40 ms·

How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India

351 points by mataug 10y ago

Scoundreller 10y ago
The article is already off to a bad start, assuming the existing therapy they're talking about is Pegetron: > The interferon-based treatments weren't successful half the time, and the side effects were so debilitating few patients could endure the months-long punishing protocol. If the success rate is 50%, I would say that's pretty good, especially since we're talking about treatment, not just managing the disease (as we can only do nowadays with HIV). And from the product monograph: "The most frequently reported adverse reactions were mostly mild to moderate in severity and were manageable without the need for modification of doses or discontinuation of therapy. " But no doubt, the pre-existing therapy sure has a pile of side-effects.
- refurb 10y ago
  I worked on one of the old interferon drugs before Sovaldi/Harvoni came along. They sucked. Patient compliance was low due to the side effects. From what I've heard, it was like having the flu everyday for duration of treatment. If you any mental health issues (depression, etc) you couldn't take it since the rate of suicide goes way up. The new HCV drugs are an amazing breakthrough.
  - gozur88 10y ago
    I know someone who took interferon for Hep C. It permanently damaged the nerves in his extremities to the point where he can barely walk and is in constant pain. It changed his personality, and not in a good way.
  - dannylandau 10y ago
    Does anyone know the prevalence of the most common side effects for Harvoni? I usually defer to the following site but they don't have info on the drug -- http://www.healthbee.co/ http://www.healthbee.co/
    - mhalle 10y ago
      There are some reports of side effects of varying degree, but in general Harvoni's side effects are extremely mild. When I did the trial, my physician indicated that in previous trials, patients couldn't reliably distinguish Harvoni from a placebo. My experience aligns with this statement. While I was on a 24 week trial (longer than most people today) with ribavirin (which is only used with a minority of patients today), I experienced nothing I could directly attribute to the medication. My viral load dropped to undetectable in six weeks, and has remained so since.
    - 0bamacare 10y ago
      The only place I saw them list side effects was when an article for a newer drug argued for it's use. It was the one for those who'd previously tried interferon.They said it had no sides as opposed to Harvonihttp://www.fiercepharma.com/regulatory/updated-zepatier-beats-harvoni-sovaldi-hep-c-clinical-data-safety-showdown-advera-health http://www.fiercepharma.com/regulatory/updated-zepatier-beat...
- mhalle 10y ago
  > "The most frequently reported adverse reactions were mostly mild to moderate in severity and were manageable without the need for modification of doses or discontinuation of therapy." Having gone through two interferon treatments for HCV, one with the most current regimen of pegalated interferon and ribavirin, I can personally attest to this description being ridiculously inaccurate. The OP may exaggerate some, but the contrast with Harvoni is stark. Headaches, flu-like symptoms, anemia, lethargy, and chemical depression, not to mention high stress on the liver you're ultimately trying to cure, are just some of the lovely side effects of interferon-based treatment, which could last up to 72 weeks. Many people dropped out, many weren't cured. Success rates depended on viral genotype; certainly for some people it was well below 50%. And don't forget the two forms of birth control, since ribavirin basically guarantees birth defects (as if you'd be in the mood). Harvoni may be expensive, but it and the drugs related to it are unbelievably effective in doing something many thought impossible 10 years ago: curing HCV. I cleared the virus on the clincal trials with no side effects. Unfortunately, it wasn't soon enough to spare me from a liver transplant. Hopefully the new drugs will reach enough people in time to let them avoid severe liver disease. There aren't enough donor livers to cure, and liver failure is a uniquely crappy way to die.
Scoundreller 10y ago
> took the pills for 83 days (saving one for possible testing just in case) I would try to arrange testing before starting therapy, or at least at the point of starting therapy. There are labs that will run the test for a few hundred dollars (and a lot less if you know someone at a university, it could even be an analytical chemists' bachelor degree project).
- giarc 10y ago
  I guess you could reason they are safe to take regardless. If they are counterfeit, they would likely make them out of sugar or flour not harmful chemicals. It wouldn't be in the best interest of the counterfeiters to make pills that harm or kill the buyer.
  - grumpopotamus 10y ago
    I wouldn't bet my life on that. In fact, counterfeit drugs are estimated to kill hundreds of thousands of people a year, in many cases directly, not because they don't provide the necessary treatment. See http://www.cnn.com/2012/07/17/health/living-well/falsified-medicine-bate/ http://www.cnn.com/2012/07/17/health/living-well/falsified-m... >Fakes contained chalk, talcum powder, road paint and occasionally dangerous heavy metals, instead of the expensive, hard-to-make medicine.
mirimir 10y ago
Yes, way to go! There are honest online pharmacies, but finding them is nontrivial. And there are numerous competent generics manufacturers in India. They've captured a large share of the global generics market in recent years.
- bedhead 10y ago
  .
  - giarc 10y ago
    You should re-read the article. >Last year, Gilead entered into an agreement with India that would allow Indian pharmaceutical manufacturers to produce generic versions of Harvoni and Sovaldi and sell them in 101 developing countries at "a significantly reduced flat price." >If you buy Hepcinat from India, Gilead still makes a profit as part of its licensing arrangement, but it doesn't make the unholy profits the U.S. government allows it to get away with.
  - quadrangle 10y ago
    If for some reason, a poor person needed to pirate software that they couldn't afford in order to save their life, that would be ethical too. But this isn't even comparable, this is more like buying the very same software from an overseas licensed vendor who sells it cheaper.
deleted 10y ago
[deleted]
surrealvortex 10y ago
I'm conflicted about this article. On the one hand, the pharmaceutical companies gouging ordinary Americans is abominable. Doing something to circumvent their greed is something to support. On the other hand, if enough people exploit loopholes like this, and the pharma company actually felt a significant drain in revenue, they may decide not to license the manufacture of these drugs in India at lower prices. If $84,000 seems unreasonably high in the US, imagine how out of reach it will be in India, where the cost of living is much lower.
- hueving 10y ago
  Right now US citizens are basically subsidizing other countries when it comes to drug revenue via price gouging. I would rather it be done via some other more explicit mechanism (e.g. India government subsidies) rather than at the expense of poor healthcare availability to people in the US.
  - sandworm101 10y ago
    Considering that Americans consume 75% of the world's prescription drugs, and I think it safe to assume an equivalent amount of non-prescription drugs, I don't think any of this makes much difference. The US is a very strange and unique drug market. Citation: "5 percent of the United States is the world's population and consumes 75 percent of the the world's prescription drugs." https://www.drugabuse.gov/related-topics/trends-statistics/infographics/popping-pills-prescription-drug-abuse-in-america https://www.drugabuse.gov/related-topics/trends-statistics/i... (And by "Americans" I and the gov included all those people in the US market who are not "US citizens". Ie me.)
    - adrianN 10y ago
      That statistic seems a little misleading to me, because very large parts of the world don't consume any prescription drugs at all, because they're too poor to go to the doctor.
  - bpodgursky 10y ago
    Yeah, but that's not going to happen. If a big pharm company doesn't provide India-priced versions of drugs, the Indian government just declares the patent invalid and lets generics produce it for free (yes, this happens).
hyperliner 10y ago
I really think this article is spot on taking on an issue that I believe will become more and more pressing over time as baby boomers continue to retire. However, this line felt of out of place: - "And then there's Gilead. It didn't even develop Harvoni itself; it made a business decision to pay $11 billion to buy the company that did so it could be first to market and reap the rewards, $26 billion worth. There is something obscene about that. A billion-dollar profit would have been a very respectable return on investment, but Gilead is getting much, much more than that" I mean, why is that obscene? We have seen crazier returns in [insert latest "stupid" app that made billions]. These drugs are difficult to manufacture AND to market. I am sure that if the return would have certain, then the seller would not have sold the company for that amount and would instead reaped the presumed returns. I think pharma is entitled to big returns because their business is really risky. I don't know where the answer is. Maybe it is government-driven pharma (yeah like the federal government is ever going to be good at anything), or a SpaceX for Pharma.
- rayiner 10y ago
  Note that a billion dollar profit would be a 3.8% return over the life of the drug (~10 years or whatever is left on the patent). You could literally get better returns with far less risk parking that money in Treasuries.
  - Dylan16807 10y ago
    You're doing the math wrong. The suggestion is not a billion dollar profit on 26 billion dollars of costs. Most of the 26 billion dollars is profit. Chopping the cost tremendously would still leave a healthy profit margin. As to risk, they bought an already-proven drug. That's not the sort of thing that earns massive returns.
    - rayiner 10y ago
      I did do that math wrong, but to be fair, the article is comparing apples and kumquats. $26 billion is how much Gilead has in cash, which has little to do with Sovaldi at this point. $1 billion profit (let's say that's annual, rather than over the life of the drug) on an $11 billion purchase would be less than 10% annual ROI. That's very low for what was still a very risky investment (unapproved drug).
erikpukinskis 10y ago
Ironically, if the rights were owned by Skreli, Smith could've gotten the drugs for free.
foxylad 10y ago
There is obviously something unbalanced in the pharma business, and I think it is one of the corner cases where unbridled capitalism fails - perhaps because it is a need, not a want, so it is not discretionary spending. My instinct is that pharma development should be carried out by universities (the state), so it's benefits can be shared with all citizens.
- andrewchambers 10y ago
  It sounds more like a lack of real competition.
  - rayiner 10y ago
    You can't have "real competition" in the drug industry. While the status of patents is debatable in software (where actual copying is rare), the generics manufacturers are always directly copying from the drug inventors. They don't have the capability to do their own R&D, or often even to develop a lot of the ancillary protocols themselves. So you either have a regulated market, or massive free-riding, neither of which is "real competition."
    - refurb 10y ago
      You can't have perfect competition in the drug industry, but you can get close. Gilead dropped the price of Sovaldi/Harvoni by almost 30% when Abbvie launched their HCV therapy. In fact, one of the best way to introduce competition is through "me-too" drugs. You know, the ones everyone complains about.
    - necessity 10y ago
      How much time does it take to analyze the original and copy it, set up for mass production, advertise, etc? Then, how much time until demand shifts from the original to the generic in each market (India, US, etc)? According to the OP the company was making "billions every quarter" on sales in the US. Considering the research often costs "billions", they should make a profit in the first quarter by selling in multiple markets if it takes around a month until the demand shifts to the generic.
MichaelBurge 10y ago
A quick Google search shows that they paid $11 billion for the company that sells the drug(Sovaldi), and earned $1.3 billion off of it[1] in 2016. They make half of that in the US, and something like 10% of it in all places that aren't the US, Europe, or Japan. That's a 12% return in 2016, which isn't nearly as good as the comments in this thread would have you believe. It's an okay return, but it wouldn't really be a good investment unless they can grow those sales more. It looks like they have had some growth compared to last year, so maybe it will end up working out for them. It's certainly not "100x in profits". A Google search shows the disease is ultimately hard-to-transmit and preventable[2]. $84,000 seems like a fair price to me for this particular case. Google says the total cost of raising a child is "$245,340", so paying a 30% premium in rare cases doesn't seem unreasonable. A separate complaint is that the financial industry isn't covering this case well. If you expected your insurance to cover it and they don't, that is an entirely separate issue than the price of the drug. Even if they don't, it seems like there should be a market for people wanting loans to pay for cures: It seems really hard to underwrite such a loan, but it could probably be done. What does good insurance from a reputable insurance provider that reliably pays out their claims in cases like these cost? (Edit) I may have misread the earnings report, thinking it was for the previous year rather than the previous quarter. So the percentage is closer to 50%, and a commenter clarified that they also had another product. [1] Earnings: http://investors.gilead.com/phoenix.zhtml?c=69964&p=irol-earnings http://investors.gilead.com/phoenix.zhtml?c=69964&p=irol-ear... Purchase price: http://investors.gilead.com/phoenix.zhtml?c=69964&p=irol-newsArticle&ID=1632335 http://investors.gilead.com/phoenix.zhtml?c=69964&p=irol-new... [2] Going down the list on one site that lists transmission methods: Don't have sex with weirdos carrying diseases; don't share needles with druggies; go to a licensed upscale commercial tattoo parlor instead of some shady cheap one
- themartorana 10y ago
  Or... $11B was a terrible price to pay, and their desire to recoup their shitty investment still shouldn't be allowed to bankrupt people who just want to live. It's also incredibly obtuse to call $84k a "30% premium" on raising a child. There are so many people who don't (because they can't) spend close to $245k, more that can barely pull it off, and even more that shouldn't have pharma rates kept artificially inflated on their backs.
cowsandmilk 10y ago
(1) As someone who was following the market when Gilead paid $11 billion for PharmAsset, it was not a sure thing that it would be first to market or a premier drug. They announced $137/share on November 21 for a stock that opened at $65.49 on November 11. People like to point out how much money Gilead made on the deal, but that is Monday morning quarterbacking on something where they easily could have lost billions. (2) The article claims Harvoni was acquired. That is not really true. Sovaldi (sofosbuvir) came from the Pharmasset acquisition. Harvoni is a combination of sofosbuvir with ledipasvir, a drug discovered at Gilead. The combination of the two is a key part of the treatment; sofosbuvir was still taken with interferon (and ribavirin) for genotype 1 HCV, the most common form. Treatment for genotype 1 HCV, without interferon required ledipasvir. The notion that Gilead contributed nothing scientifically to Harvoni is false; they provided a crucial component to the all-oral treatment of HCV genotype 1.
- refurb 10y ago
  As someone who was following the market when Gilead paid $11 billion for PharmAsset, it was not a sure thing that it would be first to market or a premier drug. This is a fantastic point. I remember when Gilead announced their acquisition of Pharmasset. They were ridiculed in the press. How could they be so stupid to pay that much? Many people thought that $11B was as good as gone. That's the risk involved with drug development. It's like VCs, you spend a ton of money on a lot of investments, most of which fail. Unless you get a few huge winners, it's not a feasible business.
bradleybuda 10y ago
Leaps in technology, finance, and engineering cure man of previously incurable disease. He is pissed.
bigpoppa 10y ago
- this guy took a huge risk buying this ‘life saving’ drug on the internet - amounting his worth of his existence to $82,500 - the drug companies paid to develop this drug, non-profits didn’t. - why is he not barking up their tree? http://www.hepatitis.va.gov/web-resources/advocacy.asp http://www.hepatitis.va.gov/web-resources/advocacy.asp - drugs sold in the usa have high costs to market including a massive tax burden on profits - this would be a problem with our government, not the for-profit business
hourislate 10y ago
I was under the impression most Pharma Companies will give it to you for free if you don't have insurance and can't afford it. Maybe it's different if you have insurance and they won't pay for it. The article is unfair mentioning Shkreli. He has always offered his drugs for free to anyone that couldn't afford them. It has always been his policy and continues to be so. I think it was the Insurers and their paid for Politicians that created the stink. To this day I still haven't heard of one person that had to pay the $750.00 a pill but just their co-pay and if they had no insurance they got it for free. Surprised this drug isn't available for free for those without insurance or is it?
- pavel_lishin 10y ago
  > The article is unfair mentioning Shkreli. He has always offered his drugs for free to anyone that couldn't afford them. [citation needed]
  - verroq 10y ago
    >We pledge that no patient needing DARAPRIM will be denied access >If you are uninsured and meet eligibility critera, you can get DARAPRIM for no cost http://www.daraprimdirect.com/patients http://www.daraprimdirect.com/patients
- maxerickson 10y ago
  It's not like insurance companies are paying that $750 a pill in a vacuum. They make those payments out of the premiums they collect. Shkreli may not have been screwing the poor, but that doesn't mean he wasn't screwing everyone else.
tn13 10y ago
> In the United States, there is nothing stopping pharmaceutical companies from charging whatever they think the market will bear. That is how it should be. The moment government controls prices, it will slow down overall capital investment in invention of new drugs. I think $80k price is perfectly fair given the scenario. Until Giliad Science invented that medicine the alternative to the medicine was assured death by cancer. Have you ever paid medical bills for cancer ? $80k does sound like a reasonable amount to pay for one's life in a developed country like USA. In India value of life is much less and I am not surprised Indians are willing to pay much less for their life. Poor Indians are benefiting at the expense of rich Americans. Indian would prefer to die than borrow and buy a $80k medicine. I think if Americans can save money by offshoring the cheap call centers to India they can also save money by getting their health treatment in India. The thing to remember here however is that if you die in an operation theater in USA your family might get millions in compensation. In India you have to say bad luck and move on. The pills that you buy from India could be nothing but horseshit packaged in wrappers and you can basically do nothing even if you find it out. US is at the forefront of drug inventions because markets are allowed to function, surely companies are making ton of profits but I suggest you try setting up a company and invent the same drug and sell it for cheaper price. Inventing drugs is like a startup, a giant number of research projects fail, handful of succeed. People remember Facebook and its obscenely rich Zukerberg they don't remember Bozo inventor of JokerBook, a social network for clowns. It would be good if Americans learn to appreciate what they have rather than complain about everything.
zaroth 10y ago
If you remove a bunch of constraints, you can imagine governments paying for country-wide license to the patent, and then individuals just pay enough to cover manufacturing and delivery. I'm not sure if there was any payment that went along with granting India the $1000 price. I know India carries a big-stick of "invalidating" the patent. Sure, they could have just taken the IP for themselves, which basically means Americans just bare a larger share of the overall cost. The fact is that this drug is tremendously valuable for India, so I'm glad they were able to come to some pricing agreement. Selling those drugs back into the US market clearly goes against the pricing agreement. Based on what I read in those articles about Paul Le Roux, these online drug outfits have way more volume than you might expect, and they apparently can run for a long time before being shut down. This is partly a submarine ad in that sense, even naming sources. You also might expect customs to intercept these packages, but when Le Roux can share the same FedEx account number across all their pill shipments, clearly inspection is expected to be lax. So the result is these pills could actually be pouring back into the country, and hiding within the inventory being sold for consumption actually inside India. It seems like Gilead revenue is strong for now, I don't know if they consider this to be a significant risk. In some cases insurance will not cover if you are not showing symptoms. But if they do cover it, you will be on the hook for just the out-of-pocket maximum for that year. Any other health care you receive that year will be free, so that could also help justify the cost. But in this case the insurance company didn't want to cover it anyway, so the patient was forced to pursue a gray market purchase. I'm pretty sure Gilead is pushing hard for insurance companies to cover anyone with detectable disease regardless of symptoms, and ultimately that's what we want. There's a huge population that avoided the prior treatments, but would jump on this in a second. Everyone who has HepC should get this drug. But if we can't afford to cure everyone today, how do prioritize access? And how do you limit access to an FDA approved drug for a diagnosed illness anyway, when the alternatives are more expensive and less effective? Well I guess in some places, like the NY AG is requiring coverage for commercial insurance plans. NYT reports that Medicaid is still denying coverage until the disease has advanced. We want people to pay the "right" price for this drug, really a miracle cure which is lowering the cost of treatment actually. So how do you price it? The price to the insured patient today will vary based on the financial means of the patient. The revenue to Gilead is negotiated with insurance companies / benefit management companies, and is far below the sticker price.
cheriot 10y ago
Eminent domain is not just for land. In extreme cases like this where a profit motive is the only thing keeping us from curing huge numbers of people, the US government should write a single check, take the rights, and start handing out pills. As far as the company is concerned, that could even be a preferable outcome. Cash now and the marketing benefits to promote its other drugs. Edit: Just a reminder that eminent domain requires paying the property owner. https://en.m.wikipedia.org/wiki/Just_compensation https://en.m.wikipedia.org/wiki/Just_compensation
- nickpsecurity 10y ago
  We could do that. On other hand, we could just pay them the expected market value of the drug when they first invent it then give it to public for almost nothing. "You can cure cancer with those three drugs? Was going to make tens of billions? Here you go: guarantee of tens of billions of subsidies over next 20 years in exchange for the patent and license for anyone to produce it generically." Boom! Tens of thousands of lives saved a year. Way better than investing into the TSA. :)
  - cheriot 10y ago
    Agreed, that's exactly what I'm trying to suggest :) Eminent domain requires paying the property owner.
  - necessity 10y ago
    When you say "we pay the market value" and "give to the public for almost nothing", "we" and "the public" are the same group and therefore it makes no sense to make the distinction. Unless by "we" you mean "the wealthy" and "the public" you mean "the poor", in which case the increased tax that has to be set up for that will just be reverted into the cost of the service/good provided by the wealthy, the wages of their employers, or turn into capital flight, and so forth. In short, you're basically taking money from other areas of people's lives and making them put it into health care. Which could be achieved by themselves by saving, if that's what they wanted to do.
    - 10y ago
corvallis 10y ago
Something to keep in mind is the population that typically has chronic Hep C requiring this drug. It's IV drug users who share needles. Think they have $84K? Nope. Think they have insurance? Nope. Guess who pays for it. Oh that's right, it's Medicaid! It's you, the taxpayers. Where is there a large concentration of people that have Hep C? Prisons. Guess who pays for it then? Still you! The prison systems are obligated to provide health care and treatments in accordance with community standards of care, which they do. They have treated many people already who meet the criteria of disease progression to qualify for it. Still think Gilead should be charging this much for it here and not elsewhere?
- mgiannopoulos 10y ago
  So India does not have prisons or similar laws for treatment of prisoners?
  - cheiVia0 10y ago
    Incarceration rate (Prisoners per 100,000 population): United States: 698 India: 33 https://en.wikipedia.org/wiki/List_of_countries_by_incarceration_rate https://en.wikipedia.org/wiki/List_of_countries_by_incarcera...
- refurb 10y ago
  You don't think it's fair to price a product relative to the wealth in a given country? I think it's quite fair to be honest.
  - x5n1 10y ago
    It should be priced according to ability to pay based on income. The same is the reasoning why the drug is so cheap in other countries, their people can't possibly afford the prices. So it makes no sense for citizens of wealthy countries to have to pay huge markups if they don't have the money. It makes no sense from an economic perspective to force people to go into bankruptcy just because they got sick.
ptaipale 10y ago
I actually wouldn't expect that Indian prisons provide any effective medication against hepatitis C. You might get it if you buy it yourself, and bribe the prison staff to allow you to have it. Sorry: this is not based on any real experience or references, just the overall assessment of how India stands currently.
- dragonmum 10y ago
  > You might get it if you buy it yourself, and bribe the prison staff to allow you to have it. > Sorry: this is not based on any real experience or references, just the overall assessment of how India stands currently. Jeez, you didn't have time to search but had time to fantasize like a Hollywood script writer hashing out more 3rd world stereotypes? Perhaps we should look at the treatment and hepatitis morbidity rate in our prison system and wonder whether your stereotype may more accurately fit our own prisons rather than Indian ones. Here: [1] http://www.delhi.gov.in/wps/wcm/connect/lib_centraljail/Central+Jail/Home/Medical+Care+and+Hospital+Administration http://www.delhi.gov.in/wps/wcm/connect/lib_centraljail/Cent... [2] http://www.legalservicesindia.com/articles/pri.htm http://www.legalservicesindia.com/articles/pri.htm [3] http://defensewiki.ibj.org/index.php/Right_to_Medical_Care_in_Prison http://defensewiki.ibj.org/index.php/Right_to_Medical_Care_i... Delhi Prisons have set up an Integrated Counseling and Testing Centre (ICTC) on 10.06.08 in Central Jail Hospital for detecting HIV positive inmates. Targeted intervention for HIV detection in inmates like injecting drug abusers / sexually promiscuous, inmates suffering from STD and inmates suffering from multiple / opportunistic infections. Total number of such inmates, tested for HIV positive test at ICTC from January,2010 to October'2010 were 1399, out of which 27 were tested HIV positive .Further 2254 inmates were tested for HBsAG and out of which 66 were found to be +ve for Hepatitis B. [4] https://en.wikipedia.org/wiki/Infectious_diseases_within_American_prisons https://en.wikipedia.org/wiki/Infectious_diseases_within_Ame... While the majority of HCV infections occur outside of prison, the disease is still widespread within the prison system as a result of drug injection.[15] According to one Rhode Island prison study, HCV infection was found in 23.1% of the male prison population.[16] HCV prevention proved to be more challenging than HIV prevention because inmates partake in high-risk behaviors such as “front loading” and sharing spoons to prepare drugs like cocaine.[4] The prevalence of these diseases within prisons is a concern because they pose a potential public health risk. [5] https://represent.us/action/private-prisons-1/ https://represent.us/action/private-prisons-1/
WalterBright 10y ago
Keep in mind that the potential for huge profits was what motivated private investors to fund development for a cure. Without that, Hep C would still be a death sentence, regardless of how much money you had.
- maxerickson 10y ago
  Pharmasset spent in the ballpark of $1 billion developing the candidate that Gilead decided to buy (I'm taking the annual spend on total operations there, rounding up to $100 million and multiplying by 10 to get the $1 billion). https://www.sec.gov/Archives/edgar/data/882095/000119312511331318/d260880dex991.htm https://www.sec.gov/Archives/edgar/data/882095/0001193125113... It sort of looks like they have figured out how to have excellent pricing power when they are willing to bid $11 billion for the company. Part of that is probably that looking just at this drug is a facile analysis of the value of Pharmasset (which did more than develop 1 drug, they built expertise in creating antivirals). Of course, the expertise story implies that they don't need to recover the purchase on just this drug. I guess some of it is the complexity in the medical payments system.
seshagiric 10y ago
Not sure if there is one in the USA, however in India the law does impose a maximum price for critical and life saving drugs (hypertension, heart related, diabetes etc.). There is ongoing process for adding some cancer drugs too to this list. I think the key here is that businesses should be allowed to make a 'reasonable' profit.
markvdb 10y ago
This is yet another perverse collision of care and market regulation. Other examples abound. Why do we accept this? Do we even dare think of alternatives? What if western governments stop enforcing drug development intellectual rights? Not going to happen before hell freezes over, but let's have a short thought experiment. Quality health care for all would probably blossom thanks to more access to affordable drugs than ever. Drug development would probably slow down significantly without compensating measures. But would that be so bad? Medical research is increasingly a game of diminishing returns... Many but the rarest disease puzzles have been solved already. And the huge profit margins show the current drug development system has proven inefficient handling these rare corner cases. Think https://en.wikipedia.org/wiki/Alexion_Pharmaceuticals https://en.wikipedia.org/wiki/Alexion_Pharmaceuticals . With more patents starting to expire, the existing drug development model will only get more inefficient... Aren't there more efficient ways to incentivise drug research? Crazy idea... Bootstrap an open source drug with maecenate and/or public funding, or market an existing generic with a sympathetic history. Make it super easy for people to donate something extra on top of the drug price. Think a tip at the pharmacy, directly to the researcher's drug development budget. Their drug cured them or their loved ones! Put a picture of the research team on the packaging. Show people these researchers are heroes.
- adrianN 10y ago
  I wouldn't call cancer, heart disease, alzheimer's, ageing etc "the rarest disease puzzles", yet I'm not satisfied with the status quo of medical care for these problems.
  - airless_bar 10y ago
    Mainstream access to all existing drugs would still be a hugely more favorable outcome than the "chance" of new drugs at outrageous prices.
    - peyton 10y ago
      Don't we get cheap drugs when patents expire? Are you saying we should invalidate all existing drug patents today and cease R&D rather than wait for patents to expire?
walterstucco 10y ago
Guess who can get them for free? those living in civilized countries with universal health care systems.
- bandrami 10y ago
  Very few countries offer free prescription drugs. Not even Canada does that.
  - scottishfiction 10y ago
    Scotland, Wales and NI do. And England has only a nominal charge.
    - bandrami 10y ago
      Right, and I think that's it (SK does the "nominal charge" thing).
      - MagnumOpus 10y ago
        Most western countries do the "nominal charge" thing - which in this context is just about equal to zero. For instance: German public health insurance buys a course of Sovaldi for EUR40,000 ($46,000), the patient pays a cost of EUR10 ($11.50).
  - herbst 10y ago
    It is still something different when my health care just pays for it and later talks to me about the costs than when i need to find a way to finance it from the beginning.
PieterH 10y ago
Surprised no-one has pointed to the real culprit here: the patent system, which allows individual companies to own knowledge like this and sell it at any rate it desires... private taxation by and for the rich, on the rest of society.
- cm127 10y ago
  "Gotta have patents and profits, or there's no reason to fund it." All testing, research, and funding has to be private for some reason.
  - ordbajsare 10y ago
    Soviet....
- linker3000 10y ago
  > Surprised no-one has pointed to the real culprit here Finance and the monetary system.
y04nn 10y ago
The pharmaceutical industry is disgusting me. Their goal is no more to cure people but to generate that maximum amount of cash for shareholders. To chose a price point, they don't look at what research has cost, but what people, government aid and insurance are willing to pay for it and choose chose a price that max out the benefit. In developed country it becomes ridiculous. As a note, when they have to make risky research they put the risk into a spin-off company with investors that share the risk, and this is how you end up with Gilead buying this probably co-founded research company.
- 0bamacare 10y ago
  I give you an A for finally coming w/the right answer.I was falling asleep reading all this liberal blather.
golergka 10y ago
OK, let me be a devil's advocate for a minute, before we get the pitchforks once again. Let's remember this: > Gilead Science was first out the gate, bringing the new hep C drugs Harvoni and Sovaldi to market in 2014 and 2015, respectively. And they worked great: More than 90 percent of patients taking the new drugs saw the hep C virus wiped out in three months, and without the side effects that made interferon treatments so intolerable. So, Gilead is exactly the company that created these drugs from the very beginning. I'm looking at it this way: in 2013 (situation A), there was no cure ("cure" is a simplification, of course, but for this kind of analysis it's not an important detail.). In 2016 (situation B), there is a cure, but it costs $86k. Now, the moral question here is very simple: when you change the world (as Gilead did) from situation A to situation B, is it net good or net evil deed? In which world of these two would you prefer to live?
pramttl 10y ago
I was once prescribed 4 tablets of Albandazole (a drug for worms treatment) just before my health insurance was active on file. The drug was costing over 700$ without insurance and my health center asked if I would like to wait for my student health insurance to show up as active. I said, yes (ofcourse) shocked at the price of the drug (being an international student in US from India). Even after my insurance I paid 35$ co-pay. The same drug costs <1$ in India. Even the co-pay is over 35 times the cost of the drug in India. I was trying to contrast some figures: Salary ratio: ~5:1 (Software engineer, Google based on Glassdoor); Albendazole drug cost ratio: ~700:1
ChicagoBoy11 10y ago
Nobody here is making the pretty obvious point: Yes, it is wonderful to blame the drug companies (who invented the damn cure in the first place!) for greed -- it feels great. But the real important question you have to ask is HOW ON EARTH do they get away with charging $84k for a year of treatment?!?!?!?! If they are charging this amount of money, it is because someone, somewhere, in some deep and mischievous and evil place inside those big pharma buildings, has crunched a lot of numbers and figured out this is the "correct" price for them to charge for this drug. That is their income-maximizing price. And THAT is what's insane. Blaming them for "greed" is idiotic. But you have to scratch your head and think of how on Earth the best strategy for them is to sell a product with a price tag that no individual could really afford!!! That's the real mystery, and when you start asking THAT question, perhaps you end up realizing that the answer isn't so clear. For starters, maybe ingenious strategy devised by our hero in the article, and the Indian government's positions in generic were foreseen by one of the thousands and thousands... upon thousands of lawyers, and business experts, and consultants that these companies hire, so they quickly realized that the name of the game HAS to be that they need to squeeze everything they can out of the U.S. market to make up for the hits everywhere else. "But wait, no one will be able to afford the drug," exclaimed one novice executive at the pharmaceutical. "Not to worry," the senior counsel said, "we have medicaid in the U.S., and that's where most of our customers will come from. You see, the government will effectively be our client, and since they won't have an option not to offer this treatment, all we need to do is ensure we have amazing terms with this ONE customer and we'll be aaaaaaalllll set." Etcetera, etcetera, etcetera. Don't blame the pharma companies. We have ZERO competition in many dimensions of healthcare. We have a drug approval process that costs billions of dollars for a single drug to get through, and the academic evidence is quite clear that it is actually killing more people than it is purportedly saving. I had back surgery three years ago, and a line item in my medical bill was "juice - $25." I stayed in the hospital for 19 hours. It cost me $40,000 FOR NO GOOD REASON whatsoever. I also had shoulder surgery overseas, with a Harvard medical-school trained doctor who operates on world class professional soccer players. I was in a phenomenal hospital for two days, in a private room, with nurses checking on me every hour, the works. The sticker price? $7,000. Without a penny of gov't subsidy. Big Pharma isn't the issue. Our policies towards healthcare are crippling us to no end.
nsajko 10y ago
We could make pharma companies be government contractors so the "intelectual property" would be a owned by the state. That would probably be a bit better than what we have now.
AlgorithmicTime 10y ago
There should be some sort of government chartered corporation for generic drug manufacturing. After a drug patent expires, they review the drug, determine the manufacturing cost, and compare it to the market price for the drug. If the market price is above some multiple of the manufacturing cost, they set up their own production line and sell the drug at their cost.
calvinbhai 10y ago
Health insurance in US charges you 10¢ monthly premium, to provide a $100 pill for $10, while it is available for $1 in India. Dental insurance is as bad. Travel to India + dentist costs are often cheaper than one time treatment costs.
fractal618 10y ago
Hey everyone, look! We're getting ripped off! Here's how they're doing it! We're all in this together! We have the high ground! Here's what we have to do! Look another episode of Game of Thrones is on!! Who's fucking who?
YPCrumble 10y ago
Gilead has developed the first drug since penicillin to cure a major disease and people think the price tag is too expensive. In the modern world, it's not ideal to create a drug to cure something. Once people are cured they no longer need your drug. That's why we have so many drugs like Lipitor and Viagra that treat symptoms but do not cure. The "problem" with Sovaldi/Harvoni is that the patient only takes it for ~90 days, and then they're cured. The drugs are cheaper than regular treatment of Hep C - which ends in liver transplant. Do people think the price tag was just random? No, it's because this is a price at which the taxpayer saves money by curing the disease vs. blood transfusions, liver transplants, lost economic value, etc. Not to mention that the waitlist for a liver transplant is getting halved as we cure Hep C. As we slam Gilead the other really evil pharma companies like Pfizer are taking notes and patting themselves on the back for creating drugs whose end goal is to addict the consumer.
- swalsh 10y ago
  I worked for a company that developed some PA criteria for these drugs, I can assure you a lot of debate went into this criteria.. these two specific drugs are probably the most hotly contested drugs. If we sold them at the 84k price tag to anyone that COULD use it, the entire insurance industry would go bankrupt, literally. Not even an exaggeration. While your logic is sound, the drug is cheaper than a liver transplat... not everyone who has Hep C ends up getting a liver transplant. There's a huge gap between the number of people who COULD use the drug (and have a MUCH better quality of life), and the people who are most qualified for it. The drug companies are not doing the government a favor here... sorry. Another side conversation that's interesting, is who takes the $84k hit. There's sound logic that it's cheaper to give the drug NOW vs paying for surgery LATER... but what if i'm not your insurer when you need it. With obamacare, you can't be denied because of pre-existing conditions... so it's interesting math.
  - maxerickson 10y ago
    Do you have a sense of the production costs? If they aren't very high, the US government could start making the company look like jerks by offering $50 billion for the patent. I'm pretty sure they would be able to calculate a nice return based on a payment like that. The math works fine for that, there's ~3 million people just in the US to treat, paying $50 billion would save a substantial amount just treating those patients. Of course, we don't run our government based on math that makes sense, so it's a pipe dream.
jfountain2015 10y ago
There is an excellent Radiolab piece on this: http://www.radiolab.org/story/what-year-life-worth/ http://www.radiolab.org/story/what-year-life-worth/
known 10y ago
Here is current price for Sofosbuvir in India http://www.medplusmart.com/compositionProducts/Sofosbuvir-400-MG/29220 http://www.medplusmart.com/compositionProducts/Sofosbuvir-40...
mhalle 10y ago
Our medical and social systems are ill-equipped to deal with cures for widespread diseases, which is what Harvoni and its related drugs are. We are used to paying for disease on time: relatively small amounts of money for periodic treatments that might last a lifetime, however long that lifetime may be. And we (at least in the US) often think more about the value of the treatment to the patient rather than the value of a healthy person to society. These questions of cost and value go far beyond HCV. It is a popular, medical, and entrepreneurial dream to cure cancer wholesale with a single easy course of treatment. While cancer isn't a single disease, perhaps we should begin asking now how we could assess the value and pay the price for such a "miracle" should a cure for any of the most common cancers be developed.
xbmcuser 10y ago
I see a good opportunity here build a 40-50 patient facility in touristy place like Thailand. It would cost about $250-350k then charge patients $4500 for a 3 month stay including medicine, food and board. Because of cheap labour and food your expenses won't be more than $20k per month. You would me making a profit with 40% occupancy with 85-95% you could recover your investment in under a year.
anne-marie37 10y ago
I had no side effects either. I did 12 weeks with Ledifos (generic Harvoni), and zero viral load from week 4. I'm SVR4, but still waiting to get SVR12, fingers crossed! :-) I bought Ledifos in Hyderabad, through med tour agency. The trip cost me just over 2600$, tickets included, and I only paid once in India. The guys are mellow, everything went very smoothly: hotels, doc, prescription, pharmacy, all is done in 3 days (www.cure-hepc.com). I know you can do cheaper if you just buy online, but when you pay online you never know if it's a scam.
michel123 10y ago
You Just try "oddway International" For All HCV Medication Like Sofosbuvir , daclatasvir , Ledipasvir , ETC Find All Generic And Brand Medication At Wholesale cost .... Oddway International is an Export House with a strong independent infrastructure which allows us to work in tandem with the needs of our customers across the globe. We directly cater to the needs of large, medium, small enterprises and individuals around the globe. Our aim is only maintaining a healthy, safety and understanding relationship with our customers and, it can be manifested by the excellent satisfaction they feel by being with us. Address : 5A/7, Ansari Road, Daryaganj, New Delhi-110002 (India) icon sales@oddwayinternational.com QQ : 1523458453@qq.com icon Phone : +91-11-43526658 Mobile : +91-9873336444 icon Skype : Oddway2010 WeChat : Oddway2010 icon WhatsApp : Available Viber : Available http://www.oddwayinternational.com http://www.oddwayinternational.com
deleted 10y ago
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351 points by mataug 10y ago

The article is already off to a bad start, assuming the existing therapy they're talking about is Pegetron: > The interferon-based treatments weren't successful half the time, and the side effects were so debilitating few patients could endure the months-long punishing protocol. If the success rate is 50%, I would say that's pretty good, especially since we're talking about treatment, not just managing the disease (as we can only do nowadays with HIV). And from the product monograph: "The most frequently reported adverse reactions were mostly mild to moderate in severity and were manageable without the need for modification of doses or discontinuation of therapy. " But no doubt, the pre-existing therapy sure has a pile of side-effects.

refurb 10y ago
I worked on one of the old interferon drugs before Sovaldi/Harvoni came along. They sucked. Patient compliance was low due to the side effects. From what I've heard, it was like having the flu everyday for duration of treatment. If you any mental health issues (depression, etc) you couldn't take it since the rate of suicide goes way up. The new HCV drugs are an amazing breakthrough.
- gozur88 10y ago
  I know someone who took interferon for Hep C. It permanently damaged the nerves in his extremities to the point where he can barely walk and is in constant pain. It changed his personality, and not in a good way.
- dannylandau 10y ago
  Does anyone know the prevalence of the most common side effects for Harvoni? I usually defer to the following site but they don't have info on the drug -- http://www.healthbee.co/ http://www.healthbee.co/
  - mhalle 10y ago
    There are some reports of side effects of varying degree, but in general Harvoni's side effects are extremely mild. When I did the trial, my physician indicated that in previous trials, patients couldn't reliably distinguish Harvoni from a placebo. My experience aligns with this statement. While I was on a 24 week trial (longer than most people today) with ribavirin (which is only used with a minority of patients today), I experienced nothing I could directly attribute to the medication. My viral load dropped to undetectable in six weeks, and has remained so since.
  - 0bamacare 10y ago
    The only place I saw them list side effects was when an article for a newer drug argued for it's use. It was the one for those who'd previously tried interferon.They said it had no sides as opposed to Harvonihttp://www.fiercepharma.com/regulatory/updated-zepatier-beats-harvoni-sovaldi-hep-c-clinical-data-safety-showdown-advera-health http://www.fiercepharma.com/regulatory/updated-zepatier-beat...
mhalle 10y ago
> "The most frequently reported adverse reactions were mostly mild to moderate in severity and were manageable without the need for modification of doses or discontinuation of therapy." Having gone through two interferon treatments for HCV, one with the most current regimen of pegalated interferon and ribavirin, I can personally attest to this description being ridiculously inaccurate. The OP may exaggerate some, but the contrast with Harvoni is stark. Headaches, flu-like symptoms, anemia, lethargy, and chemical depression, not to mention high stress on the liver you're ultimately trying to cure, are just some of the lovely side effects of interferon-based treatment, which could last up to 72 weeks. Many people dropped out, many weren't cured. Success rates depended on viral genotype; certainly for some people it was well below 50%. And don't forget the two forms of birth control, since ribavirin basically guarantees birth defects (as if you'd be in the mood). Harvoni may be expensive, but it and the drugs related to it are unbelievably effective in doing something many thought impossible 10 years ago: curing HCV. I cleared the virus on the clincal trials with no side effects. Unfortunately, it wasn't soon enough to spare me from a liver transplant. Hopefully the new drugs will reach enough people in time to let them avoid severe liver disease. There aren't enough donor livers to cure, and liver failure is a uniquely crappy way to die.

Scoundreller 10y ago

> took the pills for 83 days (saving one for possible testing just in case) I would try to arrange testing before starting therapy, or at least at the point of starting therapy. There are labs that will run the test for a few hundred dollars (and a lot less if you know someone at a university, it could even be an analytical chemists' bachelor degree project).

giarc 10y ago
I guess you could reason they are safe to take regardless. If they are counterfeit, they would likely make them out of sugar or flour not harmful chemicals. It wouldn't be in the best interest of the counterfeiters to make pills that harm or kill the buyer.
- grumpopotamus 10y ago
  I wouldn't bet my life on that. In fact, counterfeit drugs are estimated to kill hundreds of thousands of people a year, in many cases directly, not because they don't provide the necessary treatment. See http://www.cnn.com/2012/07/17/health/living-well/falsified-medicine-bate/ http://www.cnn.com/2012/07/17/health/living-well/falsified-m... >Fakes contained chalk, talcum powder, road paint and occasionally dangerous heavy metals, instead of the expensive, hard-to-make medicine.

mirimir 10y ago

Yes, way to go! There are honest online pharmacies, but finding them is nontrivial. And there are numerous competent generics manufacturers in India. They've captured a large share of the global generics market in recent years.

bedhead 10y ago
.
- giarc 10y ago
  You should re-read the article. >Last year, Gilead entered into an agreement with India that would allow Indian pharmaceutical manufacturers to produce generic versions of Harvoni and Sovaldi and sell them in 101 developing countries at "a significantly reduced flat price." >If you buy Hepcinat from India, Gilead still makes a profit as part of its licensing arrangement, but it doesn't make the unholy profits the U.S. government allows it to get away with.
- quadrangle 10y ago
  If for some reason, a poor person needed to pirate software that they couldn't afford in order to save their life, that would be ethical too. But this isn't even comparable, this is more like buying the very same software from an overseas licensed vendor who sells it cheaper.

deleted 10y ago

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surrealvortex 10y ago

I'm conflicted about this article. On the one hand, the pharmaceutical companies gouging ordinary Americans is abominable. Doing something to circumvent their greed is something to support. On the other hand, if enough people exploit loopholes like this, and the pharma company actually felt a significant drain in revenue, they may decide not to license the manufacture of these drugs in India at lower prices. If $84,000 seems unreasonably high in the US, imagine how out of reach it will be in India, where the cost of living is much lower.

hueving 10y ago
Right now US citizens are basically subsidizing other countries when it comes to drug revenue via price gouging. I would rather it be done via some other more explicit mechanism (e.g. India government subsidies) rather than at the expense of poor healthcare availability to people in the US.
- sandworm101 10y ago
  Considering that Americans consume 75% of the world's prescription drugs, and I think it safe to assume an equivalent amount of non-prescription drugs, I don't think any of this makes much difference. The US is a very strange and unique drug market. Citation: "5 percent of the United States is the world's population and consumes 75 percent of the the world's prescription drugs." https://www.drugabuse.gov/related-topics/trends-statistics/infographics/popping-pills-prescription-drug-abuse-in-america https://www.drugabuse.gov/related-topics/trends-statistics/i... (And by "Americans" I and the gov included all those people in the US market who are not "US citizens". Ie me.)
  - adrianN 10y ago
    That statistic seems a little misleading to me, because very large parts of the world don't consume any prescription drugs at all, because they're too poor to go to the doctor.
- bpodgursky 10y ago
  Yeah, but that's not going to happen. If a big pharm company doesn't provide India-priced versions of drugs, the Indian government just declares the patent invalid and lets generics produce it for free (yes, this happens).

hyperliner 10y ago

I really think this article is spot on taking on an issue that I believe will become more and more pressing over time as baby boomers continue to retire. However, this line felt of out of place: - "And then there's Gilead. It didn't even develop Harvoni itself; it made a business decision to pay $11 billion to buy the company that did so it could be first to market and reap the rewards, $26 billion worth. There is something obscene about that. A billion-dollar profit would have been a very respectable return on investment, but Gilead is getting much, much more than that" I mean, why is that obscene? We have seen crazier returns in [insert latest "stupid" app that made billions]. These drugs are difficult to manufacture AND to market. I am sure that if the return would have certain, then the seller would not have sold the company for that amount and would instead reaped the presumed returns. I think pharma is entitled to big returns because their business is really risky. I don't know where the answer is. Maybe it is government-driven pharma (yeah like the federal government is ever going to be good at anything), or a SpaceX for Pharma.

rayiner 10y ago
Note that a billion dollar profit would be a 3.8% return over the life of the drug (~10 years or whatever is left on the patent). You could literally get better returns with far less risk parking that money in Treasuries.
- Dylan16807 10y ago
  You're doing the math wrong. The suggestion is not a billion dollar profit on 26 billion dollars of costs. Most of the 26 billion dollars is profit. Chopping the cost tremendously would still leave a healthy profit margin. As to risk, they bought an already-proven drug. That's not the sort of thing that earns massive returns.
  - rayiner 10y ago
    I did do that math wrong, but to be fair, the article is comparing apples and kumquats. $26 billion is how much Gilead has in cash, which has little to do with Sovaldi at this point. $1 billion profit (let's say that's annual, rather than over the life of the drug) on an $11 billion purchase would be less than 10% annual ROI. That's very low for what was still a very risky investment (unapproved drug).

erikpukinskis 10y ago

Ironically, if the rights were owned by Skreli, Smith could've gotten the drugs for free.

foxylad 10y ago

There is obviously something unbalanced in the pharma business, and I think it is one of the corner cases where unbridled capitalism fails - perhaps because it is a need, not a want, so it is not discretionary spending. My instinct is that pharma development should be carried out by universities (the state), so it's benefits can be shared with all citizens.

andrewchambers 10y ago
It sounds more like a lack of real competition.
- rayiner 10y ago
  You can't have "real competition" in the drug industry. While the status of patents is debatable in software (where actual copying is rare), the generics manufacturers are always directly copying from the drug inventors. They don't have the capability to do their own R&D, or often even to develop a lot of the ancillary protocols themselves. So you either have a regulated market, or massive free-riding, neither of which is "real competition."
  - refurb 10y ago
    You can't have perfect competition in the drug industry, but you can get close. Gilead dropped the price of Sovaldi/Harvoni by almost 30% when Abbvie launched their HCV therapy. In fact, one of the best way to introduce competition is through "me-too" drugs. You know, the ones everyone complains about.
  - necessity 10y ago
    How much time does it take to analyze the original and copy it, set up for mass production, advertise, etc? Then, how much time until demand shifts from the original to the generic in each market (India, US, etc)? According to the OP the company was making "billions every quarter" on sales in the US. Considering the research often costs "billions", they should make a profit in the first quarter by selling in multiple markets if it takes around a month until the demand shifts to the generic.

MichaelBurge 10y ago

A quick Google search shows that they paid $11 billion for the company that sells the drug(Sovaldi), and earned $1.3 billion off of it[1] in 2016. They make half of that in the US, and something like 10% of it in all places that aren't the US, Europe, or Japan. That's a 12% return in 2016, which isn't nearly as good as the comments in this thread would have you believe. It's an okay return, but it wouldn't really be a good investment unless they can grow those sales more. It looks like they have had some growth compared to last year, so maybe it will end up working out for them. It's certainly not "100x in profits". A Google search shows the disease is ultimately hard-to-transmit and preventable[2]. $84,000 seems like a fair price to me for this particular case. Google says the total cost of raising a child is "$245,340", so paying a 30% premium in rare cases doesn't seem unreasonable. A separate complaint is that the financial industry isn't covering this case well. If you expected your insurance to cover it and they don't, that is an entirely separate issue than the price of the drug. Even if they don't, it seems like there should be a market for people wanting loans to pay for cures: It seems really hard to underwrite such a loan, but it could probably be done. What does good insurance from a reputable insurance provider that reliably pays out their claims in cases like these cost? (Edit) I may have misread the earnings report, thinking it was for the previous year rather than the previous quarter. So the percentage is closer to 50%, and a commenter clarified that they also had another product. [1] Earnings: http://investors.gilead.com/phoenix.zhtml?c=69964&p=irol-earnings http://investors.gilead.com/phoenix.zhtml?c=69964&p=irol-ear... Purchase price: http://investors.gilead.com/phoenix.zhtml?c=69964&p=irol-newsArticle&ID=1632335 http://investors.gilead.com/phoenix.zhtml?c=69964&p=irol-new... [2] Going down the list on one site that lists transmission methods: Don't have sex with weirdos carrying diseases; don't share needles with druggies; go to a licensed upscale commercial tattoo parlor instead of some shady cheap one

themartorana 10y ago
Or... $11B was a terrible price to pay, and their desire to recoup their shitty investment still shouldn't be allowed to bankrupt people who just want to live. It's also incredibly obtuse to call $84k a "30% premium" on raising a child. There are so many people who don't (because they can't) spend close to $245k, more that can barely pull it off, and even more that shouldn't have pharma rates kept artificially inflated on their backs.

cowsandmilk 10y ago

(1) As someone who was following the market when Gilead paid $11 billion for PharmAsset, it was not a sure thing that it would be first to market or a premier drug. They announced $137/share on November 21 for a stock that opened at $65.49 on November 11. People like to point out how much money Gilead made on the deal, but that is Monday morning quarterbacking on something where they easily could have lost billions. (2) The article claims Harvoni was acquired. That is not really true. Sovaldi (sofosbuvir) came from the Pharmasset acquisition. Harvoni is a combination of sofosbuvir with ledipasvir, a drug discovered at Gilead. The combination of the two is a key part of the treatment; sofosbuvir was still taken with interferon (and ribavirin) for genotype 1 HCV, the most common form. Treatment for genotype 1 HCV, without interferon required ledipasvir. The notion that Gilead contributed nothing scientifically to Harvoni is false; they provided a crucial component to the all-oral treatment of HCV genotype 1.

refurb 10y ago
As someone who was following the market when Gilead paid $11 billion for PharmAsset, it was not a sure thing that it would be first to market or a premier drug. This is a fantastic point. I remember when Gilead announced their acquisition of Pharmasset. They were ridiculed in the press. How could they be so stupid to pay that much? Many people thought that $11B was as good as gone. That's the risk involved with drug development. It's like VCs, you spend a ton of money on a lot of investments, most of which fail. Unless you get a few huge winners, it's not a feasible business.

bradleybuda 10y ago

Leaps in technology, finance, and engineering cure man of previously incurable disease. He is pissed.

bigpoppa 10y ago

- this guy took a huge risk buying this ‘life saving’ drug on the internet - amounting his worth of his existence to $82,500 - the drug companies paid to develop this drug, non-profits didn’t. - why is he not barking up their tree? http://www.hepatitis.va.gov/web-resources/advocacy.asp http://www.hepatitis.va.gov/web-resources/advocacy.asp - drugs sold in the usa have high costs to market including a massive tax burden on profits - this would be a problem with our government, not the for-profit business

hourislate 10y ago

I was under the impression most Pharma Companies will give it to you for free if you don't have insurance and can't afford it. Maybe it's different if you have insurance and they won't pay for it. The article is unfair mentioning Shkreli. He has always offered his drugs for free to anyone that couldn't afford them. It has always been his policy and continues to be so. I think it was the Insurers and their paid for Politicians that created the stink. To this day I still haven't heard of one person that had to pay the $750.00 a pill but just their co-pay and if they had no insurance they got it for free. Surprised this drug isn't available for free for those without insurance or is it?

pavel_lishin 10y ago
> The article is unfair mentioning Shkreli. He has always offered his drugs for free to anyone that couldn't afford them. [citation needed]
- verroq 10y ago
  >We pledge that no patient needing DARAPRIM will be denied access >If you are uninsured and meet eligibility critera, you can get DARAPRIM for no cost http://www.daraprimdirect.com/patients http://www.daraprimdirect.com/patients
maxerickson 10y ago
It's not like insurance companies are paying that $750 a pill in a vacuum. They make those payments out of the premiums they collect. Shkreli may not have been screwing the poor, but that doesn't mean he wasn't screwing everyone else.

tn13 10y ago

> In the United States, there is nothing stopping pharmaceutical companies from charging whatever they think the market will bear. That is how it should be. The moment government controls prices, it will slow down overall capital investment in invention of new drugs. I think $80k price is perfectly fair given the scenario. Until Giliad Science invented that medicine the alternative to the medicine was assured death by cancer. Have you ever paid medical bills for cancer ? $80k does sound like a reasonable amount to pay for one's life in a developed country like USA. In India value of life is much less and I am not surprised Indians are willing to pay much less for their life. Poor Indians are benefiting at the expense of rich Americans. Indian would prefer to die than borrow and buy a $80k medicine. I think if Americans can save money by offshoring the cheap call centers to India they can also save money by getting their health treatment in India. The thing to remember here however is that if you die in an operation theater in USA your family might get millions in compensation. In India you have to say bad luck and move on. The pills that you buy from India could be nothing but horseshit packaged in wrappers and you can basically do nothing even if you find it out. US is at the forefront of drug inventions because markets are allowed to function, surely companies are making ton of profits but I suggest you try setting up a company and invent the same drug and sell it for cheaper price. Inventing drugs is like a startup, a giant number of research projects fail, handful of succeed. People remember Facebook and its obscenely rich Zukerberg they don't remember Bozo inventor of JokerBook, a social network for clowns. It would be good if Americans learn to appreciate what they have rather than complain about everything.

zaroth 10y ago

If you remove a bunch of constraints, you can imagine governments paying for country-wide license to the patent, and then individuals just pay enough to cover manufacturing and delivery. I'm not sure if there was any payment that went along with granting India the $1000 price. I know India carries a big-stick of "invalidating" the patent. Sure, they could have just taken the IP for themselves, which basically means Americans just bare a larger share of the overall cost. The fact is that this drug is tremendously valuable for India, so I'm glad they were able to come to some pricing agreement. Selling those drugs back into the US market clearly goes against the pricing agreement. Based on what I read in those articles about Paul Le Roux, these online drug outfits have way more volume than you might expect, and they apparently can run for a long time before being shut down. This is partly a submarine ad in that sense, even naming sources. You also might expect customs to intercept these packages, but when Le Roux can share the same FedEx account number across all their pill shipments, clearly inspection is expected to be lax. So the result is these pills could actually be pouring back into the country, and hiding within the inventory being sold for consumption actually inside India. It seems like Gilead revenue is strong for now, I don't know if they consider this to be a significant risk. In some cases insurance will not cover if you are not showing symptoms. But if they do cover it, you will be on the hook for just the out-of-pocket maximum for that year. Any other health care you receive that year will be free, so that could also help justify the cost. But in this case the insurance company didn't want to cover it anyway, so the patient was forced to pursue a gray market purchase. I'm pretty sure Gilead is pushing hard for insurance companies to cover anyone with detectable disease regardless of symptoms, and ultimately that's what we want. There's a huge population that avoided the prior treatments, but would jump on this in a second. Everyone who has HepC should get this drug. But if we can't afford to cure everyone today, how do prioritize access? And how do you limit access to an FDA approved drug for a diagnosed illness anyway, when the alternatives are more expensive and less effective? Well I guess in some places, like the NY AG is requiring coverage for commercial insurance plans. NYT reports that Medicaid is still denying coverage until the disease has advanced. We want people to pay the "right" price for this drug, really a miracle cure which is lowering the cost of treatment actually. So how do you price it? The price to the insured patient today will vary based on the financial means of the patient. The revenue to Gilead is negotiated with insurance companies / benefit management companies, and is far below the sticker price.

cheriot 10y ago

Eminent domain is not just for land. In extreme cases like this where a profit motive is the only thing keeping us from curing huge numbers of people, the US government should write a single check, take the rights, and start handing out pills. As far as the company is concerned, that could even be a preferable outcome. Cash now and the marketing benefits to promote its other drugs. Edit: Just a reminder that eminent domain requires paying the property owner. https://en.m.wikipedia.org/wiki/Just_compensation https://en.m.wikipedia.org/wiki/Just_compensation

nickpsecurity 10y ago
We could do that. On other hand, we could just pay them the expected market value of the drug when they first invent it then give it to public for almost nothing. "You can cure cancer with those three drugs? Was going to make tens of billions? Here you go: guarantee of tens of billions of subsidies over next 20 years in exchange for the patent and license for anyone to produce it generically." Boom! Tens of thousands of lives saved a year. Way better than investing into the TSA. :)
- cheriot 10y ago
  Agreed, that's exactly what I'm trying to suggest :) Eminent domain requires paying the property owner.
- necessity 10y ago
  When you say "we pay the market value" and "give to the public for almost nothing", "we" and "the public" are the same group and therefore it makes no sense to make the distinction. Unless by "we" you mean "the wealthy" and "the public" you mean "the poor", in which case the increased tax that has to be set up for that will just be reverted into the cost of the service/good provided by the wealthy, the wages of their employers, or turn into capital flight, and so forth. In short, you're basically taking money from other areas of people's lives and making them put it into health care. Which could be achieved by themselves by saving, if that's what they wanted to do.
  - 10y ago

corvallis 10y ago

Something to keep in mind is the population that typically has chronic Hep C requiring this drug. It's IV drug users who share needles. Think they have $84K? Nope. Think they have insurance? Nope. Guess who pays for it. Oh that's right, it's Medicaid! It's you, the taxpayers. Where is there a large concentration of people that have Hep C? Prisons. Guess who pays for it then? Still you! The prison systems are obligated to provide health care and treatments in accordance with community standards of care, which they do. They have treated many people already who meet the criteria of disease progression to qualify for it. Still think Gilead should be charging this much for it here and not elsewhere?

mgiannopoulos 10y ago
So India does not have prisons or similar laws for treatment of prisoners?
- cheiVia0 10y ago
  Incarceration rate (Prisoners per 100,000 population): United States: 698 India: 33 https://en.wikipedia.org/wiki/List_of_countries_by_incarceration_rate https://en.wikipedia.org/wiki/List_of_countries_by_incarcera...
refurb 10y ago
You don't think it's fair to price a product relative to the wealth in a given country? I think it's quite fair to be honest.
- x5n1 10y ago
  It should be priced according to ability to pay based on income. The same is the reasoning why the drug is so cheap in other countries, their people can't possibly afford the prices. So it makes no sense for citizens of wealthy countries to have to pay huge markups if they don't have the money. It makes no sense from an economic perspective to force people to go into bankruptcy just because they got sick.

ptaipale 10y ago

I actually wouldn't expect that Indian prisons provide any effective medication against hepatitis C. You might get it if you buy it yourself, and bribe the prison staff to allow you to have it. Sorry: this is not based on any real experience or references, just the overall assessment of how India stands currently.

dragonmum 10y ago
> You might get it if you buy it yourself, and bribe the prison staff to allow you to have it. > Sorry: this is not based on any real experience or references, just the overall assessment of how India stands currently. Jeez, you didn't have time to search but had time to fantasize like a Hollywood script writer hashing out more 3rd world stereotypes? Perhaps we should look at the treatment and hepatitis morbidity rate in our prison system and wonder whether your stereotype may more accurately fit our own prisons rather than Indian ones. Here: [1] http://www.delhi.gov.in/wps/wcm/connect/lib_centraljail/Central+Jail/Home/Medical+Care+and+Hospital+Administration http://www.delhi.gov.in/wps/wcm/connect/lib_centraljail/Cent... [2] http://www.legalservicesindia.com/articles/pri.htm http://www.legalservicesindia.com/articles/pri.htm [3] http://defensewiki.ibj.org/index.php/Right_to_Medical_Care_in_Prison http://defensewiki.ibj.org/index.php/Right_to_Medical_Care_i... Delhi Prisons have set up an Integrated Counseling and Testing Centre (ICTC) on 10.06.08 in Central Jail Hospital for detecting HIV positive inmates. Targeted intervention for HIV detection in inmates like injecting drug abusers / sexually promiscuous, inmates suffering from STD and inmates suffering from multiple / opportunistic infections. Total number of such inmates, tested for HIV positive test at ICTC from January,2010 to October'2010 were 1399, out of which 27 were tested HIV positive .Further 2254 inmates were tested for HBsAG and out of which 66 were found to be +ve for Hepatitis B. [4] https://en.wikipedia.org/wiki/Infectious_diseases_within_American_prisons https://en.wikipedia.org/wiki/Infectious_diseases_within_Ame... While the majority of HCV infections occur outside of prison, the disease is still widespread within the prison system as a result of drug injection.[15] According to one Rhode Island prison study, HCV infection was found in 23.1% of the male prison population.[16] HCV prevention proved to be more challenging than HIV prevention because inmates partake in high-risk behaviors such as “front loading” and sharing spoons to prepare drugs like cocaine.[4] The prevalence of these diseases within prisons is a concern because they pose a potential public health risk. [5] https://represent.us/action/private-prisons-1/ https://represent.us/action/private-prisons-1/

WalterBright 10y ago

Keep in mind that the potential for huge profits was what motivated private investors to fund development for a cure. Without that, Hep C would still be a death sentence, regardless of how much money you had.

maxerickson 10y ago
Pharmasset spent in the ballpark of $1 billion developing the candidate that Gilead decided to buy (I'm taking the annual spend on total operations there, rounding up to $100 million and multiplying by 10 to get the $1 billion). https://www.sec.gov/Archives/edgar/data/882095/000119312511331318/d260880dex991.htm https://www.sec.gov/Archives/edgar/data/882095/0001193125113... It sort of looks like they have figured out how to have excellent pricing power when they are willing to bid $11 billion for the company. Part of that is probably that looking just at this drug is a facile analysis of the value of Pharmasset (which did more than develop 1 drug, they built expertise in creating antivirals). Of course, the expertise story implies that they don't need to recover the purchase on just this drug. I guess some of it is the complexity in the medical payments system.

seshagiric 10y ago

Not sure if there is one in the USA, however in India the law does impose a maximum price for critical and life saving drugs (hypertension, heart related, diabetes etc.). There is ongoing process for adding some cancer drugs too to this list. I think the key here is that businesses should be allowed to make a 'reasonable' profit.

markvdb 10y ago

This is yet another perverse collision of care and market regulation. Other examples abound. Why do we accept this? Do we even dare think of alternatives? What if western governments stop enforcing drug development intellectual rights? Not going to happen before hell freezes over, but let's have a short thought experiment. Quality health care for all would probably blossom thanks to more access to affordable drugs than ever. Drug development would probably slow down significantly without compensating measures. But would that be so bad? Medical research is increasingly a game of diminishing returns... Many but the rarest disease puzzles have been solved already. And the huge profit margins show the current drug development system has proven inefficient handling these rare corner cases. Think https://en.wikipedia.org/wiki/Alexion_Pharmaceuticals https://en.wikipedia.org/wiki/Alexion_Pharmaceuticals . With more patents starting to expire, the existing drug development model will only get more inefficient... Aren't there more efficient ways to incentivise drug research? Crazy idea... Bootstrap an open source drug with maecenate and/or public funding, or market an existing generic with a sympathetic history. Make it super easy for people to donate something extra on top of the drug price. Think a tip at the pharmacy, directly to the researcher's drug development budget. Their drug cured them or their loved ones! Put a picture of the research team on the packaging. Show people these researchers are heroes.

adrianN 10y ago
I wouldn't call cancer, heart disease, alzheimer's, ageing etc "the rarest disease puzzles", yet I'm not satisfied with the status quo of medical care for these problems.
- airless_bar 10y ago
  Mainstream access to all existing drugs would still be a hugely more favorable outcome than the "chance" of new drugs at outrageous prices.
  - peyton 10y ago
    Don't we get cheap drugs when patents expire? Are you saying we should invalidate all existing drug patents today and cease R&D rather than wait for patents to expire?

walterstucco 10y ago

Guess who can get them for free? those living in civilized countries with universal health care systems.

bandrami 10y ago
Very few countries offer free prescription drugs. Not even Canada does that.
- scottishfiction 10y ago
  Scotland, Wales and NI do. And England has only a nominal charge.
  - bandrami 10y ago
    Right, and I think that's it (SK does the "nominal charge" thing).
    - MagnumOpus 10y ago
      Most western countries do the "nominal charge" thing - which in this context is just about equal to zero. For instance: German public health insurance buys a course of Sovaldi for EUR40,000 ($46,000), the patient pays a cost of EUR10 ($11.50).
- herbst 10y ago
  It is still something different when my health care just pays for it and later talks to me about the costs than when i need to find a way to finance it from the beginning.

PieterH 10y ago

Surprised no-one has pointed to the real culprit here: the patent system, which allows individual companies to own knowledge like this and sell it at any rate it desires... private taxation by and for the rich, on the rest of society.

cm127 10y ago
"Gotta have patents and profits, or there's no reason to fund it." All testing, research, and funding has to be private for some reason.
- ordbajsare 10y ago
  Soviet....
linker3000 10y ago
> Surprised no-one has pointed to the real culprit here Finance and the monetary system.

y04nn 10y ago

The pharmaceutical industry is disgusting me. Their goal is no more to cure people but to generate that maximum amount of cash for shareholders. To chose a price point, they don't look at what research has cost, but what people, government aid and insurance are willing to pay for it and choose chose a price that max out the benefit. In developed country it becomes ridiculous. As a note, when they have to make risky research they put the risk into a spin-off company with investors that share the risk, and this is how you end up with Gilead buying this probably co-founded research company.

0bamacare 10y ago
I give you an A for finally coming w/the right answer.I was falling asleep reading all this liberal blather.

golergka 10y ago

OK, let me be a devil's advocate for a minute, before we get the pitchforks once again. Let's remember this: > Gilead Science was first out the gate, bringing the new hep C drugs Harvoni and Sovaldi to market in 2014 and 2015, respectively. And they worked great: More than 90 percent of patients taking the new drugs saw the hep C virus wiped out in three months, and without the side effects that made interferon treatments so intolerable. So, Gilead is exactly the company that created these drugs from the very beginning. I'm looking at it this way: in 2013 (situation A), there was no cure ("cure" is a simplification, of course, but for this kind of analysis it's not an important detail.). In 2016 (situation B), there is a cure, but it costs $86k. Now, the moral question here is very simple: when you change the world (as Gilead did) from situation A to situation B, is it net good or net evil deed? In which world of these two would you prefer to live?

pramttl 10y ago

I was once prescribed 4 tablets of Albandazole (a drug for worms treatment) just before my health insurance was active on file. The drug was costing over 700$ without insurance and my health center asked if I would like to wait for my student health insurance to show up as active. I said, yes (ofcourse) shocked at the price of the drug (being an international student in US from India). Even after my insurance I paid 35$ co-pay. The same drug costs <1$ in India. Even the co-pay is over 35 times the cost of the drug in India. I was trying to contrast some figures: Salary ratio: ~5:1 (Software engineer, Google based on Glassdoor); Albendazole drug cost ratio: ~700:1

ChicagoBoy11 10y ago

Nobody here is making the pretty obvious point: Yes, it is wonderful to blame the drug companies (who invented the damn cure in the first place!) for greed -- it feels great. But the real important question you have to ask is HOW ON EARTH do they get away with charging $84k for a year of treatment?!?!?!?! If they are charging this amount of money, it is because someone, somewhere, in some deep and mischievous and evil place inside those big pharma buildings, has crunched a lot of numbers and figured out this is the "correct" price for them to charge for this drug. That is their income-maximizing price. And THAT is what's insane. Blaming them for "greed" is idiotic. But you have to scratch your head and think of how on Earth the best strategy for them is to sell a product with a price tag that no individual could really afford!!! That's the real mystery, and when you start asking THAT question, perhaps you end up realizing that the answer isn't so clear. For starters, maybe ingenious strategy devised by our hero in the article, and the Indian government's positions in generic were foreseen by one of the thousands and thousands... upon thousands of lawyers, and business experts, and consultants that these companies hire, so they quickly realized that the name of the game HAS to be that they need to squeeze everything they can out of the U.S. market to make up for the hits everywhere else. "But wait, no one will be able to afford the drug," exclaimed one novice executive at the pharmaceutical. "Not to worry," the senior counsel said, "we have medicaid in the U.S., and that's where most of our customers will come from. You see, the government will effectively be our client, and since they won't have an option not to offer this treatment, all we need to do is ensure we have amazing terms with this ONE customer and we'll be aaaaaaalllll set." Etcetera, etcetera, etcetera. Don't blame the pharma companies. We have ZERO competition in many dimensions of healthcare. We have a drug approval process that costs billions of dollars for a single drug to get through, and the academic evidence is quite clear that it is actually killing more people than it is purportedly saving. I had back surgery three years ago, and a line item in my medical bill was "juice - $25." I stayed in the hospital for 19 hours. It cost me $40,000 FOR NO GOOD REASON whatsoever. I also had shoulder surgery overseas, with a Harvard medical-school trained doctor who operates on world class professional soccer players. I was in a phenomenal hospital for two days, in a private room, with nurses checking on me every hour, the works. The sticker price? $7,000. Without a penny of gov't subsidy. Big Pharma isn't the issue. Our policies towards healthcare are crippling us to no end.

nsajko 10y ago

We could make pharma companies be government contractors so the "intelectual property" would be a owned by the state. That would probably be a bit better than what we have now.

AlgorithmicTime 10y ago

There should be some sort of government chartered corporation for generic drug manufacturing. After a drug patent expires, they review the drug, determine the manufacturing cost, and compare it to the market price for the drug. If the market price is above some multiple of the manufacturing cost, they set up their own production line and sell the drug at their cost.

calvinbhai 10y ago

Health insurance in US charges you 10¢ monthly premium, to provide a $100 pill for $10, while it is available for $1 in India. Dental insurance is as bad. Travel to India + dentist costs are often cheaper than one time treatment costs.

fractal618 10y ago

Hey everyone, look! We're getting ripped off! Here's how they're doing it! We're all in this together! We have the high ground! Here's what we have to do! Look another episode of Game of Thrones is on!! Who's fucking who?

YPCrumble 10y ago

Gilead has developed the first drug since penicillin to cure a major disease and people think the price tag is too expensive. In the modern world, it's not ideal to create a drug to cure something. Once people are cured they no longer need your drug. That's why we have so many drugs like Lipitor and Viagra that treat symptoms but do not cure. The "problem" with Sovaldi/Harvoni is that the patient only takes it for ~90 days, and then they're cured. The drugs are cheaper than regular treatment of Hep C - which ends in liver transplant. Do people think the price tag was just random? No, it's because this is a price at which the taxpayer saves money by curing the disease vs. blood transfusions, liver transplants, lost economic value, etc. Not to mention that the waitlist for a liver transplant is getting halved as we cure Hep C. As we slam Gilead the other really evil pharma companies like Pfizer are taking notes and patting themselves on the back for creating drugs whose end goal is to addict the consumer.

swalsh 10y ago
I worked for a company that developed some PA criteria for these drugs, I can assure you a lot of debate went into this criteria.. these two specific drugs are probably the most hotly contested drugs. If we sold them at the 84k price tag to anyone that COULD use it, the entire insurance industry would go bankrupt, literally. Not even an exaggeration. While your logic is sound, the drug is cheaper than a liver transplat... not everyone who has Hep C ends up getting a liver transplant. There's a huge gap between the number of people who COULD use the drug (and have a MUCH better quality of life), and the people who are most qualified for it. The drug companies are not doing the government a favor here... sorry. Another side conversation that's interesting, is who takes the $84k hit. There's sound logic that it's cheaper to give the drug NOW vs paying for surgery LATER... but what if i'm not your insurer when you need it. With obamacare, you can't be denied because of pre-existing conditions... so it's interesting math.
- maxerickson 10y ago
  Do you have a sense of the production costs? If they aren't very high, the US government could start making the company look like jerks by offering $50 billion for the patent. I'm pretty sure they would be able to calculate a nice return based on a payment like that. The math works fine for that, there's ~3 million people just in the US to treat, paying $50 billion would save a substantial amount just treating those patients. Of course, we don't run our government based on math that makes sense, so it's a pipe dream.

jfountain2015 10y ago

There is an excellent Radiolab piece on this: http://www.radiolab.org/story/what-year-life-worth/ http://www.radiolab.org/story/what-year-life-worth/

known 10y ago

Here is current price for Sofosbuvir in India http://www.medplusmart.com/compositionProducts/Sofosbuvir-400-MG/29220 http://www.medplusmart.com/compositionProducts/Sofosbuvir-40...

mhalle 10y ago

Our medical and social systems are ill-equipped to deal with cures for widespread diseases, which is what Harvoni and its related drugs are. We are used to paying for disease on time: relatively small amounts of money for periodic treatments that might last a lifetime, however long that lifetime may be. And we (at least in the US) often think more about the value of the treatment to the patient rather than the value of a healthy person to society. These questions of cost and value go far beyond HCV. It is a popular, medical, and entrepreneurial dream to cure cancer wholesale with a single easy course of treatment. While cancer isn't a single disease, perhaps we should begin asking now how we could assess the value and pay the price for such a "miracle" should a cure for any of the most common cancers be developed.

xbmcuser 10y ago

I see a good opportunity here build a 40-50 patient facility in touristy place like Thailand. It would cost about $250-350k then charge patients $4500 for a 3 month stay including medicine, food and board. Because of cheap labour and food your expenses won't be more than $20k per month. You would me making a profit with 40% occupancy with 85-95% you could recover your investment in under a year.

anne-marie37 10y ago

I had no side effects either. I did 12 weeks with Ledifos (generic Harvoni), and zero viral load from week 4. I'm SVR4, but still waiting to get SVR12, fingers crossed! :-) I bought Ledifos in Hyderabad, through med tour agency. The trip cost me just over 2600$, tickets included, and I only paid once in India. The guys are mellow, everything went very smoothly: hotels, doc, prescription, pharmacy, all is done in 3 days (www.cure-hepc.com). I know you can do cheaper if you just buy online, but when you pay online you never know if it's a scam.

michel123 10y ago

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