Dubious $56,000 Alzheimer’s drug spurs largest Medicare price hike ever | Hacker News Reader

Dubious $56,000 Alzheimer’s drug spurs largest Medicare price hike ever

arstechnica.com

71 pointssamizdis43 comments

I love how a Biogen conference was responsible for one of the biggest initial outbreaks of Covid, and now every senior will be responsible for paying $20 more per month for a drug of theirs that has no clinical efficacy whatsoever.

When will they ever get what's coming to them? One must wonder...

Things are really starting to feel like France at the turn of the 18th century.

> When will they ever get what's coming to them? One must wonder...

It is probably best to accept that there is no such thing as Karma in life. We don't live in a Hollywood blockbuster where the good guys win all the time no matter what the odds.

I am aligned with this and it pushes me towards vigilantism. In the words of big Sean "if you want the crown bitch you gotta take it", although here the crown is more the abolishment of the new aristocracy.

Vigilantism is execrable. It leads to redundant punishments of the very famous, no justice for most crimes, and a lot of false positives.

"no justice for most crimes and a lot of false positives" may sum up our justice system as-is?

Unfortunately that sums up vigilantism too.

The French revolution wasn't the poor against the rich. It was the rich vs the politicians and royalty.

Not sure when exactly but definitely after election financing reform.

"Meanwhile, Biogen had set the list price at $56,000 per year. Media analyses suggested that at that price, the drug could cost Medicare up to $334.5 billion per year, which is nearly half of the budget for the Department of Defense[...]In November 2020, a committee of independent advisers for the Food and Drug Administration voted nearly unanimously against FDA approval for Aduhelm. The data did not indicate the drug is effective, the committee concluded. Ten of 11 committee members voted against approval while one voted "uncertain." But in June of this year, the FDA approved the drug anyway"

That's almost twice of the entire NHS healthcare spending for one drug that probably doesn't do anything for Alzheimer patients? This isn't actually going through at the end of the day right? The US healthcare, drug and regulatory system has lost the plot, that's just nuts.

And what on earth is going on at the FDA to approve this? Even if I was a literal pharma lobbyist I would probably skip that one because it just sounds too wrong

FDA doesn’t approve based on the projected costs to the system. That’s the underlying problem. There is no political mechanism to say “no, this treatment won’t be covered by medicare.” Further, such a mechanism would be wildly unpopular with your average voter. Nobody wants to deny their grandmas coverage to anything, and it’s a huge burden on the system and contributor to inflation.

It would not be under the FDA’s purview (nor should it be) to do a cost benefit analysis anyway. Their job is to vet medical claims, regardless of price.

Whether or not taxpayers should pay for a certain treatment for a certain population is a political excercise, usually implemented via CMS, but also state Medicaid departments.

True, with one caveat, state medicaid departments have like no incentive to not cover procedures or medications because they are 90%+ funded through the fed anyway. But most alz patients probably fall under medicare anyway.

Biogen had 'only' ~$13 billion in revenue in 2020, and won't do much better in 2021. If this one drug is really going to 25x their top line, why has the stock barely budged?

My guess is that nobody will prescribe it?

That sounds like a bad bet. Pharma ads are allowed to target patients directly, so people will ask their doctor for it, and pharma reps are cozy with doctors, so at least some doctors will go for it themselves.

This really requires some fix at the FDA or somewhere in the government or it's going to be a disaster.

Yeah, but there is so much publicity around the efficacy of the drug, people might not ask for it, and doctors might advise against it, or just refuse to write a script, particularly at that price.

You have far too much faith in people, especially scared/hurting people.

Medical industry is about milking the government for everything possible. Actually helping people is secondary.

And yet to voice concern around the current worldwide covid vaccine rollout and effects is to be "anti-vax" and anti-science. People can be funny with logic.

> And what on earth is going on at the FDA to approve this?

https://blogs.sciencemag.org/pipeline/archives/2021/07/02/th...

Can intellectual property be made public through eminent domain the same way physical property can be?

Comparing to NHS is mismatched units.

But it's 12% of all Medicare premiums

Somewhat related: Why is it that the US needs middle-men to negotiate prices - that is, why can't Medicare just negotiate the prices themselves?

If I understand it right, that's what other countries do. Countries with universal healthcare systems are basically the only buyer, and can drive a hard bargain. Yet the US needs for-profit middle-men, that can't seem to get a price as good other countries...but yet they're supposed to perform better than Medicare? Doesn't make any sense (to an outsider)

"The Medicare Prescription Drug Act expressly prohibited Medicare from negotiating bulk prescription drug prices."

https://en.wikipedia.org/wiki/Medicare_Prescription_Drug,_Im...

"Why are we hobbling?"

"You shot yourself in the foot"

"Oh, yeah, right. I forgot."

> Why is it that the US needs middle-men to negotiate prices - that is, why can't Medicare just negotiate the prices themselves?

Pharmaceutical companies bribe—sorry, lobby—members of Congress so those members of Congress vote against letting Medicare negotiate pricing.

Since money is speech, (see Citizens United v FEC) the one with the most money wins.

Not only that, but the middle men are permitted to receive rebates from the manufacturers. Rebates like that are illegal in all other industries except pharma.

As you form your observation, a few notes:

Other developed countries have a variety of systems, but they typically do at least have a public option (available to all).

US middle men are not trying to get a good price.

US consensus failures on this are based on fear of the government, entrenched interests, lack of inspiration on what specifically to change, coincidental convenience as the status quo keeps people preoccupied and risk averse, and a large very sick population that really would massively increase taxpayer costs in the first several years no matter how it would equalize in a longer term.

For Part B drugs there is no middle man beyond the doctors themselves. They buy the drugs and then bill Medicare for them. They can sometimes negotiate with drug companies to get discounts.

However, the government, by law, demands stiff discounts anyways. Medicare only pays the average of what other customers pay.

Then stack on the 340B law and drug companies give the government substantial discounts on the back end.

Congress doesn't allow it. Biden tried to get this into the reconciliation bill, but Manchin rejected it.

Meanwhile, it was one of the most popular provisions in the bill. https://www.dataforprogress.org/blog/2021/9/17/the-build-bac..., 3rd chart

It’s really annoying to watch the scare-tactic ads by the drug companies against allowing Medicare to negotiate drug prices. “Oh don’t let them take away my precious drugs!!”

It won’t just be from drug companies. There will be patient advocate groups as well. Not to mention politicians keen on bringing bad the “death panel” talking points.

I don't understand how can people advocate for this kind of society.. it's depressing

"People" don't. This is what "manufactured consent" is for.

There is rightly focus on whether this drug works, but the more interesting question is "assuming it does work, what then?".

Now you opened up the balance of cost and effectiveness. Therein lies the nest of vipers.

That’s a solved problem. The solution is called QALYS. Richer or poorer countries can set the total budget differently and then QALYS tells you how to spend it.

I don't know why anyone thinks it is acceptable for human lives to be considered more or less valuable depending on which arbitrary geographical division they were born within. Why don't we just murder and eat each other then? That is how barbaric we are.

What exactly do you mean by the word "acceptable" here? "Finding something acceptable" can describe an incredibly wide range of behaviors, from "not starting a violent revolt over it but still hating it" to "endorsing the thing as being good actually".

Why do taxpayers not choose to pay taxes to develop the medicines and have them in the public domain?

that does not at all sound controversial

$65k per year medications are Biogens specialty. They payup a patient's full out of pocket for them when they start on this. Really cools tension over the price for those receiving the drug.

Politicians whip out the inflation boogieman to wage class warfare, and of course simultaneously also do stupid things like that will just make it worse.

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