic.
When I'm just sitting here thinking that even at the old price, that medication was for rich or super-insured people only. I mean, 2 pills a day at the old price, that's my average daily salary. Let's see his face when a loved one ends up needing said drug.