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Americans Cross Border into Mexico to Buy Insulin
- decebalus1 8y agoHow unpatriotic. I hope the border wall will also keep Americans inside to contribute to the economy instead of spending their money abroad. The health care industry needs money to survive! Pharma companies need money to do R&D! Build that wall, Mr. Trump! /s
- onlyrealcuzzo 8y agoWe need to subsidize these poor drug manufacturers. It's hard times at GlaxoSmithKline.
- maxxxxx 8y agoDon't give them any ideas. They may also start not only searching your laptop and at the border but also for antibiotics.
- deleted 8y ago[deleted]
- umeshunni 8y agoRelated: https://news.ycombinator.com/item?id=17778040 https://news.ycombinator.com/item?id=17778040 https://news.ycombinator.com/item?id=19053389 https://news.ycombinator.com/item?id=19053389
- whatshisface 8y agoInsulin has been manufactured for decades, and is made by more than one company. Why are the prices rising?
- RcouF1uZ4gsC 8y agoNot all insulins are the same. My guess is that this insulin is glargine (https://en.wikipedia.org/wiki/Insulin_glargine https://en.wikipedia.org/wiki/Insulin_glargine) which just came off of patent in 2015. Glargine is a synthetic long-acting form of insulin that gives allows absorption without peaks, which is much better than previous types of long-acting insulins.
- ng12 8y agoShort acting is the biggest problem. There's no generic for it.
- echlebek 8y agoMy understanding is that there are insulin analogs that are vastly better treatments, due to being faster acting. These analogs are still patented. However, even considering the patents, insulin prices for the same product are much higher in the USA than in Mexico or Canada. American prices have increased by an order of magnitude. [1] IMO this rampant price gouging can only be explained by the pharmaceutical lobby, and a political apparatus addicted to their money. [1] https://www.washingtonpost.com/news/wonk/wp/2016/10/31/why-insulin-prices-have-kept-rising-for-95-years/?noredirect=on&utm_term=.318cf26db23b https://www.washingtonpost.com/news/wonk/wp/2016/10/31/why-i...
- deleted 8y ago[deleted]
- whatshisface 8y agoIt sounds like the solution should be that patients can opt for cheaper, worse treatments, if they do not like that the more recent treatments are also more expensive.
- echlebek 8y agoWhy? Why should people have to pay inflated prices for treatments that have been standard since the 90s? Edit: just to be clear, the price of Humalog, a patented analog, has increased in price by 700% in the last 20 years. This is not simply a case of newer treatments being more expensive.
- ng12 8y agoThe short answer is patents. There's a cartel of a few makers (Novo-Nordisk, Lily and Sanofi) that slightly "improve" their insulin every few years to extend the patents. There are some generics available but they're not the fast-acting kind most diabetics use.
- noir_lord 8y agoThe perverse one is where the new patented version is only marginally more effective but 5x the price and they stop making the old one. It's a sick system.
- koolba 8y agoIs the new, still under patent, insulin that much better than what would be available to a generic manufacturer? If the previous generation would work for plenty of patients that’s a huge market opportunity.
- SamReidHughes 8y agoWhat do you mean extend the patents? Making a new version of insulin prevents the older version from going out of patent?
- deleted 8y ago[deleted]
- jahewson 8y agoUnlike most drugs insulin is derived from animal cells so it’s not really possible to make a generic because you can’t demonstrate that your end product is identical to an existing product (at least not as far as the FDA is concerned). The formulations are constantly tweaked by manufacturers to evergreen the patents too. New patents allow the price to be pushed up without risking new competition arriving.
- acdha 8y agoInsulin has been produced by bacteria since the 1980s when recombinant DNA techniques became viable. That’s very precisely controllable compared to the historic animal sources.
- fzeroracer 8y agoBecause endless profit growth is the only thing that matters regardless of the morality or reality of the situation. And what better market to exploit than one where most people have to make a decision between being priced gouged or death. This is of course an extremely simplistic way of looking at it but the reality is that we allow companies to abuse the patent system (under the guise of making research profitable for profiteering medical research) making generics impossible for things such as Insulin.
- KorematsuFred 8y agoMost insulin companies are not really making endless profit growth. They are very profitable but not by as much as you think. Secondly, no one runs a business of charity. Can't really blame them if they want to make huge profit by offering you something you really want. The real solution here is that FDA needs to close the loopholes on the patents that help them renew patents indefinitely. Secondly, drug import must be simplified from countries like Canada, China and Mexico for personal consumption. Third, people should opt for cheaper alternatives which might be slightly less effective than cutting edge.
- fzeroracer 8y agoI just wanted to start by addressing this one really disengenous comment >Can't really blame them if they want to make huge profit by offering you something you really want This isn't a company offering you something you really want. This is a company gouging the prices on something you literally need to live. So allow me to call you out on that shitty argument, first of all. And second, many people don't have the option to opt for cheaper alternatives. They have one choice, which often leads to people having to ration their insulin and die from it [1]. So I would highly recommend you actually do some reading up on the situation before you make claims about alternatives. [1] https://www.npr.org/sections/health-shots/2018/09/01/641615877/insulins-high-cost-leads-to-lethal-rationing https://www.npr.org/sections/health-shots/2018/09/01/6416158...
- KorematsuFred 8y ago
- refurb 8y agoThe actual price the manufacturer charges hasn't been going up much. Novolog list and net prices show Novolog vial has gone up 36% in price since 2001 (less than inflation) and Novolog Pen has gone up 3% since 2001.[1] [1] https://www.drugchannels.net/2016/12/novo-nordisk-sheds-new-light-on-pbm.html https://www.drugchannels.net/2016/12/novo-nordisk-sheds-new-...
- Ancalagon 8y agoAmerican healthcare is frankly - and I say this as an American - disgusting and infuriating. It needs to be re-structured from the ground up.
- ushealth 8y agoAs a Dutch person who spoke to US people in Dutch hospitals —- who needed to pay full price —- I daresay the US health care system is worse than some 3rd world countries their health care system. It is indeed infuriating.
- dmarlow 8y agoI think there are some differences though. "Worse" is a term that needs to define quantitatively what is worse. The quality is actually quite good here.
- maxxxxx 8y agothe treatment is fine. The billing practices are plain corrupt.
- yawz 8y agoAgreed. In the US (just like in many places) you're not exposed to many problems if you have a good insurance and/or have enough money. The system is usually fast, you're treated well and the infrastructure, equipment etc. are great.
- davidw 8y agoLife expectancy vs % of GDP spent on healthcare. The US is a huge outlier: we spend way more than other countries and don't even live as long. There are other ways to measure it too, which is good to investigate, as it is a complicated subject. Here's a HN relevant way to measure it: how much time does your average 5, 50, and 500 person company spend dealing with health insurance stuff? The startup I worked for in Italy spent 0 time on it, because it's not relevant to the company at all. Of course, Italy has massive amounts of bureaucracy for other things, which more than make up for the lack of it in health care, but that's another story.
- HillaryBriss 8y agothis story cites one estimate that, for a certain list of drugs, the savings from buying in Mexico was 40-60% that's huge. but -- how can US consumers possibly save any money by going to another country to buy a product? i thought globalization had brought US consumers free trade.
- maxxxxx 8y agothere is no free trade in drugs,
- HillaryBriss 8y agoUS trade laws and agreements appear to protect certain sectors. has the US ever really had "free trade"?
- pessimizer 8y agoThe US is highly protectionist when it comes to intellectual property and agriculture. It generally only supports free trade in order to take advantage of lower labor costs and/or standards or raw materials in other countries.
- RileyJames 8y agoThere seem to be services that mail insulin from Canada already, which is significantly cheaper. Is it really cheaper, or necessary to fly to Mexico to pick it up yourself? https://www.canadianinsulin.com/ https://www.canadianinsulin.com/
- sithlord 8y agoSince this is technically not legal, i wonder what percent get taken by customs
- queercode 8y agoI didn't know this was news. My mother, a US resident who's lived in the US for ~30 years, in a border town, goes across every time she needs any sort of medical care. The Red Cross only takes cash, but it's so much cheaper (actually affordable).
- jfnixon 8y agoHuh, who woulda thought paying cash would be cheaper than filing a bunch of forms with an insurance company, giveing them a hefty discount, then waiting a few months to get paid.
- shaftway 8y agoAgreed. Many years ago I knew people who worked in an IVF office in Northern California. There was some drug they needed / used / prescribed / ??? that was crazy expensive. One of the nurses would drive down to Tijuana once a month to stock up. I thought this was just common practice.
- Havoc 8y agoSame with tech actually. Busy flying a family member halfway across the world because the price diff on a single (!) laptop and cellphone covers the long haul flight costs. Literally fly over, crash on my couch and spend a week exploring a different country for zero additional cost.
- theatraine 8y agoWhat country and tech? I haven't heard of this before and I wonder if it's a recent phenomenon due to the strength of the US dollar.
- miguelrochefort 8y agoAre you talking about the US or China?
- interlocutor 8y agoIt is not just insulin. Prices of all drugs have been rising in the US, from 2x to 3x at a minimum, to 1000x in some cases. The reason is insurance. When individuals are paying for drugs, drug companies can only charge what individuals can afford. When insurance is paying for drugs, drug companies charge what insurance companies can afford, and insurance companies are able to pay much higher prices (and they recover their costs by raising premiums.) You can't blame pharmaceutical companies for not leaving money on the table. The fact that Medicare is legally not allowed to negotiate drug prices (a big handout by Bush administration to Big Pharma) isn't helping either.
- freeflight 8y agoIf that'd be the case then any country with a single-payer healthcare system would suffer from similarly inflated drug prices as the US, but that's simply not the case [0]. What's stopping US insurers from pressuring drug companies into price agreements? Shouldn't that be also in their best interest, instead of just passing the costs along to the patients? If that's all they are doing, what do you actually need them for? In Germany, price agreements between drug manufacturers and insurers happen plenty of times, and it usually works out because drug companies take reduced profits over no profits, any time of the day. Patients still have the option to buy the "fancy version", paying out of their own pocket, but the vast majority of patients are completely fine with whatever their insurance covers. [0] https://www.commonwealthfund.org/publications/issue-briefs/2017/oct/paying-prescription-drugs-around-world-why-us-outlier https://www.commonwealthfund.org/publications/issue-briefs/2...
- Sileni 8y agoInsurance companies in the US have to pay out a certain percentage of the premiums they take in (80% last I checked) [0]. So they're also incentivized to let prices climb; their 20% for "administration and profit" is inflated when prices are inflated. [0] https://www.healthcare.gov/health-care-law-protections/rate-review/ https://www.healthcare.gov/health-care-law-protections/rate-...
- 8y ago
- tomca32 8y agoNot sure about some of the numbers there. They say that a 3 month supply is $3700. Humalog without insurance costs $95 per 3 ml cartridge, let's say it's a $100. This would mean that this child needs 37 cartridges for 3 months, or 12 cartridges per month, 3 per week. That's a pretty crazy amount of insulin. I'm a T1 diabetic, that doesn't eat particularly healthy, and I need 2-3 cartridges a month, almost an order of magnitude less than the person in the article. I don't think those numbers are right.
- acdha 8y ago> Humalog without insurance costs $95 per 3 ml cartridge, let's say it's a $100. You have a citation that it’s available from every provider in the country at that price? The person quoted specifically said they’d been quoted that much and I would assume that people aren’t making up reasons to go on 5 hour drives.
- tomca32 8y agoI don't. I have this link that lists a bunch of providers and their prices and I don't see anyone going over $100 per 3ml cartridge: https://www.goodrx.com/humalog?dosage=3ml-of-100-units-ml&form=vial&label_override=Humalog&quantity=1 https://www.goodrx.com/humalog?dosage=3ml-of-100-units-ml&fo... Of course, there might be a more expensive provider that I don't know of. I don't think that those people are making up reasons to go on 5 hour drives, but I do think it's quite likely that journalists fudged the numbers or just found some theoretical maximums and approximated the price from there. Just so it's a juicier story, of course.
- acdha 8y agoIt’s a direct statement from one person, not approximation. Either the journalist or the source has to be wrong for it to be incorrect. It’s possible but I’m assuming this is yet another example of the exhaustively documented broken economic model in American healthcare producing wide varaiation as everyone charges whatever they can get away with.
- 8y ago
- usausa9 8y agobecause it was haphazardly stitched together we ended up with healthcare that 1. does not cover everyone 2. it is rationed by for-profit companies 3. is is expensive and can bankrupt you 4. tied to employment which means you can lose it easily 5. confusing since you often have to deal with paperwork and multiple providers If you are rich and can afford it the american system is great but it is awful for everyone else.
- calyth2018 8y ago4a. Because US health coverage tied to employment, it serves as golden handcuffs. But hey, got to have those profits...
- StephenAmar 8y agoThat's the case in other countries, like France.
- usausa9 8y agoyou are right, it forces people to stay in jobs they don't like a forego other opportunities like starting a business.
- infocollector 8y agoThere are five beneficiaries of these prices (or the broken system): Insurance, Doctors, Hospitals, Suppliers (Drug companies) and Politicians. It is easy to fix - fix the government (Politicians) - and everything fixes itself. And once the government is fixed, incentivize them to punish monopolies.
- SamuelAdams 8y agoI wonder if drugs are cheaper due to more relaxed regulations? the American FDA has many strict requirements around manufacturing and distributing drugs, but Mexico and Cananda do not need to follow the same standards, resulting in lower operating costs. Lower operating costs = lower price.
- decebalus1 8y agoNah.. Does the UK have lower standards or more relaxed regulations? What you're seeing here is the free market without government price control, at it's 'best'. Things in general are priced at what consumers are willing to pay. That's basically it.
- danans 8y ago"what consumers are willing to pay" is intermediated through health insurance companies, whose policy premiums have skyrocketed in the US in the last few decades. Before relatively recently, most US medication consumers didn't understand that rising drug prices were a factor in the rise of their health insurance premiums. Now they are catching on to that, which is why it is becoming a politically important issue.
- XaspR8d 8y agoIf you ever find yourself near Yuma, AZ, and have a sense for "weird travel" like I do, I'd recommend taking a jaunt into Los Algodones (AKA Molar City) immediately across the border. You can park at the border station and walk in. The tiny city is pretty much entirely dedicated to discount medical sales and is packed to the brim with dentists, pharmacists, opticians, and cosmetologists. When I was there, salesmen would literally call out "cavity? cavity?" to the passersby on the street. It's like some eerie alien recreation of Las Vegas where gambling is replaced with curbside botox and root canals. We only spent about 20 minutes walking around (probably spent more time in the border office), but it was a super memorable pit stop for me.
- chiph 8y agoThe Wynns went there about 5 years ago. To sum it up: It's a dental free-for-all, and there's no accreditation process or licensing, and everyone there is trying to sell you something on commission. But if you find a good dentist, you'll pay about 30-40% of what it'd cost in the US. https://www.youtube.com/watch?v=KAECrmAOqy4 https://www.youtube.com/watch?v=KAECrmAOqy4
- deleted 8y ago[deleted]
- triplee 8y agoWhat if this whole time the wall is really to keep US residents inside the country to make sure those hard working pharma execs get their rightful money? The slats are like those parking garage spikes that go one way -- US residents stay in, and everyone else can come in but never leave, keeping the easily exploited workforce from drying up. Nah, that'd never happen.
- opless 8y agoThis doesn’t happen with socialised healthcare that’s free at the point of service. A government can negotiate lower prices than a commercial entity. They also can legislate to force bad actors to be reasonable. Sadly the UK’s NHS is being slowly converted to the USAs fundamentally broken system of “what the market can bear”. Rampant capitalism didn’t work for the banks either. They needed a social bailout when their markets crashed.