Prescription drug prices discussion

[Satchel 6908]

1 hour ago, Incredulity said:

This has already been addressed above

The Health and Human Services secretary would be authorized to begin negotiating the prices of 10 high-cost prescription drugs in 2023, and the negotiated prices would go into effect in 2026. The number of drugs whose prices would be negotiated on behalf of Medicare would increase to 15 in 2028 and 20 in 2029.

So, this is going to render big pharma impotent and unable to fund drug research?

 

[Gengs1 2583]

Whenever someone brings up new drugs, show them this 

 

 

[Fudge Nuggets 19151]

8 hours ago, Incredulity said:

Wtf is “manufactured scarcity”?

See farm subsidies. 

[Anastasis 23394]

HHS can’t negotiate the price of any drug within its first 7 years (small molecule) or 11 years (biologic) on market. And the market price established during that initial period becomes the cap on the top end for the negotiated price. Lol. Wonder what effect that will have on launch pricing across the board. 

Edited August 7, 2022 by Anastasis

[Incredulity 11555]

8 minutes ago, Anastasis said:

Wonder what effect that will have on launch pricing across the board

The government 

[TwiceHorn 31285]

1 minute ago, Incredulity said:

The government 

This is not an issue from which you can extract the government.

There is no "free market," unregulated solution to any of this, whatsoever.

Which is why, despite being somewhat skeptical of government solutions for everything, I am in favor of some form of universal healthcare.  The bargaining positions between health care providers, to include pharma, and patients is too wide.  And insurers do a lousy job of taking up the slack.

[Anastasis 23394]

Just now, TwiceHorn said:

This is not an issue from which you can extract the government.

There is no "free market," unregulated solution to any of this, whatsoever.

Which is why, despite being somewhat skeptical of government solutions for everything, I am in favor of some form of universal healthcare.  The bargaining positions between health care providers, to include pharma, and patients is too wide.  And insurers do a lousy job of taking up the slack.

Bernie tried to broaden the number of drugs eligible for negotiation and it was shot down 99-1. 

[Gengs1 2583]

9 minutes ago, Incredulity said:

The government 

Republican solution

[Homercles 10205]

I have absolutely no knowledge or experience or understanding of any of this…and I have just as much sympathy for the industry crowing about R&D costs when the tv is plastered with ads telling me to ‘ask your doctor about Provasic’  30 years ago my parents used to bring me tons of random crap they were given by pharma reps including some very pricey custom items like a fosamax clock.

How many billions do they spend every year advertising to consumers and manufacturing pens, clocks, calendars and other crap, or sending docs on golf vacations to peddle their wares?

 

 

[Underdog 28457]

1 hour ago, Anastasis said:

Bernie tried to broaden the number of drugs eligible for negotiation and it was shot down 99-1. 

For further clarity... 

The Vermont independent intends to introduce amendments to change the bill, such as one measure that would empower Medicare to pay an amount equal to the Department of Veterans Affairs for prescription drugs. Sanders later stood alone as both Democrats and Republicans rejected his amendment to cap costs for covered prescription drugs under Medicare parts B and D by a 99 to 1 vote

 

https://news.yahoo.com/bernie-sanders-knocks-schumer-manchins-004347908.html

 

[HenryJames 65890]

 

[safe sex 11684]

Cruelty for the sake of it. No manufacturer would go broke with insulin capped at $35. People will die with it uncapped. 

[Welch 635]

19 minutes ago, HenryJames said:

So Dems supported it 50-0, and Republicans opposed it 43-7… and it’s framed as the Democrats falling short?

 

I wish the media were half as tough on Republicans as Republicans claim the media is.

Edited August 7, 2022 by Welch

[Neonmoon 38127]

Biden should just declare an emergency y for diabetes and then sue Pharma for price gouging 

It’s amazing how many Republicans are for free markets and yet don’t want the largest consumer (Medicare) to be able to negotiate drug prices from their supplier. 

[Biff Tannen 45499]

3 hours ago, Homercles said:

I have absolutely no knowledge or experience or understanding of any of this…and I have just as much sympathy for the industry crowing about R&D costs when the tv is plastered with ads telling me to ‘ask your doctor about Provasic’  30 years ago my parents used to bring me tons of random crap they were given by pharma reps including some very pricey custom items like a fosamax clock.

How many billions do they spend every year advertising to consumers and manufacturing pens, clocks, calendars and other crap, or sending docs on golf vacations to peddle their wares?

 

 

We are also the only country that allows that bullshit.

[Bama Chick 28596]

I have absolutely no knowledge or experience or understanding of any of this…and I have just as much sympathy for the industry crowing about R&D costs when the tv is plastered with ads telling me to ‘ask your doctor about Provasic’  30 years ago my parents used to bring me tons of random crap they were given by pharma reps including some very pricey custom items like a fosamax clock.
How many billions do they spend every year advertising to consumers and manufacturing pens, clocks, calendars and other crap, or sending docs on golf vacations to peddle their wares?
 
 

I’ve mentioned this before but pharma companies haven’t been allowed to pass out as much as a pen promoting drugs for like 15 years.

And those fabled golf trips and the like haven’t been a thing since I started as a pharma rep in the late 90s.

The commercials are still a thing but they’re a drop in the bucket.

And the number of reps that still exist is probably about 10% of the number of reps that existed back in the day.

When I left the industry, the yearly cap we could spend on a provider in a calendar year was $150.

There’s not a provider alive that can be swayed to prescribe anything because of a soup and salad from Panera.

Physician prescribing habits are influenced and driven by formulary status. I have no idea what different pharma companies expenditures are but I would bet way more money goes to gaming PBMs and formulary managers than providers these days.

Signed - A former pharmaceutical rep of 25 years

[Nivek 16861]

Biden should just declare an emergency y for diabetes and then sue Pharma for price gouging 
It’s amazing how many Republicans are for free markets and yet don’t want the largest consumer (Medicare) to be able to negotiate drug prices from their supplier. 

Republicans are for free markets as a campaign slogan. Just like they are fiscal conservatives during election year, and interested in supporting family structures (some types need not apply) and religion (except for what that hippie Jesus actually says) also during election years.

[Js1 85114]

The insulin cap for private insurance will be brought up as a standalone vote.

7 Republicans supported it previously.  Needs 3 more GOP votes to beat the 'buster.

Several Republicans indicated they are amenable to it as a standalone bill and their "no" vote was only because it was part of the IRA.  There's 6 retiring Republicans who didn't vote for it and 3-5 who are up in 2022 that probably don't want a second "no" vote for it on their record. 

[Anastasis 23394]

On 8/7/2022 at 10:42 AM, trauma babe said:

Cruelty for the sake of it. No manufacturer would go broke with insulin capped at $35. People will die with it uncapped. 

It's not a cap on the price that manufacturers can charge.  It is a cap on the end user cost share.  Which will just further obscure the actual price to the broader system, and allow manufacturers to increase the costs in a fashion that is clouded from consumers. The ultimate result will be premium increases that spread the hit around broadly, and probably to some extent restrictive formularies to leverage rebates to try to buy down that premium increase. These half step measures are counterproductive, imo. 

If you are offended by insulin prices in this country, and we all should be, it is best addressed by directly capping the prices that manufacturers can charge, imo. This does not do that.     

Edited August 9, 2022 by Anastasis

[Captainant 27467]

1 hour ago, Anastasis said:

The ultimate result will be premium increases that spread the hit around broadly, and probably to some extent restrictive formularies to leverage rebates to try to buy down that premium increase. These half step measures are counterproductive, imo. 

Yeah you're right. The problem is charging premiums for giving people access to lifesaving care and medication. Some might even call it barbaric

[Anastasis 23394]

53 minutes ago, Captainant said:

Yeah you're right. The problem is charging premiums for giving people access to lifesaving care and medication. Some might even call it barbaric

Same principles apply whether we are talking about a system funded by taxpayers or a premium based private insurance model. And in this case we are talking about both since the various legislation being considered impacts alternatively both Medicare and private insurance. 

Edited August 10, 2022 by Anastasis

[Gil Bang 25898]

On 8/6/2022 at 10:58 PM, Gengs1 said:

Whenever someone brings up new drugs, show them this 

 

 

She is the absolute star of the house.  

I've said it before and I've received pushback, but I'm right.

If she were a little more attractive, she'd be POTUS material.  

 

 

*I'm not saying I wouldn't fuck her, because I totally would.

 

 

 

**Katie, if you're reading this, I can be up in your district in about an hour

[safe sex 11684]

From everything I can find with a cursory google search and read through of a couple of studies, insulin costs about $10 / vial to manufacture (and that's likely a bit generous. In 2018 a study estimated it was around $3.50).

Fuck pharma. Fuck insurance companies.

[Anastasis 23394]

12 minutes ago, trauma babe said:

From everything I can find with a cursory google search and read through of a couple of studies, insulin costs about $10 / vial to manufacture (and that's likely a bit generous. In 2018 a study estimated it was around $3.50).

Fuck pharma. Fuck insurance companies.

That article is a @TwiceHorn bat signal.

Patents, Open Source, and Open Insulin

Three pharmaceutical companies control the patent rights for the majority of insulin products on the market. These companies have over the past decade raised the price of insulin egregiously. As a result, many diabetics and their families are struggling to afford this life-saving medicine and, in some cases, taking desperate actions to get the medicine their life depends on.

It is well documented that pharmaceutical companies regularly exploit the patent system in order to maintain exclusivity and thus increase their profits. Such tactics include pay-for-delay (also known as pay-to-play), evergreening, patent-thickets, product hopping, and large corporations draining smaller companies’ financial and legal resources during the strategy known as the “patent dance.”

In the insulin space, however, the main issue is not that these manufacturers have blatantly abused the patent system to reap their large profits, although there's certainly some of that (see, for example, the 74 patents filed on Lantus); rather, the system is operating as it was intended. Newer, superior versions of insulin have been developed incrementally. This has led to a steady string of patents issued and no generics successfully launched until 2021, 100 years after insulin was discovered. Patents provide a mechanism to monopolize the market. This reduces or eliminates competition and allows manufacturers to price medicines at extraordinary costs to patients. A vial of Humalog (insulin lispro) in 1996 cost $21; in November 2020, the cost was over $350 without insurance.

Ultimately, patents reduce access to medicines by limiting who can manufacture and sell patented medicines. We see this playing out with COVID-19 vaccines and the unequal manufacturing and distribution across the world. Countries from the Global South formally requested patents be waived for COVID-19 vaccines in order to allow for more vaccines to be manufactured. The request was swiftly quashed by leaders in the Global North.

Recognizing the role patents play in driving up the cost of pharmaceuticals by allowing companies to continuously monopolize a resource and subsequently reduce access to life-saving medicines, Open Insulin Foundation (OIF) was founded with the goal of producing insulin using an open source framework.

[Dbeasy 14970]

I know quite a bit about the insulin problem and just emailed Senator Cornyn about it, urging action. He won’t do anything, but at least I can say I tried. 

The best thing government can do is force insurers to not subject insulin to the medical deductible. Right now many people on ObamaCare and other insurance programs have a deductible it’s likely to be $8-10k+. Twelve months of insulin can cost $10k per year or more, and if reimbursement is subject to the deductible first, few can afford that.

By having co-pays right away, you get people out of that financial mess, while still having them share in their healthcare costs, but at a level that is affordable. And there are no price controls, which eliminates the problem of price controls. 

[ChiTownDoc 21102]

On 8/7/2022 at 9:14 AM, Homercles said:

I have absolutely no knowledge or experience or understanding of any of this…and I have just as much sympathy for the industry crowing about R&D costs when the tv is plastered with ads telling me to ‘ask your doctor about Provasic’  30 years ago my parents used to bring me tons of random crap they were given by pharma reps including some very pricey custom items like a fosamax clock.

How many billions do they spend every year advertising to consumers and manufacturing pens, clocks, calendars and other crap, or sending docs on golf vacations to peddle their wares?

 

 

Lol. The sending docs on golf vacations ended decades ago.  Hell the last decade or so you have to give an educational session just to give a doc a pen.  Even pharma dinners are mostly a thing of the past.  Covid probably killed off what was left of that industry - thank God.  

[Gil Bang 25898]

Governor Newsom announced that CA will manufacture it's own insulin.  100 Million was initially allocated. 

[safe sex 11684]

2 minutes ago, ChiTownDoc said:

Lol. The sending docs on golf vacations ended decades ago.  Hell the last decade or so you have to give an educational session just to give a doc a pen.  Even pharma dinners are mostly a thing of the past.  Covid probably killed off what was left of that industry - thank God.  

I enjoy the Starbucks I get every now and then from HIV/PrEP drug reps, but the lecture about kidney labs that hasn't changed in a couple of years is tiresome. I usually run to the back when I see them now and grab my drink after they leave.

[Gil Bang 25898]

Y'all got the smokeshow pharm reps bringing starbucks and pharma samples. 

I was  a surgery center schmuck, and I got the fat guy repping stericycle offering me a tote bag. and talking to me about all the cool shit they could do for me hauling away fat and blood. 

Or the Airgas dipshit offering me a  new air nozzle for my scrubs to use in the dirty room.

Edited August 10, 2022 by Gil Bang

[TwiceHorn 31285]

1 hour ago, Anastasis said:

That article is a @TwiceHorn bat signal.

Patents, Open Source, and Open Insulin

Three pharmaceutical companies control the patent rights for the majority of insulin products on the market. These companies have over the past decade raised the price of insulin egregiously. As a result, many diabetics and their families are struggling to afford this life-saving medicine and, in some cases, taking desperate actions to get the medicine their life depends on.

It is well documented that pharmaceutical companies regularly exploit the patent system in order to maintain exclusivity and thus increase their profits. Such tactics include pay-for-delay (also known as pay-to-play), evergreening, patent-thickets, product hopping, and large corporations draining smaller companies’ financial and legal resources during the strategy known as the “patent dance.”

In the insulin space, however, the main issue is not that these manufacturers have blatantly abused the patent system to reap their large profits, although there's certainly some of that (see, for example, the 74 patents filed on Lantus); rather, the system is operating as it was intended. Newer, superior versions of insulin have been developed incrementally. This has led to a steady string of patents issued and no generics successfully launched until 2021, 100 years after insulin was discovered. Patents provide a mechanism to monopolize the market. This reduces or eliminates competition and allows manufacturers to price medicines at extraordinary costs to patients. A vial of Humalog (insulin lispro) in 1996 cost $21; in November 2020, the cost was over $350 without insurance.

Ultimately, patents reduce access to medicines by limiting who can manufacture and sell patented medicines. We see this playing out with COVID-19 vaccines and the unequal manufacturing and distribution across the world. Countries from the Global South formally requested patents be waived for COVID-19 vaccines in order to allow for more vaccines to be manufactured. The request was swiftly quashed by leaders in the Global North.

Recognizing the role patents play in driving up the cost of pharmaceuticals by allowing companies to continuously monopolize a resource and subsequently reduce access to life-saving medicines, Open Insulin Foundation (OIF) was founded with the goal of producing insulin using an open source framework.

I did a little scientific looking.  Apparently, synthetic human insulin, which is the stuff whose patents expired in the 40s, is not nearly as good as more modern insulin analogs, which were developed mostly in the 90s.  Lispro/Humalog is one of the first and was approved in 1996, which means any patents would have been filed by then, typically years prior, so they should have expired in the mid 2010s (20 years from filing date).  There is some indication that the last of the Humalog patents expired in 2013.

It seems that many of the other, modern insulin analogs were developed and patented, originally, in the same time frame. I.e. insulin glargine, Sanofi's Lantus, the basic patent of which expired in 2015

So, not only is synthetic human insulin in the public domain, and has been for 75 years, so are a pretty fair number of the more modern and efficacious analogs.  At least as far as patents are concerned.

Of course, pharmas are constantly tweaking shit, which is a new drug and a new patent, ostensibly.

But there seems to be a baseline of insulin products available that are not subject to patents.  Yet, they don't seem to be available, or available at reasonable, non-monopolistic prices.  And, the cited example of Humalog is post patent expiration.

Something else is going on.  I have some ideas what, related to the FDA and to pharma marketing practices, but it sure as fuck isn't patents.

 

Edited August 10, 2022 by TwiceHorn

[TwiceHorn 31285]

5 minutes ago, TwiceHorn said:

I did a little scientific looking.  Apparently, synthetic human insulin, which is the stuff whose patents expired in the 40s, is not nearly as good as more modern insulin analogs, which were developed mostly in the 90s.  Lispro/Humalog is one of the first and was approved in 1996, which means any patents would have been filed by then, typically years prior, so they should have expired in the mid 2010s (20 years from filing date).  There is some indication that the last of the Humalog patents expired in 2013.

It seems that many of the other, modern insulin analogs were developed and patented, originally, in the same time frame.

So, not only is synthetic human insulin in the public domain, and has been for 75 years, so are a pretty fair number of the more modern and efficacious analogs.  At least as far as patents are concerned.

Of course, pharmas are constantly tweaking shit, which is a new drug and a new patent, ostensibly.

But there seems to be a baseline of insulin products available that are not subject to patents.  Yet, they don't seem to be available, or available at reasonable, non-monopolistic prices.  And, the cited example of Humalog is post patent expiration.

Something else is going on.  I have some ideas what, related to the FDA and to pharma marketing practices, and possibly collusion, but it sure as fuck isn't patents.

 

Some more on the above. https://www.pbs.org/newshour/health/insulin-market-shakeup-patients

[TwiceHorn 31285]

One very curious thing relating to patents, pharma, and the FDA is this.

Normally, to infringe a patent, you must make, use or sell a patented product.  Because you don't often make without selling, and users are not good lawsuit targets most of the time, that boils down to selling.  Which makes sense, because selling is how you compete, generally speaking, and how you harm a patent holder.

Except when it comes to generic drugs.  Thanks to the Hatch-Waxman Act, when a company files an Abbreviated New Drug Application with the FDA, which is what you file when you're claiming your drug is chemically and pharmacologically identical to an already approved drug, i.e. a generic drug.  That is an act of patent infringement, despite the fact that the ANDA filer cannot legally sell the drug until the ANDA is approved and the patent owner will suffer no competition from the generic drug until patent expiration.

So, a patent holder can sue and enjoin a generic manufacturer and slow down/halt generic approval until after the patent is expired.

That's some bullshit, right there.  And, although that touches on patent law, it's mostly an FDA thing.

[Anastasis 23394]

 

Initial price negotiation list released.  

https://www.nytimes.com/2023/08/29/us/politics/medicare-drug-pricing-negotiations.html

Drugs Selected for Price Negotiations

1. Eliquis, for preventing strokes and blood clots, from Bristol Myers Squibb and Pfizer

2. Jardiance, for diabetes and heart failure, from Boehringer Ingelheim and Eli Lilly

3. Xarelto, for preventing strokes and blood clots, from Johnson & Johnson

4. Januvia, for diabetes, from Merck

5. Farxiga, for chronic kidney disease, from AstraZeneca

6. Entresto, for heart failure, from Novartis

7. Enbrel, for arthritis and other autoimmune conditions, from Amgen

8. Imbruvica, for blood cancers, from AbbVie and Johnson & Johnson

9. Stelara, for Crohn’s disease, from Johnson & Johnson

10. Fiasp and NovoLog insulin products, for diabetes, from Novo Nordisk

[Nice Guy Eddie 13414]

sorry if asked and answered but does negotiating on these drugs also prevent increases on non-listed drugs? It doesn't help much if a 10% drop, in these prices, creates a 20% increase in others.

Edited August 29, 2023 by Nice Guy Eddie

[Longhorn_Fan68 33843]

1 hour ago, Nice Guy Eddie said:

sorry if asked and answered but does negotiating on these drugs also prevent increases on non-listed drugs? It doesn't help much if a 10% drop, in these prices, creates a 20% increase in others.

Possibly, but hopefully this lays the groundwork for the govmint to negotiate and/or regulate prices going forward.

[hayden_horn 11360]

3 hours ago, Anastasis said:

 

Initial price negotiation list released.  

https://www.nytimes.com/2023/08/29/us/politics/medicare-drug-pricing-negotiations.html

Drugs Selected for Price Negotiations

1. Eliquis, for preventing strokes and blood clots, from Bristol Myers Squibb and Pfizer

2. Jardiance, for diabetes and heart failure, from Boehringer Ingelheim and Eli Lilly

3. Xarelto, for preventing strokes and blood clots, from Johnson & Johnson

4. Januvia, for diabetes, from Merck

5. Farxiga, for chronic kidney disease, from AstraZeneca

6. Entresto, for heart failure, from Novartis

7. Enbrel, for arthritis and other autoimmune conditions, from Amgen

8. Imbruvica, for blood cancers, from AbbVie and Johnson & Johnson

9. Stelara, for Crohn’s disease, from Johnson & Johnson

10. Fiasp and NovoLog insulin products, for diabetes, from Novo Nordisk

so, old people drugs, cool.

[Nivek 16861]

so, old people drugs, cool.

I am sure they will run into supply chain issues and then force consumers to alternatives that are not price controlled.

[Anastasis 23394]

1 hour ago, hayden_horn said:

so, old people drugs, cool.

Chronic disease is where the pharma money at. Surprised that no COPD drugs cracked their way in. 

[safe sex 11684]

2 hours ago, hayden_horn said:

so, old people drugs, cool.

Mostly, but there are plenty of young people on insulin, and Chron's disease affects people of all ages as well.

It's better than what we've got now

[Felix 599]

Medicare is for old people so I'm not really surprised that would be their initial focus.

[Anastasis 23394]

Interesting that there isn't a GLP1 on there. Means no pricing negotiation impact on those until at least 2027 and maybe longer.  

[safe sex 11684]

3 hours ago, safe sex said:

Mostly, but there are plenty of young people on insulin, and Chron's disease affects people of all ages as well.

It's better than what we've got now

For some reason I just assume that this will help Medicaid recipients? 🤷‍♀️ idk 

[TwiceHorn 31285]

6 hours ago, hayden_horn said:

so, old people drugs, cool.

Well, it is Medicare that does the negotiating, and the drugs have to be among the most prescribed/paid for by Medicare.  So yeah.  Except the insulin (analogs).