CEO of UHG Shot and Killed in NYC - WTF is wrong with you New York

[TwiceHorn 32108]

7 minutes ago, Chopper said:

But yes of course the pharmaceutical co is going to try to extend their patent. Typically based on a illusory improvement in the medication.

That's not the basis for a patent term extension. https://www.law.cornell.edu/uscode/text/35/156  Such extensions are based on the length of the regulatory review period.

The "illusory improvement" game was effectively ended in 1996.

 

Edited 20 hours ago by TwiceHorn

[Chopper 17450]

1 minute ago, TwiceHorn said:

That's not the basis for a patent term extension. https://www.law.cornell.edu/uscode/text/35/156

The "illusory improvement" game was effectively ended in 1996.

 

Certainly. But you may not be aware that patent thickets, mentioned in a post above, have replaced the direct application for an extension - the improvements are still just as illusory and bogus, they're just using a circuitous route to obtain patent extensions. 

I-Mak, an organization that works for patent reform and healthcare equity, put out this report in 2022 (pdf) https://www.i-mak.org/wp-content/uploads/2022/09/Overpatented-Overpriced-2022-FINAL.pdf Each medication will have multiple dozens of patents. The top-sellers in 2022 had an average of 74 patents on it - for just one medication. 2/3 of the patents were filed for AFTER the med was on the market. That's a patent thicket. Those companies are desperate to protect the huge revenue streams that exist because of their monopolies. We're talking $24 million per day of revenue. In Europe, where the laws are much more consumer friendly, patent thickets are not as prevalent and as a result of that, they have more generic medications on the market competing with the most popular medications.   

Also, if you're a company that's about to come out with a generic version of any medication that's been on-patent, especially in the US, get ready to be sued for hundreds of millions of dollars. It's a huge impediment to market and huge cost of doing business, because pharma co's has been stuffing their pockets for years off monopolistic prices, and can pay endless litigation.

 

[Nice Guy Eddie 13743]

2 hours ago, Chopper said:

If there are 10 different people in line at a pharmacy each with a script for the same medication, all 10 will pay a different price depending on their insurer and their particular plan. It's worse than airlines because there's zero transparency. We haven't even touched on the evil-ness of the drug formulary scam.

Doctors have zero ability to quickly determine the cost of any one patients prescription. Out of curiosity I checked my health plan/PBM and Minocycline (whatever that is) 100mg tablet are listed at $22 for 90 days mail order.  Never hurts to research alternative pricing and ask ChatGPT for alternatives if the price is too high. Then send a message to the doctor to switch up if they’re in agreement.

obviously sometimes drugs are time sensitive and then you just need to go with whatever options you have.

[Chopper 17450]

10 minutes ago, Nice Guy Eddie said:

Doctors have zero ability to quickly determine the cost of any one patients prescription. Out of curiosity I checked my health plan/PBM and Minocycline (whatever that is) 100mg tablet are listed at $22 for 90 days mail order.  Never hurts to research alternative pricing and ask ChatGPT for alternatives if the price is too high. Then send a message to the doctor to switch up if they’re in agreement.

obviously sometimes drugs are time sensitive and then you just need to go with whatever options you have.

I don't think I even implied they do, let alone stated it as a truth. In the example you quoted doctors weren't even a part of it. The discussion about price variations came about because of the way health insurers, their PBMs, and pharmaceutical companies conspire to gouge consumers.

edit to add - the example I used of 10 different people at the pharmacy for the same med was specific to illustrate the lack of transparency. Most people won't know how much their medication will cost until after the pharmacy fulfills it. That's why it's good to know about GoodRX but it comes with some negatives to the individual and huge positives to the insurer. Depending on your plan and the med, GoodRX may be lower than your co-pay amount, but Cuban's pharmacy is usually less expensive than GoodRX if a patient has the time to deal with it. 

Edited 18 hours ago by Chopper

[Captainant 28601]

59 minutes ago, Chopper said:

the example I used of 10 different people at the pharmacy for the same med was specific to illustrate the lack of transparency. Most people won't know how much their medication will cost until after the pharmacy fulfills it.

This is also the case for basically any medical or doctor or hospital care. They have no idea what it'll cost because it basically just matters what they code it as. And if you disagree with the coding, you can go get bent

[GenXer 3483]

9 hours ago, Bevo said:

Insulin basically comes from three manufacturers who keep prices high. They have switched the market from less expensive human and animal insulins to more expensive insulin analogs.
 

I’m not going to speak for all T1Ds but I’ve been one for 38 years.

The animal and human insulins work reasonably well if you aren’t what I call “brittle”.

Up until I hit 30, I could feel my blood sugar drop before hypoglycemia took hold. I was on human insulin through that time. There’s two categories of insulin: short acting and long acting. The short acting human insulin made low blood sugar episodes happen pretty frequently for me once I hit thirty. I became brittle where I couldn’t fight it off and had severe episodes where I woke up in the hospital a couple of times, other times where the wife had to call paramedics.

The short acting analog I take (lispro) doesn’t have that same effect.

I’d likely be dead without the short acting analog. Seriously. I’ve had several episodes where I was entirely alone and fighting as my brain was shutting down to get a candy bar.

I rail on the price of insulin a lot on surly. But I will be the first to thank pharma companies for the advances they’ve made with insulin since those Canadians first extracted it from pigs’ pancreases 100 years ago.

I think pharma companies should get a good return on their R&D and production. I don’t think putting the same insulin in a pen rather than a vile warrants a new patent. Gimme an old fashioned vile and syringe, and I’m good.

Counterpoint: there’s this guy

 

[TwiceHorn 32108]

3 hours ago, Chopper said:

Certainly. But you may not be aware that patent thickets, mentioned in a post above, have replaced the direct application for an extension - the improvements are still just as illusory and bogus, they're just using a circuitous route to obtain patent extensions. 

I-Mak, an organization that works for patent reform and healthcare equity, put out this report in 2022 (pdf) https://www.i-mak.org/wp-content/uploads/2022/09/Overpatented-Overpriced-2022-FINAL.pdf Each medication will have multiple dozens of patents. The top-sellers in 2022 had an average of 74 patents on it - for just one medication. 2/3 of the patents were filed for AFTER the med was on the market. That's a patent thicket. Those companies are desperate to protect the huge revenue streams that exist because of their monopolies. We're talking $24 million per day of revenue. In Europe, where the laws are much more consumer friendly, patent thickets are not as prevalent and as a result of that, they have more generic medications on the market competing with the most popular medications.   

Also, if you're a company that's about to come out with a generic version of any medication that's been on-patent, especially in the US, get ready to be sued for hundreds of millions of dollars. It's a huge impediment to market and huge cost of doing business, because pharma co's has been stuffing their pockets for years off monopolistic prices, and can pay endless litigation.

 

Of course I'm aware of patent thickets, I do this for a living.   The patents in a thicket all expire on the same day

One of the main things driving the US problem with generics is that filing an ANDA is considered an act of infringement, so a potential generic doesn't have to be made, used or sold in the US (the usual acts of infringement) before a patent owner can sue.  Otherwise, a generic manufacturer could be approved and ready to sell on patent expiration, but not here.

That's not applicable to any other kind of patent.  It's the result of pharma lobbying.

[Bevo 13926]

39 minutes ago, Captainant said:

This is also the case for basically any medical or doctor or hospital care. They have no idea what it'll cost because it basically just matters what they code it as. And if you disagree with the coding, you can go get bent

 

The code is more rules than what you just call guidelines.

[Beau Vine 55893]

31 minutes ago, GenXer said:

I’m not going to speak for all T1Ds but I’ve been one for 38 years.

The animal and human insulins work reasonably well if you aren’t what I call “brittle”.

Up until I hit 30, I could feel my blood sugar drop before hypoglycemia took hold. I was on human insulin through that time. There’s two categories of insulin: short acting and long acting. The short acting human insulin made low blood sugar episodes happen pretty frequently for me once I hit thirty. I became brittle where I couldn’t fight it off and had severe episodes where I woke up in the hospital a couple of times, other times where the wife had to call paramedics.

The short acting analog I take (lispro) doesn’t have that same effect.

I’d likely be dead without the short acting analog. Seriously. I’ve had several episodes where I was entirely alone and fighting as my brain was shutting down to get a candy bar.

I rail on the price of insulin a lot on surly. But I will be the first to thank pharma companies for the advances they’ve made with insulin since those Canadians first extracted it from pigs’ pancreases 100 years ago.

I think pharma companies should get a good return on their R&D and production. I don’t think putting the same insulin in a pen rather than a vile warrants a new patent. Gimme an old fashioned vile and syringe, and I’m good.

Counterpoint: there’s this guy

 

That dude is vial.

[TwiceHorn 32108]

39 minutes ago, GenXer said:

I’m not going to speak for all T1Ds but I’ve been one for 38 years.

The animal and human insulins work reasonably well if you aren’t what I call “brittle”.

Up until I hit 30, I could feel my blood sugar drop before hypoglycemia took hold. I was on human insulin through that time. There’s two categories of insulin: short acting and long acting. The short acting human insulin made low blood sugar episodes happen pretty frequently for me once I hit thirty. I became brittle where I couldn’t fight it off and had severe episodes where I woke up in the hospital a couple of times, other times where the wife had to call paramedics.

The short acting analog I take (lispro) doesn’t have that same effect.

I’d likely be dead without the short acting analog. Seriously. I’ve had several episodes where I was entirely alone and fighting as my brain was shutting down to get a candy bar.

I rail on the price of insulin a lot on surly. But I will be the first to thank pharma companies for the advances they’ve made with insulin since those Canadians first extracted it from pigs’ pancreases 100 years ago.

I think pharma companies should get a good return on their R&D and production. I don’t think putting the same insulin in a pen rather than a vile warrants a new patent. Gimme an old fashioned vile and syringe, and I’m good.

Counterpoint: there’s this guy

 

Just for the record, it is not the combination of any old syringe with the pharmaceutical composition that makes it patentable.  The syringes have special features that are unique to the composition in question, or to the type of patient or some such.  It's really just a patent on an insulin syringe or applicator.

And infringement is easily avoided by selling the composition/drug in a vial, as you note.  But there are some strange things going on in pharma where it seems only single-use syringes get prescribed and the vial gets left out.

It is interesting to know that the analogs are an actual improvement on straight insulin.  I should say very interesting in that it has improved your outcome.  

In the patent game more broadly, there are patented improvements that aren't really improvements, but various anomalies give them the market reception of a massive improvement.  I'm not actually aware of many of those in blockbuster or important drugs, other than the syringe-type scenario, which I guess is like prescribing the branded over the generic, but dialed to 11.

Edited 16 hours ago by TwiceHorn

[GenXer 3483]

Lulz. I think I had a freudian slip as I started thinking about shkreli as I was finishing with the vial and syringe thought.

[TwiceHorn 32108]

Just now, GenXer said:

Lulz. I think I had a freudian slip as I started thinking about shkreli as I was finishing with the vial and syringe thought.

Shkreli didn't even deal in patented drugs.  His gambit was "orphan drugs." https://en.wikipedia.org/wiki/Orphan_drug  The key passage there is this:

Under the ODA orphan drug sponsors qualify for seven-year FDA-administered market Orphan Drug Exclusivity (ODE), "tax credits of up to 50% of R&D costs, R&D grants, waived FDA fees, protocol assistance^[10]: 660 and may get clinical trial tax incentives.^[13]

[GenXer 3483]

8 minutes ago, TwiceHorn said:

.

It is interesting to know that the analogs are an actual improvement on straight insulin.  I should say very interesting in that it has improved your outcome.  

 

When I first became a T1D, I was told by doctors that there were insulin resistant T1Ds. Meaning their bodies rejected the pork and human insulin. Death was imminent.

The analogs work better for insulin resistant T1Ds. The improvements over my lifetime are significant.

[Anastasis 23718]

2 hours ago, Captainant said:

This is also the case for basically any medical or doctor or hospital care. They have no idea what it'll cost because it basically just matters what they code it as. And if you disagree with the coding, you can go get bent

No, you tell them to go get bent. Everything is negotiable. Including your medical expenses. Works best with hospitals and device charges in my experience. You have no leverage at the pharmacy counter. 

[Chopper 17450]

2 hours ago, TwiceHorn said:

Of course I'm aware of patent thickets, I do this for a living.   The patents in a thicket all expire on the same day

Well then you know the point isn't necessarily the date they expire. It's the barrier that having to litigate over potentially 80 or more patents for one medication presents to potential competitors.

Edited 14 hours ago by Chopper

[Pato del Muerto 53603]

I’m late to this particular party, but when a novel drug costs 100 million dollars to go from early molecule screening to pre-clinical development to regulatory agency submission to phase 1-3 trials to commercial, and say there’s a 100k patient pool annually that need it (a very aggressive number), and they have a patent window to get their money back, how much should be charged per dose?  
understanding that for every drug that gets to market at 100mm price tag there are several that are abandoned at some point during the process for things like lack of clinical signal that have run up a multimillion dollar bill.

what incentivizes these companies to continue researching?

and- if a cheap drug works as well or almost as well as an expensive one, then yes the cheap drug should be prescribed in most cases. 

[Gatorubet 30789]

54 minutes ago, Anastasis said:

No, you tell them to go get bent. Everything is negotiable. Including your medical expenses. Works best with hospitals and device charges in my experience. You have no leverage at the pharmacy counter. 

there are people and companies that specialize in auditing medical charges for reasonableness.  You do not have to pay for the $10 aspirin or $10 box of Kleenex.   Of course they will try to intentionally fuck you, and while you cannot avoid the fucking, you can slightly affect change in the length and the lube

[Anastasis 23718]

10 minutes ago, Pato del Muerto said:

and- if a cheap drug works as well or almost as well as an expensive one, then yes the cheap drug should be prescribed in most cases. 

But this is not how our system works. Drug companies should be required to stand their innovations up against the standard of care during the authorization process. We figure out what works and what doesn't and what the incremental cost effectiveness is. Innovation is good and we should reward it. But you need the model inputs.  

[Pato del Muerto 53603]

4 minutes ago, Anastasis said:

But this is not how our system works. Drug companies should be required to stand their innovations up against the standard of care during the authorization process. We figure out what works and what doesn't and what the incremental cost effectiveness is. Innovation is good and we should reward it. But you need the model inputs.  

Clinical results of novel drugs are absolutely compared with those from current standard of care.  Pharma wants those because they want them to show a statistically significant improvement so their move drug becomes the new standard of care. 

[Anastasis 23718]

Just now, Pato del Muerto said:

Clinical results of novel drugs are absolutely compared with those from current standard of care.  Pharma wants those because they want them to show a statistically significant improvement so their move drug becomes the new standard of care. 

This is not the guidance from the FDA. And drug companies absolutely do not want their novel drugs compared to standard of care on an equal footing. 

[Anastasis 23718]

https://www.fda.gov/media/71349/download

[Chopper 17450]

 

 

[TwiceHorn 32108]

11 hours ago, Chopper said:

Well then you know the point isn't necessarily the date they expire. It's the barrier that having to litigate over potentially 80 or more patents for one medication presents to potential competitors.

Well, that's not usually the reality.  It is true that pharma milks the living shit out of the patent system and every other legal/regulatory regime applicable to them.

But, in almost every patent thicket, it boils down to a relatively small handful of patents that have competitive value, and those tend to be focused on the actual technological merit of the invention, rather than some peripheral, possibly trivial bullshit.

If you drill down on any of the alleged patent thickets, you'll find that there are usually fewer than 10 patents, in one country, at least, that are enforcing the monopoly.

And, expiration dates matter.  Tremendously.  It doesn't matter how many patents cover something if they all expire on the same day:  they're off-patent on that day.

And, generic manufacturers aren't helpless.  They're as sophisticated as the "innovators," but lack the leg up that innovation confers.  They are frequently in pari delicto with the innovators in taking ANDA infringement settlements that pay them to hold off pursuing valid claims until patent expiration or some other event.  In many cases, a "generic" on one drug will be "brand" or innovator on another.  

[South Austin 53270]

2 hours ago, Chopper said:

 

 

That’s only five reasons.

[Chopper 17450]

11 minutes ago, South Austin said:

That’s only five reasons.

It might only be 2 or 3. I had to leave and forgot to leave the link though. https://archive.is/HV3K7

[South Austin 53270]

Just now, Chopper said:

It might only be 2 or 3. I had to leave and forgot to leave the link though. https://archive.is/HV3K7

Don’t pull that shit again.

[Chopper 17450]

36 minutes ago, TwiceHorn said:

Well, that's not usually the reality.  It is true that pharma milks the living shit out of the patent system and every other legal/regulatory regime applicable to them.

But, in almost every patent thicket, it boils down to a relatively small handful of patents that have competitive value, and those tend to be focused on the actual technological merit of the invention, rather than some peripheral, possibly trivial bullshit.

If you drill down on any of the alleged patent thickets, you'll find that there are usually fewer than 10 patents, in one country, at least, that are enforcing the monopoly.

And, expiration dates matter.  Tremendously.  It doesn't matter how many patents cover something if they all expire on the same day:  they're off-patent on that day.

And, generic manufacturers aren't helpless.  They're as sophisticated as the "innovators," but lack the leg up that innovation confers.  They are frequently in pari delicto with the innovators in taking ANDA infringement settlements that pay them to hold off pursuing valid claims until patent expiration or some other event.  In many cases, a "generic" on one drug will be "brand" or innovator on another.  

So there's little or no patent abuse by pharma and their monopolies shouldn't really bother us...do I correctly understand what you're saying?

Here's an NIH study. It's a few years old and the data is only through 2018, but pharma profitability has only increased since then. https://pmc.ncbi.nlm.nih.gov/articles/PMC7054843/

Here's another NIH study, this one's from 2020

and here's their recommendations for reform from 4 years ago

https://pmc.ncbi.nlm.nih.gov/articles/PMC7311400/