Drug made famous by Shkreli’s price hike is still $750 a pill
arstechnica.com
arstechnica.com
Sounds like the old price of $13 was way too cheap. Given that its off patent and still no one else wants to make it I'd think the new $750 prices is probably not crazy.
http://www.lepharmacien.fr/produitafine/medicament/substance...
Because reimporting prescription drugs (manufactured in the US and sold abroad) is illegal. There was a bill that would have allowed this, but it was voted down in the Senate last January.
To be entirely honest, if that bill ever did pass, there would be serious pressure political pressure on European governments to ban re-exports of prescription drugs from the EU. The current barrier to trade is what enables European governments to set low prices for prescriptions while still maintaining the same level of profits for European pharmaceutical companies - the latter simply raise their prices in the US to make up the difference.
>So the examples of European healthcare working well are (somewhat) contingent on price gouging Americans?
It's more related to the development of new healthcare technologies/medicine. Once a drug is developed it's super cheap to produce and distribute. Getting it developed is where $X billion is spent. If the US incentivized global pharmaceutical companies less by allowing for less profit, the drugs we have now would still exist but new development would probably decrease significantly. That said there are most likely solutions to this problem (government research into medicine instead of for-profit etc).
The US doesn't permit importing those drugs period (regardless of where they're manufactured).
The topic is generally referred to as "reimporting", and in this case the drug is manufactured by a US company, but it doesn't matter if the drug was manufactured by a Brazilian company; it can't be imported from that manufacturer to the US.
On top of that, there was an investigative article a while back that tried to measure the actual effects on patients.
Turns out, they weren't able to find any patients who themselves had to pay anything close to $750/pill for the drug. It's not prescribed that commonly in the US, and the only patients who needed it were all on insurance plans that covered it, subject to standard copays and deductibles. Many of the patients already meet their annual maximum deductible anyway, due to the other medical care they already have to receive, so the marginal cost to them was $0. In other words, raising the price of the drug literally did not increase the price that those patients had to pay by one cent.
I'm aware that this has a complicated and implicit impact on prices elsewhere, but that's the real problem: medical billing is ridiculously convoluted, and focusing on the price of a single drug - especially the price that isn't actually paid by any consumer - is missing the real problem that needs to be fixed.
Since the ACA capped profit percentages, the insurance companies have been looking for ways to increase pay outs, os they can increase total revenue, and then total profit. That perverse incentive is one of the reasons why insurance premiums have been going up so much the past few years.
They're not still paying it. Collectively, yes, the insurers are passing the cost on to the insured population. But the number of people taking that drug is tiny[0], so it amortizes very quickly. For the patients taking the drug, the effect on their own premiums from that price increase is less than a penny.
This is what I'm talking about when I say that medical billing is the real problem: the effects are non-obvious and highly-interconnected. You're right about the perverse incentive created by the MLR; and that's just the tip of the iceberg.
[0] There were 500 pills sold in Dec 2015.
Seriously, average premiums increased in my state 26.7% last year. It's because of systemic issues that this a perfect example of a facet of.
https://www.thedenverchannel.com/news/politics/colorados-201...
The problem is that the media coverage of the issue is like 99,5% Shrkeli, his smug face and lacking social skills. Look at the title of this post alone - and we're on the rational, reflecting side of the internet here
I don't understand, because it sounds like you're trying to argue with what I'm saying, but we're literally making the same point.
Shkreli makes for an easy target because he's the absolute caricature of a villain. But at the same time, focusing on this drug misses the point. Even if Shkreli cut the price of the drug to $0, there would be no measurable effect on patients. And while not everyone is as overtly malevolent as Shkreli is, the incentives that cause this sort of behavior aren't caused by the pharmaceutical companies (nor can they really be fixed by the pharmaceutical companies - at least not systemically - because they're just responding to the incentives that have already been created).
They've gone up much faster after the ACA has gone into effect.
Here's one that contradicts this directly:
https://www.forbes.com/sites/robbmandelbaum/2017/02/24/no-ob...
> Except that it doesn't seem to be true. Health insurance premiums have been rising for decades, almost (though not quite) as stubbornly reliable as an eastern sunrise. And it turns out that these increases actually slowed after the Affordable Care Act became law in 2010. That's according to data collected by the U.S. Department of Health and Human Services, which tracks a range of topics around spending on health care in its Medical Expenditure Panel Survey. The survey tracks the health insurance offered by private firms big and small, and in all cases, the average rate of premium growth from the time the law passed in 2010 through 2015 was actually lower than from 2004 to 2010. And premium growth was lowest for firms with fewer than 50 employees.
[1] http://thehealthcareblog.com/blog/2012/02/04/does-obamacare-...
There was no incentive before ACA to control prices either.
Sure there was. Profit = revenue - costs. Previously, lowering costs - particularly claims - was a direct way to improve profits.
Now, the formula is more complicated, because 80% of costs must be spent on claims. Lowering claims directly reduces the maximum amount of profit you can make. There's still an incentive to reduce non-medical costs, but there's an incentive to increase medical costs, or shift non-medical costs to medical costs, in order to satisfy the 80% rule.
it's not uncommon for a doctor to ask, "are you on insurance? otherwise this drug would be too expensive for you". there is no statistic on how often this happens.
Some villain.
Saying "oh duh medical billing is just so complicated and convoluted, i guess the money just comes out of the ether." is wrong. It is actually not that complicated. If a drug company charges medical insurance companies really high prices, all people that pay medical insurance (even those not using that particular drug) end up paying these high prices through their premiums.
When we're literally talking about medicine, I don't have a lot of patience for increasing costs to 'what the market will bear'. There's obvious market failures occurring.
<blunt>
But if you're unlucky enough to have a baby that gets toxoplasmosis, you're fucked. The people backing the insurance which is paying that new price are fucked. But it's OK that this is a net negative for society, because the company is now making a 'proper' amount profit off it, right?
</blunt>
Bid for Allergan Puts Valeant's Research and Development Cuts Under Scrutiny $53 Billion Bid Puts Focus on Strategy of Shedding Research Operations and Making Money Selling Products
https://www.wsj.com/articles/bid-for-allergan-puts-valeants-...
This common apologetic ignores the real-world cost of infrastructure, overhead, and accruing a user-base that an existing company has already established.
It excuses irresponsibility and negligence of the public trust. Nobody would say, for instance, "corrupt politician? You're free to stage a revolution, overthrow the existing state, draft a constitution, establish a sovereign power and diplomatic ties with other states if you want"
No, we know how absurd and ridiculous that is, so we have tried to create reasonable mechanisms for dealing with political corruption through the ballot box and removing barriers to entry for legitimate challengers.
But in business, this trope is implying "You're free to abandon your career, study chemical engineering, get financing to start a lab, hire a large staff of experts, buy the machinery, run an advertising campaign, establish the customer base ..."
It changes the frame of reference from abuse and incompetence on important matters to essentially shaming people for not starting multiple successful industrial capitalist enterprises in their leisure time.
There needs to be more reasonable mechanisms for dealing with abuses of power then requiring such expensive and elaborate responses. Otherwise most abuses go unchallenged.
On the other hand, this trope also implies that you have to pay for all of this, and perphaps $13 is not a good price for the drug.
What is an appropriate price for this drug?
You say it's abuse and incompetence, but could it be that you're wrong and it's a rational decision?
And the point was about existing infrastructure. The drug existed, and made money, at $13, using paid for infrastructure that did other things, made other drugs as well, run by an existing staff that had other tasks.
You don't buy a car to drive 1 mile or start a restaurant to serve 1 meal.
Instead, an existing company should make a competitor, say Imprimis Pharmaceuticals, which did so in 2015 for $1.00 each.
This is fundamentally about abusing power and position for profit and saying others should get the same power and position to stop the abuse.
My only contention is that isn't reality and the world doesn't work that way.
The outrage at Shkreli is misdirected. Be outraged at the system, not someone acting rationally within the system. If you're upset drugs are too expensive, argue and work towards non-profit manufacturing. If drugs aren't profitable, they cannot be manufactured. Equipment, technicians, supply chains, and FDA regulatory compliance all cost money.
Wow I had no idea. Source? If true I certainly am guilty of misdirected outrage.
"In one breath, he calls himself a capitalist and in the next an altruist—the latter because, he claims, his real goal is to invent new drugs for rare diseases. Turing recently announced discounts of Daraprim for hospitals, and Shkreli says that for people without insurance it will cost only $1 a pill. For everyone else, insurance, which he argues is paid for by corporate America’s profits, will cover the cost. “I’m like Robin Hood,” he continues. “I’m taking Walmart’s money and doing research for diseases no one cares about.”"
http://money.cnn.com/2015/11/25/news/companies/turing-pharma...
"Turing said it would offer smaller bottles of 30 tablets to make it easier and cheaper for hospitals to carry the drug, and free sample packages for doctors needing to treat patients in emergency situations. The company estimates that "nearly all patients will receive Daraprim for $10 or less out-of-pocket per prescription.
While Turing is dropping the price for hospitals, it is not reducing the list price of Daraprim at pharmacies, because that would not help patients, Retzlaff said."
https://www.thepharmaletter.com/article/turing-pharma-reduce...
"Additionally for the outpatient setting, Turing will continue to:
* Participate in federal and state programs such as Medicaid and the Section 340B discount program having costs as low as $1 per 100-pill bottle, which currently account for about two-thirds of Daraprim sales. (!!!)
* Commit to patients with commercial insurance that their out-of-pocket obligation will be no more than $10 per prescription when Turing's co-pay program is used.
* Contribute to Patient Services Inc (PSI), a longstanding independent charity that provides financial assistance for Medicare patients' cost-sharing requirements on toxoplasmosis therapies, consistent with PSI's advisory opinion from the HHS Office of Inspector General.
* Provide Daraprim free-of-charge to uninsured, qualified patients with demonstrated income at or below 500% of the federal poverty level through our Patient Assistance Program."
This is the core reason that Shkreli got raked over the coals. He went on television and clearly broadcast that he didn't care about the rules or conventions of the ruling class. He was going to make the noise he felt proper, and he was in a position with too much influence to tolerate such noise-making -- that's besides his failure to cave to their pressure to lower the price back down and/or provide some other form of damage control when faced with media pressure, as most executives would've (resulting in a win for insurance companies).
Shkreli was naive to believe that he could signal his non-compliant thought process without becoming a target for those who are seriously invested in maintaining the status quo. The people who work to maintain this careful balance between public exploitation and complacency immediately recognized it as something they couldn't tolerate and set up to paint him as the sniveling, greedy bad guy who liked watching babies die.
Everyone should pay attention. Anyone who does anything more complex than collecting a standard W2 paycheck can easily be brought up on a variety of white-collar charges (and those who just collect a paycheck can be brought up moderately easily).
Shkreli is an example of why you have to be careful what you say and can't just come out and let the cold hard truth do the talking for you. Spinmasters and assailants are lurking out there, and they will turn nasty quick if they interpret a threat.
Watch your back out there. Shkreli is a peer of many of us who read HN. It can happen to you, too.
No, society does though raised insurance premiums.
EDIT: The drug, per TFA, was profitable. Just not profitable enough for Shkreli et.al.
It's true that the system encourages this behavior through poorly designed incentives, but outrage and publicity is the only check on this. So the outrage is perfectly well-placed.
Yes, they are. They are permitted to raise premiums "as much as necessary" due to a lack of cost controls, and the ACA/Obamacare simply subsidizes insurance with little eye towards costs. They get their admin skim regardless. Your blame is misplaced.
If you want your drugs affordable, manufacture them without a profit motive (through a government sponsored entity, for example). Use government funding through the NIH, the NSF, and DARPA for drug development. Put cost controls in place and use Medicare as a single payer system. If you leave any room for profiting, someone will find a way to exploit it. That's capitalism.
Yes, absolutely. To the extent that "evil tycoons" exist in the real human world and are not just propagandist's caricatures, anyway.
Medical insurers provide near-zero tangible value and are the main reason that the medical system is FUBAR'd. I understand that there are many good people working for insurers because they need to put food on the table, and I sympathize with that, and I probably would take such employment myself if necessary.
But we should not pretend that medical insurers are good or that they are entitled to anything. The belief that they deserve a place in the economy is immensely destructive. They are paper pushers who leech from the providers administering medical care, the patients receiving it, and literally everyone in between, including the state and the patient's employer(s).
We do not have to accept medical insurers, nor pretend their role is legitimate. I personally believe most types of medical insurance should be immediately and completely outlawed.
Yet this logic can be applied to anything. Should food companies make healthy food cheaper at a loss so that more people get the nutrients they need and thus live longer?
If you are exactly copying a drug that has already been proven, safe there shouldn't be much safety concerns. So the FDA approval is not supposed to test whether the actual chemical formulation is safe (as this is already proven) but that the process of manufacturing is safe and reliable.
In a rational world, this should be a very quick approval. But in reality it is a very slow approval because congress and the FDA administration intentionally keep the department of the FDA that handles generic approvals understaffed. Thus there are massive backlogs and waiting lists to get a generic drug approved.
The stock went from $0.90/share to as high as $45/share overnight. If you were short you were very screwed as your broker bought you in at h igh prices that dropped pretty quickly after that.
Never hold a short overnight unless you are really really sure and even then never hold a short overnight no matter what if its a penny stock. They are just too volatile and can see 500% + price spikes.
https://www.thestreet.com/story/13374131/1/kalobios-pharmace...
And I'm a big fan of these inspections. As bad as some of our prescription distribution is, it's nothing compared to India/China and their customer nations. You're borderline lucky to get the right drug, that's been manufactured to spec, and has been stored properly.
[0] https://en.wikipedia.org/wiki/Pyrimethamine
[1] https://www.ibtimes.co.uk/daraprim-like-drug-costs-less-0-07...
And it is covered by insurance. This is exactly how one leverages inefficiencies of the insurance market place - insurance companies cover it and they are charged that rate.