8 ms·

The price differences between domestic and international medicines can be truly outrageous. I just got back from a work trip to a hospital in Sierra Leone, wher

The price differences between domestic and international medicines can be truly outrageous. I just got back from a work trip to a hospital in Sierra Leone, where the anthelmintic medicine Albendazole costs the equivalent of $1 USD at a private pharmacy (or even less if you don't care about packaging). The same treatment in the US (a single dose) cost me $430 USD (before insurance). This medicine is out of patent; the R&D costs have been recovered. There's no reason for it to cost as much as is does in the US, apart from greed. It's more of a niche drug in the US than it is in sub-Saharan Africa, but it is shelf stable unlike say the antibodies of an immunotherapy, or the rabies vaccine, so it's not perishable. I trust the purity of the US version more than the version sold internationally, but that is probably an irrational fear. Even with added costs of laboratory purity testing and import tariffs, those in the US would still be better off if we could import drugs from overseas. Some medicines are expensive for a reason: they're new and need to have R&D (and FDA) costs recovered (this is why we have patents), they have niche use and are produced in small quantities (cancer immunotherapies), they're perishable (biologicals), or all three. Many others are expensive because we have no regulatory protections against price gouging. Epi-Pens are another example. A 1mL vial of epinephrine costs ~$5, and the syringe to inject it costs pennies. Auto-injectors add some value, but not the $700 Mylan charges. They're fundamentally a pre-filled syringe a spring, and an injection molded case. I wonder what the system would look like if we granted longer pharmaceutical patents (say, 30 years), with the change that upon expiration of the patents medicines would be produced by the government and sold at cost (or provided for free).

HarryHirsch 9y ago
You'd expect just that to happen. The domestic market for human-rated albendazole is so small that it will sustain just one manufacturer, it's effectively a monopoly, and the monopolist can set prices to whatever he wants. We know what to do in such a situation (turn the monopolist into a regulated utility), but the current political climate won't permit this action. See the vet, get fenbendazole for huge dogs.
- devoply 9y ago
  This sort of rhetoric might work, but it doesn't in the face of Indian manufacturers who can easily be certified who will produce it for $1 and ship it to you the next day for $1 more. It's simply regulatory capture and a way of printing free money for people who already have money so they can rob the masses who don't. It's a scam, and it's stupid that we fall for it. The rich do get richer, and not for any other reason then they have money to affect regulatory capture. Generics should be nearly free. There is no reason for anyone to be making such large sized gains on generics.
  - rayiner 9y ago
    What's stopping generics from being "nearly free" in the U.S.? Why do we need to import them from India?
    - chimeracoder 9y ago
      > What's stopping generics from being "nearly free" in the U.S.? Why do we need to import them from India? Pay-to-delay is a big one. https://www.ftc.gov/news-events/media-resources/mergers-competition/pay-delay https://www.ftc.gov/news-events/media-resources/mergers-comp...
  - refurb 9y ago
    This is why we don't want to import drugs from India: Thakur knew the drugs weren’t good. They had high impurities, degraded easily, and would be useless at best in hot, humid conditions. They would be taken by the world’s poorest patients in sub-Saharan Africa, who had almost no medical infrastructure and no recourse for complaints. The injustice made him livid. Ranbaxy executives didn’t care, says Kathy Spreen, and made little effort to conceal it. In a conference call with a dozen company executives, one brushed aside her fears about the quality of the AIDS medicine Ranbaxy was supplying for Africa. “Who cares?” he said, according to Spreen. “It’s just blacks dying.”[1] [1]http://blogs.sciencemag.org/pipeline/archives/2013/05/17/a_little_ranbaxy_example http://blogs.sciencemag.org/pipeline/archives/2013/05/17/a_l...
walshemj 9y ago
There is wide spread counterfeiting of drugs are you sure you where getting 100% Albendazole ?
ams6110 9y ago
> There's no reason for it to cost as much as is does in the US, apart from greed. The reason is people don't "pay" for it. Insurance does, and so nobody cares. Edit: Well, the insurance companies should care, but if it's something that's rarely prescribed, it might be easier to just pay the claim instead of devoting people to negotiating a lower price.
- mmjaa 9y ago
  Who pays for insurance? (Hint: its you and me, buddy.)
  - cmdrfred 9y ago
    A lot of those costs are taken indirectly via suppressed wages as many people get insurance via employment. It seems to me that a great deal of effort goes into hiding the costs of services and products from those who are paying them in this market.
  - zulln 9y ago
    Yes, but the point is if regular people was faced directly with the cost people would be angry, when hidden by insurance cost it is not made as clear. You expect the masses to think one step further, which will not happen on enough scale.
  - therpe1 9y ago
    Um, no, the tax payers pay for it through Medicaid. People seem to have very strange ideas about how the healthcare industry actually works. But it's not a secret, you can go look at their SEC filings and see the numbers in black and white. Most insurance companies are enjoying record profits because of ever-expanding government funded health programs like Medicare [1]. This is just a fact. Now combine the "limitless pockets" of the Federal government with the total lack of price controls and you get exactly what you would expect in the USA -- prices going straight to the moon. I very much expect this is not going to change any time soon. There is no political desire or will to limit Medicaid and/or institute price controls. This makes investing in health insurers very lucrative. The industry has been enjoying record profits since 2009 [2] and this will continue until the American public learns to do math... [1] https://www.healthinsurance.org/blog/2016/03/01/no-obamacare-isnt-killing-the-insurance-industry/ https://www.healthinsurance.org/blog/2016/03/01/no-obamacare... [2] https://www.consumeraffairs.com/news/health-insurance-industry-rakes-in-billions-while-blaming-obamacare-for-losses-110116.html https://www.consumeraffairs.com/news/health-insurance-indust...
wereHamster 9y ago
> The wholesale cost in the developing world is between 0.01 and 0.06 USD per dose. In the United States, however, it is very expensive as of 2015 at about 201 USD per dose. Source: https://en.wikipedia.org/wiki/Albendazole https://en.wikipedia.org/wiki/Albendazole
- frost_knight 9y ago
  I volunteer at a rabbit shelter, and have performed rabbit care for years. Albendazole is used to counter a rabbit parasite called E. Cuniculi. A complete 30-day Albendazole regimen, for a rabbit, is about $40.
  - briandear 9y ago
    Rabbits don't sue you if they are harmed.
    - xenadu02 9y ago
      Several states have passed tort reform laws, including Texas. It hasn't made any difference. The big pharma players spend more on marketing than R&D. The smaller players like Mylan specifically try to find niche drugs so they can buy the rights and jack the prices. It's pure rent-extraction and a drain on our healthcare system and economy.
    - deleted 9y ago
      [deleted]
rayiner 9y ago
> This medicine is out of patent; the R&D costs have been recovered. There's no reason for it to cost as much as is does in the US, apart from greed. So apparently this medicine is used for treating parasitic worm infections, which I imagine is a vanishingly small market in the United States. That means that the costs of tooling up to produce the drug (and producing it to the standards of safety and purity demanded of any medicine produced in the U.S.) must be amortized over a tiny population of customers. To make a comparison: a commercial Common Lisp IDE runs nearly $1,000 for a hobbyist edition, while you can get professional versions Clion or Jetbrains for $100-400. But there's no patent or other protections limiting competition in the development tools industry. It's simply the economics of making a product that caters to a tiny niche of potential customers.
- maxerickson 9y ago
  It'd be really interesting to see their actual costs for whatever run size is justified by the US market (and some ancillary information like how much they throw away to keep the supply fresh and so on).
- chimeracoder 9y ago
  > So apparently this medicine is used for treating parasitic worm infections, which I imagine is a vanishingly small market in the United States. It's incredibly common in veterinary medicine in the US. Veterinary pharmaceuticals are oftentimes (though not always) manufactured in the same plants. Sometimes the inactive ingredients are not safe for human consumption, so that doesn't mean that you can always just take veterinary drugs safely, but sometimes (particularly in the case of antibiotics), they are literally manufactured on the same lines, and are simply packaged and distributed differently. Given the massive difference in price between albendazole for humans and albendazole for animals, I'm willing to bet that this is another attempt at market segmentation (which we already know is rampant in the US pharmaceutical industry - that's how they make their global profits!), rather than a real necessity of the scale.
- johnchristopher 9y ago
  Even so, 430 times the lowest price shows how distorted the market is. Unless it's okay because we can rationalize it as "it helps make the product accessible to poorer countries".
wheaties 9y ago
Since my wife works in pre-fills and other things I can tell you for a fact that you still have to go through FDA approval. If you change something slightly, you go through approval. There are often clinical trials if the change is not incremental, sometimes even if it is. Change the packaging? FDA review. Change the color of the label? FDA approval. Change suppliers? FDA review. So yes, the syringe and container themselves don't cost that much on a per unit basis (no clue but it's not nothing.) The regulatory costs are astronomical and have to be paid for over time. The general inanity of this stuff is mind boggling. The amount of paperwork insane.
- maxerickson 9y ago
  Mylan has a patent on some minor improvement to Epipens. So it isn't just the FDA, they pushed generics off the market. Mylan flat out admitted that costs aren't any more than $150 per pen when they launched a generic version of their own branded product. Everything above that is clearly them working to get as much price differentiation as possible.
  - pc86 9y ago
    So why not sell Epipens without those minor, patented improvements for $20? Surely if there's profit to be made another provider would come in and destroy the $700 marginally better Epipen market.
    - maxerickson 9y ago
      I don't know why there weren't more competitors. Apparently part of it is that it is difficult to get right. Adrenaclick generics have been on the market much of that time for $150 or less. One thing though, they would be epinephrine auto injectors, not Epipens, that's one of the things the patent did, it made it so that a prescription for Epipen could only be filled with Mylan's product.
  - deleted 9y ago
    [deleted]
bigtimeidiot 9y ago
>This medicine is out of patent; the R&D costs have been recovered. Do you think the financial analysis involved with a new drug stops at "costs recovered"? Why should it? I find it completely bizarre that, instead of getting behind the fact that the US is essentially subsidizing drugs for the 3rd world, people think rich first worlders should be paying sub-Saharan rates.
- ksk 9y ago
  >instead of getting behind the fact that the US is essentially subsidizing drugs for the 3rd world, Could you explain more about what makes it a "fact" ?
joering2 9y ago
What truly upsets me is that not a single politician really knows or wants to see how to fix healthcare! Right now its like pulling a rope - we keep Obamacare at cost of billions of dollars, or we lose it at cost of millions lives affected, eventually. Meanwhile big pharma thrives and examples like yours prove how corrupted US system is! I'm still waiting for one single politician (not its not Trump) to actually start fixing healthcare from the bottom up! Fix the cost of drugs, therapies, etc, and all of sudden we need 1/10,000th of the initial costs.
- rhizome 9y ago
  Lots of people are working on this, but there are also lots of moving parts. It sounds like you know how large the health industry is, do you have any idea how hard it is to change a multi-trillion dollar market? Evergreen suggested reading: http://steve-yegge.blogspot.com/2009/04/have-you-ever-legalized-marijuana.html http://steve-yegge.blogspot.com/2009/04/have-you-ever-legali...
  - joering2 9y ago
    okay I guess in this case since its such a big issue, let's leave it like it is and add another 10 trillion in debt because we need to pay 400x what other countries pay for the same drug.
    - rhizome 9y ago
      Fallacy of the excluded middle, man. There's other options.
overcast 9y ago
Spent a month in India last year, about two weeks in got the Delhi Belly. Doctor visit + drugs = $8.
finid 9y ago
If you happen to be in NYC (USA), stop by any major Chinese grocery store in Flushing, Queens. You'll find albendazole and other anthelmintics for about $10/pack.

HarryHirsch 9y ago

You'd expect just that to happen. The domestic market for human-rated albendazole is so small that it will sustain just one manufacturer, it's effectively a monopoly, and the monopolist can set prices to whatever he wants. We know what to do in such a situation (turn the monopolist into a regulated utility), but the current political climate won't permit this action. See the vet, get fenbendazole for huge dogs.

devoply 9y ago
This sort of rhetoric might work, but it doesn't in the face of Indian manufacturers who can easily be certified who will produce it for $1 and ship it to you the next day for $1 more. It's simply regulatory capture and a way of printing free money for people who already have money so they can rob the masses who don't. It's a scam, and it's stupid that we fall for it. The rich do get richer, and not for any other reason then they have money to affect regulatory capture. Generics should be nearly free. There is no reason for anyone to be making such large sized gains on generics.
- rayiner 9y ago
  What's stopping generics from being "nearly free" in the U.S.? Why do we need to import them from India?
  - chimeracoder 9y ago
    > What's stopping generics from being "nearly free" in the U.S.? Why do we need to import them from India? Pay-to-delay is a big one. https://www.ftc.gov/news-events/media-resources/mergers-competition/pay-delay https://www.ftc.gov/news-events/media-resources/mergers-comp...
- refurb 9y ago
  This is why we don't want to import drugs from India: Thakur knew the drugs weren’t good. They had high impurities, degraded easily, and would be useless at best in hot, humid conditions. They would be taken by the world’s poorest patients in sub-Saharan Africa, who had almost no medical infrastructure and no recourse for complaints. The injustice made him livid. Ranbaxy executives didn’t care, says Kathy Spreen, and made little effort to conceal it. In a conference call with a dozen company executives, one brushed aside her fears about the quality of the AIDS medicine Ranbaxy was supplying for Africa. “Who cares?” he said, according to Spreen. “It’s just blacks dying.”[1] [1]http://blogs.sciencemag.org/pipeline/archives/2013/05/17/a_little_ranbaxy_example http://blogs.sciencemag.org/pipeline/archives/2013/05/17/a_l...

walshemj 9y ago

There is wide spread counterfeiting of drugs are you sure you where getting 100% Albendazole ?

ams6110 9y ago

> There's no reason for it to cost as much as is does in the US, apart from greed. The reason is people don't "pay" for it. Insurance does, and so nobody cares. Edit: Well, the insurance companies should care, but if it's something that's rarely prescribed, it might be easier to just pay the claim instead of devoting people to negotiating a lower price.

mmjaa 9y ago
Who pays for insurance? (Hint: its you and me, buddy.)
- cmdrfred 9y ago
  A lot of those costs are taken indirectly via suppressed wages as many people get insurance via employment. It seems to me that a great deal of effort goes into hiding the costs of services and products from those who are paying them in this market.
- zulln 9y ago
  Yes, but the point is if regular people was faced directly with the cost people would be angry, when hidden by insurance cost it is not made as clear. You expect the masses to think one step further, which will not happen on enough scale.
- therpe1 9y ago
  Um, no, the tax payers pay for it through Medicaid. People seem to have very strange ideas about how the healthcare industry actually works. But it's not a secret, you can go look at their SEC filings and see the numbers in black and white. Most insurance companies are enjoying record profits because of ever-expanding government funded health programs like Medicare [1]. This is just a fact. Now combine the "limitless pockets" of the Federal government with the total lack of price controls and you get exactly what you would expect in the USA -- prices going straight to the moon. I very much expect this is not going to change any time soon. There is no political desire or will to limit Medicaid and/or institute price controls. This makes investing in health insurers very lucrative. The industry has been enjoying record profits since 2009 [2] and this will continue until the American public learns to do math... [1] https://www.healthinsurance.org/blog/2016/03/01/no-obamacare-isnt-killing-the-insurance-industry/ https://www.healthinsurance.org/blog/2016/03/01/no-obamacare... [2] https://www.consumeraffairs.com/news/health-insurance-industry-rakes-in-billions-while-blaming-obamacare-for-losses-110116.html https://www.consumeraffairs.com/news/health-insurance-indust...

wereHamster 9y ago

> The wholesale cost in the developing world is between 0.01 and 0.06 USD per dose. In the United States, however, it is very expensive as of 2015 at about 201 USD per dose. Source: https://en.wikipedia.org/wiki/Albendazole https://en.wikipedia.org/wiki/Albendazole

frost_knight 9y ago
I volunteer at a rabbit shelter, and have performed rabbit care for years. Albendazole is used to counter a rabbit parasite called E. Cuniculi. A complete 30-day Albendazole regimen, for a rabbit, is about $40.
- briandear 9y ago
  Rabbits don't sue you if they are harmed.
  - xenadu02 9y ago
    Several states have passed tort reform laws, including Texas. It hasn't made any difference. The big pharma players spend more on marketing than R&D. The smaller players like Mylan specifically try to find niche drugs so they can buy the rights and jack the prices. It's pure rent-extraction and a drain on our healthcare system and economy.
  - deleted 9y ago
    [deleted]

rayiner 9y ago

> This medicine is out of patent; the R&D costs have been recovered. There's no reason for it to cost as much as is does in the US, apart from greed. So apparently this medicine is used for treating parasitic worm infections, which I imagine is a vanishingly small market in the United States. That means that the costs of tooling up to produce the drug (and producing it to the standards of safety and purity demanded of any medicine produced in the U.S.) must be amortized over a tiny population of customers. To make a comparison: a commercial Common Lisp IDE runs nearly $1,000 for a hobbyist edition, while you can get professional versions Clion or Jetbrains for $100-400. But there's no patent or other protections limiting competition in the development tools industry. It's simply the economics of making a product that caters to a tiny niche of potential customers.

maxerickson 9y ago
It'd be really interesting to see their actual costs for whatever run size is justified by the US market (and some ancillary information like how much they throw away to keep the supply fresh and so on).
chimeracoder 9y ago
> So apparently this medicine is used for treating parasitic worm infections, which I imagine is a vanishingly small market in the United States. It's incredibly common in veterinary medicine in the US. Veterinary pharmaceuticals are oftentimes (though not always) manufactured in the same plants. Sometimes the inactive ingredients are not safe for human consumption, so that doesn't mean that you can always just take veterinary drugs safely, but sometimes (particularly in the case of antibiotics), they are literally manufactured on the same lines, and are simply packaged and distributed differently. Given the massive difference in price between albendazole for humans and albendazole for animals, I'm willing to bet that this is another attempt at market segmentation (which we already know is rampant in the US pharmaceutical industry - that's how they make their global profits!), rather than a real necessity of the scale.
johnchristopher 9y ago
Even so, 430 times the lowest price shows how distorted the market is. Unless it's okay because we can rationalize it as "it helps make the product accessible to poorer countries".

wheaties 9y ago

Since my wife works in pre-fills and other things I can tell you for a fact that you still have to go through FDA approval. If you change something slightly, you go through approval. There are often clinical trials if the change is not incremental, sometimes even if it is. Change the packaging? FDA review. Change the color of the label? FDA approval. Change suppliers? FDA review. So yes, the syringe and container themselves don't cost that much on a per unit basis (no clue but it's not nothing.) The regulatory costs are astronomical and have to be paid for over time. The general inanity of this stuff is mind boggling. The amount of paperwork insane.

maxerickson 9y ago
Mylan has a patent on some minor improvement to Epipens. So it isn't just the FDA, they pushed generics off the market. Mylan flat out admitted that costs aren't any more than $150 per pen when they launched a generic version of their own branded product. Everything above that is clearly them working to get as much price differentiation as possible.
- pc86 9y ago
  So why not sell Epipens without those minor, patented improvements for $20? Surely if there's profit to be made another provider would come in and destroy the $700 marginally better Epipen market.
  - maxerickson 9y ago
    I don't know why there weren't more competitors. Apparently part of it is that it is difficult to get right. Adrenaclick generics have been on the market much of that time for $150 or less. One thing though, they would be epinephrine auto injectors, not Epipens, that's one of the things the patent did, it made it so that a prescription for Epipen could only be filled with Mylan's product.
- deleted 9y ago
  [deleted]

bigtimeidiot 9y ago

>This medicine is out of patent; the R&D costs have been recovered. Do you think the financial analysis involved with a new drug stops at "costs recovered"? Why should it? I find it completely bizarre that, instead of getting behind the fact that the US is essentially subsidizing drugs for the 3rd world, people think rich first worlders should be paying sub-Saharan rates.

ksk 9y ago
>instead of getting behind the fact that the US is essentially subsidizing drugs for the 3rd world, Could you explain more about what makes it a "fact" ?

joering2 9y ago

What truly upsets me is that not a single politician really knows or wants to see how to fix healthcare! Right now its like pulling a rope - we keep Obamacare at cost of billions of dollars, or we lose it at cost of millions lives affected, eventually. Meanwhile big pharma thrives and examples like yours prove how corrupted US system is! I'm still waiting for one single politician (not its not Trump) to actually start fixing healthcare from the bottom up! Fix the cost of drugs, therapies, etc, and all of sudden we need 1/10,000th of the initial costs.

rhizome 9y ago
Lots of people are working on this, but there are also lots of moving parts. It sounds like you know how large the health industry is, do you have any idea how hard it is to change a multi-trillion dollar market? Evergreen suggested reading: http://steve-yegge.blogspot.com/2009/04/have-you-ever-legalized-marijuana.html http://steve-yegge.blogspot.com/2009/04/have-you-ever-legali...
- joering2 9y ago
  okay I guess in this case since its such a big issue, let's leave it like it is and add another 10 trillion in debt because we need to pay 400x what other countries pay for the same drug.
  - rhizome 9y ago
    Fallacy of the excluded middle, man. There's other options.

overcast 9y ago

Spent a month in India last year, about two weeks in got the Delhi Belly. Doctor visit + drugs = $8.

finid 9y ago

If you happen to be in NYC (USA), stop by any major Chinese grocery store in Flushing, Queens. You'll find albendazole and other anthelmintics for about $10/pack.