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Comment by barbariangrunge | Hacker News Reader

1100-1500/month is pretty brutal. It’s a bit of a middle finger pointed at lower income people

You can get these wholesale from China from "reputable" gray-market wholesalers who get the chemicals made at contract manufacturing facilities. Independent purity tests via HPLC are available for <$100 if you don't fully trust your supply chain. Semaglutide is very, very cheap in the gray market. It's somewhat less effective than Tirzepatide and has slightly more side effects if you ramp up the dosage too quickly.

If an annual amount is purchased on the gray market, this brings the monthly cost down to:

- Tirzepatide: $60/month

- Semaglutide: $10/month

- Liraglutide: $87/month

Note that in the USA, it is legal to import certain amounts of FDA-approved drugs if you have a prescription for them. However, just because something is the exact same chemical as an FDA-approved drug does not make it an FDA-approved drug. It must be manufactured in an FDA certified facility and be the same brand/manufacturer/packaging/labeling/etc as the approved drug.

e.g. importing generic Sildenafil/Viagra is legal if you can find the Teva(tm) brand generic sildenafil in, say, Mexico or Canada for a better price. But it must be the pills manufactured by Teva in the appropriate facility with NDC #0093-5342-56[0]. If you import generic sildenafil "Cenforce" from the (very legitimate but not FDA-approved) Indian pharmaceutical manufacturer "Centurion Laboratories"...

...that would still be potentially criminal smuggling. Even if the pills you import show via laboratory test that they precisely match your medical prescription, they are not "FDA approved" and therefore not legal to import.

A lot of people do though!

0: https://ndclist.com/ndc/0093-5342/package/0093-5342-56

>> You can get these wholesale from China from "reputable" gray-market wholesalers

Hard pass.

Unfortunately it's really expensive to research and produce drugs and somebody's gotta pay for it. The rest of world isn't willing to so it looks like rich people's insurance is the one that will foot the bill which means lower income people have to wait.

It sucks and it's a inefficient way to fund research but it's better than the alternative where no one funds this research and we (both rich and poor) never get the drug.

Another alternative is the government funding this research and/or buying the drug directly. This is what was done for the government ordering 30 billion dollars worth of covid vaccines from moderna, pfizer, and j&j.

What the difference between consumers paying for drugs directly or paying taxes that pay for the drugs?

Many. For one the government can now collectively bargain for better prices. They can also subsidize the drug such that its available for everyone who needs it, not just those who have great insurance or who can afford to pay entirely out of pocket. Keeping your working population healthy has massive second order effects on the economy, it would be an investment paying for medical care.

Where does this money come from? The people in this country who make way too much money to notice any decrease in quality of life from this potential tax hit. This country is full of such whales who could front a lot of money for collective good if we thought about things in a more redistributive manner instead of the "screw you I got mine" manner that somehow got perverted into the American way.

If the government is making the drugs how do they bargain for a price?

And if the inefficiency of the government in terms of defense spending is any indication, I’m sure we’d be getting way less for our money than we currently do.

If the USPS ran like the DoD, the country would fall apart.

Government is capable of efficiency.

Most analysis of single payer versus the status quo suggest we'd all be saving money hand over fist. Sure the government is not the most efficient, but private companies are often even more inefficient unless you are a shareholder and your metrics for efficiency are profit versus the wellbeing of your customers.

Single payer systems are not more efficient at producing drugs, they just pay less for drugs by virtue of being a monopsony buyer.

If we had a single payer system we would pay less for drugs, but we'd also have less drugs. This is probably a good tradeoff in the short term, and a bad one in the long run.

If you get a disease today that has a significantly better prognosis than 20 years ago, what's the most likely reason? Better drugs. What is only 10% of our healthcare expenses, drugs. I don't think we should be so quick to cut funding to a sliver of healthcare expenses that is driving 90% of the progress.

"Most analyses"?

United Healthcare, the largest US insurer, has more members than the entire population of Canada. Why don't they get better drug prices than Canada?

And in terms of efficiency, please list all the new, innovative drugs the government has brought to market.

Governments already fund much of the basic science research needed to find new drugs. That isn't the issue. The real funding issue is with stage 3 clinical trials, which now often cost on the order of $1B each.

In theory we could nationalize the whole industry and have the government run all clinical trials. So the decisions on which drugs to develop would then be based on lobbying and campaign contributions. Would that produce better outcomes than what we're getting now? The government has a poor track record on picking winners.

Pharma profits so far could pay for research thousand years into the future.

Pharma companies have profits that are around 13% mostly comparable to other companies of the same size doing lots of r&d.

Pfizer could fund research for two thousand years at only 10 million a year?

Lower income people of 2036 and beyond will have a magical medicine for probably 30 bucks a month.

It will be too little too late for many by then

So we should stop designing new drugs because only future generations will benefit?

We should instead publicly subsidize the drugs that people need to be healthy just like we did for the covid vaccines that we offered to everyone at no cost.

It's covered by insurance and the manufacturer has a $25/month program.

Running shoes cost about $50-$100 for a decent pair and last for many months

1) Decent running shoes cost more than that and it's a prohibitive spend for lower income people.

2) This is an extreme oversimplification of the problem and feels to be made in bad faith.

I'd never consider exercise gear, esp running shoes to be 'prohibitive spend for lower income people', taking care of your health is probably some of the best money you can spend ... and you can most certainly buy quality running shoes for around $100. Here are some high quality trail runners for around 100, some under: https://www.saucony.com/en/saucony-peregrine/

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