It's fine with me. And while we're at it, the time has come to ban all consumer drug advertising.
56
Maybe big pharma will stop the incessant television advertising. It makes sense for widely prescribed meds taken by a large population. But ads for narcolepsy, cancer, or other serious conditions are disgusting.
33
We don't want drug companies and insurance companies deciding what they will pay for, so they don't have to cover every drug on the market. Insurance companies are already doing that by making people beg for the drugs that work best for them instead of substituting something cheaper for insurance companies to cover. The drug companies want to make the most money they possibly can. We don't have to help them by giving them another way to restrict services for their customers. The public already sacrifices enough to corporate domination over our government.
6
OK, but lowering drug prices will have little impact on health care costs, since pharmaceuticals only make up about 12% of overall health care costs. Seems to me this is focusing on pharmaceuticals because they are easy to understand, there is an easily identifiable villan, and because a lot of consumers pay for drugs out of pocket.
For the remaining >85% it gets complicated. My understanding is that salaries and administrative costs are the primary expense in health care. But is rare to hear any debate on how to corral those health care costs.
13
I think this proves the House can chew gum and walk at the same time. They can proceed with impeachment and pass meaningful legislation.
14
The reason is simple. Republicans prefer socialism for the rich and capitalism for the rest of us. They achieve this via legalized bribery.
The pharmaceutical industry has had a robust and organized lobbying operation on Capitol Hill for years. Over the last decade, Big Pharma has spent roughly $2.5 billion lobbying the federal government on a broad range of issues, including efforts to limit drug prices. The industry allegedly promised to support President George W. Bush’s 2006 Medicare Part D plan on the condition that the Centers for Medicare and Medicaid Services (CMS) would be forbidden from negotiating for lower drug prices. In 2009 and 2010, during the negotiations and horse trading leading up to the passage of the Patient Protection and Affordable Care Act, more commonly known as “Obamacare,” the industry allegedly made sure that the new law would not include any proposals that would reform how prices are set for prescription drugs. These types of results don’t come cheap: in 2017 alone, the pharmaceuticals and health products industry employed more than 1,400 lobbyists and spent more than $277 million lobbying the federal government, making it one the strongest special interest groups in our nation’s capital.
The only way to stop it is campaign finance reform.
26
What's to worry about ? Almost all new drugs that come to market are already developed in medical schools,labs,etc with tax payer money.
9
My mother and I both have the same inherited pancreatic condition which requires around 8 pills per day. We're on the same dose of the same medication (a medication that doesn't have a generic alternative despite being the same medication my mom has taken for nearly 40 years). I have private insurance and a subsidy through the drugmaker, so I pay $5 for a 3-month supply. She has Medicare and isn't eligible for the drugmaker subsidy because of that. She pays anywhere from $100 a month to $600 a month when she hits the "donut hole." We both need it to survive, but I don't have to make the choice between utility bills and medication when a certain time of year rolls around.
Our current system isn't flawed or broken. It works exactly as intended--rigged to benefit the drugmakers.
35
Love how the rationalization for uber high health care prices is always all the cost towards research and development that companies rack up. Yet when it comes right down to it, bringing out new medicine is pricey so why bother when the cash cow is producing right now.
5
Banning prescription drug advertising might spin out more money for research to develop more new drugs.
22
What this editorial fails to address is the fact that other countries around the world enjoy low drug prices while benefiting from the R&D paid for by the US consumer.
19
It's about time The Times brought one of the House Democrats' many important legislative initiatives to the forefront and into the public discussion. These are not "do-nothing Democrats" as the propaganda tweeter-in-chief falsely labels them. If their bills were not buried on Mitch McConnell's desk, under federal judge appointee files, and if the "do-nothing president" wanted to do something to help the American people, we would have already had cheaper prescription drugs and who knows how many lives would have been extended and how much suffering relieved. It would be nice if The Times made a habit of covering legislative progress in the House and helped clear the logjam in the Senate.
15
@abigail49 If a republican senate keep passing bills the house would not pass would you also say the senate was productive? Both parts of our legislative branch need to be willing to meet and reach compromises that lead to actual positive bills which can pass.
3
If you receive a medication in its original packaging you will note that the place the drug was manufactured most often is outside the United States, for example Ireland. Complaints by the pharmaceutical industry of high manufacturing costs is, thus requiring high cost to the consumer, fraudulent. Congress, meaning the Senate Republicans, should surprise us all and do something that benefits the consumer.
13
According to Washington Post big pharma spends more on marketing than research. These TV ads are very annoying -and long- and repeated over and over again about conditions I have never heard of. It should be illegal to inflict this on the public, which is the way it was before the 80s. Pharma could then use the money for research.
20
US pharmaceutical companies have an unprecedented record of selling out consumers. Tax cuts equals more money for the top stock holders and more lousy deceptive TV ads. For cheaper prices you have to leave the country since their is absolutely no incentive for drug companies to lower their prices. Drug consumers pay for cheaper drug prices in other countries not due to the fact to a unfair market manipulation but because US companies have to sell their drugs at a price lowered because other countries have market power to make US companies do it. The US Senate allows the US pharmaceutical companies to utterly disrespect US consumers.
8
Unprecedented??? NO! This is the capitalist system and in a capitalist system driven by consumer spending this is one of the two best ways to get big profits. (The other is to create a monopoly position in the very unfree market.)
6
When the rich of the world need medical care, they don’t go to Canada. They come here; where the best medicine on earth is practiced. If we discount innovation in the name of mediocrity, we get what we pay for, which means, mediocrity now which will be eroded over time.
Government does many things well; innovate is not one of them. Leave medicine alone please; we have the best in the world because of how we reward successful new drugs. Remove incentive and we lose new drugs. Like those that make AIDS no longer a death sentence.
15
We have the best in the world if you can afford it. many, many people in this country cannot.
17
Thanks to Speaker Nancy Pelosi and House Democrats for addressing this life-or-death issue while Republicans rant and rail about how "unfair" it is to hold a president accountable for gross misconduct. Their cowardice is in stark contrast with the courage it takes to confront the powerful pharmaceutical lobby and advocate for sick and suffering people.
12
One significant solution to help control skyrocketing prices. Have the FDA (or approve other monitoring authorities) certify drug manufacturers in the rest of the world. Re-target ICE. Possibly create a UN group (maybe WHO) once we can regain world status instead of a corrupt and rapacious government trying to destroy the world.
Then drop the idiotic regulations enforced to prevent purchase by US citizens of non-US manufactured drugs.
US drug manufacturers, have spent enormous amounts of money buying politicians, creating and supporting "grass root organizations" causing loss of access to financial services to legitimate foreign suppliers. I also believe that a significant amount of foreign drugs show up in the US while being sold by US "manufacturers".
Eliminate public advertising for drugs. Completely wrong move to have allowed it.
Prohibit the drug sales persons with their sample bags in doctors offices. Or while being taken to some expensive dinner, sports event, etc.
Eliminate the brokerage layer in drug distribution. $$$
Require clear and unencumbered pricing to everyone. Public information. No restrictions and diversions destroying what pharmacies were supposed to be.
The country is being ruled by a relatively small number of billionaires that control much of our lives and what is left of our government.
One additional idea: make use of developing technology and require significant level public servants to open full disclosures of incomes and "gratuities".
8
Just yesterday I was at CVS and a mother with a sick child went to pick up her prescription but gasped when she saw the cost and hurried out leaving the medicine on the counter.
I have done the same thing. I know other seniors who ration their medications. Now I get my prescriptions from Canada at 1/4 the cost.
My European relatives are right. US expensive for profit health care is barbaric.
15
Some day the wingers may realize people are more important than corporate profits.
7
The situation remains the same: don't get sick.
4
So if this bill had been in effect 30 years ago the HIV medicines that keep me alive today would never have been developed? No thanks.
9
Well darn it whose fault is it when we the people often fund the research and let big pharm do as they will with the drugs and gee can you blame them for squeezing as much money as they can for profit? Just because they sell the same drugs cheaper everywhere else what is your beef? Capitalism at it's finest. So what if people die? It is only poor people. Their own fault they are poor, who needs em. Certainly not the politicians who have become rich from big pharma bribes to be allowed to let people die for profit. That terribly weak bill in the house which gives the right to bargain for a few not important throwaway drugs is proof positive just how much Nancy and crew cares about human life.
2
"...much of the pharmaceutical industry’s 2017 windfall went to stock dividends and share buybacks, not research and development."
A huge problem in our economic system--overpay the execs & please the investors, but don't worry about employees or customers.
Check out the pay of CEOs of top bio pharmaceutical companies (How about $38 million a year?)
https://graphics.wsj.com/table/CEOPAY_slice_Pharma_0606
Big Pharma spent nearly $30 billion in 2016 on advertising, which includes gifts and "incentives" to doctors. $6 billion went to direct to consumer drug ads on TV, in magazines, etc.
But, the US is only 1 of 2 countries allowing direct-to-consumer advertising of prescription drugs, and there are lots of reasons why other countries do not permit such ads. Think about it.
Some drug companies fold their advertising costs in with their research costs, and in some cases, their ad costs are higher than their research costs.
And I won't get involved in the weeds of how drug companies sponsor academic research and "education." At a conference years ago, there was a panel on how drug companies do the research, write the article/report, then hire doctors to be the authors of the study to get the results published. I don't know if this is still being done.
A positive effect: Two of our youngest daughter's friends were drug reps, but they hated it, quit, got the masters degrees and became public school teachers.
The 100% Big Pharma $$-business model is failing us!
9
What absolute nonsense! It's actually cruel that lifesaving drugs might never be developed. Drug patents eventually expire and then the drug is available to all at low cost.
6
Big Pharma corps that underwrite the research will eventually stop if there’s no “return on investment” for them.
It’s a tangled web that’s been woven over the years. Who pays? The ill patients who are lured by these “miracles of better life through chemistry” - those who don’t ask questions like “how much will this cost?” or “Will I become addicted?” Gee, J&J and all the opioid manufacturing hoped you would! Same with the drug store chains! Money money money for them because you’re sick!
The big marketing machine of Big Pharma is designed to sell sell sell!
Big price hikes. No control. Free market capitalism - hah! No competition with fresh patents! What a bird nest on the ground!
All those ads on TV, in printed publications, and popping up on your mobile device - all the happy shiny people in the ads with the required tiny print rapid read of the adverse reactions and potential side effects that often include reactions that are what the drug is supposed to prevent! Anti-depressants that have side-effects of suicidal thoughts! Cancer drugs that cause cancer! Gastro drugs that cause gastro distress or bleeding! There’s more!
Other countries strip hype off better than the US does. Maybe they are more ethical on their approach? Maybe they do their homework better. Maybe they see through the shams.
Try this the next time you’re prescribed an amazing new drug - ask your doctor how much it will cost you. I will bet that your doctor can’t give you an answer.
5
What we need more than anything is a cure for greed.
Until we find that, we can’t solve the other problems that we face.
9
The Federal government should disincentives drug companies spend on advertising. They can do this by capping the amount they can deduct as a business expense. So, for example, advertising spend over 10% of revenue wouldn't be deductible.
We should treat this kind of spending for what it is, a waste of money, and not let a drug company write it off as an business expense.
11
I’m proud to work at Pfizer because I believe in our mission to bring breakthroughs that change patients’ lives. That’s why I share the New York Times’ concern about patients being unable to afford their medicines. And it’s why Pfizer strongly supports an out of pocket cap for seniors in the Medicare program, and rules to make sure that the deep discounts insurance companies negotiate with us go directly to patients at the pharmacy counter. But I strongly disagree with the notion that we should accept a health care system that discourages the next critical innovations to treat cancer, rare disease, or infections. That loss of innovation means everything when the patient is our spouse, child, parent or friend whose life is in balance. That’s what’s at stake in this debate, and it’s why I am committed to working toward solutions that help make medicines affordable, and support the next generation of breakthroughs that will change patients’ lives.
11
@Sally Susman We can and we should encourage medical innovations. But the rewards need to be directed away from shareholders and to the scientists and doctors who develop the innovations! Doctor Michael DeBakey died a rich man. He deserved it. The roller pump that he designed to repair failing hearts saved hundreds of lives. I don’t begrudge his wealth for a second. Likewise Jonas Salk. But pharma brah Martin Shkreli who got rich doing nothing other than playing markets with the cold-money driven heart of a young Ivan Boesky? Heather Bresch whose wealth game from her skill at lobbying (it runs in the family) and nothing else? Sorry. I do begrudge them.
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Scientists at Rice University are developing new cancer treatments using nanotechnology. They promise to be just as effective as chemo, but without the debilitating side effects. I dare the University to buy their patents using Endowment money, to keep it out of the hands of profit seeking Pharma companies. In return - they could give the scientists tenure and big pay raises. .
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That’s the sort of thing I wish would happen.
17
An additional point is that most of the R&D is being paid for by the government in the first place with little return to the government for its investment while the manufacturers reap the profits.
And, there is a lot of molecular fiddling around with a patented drug to claim that this is a new drug when it basically isn't. Very small amounts of R&D are required for this.
Private enterprise innovation is pretty minimal.
5
Generally speaking, anytime you say that something is "complicated," the invariable response is that that's an excuse to justify doing nothing and leaving the status quo in place forever. That the status quo needs reform is so obvious as to make saying it superfluous. But it's complicated.
Just because someone working for the pharmaceutical industry says something, that fact alone does not make it false. And just because someone comes in the Name of the People, "standing up" (as Warren and Sanders like to say) to this or that corporation or industry, that likewise doesn't make what they have to say true. Politics is not a place where Good and Evil clash.
It is absurd to claim that "innovation is useful only if people can afford the resulting products." How obvious is it that the luxuries of today are the necessities of tomorrow? Great innovations are commonly the luxuries of the elite; and, in time, as we are able to produce these products cheaper, they become available to everyone (look at the conveniences of modern life that were once permitted only to the wealthiest of the wealthy).
Suffice it to say that there's a reason why the U.S. innovates so much. It's not magic. We can't solve our problems by importing European solutions wholesale. One cannot ignore demographics, history, politics, particularities, and existing states of affairs. https://www.wsj.com/articles/americas-miracle-medicines-11572649241?mod=hp_opin_pos_3
2
I have just finished reading "Blowout", by Rachel Maddow. Much of the book, and perhaps its most enduring conclusion, is the way the oil industry has managed to bamboozle governments (federal & state) in treating it as an object of special concern.
This article seems to point out that the pharmaceutical industry has caused government the same way it treats the oil industry. Perhaps a lot of publicity about this would cause the electorate to keep a better eye on what our legislatures are doing. The costs of the publicity would be money will spent.
4
@Dirtlawyer Please check in at StatinStories.com. We know how broken the system is. Profit-driven healthcare produces profit, not health. Lessons from the tobacco industry are probably even more to the point than those of the oil industry, but both are pertinent. The food industry is right up there in the mix--bogus labeling, purposely confusing. Corruption.
The most "innovative" drugs are those that the pharmaceutical industry gets tons of people to take every day forever until they die. They are costly for two reasons:
1. No proof of benefit, other than that provided by studies funded by the pharmaceutical industry itself.
2. Inevitable adverse effects--because, of course, all drugs have them.
So no proof, or inadequate proof, of benefit, adverse effects, and a financial cost.
The drug that got me costs $17 billion a year. Some people seem to benefit (those who've already had a cardiovascular event); but the rest of us just take it. We have no system for tracking adverse effects, but we call them "extremely rare." That depend on what "rare" means. If I know four people in my town, two of them MDs, is that "extremely rare"? And I only know them by coincidence, no studies..
On top of this, the adverse effects bring their own costs, sometimes huge, to the healthcare system.
Sure, a truly innovative and helpful drug shouldn't cost an arm and a leg. But before worrying about the cost, how about being more sure about benefit? And taking into account the cost of damage.
3
Like most Dem legislation that infringes on upward wealth distribution, it doesn’t even come close to going far enough.
We spend close to $400 billion/year on prescription drugs, so savings of “$345 billion in federal spending over seven years” and reducing “out-of-pocket costs” by $158 billion over a decade” is paltry.
And the legislation only covers a limited amount of drugs- and no negotiations.
2
While there are some situations where diet and exercise can eliminate the need for pharmaceuticals, there are obviously others that require medication.
Though—in the foreseeable future—we are likely to be able to regenerate bodies and control disease through cell and gene manipulation, the fact remains that our current arsenal of drugs need to be affordable, and I applaud any effort to reduce their costs.
2
Per GoodRx, the current estimated costs of the brand-name versions of the very common, widely used drugs I am prescribed for ADHD and depression:
Drug A: $434/30 pills
Drug B: $2,190/30 pills
Drug C: $4,871/30 pills.
Insurance covers none of them. The most intriguing part is how the drug costs fluctuate wildly and with no apparent underlying pattern or rationale-- or, at least, none that's available to the consumer.
The other choice is generics-- made who knows where and which are less effective for me and cause heart palpitations. (I'm young and healthy so we'll just.. hope it's all good.)
Even the cost of generic Drug A under my insurance plan is $250 until I meet my deductible. There is no generic for Drug C.
1
Nancy Pelosi’s plan is a good one. Allowing Medicare to negotiate drug prices is absolutely crucial to their affordability. It should be the first step in a multi-step approach to forcing pharmaceutical company executives to understand that what they’re doing is unfair and is literally killing Americans.
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The second step:, rework patent laws to end patent evergreening and pay-for-delay settlements. Third: allow the Federal Government to buy patents to certain widely used, overpriced medicines and medical technologies (such as Insulin and adrenaline auto injectors) so that they can open up the markets and encourage competition. Fourth, use the full weight of antitrust law to go after anticompetitive behaviors in the pharmaceutical companies. And fifth: put a new tax on pharmaceutical companies, individually set to a rate based on the difference between what the company charges Americans for medicines, versus what they charge overseas, and paid on their corporate profits, plus their lobbying budgets, plus executive pay, minus their R&D budget.
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That fifth part is important, because of the argument they always make. Whenever someone says high prices are necessary for research, I feel compelled to ask them: if that’s the case then why do other countries pay so much less for the drugs than we do? Are Americans alone, shouldering the cost for medical research to benefit the whole world? Can anyone explain why they think that’s fair?
7
I have to question much of the premise of this article. While "Big Pharma" is an easy, big target for populists on the left and right because they are represented identifiable, "fat cat" companies, the reality is that drug spend represents a little less than 10% of total healthcare costs. And, over recent years, drug costs have remained remarkably stable - even as new, more expensive therapies reach the market, others have gone generic, driving prices down. When a competitive generic market exists, it results in 90+ percent deflation relative to the brand market. While M'care and M'caid do not "negotiate" with pharma companies for the price of covered drugs, their reimbursement rates are driven by metrics from commercial sales and, in the commercial market, the nearly monopolistic 3 buying groups that dominate the US pharma industry have driven commercial prices down. So, the only place for the rubber to really hit the road here would be for M'care and M'caid to determine that they simply won't cover some drugs - unless their is a cost/benefit analysis showing that new drugs are beneficial and a meaningful scientific advancement over drugs that are already generic, they just would not be covered by Medicare or Medicaid.
3
Just a look into the future. The trade off less drugs being brought to market so a broader swath of people may have access to the most popular drugs. Anyone happily insured now can expect to see access curtailed. It is the only way Medicare for all can survive. Force people off private insurance and compel them into the only game in town where they will get less so all can get some.
1
I didn't realize how much a drug can cost until I was recently diagnosed with multiple myeloma. The treatment protocol is well established and a primary medication is Revlamid. My initial prescription for a total of 14 pills cost $2,020! I have Medicare Part D coverage and the cost for the initial prescription took care of the "Donut Hole" in my Part D coverage. The $2,000+ cost was at a discount from the list price of about $9,500, thanks to the price negotiated by the company from whom I purchased the Medicare Part D policy. The subsequent 14 pill prescriptions cost less, "only" about $540 -- that's a three weeks supply.
It is fair to assume that the manufacturer of Revlamid is still making a profit when they're paid "only" $540 instead of $9,500 for 14 pills.
Yes, drug prices are out of hand and "whatever the market will bear" may be best for "enhancing shareholder value" but not for the health (physical and fiscal) of the people who need a high profit margin drug to stay alive.
I support having the government negotiate directly with drug companies to set prices for their products. I'm also in favor of requiring any new drug to prove that it is more effective in treating diseases than an existing, often less expensive, drug.
A stanza from an old spiritual applies: "If living were a thing that money could buy, the rich would live and the poor would die". No one should die because they can't afford a drug with a grossly inflated profit margin.
9
@Pete ... "I'm also in favor of requiring any new drug to prove that it is more effective in treating diseases than an existing, often less expensive, drug."...On the surface this seems to be a good idea, but in reality not so much. For example, there may be three competing drugs for a given disease state. Drug A may work best for 80% of the people; drug be best for 15%, and drug see best for 5%. Obviously drug A is the preferred choice….but not for everyone. What is best often ends up being subjective.
1
There is a little provision in the Constitution that says that Congress shall not adopt any "ex post facto" law, and I would expect that the drug companies would argue and perhaps successfully that adopting this new regime to existing drugs that are still under patents is an ex post facto law and unconstitutional. But that probably doesn't mean that the government can not decide that Medicare or Medicaid will not pay more than a certain amount for existing drugs, and thus decide like the Europeans that it would rather see some people die rather than pay the price demanded. In a free market which is all that has been promised to the drug companies with respect to existing drugs is that the buyer, who may or may not be the consumer, gets to decide whether the price is worth it. So if the government is the buyer it gets to decide whether the price is worth it, and if it decides that it is not, the consumer has to do without or pony up the difference between what the seller is demanding and what the government is willing to pay. And I would think the government could also prohibit the drug companies from selling their drugs for lower prices to Canadians and Europeans for less than they sell them to Americans without running afoul of that little provision. And with regard to future drugs, say drugs that are ten years out, the government can do anything it wants to do, and humanity will probably keep on trucking without American drug companies.
1
This is a long overdue law. Unfortunately, after Pelosi gets this through the House it will become just another body buried in McConnell's legislative graveyard. He won't even allow it to be brought up for vote to protect the Republicans from having to go on the record as voting against their constituents' interests.
Another example of the value of having a lawful option for the citizenry to bring forward their own laws for a vote.
4
@Steve
Assuming the bill is approved by the Democrat majority House and is then buried by McConnell, I hope Speaker Pelosi schedules a second guest slot with Stephen Colbert to tell the public what's going with Grim Reaper McConnell. Public outrage will be very effective come the November 2020 election.
4
Discovery of new drugs, better crop varieties, new technology to solve just any issue or even to invent a new problem that did not exist before only to coerce consumers to use the new technology can only the beneficial to the society/country/world if we make our education system more democratic with a sense of truth and justice. Currently our higher education sector and professionals coming out from such a dysfunctional system are more interested to enrich themselves and gain/maintain the power that comes with it. Systematic destruction of public education including higher education, making it more expensive, provoke corporate executives to worry least about the consequences of their actions so long it pays them more and keep enough money to bribe/lobby to politicians.
If I know that those expensive drugs can only save me or my loved ones for few more weeks but would bankrupt me/him/her, then logically I would not be that interested to save me/him, yet emotionally people tend to do just that. And those pharma companies and their political patrons exploit this weakness.
Consequences are not just in health care which is highly political & in public focus, but equally present in farming, technology, finance, and almost every other sectors.
2
Discovery of new drugs, better crop varieties, new technology to solve just any issue or even to invent a new problem that did not exist before only to coerce consumers to use the new technology can only the beneficial to the society/country/world if we make our education system more democratic with a sense of truth and justice. Currently our higher education sector and professionals coming out from such a dysfunctional system are more interested to enrich themselves and gain/maintain the power that comes with it. Systematic destruction of public education including higher education, making it more expensive, provoke corporate executives to worry least about the consequences of their actions so long it pays them more and keep enough money to bribe/lobby to politicians.
If I know that those expensive drugs can only save me or my loved ones for few more weeks but would bankrupt me/him/her, then logically I would not be that interested to save me/him, yet emotionally people tend to do just that. And those pharma companies and their political patrons exploit this weakness.
Consequences are not just in every sector besides health care which is highly political & in public focus, but equally present in farming, technology, and other sectors as well.
1
Recently, I spent time looking for medigap and prescription drug insurance for 2020 that covered my requirements at a reasonable price.
I have had a prescription drug plan (PDP) for the past six years that was acceptable even though the monthly premiums have doubled in the past six years.
Looking at the monthly insurance premiums for 2020 for this plan, I was surprised and disappointed to see that the monthly premiums for 2020 will increase by 93%, almost double what they were in 2019. I do not understand the large increase given that the drugs I will take in 2020 are the same as the drugs I have taken for at least the last three years.
A 93% price increase is not justified by a higher inflation rate or anything thing else I can think of other than that the cost of the drugs was increased by the pharmaceutical companies and the insurance company is passing the cost increase on to me.
Remember: Some of these pharmaceutical companies (think Perdue, Johnson & Johnson, et al) are the same companies that have made billions of dollars in the last decade or so, selling opioids to millions of Americans and creating a self-sustaining market and the resulting opioid drug crisis.
Until we get the profit motive out of our health care system, citizens of the United States will continue to pay more for less.
This legislation is a good first step to lowering drug prices for American consumers.
11
@NRK
My guess is that it was a company-wide price hike on the plans and you, who use few drugs, are being held responsible for covering those people who use loads of drugs.
I have been buying for years all my prescription drugs in Europe during my yearly visit to my family .
Not only are the drugs 5 to 10 times cheaper , but they come in small boxes from the manufacturing factory , with name and address of the plant , with Braille language for the visually challenged .
Nobody handles and counts manually the pills like in the USA , where I am afraid some human error might happen .
But the real problem in America is that healthcare has been taken hostage, with the strong help from the GOP, by greed in Wall Street.
America , because of greed , has lost its moral compass and doesn’t care anymore about the poor and the sick, and this happens in a country with so many religious zealots.
I have never seen in Europe patients who can’t afford insulin or other life saving medications.
European governments know how to take care of their citizens !
In America we are spending too much money in the last year of life , for treatments that are unnecessary and unhelpful.
The lack of research in antibiotics is serious business, opening the way to major deleterious epidemics.
We have to concentrate our efforts to make prescription drugs accessible and affordable, no matter what !
17
It seems to me that coincidental with the ability of pharmaceutical companies to advertise to patients came the beginning of the rise in prices.
Can you draw a straight line between the number of psoriasis drug commercials on TV with the increase in the price of insulin and asthma drugs? Let’s do away with pharmaceutical advertising to patients and see if it helps, along with the House bill, to lower costs.
6
This is a good first step.
I’m nearly finished reading T.R. Reid’s The Healing of America (a previous NYT bestseller, back around 2010) which is an excellent comparative analysis of health systems in key counties (France, Germany, England,Japan, Canada, among a few others).
All these countries opted for universal coverage, a moral decision according to Reid), AND set prices for both pharmaceuticals and services.
Expect huge push-back by drug companies (thank you Citizens United and current campaign finance laws), but this can be countered by the political will to actually make something happen.
6
Sure, if an exorbitantly priced, miracle drug came along that would cure the disease I have, I'd want it. In fact, since the disease I have was caused by a medication that I didn't need, but that was pushed hard on me, I'd feel justified in asking for the miracle at zero financial cost.
The biggest expenditure on drugs is on those with no proven benefit. We are being massively over-medicated, and since all medications have side effects, we're suffering a huge number of adverse effects for no proven benefit.
The US isn't 43rd among the world's nations in longevity (and dropping) for no reason. Approximately 128,000 Americans die each year as a result of taking medications as prescribed. By far the greatest number of prescription drug-related]deaths occur from drugs that are prescribed properly by physicians and taken as directed. By those who study such things, taking properly prescribed drugs is estimated to be the fourth leading cause of death in the U.S.
So we have those drugs without which we would die, and as far as pricing, the sky's the limit. But more insidiously, we have other drugs that tens of millions of us take year after year: the price may even go down, but as more millions go on the drugs, the profit still goes up.
My drug was one of the later. $17 billion in sales annually; no proof of benefit (given for primary prevention, great lipid ratios, etc); to be taken forever. I was healthy and cost little to the healthcare system. Not now! StatinStories.com
5
"The proposed law would enable the Health and Human Services secretary to negotiate prices directly with drugmakers..."
Hmm.... and exactly who is the HHS secretary?
Why, it's Alex Azar...
From 2012 to 2017, HHS Sec. Alex Azar was President of the U.S. division of Eli Lilly and Company, a major pharmaceutical drug company, and was a member of the board of directors of the Biotechnology Innovation Organization, a pharmaceutical lobby.
Thanks Nancy.
I'm sure he will negotiate a fair price.
6
For whatever it’s worth, Secretary Azar’s proposals, which are serious, have been ignored by both parties and the Congress. Plus, anything from the President? I truly doubt he’s interested in passing anything here, especially a proposal his caucus doesn’t back.
Perhaps we should be striving for half a loaf at a time.
2
Such a timely editorial. Our society has yet to balance the sizable financial risk of new drug development with the concept of reasonable return on investment, e.g.spinal muscular atrophy is a tragic genetic disorder, but charging $2.1 million for a cure beggars the concept of reasonable. Notice that few significant pharmaceutical advances are developed outside the US. Our government must help, but they need to preserve the motivation to innovate. Comparing US drug pricing to the UK or Canada fails to acknowledge that those countries are consumers, not innovators in pharma.
2
The situation as it is cannot go on. What cost $10 is being sold for hundreds or thousands. People are being financial ruined and then dying because they can't afford their medicine. Drug companies spend their time/money/efforts on making "improvements", minor changes to drugs that don't need them to make the drugs more salable or to keep a patent. I say give this bill a chance, pass it.
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@sjs ….For a new drug that costs $10 to put in a bottle; the cost of discovery, development, and clinical trials can easily run a $ billion dollars and more. It will usually take at least 12 years. All that money and time is spent before the drug company sells their first script. Patents only last 20 years and while minor improvements may lead to new patents, they do not extend existing patents.
4
@W.A. Spitzer - And how much of the research was funded by the federal governments, tax breaks, etc and how much relies on the fundamental research the federal government has been funding for decades?
29
@W.A. Spitzer
I respect the cost of R&D as much as anyone.
But I'm supposed to believe that the actual cost of a name brand drug that was created back in the '80s that I'm trying to purchase right now is actually bears a rational relationship to the cost of the development of the drug and that it needs to be as high as it is --right now-- for the company to recoup its development costs?
Really?
Can you explain to me then why the prices fluctuate so often? Can you explain to me how negotiation of drug costs factors in? Explain why pyramethamine--aka Daraprim--, which can be compounded for a dollar, now "costs" thousands and thousands? Also, explain what it was that caused that price jump.
18
Pharmaceutical and biotech companies don’t charge astronomical prices because they need to cover the costs of all their R&D failures. They charge astronomical prices because they can. I wrote about this in a book entitled ‘In Jake’s Company’.
The Orphan Drug Act of 1983 stated that companies that receive the FDA’s first market approval for “orphan drugs,” which treat rare diseases - defined as diseases that affect patient populations of under 200,000 in the U.S. - receive MARKET EXCLUSIVITY for periods of many years beyond the periods of patent protection that non-orphan drugs receive.
This market exclusivity for orphan drugs EXCLUDES ALL COMPETITION, sometimes for decades, from companies that, in the non-orphan drug world, would otherwise rush in with MUCH CHEAPER but equally effective generic copies.
Without any competition for such lengthy periods of time, pharmaceutical and biotech companies greedily take extraordinary advantage of the 1983 Orphan Drug Act, and that is why some “orphan drugs” for rare diseases cost over $1 million per year, to treat a single patient. A 3-drug treatment for cystic fibrosis was just approved, and a year’s treatment will cost $311,000.
Third-party payers (OUR insurance companies) and the government (OUR tax dollars) pick up the tab for the 25 million rare-disease patients in the U.S. who need orphan drugs to live.
For drug companies, the rare-disease market is therefore an unlimited ATM, fed by us - our insurance premiums and taxes.
197
@James Murrow, Novelist Just out of curiosity, if that life-saving, newly approved, cystic fibrosis drug did not exist, what would the next best treatment option for such a patient be?
A second question: how much is a human life worth (and are we collectively willing to pay that price, should needs be)?
11
@James Murrow, Novelist
Instead of simply giving orphan drugs an extended period of protection, why not simply extend patent protection on all new drugs for as long as it takes to recoup a reasonable multiple of actual development costs? A profit generous enough to encourage innovation, but not the grotesquely inflated numbers we are seeing now.
Result: There would be no more orphan drugs. Conversely, drugs used by the most people would be the first to move to generic pricing and affordability.
12
@Neil C. There is nothing else. Over time those patients will get sicker, need a lung transplant (not everyone will get one) ) or die. This drug will add decades to people’s lives. As someone who has lost two family members to CF I am concerned about changes that would affect innovation in the drug industry.
6
Our for profit pharmacology industry is out of control. While we have new multimillion dollar biologic drugs that are out of reach for most consumers, drug companies are creating strategic shortages of old but crucial medications like heparin, a very cheap drug without which open heart surgeries cannot be done. Hospitals across the country have had to postpone cardiac procedures due to heparin shortages. Insulin prices have skyrocketed for no good reason, becoming unaffordable for people who have had decent drug coverage. Let’s tackle the problem of basic, life sustaining medications affordability first before we worry about the big ticket drugs of dubious efficacy that get rushed through the FDA approval process without it being proven that they are actually helpful.
227
@Amy Raffensperger Just what I wanted to say! Let the government create a formulary of the most effective drugs for saving and extending lives and those most prescribed for the common diseases like heart disease and diabetes. Lower and cap the consumer prices of those drugs, or if the government wants to subsidize them, make them free to consumers. No diabetic should ever miss a dose of insulin or ration it because they are short of cash when they need a refill. In the long run, it saves the insurance companies and the government money to prevent complications. Compassion and common sense often go hand in hand.
12
@Amy Raffensperger ...The issues involving the cost of new drugs under patent and the cost of older generic drugs are two rather different subjects; and in fact many of the major pharmas whose names you recognize do not even engage in selling generics.
2
@Amy Raffensperger -- Capitalism means never having to say you're sorry.
It's nothing personal --
it's just Business.
11
I recently watched a commercial for a drug designed to treat chronological disorientation in patients who are totally blind. That drug obviously might be of use to a tiny fraction of the national audience of that commercial, and of course those individuals could not buy it directly but only ask their specialist physicians.
What must the markup of that medication be to justify to the pharmacology company the cost of that advertisement?
Such advertisements to consumers are outlawed in virtually all other advanced nations, as was the case for many decades here. Advertisements are by definition biased; if the product is a laundry soap, buyer beware. If it is a medication this bias is obviously inappropriate.
We should reinstate the ban on such advertising. Among other benefits I wouldn’t have to spend my television time watching amazingly healthy appearing people frolicking with their rheumatoid arthritis or cancer.
11
@Richard Williams MD Yes, please ban all drug advertising on TV the sooner the better and use the money for drug development.
1
The board is right: the ability of drug makers to price uncompetitively has led them to spend more time developing "me too" or lifestyle medications over much-needed new antibiotics or heart meds taken by lower-income patients covered by Medicaid that controls prices.
Does the world really need yet another rheumatoid arthritis psoriasis drug or late-stage oncology treatment that might give a patient a few more days?
TV drug advertising was one of the worst decisions ever made by the FDA, at the insistence of big pharma. I used to work in drug marketing and the ability to market direct to patients (which annoys physicians) was seen as the holy grail of creating patient desire, not "disease awarenes."
As for why the US pays the highest drug costs, it's simple: because the rest of the world won't, insisting on national budgets based on cost-benefit studies. With unlimited lobbying of Congress, is it any wonder prices stay sky high?
340
@ChristineMcM ....we need editorials, columnists and TV pundits to discuss just what you say.
Only in New Zealand and the U.S. is direct-to-consumer pharmaceutical advertising completely legal ... per Wiki and per Harvard Health, etc.
Other countries ban the drug ads that swamp American media 24/7. They think that drugs are a matter between doctor and patient, not to be marketed to customers like any consumer product. That shows a huge difference in attitude to profits and citizens' rights.
Amerians are subjected to several drug commercials every hour on most TV channels, increased from past years. They use quite elaborate productions and casts of characters to manipulate viewers.
The Times must make the explicit connection to our campaign financing, esp post Citizens United, when the Court removed any limits on mega donor financing of our candidates.
This effectively muffled the voice of average citizens. Most Americans want campaign finance reform, lower drug prices with regulation, universal health care and stronger gun laws. They want safety and protection.
But American voters don't have much clout---the corporate donors have big clout and super organization. Our voters can't compete to get what's common in most other democracies. We can only stand in long lines to vote for what we're offered.
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@ChristineMcM
So, prioritize the health of lower income Americans over the health of those who have good insurance and drug access? No thanks...I have no interest in reducing my healthcare to benefit the poor. I also don’t care if a cancer drug only adds a few weeks of life if it is my life you are talking about.
7
@ChristineMcM Many drugs are shown to have no benefit and are not effective yet the FDA keeps approving them for Big Pharma to make more money. The FDA is broken and needs repair when glass, bacteria and other contaminants end up in our drugs rushed to market.
https://www.thedailybeast.com/fda-keeps-brand-name-drugs-on-a-fast-path-to-market-despite-manufacturing-concerns?ref=home
9
Many new drugs are not significant improvements in therapy over existing ones. They merely represent another "me too" addition to a class of agents that are virtually indistinguishable from each other in terms of safety and efficacy. True breakthrough agents will still be developed and marketed by the industry.
In the absence of manufacturers offering U.S. consumers the same prices they charge elsewhere, we have little option but to demand they at least negotiate their prices. The alternative is for the U.S. to continue to subsidize new drug development for the rest of the planet, and that is neither fair nor sustainable.
1
Drug companies have no business being marketing companies they have morphed into. CEO should not be making 40 million dollars a year. They use the same garbage about potential risk as the tobacco industry . If we prohibit smoking indoors people will stop shopping! Well that never happened.
it is time the country votes in its own interest rather than swallowing the bitter pill that Lobbying Companies in the pay of drug companies force it to take.
3
The money is there for R&D. It is just used for legerdemain like stock buybacks. As for the Senate, a useless political body, created by the Slavers and Enablers Club of 1787. Get rid of it. Make it like the House of Lords. Hey let them even inherit their seat. Let them advise. Let them bribe industry. Just get them out of the decision making process. As for pharma, we do cost benefit analysis all the time. Doing cost benefit on drugs seems to be rational. Trust me, those pharma companies do it on your life.
1
Medicare imposes price controls on hospital services. The amount that Medicare pays hospitals far exceeds what countries with socialized medicine for comparable services. But the hospitals argue that the Medicare reimbursement rates are below their cost of care and so increase what they charge to the insurers covering the rest of their patients.
Why would imposing price controls on the price Medicare pays for prescription drugs not result in cost shifting to everyone else?
Here is a better idea. Insist that Medicare part A [hospital] and part B [outpatient] providers pass along all discounts on drug, supplies and services to consumers and government payers. It is already true that Medicare part D insurers [prescription drug coverage] are not required to cover all drug treatments and are free to set co-pays to discourage the use of overpriced drugs. Individuals who use high cost drugs pay higher premiums to buy down co-pays. Individuals who are users of low cost prescription drugs buy less expensive policies.
The reason the bill is unlikely to pass in a Republican Senate is because although it might very well save the federal government billions of dollars, those same dollars will be cost shifted to the middle class.
The Pelosi House wants to reduce the amount of money hospitals have to pay for drugs, so hospitals can increase executive salaries. They pretend that they are going to take the money away from drug companies.
2
The push to control drugs cost is necessary. The issue of losing a few potential drugs may not be so costly if those drugs are me-too or the benefits are marginal v current standard of care.
But why isn’t the NYT focusing 80% of its push to control costs by focusing on the approximately 80% of billings, that attributed to hospital and medical costs? Has no one on the editorial board looked at how hospital systems are billing patients and payers? Notice the facility charges? Those with commercial insurance aren’t getting swamped financially by drug out of pocket costs, it’s the co-pays, deductibles, facility charges, etc.
Please widen your sights
1
This is a horribly-poorly written editorial. It is full of horrible assumptions and a total lack of understanding of how pricing, distribution and consumption works in the market. Almost 90% prescriptions written in the US are for generics. The margin in generics for the pharma industry is very thin. Producers routinely have shortages as they leave the business. Most of our generics are manufactured in India and China. The chain drug stores make more margin off generics by far than they do for patented drugs. If you are looking for impact on price start there. Second PBMS (Pharmaceutical Benefit Managers) receive a discount of 30-40% on branded patented drugs and do not pass this along to the consumer. You have a disproportionate care program (DSH) for hospitals and hospital systems which receives a 50% discount from the pharma industry. Federal law requires that pharma companies provide state Medicaid programs this discount and make Disproportionate Share Hospital (DSH) payments to qualifying hospitals that serve a large number of Medicaid and uninsured individuals. Once again the discounts are not passed along by the hospital system to patients but kept as profits. Our VA system receives discounts in the range of 40%. IF you really want to impact price have the federal government and the FDA write better biosimilar rules which allows a quicker development path to create competition in the specialty drug markets.
3
The pharmaceutical industry is indicative of a market driven healthcare system in which the sick are merely seen as a profit center. You want to know why prescription drug prices are so high? It's because that's what the market of sick people will pay (if they can).
2
I believe it was in 2016 that Pres. Obama kicked off the PMI (precision medicine initiative) through the NIH. A genetic understanding of disease would now lead toward personal health.
Later, Novartis priced Zolgensma for $2.1 M - now we realize where the PMI is leading. To the rich.
3
When a common anti-cancer drug is in short supply because it's generic and there's only one manufacturer every cancer patient in need of that drug suffers no matter how cheap it is. The truth is that many of the "new" drugs are older drugs on steroids. All that's been done is a small change in the formulation to keep it on a patent for longer. Some older drugs which worked quite well have been superseded by new ones that carry greater risks. Pharmaceutical companies don't want to admit to that.
In truth they spend far more money on market research than they do on pharmaceutical research. The ads on television or in magazines or online show "healthy" patients and that's extremely misleading. But they want patients to demand the latest and greatest from their physicians regardless of the cost. The opioid crisis can be laid squarely on the shoulders of the pharmaceutical industry.
Drugs like antibiotics are overprescribed. So too are psychiatric medications. But the worst thing of all is needing a drug to survive while being unable to afford it because one's insurance won't cover it or it's too expensive even with a co-pay, or one doesn't have insurance. Yes, insulin.
Innovative drugs or run of the mill drugs are useless if we cannot afford them and the associated care. We do not have the best health care in the world. What we have is a fragmented system that hurts patients and their families.
11/2/2019 10:18pm first submit
3
Only in New Zealand and the U.S. is direct-to-consumer pharmaceutical advertising completely legal ... per Wiki and per Harvard Health, etc.
Other countries ban the drug ads that swamp American media 24/7. They think that drugs are a matter between doctor and patient, not to be marketed to customers like any other consumer product.
Amerians are subjected to several drug commercials every hour on most TV channels, increased from past years. They use quite elaborate productions and casts of characters to manipulate viewers.
Other capitaliast countries' attitudes to the rights of their citizens are shown by their generations of universal affordable health care, that we still achieve.
They also have strong gun laws, thus greater citizen safety. They don't let a for profit gun maker NRA type lobby subsidize politicans, to set norms for gun laws, endangering their populations.
Their candidates don't depend on corporate mega donors to finance campaigns, forcing their parties must compete for big money. Can that be the next NYT editorial board column? Make the explicit connection.
1
How many hundreds of millions of dollars spent on drug advertisements every year could instead be funding research?
This entire story can be summarized as " If things were different in the drug industry then they won't be the same"
Thanks NYT for the insights!
1
Just ban the drug commercials. It is such a relief to not watch them. Tell your doctor (ha).
2
Unfortunately, dream on. This bill will never be allowed to see the light of day.
1
It seems wildly delusional to me to expect Alex Azar, or any HHS Secretary appointed by a Republican president, to negotiate affordable drug prices. And if the HHS Secretary has been appointed by a Democratic president, I wouldn´t expect much either. The drug companies have too much money to lobby with and politicians are too dependent on it.
The only way to lower prescription drug prices is if we replace the current for profit insurance providers with single payer, universal coverage so that we can more directly negotiate and set prices. The difference between what many drugs cost to manufacture and what we are charged for them is outrageous and immoral.
We´ve been sold a fantasy that market forces will bring down health care costs -- for how long now? How long have we been hearing that? And all the while, costs go up and up and up. When are we going to admit that it hasn´t worked? This crazy complicated, deceptive, cherry picking, rapacious private insurance based system is not working. Tinkering with it isn´t working and people are dying, their health is at stake, they´re losing everything just to pay medical bills. It´s wildly unrealistic to think we can fix this system. But there are other options that do work, and they´re not radical at all; they´re rational. Single payer works in other countries and if others can make it work, so can we. It´s the only way we´ll ever be able to get drug prices under control
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@JJ
The answer is simple: we need publicly funded elections to get special interest money out of politics. Is there any wonder why we Americans distrust the current system of shady political campaign "donations" coming from Political Action Committees? These donations are nothing but political bribes to make sure that the current status quo is kept in place. Disgusting.
7
Britain is significantly poorer than the US, making it inappropriate for a pricing benchmark unless the goal is to slow the development of new drugs by continually cutting their cost in the US and then again, as a result, in Britain. Switzerland and Norway should be in a basket together with Canada and Australia to capture what's affordable for the US.
1
I have noticed personally and professionally that many "new" drugs are cocktails of exisitng ones, which then get new patents and new pricing. It takes several years to get them onto an insurers formulary and then their copays are extortionate. It is a symptom of systemic disfunction that these drugs, and many long-existing drugs - are an order=of-magnitude less expensive with a coupon than with my expensive Medicare prescription drug plan. Further, contrary to the assertion in the article "most" drugs aren't covered. A most common senior surgery is for cataracts - and the two peri-surgical drops prescribed by the local surgeons are not on one single Medicare plan formulary available in Southesatern Michigan. Again, I got mine without paying hundreds of dollars because a pharmacist took pity on me and looked for coupons.
2
More complicated than the editorial indicates, look no farther than private equity and hedge fund spending countless billions buying up the rights to and the manufacturers of generic medications, then jacking up the prices. Goes on here and in Europe. Private equity is now going after the rights of drugs in current development. It takes steep price increases to support the PE partners greed and lifestyles as billionaires, and their investor's expectations on outsized ROI. Both political parties protect the toxic and destructive behavior of the private equity industry. Consider that more carefully at the next national election
Increasing costs for both generic and newly developed drugs are unsustainable. There needs to be transparency on drug costs, both generic, patent protected drugs, and those in development. The US government should be able to negotiate the costs for the benefit of us while ensuring there is sufficient incentive for pharma to take risks on developing new drugs. And get private equity out of the equation now.
1
Medicare's inability to negotiate drug prices was the big slurpy kiss given by Republicans (mainly) and the W. Bush administration to the drug industry, over 15 years ago, when Part D was created. That needs to be changed--bigly, as the Current Occupant might say.
Here's another way to limit drug prices: severe price controls on any drug whose development partook of tax money. It's obscene for the public to pay taxes toward drug research grants, after which the corporations that got the grants are then allowed to gouge the public on drug prices.
Congress could also end all programs which in any way promote the meat, tobacco, alcohol, and chemical-based agribusiness industries, whose products are known to produce expensive diseases.
Stringent environmental protections must also be a "macro" part of any arrangement which actually seeks to produce "health," rather than just treat disease already in progress. Of course, the Current Occupant and his henchpeople are doing exactly the opposite.
And none of the above will fully solve the problem that, in a neoliberal "market-based" system, people who can't afford treatment don't represent economic "demand," no matter how desperately ill they may be, just as people who can't afford good-quality food don't represent economic "demand," no matter how ill-nourished they may be. Therefore, any program which addresses medical costs but not income inequality and suppressed wages is, as the saying goes, "necessary but not sufficient."
1
As soon as Americans are willing to stop demanding better healthcare than any other country in the world, and stop expecting someone else to pay for it (while they happily take on debt and line up for hours for the latest IPhone), then we can have a conversation about pricing drugs and medical procedures.
7
Just read a few comments. None that I read are both unconflicted and educated. Many are simply naive, trying to project personal experience on a complex ecosystem that is probably considerably bigger than the U.S. military in its scale, scope, costs and corruption.
Honestly, regulation has been shown again and again to improve innovation and thereby stimulate real competition, not limit it. The entrenched fight regulation. The innovators embrace it. This is why the FDA has had any success at all in promoting new drugs. By serving as gate-keepers, they allow companies to have exclusivity at the cost of only selling safe and effective medications. Now, we just need to add cost controls, which has not been in the FDA charter.
Given the current winner take all system, far too many of the newly approved drugs are simply "me too" agents, neither directed at new targets nor even fundamentally new molecules. Many are the result of disingenuous efforts to overcome the threat of generic competition by coming up with incremental advances. We need truly new drugs. Not new, more expensive solutions for solved problems.
9
@Steve, your comment implies that you, unlike other commentators, have an intimate knowledge of this industry. If this were true, you wouldn’t misrepresent FDA’s role in stimulating innovation. By serving as a marketing gatekeeper, and imposing requirements for data to support marketing authorization, the FDA actually pushes innovation into the sectors who serve the smallest numbers of people: oncology and rare disease, where data requirements and clinical trial programs (thus development and marketing costs) are much smaller, and where ironically payers (and NYT editors!!) don’t balk at huge price tags. FDA has done nothing to stimulate innovation in infection disease or mental health, for example, where massive clinical trial programs of tens of thousands of patients (v. 100 or less for some cancers and rare disease) are required for approval. Please don’t criticize other’s comments when you, yourself, don’t seem to fully understand the complexity of this industry.
2
Pharma spends more on advertising than product development. And most new drugs in development come from government-funded research, it lharm?
End to-consumer pharma advertising.
Put price controls on pharma drugs.
This bill is a great idea.
3
While I agree there are a few examples of pharmaceutical companies price gauging, how does that differ from other types of business in America? I have no problem with reasonable regulations, including on prices. But if investors do not get a return on investment, they do not invest. Like so many industries already have, pharma R&D will move to China, Japan, and India. The jobs will go with them, and another great American industry will disappear. The main reason we pay so much for new drugs, aside from the high R&D cost (driven largely by the need for large clinical trials to get FDA approval), is that investments must be recovered before patents expire, and most trial drugs fail, so the cost of failed experimental drugs need to be recouped in the few that are successful.
3
@William Meyers
1- No. One of the main reasons we pay so much is that big pharma now spends more on advertising than R&D.
This is easily googled, and the facts come from the companies themselves.
2- Can you tell us how much "return" on investment is too much? Frankly, I would welcome the Japanese approach to "return on investment", CEO salaries and their ban on drug advertising.
5
Innovative drugs are created by pharmaceutical companies to make profits for their shareholders, not save lives. It's called capitalism. When a government uses its finite pharmaceutical budget to maximise the overall benefit to the population as a whole, that's called socialism.
5
@Abraham
If "socialism" gets more care to more people at lower cost, give me socialism.
A healthcare system based solely on profit, as opposed to saving lives, is barbaric.
And that's exactly what my Canadian in-laws call our "system". I note that you prefer ideologic purity over
what works. Which is very Soviet of you.
@Abraham
Socialism results in the government selecting winners and losers, ostensively for the common good. In reality, the cronies win at the expense of the people. The proposed law reduces the price hospitals pay for drugs at the expense of drug manufacturers. Drug manufacturers will cost shift the lost profits to the rest of consumers.
The middle class pays for everything.
Sure, innovative medicines and treatments come from universities or the government, or are simply imported...
How naive are you?
Drug costs make up a total of ca. 15% of medical treatment. Thus, the bulk of the costs come from other sources, doctors and hospitals etc. The NYT had many articles about the inefficiencies of the US health system causing much of the excessive costs.
Yes, there are extremely expensive drugs out there, and in some cases this is a problem which needs a solution. And every new cancer treatment initially looks at a couple of months additional life time before there is eventually enough data to show (or disprove) longer term benefits.
If you want to restrict yourselves from the most innovative treatments, also for new ailments like Ebola or Malaria making their way into the country with climate change, go for it.
Rather than cultivating the hatred against medical R&D the NYT might want to analyze the root cause of the ultra-high medical costs in the US and search for some root fixes.
By the way, the off-the-cuff comparison to other countries I see in some comments is often even comical. The UK or French system?
Try to get an MRI or an appointment with a specialist: Waiting times in the months are quite common, if you have cancer or you suffer from cardiac issues this can mean the difference between life and death. Of course you can get high-quality treatment fast, you just have to pay this out of pocket.
8
@LL Just had two visitors from England here...at the same time the insurance company denied my son's medication that keeps him out of the ER, one he's been on for four years. Both of them were quite happy with universal care, and both said the agony I was going through would never happen in England. Enough of the fear mongering.
17
@Kathy
No fear mongering here, I live next door to the countries.
Are there examples of good treatment in these countires? Of course there are.
But there are many other examples as well.
A colleague of mine needed an MRI after there was a suspected stroke for her mother. Didn't happen, maybe because the doctor didn't see the urgency, or because of cost issue.
The MRI was done out of pocket at a private hospital to show an aneurysm (enlarged blood vessel) that required surgery and is extremely dangerous.
Another colleagues from the UK needed surgery to fix a ripped ligament in his ankle. Next appointment 2 months away, he was asked to take pain killers during this time.
He resorted to a private hospital to get the treatment he needed.
If you don't have more data (I came from another European country and work in an international company in Switzerland) it is misleading to extrapolate from single examples.
Also read e.g. The Guardian about the dire situation of the UK NHS health system, this should be an eye opener.
2
@LL All the stats I've ever seen say that we pay on average about twice what other industrialized nations pay for healthcare, and have far lower outcomes as measured by mortality and other factors. ALL OF THE STATS.
3
How did the United States end up being responsible for supporting all the drug research for the world? If there were restrictions on drug prices, in the United States, drug companies would develop other steams of revenue to fund development of new drugs or end up going out of business. Some of the biggest abusers of predatory pricing are companies that produce generic drugs, who spend nothing on R&D for new medications. That all development on drugs would stop if the government got involved in setting drug prices is the biggest myth in the United States today.
3
@KD Terminal patients are not allowed to die anymore. The longer they are kept alive the more money the hospital corporations and pharmacy industries make. That's why hospice and palliative care are rarely mentioned and social workers don't educate patients and their families about the importance of a living will or guide them through the process.
4
@KD Actually, generic drugs do have to be approved by the FDA, and that does cost money, if nowhere near as much as developing a new drug from concept, through preclinical and clinical trials. Biosimilars, the generic equivalents for large molecules like insulin and antibodies, actually cost a great deal of money to get to market, a process that can take years.
1
@Ellen F. Dobson
I was diagnosed with stage 4 lung cancer 7 years ago. I was never a smoker and my cancer was a mutation that only 3% to 5% of lung cancer patients have. I have been on a check point inhibitor since I was diagnosed. Based on your comment I would have been considered terminal and let to die. Not sure my family, friends or me for that matter was willing to accept that faith.
5
Let's get a few things straight. Drugs only prolong life: it ends at some point in time.
Prolonging life for three months at a cost of more than 50K may be of less benefit to a person/family than a 50K payment for forgoing the meds might be. Yes, pay people to refuse ridiculously expensive treatment. There can be a ridiculous amount of expensive medical care during the last six months of life-- well known fact! and the person receiving the care may suffer or have no benefit.
How many different anti-coagulants do we need. Eliquis, Xarelto, Pradaxa are roughly the same and for knee surgery, my MD prefers aspirin. Will my brother outlive me (Diabetes 2 and somewhat elevated LDL) with his LDL below 50 and his hypertension? A,h the race to the end.
On my 2000 units a day of Metformin I can pay a lot more for a time-released1000 mg pill or go with four 500 mgs. also time released. And none of those once a week helpers. Thus far nothing for the bones (Osteoporosis diagnosed 15 years ago. Very careful not to fall, lest I damage my artificial knees!!)
Won't Medicare for all be interesting. (Will there be a free market allowed for replacement organs? Apparently kidney replacement costs less than dialysis at almost 100K per annum?
Essays like these are designed to
a) Scare the public?
b) Support the predatory capitalism where dividends are the only thing that matters?
c) Prevent current Medicare from negotiating drug prices?
d) Start a discussion?
3
If 8-15 fewer drugs are projected to *reach* market over the next decade, then hundreds of fewer drugs will be developed over the next decade. Pharma operates (by necessity) on a log-normal model: for every drug that reaches market, 10s~100 do not for a variety of reasons, some scientific/medical, some business-related. Better guesses are outside the scope of an internet comment. And it’s true, many of these drugs aren’t NMEs or first-in-class, but best-in-class and follow-ones do help to pressure drug costs down (take HepC treatments as an example).
All this to say, if this bill or something like this passes, R&D for the drug industry will recede significantly and is likely to disproportionally impact the smaller, innovative pharma companies much more since they directly carry out much of the development work. I don’t know what we do with the scientists and engineers who would be out of jobs, but pharma is a niche skill set and I don’t see these workers reskilling to install solar panels or write web apps. I think the bill authors or the NYT editorial board should share their thoughts on the jobs issue.
Drug costs are too expensive in the US, but it’s like higher ed: don’t be fooled by list prices. Compare actual transaction prices to other countries, and yes, we so pay more, but it’s in line with our other healthcare costs (we pay more across the board). This bill is not a magic pill that fixes healthcare costs because drug pricing is far from the sole problem.
5
In Britain there is a charge imposed on each prescribed drug when the recipient is employed. It amounts to about $9 for a two month supply.
3
At the moment the drug cartel has total control over drug availability and prices, not just patented drugs but generics as well. We need Medicare (the US government program, not the insurance cartel that is trying to steal it) to fight for us.
3
The editorial board is generally correct that the best option to curb drug prices is to adopt international reference pricing. Rather than focus on just price, the US should consider adopting the same general principles used in the UK, Canada and Australia that allows only new medicines to come to the market that have better efficacy than the standard of care offered by an existing drug on the market. In addition those governments negotiate directly with the manufacturer to get the best price possible. Other countries like Japan automatically lower the price of a new drug every two years assuming we shouldn’t have to pay for innovation that is no longer new.
4
"Support for the same ideas shrank when respondents were told that research and development would be imperiled as a result of these changes."
Perhaps we can change that to "might be imperiled" since (unfortunately, not addressed here) that does not have to be the case. We can do better.
2
Another element not mentioned:
When I was researching my own cancer treatments that are in testing, I was shocked at the amount of duplication. Minor variations were responsible. Each of those companies needs to find ways to pay for that research and testing. They do it by charging outrageous amounts on the drugs that make it to market. The only player that can prevent this abuse is the Federal Government. We need coordination at the top.
Perhaps this legislation, if passed, would reduce this duplication of effort, but it would not eliminate it as long as the drug companies can subsidize their outrageous duplication of research and testing with the returns on their few, successful drugs.
7
When you say Medicare covers drugs…I'm on Medicare. I've also been prescribed a medication where the copay is over $1000 a month. I suppose that's coverage, in that I am permitted to receive that drug, but how many people can afford to actually pay for it?
17
@Blonde Guy Not sure of your circumstance, I have a drug for my cancer that is ~ $11,000 per month. It is covered. Perhaps there is more to the story, like, the drug is not shown to be effective?
4
My expensive for profit insurance company reclassified my chemo to “specialty drug” which they don’t cover. No advanced warning. I just received the bill. Like so many other Americans my retirement savings took a hit. Only in the USA.
4
One small thing to help in the US: bring back the ban on drug advertising. Said ban was lifted, when, say in the 1980’s? Not sure. But then we started seeing the ads stream forth: couples in bathtubs perched cliffside overlooking the ocean sunset, et.al. And henceforth the dollars in advertising, and patients rushing to their doctor because a targeted ad triggered their need. Of course, spending big on direct payments to doctors always was happening and needs to stop too.
21
@Ross Jory
Honorariums and first class trips to exotic locales also worked wonders with doctors only too happy to " try " new drugs.
Just look how popular Ritalin became. So many children " diagnosed" and treated with it. Particularly in the South. Moms enjoyed the pick me up too.
The benefits to pharma, doctors and parents has been incalculable. To kids - not so much. I'll bet most never received it.
10
@Ross Jory
Indeed. This Pro-publica piece has advertising costs in 2016 at $26 billiong/yr. It makes the case that the cost of the ads is driving the increase in prices. See
https://qz.com/1517909/big-pharma-spent-an-additional-9-8-billion-on-marketing-in-the-past-20-years-it-worked/
1
So you are telling me that a drug that can, in the future, save my life won’t be produced because Mr. and Ms. Obese American can’t pay for the insulin for their self-inflicted diabetes? Sure, let’s just kill innovation in the service of equality. Let’s stop medical progress because it’s not fair that some people have money and some don’t; some take care of their health and some don’t. If you want to understand why socialism never works, this is a case in point. It’s true that a universal healthcare system cannot cover everything but this is why you have supplementary health insurance. In Europe, no country system covers all possible drugs but people with sufficient money can pay for innovative treatments, mostly developed - where else? - in the US. If the US cannot develop a rational balance between progress and basic coverage for everyone, I want progress, even if it means some people cannot afford their drugs.
10
@Mor Woah. You are missing the point. Consider the recently developed drug for Cystic Fibrosis. It costs $330,000 per year! How is that possible? Simply, the drug companies are extorting us. How? In part because they participate in many, many duplicative efforts in which they expect a low return. The high prices on the drugs they can extort for make up for that poor investment. Time to eliminate advertising, and any form of doctor incentives. Moreover, the Federal government has to coordinate the research efforts to avoid wasteful duplication.
21
It’s working very well in Europe. Read the article, research is not being done where it’s needed. Many new drugs are unneeded. Our doctors tell us the old ones are just as good.
7
How is it possible? It's possible because it's been a work in progress for decades. It's worth it because a friend with two daughters that have the disease are still alive when they should have died 15 years age. Who is anyone to judge?
4
Perhaps we should nationalize the drug industry, make government researchers responsible for all pharmaceutical development and price drugs to fund that development - but no advertising.
14
@J. Waddell
Perhaps we should nationalize the K-12 education system. That worked out so well.
2
You would agree that the USA is not “the greatest” since other first world nations are able to provide first rate public education and university education as well as free health care for all and modern public transit. USA is just not great.
2
@J. Waddell Here's an interesting dialogue from the other day about this very issue:
https://www.nytimes.com/2019/11/01/opinion/did-warren-pass-the-medicare-test-i-think-so.html#commentsContainer&permid=103441061:103442016
Biopharma companies do little to innovate. Drug breakthroughs mainly come from public hospitals and universities. Drug industry spends very little on R&D compared to what they spend on marketing and lobbying.
49
@Lenny-t And on the bribes, sorry, user fees they pay to the FDA for exclusive marketing arrangements. Competition does not work with drugs because the drug cartel selects only one generic manufacturer (usually Mylan) to make each generic drug.
18
And how about corporate socialism?
Drug Industry making deals with govt to limit price competition?
Oil and gas subsidized to the tune of billions a year?
Farmers subsidized in the last two years more than what Obama used to bail out auto industry after financial crisis?
So your ok socialism for corporations but not the person working three jobs?
9
@Lenny-t ... "Drug breakthroughs mainly come from public hospitals and universities."....I worked in research for a major pharma for 30 years. In that capacity there was opportunity to interact with research from public hospitals and universities. While ideas and concepts may originate from public sources, the vast majority of drug breakthroughs come from the drug companies. Further, their R&D spending is very significant. The corporation I worked for employed on the order of 500 Ph.D. level scientists. You do the math.
3
As others have mentioned, the obscene amount of advertising needs to be curtailed. If you dont trust your doctor to have the knowledge of diseases and medications, it is time to find another doctor. Enough of the direct-to-consumer advertising
44
@tim
One hilarious bit of advertising I've just seen is for a men's comdition called PD.
It seems that some men as the age see shape changes that horrifies them.
A certain appendage becomes curved.
The commercial shows dozens of pics of curved cucumbers and bananas.
WOW. LOL
3
Innovative drugs only save lives if they exist. Drug companies have shown that they're only interested in developing such drugs if they think that they can make a killing on them. There needs to be a major public program for developing pharmaceutical products based primarily on medical criteria.
13
@Stephen Merritt
There is. It is called the NIH. It hasn't been very successful in drug development.
2
@Froat
Nowhere in the NIH mission statement do I see drug development as their primary function. Research grants, education programs, and data collection yes. Drug development, no.
https://www.nih.gov/about-nih/what-we-do/nih-almanac/national-cancer-institute-nci
Remember George W. Bush's Medicare Part D 'agreement' with Big Pharma, that the federal government could not bargain for better (lower) prices? This tells you how powerful the Drug Lobby is, and how cheap our politicians are willing to sell themselves for. At the cost of less 'potentially transformational medications via R and D', affordability is an urgent matter now...hence, worth pursuing. How about a bit more Ethics...and a bit less Greed? How about some basic decency, and solidarity, towards the least among us? And strive towards a stronger democracy by cutting down the current gross inequities of out capitalistic system? As they say, 'no chain can be stronger than it's weaker link'.
15
The problem is that Americans can’t afford their medicines. And they can’t afford to live on low wage jobs. Too much suffering in the USA.
I always wondered why drug companies feel the need to spend millions of dollars in advertisements. Do people really watch these ads listing all the potential side effects including suicide, hallucinations, panic attacks. exploding heart & other horrific ailments & then think, oh yes this is the drug for me? Then immediately make an appointment with their doctor to ask to be prescribed same drug. Or do the advertisements create a familiarity with certain drugs allowing them to go mainstream similar to the medical community & public's general embrace of opiates & eventual devastation of whole swaths of the American landscape?
It seems reasonable for the federal government to negotiate with their research funding for certain drugs while still in the incubation stage. For instance, I doubt that Jonas Salk invented a vaccine to cure polio based on whether or not it would create a profit in the future. True medical researchers have higher aspirations when devoting their careers in search of cures for diseases than the eventual price of the stock & whether Medicare will negotiate the pricing.
19
"Support for the same ideas shrank when respondents were told that research and development would be imperiled as a result of these changes."
My pharmacist tells me that the government funds over half of all pharmaceutical R&D in our country. Then Bayh-Dole Act, which gives the patents on such socialist drugs to the pharmaceutical company involved.
So the public pays twice. First, when we pay for the R&D. Second, when we pay a monopoly price for said drugs.
Thus, claims that allowing Medicare to negotiate drug prices will devastate innovation are devastatingly false.
19
Medicare covers drugs without concern for price? Not a single private insurance plan does that. Maybe prices are high because pharmaceutical companies know the government will pay.
8
It seems that most of the ads on TV are for wildly expensive biologics to treat auto immune diseases. It seems to me that much of the money spent on drug development might be better spen trying to figure out the causes of these diseases and how to prevent them. Our medical system thrives on treating symptoms, not on eliminating causes.
19
@BA That is where the money is, treating symptoms not making people healthier.
If a fraction of the amount spent on new and existing medications could be found for preventive programs, and for countering the marketing onslaught from the food and beverage industry and the pharmaceutical industry, overall health in America would get a boost. While this would not solve the current dilemma for those who must take medications regardless of price, it could help others reduce their need for medications or get off them.
4
It's about time for some lines to be drawn on pharma pricing practices. Pharma has been hiding too long behind several big lies. Medicare should be free to negotiate prices.
The biggest lie is "We won't be able to innovate." Pharma is not very effective at innovating as it is and they waste a lot of money in futile efforts and marketing gimmickry. Recent strategy has shifted to gobbling up smaller, more innovative companies who DO innovate.
Second, making healthy profits instead of obscene profits will still allow the industry to do quite well AND not force the American consumer to subsidize lower pricing elsewhere in the world.
11
This reminds me of the commercial I've been hearing lately on "commercial-free" National Public Radio, from the pharmaceutical companies' trade group. Paraphrasing, "We are committed to keeping drugs affordable, as long as that does not interfere with funding needed research on new drugs."
If only! It would be more accurate to say, "as long as it does not lower our obscene profits, which we desperately need, because our addiction to greed is out of control, and we have no drug for that illness."
It is more than time for government intervention. Capitalism is great. But, thanks to the Republicans, we are daily reminded of the train-wreck that is unregulated capitalism.
Don't believe the defenders of all-out greed when they falsely equate sensible regulation with communism.
86
@Richard Waugaman, M.D.
I noticed that too. NPR doesn't run "ads". What it runs is pure corporate propaganda infomercials.
4
@Richard Waugaman, M.D.
"the train-wreck that is unregulated capitalism" Amen to that.
6
What so many people fail to realize is that a great deal of R and D is paid for with government research grants, and not by the companies themselves. They get the research funded no strings attached and are free to reap all the profits. That also needs to change. If the taxpayers are funding R and D, they should be getting something in return other than the privilege of spending a fortune if they ever need it.
45
@Scott …"What so many people fail to realize is that a great deal of R and D is paid for with government research grants." This is false. To begin, you have to understand the difference between basic and applied research. Both are essential for the discovery of new drugs, but they cannot be substituted for each other. Most government grants support basic research. Pharmaceutical companies engage in applied research. Basic research supplies concepts and ideas. Applied research takes those concepts and ideas and converts them into reality.
4
@Scott Also many of the big Pharma companies have greatly reduced their R&D employees. Rather they follow the work of small entrepreneurial companies that are doing drug discovery, and when it seems they have a discovery buy them out. Big pharma is a scam.
4
Give Big Pharma a gift. Medicare negotiates drugs and pricing, and all the pharma companies get a ban on advertising. It lessens the competition, and frees up lots of money for R&D. Win-win.
25
@Barbara Lee
But if ads are banned, what happen to all those healthy, smiling, young-looking senior actors we see in all the drug ads?
13
It's fine until you realize that there are people whose lives will be saved or dramatically improved by those new drugs. We're not simply trading savings for fewer new drugs, we're trading for fewer people benefiting in meaningful ways including an unknown number dying. We could save lots by refusing the elderly expensive therapies, but should we?
5
@SM life is about choices, unfortunately. Individual life and the life of the society. Drugs which can change lives of a lot of people will still be developed, because they will be profitable regardless. Drugs that affect very few people may be abandoned. The work on such drugs could be continued by the government, through NIH grants to academia. It may also be necessary for the government to take over the urgently needed R&D for drugs that Pharma does not want to work on, like new antibiotics.
8
@SM Yes, we should save lots by refusing expensive therapies to the elderly that DON'T WORK. If a therapy is not improving, and in many cases is reducing quality of life, it shouldn't be offered.
2
Republicans like the free-market until they don't.
Walmart negotiates low prices from suppliers because of the volume it buys.
But we don't want the same buying power used by the government for the good of us.
Another thing W Bush will be remembered for. The unfunded prescription drug benefit that also prohibited the government to negotiate prices.
19
As a chemist who spent the bulk of my career dealing with the pharmaceutical industry, I can say emphatically that this bill is a great idea.
I would also include in it, though, a provision that outlaws drug advertising. You cannot buy the drugs you see on TV, so why do they advertise? Two reasons.
To buy off the media corporations so they do not honestly discuss the industry practices, and to impress those who lack a background in pharmaceutics with their ridiculous claims for products which often have no significant advantages over those already on the market at much lower prices.
If they didn’t spend on advertising, those funds would be available for innovation. Or buying back their stock. Only two nations even allow this, America and New Zealand. Time to put a stop to it.
74
The main problem with the US health care system is that there is too much reliance on the "free market" system, which is ultimately based on corporations trying to maximize profits - or actually corporate CEO's maximizing their income. There is no reason to assume that decisions which give the greatest income to CEO's will always be the best for the majority in society.
However, patents actually shield pharmaceutical companies from pure competition, giving them the right to set prices at whatever they want for a limited time. This is supposed to allow them to allocate the substantial funds necessary for research and testing. But as patent terms have lengthened and patents are allowed for minor changes in existing drugs, what we have actually been seeing is the effect of the political influence of the huge amounts of money commanded by the industries. There are ways to reform the patent system, and it could be largely superseded by government research, but Congress is apparently not considering any really major changes, nor are any such discussed in this piece. The House Bill represents a small increment in terms of what could and should be done. Democrats should be proposing much more if they get control of government.
5
The is a cruel editorial. The subheadline says it all: "Under a new bill, a handful of new drugs might never get produced. That would be worth it."
That would be worth it?? Try telling that to someone who desperately needs one of the drugs that would never get produced. For example, interview someone with cystic fibrosis, a devastating inherited disease that kills its victims slowly; in the past most people with CF died in their early 20's. This past week, the results of clinical trials on a new drug therapy were published. The new therapy will be a life changer for 90% of the victims of CF; many physicians and scientists believe it will allow them to live nearly normal lives.
The therapy will initially be very expensive to cover the cost of its development and testing, That's unfortunate, but for a life saving drug, an expense society must bear.
I'm guessing whoever at the Times wrote the words "that would be worth it" doesn't have cystic fibrosis.
It's absolutely true that drugs in the US cost too much, and that something needs to be done. Bringing the cost of drugs in the US in line with what they cost in Europe is actually a good idea, if it's done carefully.
An even better idea would be US tort reform. Lawsuits, many based on junk science, are now threatening to drive many ethical drug companies into bankruptcy, while making a handful of lawyers extremely wealthy. This is not a good thing if the goal is affordable medications for us all.
10
@Alex
Bad example. Significant CF research was done by desperate patient families banding together raising money to pay for research themselves. Big Pharma wasn't interested in paying for the research.
13
@Alex
Maybe you didn't really read the article. A small percentage of drugs maybe, MAYBE, won't be produced. Its more than likely just another lie from our bought off politicians and their corporate overlords. Other countries manage to allocate funding for research and development and production, distribution and sales while still determining which drugs offer the most benefit for the most people at the best prices.
In other words, if you can't afford the drug what difference does it make whether it is available or not?
The most disturbing thing is that every business has to allocate their funds in a responsible manner to stay in business. That's the free market the Republicans have been choking us with for decades. All of a sudden, when its profit over people for the corporate donors there's no free market and they scare dupes into believing this is in their benefit every time.
Until you wake up and stop buying the fear mongering, you will die regardless of what drugs the drug companies make or don't make because if you become sick, you will be, without a doubt, too poor for treatment and necessary drugs. So, stop the nonsense already and pay attention.
1
Nice job leaving out all the relevant information.
ALL drug discoveries in the US, even the most "expensive" ones, after 20 years lose patent protection and can then be made inexpensively by any competent drug manufacturers.
So, NO. There has never been a drug that will be unaffordable for ever. At most they will be unaffordable for 20 years.
And even in those 20 years, manufacturers will price the drugs for maximum profit during those 20 years. That includes making it affordable enough for a large enough group of people to actually recover the invest, plus dissuade competitors from investing disproportionate in an alternative.
There is a reason why the vast majority of innovative, life saving drugs are discovered in America.
But liberals can't see any well functioning industry - i.e. those with innovation and profits - without wanting to tax it out of existence.
5
@Baron95 Um, insulin is now even more expensive that it was when some of the newer insulins were introduced. Drug companies tweak the formulas and get new patents issued. So, like most things, they've figured ways around patent protection. It may be exception to the rule that you mentioned but for folks like me it's a life-changing exception.
18
@Baron95
This argument is seriously flawed. The most obvious example is insulin, a very, very old drug with some new iterations. The price of insulin has skyrocketed to such levels that patients cannot afford it, even with insurance. Eli Lilly has had that patent for years, but decided it needed more profit. Insulin dependent patients cannot wait 20 years for the price to return to reasonable levels. The patent and pricing system needs immediate regulation.
21
@Baron95
Unfortunately, this is not a well functioning market.
The article said that Medicare is required to pay for any drug, regardless of price.
I had a small manufacturing business and know that it is possible to make more profit selling less quantity if the price is high enough.
And that is what pharmaceutical companies are doing.
It comes at the expense of the health of our fellow citizens.
Also, they tweak patents and extend them as long as possible.
This is not about free-market but about a monopoly.
In addition, with W Bush's prescription drug law, Medicare was prohibited from negotiating prices.
This is like telling Walmart, with their huge buying power, they can't negotiate with their suppliers.
I would make the opposite observation, conservatives are sometimes blind when defending capitalism.
10
Not every generic is as safe as the brand medication. Physicians, particularly subspecialists, need greater clout in prescribing for Medicare exceptions. My name brand Keppra was $2k before ACA closed Plan D gap. Same medication, higher dosage, was $7.50 when I was covered under Medicaid expansion MassHealth Common Health. the Plan D Insurers are also culpable re medication cost .
4
I've seen drugs that are effective and cornerstones of treatment for decades skyrocket in price, or get notifications that our pharmacies are out of basic medications, with the explanation that only one manufacturer is marketing them.
There should be protections that if a drug is an established workhorse meeting patient needs, that those medicines would be multiple sourced and quality controlled so that there are no chances of contamination.
I'm sure the patients affected by less common diseases and conditions are thankful for their thousands of dollars per month injections of the newest biologics, but to not have safe available and affordable treatments for blood pressure that impacts far greater numbers of our citizens, for example, is a failure of our Congress.
And the lack of profits for the companies bringing these new innovative medications to market? They can make up a large part of that when they stop producing and buying expensive ads in prime time on every network or satellite channel that exists.
10
What took them so long to realize it? In this country it's sacrilege to challenge profits but this is exactly why we should move health care out of the free enterprise zone.
28
The numerous ads on TV and radio about this bill stifling innovation are infuriating. What they really mean is stifling outrageous profits. Perhaps if pharmaceutical shareholders and C-suite management weren't taking home billions one could make that innovation argument.
38
What about when older, cheaper AND BETTER- medications are taken off the market so the companies can force patients to purchase the newer, more expensive and not as effective products ?
33
The fallacy in this argument is that even if innovative drugs are so monumentally expensive that not everyone can afford them and some go without, after the patents run out in 20 years, they will be affordable. Twenty years of limited availability vs. never. And many benefit now. A perfectly acceptable trade off, in my view. And in the view of all future generations, I would suspect.
5
@Froat
" Twenty years of limited availability vs. never."....
That's only if you truly believe that the current system is the only way to bring these drugs to availability.
2
@Froat
And yet prices just keep going up. Patents are to protect investment. Competition and regulation are to protect consumers. It can't all be in their favor or we end up where we are. This nonsense that the drug companies will simply stop innovating or making new drugs if we regulate prices and the health care industry is a lie. Most of what they make is useless garbage. Generic drugs were supposed to save us money. They don't because of lack of competition and no regulation. If I hold a gun to your head and say give me all your money or I'll pull the trigger, you will give me you money. But I will have committed a crime. Why then do we allow drug companies to do virtually the same thing with drugs? Why are you so concerned about their bloated profit margin. Who are they that they shouldn't have to live as civilized people that are part of our society and not the slave overlord owners of it?
"This approach acknowledges that innovation is useful only if people can afford the resulting products"....This statement is greatly flawed, in fact it s wrong. The difference between a life saving new drug that is unaffordable and a life saving new drug that doesn't exist is huge. What is unaffordable today will very often become easily acquired tomorrow; and the statement completely ignores the critical importance of proof of principle. If a new unaffordable drug proves that a certain mechanism of action is effective in treating a disease state, it will soon be followed by other affordable drugs that treat the same target. When the first hand calculator came out from Texas Instruments it cost $65 dollars; how long did that last? Find a way to make drugs more affordable, but stepping on innovation to do it is a terrible idea.
6
@W.A. Spitzer
But that's not what's happening with drugs. Even formerly cheap generics are skyrocketing.
Calculators can be understood by ordinary people, are not a life-and-health necessity, and do not have a complicated relationship to insurance and employment. They are truly a free-market commodity that responds to market forces.
Except for purely elective stuff like cosmetic surgery, medical care does not fit your free-market example.
8
If people’s lives depended on their purchasing $65 calculators and their insurance companies paid $42 of the cost before they saw the bill, and no other companies were allowed to sell calculators, the cost of calculators would have risen to $3000 by now.
8
@Naomi ...Calculators are not necessities, but it is also true that you can't buy a life saving drug no matter how much money you have if it doesn't exist.
As a physician in practice for 30 years I have seen the arc of drug prices over that period. They are the result of a fundamentally dysfunctional market.
I live in the DC metro ares so the morning news station drive time is filled with ads from pharmaceutical associations protesting pending legislation. They protest of the need for more innovation and propose instead as a "solution" for sky rocketing prices market based competition.
There is no "competition" except to see which of the now 15ish Multiple Sclerosis drugs can charge the most. The drugs cost $800 per month 20 years ago and now with many more choices and some generics available they cost more than $5000 per month.
The problem is that the cost sensitivity side of the market is absent. When drug reps call on me I always ask how much it costs. They invariably respond the the copay card means that the patient pays "only $20 per month."
No, I ask how much does it actually cost?
They hem and haw, with answers ranging form "I don't know" to $600,000 per year.
They seem put off when I point out that their product is not a radical breakthrough but merely an extended release version of a old medication otherwise available as a generic.
A basic feature of any reform must be price transparency to physicians and to patients. This is especially true for the direct to consumer ads where the public has no idea how much this stuff costs.
100
@LRW
Agreed. The patent system also needs reform now. Changing one molecule of an existing drug (with no change in basic function) now makes it a new drug with exclusive patent protection for 7 years. Big pharma uses such tactics to extend their patent protection and high prices.
11
Pharmaceuticals those pretty drugs paraded across her TV screens by really pretty people. Which miraculously cures everyone, hidden is the cost, usually more than many make in a month or a year.
The reality is that Pharmaceuticals is a very profitable business. Because there is so much wealth behind drugs, they have a Lobby that influences our Representatives with money. By and far, most pharmaceuticals cost pennies to produce. For example, Insulin has been very cheap to produce for decades. Therefore the Pharmaceutical companies decided to enhance insulin, for better or for worse, which drive cost. This guarantees that the end cost is prohibitive.
The problem is R&D, unfortunately, the US bears the largest burden of cost. These costs must be shared by all nations. Another problem is the ten-year reward of no competition after the development of a new drug. The problem here is greed, the original pharmaceutical company changes some components of the drug, which may not benefit anyone or may even harm, to gain another ten years of the exclusive right to produce.
Agreed, that drug prices should be uniformed throughout the world. Medicare, as well as the Health Insurance Companies, should be able to negotiate cost based on volume.
9
Pharmaceutical corporations and their owned or rented members of Congress don’t care about health care or patients regardless of what their glossy adds say. It’s profits. That is their goal.
Remember when scientists worked to make human life better? No more corporations own scientific research even when tax payers pay for it. We pay for it and others in other countries enjoy the benefits.
7
The threat that negotiating prices with the government would lead to pharmaceutical companies creating fewer novel medications would seem easily addressed in other, more strategic ways. Using money saved from the lower drug prices, the government (or the most recent science) might identify a problem needing a new treatment (e.g., new antibiotics for resistant bacteria) and then offer financial incentives to pharmaceutical companies for creating them. But at least that way, we determine the health problem needing to be addressed and use targeted incentives to fix it while controlling the cost. In general, leaving pharmaceutical companies to determine how and when to invest their profits in R & D is not a good solution for addressing the most important health problem affecting the population.
13
This editorial is very callus when it comes to new innovations. If you are a cancer patient out of options, an Alzheimer’s patient, a rare disease patient with no good treatment options, you will fall victim to a reduction in R&D. If you look at real price increases in the pharmaceutical industry, not the list prices reported, they track closely or even below medical inflation. But no one is comfortable talking about skyrocketing prices of medical procedures or doctor fees. Trying to curb a true affordability problem by shifting all of the savings burden to a small part of the healthcare ecosystem is small minded, and cruel to the millions of patients who would not see new treatment options to their very real medical struggles as a result.
5
@AHMJ
The article is callus because it does not acknowledge we can fund R&D into pharmaceutical research more effectively than we do now without having to stifle innovation. Note that much R&D is already government funded (and not just for medicine) . Overall drug costs are lower than advertised because of this type of negotiating. This is more of the same. This editorial, unfortunately, draws the same doomsday conclusions the pharmaceutical industry wants us to believe.
4
@AHMJ
I’m afraid you have fallen for the drug industries’ advertising. You are also misinformed about the price increases in drugs—ask any pharmacist about those. The vast majority of patients are now paying exorbitant prices—not a “Small part of t he healthcare ecosystem.”
2
@AHMJ
I will be callous and say that if you are a patient out of options, then you are no worse off than you were yesterday, last year, or ten years ago. There are no miracles, just long clinical trials. The basic research on new drug development is generally done at the university level with the support of Pharma- that isn’t going to change simply because we rein in the excessive profits.
There is usually a dollar amount attributable to an individual human life. What cost does Society think is appropriate for a child with cystic fibrosis? A lifetime at $300,000 per year? What about medication costing over $1,000,000 per year? I’m not sure that my life is worth (in terms of my contribution to Society) that much. We believe ourselves to be irreplaceable, yet we will all die. I would rather die sooner than suffer pain at the end. I would also rather die without leaving a mountain of debt for my family just to eke out one more day.
1
Medicare market power can actually privilege big Pharma. The only enduring solution is to increase competition.
The industry is ripe for competition. It no longer requires large budgets to develop drugs: computerized search for drug candidates has enabled small companies to develop drugs in a particular domain. FDA fast-tracking, new statistical analyses, and patient advocacy groups have reduced the costs of trials. Big Pharma has responded by buying companies that threaten monopolies and tying up investigators in early deals.
The Feds should do their job:
(1) The FDA should rigorously avoid insider relations and regulations designed to reduce competition by increasing the burden of approvals.
(2) The DOJ should investigate and prohibit any merger or contract that creates or preserves monopolies over diseases treatments or drug classes.
(3) The patent office should intervene in patent lawsuits big Pharma uses to block small players.
(4) The DOJ should investigate the input markets for monopolistic behavior in development and testing. Illumina ties contracts for DNA sequencing machines to reagents and software, reagent companies try to get into instruments, and lab companies develop monopolies over entire regions or categories of tests (many new drugs are require companion diagnostics to verify the underlying genetic defect).
Also:
(5) We need reliable quality control over foreign drugs.
(6) We need reduced IP protections for generic enhancements.
8
Why not increase competition. Allow Americans to buy pharmaceuticals from foreign sources at their own risk. Currently companies have a captive market which distorts prices. Foriegn competition greatly improved the quality of US auto makers while spurring innovations. Give folks more choices.
8
@Lane
Why? Drug prices are higher in the U. S. because other governments regulate prices. So, instead of having a U. S. Company sell to a foreign country, then send it back to the U. S., why not simply regulate the price at the source? And regulate the price for foreign sources as well, eg GSK, Novartis, Sanofi, etc.
2
@Lane …. "Allow Americans to buy pharmaceuticals from foreign sources"...New drugs don't come from foreign sources. New drugs may cost less in other countries, but they come from the very same place.
1
@Evan Katz Good point. For new drugs it wouldn't help much initially.For existing drugs and over the counter medications it could.
Regulating prices though invariably has unintended consequences.
1
This is a small-step approach to a general problem, but given its low chance of passage in the senate, a good demonstration of a legislative approach. I have worked in the pharma industry. Their cries of a cessation of research are absurd for three reasons.
1) Their biggest profits come from drugs currently covered by patents. Those margins evaporate the day the patent expires. They Must have new golden geese.
2) A victory in this battle may prove Phyrric, This bill allows them to raise prices further for much of the American market. Winning here could help Democrats fight for national drug (and health) price controls.
3) Be real. They spend Much more on marketing and pricing gimmicks and 'rewarding' prescribers than they do on R&D. Suppose Congress instead requires that they spend dollar-for-dollar as much on R&D as on that other stuff combined? Or doubled the R&D tax writedown like Reagan did in 1981?
Obscene profits that harm people are not a constitutional right.
31
So why is it that drugs in countries like Canada or Britain cost only a fraction of what they cost here? Maybe those countries don't have a political party that supports large corporations at the expense of average citizens.
19
@Clark Landrum Actually, it is because both countries have national health care systems that use their negotiating power to keep prices in line.
Something that we are not allowed to do, because, lobbying and political patronage.
10
If we could have the government instead of for profit greedy companies running the pharmaceutical research and development we would be a whole lot better off. Who hasn’t wondered at one time or another if “they are holding back the cure to make a profit selling a pill instead?” Cut the military budget a bit and poof there’s the money to run not to mention the savings of the over priced drug cost these greedy corporations charge the government. It’s time for a better solution.
4
@J Clark
Agreed. Have often wondered why we don’t have government run or government contracted plants that produce drugs, such as flu vaccines or shingles vaccines. I have waited over 8 months for the new shingles vaccine, because not enough is being produced. The same with the higher dosage flu vaccine—had to search providers because of manufacturers’ shortages. God help us in the event of a catastrophic outbreak that requires certain drugs and we have a “manufacturers’ shortage.”
4
Over time, drug manufacturers have shown a consistent bias toward extending patent protections for profit through dubious means. Two examples will suffice.
When Valium was going off patent, Roche introduced Valrelease, a time-released version of diazepam. This ignored the fact the original drug had a half-life of about 30 hours and its primary metabolite, desmethyldiazepam, had a half-life of 96 hours, with its metabolite, oxazepam, also active as a drug. So the "old" product was already slow to be metabolized, taking about a week to clear the body overall.
Lilly did one better. They once made Darvon or l-propoxyphene marketed as an agent for pain. Their process left a large pile of its stereoisomer, d-propoxyphene, around. As Darvon waned, they packaged up the byproduct and sold it as Novrad (Darvon spelled backwards) despite the fact dextrorotatory molecules are functionally inert in our earthbound biologic systems.
Big Pharma is not an unalloyed good. I am pleased to see Congressional action (if only in the House thus far) to end their reign of error. $500 epinephrine and $300 insulin must end.
79
@Doug McNeill ...You don't understand how patents work. A new modification may be patentable but the patent on the older form of the drug still expires at the prescribed time and becomes part of the public domain. Further, the d-isomer of Darvon to which you refer is not exactly inert as you claim; but rather, while it has no affect on pain it is also metabolized by the liver and serves to extend the l isomers half life. And you forgot to mention that this did extend the patent life of the pure l isomer.
1
@W.A. Spitzer
1. Novrad was sold to be used alone; no l-propoxyphene was dosed with it.
2. The original patent might expire but the pharmaceutical company sought to extend the cachet of the old form with new window dressing or a new formulation (e.g. Keflex became Keftabs)
3. Propoxyphene has been discontinued as it was never a great drug for pain IMHO.
5
@Doug McNeill ….There are two requirements for a patent. The invention must be novel and it must be useful. The addition of "new window dressing" to an old patent, does not prevent the public from using the drug with out "the window dressing" as a generic.
2
It's a trade off that we have to learn to accept.
I work in ophthalmology, and have seen on or two drugs come to market that act differently from others- have different mechanisms of action, different results for people who failed on existing mediations. I have also seen manufacturers tweak current meds to expand a patent, and keep prices artificially high.
I have seen one manufacturer fight to hold the patent of a drug that was introduced in 1972 for another purpose, so that it cannot be generically produced even as the monthly price for a person with no insurance or a deductible runs at $300. They tried to move the patent to a NYS state Native American tribe to circumvent the ability of US courts to hear a patent case.
Some development has been very valuable - think of the hepatitis C drugs - but the reimbursement is also unaffordable to anyone without insurance - and drives up drug costs. The cost benefit of the drug is tricky, since no other drug cures the condition.
Someone has to make these calls, and Medicare is the right place to start.
36
@Cathy
Physicians are not monolithic with respect to opinions concerning drug costs and regulations. TNF inhibitors (esp. Humira) are a huge profit center for pharmaceutical firms and patent regulations present all sorts of problems.
It is true that someone has to make the calls, but like so many industries around a lot of money, maybe it is best not to let the industry itself call so many shot.
You say that the hepatitis C drugs are valuable. That is true, in several senses. No doubt regulation is a delicate balance, but the NYTs editors have a point: we do not need all that is marketed.
Those marketing departments with pharmaceutical firms are often just going to charge what the market will bear, no matter other consequences. This is an all too common story-line within modern medicine.
3
The single most important healthcare reform we need is to control the price of pharmaceuticals by allowing Medicare to negotiate directly with drug makers. An added benefit is that negotiating drug prices will extend solvency of the Medicare trust fund by many years.
I wonder whether we could create a Medicare drug plan that every American could buy into--a less ambitious goal than MfA, but very achievable. I don't know what if any downside there is to having a universal Medicare drug registry.
6
@SandraH
This is certainly important, but may not be the largest problem: https://www.pbs.org/newshour/economy/why-does-health-care-cost-so-m ("Why Does Healthcare Cost So Much in America?").
Administrative costs are actually the biggest driver of most of our cost problems. This does not mean that we need Medicare for All (some of the costs within Medicare are hidden from public view and could get magnified with a sudden and massive switch). We do need experts to come together and figure a better way to handle the quagmire.
Drug costs tie to the fact that we pay so much more for the same things (drugs, tests, hospital care, etc.) as other countries. There are a few other major drivers.
1
@JSK "Administrative costs are actually the biggest driver of most of our cost problems"
This is true for healthcare as a whole, but not for drugs. The goal of this effort is to reduce drug costs.
Nor should we excuse excess drug costs just because admin costs are a bigger problem.
2
@we Tp
I understand but was responding to the initial post: "The single most important healthcare reform we need is to control the price of pharmaceuticals..."
Not sure why you suspect I was excusing things--not the case.
2
Almost 90% prescriptions written in the US are for generics. Generic drug prices in the US are generally far lower than overseas because there are multiple manufacturers on the market once a patent expires. There is a bit of cherry picking going on to just focus on a small percentage of drugs prescribed. Plus every drug company gives away product to those who can't afford them. There are definitely some bad actors in the pharmaceutical industry but people are living longer and healthier lives despite the negative trends in exercise and diet. And I agree with the article that more needs to be done to support the development and usage of new antibiotics.
7
@G Dives
But many generics and off-patents are skyrocketing too. I needed prednisone eye medicines that cost $100+ for a tiny bottle. Insulin, asthma inhalers, and many others are going up, not down.
The industry incentives are totally broken in terms of patient access.
6
I suppose the drug companies could spend less on advertising, but then wouldn't the NY Times and most TV networks go out of business?
Anyway, there was another interesting wrinkle in the drug price debate reported on from the NY Times just last week:
"Chronic drug shortages that threaten patient care are caused by rock-bottom prices for older generic medicines and a health care marketplace that doesn’t run on the rules of supply and demand, among other factors, according to a federal report published on Tuesday.
The report, the work of a task force led by the Food and Drug Administration and comprising representatives from various federal agencies, recommended that buyers like hospitals consider paying higher prices for older generic drugs.
https://www.nytimes.com/2019/10/29/health/drug-shortages-generics.html
Perhaps it is time to be more specific about the drug cost problem. Maybe then we can target the cost and supply issues of drugs we actually need.
2
@Neildsmith Would newspapers and visual media go out of business if the very expensive to produce and distribute ads were minimized?
No, they wouldn't. We'd see the massive spending by our candidates seeking office flood in to sop up every available second of newly available time and page space.
2
Unfortunately this article is little more than a labeled statistical analysis. I say unfortunate because the bill is a good idea. However the first question I would ask is what 5-8 drugs would be eliminated and whose family will suffer. That’s the analysis I would like to see with real life examples.
Nevertheless, our policies should value what we do best and leverage that without destroying the lever- create markets. How does the bill do that is what I want to know.
2
Many drugs are initially developed in universities using tax payer dollars. A significant portion of the cost of drug research is already tax payer subsidized. Additionally, a fair quantity of the research pharmaceutical companies conduct is not directed toward developing new drugs, but toward finding new uses for current drugs to keep them on patent.
55
Actually it costs another $1-3 billion (including cost of failed drugs) to develop a drug successfully after the initial basic research at a university or other publicly funded institution.
The academic work usually just figures out a hypothesized mechanism from cell lines (not even mice) that is at best an educated guess. The actual research and development to make the drug work for humans (like delivery to the right organs, how to manufacture at scale, and all clinical trials) costs $1-3 billion after the academic research. Also the money spent on academic research is tiny per topic, like several millions, not billions.
Almost none of the drugs humans take are substantially funded by taxpayers. The very early “hey I think there’s a signal in this Petri dish” stuff from academic work costs a trivial amount of money and fails most of the time. The reason the gov funds this stuff is because it’s too early and almost always flops so private investors don’t want to waste their money. You can claim that we need gov funding in basic science to fill the market failure but you really cannot claim that the academic research is most of the funds or the work to research and develop a drug. Most of the funds and work are from private investors and drug companies.
3
@NYCresident
Maybe it costs less because the research is done by a nonprofit?
1
I think if more Americans realized how much more they pay for medicine in the US compared to other developed economy countries they would demand firm government action. We have visiting friends and family who stock up on medicine here in Spain because it is so much cheaper. Same medicine, same dosage, far lower price!
In the US, we pay more, by far, for our healthcare than any other country, but do not get measurably better results. At best we are in the lower middle of the pack, and in some health measures even behind other far less well off countries. As the writer points out, the high cost of medicine due laws designed to protect hugely profitable pharmaceutical companies too often means prices folks can not afford. Time for change!
21
It's absurd that commonly used - and necessary - drugs like Insulin are so expensive.
Anyone who'd had cancer faces years of drug treatment that can bankrupt you if you lack insurance.
When an EpiPen costs over $300 but can be produced for $10, something is VERY wrong.
If the goal is population reduction, we're on the right path. No other explanation makes any sense.
137
@cynicalskeptic The other explanation is simply greed by the pharmaceutical companies which continues unabated.
9
@cynicalskeptic
The old phrase was "as much as the market will bear".
And lets face it, the "market" (us) will bear alot if the only other choice is dying.
And you can bet that big pharma has legions of accountants and marketers who determine how high they can go.
9
@cynicalskeptic -- 'If the goal is population reduction, we're on the right path."
Precisely the Republican 'healthcare' plan: 'Let 'em die.'
"No other explanation makes any sense."
Bingo.
4
More than two-thirds of new medicines approved by FDA within the last 5 years while brought to market by hated-by-most-everyone Big Pharma had not been invented and patented by those companies. They came from the small and highly innovative biotech companies - of which 9 out of 10 go out of business when their drug candidate flops. Tens and hundreds of millions $$ each of these companies burns before either dying or having their drug launched don't come from NIH, patients, or fairy godmother. They come from the venture capitalists and later from the public market investors - who believe that a single big hit pays for 9 flops. This big hit could only be big if the value of the drug to big pharma justifies it. Strangling the profit margins as Ms Pelosi's legislation does would effectively kill the flow of any investment capital to emergent biotech companies. 10 years after it is enacted you can count on drug innovation virtually grinding to a halt.
It will be a shame since in the long run modifying the disease via pharmaceuticals is the most cost-efficient way of extending the lifespan (I am talking medical ways here, not fat-fighting) - so saving people's money by paying drastically less on drugs will one day result in paying more for hospitals, nursing homes, special educations and surgeries. Besides, tens of thousands PhD biologists and chemists become unemployed - but this is not interesting to the reader. Apple's profit is greater than of all the Pharma combined...
10
@cobbler Full disclosure: My income is directly tied to venture investment in healthcare biotechnology. That said, to ignore the impact of ever increasing drug prices for life-saving/extending meds is self destructive, I speak in particular here of drugs in oncology. Yes, there have been extraordinary breakthroughs of late (the checkpoint inhibitors are a HUGE advance, as are CAR-T agents, with the former winning two Nobel Prizes last year) but if those technologies are as widely approved and adopted as the market wishes/projects, it will absolutely break the healthcare system. The money simple does not exist.
3
@Neil C.
Then, we need as a society to tell that we are not going to spend more than certain amount to save someone's life (for that matter, legislative actions like eliminating lifetime maximum for the insurance policy go exactly in the opposite direction). This will meaningfully change many things in healthcare, not only drug business. To note, unlike the ever-skyrocketing costs of surgeries and hospital stays, prices of drugs (at least the small molecule ones) plummet when they go generic - so if one looks a generation or two ahead, what is now super-expensive will be dirt cheap, and our children will benefit almost for free from today's expensive innovation.
Today's situation with antibiotics (companies go bust despite new and better products) will be the case for every area of pharma business if the draconian price controls go into efrfect.
2
@cobbler,
All we would be doing is seeking the same terms the rest of the world obtains.
Are you really saying that our citizens of limited means should forgo essential, basic medicines so entrepreneurs can try to make a killing (no pun intended) and the rest of the world can get drugs at prices they can afford?
That doesn’t make any sense.
2
Research costs + Capitalism = Expense passed on.
9
Revenue - Expenses - R&D = Taxable Net Income
Taxable Net Income - Taxes = Net Income available to equity owners as return on the equity they’ve invested in the company
Reduce revenue and something has to give... probably R&D
2
@Mark
They could always reduce the expense number by paying the C-suite less and ending TV marketing.
4
Most medical innovations never see the light of day, at least in the mass market. Press releases, often from universities, routinely trumpet some revolutionary diagnostic tool or treatment, and that's the last they will ever be heard of again, more often because they threaten some exciting, highly profitable approach than because they're too expensive or impractical. Going back through all these lost advances would be as disheartening as discovering the airplane had been invented 10 times prior to the Wright brothers, a hundred years earlier.
22
Actually, the reason that these “advances” don’t end up in the clinic is because the press releases are for discoveries that are early in the process. It takes a lot more work before a finding in a lab....no matter how scientifically interesting....has been tested enough to show it’s either safe or clinically useful. I’ve been a part of early research on three products that eventually came to market. Our early findings were amazing. But the 10 additional years it took before they ended up on the market were absolutely necessary to show they worked in people, were better than existing treatments, and were safe. With this very reasonable standard in front of many university findings, it’s no wonder that most university press releases report things that don’t end up in the clinic.
19
If we want more innovation in drugs, then giving the NIH more money to invest in research would be more cost-effective for our real needs, like anti-biotics.
163
@Jennie
My feelings exactly. If I could like this a dozen times, I would.
1
No pharmaceutical company invented researched and created insulin. It came about as a result of evolution by natural selection.
Yet companies manufacture, market and sell this natural product at increasingly exorbitant prices.
One of the failures of George W. Bush and Barack H. Obama was their failure to reasonably control and limit price gouging by pharmaceutical companies for prescription drugs.
While nominal differences exist in price between patented and generic pharmaceuticals in reality corrupt crony capitalist corporate plutocrat oligarch welfare Big Pharma always finds a way to scrape Lincoln's face off of a penny.
115
@Blackmamba The providers of inulin to U.S. markets are few. There are lower cost providers in other countries, some in countries which have seen dramatic increases in diabetes (e.g. India), but they lack U.S. FDA approval. I suspect it is not worth their while to push for U.S. market entry with the current providers so entrenched and having a captive regional market.
5
Insulin as a pharma product has changed tremendously over the past 100 years. Patients and doctors strongly prefer the modern synthetic versions of human insulin over insulin extracted from animals. Talk to patients who started taking insulin in their 20s who are now in their 70s on how vastly insulin has improved
See https://www.diabetes.co.uk/insulin/history-of-insulin.html
@Blackmamba
the insulin being sold and marketed is the biologic (recombinant) version, which is indistinguishable from human insulin, unlike animal (pig) insulin.
2