[HN Gopher] Big Pharma claims lower prices means giving up mirac...
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Big Pharma claims lower prices means giving up miracle medications.
Ignore them
Author : rntn
Score : 64 points
Date : 2024-08-25 20:14 UTC (2 hours ago)
(HTM) web link (www.vox.com)
(TXT) w3m dump (www.vox.com)
| AlbertCory wrote:
| Drug for discussion:
|
| Bimzelx (for psoriasis). This costs six figures or more per year,
| from what I can glean. Watching baseball a lot, I see this
| advertised multiple times per game, and God only knows what else
| they spend on marketing. (I don't have psoriasis
| or know anyone with it, if that matters)
|
| Looking at UCB's financials (helpfully broken out by drug), they
| took in $242 million on that drug alone in fiscal 2024. So that's
| how they can afford all those ads. It's also probably something
| patients would demand, and maybe even be happy to pay for out of
| pocket.
|
| > they will help the Medicare program cap what individual
| patients spend out of pocket on their prescriptions in a year at
| $2,000.
|
| So if you want clear skin, you probably have to pay big bucks.
| But maybe these immensely profitable drugs subsidize the life-
| saving ones.
| bryanlarsen wrote:
| > (I don't have psoriasis or know anyone with it, if that
| matters)
|
| Psoriasis is very common, especially the mild forms. You
| probably know people who have it.
| __MatrixMan__ wrote:
| C6552 H10132 N1750 O2029 S42, 147229.87 g*mol, what a monster.
| Probably not making that one in your garage.
| exyi wrote:
| It's apparently a monoclonal antibody
| (https://en.wikipedia.org/wiki/Bimekizumab). That's just a
| protein, so it might actually be easier to make in your
| garage than your average small molecule ;) ... not that
| either would be practically possible, but it might be
| available in countries where they don't care too much about
| patents and such
| twic wrote:
| And if you're really willing to DIY, easier to make in your
| body than in your garage.
| zdragnar wrote:
| Clear skin is the least of the problems with psoriasis. From
| their website: Bimzelx, alone or in
| combination with methotrexate, is indicated for the treatment
| of active psoriatic arthritis in adults who have had an
| inadequate response or who have been intolerant to one or more
| disease-modifying antirheumatic drugs (DMARDs).
|
| In other words, it's for people with bad cases who don't
| respond well to other drugs. Keep in mind, other drugs often
| come with serious complications- constant use of topical
| steroids will thin your skin, and give you glaucoma if you
| develop it and use them near your eyes. Many biologics have
| even worse potential side effects.
|
| On top of that, psoriatic arthritis is degenerative, if you're
| unlucky enough to get that too, so not treating it means not
| only constant pain, constant threat of skin infections from
| scabbing, but permanent joint damage.
|
| I ended up on Taltz, another very expensive biologic, but the
| eli lily foundation covered almost all of the cost since my
| insurance wouldn't. Before then, I looked like an alcoholic,
| because my nose was constantly red and inflamed, and I didn't
| have anything safe to put on it- glaucoma runs in my family,
| and I wasn't brave enough to risk anything strong enough.
|
| If that was the only problem, I might not have even gone the
| route of Taltz, but I was also developing it all over my body,
| and there wasn't much that was helping.
| AlbertCory wrote:
| Thanks.
|
| I finally realized I was seeing this ad _constantly_ and
| decided to look into it.
| vostok wrote:
| Assuming this is post-Obamacare, do you know why your
| insurance didn't cover it? I had this simplified model that
| insurance covers everything once you hit maximum out of
| pocket and I'd love to learn how that model breaks down in
| practice.
| maxerickson wrote:
| Your insurance has a pharmacy benefit manager (PBM) that
| has a formulary (the list of drugs they cover). Multiple
| insurers might use the same PBM. New drugs aren't
| automatically covered, as they haven't necessarily made the
| calculation that the cost of it justifies using it versus
| the alternatives.
|
| It's intentionally complicated in order to fracture
| responsibility, avoid paying out claims and extract payment
| from publicly funded insurers.
| howard941 wrote:
| _If_ the medication is on the formulary the max out of
| pocket is usually somewhere around $12K. It 's not capped
| if it's not on the formulary. And fancy new drugs are often
| off the list.
| Neil44 wrote:
| Obviously you need to subtract costs from that, not just
| production costs for this year but development costs, and the
| development costs of other drugs that didn't even make it to
| production.
| AlbertCory wrote:
| > Obviously
|
| Yes, it is. I didn't say it was all profit.
| fgonzag wrote:
| My feet have had open wounds for the past year due to psoriasis
| (and I've gone to every dermatologist I can). It's not just
| clear skin, it gets very bad with quite painful wounds from the
| scratching. Especially in hot humid conditions, and I play
| tennis a lot. 3 people I train with have bad cases, as in
| having to stop playing for a while
| BenFranklin100 wrote:
| You seem to be implying the advertising costs are a significant
| driver of the price for drugs. They are not. The significant
| driver of the cost in drug is the development costs, including
| the cost of the many failures along the way. Also, in general
| and not specific to this case, the prices need to targeted high
| enough to encourage investors to invest in the first place. If
| prices are not set at a sufficient premium to offset the
| volatility and risk, in the future investors will realize
| biomedical research is a poor investment and put their money in
| less socially beneficial investments like Facebook.
| AlbertCory wrote:
| > You seem to be implying the advertising costs are a
| significant driver
|
| No, I'm not. That's in your mind.
|
| The advertising costs can be justified by their return.
| Business 101.
| BenFranklin100 wrote:
| Ok good, thanks. I just wanted to clarify that point for
| other readers.
|
| As an aside, as someone who works in the life sciences
| field, I'm a bit conflicted about advertising new
| therapeutics. I see why it is an often necessary practice
| in order to raise awareness among potential patients. On
| the other hand, in an ideal world, primary care physicians
| would be up on the latest therapies and recommend them to
| their patients as appropriate. Sadly, that is not always
| the case.
| AlbertCory wrote:
| Good, I thought we were about to have a flame war there.
| People are so accustomed to everything having an
| ideological point that they infer one if you don't say
| it.
|
| Putting myself in the place of the doctor: if I say "hey,
| there's this new drug Bimzelx!" and then I have to tell
| the patient what it costs, I can imagine being happy to
| wait until THEY bring it up. Of course, if they just ask
| "are there any drugs for this?" I'd be duty-bound to
| answer.
| istultus wrote:
| Like many a disease with an old name, Psoriasis refers to a
| localized cutaneous autoimmune disease usually treated by
| dermatologists, and a severe family of Rheumatic (autoimmune)
| diseases, part of the Spondyloarthropathy family, that happens
| to have a cutaneous element which is the same (and often is the
| first symptom). This treats the latter, debilitating and
| possibly life-threatening variety.
| nemo44x wrote:
| What needs to happen is more and more money has to go to pharma
| from tax payers for novel medicine research. Today there is some,
| yes. But the vast majority of money comes from the markets. And
| anyone that has invested across the bio sector knows it's capital
| intensive and almost everything fails. Money is just burned
| through so quickly.
|
| So yes with lower returns investors will look elsewhere.
| Especially since overall pharma doesn't really outperform.
| There's no alpha across the sector.
|
| So the money has to come from somewhere. If not then yes,
| innovation will slow down.
| riffraff wrote:
| There's a problem with this line of thinking: the rest of the
| world already pays the same medicines less.
| nemo44x wrote:
| You're not serious, are you? The USA consumer subsidizes
| everyone else in many cases. Similarly to how the USA
| taxpayer subsidizes the protection of trade, supply lines,
| and logistics through her mighty military.
|
| Just compare the small and mid cap bio market of the USA to
| the rest of the world. These are the companies that get
| acquired by the large caps once they've gone through a P1 or
| P2 successfully. But most die before acquisition. This is
| where the real work happens in most cases.
| istultus wrote:
| The rest of the world has governments that negotiate directly
| the Pharma companies and strike up deals that subsidize the
| first X doses per year per Y number of people. Once the limit
| is passed it's the same for everyone - pay the price or find
| an alternative. NB that this doesn't happen only with US
| companies, e.g. Roche is very profitable selling Million-
| dollar-per-course cancer treatments. But in general, the fact
| that Pharma companies can sell at "full price" in the US
| subsidizes the drugs for the rest of the world.
| BenFranklin100 wrote:
| To add to your point about expensive failures, this weekend it
| was announced that Tome Biosciences is going belly up. This is
| only a few years after being founded on some very promising
| research out of MIT. That's $213M in investor money gone.
|
| https://www.statnews.com/2024/08/22/tome-biosciences-gene-ed...
| lvl155 wrote:
| US pharma already benefits from academic research which is paid
| for by tax money. This is a classic example of socializing the
| costs and privatizing the profits. Often times, you're looking at
| 10-100x the cost for "statistically significant" uplift in
| efficacy. What happened to value-based medicine?
| gruez wrote:
| Nobody is forcing you to buy the more expensive drug. You can
| always use the older generic version.
| mesk wrote:
| Well, 'somebody' might be forcing you, the illness itself,
| because the generic drug might not be good enough in your
| case.
| varispeed wrote:
| "privatising profits" is a bit vague term. May suggest that
| simply everyone but government benefits.
|
| I think it's better to say that it is socialising losses and
| making the rich richer.
| jimmar wrote:
| Why not make these same arguments for cars, food, or anything
| else that we buy? Just have the government negotiate maximum
| prices that manufacturers can charge. Maybe AI will help make
| cars cheaper in the future.
| cerved wrote:
| Is the US government not already negotiating the prices for
| cars and food it buys?
| mesk wrote:
| Car, food manufacturers etc... operate in mostly free market -
| pharma, insurance, hospitals operate in highly regulated markes
| and 'somehow' for all of them is better if the price goes up,
| because 1% of 10mio is more than 1% of 1mio. And what is maybe
| also important, when buying car you pay for it directly, and
| know the price in advance and there is no urge to buy it just
| to stay alive...
| saulrh wrote:
| If funding pharmaceutical research is a common public interest,
| then it should be funded the way all common public interests
| should be: taxes. Taxes pay for the weather predictions that make
| modern agriculture possible. Taxes pay for the basic physics
| research that keeps Moore's Law on track. Taxes pay for the
| transportation and logistics infrastructure that make the modern
| economy possible. Taxes pay for the fire engines that might keep
| your house from burning down some day. Taxes can and should pay
| for the pharmaceutical research that makes modern medicine
| effective. This kind of generalized "everybody needs it but no
| single person can pay for it and trying to do it through
| capitalism distorts everything" benefit is precisely what taxes
| are designed for.
| gruez wrote:
| Right, but what sort of taxes? If the answer is "just an
| overall tax on everything", then that's basically the status
| quo, with all the accompanying "socializing the costs and
| privatizing the profits" (eg. [1]). If it's tax on the industry
| in question specifically, then that's something that's not
| usually done. For instance, you mention "Taxes pay for the
| basic physics research that keeps Moore's Law on track", but to
| my knowledge there's no semiconductor tax to attempt to recoup
| the cost of that research. The same goes for agriculture. You
| might have a point for roads since they're financed via a fuel
| excise tax, but it doesn't generalize to ocean/air freight.
|
| [1] https://news.ycombinator.com/item?id=41351872
| spondylosaurus wrote:
| Half-joking, half-serious counter: why not socialize the
| costs and socialize the profits, too? Think big!
| firesteelrain wrote:
| Taxes do pay for pharmaceutical research though private funding
| makes up the majority of the funding. For example, NIH, DoD and
| CDC all provide funding.
|
| NIH has an annual budget of $45 billion - all taxes.
|
| [1] https://www.nih.gov/grants-funding [2]
| https://jamanetwork.com/journals/jama/fullarticle/2775400
| Noumenon72 wrote:
| Am I summarizing this article right?
|
| * The US premium paid is 150% of R&D costs, therefore cutting it
| will only cut spending on the costs that aren't R&D
|
| * M&A did not drop in the first year of the program, which
| covered 10 drugs, therefore the program will have no effect once
| phased in
|
| * We think AI might develop new drugs for us someday, so it's
| safe to throw away the existing system today
|
| Not very solid reasons to go after the golden goose!
| mschuster91 wrote:
| First, one thing to keep in mind: "Big Pharma" is the medical
| equivalent of "venture capital" in technology. They buy up _a
| lot_ of patents and very early stage startups in the hope that 1
| or 2 of 100 investments actually strike it big, and that explains
| a part of why new medical innovations cost so much - all the loss
| has to be distributed.
|
| > It is a harrowing proposition: that in trying to control drug
| prices for 67 million Medicare patients now, we might
| inadvertently prevent the development of future drugs that could
| save lives. Implied, if not stated outright, is that we're
| putting a cure for cancer or Alzheimer's or some other
| intractable disease in jeopardy.
|
| Well... given that _a lot_ of the fundamental research in
| pharmaceuticals happens at universities and /or on taxpayer
| grants, what exactly is preventing the US government from taking
| over the later stages of development _and the associated risk_
| itself, and only use external providers for manufacturing at
| scale?
|
| Of course, it's a rhetorical question. The answer is two-fold
| here - primarily the obvious: large parts of the US (and most
| Western nations facing similar questions) prefer a "small state",
| preferably as small as possible. But there's also a second
| answer... the US' _very_ dark history in government-run medicine.
| The Tuskeegee syphilis study, the consistent discrimination
| against PoC and women in medical research, MKULTRA or the US just
| about permanently burning all of its trust across the world by
| using "vaccination drives" as a pretext to verify Bin Laden's
| presence in that compound in Pakistan [1] - antivaxxers, Covid
| deniers and their ilk didn't sprout up from nothing, they have
| very fertile soil.
|
| [1] https://www.npr.org/2021/09/06/1034631928/the-cias-hunt-
| for-...
| Kye wrote:
| What good is a miracle if the only people who can afford it don't
| need it because they can afford to maintain their health?
| pg_bot wrote:
| Would you rather live in the world where we don't have a
| solution or the world where the solution is expensive now but
| will eventually become cheap?
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