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Comment by anon49124 | Hacker News Reader

Yes, the "free-for-all" sucks. Shkreli-style and worse profiteering on illness, misery and bankrupting people.

And this reminds me: there are long off-patent generics costing $10 USD/pill ($300/mo). Isn't this crazy, even considering regulatory and medium-overhead operations?

Doesn't this seem like a reasonable social-enterprise opportunity for non-hospital-/non-insurance-owned, employee- & customer-owned co-op generic pharmaceuticals for the US market at a minimum? Fixed margins on products based on production costs and overhead... but with enough investment so it can't get "DRAM price war"ed butt-kicked.

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The only issue with that from my limited knowledge of the generics industry is that it doesn't account for legal spend by generics firms. The patent wars are waged in courtrooms by generics firms fighting branded firms. The big generics firms have massive legal budgets and expertise on all the arcana of patent law.

You could certainly try to make a small scale manufacturing firm to sell some expensive generics drugs at cost, and that could be a good idea (some hospitals are doing it), but these types of firms would probably not be able to develop "first inclass" generics without legal and administrative expertise

Until the last few years, you really wanted to be the first genetic. These first generics get 180 days of market exclusivity I think as an incentive to do all the grunt work of challenging patents. If you were later to market it was really hard to make money

Which has led to a situation where some generics markets have found themselves with only a few generics makers. These manufacturers have realized it and have been increasing price. So a co-op could be viable for markets like this. But you would need to do some r&d work for each generic you develop to show it is bioequivalent and get your manufacturing facility registered with fda, etc

However I don't think it accounts for much of the higher per capita rx drug spend in the US (unfortunately can't find source)

If anyone is interested, an executive from Bristol-Meyers-Squibb was convicted of fraud a while back and his punishment was to write a book about how he ended up in jail.[1] The judge thought it would give him time to reflect, but his main argument was that he wasn't guilty.

Regardless, it goes into a ton of detail around the negotiations a branded and generic drug company go through. What I found most interesting was the comment from the CEO of Apotex (huge generics company from Canada). To paraphrase "I don't make any money from the drugs, all my profit comes through winning court cases".

Since the book was written as a part of this CEO's trial, it's a part of the court records and was publicly available at the time (not sure if it still is - I think he is now self-published). It's titled "The First Question" and is by Andrew Bodnar.

[1]http://www.expertbriefings.com/news/bristol-myers-squibb-exe...

>>"And this reminds me: there are long off-patent generics costing $10 USD/pill ($300/mo). Isn't this crazy, even considering regulatory and medium-overhead operations?"

The worst part, you can get the same drug for pennies outside USA. The drug that probably US companies or research invented.

> The worst part, you can get the same drug for pennies outside USA. The drug that probably US companies or research invented.

I have direct personal experience with this, as an American living in the Netherlands. My youngest kid recently had worms appear in her poo. I called up the doctor's office and got a straightforward direction over the phone: go to any pharmacy, ask for mebendazole, give her one pill directly and one more after 2 weeks. No prescription necessary, no doctor's visit necessary unless worms persisted after the second dose.

I went to the pharmacy. The medication - 2 doses - was 90 cents. Problem solved.

Out of curiosity, I looked up the medication online. It's generic now, having been first marketed in the early 70's. It's considered one of the two standard de-wormers for humans and is on the WHO list of essential medicines.

In America, it costs somewhere between $200 and $400 per dose (i.e. double that for a course of treatment.) Why? Because one generic maker (Impax) has cornered the US market. And it would have required a doctor's visit and prescription to acquire.

US health care is so fucked.

Mebendazole didn't use to be so expensive in the US. This is another Martin Shkreli type situation.

In the United States a single dose was about 18 USD in 2015.[3] In 2016 the price increased to 440.00 USD per dose in the U.S. as Amedra Pharmaceuticals acquired the rights from Teva in 2013.[8] In 2010, Amedra also bought the U.S. Marketing rights to the only other interchangeable anti-parasitic medication, albendazole, from GSK. The result of these acquisitions created a monopoly these medications and the price increased dramatically.[18]

https://en.wikipedia.org/wiki/Mebendazole#Cost

Or in some cases, the same prescription for your cat or dog at a fraction of the price, in the states. For the same pills.

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