[HN Gopher] Novo Nordisk facing pressure as study finds $1k drug...
___________________________________________________________________
Novo Nordisk facing pressure as study finds $1k drug can be made
for $5
Author : paulpauper
Score : 96 points
Date : 2024-03-30 20:08 UTC (2 hours ago)
(HTM) web link (fortune.com)
(TXT) w3m dump (fortune.com)
| echelon wrote:
| Ozempic is blowing up on TikTok. Celebs and young people are
| using it left and right. This is wildly popular and there are
| resellers and apps popping up everywhere to make it easy to get
| prescriptions.
|
| "Ozempic face" has become a meme as people try to guess who is
| using it.
|
| Several of my neighbors are admittedly using it. And they've lost
| 30, 40+ pounds in a matter of months. _Months_.
|
| This is a diabetes drug. There has to be a biochemical catch
| here.
| quotemstr wrote:
| > This is a diabetes drug. There has to be a biochemical catch
| here.
|
| What if there isn't a catch? Sometimes technology really does
| just improve the human condition with no serious downsides.
| Consider refrigeration or sanitary surgical techniques.
| sandspar wrote:
| Ozempic's side effects range from frequent diarrhea to
| pancreatitis and vision loss. Individuals can consider
| whether the benefits outweigh the costs. But it isn't free.
| We might try a Fermi problem to estimate how many of those
| cheerful Ozempic influencers talk about pancreatitis.
| toomuchtodo wrote:
| Side effects are real but obesity kills too. Importantly,
| GLP-1 agonists can also inhibit addictive behaviors
| (alcohol and substance abuse, gambling) due to a brain
| chemistry mechanism. Additional harm reduction to consider.
|
| https://ourworldindata.org/obesity
|
| https://www.scientificamerican.com/article/could-new-
| weight-...
| MichaelZuo wrote:
| All the usable refrigerants were either flammable, toxic, or
| highly ozone depleting, or a combination, up until the 90s...
| grogenaut wrote:
| Pretty sure R290 is flammable and I believe being used more
| and more
| MichaelZuo wrote:
| Yes, R600 even more so, there are some very expensive
| exotic refrigerants that are not, but they literally
| didn't exist pre 90s.
| koverstreet wrote:
| The human body is a massive system of interconnected feedback
| loops. Tweak one knob, and there are always cascading side
| effects.
|
| I could entirely see this being a net positive for a lot of
| people, but I want to know what those side effects are.
| olliej wrote:
| Plenty of people have got digestive system paralysis, so
| that's a downside. Obviously the big issue is that for people
| with diabetes this has made the drug unavailable for actual
| medical problems that don't have other treatments.
|
| Long term studies are also not super complete - even
| something known to cause cancer like smoking or asbestos
| takes decades to show up.
| dpacmittal wrote:
| Refrigerants contribute to global warming, no?
| QuesnayJr wrote:
| I was wondering this. How often does it turn out that a drug
| has no serious downsides? I guess penicillin was, if you're
| not allergic. (There is microbes evolving antibiotic
| resistance, but that's probably not a concern for ozempic.)
| yread wrote:
| Try taking strong antibiotics for 2+ weeks. The list of
| serious downsides will be quite long
| softwreoutthere wrote:
| Thyroid cancer is one catch.
| pluc wrote:
| They said the same about Viagra.
| Mencius- wrote:
| The Law of Equivalent Exchange can be dodged, delayed, and
| ignored for only so long. There may not be a biochemical catch,
| but we will certainly pay in some other way. Perhaps spiritual,
| mental, etc.
| kobalsky wrote:
| imagine if you were saying this about vaccines or
| antibiotics.
|
| this drug has side effects on some people but it's may make
| obesity a thing of the past. especially if generics could be
| made so cheaply
| lxgr wrote:
| To be fair, some people are saying that about vaccines or
| antibiotics.
|
| Fortunately they don't regulate access to either for most
| people in the world.
| Mencius- wrote:
| Different people place different weights on different
| values and outcomes. I'm sure there are many elderly people
| who miss the culture of sociability with neighbors that was
| largely a byproduct of material scarcity. Borrowing the
| sugar, congregating at the neighbor's house who is the only
| one on the block with a TV, etc. Our loneliness and mental
| health crisis is largely the price we paid for vanquishing
| material scarcity.
|
| If you cannot see the dysgenic effects of vaccines,
| antibiotics, etc I doubt I can convince you in a a single
| comment. Just take my word for it that the percent of the
| population that will have permanent defects that require
| lifelong treatments is continuing to rise. Sperm loads and
| quality are continuing to drop.
|
| I am not implying that these trade-offs aren't worth making
| -- just that our collective leadership should be making
| them with eyes wide open and planning for the inevitable
| sacrifice each piece of 'progress' requires.
|
| Edit: Just as a simple thought experiment: If these obesity
| drugs are really the miracles they seem to be, I can see a
| future in couple generations where any disruption in supply
| will lead every single person to balloon to the size of the
| fattest person you have ever seen in your life. What ever
| gene(s) are regulating satiation will be rendered moot and
| thus have zero selection pressure. The outsourcing of this
| function is just that -- the human organism will no longer
| have any method of regulating hunger, satiation, etc.
| Kye wrote:
| Fullmetal Alchemist isn't real life. You don't have to
| account for every microgram of material along the way for a
| drug to be useful and safe.
| lxgr wrote:
| Except that that's not an actual natural law. In the same way
| that sometimes bad things happen to good people for no reason
| and with no compensation whatsoever, sometimes good things
| happen to people as well, whether they "deserve" it or not.
|
| Other than that, what's the problem with a weight loss drug?
| That it's "unnatural" or "cheating nature"? The weight gain
| and the corresponding lifestyle and nutrition that often
| cause it aren't exactly nature-given either.
| clan wrote:
| What I find weirder is that people chase Ozempic even though
| they have introduced Wegovy. Which is basically the same drug
| but without glycemic control and hence more suited for non-
| diabetics. Both are Semaglutides and Wegovy directly targets
| weight loss.
| ewoodrich wrote:
| They are the exact same active pharmaceutical ingredient
| (semaglutide), only differ in dosage and the design of the
| pen used to inject them. Ozempic is a multi use pen while
| Wegovy comes in fixed dosage single use pens that max out
| higher than Ozempic's highest dosage.
|
| Glycemic control wouldn't be any different between the two at
| the same dosage but yes, people should really be seeking out
| Wegovy or Zepbound (tirzepatide) since those actually have a
| chance of being approved by their insurance for weight loss
| based on their FDA indication vs Ozempic or Mounjaro.
| SmellTheGlove wrote:
| No it's the exact same drug. There's no "without glycemic
| control" difference. The largest dose of Ozempic available is
| a little more than the largest Wegovy but it's the same drug.
|
| I'm on Ozempic and not Wegovy. Here's why:
|
| - Wegovy is impossible to get. I had it prescribed a year ago
| and it still hasn't been filled. Multiple pharmacies too.
|
| - In the meantime, my new insurance doesn't cover it or
| Ozempic. So I'm out of pocket.
|
| - Ozempic 2mg pens are readily available and unlike Wegovy,
| you dial the dose, so that 2mg pen lasts me 2 months. It's
| not officially indicated and they tell you not to, but just
| google an Ozempic click chart to see. My doctor was the one
| who suggested this!
|
| - Wegovy pens don't have variable dosage. Only Ozempic does.
|
| - Theres no price difference in the pen sizes for Ozempic or
| Wegovy near me. No matter what dose pen you get, and no
| matter if it's Ozempic or Wegovy, it's $1000 for a 4 dose
| equivalent of the prescribed amount.
|
| So for me it's a no brainer if I'm paying retail - give me
| the highest dose Ozempic pen and I'll dial the smaller dose
| that I take. It'll last me twice as long since I take 1mg
| weekly. And I can actually get it.
|
| The fact that 0.5, 1, and 2mg dose pens all cost the same
| tells you how badly we're getting worked here.
| wighty wrote:
| > Which is basically the same drug but without glycemic
| control
|
| No... The effects are the same because they are exactly the
| same drug (semaglutide), the difference is the dosing
| schedule and max dose (wegovy is 2.4mg and ozempic is 2mg).
| homero wrote:
| Pretty weird diabetics have a lower dose
| ashconnor wrote:
| Ads are all over Instagram. Every TRT company is also offering
| it.
| spanktheuser wrote:
| >This is a diabetes drug.
|
| It was developed as a drug that increases insulin response, but
| it also appears to have a substantial impact on CNS processes
| controlling food cravings and other types of desire.
|
| Given that, it's possible we've stumbled upon the mechanism
| responsible for genetic differences in how we put on weight,
| whether that's appetite, metabolic differences or both.
| TeaBrain wrote:
| GLP-1 medications have been hypothesized to possibly result in
| the loss of muscle mass and bone density. There will probably
| be better data in a few years.
| paulpauper wrote:
| Of course, the marginal cost of production is low at scale. Most
| of the mark-up is for advertising and overhead. Also, once it
| goes generic that will hurt future sales too.
| lxgr wrote:
| No, it's for the massive upfront cost of research and
| regulatory approval.
|
| The stuff basically sells itself at this point; marketing
| probably doesn't even register in their budget for it.
| paulpauper wrote:
| that is what overhead is
| lxgr wrote:
| If you can find a way to cut the overhead of researching
| new (safe) pharmaceuticals, please do immediately start a
| company!
|
| We could have all kinds of interesting discussions around
| the parallels between research funding and tech VCs,
| sprawling regulations and delayed approval procedures etc.,
| but even in a libertarian utopia without an FDA I think
| you'll find that all researches like getting paid at the
| end of the month consistently, and not just the few that do
| eventually hit the jackpot.
| karles wrote:
| Producing it is not the hard part.
|
| Researching it is... And you are not paid for your research "up
| front". It's added to the cost afterwards.
| smitty1e wrote:
| #DingDingDing
|
| In general, mono-dimensional arguments merit an extra dose of
| skepticism from the audience.
| lxgr wrote:
| On top of research, FDA approval doesn't come for free either.
| lxgr wrote:
| Are the downvotes expression of disapproval with the FDA
| process or disagreement with the assertion that it's become
| slow and expensive enough to pose an ethical problem (e.g.
| for people with diseases for which a cure exists but is still
| waiting for approval)?
|
| Or does anybody actually believe FDA approval is very easy
| and cheap to come by these days?
| RantyDave wrote:
| I'm not Pharma industry expert but ... I'm pretty sure it's
| much the same as venture capital.
|
| That is to say that's it's not _that_ expensive to R &D it,
| certainly compared to the eventual sale price, but it's
| carrying the cost of the hundred potential drugs that never
| made it to market that's the killer.
| max_ wrote:
| It takes $300m to $2B to get a drug approved.
|
| And the approval rate is less than 12%.
|
| The crazy pricing is to compensate for the failed projects.
|
| Also, it's not like you can bootstrap yourself or grow
| organically like Startups.
|
| You have to wait for like 10 - 15 years. To actually start
| selling it.
|
| [1]: https://www.google.com/amp/s/www.policymed.com/amp/2014/
| 12/a...
| lostlogin wrote:
| > Also, it's not like you can bootstrap yourself or grow
| organically like Startups.
|
| So if they have a effectively built monopoly, chopping down
| the maximum they can charge via regulation would seem
| sensible wouldn't it?
| bryanrasmussen wrote:
| there is also a lot of problems with pharma not wanting
| to invest in cures for smaller diseases because the
| payback seems unlikely to happen or not be great enough
| to warrant the risk, so this seems like a pretty good
| vote getting maneuver that might have unintended
| consequences.
| Scandiravian wrote:
| I think that's difficult to implement. There's a risk
| that companies might end up not launching new products on
| the US market
|
| There's several factors that impact US drug prices. For
| instance FDA approvals are significantly more costly than
| EMA ones and the bargaining power of healthcare providers
| is worse compared to a single payer system
|
| I have no knowledge of US laws, but I wouldn't be
| surprised if there's some kind of law preventing
| government interference with "the free market"
| joatmon-snoo wrote:
| No such law here in the states, just a political
| atmosphere where some people adore the idea of socialism
| and others see it as the coming of the end of times.
| Combine that with a highly complex industry structure
| that's been entrenched for decades, and you end up in a
| situation where it's near impossible to pass laws that
| actually structurally change our system.
|
| (It's almost the opposite, in fact, where our courts have
| expanded the Commerce Clause over time to allow the
| federal government the ability to regulate close to any
| economic activity.)
| Scandiravian wrote:
| Thanks for the clarification! :)
| ethanbond wrote:
| No it's also ludicrously expensive to R&D a drug, even if you
| just count the costs of the successful program. You'd be
| looking at _easily_ $50-$150MM just in clinical trial costs,
| not to mention the years or decades of preclinical work.
|
| Factor in the failed programs and you're looking at about $2B
| of spend in order to bring a drug to market.
| Scandiravian wrote:
| If I remember correctly that cost is also only the price of
| developing a successful drug
|
| Several drug developments are halted before they reach
| market. Novo for instance lost a lot of money on their bet
| to develop inhalable insulin 15 years ago
|
| That cost also has to be recouped when finally hitting the
| jackpot
| FireBeyond wrote:
| Of the top 10 pharma companies, 5 are American, and three
| of them rank 8th, 9th and 10th for R&D investment.
|
| So the whole "American big pharma needs to make a billion
| dollars a week in profit to recoup their R&D" is nothing
| but marketing fluff.
| tacticalturtle wrote:
| Does it matter that only some of them are headquartered
| in the US? Presumably those other companies also sell
| drugs in the US?
|
| I would think any company - regardless of where it's
| headquartered - would seek to recoup R&D costs in a huge
| market like the US where prices aren't capped by the
| government.
| joatmon-snoo wrote:
| It's even riskier than VC, because the capital requirements
| in pharma per venture are _significantly_ higher.
| ecocentrik wrote:
| There's not a single drug company on the market that stops
| charging a high price for a drug as soon its covered its
| research expenditure.
| rapatel0 wrote:
| you also need to cover the cost of the 100 drugs that failed
| at various stages of the pipeline.
|
| Not saying that it's not a screwed up industry, but stories
| like these distort the problem as well
| kittiepryde wrote:
| Are the people running drug companies barely scraping by?
| ecocentrik wrote:
| Not nearly as much as they claim they are. The system is
| basically rigged in their favor. Just compare the
| financial statements of companies like Ford and Boeing to
| Eli Lilly and Novo Nordisk. Pharma does very good
| business.
| briandear wrote:
| Should they not profit on that capital invested for that
| research? Do landlords drop rents when the loan is paid off?
| Of course not, they're going to price rents what the market
| supports. Competition is what makes markets work. Invent a
| drug? And someone else invents a similar drug? Prices will go
| down.
| nvy wrote:
| There's no free market for lifesaving drugs. Just
| extortion.
| lxgr wrote:
| Is it ethical for a doctor to accept payment for life-
| saving services, then?
|
| A much more interesting discussion could be had around
| _who_ pays for it (and how, and how the prices come to be
| as high etc.) - because somebody ultimately does.
| gtvwill wrote:
| Nope it's not. They can get paid a wage from gov and
| charge nothing. Private Healthcare in its entirety is
| unethical. Shouldnt exist. Full stop.
| lxgr wrote:
| That's exactly the more interesting discussion I meant.
| Who pays the doctor, nurse, pharmaceutical companies, how
| are wages and prices negotiated etc.
|
| But I hope you agree that in all of these models, the
| doctor does in the end get paid, i.e. accepts payment? I
| never said that the patient should be the one paying them
| directly. But if nobody does, there will be no doctor.
| maxcoder4 wrote:
| That sounds noble but... What do you propose? Free drugs
| for everyone? If nobody is allowed to profit on
| researching drugs, nobody has a reason to sponsor drug
| development - which is very expensive.
|
| Of course I agree this market should be regulated - like
| we regulate it in Europe - but at the end some company is
| investing into drug research in order to make a profit.
| gtvwill wrote:
| Rental markets rooted where I am. Fails to provide for
| society the purpose it exists for. So yeah if your saying
| big pharma is the same sure I'm on board.
|
| Profit enough to survive. But don't take more than your
| worth. Tbh profiting off medicine is about as low as
| profiting off weapons manufacturing. You literally make
| money out of the misery of others.
|
| Thank f#@k I live in a country that has free healthcare.
| The concept of privatizing the health of your citizens and
| letting a select few profit from that is absolutely batshit
| insane.
| lostlogin wrote:
| There is an awful lot of sympathy for the drug company in this
| thread. You are correct, research and approval is expensive.
| But at some point there is a limit.
|
| Things like insulin are long paid off, and the pricing there
| has generated controversy. People have been charged $1000 a
| month for it [1].
|
| What's fair? They are screaming out to be regulated when they
| behave so badly, and that's what's happened with insulin.
|
| [1]
| https://www.thelancet.com/journals/landia/article/PIIS2213-8...
| pstrateman wrote:
| Insulin isn't a single product.
|
| If you're not distinguishing between insulin extracted from a
| horse circa 1922 and a modern synthetic analog, well that's
| just not being honest.
|
| There's good arguments that the modern synthetic analogs are
| overpriced, but that's a more subtle argument.
| lostlogin wrote:
| The situation described in that Lancet article doesn't seem
| very subtle.
|
| And if the US is able to impose maximum pricing that is so
| much lower, it would seem likely that price gouging was
| occurring.
| pstrateman wrote:
| The lancet 'article' doesn't actually say anything. It's
| just a political hack job.
| zachmu wrote:
| When people complain about being forced to pay thousands a
| month for insulin, they're talking about the newest
| synthetic insulins that were developed very recently at
| substantial costs.
|
| They could take the older insulins for $50 a month, no one
| is stopping them. It's just that those older products are
| less convenient.
| lostlogin wrote:
| So why is older insulin more expensive in the US than
| elsewhere, by a large margin?
|
| https://www.visualcapitalist.com/cost-of-insulin-by-
| country/
|
| https://www.rand.org/pubs/research_reports/RRA788-2.html
|
| https://worldpopulationreview.com/country-rankings/cost-
| of-i...
| pstrateman wrote:
| Only the last one makes the distinction between modern
| synthetics and basic insulin.
|
| Frankly the US pays for the cost of the research while
| the rest of the world just pays for the cost of
| production.
|
| If you want to fix the cost of insulin products (and many
| other drugs) in the US you need to figure out how to make
| everybody else pay for the true costs.
|
| Edit: also your last source there doesn't even know what
| it's talking about Novolin is a generic brand name for 3
| distinct products that have distinct pricing.
| lostlogin wrote:
| The argument that the US is paying for everyone else's
| drugs is often made in defence of big pharma, but their
| profits make it hard to swallow. In recent times the US
| hasn't really shown any other other signs of chasing
| socialist policy where it subsidises the rest of the
| world.
| ToucanLoucan wrote:
| > Frankly the US pays for the cost of the research while
| the rest of the world just pays for the cost of
| production.
|
| Oh come the fuck on, this has been the talking point
| since the early 2000's. Surely nobody still believes this
| horse shit. Phizer by itself raked in 50 billion last
| year alone.
| lostlogin wrote:
| It comes up here in NZ every few years, as there is
| frustration that we aren't paying as much as the drug
| companies would like. The US leaned on us hard to scrap
| our single payer system.
|
| This sympathy for these massive companies in this thread
| depressing. Big Agg and Big Tech don't get this free
| pass.
| ToucanLoucan wrote:
| It was depressing in 2008, now it's just pathetic. It's
| no wonder they feel so emboldened to continue fucking
| people raw for their medications, they have hordes of
| defenders in government and otherwise ready to offer page
| upon page of apologia for their rampant profiteering.
| pstrateman wrote:
| Pfizer's world wide net income was $2.12bn USD in 2023.
|
| I guarantee you 100% of that came from the united states.
| aaomidi wrote:
| Okay? Then if the US starts changing its policy they
| won't make stupid deals with the rest of the world then.
| votepaunchy wrote:
| Pfizer net income for 2023 by quarter. After taking in
| 10s of billions in vaccine profits this certainly looks
| like some fun accounting.
|
| 2023-12-31 $-3,369 2023-09-30 $-2,382 2023-06-30 $2,327
| 2023-03-31 $5,543
|
| https://www.macrotrends.net/stocks/charts/PFE/pfizer/net-
| inc...
| mitthrowaway2 wrote:
| The history of insulin shows a great deal of involvement
| and progress made by researchers in several countries,
| and the US would probably not even rank as first among
| them.
| pstrateman wrote:
| Eli Lilly was the first commercial producer of insulin at
| any significant scale.
|
| Genentech developed biosynthetic human insulin using
| engineered ecoli.
|
| Eli Lilly produced the first of the modern synthetic
| insulin analogs.
|
| Literally every major breakthrough except the initial
| bovine extracts were done in the US.
| RealityVoid wrote:
| Novo Nordisk is based in Denmark and they did a lot of
| research. Of course, cherry picking the stuff Eli Lilly
| brought first makes it seem they are the ones driving the
| thing forward but it only makes sense in the wider
| contact and when compared with what other have done first
| as well.
| FireBeyond wrote:
| > Frankly the US pays for the cost of the research while
| the rest of the world just pays for the cost of
| production.
|
| Top 10 pharma companies, 5/10 are US (2 UK, 2 Swiss, 1
| French).
|
| 4 of the top 6 for profit margins (from 43%(!) to 19%)
| are US (Merck is the only outlier, 9th, at 10%).
|
| 4 of the top 5 for Sales and Marketing Spend (both on raw
| dollars and as a percentage of revenue) are US.
|
| 3 of the bottom 5 for R&D spend (as a percentage of
| revenue) are US.
|
| Source: http://www.bbc.com/news/business-28212223
| Wytwwww wrote:
| That's a 10 year old article. Although if we rank by
| market cap top 6 are from the US these days (by revenue 5
| out 10 seem to be European) so not much has seemingly
| changed (besides Novo Nordisk becoming the second most
| valuable pharma company out of nowhere)
| zachmu wrote:
| Because almost nobody actually pays those prices
|
| > One key limitation of this study is that most of our
| analyses used manufacturer gross prices, not manufacturer
| net prices after rebates and other discounts are
| applied.16 Given the generally competitive insulin
| market, rebates in the United States are substantial
| (Mulcahy, Schwam, et al., 2021; Dickson et al., 2023).
| After applying a 76 percent manufacturer gross-to-net
| reduction, U.S. prices were roughly twice as high as
| those in other countries (compared with nearly ten times
| as high without the discount). We caution that these
| results likely underestimate the magnitude of the price
| differential because we were unable to estimate similar
| gross-to-net discounts in other countries. If
| manufacturer net prices in at least some non-U.S. OECD
| countries are lower than their manufacturer gross prices,
| the ratio of U.S. to other-country prices would be
| higher. In addition, because of data limitations, we
| applied a single U.S. gross-to-net reduction across all
| insulins. Actual product-specific gross-to-net discounts
| likely vary along product characteristics (for example,
| prescription versus over the counter and timing
| category). As a result, our estimated ratios of U.S. to
| other countries' prices for specific insulin categories
| likely reflect measurement error.
|
| As far as I can tell they also aren't attempting an
| apples to apples comparison, they're lumping all "long
| lasting" insulin drugs together. There is no such drug as
| "insulin", or even "long-lasting insulin". There are
| dozens of insulin analogs being sold at an incredible
| range of prices, easily over 10x from the most expensive
| to the cheapest.
|
| https://www.goodrx.com/healthcare-access/research/how-
| much-d...
|
| My default take on this kind of analysis is that people
| in the US are wealthier and are therefore paying for the
| newer, more effective, more expensive insulin drugs than
| people in other countries. I'm happy to be proven wrong
| on this but I haven't ever seen that analysis, they
| always conspicuously avoid direct comparisons of the same
| drugs.
| ikr678 wrote:
| This falls into a greater pattern of behavior in the us
| that I have noticed where pricing for almost everything
| is completely opaque. The price on the menu for a burger
| is not what comes out on the bill (tax, gratuity).
|
| The price for healthcare is beyond understanding for
| mortals. The price for drugs, again you and your
| neighbour could be paying something completely different
| for the same medication. The actual cost to your wallet
| for university? Who know, everyone seems to get different
| levels of subsidy and scholarship. Visa Cash App - you
| can make the same purchase on two different days and pay
| different prices, unique only to you.
|
| I find it incredibly exhausting to visit the US and
| navigate all these pricing systems, I dont know how you
| have let this become a psychological status quo.
| rufus_foreman wrote:
| >> So why is older insulin more expensive in the US than
| elsewhere, by a large margin?
|
| Here you go kid: https://en.wikipedia.org/wiki/Free-
| rider_problem
|
| Read that, and then you can explain to me the answer to
| your question.
| tacticalturtle wrote:
| One bit of nuance here is that you cannot buy FDA approved
| non-human insulin in the U.S.
|
| That's not because of an action by the FDA, but just that
| the manufacturers stopped selling it between 1998 and 2006:
|
| https://www.fda.gov/drugs/frequently-asked-questions-
| popular...
|
| So your only option is to buy the modern day synthetic
| analogs - or illegally import the old stuff, which the FDA
| notes here it has the right to block, but may allow under
| exceptional circumstances.
| throwup238 wrote:
| That limit is the length of a patent (plus/minus some factors
| like extensions and time to market). That's been the deal
| ever since the FDA was a thing. It's nothing new.
|
| My understanding is that the controversy is over a newer type
| of fast acting insulin that's not yet generic. In general
| insulin is really cheap, but the really nice new stuff makes
| life a lot easier for diabetics so everyone wants it.
| jauntywundrkind wrote:
| Turns out many many of the drug companies have been abusing
| the systems. The feds created a process for handling drug
| patents, and companies keep filing extenuating patents on
| existing stuff, and they also have been submitting not just
| drugs but devices to the registry illegally too, to hold
| monopoly. No one has guarded the registry.
|
| FTC is finally taking some charge, after all the other
| agencies (patent office, FDA) have failed to do any
| enforcement.
|
| Really good recent write up by the usual king of company &
| capitalism watching,
| https://www.thebignewsletter.com/p/monopoly-round-up-how-
| ftc...
| pfdietz wrote:
| > There is an awful lot of sympathy for the drug company in
| this thread.
|
| And for good reason.
| acchow wrote:
| > Things like insulin are long paid off, and the pricing
| there has generated controversy. People have been charged
| $1000 a month for it [1].
|
| Humalog and NovoLog both have expired patents. There are
| newer, better insulins. But these drugs were state of the art
| just 25 years ago.
| lostlogin wrote:
| The older products are much more expensive in the US too.
| It's price gouging, and that's when regulation has been
| imposed.
|
| The newer products are cheaper elsewhere in the world. The
| US is getting ripped off by big pharma.
| Scandiravian wrote:
| First of, I think that health-care prices in the US are
| horrible and have terrible consequences for patients
|
| However, the blame doesn't lie with pharmaceutical
| companies. They're not selling their products cheaper
| elsewhere because they hate the US and love other
| countries
|
| They're doing it because the US has created a system that
| benefits corporations more than its citizens. If blame
| needs to be distributed it lies with the people in power
| who built these systems and those who gave them that
| power
|
| Healthcare in Europe is cheaper because the population
| fought for it, sometimes literally
| aaomidi wrote:
| And they're actively lobbying to keep it that way.
| sheepscreek wrote:
| I can think of two reasons on how we got here:
|
| 1. Expensive drugs are expensive to compete again. Any new
| entrant will have an uphill climb. They will need a new way
| to solve the problem, so it doesn't infringe on the
| incumbents patents.
|
| 2. Drug manufacturing is still a niche business. In many
| other advanced industries, the tooling has become
| commoditized leading to a lower bar for entry and increase in
| competition. Repairing phone displays and soldering memory
| modules is now possible at home. Pharma is still waiting for
| that 3D printer/indie moment.
|
| I don't know if it's even possible - we're talking about
| chemicals and amino acids here. Every drug will need a
| different set of ingredients (not that different from cooking
| food).
| huytersd wrote:
| You can have selective outrage. Insulin is clearly
| overpriced. Semaglutide, maybe not as much.
| huytersd wrote:
| It's pretty simple. The US is the country that does the
| research and comes up with most of these drugs and has been
| extraordinarily successful at coming up with treatments for
| just about everything. We the citizens unfortunately bear the
| cost of the service we provide to the rest of the world.
| amelius wrote:
| Society contributed to that research in the form of education,
| academia, infrastructure, ...
| Cupprum wrote:
| And Novo Nordisk contributed back to society. By a lot. Large
| part of earnings goes to Novo Foundation, which is used to
| help people in Denmark and make it to a nicer country for
| people (even though its already amazing country).
| clumsysmurf wrote:
| There was a recent story right here on HN that contradicts that
| narrative.
|
| "Big Pharma spends billions more on executives and stockholders
| than on R&D" https://news.ycombinator.com/item?id=39405547
| consumer451 wrote:
| According to Acquired.fm, they are required to sell their
| products at cost in Denmark, and allowed to make up for that
| around the world. I am curious for feedback here on the
| accuracy of this information.
|
| I can't believe that I'm sharing YouTube shorts on HN, but this
| is the best way to share this info at the moment:
|
| https://www.youtube.com/shorts/IVut-PE6LCA
|
| https://www.youtube.com/watch?v=lsCvQSNsaVk
| yread wrote:
| Pharma stocks actually underperform compare to other companies.
| So, it's not like pharma companies are making insane profits.
| Research, regulation, approvals and failures are expensive
| FireBeyond wrote:
| > So, it's not like pharma companies are making insane
| profits.
|
| Huh.
|
| > Gilead Sciences gross profit for the twelve months ending
| December 31, 2023 was $20.618B
|
| Not insane profits, indeed.
| datavirtue wrote:
| Marketing spend dwarfs (dwarves?) R&D costs by multiple
| factors.
| TaylorAlexander wrote:
| I agree, someone has to pay for the research.
|
| Stories like this seem to pretty clearly represent the hazards
| of private funding for drug research. Publicly funded research
| and possibly publicly funded drug production could eliminate
| this issue.
| throwaway5959 wrote:
| If the EU can fine Apple and Google, the US should be able to
| fine Novo.
| lxgr wrote:
| If they have a case against them under US law, sure! Do they?
| Dah00n wrote:
| Why? EU have never gone after Apple or Google because of their
| prices. This isn't Apple. Novo Nordisk doesn't make medicine
| that only work if your other medicine is made by them or force
| you to use their payment card (?!?!?).
|
| If your point is the price then the US could go after every
| single US medicine company.
| throwaway5959 wrote:
| Absolutely they should.
| SahAssar wrote:
| That point is a bit different than comparing to Apple and
| Google.
| throwaway5959 wrote:
| I didn't raise it.
| SahAssar wrote:
| > If the EU can fine Apple and Google, the US should be
| able to fine Novo.
|
| So what did you mean by that?
| nabla9 wrote:
| That's against US law. The US has innovated the laws that make
| NN profits possible and helped other countries to adopt them.
|
| EU created anti trust laws that makes fining Apple and Google
| possible.
| throwaway5959 wrote:
| Citations for all of this please.
| pg_1234 wrote:
| US laws prioritize corporations over people.
|
| EU laws prioritize people over corporations.
|
| So EU corps selling in the US can bleed their customers
| dry, just like the local US corps.
|
| And US corps operating in the EU are restricted in the
| people's interest, just like the local EU corps.
|
| This is the just application of the respective laws as they
| stand.
|
| This is the outcome the respective populations voted for.
|
| Although the rest of the world does wonder what the US
| voters were thinking ...
| DarkmSparks wrote:
| why just novo nordisk?
|
| https://www.ndtv.com/world-news/at-850-000-drug-to-treat-bli...
|
| can be made for .1c
|
| heck, a top of the line AMD server chip costing $10,000 only
| contains a few milligrams of plastic copper gold and sand.
| TylerE wrote:
| "There are currently about 1,000 cases of people who suffer
| from hereditary degeneration of the retina, and 10 to 20 new
| cases are expected to be added each year."
|
| I mean, let's be realistic here.
| DarkmSparks wrote:
| so it would be better for orzempic to cost $850,000 and limit
| its indication to people with MODY?
|
| How is that realistic?
|
| TBH I have way less a problem with pharma industry being
| allowed to make profits than health insurance companies. In
| fact the US is about the only country in the world that
| allows profits from health insurance.
| Ekaros wrote:
| I don't see health insurance making profit being
| unreasonable. That is key reason why anyone would run an
| insurance scheme. Now the USA model is entirely wrong. But
| fundamentally, to offer insurance you must get something
| out of it.
| DarkmSparks wrote:
| health insurance profit is forgone health.
|
| every other country only allows them to exist as not-for-
| profits.
|
| whereas expensive medicines just make health insurance
| less profitable.
|
| This is the basic principle behind why the US spends the
| most in the world on healthcare to achieve among the
| worst outcomes (e.g. same life expectancy as most
| undeveloped 3rd world countries)
| TylerE wrote:
| The target market for Ozempic is tens of millions of people
| taking it every week.
|
| The blindness thing has a worldwide demand cap of about 40
| doses per year - it's a single dose for life in each eye).
|
| Are you equally surprised when a one-off bespoke PCB costs
| more than a stock RaspPi?
| j7ake wrote:
| Novo Nordisk is now Europe's most valuable company. Congrats to
| them.
| throwaway35777 wrote:
| I mean, they just cured _obesity_. Surprised Sen. Sanders is
| trying to take away the revenue from their discovery given the
| massive public health benefit in the U.S.. Surely the reduced
| healthcare cost from curing obesity is worth the $12k /yr per
| obese citizen.
|
| I don't want to see U.S. policy drive away the next company
| that's trying to cure a crippling illness.
| Scandiravian wrote:
| I get that point, but given that Ozempic sells for
| significantly less in other countries I think it's worth
| considering why it's that much more expensive in the US
| SmellTheGlove wrote:
| Exactly this. And it's because the US consumer is paying
| for the R&D on drugs for the rest of the world. We could
| balance this out a bit by passing a law that says the
| retail cost of a drug in the US can't be any higher than
| the median of the EU + Canada (or something approximating
| the set of developed economies).
| Scandiravian wrote:
| I do get that point, but I'm not sure it would actually
| work
|
| Drug prices in the US are, in part, higher because FDA
| requirements are much, much stricter so it's more
| difficult to actually get a drug approved. It's simply
| more expensive to launch a product in the US, so if it
| becomes less profitable it might not be worth the risk
| for companies
|
| You could also risk that drug companies launch an
| analogue of the effective compound in the US to
| circumvent such a regulation, since it would be two
| different drugs
|
| The reason it's cheaper in Europe is in some part due to
| having single payer healthcare, which mean that there's a
| single entity negotiating purchase prices for the entire
| country, which improves bargaining power significantly
| xyzal wrote:
| Isn't everything healthcare-related much more expensive in
| the US?
| pfdietz wrote:
| It's because those other countries are free riders.
|
| I think we should do the same thing in reverse on limiting
| CO2 emissions. How does that sound?
| Scandiravian wrote:
| Can you elaborate on how other countries are free riders?
|
| It's not like the board at Novo has a board meeting where
| they decide "we hate the US so lets charge them more for
| our products"
|
| The simple fact is that the US has higher drug prices
| because it has created a healthcare system that allows
| pharmaceutical companies to charge much more for their
| products
|
| The way to lower drug prices is to change the system to
| prevent that
| pfdietz wrote:
| They have monopsonies. The drug maker has a choice of
| either losing some operating profit or going along with
| the price they set. The free riding is in these countries
| not paying a price that pays their share of the
| development cost of the drug.
| Ekaros wrote:
| These companies are not selling drugs at loss in these
| countries. And these countries are not forcing the sale
| of drugs in the first place. The companies choose to take
| some profit over none. That does not make smarter
| countries that do negotiation anyway free riders.
| pfdietz wrote:
| Indeed, they are not selling the drugs at a price that is
| below their marginal costs. But they are also not selling
| drugs at a price that compensates them for the
| development cost, including the cost of drugs that didn't
| reach the market. They are free riding on this latter
| part.
| ethanbond wrote:
| They almost certainly didn't cure obesity. Food manufacturers
| are already scrambling to figure out how to make foods even
| more compelling and less satiating.
|
| Regression to the mean, and our grocery selection will suffer
| further.
| Scandiravian wrote:
| Their market cap is also bigger than the GDP of their home
| country (Denmark)
|
| As a Dane that's pretty terrifying to me (see Nokia and Nortel)
| nabla9 wrote:
| Apples to oranges comparison. Revenue to GDP is better.
|
| Novo Nordisk $35 billion in revenue.
|
| GDP of Denmark:$400 billion.
|
| Their revenue is roughly 9% of GDP.
| Scandiravian wrote:
| I think that depends on what I'm trying to illustrate
|
| There's a lot of pensions and savings tied up in Novo
| stock, so a potential downturn would have a catastrophic
| impact on the danish citizens
|
| The danish economy is, to a large extend, dependent on the
| stock price of Novo, not its revenue
| eliben wrote:
| Adobe facing pressure as study finds $99 program can be made for
| $0
| lxgr wrote:
| Let's be reasonable here: CDNs aren't free. They might be
| spending a couple of cents per user!
|
| But yeah, people might not like the implementation or idea of
| intellectual property, but that's what's happening here.
| Pretending it's something else makes it hard to argue about it.
| musicale wrote:
| $60/month, but that does include 100 GB of storage that you
| might otherwise have to store on a $20 SD card.
| kgbcia wrote:
| Goes for any software that can be copied
| lostlogin wrote:
| It's not quite the same, although I'm assuming that no one
| needs Adobe to stay alive.
| andrewstuart wrote:
| I literally laughed out loud when I read this and that actually
| pretty much never happens despite sending LOL in text messages.
| Scandiravian wrote:
| I think the complexity of the issue isn't really reflected by the
| article. The most obvious points that are missing are the risks
| associated with developing a new drug, the costs of research, and
| the regulatory requirements from the FDA
|
| Since pharmaceutical companies are, for the most part, publicly
| traded they're beholden to stock holders to create a profit. If
| they stop doing that they're in trouble
|
| If the ability to generate profit from developing new drugs are
| limited, they'll simply stop doing it
|
| Personally I think this kind of profit incentive for healthcare
| is perverse and ultimately doesn't serve public interest, but
| until the systemic issues behind these prices are addressed, I
| find it difficult to see a solution that'll ultimately benefit
| the end-user
| lostlogin wrote:
| Regulating drug pricing is what has started to happen. And I'll
| bet they don't like that.
|
| A single payer system would at least change the negotiating
| power that big pharma has - even in a small market, drug
| companies hate dealing with a single buying. Here in New
| Zealand the point even made it into the TPP agreement
| negotiations. The US wanting our (deeply imperfect) healthcare
| system to be a bit more like the US one is rather grim.
| Scandiravian wrote:
| Completely agree. That's part of why Ozempic is cheaper in
| Europe. I actually worked for the company who negotiates drug
| purchases for all hospitals here in Denmark (Amgros), so I'm
| somewhat familiar with the process
|
| There's flaws in this approach as well, but in the end it's
| definitely an improvement to the issues US patients are
| facing in regards to costs
| aceofspades19 wrote:
| No, publicly traded companies are beholden to act in the
| interests of the shareholders which in practicality is fairly
| vague. All companies are sort of designed to turn a profit or
| try to as they generally need that to continue existing but
| there is no legal requirement that they need to create a profit
| or maximize it, publicly traded or not. Obviously, companies do
| try to maximize profit as it makes everyone involved money but
| they don't have to.
| quotemstr wrote:
| The world no longer has an obesity problem. It has a semaglutide
| access problem. We can't manufacture virtue at scale, but we can
| make vast amounts of a simple organic compound.
|
| Give it away. The public health benefits will pay for themselves.
| kwhitefoot wrote:
| Wouldn't be better for people to simply eat better? Obesity
| levels are much lower in Norway than they are in the UK and US.
| As far as I can tell this is because in Norway we simply eat
| less fast and ultraprocessed food.
| quotemstr wrote:
| > Wouldn't be better for people to simply eat better?
|
| Has a half-century of telling people to "simply eat better"
| worked?
| hilux wrote:
| By the same logic, all software should be free, because the cost
| of manufacturing the bits is zero! (Yes, I'm very aware of rms
| and the FSF.)
| kaashif wrote:
| > (Yes, I'm very aware of rms and the FSF.)
|
| rms and the FSF believe selling software is totally fine as
| long as you provide source code to your users.
|
| They don't think there's any moral imperative for software to
| be free as in priced at $0, but software should respect its
| users' freedom.
| icegreentea2 wrote:
| The paper models a competitive (cheaper) and conservative (more
| expensive) pricing. The conservative model assumes a 50% profit
| for Ozempic (the competitive model assumes 10%). These are
| margins that cannot realistically sustain drug development in the
| current western regulatory regime.
|
| At the same time, its quite clear that the cost of drugs,
| particularly in the US is out of control.
|
| In that sense, focusing on the fact that a company that received
| the technical data package and plant for manufacturing Ozempic
| for free could then indefinitely sell Ozempic for $5 a month is a
| red herring, and not likely to lead to any fruitful change. The
| price differential between US pricing and say... UK pricing ($350
| a month for injectable Ozempic vs ~$80 a month) is enough to
| hammer in on.
|
| On a side note, what I found interesting is that while the
| article says a injectable Ozempic can cost ~1k a year, the actual
| study marks it at more like $350 a month.
| homero wrote:
| Yeah that's almost every drug so what
| 8thcross wrote:
| this is the conundrum the US Pharma is facing. GLP1 took NN 10+
| years of investment to come up. Acquired podcast has a great
| story about them. The middleman is what is different between the
| various country healthcare systems. USDOJ is trying/tried going
| after but one word - lobby. The regulation required is for
| consumer to directly buy from pharma skipping all middlemen. my
| 2cents.
| sudosysgen wrote:
| NN didn't come up with GLP1. It's a natural peptide, and people
| have been taking it for a very long time. Nordisk did get it
| approved, yes, and that was costly, but let's not massively
| overstate the innovation.
|
| Semaglutide is not GLP1, it's a bit different. But it's not the
| first GLP1 analog. It's not even the first to be approved :
| AstraZeneca was the first to get a GLP1 agonist approved, in
| 2005. In fact, it even is used off label for obesity.
|
| Nordisk's big break was convincing the regulators to get it
| approved for obesity and not just type 2 diabetes.
| tokai wrote:
| All drug research and production should just be done with public
| money by the public sector. Drug companies are already deeply
| reliant on university produced researchers and research, and in
| most cases the actual drug production is trivial. Imagine the
| human and economic benefits if there was no profit barrier to
| health.
| Quinzel wrote:
| Doesn't the price of a drug come down only once the patent
| expires and other drug companies can start making it?
|
| But the reason they have patents that last like 20 years is to
| allow them to recover the costs of R&D.
| lvl102 wrote:
| Who educates these scientists through PhD programs? Oh, OK. So we
| are paying these people to get their PhDs so they can go and
| start a company to scalp people with drugs that deliver 10% lift
| in efficacy. What a scam model.
| Cupprum wrote:
| How much do you know about this? Novo Nordisk sponsors many
| universities around Denmark, they pay a lot of money for those
| graduates.
| andrewstuart wrote:
| So this boils down simply to cost based pricing versus value
| based pricing.
|
| Novo Nordisk is applying a pricing strategy that reflects demand
| and what people are willing to pay.
|
| https://en.wikipedia.org/wiki/Value-based_pricing
|
| There are many, many MANY people in this world will to pay for
| this on the basis of value. Heck if I had a lazy $5,000 I'd buy 5
| months worth of the stuff and I'd be extremely happy with my
| purchase and I would not care what it cost to make.
|
| Losing 20 kilos is easily worth $5K to me.
|
| The only problem is I can't get it at any price - Wegovy is
| simply not available here in Australia and for all I know it
| might take 10 years until they can make enough to supply the
| market.
|
| If someone could get it for me I would pay them except I'd never
| trust the black market - you're unlikely to be getting the real
| thing.
| nabla9 wrote:
| There is currently a supply problem. Novo Nordisk is building
| more capacity, but it takes time. Meantime those who are willing
| to pay more for it, get it. Mostly citizens of rich countries.
|
| Novo Nordisk is controlled by the Novo Nordisk Foundation (>
| 77.1% of votes, 28.1% of capital) with aim to make a positive
| impact on health, science, and society by generating long-term
| returns on the assets of the Novo Nordisk Foundation.
|
| One of the reasons why Novo Nordisk has been so successful is
| because their owner takes a long term view in R&D unlike purely
| profit-seeking owner.
| Ekaros wrote:
| I'm not sure there is other model, unless we move to entirely
| funding drug research publicly. And then set some bidding process
| for manufacturing...
| fvdessen wrote:
| I find it a bit jarring that first reaction from the American
| public to foreign companies finding success in the USA is think
| about nationalising them. You see this in this thread, but also
| with TikTok. It's especially strange given the usual total
| economic dominance of the USA over the rest of the world. Did big
| tech get so rich by charging low prices ? Is the rest of the
| world 'subsidising' the Silicon Valley ?
| j7ake wrote:
| They made a product that people want to pay lots of money for.
|
| I don't see why they should not be allowed to price this product
| to meet the insanely high demand.
|
| How much it costs to make is irrelevant to the discussion. This
| drug wouldn't have existed without Novo Nordisk, they deserve to
| profit so they can continue making new drugs.
|
| What is next, should we limit the amount of money JK Rowling can
| make off her books because it is essentially free to produce?
| gizajob wrote:
| You know what else is cheap and helps with weight loss?
|
| Bicycles.
| RcouF1uZ4gsC wrote:
| I want Pharma to be incredibly profitable. I want kids to sign up
| for chemistry majors hoping they can work for pharmacy companies
| rather than sign up for computer science hoping they can work for
| companies serving ads.
|
| I want there to be full employment for experts in drug design and
| testing.
|
| I don't want Pharma to be a limited profitability industry that
| slowly loses money and talent to other industries such as tech or
| entertainment.
|
| I want kids to dream of becoming the next billionaire by develops
| drug that cures cancer rather than becoming a billionaire by
| inventing a more addictive social media app.
|
| Talent goes where the money is. If the money gets removed, the
| innovation will slowly go away. And like with Boeing, it may take
| decades for the results to be fully realized.
|
| Covid-19 demonstrated how important Pharma was to society. With
| the vaccines, Pharma yielded a consumer surplus of literally
| trillions of dollars (just from being able to re-open the
| economies).
|
| Yes there was academia that had the basic research, but you
| needed companies and scientists that had years and years of
| experience designing, testing, productionizing, and distributing
| medicines and vaccines.
| datavirtue wrote:
| Wait until everyone realizes the drug does more harm than good.
| sschueller wrote:
| Ozempic is potentially not good for you in the long run [1] and
| for almost everyone it would be much better to eat better and
| exercise a bit.
|
| The person who can't afford the 1k and is forced to fix their
| diet will be healthier in the long run ironically.
|
| [1] https://vial.com/blog/articles/what-clinical-research-
| says-a...
| aaomidi wrote:
| Not understanding how this medication makes this possible is
| part of the problem here.
| RealityVoid wrote:
| I strongly success people listen to the Aquired episode on Novo
| Nordisk. It's quite interesting and we'll researched.
|
| https://www.acquired.fm/episodes/novo-nordisk-ozempic
|
| If you don't want to listen, there is the transcript right there
| on the page.
|
| In there, they mentioned "It's pretty interesting. Pharma as a
| whole of the medical pie only occupies about 13% of revenue."
|
| "The administrative costs of health insurance are 8%."
|
| "I will say, who is taking any risk in this whole ecosystem? It's
| only pharma. Who's taking risk to innovate and make anything
| better? Every other bet that a hospital makes or that an
| insurance company is just probably going to pay off."
|
| Say what you will, but pharma is pushing healthcare forward so I
| am not against them making money. Of course, I also don't want
| people to have lack of healthcare access because merely money, so
| there is a line to tow here.
|
| The way insurance and drug pricing works in the US is bonkers and
| I would not solely blame pharma for that.
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