13 ms·

The cost of medicine I require to be functional enough to hold down a job has risen so much that the copay is the equivalent of the entire out-of-pocket cost fr

The cost of medicine I require to be functional enough to hold down a job has risen so much that the copay is the equivalent of the entire out-of-pocket cost from a few years ago. The medication was discovered in 1969. The application method, which is the shitty excuse for the patents protecting its $2,200/month price tag, was first approved for use by the FDA in 1979. The drug has been for sale in it's current form for over a decade.

octaveguin 9y ago
Enbrel? They just received another patent extension, too. This is what government granted monopolies look like.
- dv_dt 9y ago
  This is what the breakdown of working competitive markets look like, and in this case it takes both government monopolies, as well as well as overwhelming short-term greed on the part of the private companies. Long term don't these companies think that charging outrageous prices for drugs will cause a future voter/government backlash of some sort... or maybe they think they should extract profits now because of a chance of drug price regulation coming to the US in the future?
  - Sangermaine 9y ago
    >Long term don't these companies think that charging outrageous prices for drugs will cause a future voter/government backlash of some sort No, because it demonstrably won't. People say they're angry and then do nothing about it. The US has an entire political party angrily decrying any effort to regulate healthcare as socialist slavery. The drug companies know they'll be just fine. Maybe some token slaps on the wrist and public performance of cosmetic changes to appease people now and then, but nothing will happen to them.
    - dv_dt 9y ago
      Perhaps, though I think I'm more energized personally voting & with campaign involvement in the upcoming elections this year than ever before. And part of that is knowing that it might help Medicare for all or other universal healthcare options - maybe not this election or the even the next - but personally I feel it has to happen and is worth working towards.
    - alexanderstears 9y ago
      the US has an entire political party angrily decrying any effort to regulate healthcare as socialist slavery. Argubly regulation is the problem we're in this mess. Do you think an epipen would cost $600 if there weren't a Government granted monopoly? We have two parties who love the current amount of regulations on competition - you need to go to an AMA approved medical school to become a doctor, there aren't H1Bs for health care workers, and the government gets to pick and chose who's allowed to sell medication. They just disagree on the amount of subsidies for poor people. One party thinks prepaid consumption with cross subsidies is insurance and the other party thinks that insurance shouldn't be so binding if you get sick.
      - dv_dt 9y ago
        Regulations can put pressure on prices (and if you look at epipens in particular, part of the regulations allowing the increase of their price have nothing to do with monopoly and a lot to do with getting policy placed into areas where organizations are required to keep an epipen on hand by regulation...). But in terms of overall effect, one can't ignore other nations which pay much lower prices for healthcare with both regulation for drug patents, as well as regulation on drug prices. That combination manages to deliver better care at lower costs than the US (we pay on average double per capita). So I don't think one can generically fault "regulation" for a poorly performing health market in the US.
        alexanderstears 9y ago
        So I don't think one can generically fault "regulation" for a poorly performing health market in the US. You're absolutely right, however, I do think the worst parts of our medical system exist as consequences of regulation. The mandate that emergency rooms treat anyone who enters is onerous and there's no free lunch, paying customers are stuck with the bill. The licencing system isn't optimal for cost effective care. There's a lot to be desired for people who favor supply side solutions to expensive problems.
  - rubyn00bie 9y ago
    No. :( Businesses have no concern over their long term viability. Executives are not incentivized in anyway to care about long term interests. In fact all their bonuses and compensation explicitly reward the short term. Compounding the problem is a simple cost benefit analysis means they've already costed out the future "backlash," and still find themselves to be more profitable. The "long term" is nothing but a mental exercise with no real world manifestation for businesses. The closest you can probably get to it having meaning is for business school grad students doing case studies.
  - freethinker777 9y ago
    You don't need price regulation if you reduce the length of the patents or get rid of the patents completely. Keep in mind patents are a government granted monopoly, the problem is the patents not the prices. If someone else can make the drug for 800 and is happy to sell it for 1000 then it won't be sold for 84,000 anymore because no one will buy it for that price.
  - PeterStuer 9y ago
    No, this is exactly what a 'working competitive market' looks like. If you somehow still believe the simplistic fantasies of economics 101 with a clean partition between 'the market' and the meta-market game, then you urgently need to wake-up.
- rightos 9y ago
  It's a difficult balance to strike - you want the companies to keep developing drugs, you want onerous regulation on those drugs to make sure they're produced and tested for safety and efficacy. But then you want them to be cheap for patients and insurance companies. The best solution is probably to simply drop patent extensions for these things and allow generic drug manufacturers to do what they do best, but if you do that too early you risk damaging funding for new drug development. Too late and you wind up with companies just building up piles of cash like we have today. You need to hit that point of "we need to develop new drugs to make a profit" - what that is, I'm not sure.
  - knieveltech 9y ago
    You want pharma companies to keep doing drug discovery why not ban outright any kind of marketing or advertising for their products? R&D spend across the industry is a fraction of the marketing spend. Think of all the good research that money would fund once pharma companies were freed from spending it on advertising.
    - rightos 9y ago
      Seems like a reasonable idea to me, has anyone attempted to apply some of the less controversial possible solutions here in the US? Like shorter patent lifetimes or a ban or reduction on drug advertising?
      - ajmurmann 9y ago
        Things definitely have been tried. However, companies find loop holes and frequently things get worse after. Check out this amazing episode of econtalk: http://www.econtalk.org/archives/2017/06/robin_feldman_o.html http://www.econtalk.org/archives/2017/06/robin_feldman_o.htm...
    - djhworld 9y ago
      Whenever I visit the US I find it insane how much advertising for drugs is shown on TV, with the usual "ask your doctor about..." disclaimer at the end. Why aren't more American's up in arms about this?
- rayiner 9y ago
  Enbrel didn't receive a patent extension.[1] In 2011, a patent was issued that covered certain aspects of Enbrel that had originally been applied for in 1990. Under the rules applicable to pre-1995 patents, the life of that patent runs 17 years from the date of issuance (or 2028). That could not happen under the current law. Patents issued after 1995 are only valid for 20 years from the date of filing, with current limited adjustments due to delays at the USPTO. [1] There isn't really any such thing, at least as a way to resurrect patents that would otherwise expire.
- johnny99 9y ago
  And this is what populists should be irate about. Not... other things.
- WalterSear 9y ago
  EMSAM Unfortunately, no other class of drug class has worked, and the traditional delivery methods (ie - pill form) caused measurable hearing damage, just from the trial periods.
  - deftnerd 9y ago
    If you take the oral version (as opposed to the patch version) you can get it from India (where the patents have expired). A site I've used in the past that's reliable is AllDayChemist. Search for Selegiline and you can get it for as cheap as 18 cents per 5mg tablet. Good luck! Edit: Sorry, read below that you need the trans-dermal version.
tiggybear 9y ago
And all the scientists that helped develop it are screaming out "Look what a good person I am." It's time for the paradigm to shift from ethical consumption to ethical production.
x0x0 9y ago
I am astonished that a couple of the biggest insurance companies in the US haven't banded together to form a drug manufacturing co-op. Find stuff that's off-patent and build generics for things like epi-pens. The best bit (to my thinking) is after doing this to just a few drugs, the insurance companies would have a very big negotiating stick to go after other companies pricing off-patent drugs way over cost. If I knew a thing about pharma manufacturing I'd be spending my time trying to do this.
- alexasmyths 9y ago
  "Find stuff that's off-patent and build generics" There are a lot of companies that do that.
  - x0x0 9y ago
    But yet things like Epi-Pen price increases occur, so it seems like there's room for a lot more.
    - alexasmyths 9y ago
      You should consider the fact that EpiPen is 'off patent' and that it is priced at some high number by a generic company and that there apparently are no others. The 'market is speaking'. If it were in way lucrative, someone would be doing it. I suggest that it's just a very expensive thing to develop and make, and there isn't a huge demand - otherwise, someone probably would. Now, $600 seems just crazy to me, and like you, my instinct might be 'there's room for someone' - but in reality, it's never that easy. My father worked in Pharma, and once sold a small empty building on behalf of a company for huge $$$ to a Chinese firm - only because it was 'approved' by the Canadian government for making drugs of a certain quality, and that this approval would have been very expensive to obtain. This is just at the top of the list of how many regulatory issues there are in making drugs - and why they are so expensive. I mean it does seem a little crazy that there are $600 EpiPen's but no others - when anyone can make them, but that's where we are.
- virtuabhi 9y ago
pcnonpc 9y ago
Is it not possible to order a generic from India or another country? The drug should be out of patent a long while already? If no competitor is available, why doesn't anyone set it up? It looks like a great startup opportunity.
- Skunkleton 9y ago
  Import laws exist to prevent this specific scenario.
  - deleted 9y ago
    [deleted]
  - tehlike 9y ago
    travel might still be cheaper, no?
- WalterSear 9y ago
  The drug is out of patent. As soon as it went out of patent, they patented the drug + transdermal patch. So, in order to keep their profits up, everyone went without the patch system until their original patent was about to expire. So now they can charge $2,200 for something they developed in the 1990s, but intentionally kept off the market to monopolize. This happens as a matter of course, with every new drug. Without the transdermal system, I can't take the drug. I have to take too much of the active ingredient, and it causes pain and permanent hearing damage. Thanks for suggesting grey market alternatives - I hadn't given it a thought. However, they would definitely be grey/black market, since it's not off-patent, which means there will be higher risks, and it will harder to obtain.
shams93 9y ago
The next Mickey Monday won't be flying cocaine he'll be flying in life saving basic meds from India.
pcnonpc 9y ago
If the drug is out of patent and it is very profitable, why doesn't anyone set up a company to manufacture and sell it cheaper in the US? Same question with epipen.
- WalterSear 9y ago
  The drug was repatented with the delivery mechanism, as soon as the original patent expired. It's the usual practice to keep novel delivery system/drug combinations off the market until the original drug patent expires, thereby extending the profitability of the patent, at the cost of users suffering medicine that is consequently decades out of date.
  - joveian 9y ago
    I think a similar issue applies with Epipen. There is an alternative, Adrenaclick (still expensive but not quite as bad), but because the delivery mechanism is different the prescription needs to be written differently. Transdermal delivery unfortunately seems to be underexplored and very expensive in general. Transdermal estradiol is another one that is much more expensive than the pill form but is better in terms of safety. Generic patches available outside the US are less expensive (than patches in the US, still quite a lot more expensive than pill form). I'm not sure if generic patches are completely unavailable in the US or if they are just also quite expensive. Melatonin is another case where transdermal delivery can be helpful, but it is difficult to find and fairly expensive (not quite as bad, though). Beyond delivery mechanisms, drug companies also create modified forms of a drug (prodrug or metabolite or slightly different but similar substance) that have small advantages over the previous version. Again, these can't be substituted and doctors need to know to write the prescription for the form available as a generic. Best for the drug companies is when the origional form is pulled from the market by the FDA right after the patent expires, as happened with the antihistamine Seldane/terfenadine (replaced by Allegra/fexofenadine, a metabolite). In other cases where out of patent drugs are not available as generics it is because the market is small and the current manufacturer can instantly drop their price to match if a generic appears, making it likely that anyone who attempts to make a generic will loose money.
namlem 9y ago
Can you not just get it from an online Canadian pharmacy?
- the_watcher 9y ago
  It's much easier to avoid detection, since the only laws being broken are when you actually make the drug. This is in your home, so you can feasibly break no laws in the view of anyone (as opposed to buying from a Canadian pharmacy and running the risk of USPS catching it).
- WalterSear 9y ago
  I hadn't thought of that before, but from searching today, it doesn't look an actual 'canadian pharmacy' is findable among the colossal numbers of non-canadian companies shifting cheap generics. And, since this isn't a generic, or even a pill that can be copied, they aren't stocking it. :(

octaveguin 9y ago

Enbrel? They just received another patent extension, too. This is what government granted monopolies look like.

dv_dt 9y ago
This is what the breakdown of working competitive markets look like, and in this case it takes both government monopolies, as well as well as overwhelming short-term greed on the part of the private companies. Long term don't these companies think that charging outrageous prices for drugs will cause a future voter/government backlash of some sort... or maybe they think they should extract profits now because of a chance of drug price regulation coming to the US in the future?
- Sangermaine 9y ago
  >Long term don't these companies think that charging outrageous prices for drugs will cause a future voter/government backlash of some sort No, because it demonstrably won't. People say they're angry and then do nothing about it. The US has an entire political party angrily decrying any effort to regulate healthcare as socialist slavery. The drug companies know they'll be just fine. Maybe some token slaps on the wrist and public performance of cosmetic changes to appease people now and then, but nothing will happen to them.
  - dv_dt 9y ago
    Perhaps, though I think I'm more energized personally voting & with campaign involvement in the upcoming elections this year than ever before. And part of that is knowing that it might help Medicare for all or other universal healthcare options - maybe not this election or the even the next - but personally I feel it has to happen and is worth working towards.
  - alexanderstears 9y ago
    the US has an entire political party angrily decrying any effort to regulate healthcare as socialist slavery. Argubly regulation is the problem we're in this mess. Do you think an epipen would cost $600 if there weren't a Government granted monopoly? We have two parties who love the current amount of regulations on competition - you need to go to an AMA approved medical school to become a doctor, there aren't H1Bs for health care workers, and the government gets to pick and chose who's allowed to sell medication. They just disagree on the amount of subsidies for poor people. One party thinks prepaid consumption with cross subsidies is insurance and the other party thinks that insurance shouldn't be so binding if you get sick.
    - dv_dt 9y ago
      Regulations can put pressure on prices (and if you look at epipens in particular, part of the regulations allowing the increase of their price have nothing to do with monopoly and a lot to do with getting policy placed into areas where organizations are required to keep an epipen on hand by regulation...). But in terms of overall effect, one can't ignore other nations which pay much lower prices for healthcare with both regulation for drug patents, as well as regulation on drug prices. That combination manages to deliver better care at lower costs than the US (we pay on average double per capita). So I don't think one can generically fault "regulation" for a poorly performing health market in the US.
      - alexanderstears 9y ago
        So I don't think one can generically fault "regulation" for a poorly performing health market in the US. You're absolutely right, however, I do think the worst parts of our medical system exist as consequences of regulation. The mandate that emergency rooms treat anyone who enters is onerous and there's no free lunch, paying customers are stuck with the bill. The licencing system isn't optimal for cost effective care. There's a lot to be desired for people who favor supply side solutions to expensive problems.
- rubyn00bie 9y ago
  No. :( Businesses have no concern over their long term viability. Executives are not incentivized in anyway to care about long term interests. In fact all their bonuses and compensation explicitly reward the short term. Compounding the problem is a simple cost benefit analysis means they've already costed out the future "backlash," and still find themselves to be more profitable. The "long term" is nothing but a mental exercise with no real world manifestation for businesses. The closest you can probably get to it having meaning is for business school grad students doing case studies.
- freethinker777 9y ago
  You don't need price regulation if you reduce the length of the patents or get rid of the patents completely. Keep in mind patents are a government granted monopoly, the problem is the patents not the prices. If someone else can make the drug for 800 and is happy to sell it for 1000 then it won't be sold for 84,000 anymore because no one will buy it for that price.
- PeterStuer 9y ago
  No, this is exactly what a 'working competitive market' looks like. If you somehow still believe the simplistic fantasies of economics 101 with a clean partition between 'the market' and the meta-market game, then you urgently need to wake-up.
rightos 9y ago
It's a difficult balance to strike - you want the companies to keep developing drugs, you want onerous regulation on those drugs to make sure they're produced and tested for safety and efficacy. But then you want them to be cheap for patients and insurance companies. The best solution is probably to simply drop patent extensions for these things and allow generic drug manufacturers to do what they do best, but if you do that too early you risk damaging funding for new drug development. Too late and you wind up with companies just building up piles of cash like we have today. You need to hit that point of "we need to develop new drugs to make a profit" - what that is, I'm not sure.
- knieveltech 9y ago
  You want pharma companies to keep doing drug discovery why not ban outright any kind of marketing or advertising for their products? R&D spend across the industry is a fraction of the marketing spend. Think of all the good research that money would fund once pharma companies were freed from spending it on advertising.
  - rightos 9y ago
    Seems like a reasonable idea to me, has anyone attempted to apply some of the less controversial possible solutions here in the US? Like shorter patent lifetimes or a ban or reduction on drug advertising?
    - ajmurmann 9y ago
      Things definitely have been tried. However, companies find loop holes and frequently things get worse after. Check out this amazing episode of econtalk: http://www.econtalk.org/archives/2017/06/robin_feldman_o.html http://www.econtalk.org/archives/2017/06/robin_feldman_o.htm...
  - djhworld 9y ago
    Whenever I visit the US I find it insane how much advertising for drugs is shown on TV, with the usual "ask your doctor about..." disclaimer at the end. Why aren't more American's up in arms about this?
rayiner 9y ago
Enbrel didn't receive a patent extension.[1] In 2011, a patent was issued that covered certain aspects of Enbrel that had originally been applied for in 1990. Under the rules applicable to pre-1995 patents, the life of that patent runs 17 years from the date of issuance (or 2028). That could not happen under the current law. Patents issued after 1995 are only valid for 20 years from the date of filing, with current limited adjustments due to delays at the USPTO. [1] There isn't really any such thing, at least as a way to resurrect patents that would otherwise expire.
johnny99 9y ago
And this is what populists should be irate about. Not... other things.
WalterSear 9y ago
EMSAM Unfortunately, no other class of drug class has worked, and the traditional delivery methods (ie - pill form) caused measurable hearing damage, just from the trial periods.
- deftnerd 9y ago
  If you take the oral version (as opposed to the patch version) you can get it from India (where the patents have expired). A site I've used in the past that's reliable is AllDayChemist. Search for Selegiline and you can get it for as cheap as 18 cents per 5mg tablet. Good luck! Edit: Sorry, read below that you need the trans-dermal version.

tiggybear 9y ago

And all the scientists that helped develop it are screaming out "Look what a good person I am." It's time for the paradigm to shift from ethical consumption to ethical production.

x0x0 9y ago

I am astonished that a couple of the biggest insurance companies in the US haven't banded together to form a drug manufacturing co-op. Find stuff that's off-patent and build generics for things like epi-pens. The best bit (to my thinking) is after doing this to just a few drugs, the insurance companies would have a very big negotiating stick to go after other companies pricing off-patent drugs way over cost. If I knew a thing about pharma manufacturing I'd be spending my time trying to do this.

alexasmyths 9y ago
"Find stuff that's off-patent and build generics" There are a lot of companies that do that.
- x0x0 9y ago
  But yet things like Epi-Pen price increases occur, so it seems like there's room for a lot more.
  - alexasmyths 9y ago
    You should consider the fact that EpiPen is 'off patent' and that it is priced at some high number by a generic company and that there apparently are no others. The 'market is speaking'. If it were in way lucrative, someone would be doing it. I suggest that it's just a very expensive thing to develop and make, and there isn't a huge demand - otherwise, someone probably would. Now, $600 seems just crazy to me, and like you, my instinct might be 'there's room for someone' - but in reality, it's never that easy. My father worked in Pharma, and once sold a small empty building on behalf of a company for huge $$$ to a Chinese firm - only because it was 'approved' by the Canadian government for making drugs of a certain quality, and that this approval would have been very expensive to obtain. This is just at the top of the list of how many regulatory issues there are in making drugs - and why they are so expensive. I mean it does seem a little crazy that there are $600 EpiPen's but no others - when anyone can make them, but that's where we are.
virtuabhi 9y ago

pcnonpc 9y ago

Is it not possible to order a generic from India or another country? The drug should be out of patent a long while already? If no competitor is available, why doesn't anyone set it up? It looks like a great startup opportunity.

Skunkleton 9y ago
Import laws exist to prevent this specific scenario.
- deleted 9y ago
  [deleted]
- tehlike 9y ago
  travel might still be cheaper, no?
WalterSear 9y ago
The drug is out of patent. As soon as it went out of patent, they patented the drug + transdermal patch. So, in order to keep their profits up, everyone went without the patch system until their original patent was about to expire. So now they can charge $2,200 for something they developed in the 1990s, but intentionally kept off the market to monopolize. This happens as a matter of course, with every new drug. Without the transdermal system, I can't take the drug. I have to take too much of the active ingredient, and it causes pain and permanent hearing damage. Thanks for suggesting grey market alternatives - I hadn't given it a thought. However, they would definitely be grey/black market, since it's not off-patent, which means there will be higher risks, and it will harder to obtain.

shams93 9y ago

The next Mickey Monday won't be flying cocaine he'll be flying in life saving basic meds from India.

pcnonpc 9y ago

If the drug is out of patent and it is very profitable, why doesn't anyone set up a company to manufacture and sell it cheaper in the US? Same question with epipen.

WalterSear 9y ago
The drug was repatented with the delivery mechanism, as soon as the original patent expired. It's the usual practice to keep novel delivery system/drug combinations off the market until the original drug patent expires, thereby extending the profitability of the patent, at the cost of users suffering medicine that is consequently decades out of date.
- joveian 9y ago
  I think a similar issue applies with Epipen. There is an alternative, Adrenaclick (still expensive but not quite as bad), but because the delivery mechanism is different the prescription needs to be written differently. Transdermal delivery unfortunately seems to be underexplored and very expensive in general. Transdermal estradiol is another one that is much more expensive than the pill form but is better in terms of safety. Generic patches available outside the US are less expensive (than patches in the US, still quite a lot more expensive than pill form). I'm not sure if generic patches are completely unavailable in the US or if they are just also quite expensive. Melatonin is another case where transdermal delivery can be helpful, but it is difficult to find and fairly expensive (not quite as bad, though). Beyond delivery mechanisms, drug companies also create modified forms of a drug (prodrug or metabolite or slightly different but similar substance) that have small advantages over the previous version. Again, these can't be substituted and doctors need to know to write the prescription for the form available as a generic. Best for the drug companies is when the origional form is pulled from the market by the FDA right after the patent expires, as happened with the antihistamine Seldane/terfenadine (replaced by Allegra/fexofenadine, a metabolite). In other cases where out of patent drugs are not available as generics it is because the market is small and the current manufacturer can instantly drop their price to match if a generic appears, making it likely that anyone who attempts to make a generic will loose money.

namlem 9y ago

Can you not just get it from an online Canadian pharmacy?

the_watcher 9y ago
It's much easier to avoid detection, since the only laws being broken are when you actually make the drug. This is in your home, so you can feasibly break no laws in the view of anyone (as opposed to buying from a Canadian pharmacy and running the risk of USPS catching it).
WalterSear 9y ago
I hadn't thought of that before, but from searching today, it doesn't look an actual 'canadian pharmacy' is findable among the colossal numbers of non-canadian companies shifting cheap generics. And, since this isn't a generic, or even a pill that can be copied, they aren't stocking it. :(