What is “supposed” to be driving the costs down, universally, are when more people “buy into” the ACA. This helps distribute the costs to everyone. It’s still too early to determine if this is actually working since the “penalties” for NOT buying into Obamacare (tax penalties) only just started. Once those who are not in ACA begin getting the heftier fines each year they’ll buy in and then perhaps we’ll begin to see if the system works (aka - prices reducing for everyone)
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Which [quote=“Sam19, post:19, topic:56261”]
Well that part actually is pretty easy to explain . . . How much was the sale price of your home when you bought it? Now what is the sum of all of your mortgage payments combined over 30 years?
[/quote]
It’s easy to explain because the “easy” explanation makes utterly no sense. My mortgage payment is steady across the entire 30 years, and the interest paid goes steadily down, not up. Epi pens have been around a long time. If amortization were actually the controlling factor, their price would be dropping, not rising.
And all of this ignores the fact that a home is a single purchase spread out over years, not a single atomic transaction completed and finished on the spot. A home purchase is like prescription drug marketing in the same way that a cup of coffee is like an automobile factory. That is, not at all.
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Your mortgage payment stays the same but if you add up all of your principal and interest payments over 30 years you reach a sum several times the purchase price of the home. Kinda like amortizing the cost of research and development (or anything else for that matter) over many years…
Anyway that doesn’t give them the excuse to gouge the hell out of us, which I firmly believe they are doing.
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Yeah, except Mylan has zero research and development costs in regards to the epipen. They acquired the rights to it as part of another closed door behind the scenes deal made with Merck. And 40% of all Mylan profits come from the Epipen. They’ve even paid off the FDA and congress to deny competing companies making generics of the epipen coming onto the market.
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One word: Mylan.
Two words: Greedy Bastards.
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Insurance companies have an anti trust exemption that goes back to WWll.
Believing that they don’t exploit this to gouge their customers is to suspend belief in basic human nature.
An attempt was made to end this during the Obama Care debate but it never had a chance, way too much lobbying money involved.
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No it doesn’t.
It assumes nothing. I am only asserting the reality that development costs are heaped on the backs of US patients – nothing more.
While it is true that a disproportionate share of new treatments and discoveries are the yield of US companies, certainly there are plenty of foreign miracles as well.
Ironically, these companies base a disproportionate share of their R&D activities in the US, and like US companies, recoup amortized costs on the backs of US patients.
Not sure why this gets so contentious. It’s simply a fact. Indeed, it’s the very reason we have this discussion in the first place: High prices in the US system, while those elsewhere in the world pay a pittance due to price controls.
Please, can we just have a rational discussion? I am, truly, very open-minded about this. I certainly may be missing something that would radically change my thinking. The fact-pattern I’m dealing with is modest drug-company profits (really, quite unexceptional), high prices for things like Humalog here in the US($250/10ml), low prices in places like Canada, the UK, Germany, etc. etc. (around $25-50/10ml).
Those are simply facts. Somehow, when all that Humalog is sold, Lilly doesn’t seem to make much profit. Despite the high prices in the US. Lower those prices, and I expect they will make less than the modest profit they’re making. Indeed, I am concerned it may not be profitable at all, in which case there is a risk it would no longer be available.
Someone please tell me where I’ve erred in this analysis. I’d like to get away from emotionally provocative things like “greed”. I’d rather understand HOW, given the actual financials of the drug industry, prices in the US are brought down in line with, say, Canada, and drug companies still make a profit and stay in business.
You’d have me if profit margins in the drug industry were like the software industry. But they’re not.
Someone please explain this to me.
[quote=“Jason99, post:24, topic:56261, full:true”]
Yeah, except Mylan has zero research and development costs in regards to the epipen. They acquired the rights to it as part of another closed door behind the scenes deal made with Merck. And 40% of all Mylan profits come from the Epipen. They’ve even paid off the FDA and congress to deny competing companies making generics of the epipen coming onto the market.
[/quote]And here is exactly what I was referring with the Epipen.
Is Mylan being greedy? Honestly, without the ability to examine their internal financials, I can’t say. Is their overall profitability way out or line? Again, I don’t know. However, I don’t care if this one, particular company is greedy or not – they’re not the problem.
They have no power. They can’t make law. They can’t force others NOT to make competitive products.
No, the only party that has that sort of power is government. And that’s exactly what the problem is here.
Epinephrine is nothing novel. Nor is an autoinjector delivery system. Mylan has a monopoly, resulting in what monopolies always do: Poor product/service at insane prices.
The reason for this is government regulation. Pure and simple. Corrupt regulation. Regulation tailored to help Merck, and now Mylan, keep their monopoly.
What always strikes me is how so many people, in situations like this, blame and are angry with the private company, rather than the politicians and regulators. I’m odd, I guess, in that I have no animosity for the private company, lobbying and trying to get the best possible environment it can for its situation.
In other words, act in its own interest. That’s what I expect private parties to do.
My wrath is reserved for the “public servants” whose fiduciary is the general public at large, yet engage in corruption serving narrow interests to their own personal benefit – usually.
And the answer to this so many of you seem to favor is – MORE regulation, more control by government officials, the very people that act against your interests all the time.
No, the solution is not the Congress forcing Mylan to sell cheap Epipens. The solution is opening the door very wide to competitors. The nature of the drug and the device is such that competition could bring the whole thing down to probably $50 per two pack. Little to no R&D necessary at this point.
[quote=“BadMoonT2, post:26, topic:56261, full:true”]
Believing that they don’t exploit this to gouge their customers is to suspend belief in basic human nature.
[/quote]Count me as one with suspended belief 
I don’t see it. This “gouging”. What is the evidence before you that makes you think this?
Prices alone aren’t a fair measure, are they? Isn’t it necessary to also look at costs, and the net profit, to decide if we’re being ripped off by greedy insurance companies, or simply being served by insurers trying to deliver what are very expensive products and services at a reasonable profit?
Let’s take private insurance out of the picture. Eliminate it. Have all insurance management as a non-profit pass-through. Let’s also do the same for Pharmaceutical Manufacturers. Make them non-profits.
Leave everything else the same (for example, price controls in other countries, none in the US).
What do you all think the price of a 10ml vial of Humalog, Novolog, etc. would be then? Really, eliminate anything that could possibly be “greed” from the equation. The financials for pharmas and insurers are public. Making a reasonable guess at this isn’t hard.
We can’t solve a problem if we keep attacking a “problem” that isn’t really the problem.
I won’t even accept that, not insofar as it pertains to the meds that matter to me. If it were true, two of the three main makers of insulin would be American and one foreign — not the other way around.
I disagree with this premise. Pharma companies have plenty of power as evidenced by the success of their lobbyists to get Congress to develop legislation (laws) favorable to them. These range from tax benefits to exclusionary policies for competitors, patent extensions and the like. As to government, it’s certainly not perfect, but it’s not Medicare that asked that it be prohibited from negotiating drug prices. If you think government is the problem then let’s remove all the governmental favors handed out to pharma.
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No, no, no! They have all kinds of power. Like being able to get their captive regulators to erect protective tariffs without the bother of seeking legislation, along with a myriad of other handy levers and controls. To believe otherwise is to believe in the tooth fairy and Santa Claus. He who has the gold makes the rules.
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One word…as has been expressed before. Lobbyists.
Anyone believing Congress isn’t bought and paid for by the big dollar Lobbyists is a fool. 
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I know the inculcated value to be independent and self-supporting and I think maybe it has been a bit of a crutch to me. It took me way too long to start explaining to people why I can’t do as they would have me to…be more spontaneous, drive the bus (metaphorically), be “more community involved”. Chronic illness is a real time-hog. One must respond more often and more focused-ly (?) to one’s own body. Also, the idea of taking care of oneself and not one’s neighbor gets a little questionable when we realize that the person who helped us learn how to grown the food (or packaged the seeds, or drove them to the store) or repair the motor needs our help. No one is truly independent and self-supporting.
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It’s clear we’ll just have to agree to disagree here.
When government officials make decisions based on lobbying efforts it’s the government official I hold responsible, not the lobbyist. The lobbyist has no duty to me to act in my interest. In fact, quite the opposite – they have a duty to act in the interest of the private party they’re representing.
The government official, on the other hand, is the party that has the duty to NOT be swayed by “gold”. When they are, it is them I hold responsible, and them that I direct my scorn at. It is dealing with their corruption that can improve the issue.
No one has taken the challenge to explain where all the excessive profit from greed is being hidden, nor how completely eliminating the modest profit margins of drug and insurance companies would dramatically lower costs.
Instead, we seem to be engaging in the same pointless, emotional, fact-free criticism of the private players in the industry, demonizing, and as always getting no where.
Here’s a fact, rather than argument: I have a Dexcom CGM, covered by Blue Shield insurance. Is it incredibly expensive? YOU BET! Is even my 20% co-insurance a fair slice of my financial pie? YES!
I note, however, that if I were in Canada, I simply would not be able to have it – PERIOD. Why?
To make this worse, I’m T2. I wouldn’t be able to have this technology covered in most (maybe all) public health systems. Why?
This has been my argument from the beginning: I would rather have a choice, even if it is really expensive, than not have it at all. The perspective of a Canadian that would really benefit from a CGM is very different than those of us that CAN have them, but complain about the cost. I claim that, absent the US market, there would be no Dexcom, no R&D on CGMs, no R&D on closed-loop systems. I find it remarkable that people who’ve been around a while and seen how government budgets are negotiated would believe money would be spent on this sort of research.
It wouldn’t, because such decisions are made politically. There isn’t a big enough constituency to force it. Look at the effort necessary get inadequate funding for Breast Cancer Research from the public trough.
Discussing whose “fault” it is debating angels on the head of a pin. The topic (mine, at least) was whether greed is a factor. Regardless of whether the lobbyist forces his agenda through, or a government official bands over and allows it, it happens.
And that’s only one of the causes. I listed several others.
I agree (mostly) that discussing “fault” is an endless, irresolvable discussion.
But then I’d say the same thing about discussing motives, like “greed”, too.
That’s why I think the only fruitful path is to look at hard facts, rather than opinion. I don’t see the excess “take” on the part of the health care industry that is a ripe target for reducing costs, and therefore giving us, the patients, some relief in what it costs us to manage this disease.
Rather, I see comparisons of costs between price-controlled environments and free-market environments as the basis of accusations of “greed”, without apparent understanding of why those prices are as grossly out of line as they are, and what the overall financials look like.
If the problem were simply greed, I suspect very strongly we’d see lower prices from either competition, or government intervention. Those pushing that view would be making the case, loudly, that 40% profit margins, on the backs of sick people, are cruel, unfair, immoral, and greedy. Anyone arguing to maintain those sorts of margins would be fighting a losing battle.
Well, that’s not our reality. Our reality is drug companies make a modest profit, in line with other “bread and butter” industries, and do it with the global pricing landscape we see. So, what gives? Where’s the greed? How is it this greed, with outrageous prices in the us, is failing so spectacularly to line the pockets of the drug companies with truckloads of cash?
I given my explanation here. Those of you seemingly bitter toward Big Pharma are, to me at least, noticeably silent in addressing this fact-landscape and reconciling it with accusations of moral malfeasance by drug companies and their greed.
Here’s something to think about: Is Mannkind greedy because of the very high price of Afrezza? Or is there more to consider before drawing judgement?
Dave, really like the pancake on your head. Have you found time to try out Afrezza yet? I recall you did a ton of research on Afrezza (a mini-phd education ) when Afrezza first came out back in early 2015. In that sense really look forward to your feedback once you have time to try it out.
It appears Afrezza was kind of expensive when it first came out (in Jan/Feb. 2015), but after the last two years’ insulin price hikes, with Afrezza price being stable (or in fact reduced if we look at the per unit price for the larger packages came out after the lunch and then the recent rollout of the titration pack), the price of Afrezza appears to be now comparable to RAAs. (Wish Afrezza had better insurance coverage, then it would be much more accessible to more people). The following twitter message seems to be consistent with above observation as well.
Hi Charles! Too many other issues on my personal plate right now… Afrezza doesn’t make the cut at the moment, as my D management is working well. And like I said, I got other things to worry about, so Afrezza is on the back burner at the moment.
Not sure that pointing out that other insulins have simply got as expensive as Afrezza makes the case that Mannkind isn’t greedy. One could argue that Mannkind was greedier, and the rest of 'em just now got around to catching up 
My point in bringing up Mannkind and Afrezza in the context of this thread was this: The charge of 'greed" seems to be made on the basis of the pricing of various treatments, and the burden we, PWD, bear as a result. I’ve been arguing that these things cost this much – it’s not greed, and immoral profiteering, that results in these prices.
Since Mannkind has a single product, Afrezza, it’s an easy analysis. My argument is that, absent Mannkind’s ability to recoup the R&D costs for Afrezza with the pricing they offer, well, we simply wouldn’t have Afrezza.
I’m still waiting for someone to lay out the case for how greed is indeed the driving force behind the high cost of our medical treatment. Honestly, the only connection I’ve seen is “high prices in the US compared to elsewhere, therefore greed”.
That’s an overly simplistic, ignorant analysis. Which, unsurprisingly, leads to bad solutions.
I’m not reactively opposed to public funding for health. I support it. It’s the “how” that’s important to me. I simply do not think the public sector capable of innovating, and I’m extremely cynical about decisions made where political considerations are prime.
For example, I’d fully support public reimbursement of R&D costs for proven, successful therapies, eliminating the need to recover those costs amortized over the expected life of the treatment. Then, the drug/device can be priced based on manufacturing costs with a fair, modest profit margin.
We’d be paying $35/10ml for humalog under those conditions, instead of $250.