5 ms·

Do payers in other countries agree to cover 2.1M bill or is it only the US?

by avocado4 7y ago

tzakrajs 7y ago
waits for generic treatment to surface for 1/10000 of the price in another market
- jtmcmc 7y ago
  this is not just synthesizing a chemical - this is using an engineered virus to deliver a newly functional gene. There is a reality here that these therapies are really fucking expensive to produce. If we want them to be cheap or free their discovery needs to be subsidized and funded in a non-profit driven manner
  - bilbo0s 7y ago
    Actually, tzakrajs is correct. These therapies are just like any other medication as far as their discovery and production are concerned. It requires enormous amounts of resources to discover them. The problem is that once you know the process for an effective therapy, it's relatively easy. So it's critical that access to any information regarding the process used to produce the therapies be as restricted as humanly possible. This is not because drug companies are dastardly profit mongers. (Although that is certainly part of it.) But it's more because we have to fund the research that found that process somehow. People laud places like Cuba because their health care is head and shoulders above the rest of Latin America. (Above even the US in some cases.) But here's the thing, the Cubans simply take all of the research that everyone has done and give it away for free. I understand. Their duty is to their people, not Pfizer. I get that. Here's the thing is though, if everyone does that then the research funding dries up, and the rate of discovery slows. (And yes, I understand that Cuba does its own research and contributes drugs to the global knowledge base as well. Drugs for Hep being a notable example.) But the balance of value is in the drugs researched and discovered by everyone in the world, not just the drugs researched and discovered in Cuba. So what happens when the rest of the world slows down? Well, Cuba gets less overall value too. That, eventually, would hurt the Cuban people just as much as it hurts everyone else. It's relatively easy to take any therapy and use it on your own if you are a state level actor. As someone who had to do business in the health care sector for a long time, I can tell you that with authority. If the Cubans, for example, want to use this badly enough, they will. No amount of complexity will confound Cuban researchers. That's just life. At the same time, it's a very destructive practice under the present circumstances that drug research finds itself in. A more responsible approach would be some sort of global conventions on how to proceed if we want such a system.
    - jedberg 7y ago
      > if everyone does that then the research funding dries up, and the rate of discovery slows. Does it? Or do we go back to the system where universities use government money to do drug research with no profit motive?
      - candiodari 7y ago
        Well it took $8.7 billion to build this drug (granted, most of that was for any viral genetic treatment, and so probably can be amortized in the future. I would point out that that doesn't change that that money was required to get to this treatment). How long until government university research amasses that kind of money ? We all know the answer: more than a century. And now you might say "yes, but half the research was done at universities". That's true, probably more than half, but a significant portion of that was still paid by Novartis. Furthermore Novartis helps professors coordinate, pays for conferences, ... Novartis profit margin is about 20%. In their best years it was 30%. So even in a communist system, this drug would only be 20%-30% cheaper, and take another century before it became available. That would bring it from 1.2 million to, let's round off and say a million. Would that solve your problem with this drug ?
        jedberg 7y ago
        I never actually said I had a problem with this drug or the price. (I do, but I never said that) Imagine we live in a world where all drug research must be given away freely. Chances are private companies would no longer do the research, since any of their competitors could pick up the research and make it. In which case almost all funding for drug research would revert to universities and drug companies would simply be manufacturers, and would have to compete on manufacturing efficiency. Now, we know that the 8 billion came from somewhere in our economy, so at this point it would be an academic exercise to figure out how to extract that from the economy and transfer it to universities to do the research. What I'm saying is that we need to remove the profit motive in health care, because there is no elasticity in the market. People will pay infinity to keep living. There is no price point where someone says, "that's too much" when it comes to health care, so the market doesn't operate like any other.
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tareqak 7y ago
Payers in other countries can use their countries' negotiating power to negotiate with Novartis. The United States is definitely capable of doing the same in theory.
- arkades 7y ago
  No, it’s not. Medicare is legally restricted from negotiating drug prices. Yes, that’s a ridiculous law. Edit: to clarify, Medicare does not only cover seniors. Other important groups include those with end-stage renal disease and those with significant disabilities. Those often also receive Medicaid, and are known in industry jargon as “dual-eligible.” Medicare becomes their primary payor, with Medicaid picking up the balance of what Medicare won’t cover. Both programs are ultimately overseen by CMS (center for Medicare and Medicaid services). Pay negotiations for Medicaid occur on a state level, but a huge chunk of the tab is picked up federally, so they tend to weigh in. Newborns with SMA will almost certainly be initially covered by parental private insurance (pre-dx), and transition to dual coverage afterwards. Please note that there are a combination of gene therapies under discussion, only one of which will be given once at birth- the rest will entail ongoing costs that will be borne by Medicare and Medicaid.
  - tareqak 7y ago
    Thanks for that 'arkades: I'll update my comment to add "in theory".
  - phkahler 7y ago
    I dont think any insurance company should be able to negotiate prices.
    - tareqak 7y ago
      Might I ask why not? On a personal level, I don't like negotiating myself e.g. I don't like stores that have posted prices. On a macro level, negotiating prices is how large transactions clear such that the buyer and seller get something closest to what they want (hopefully). I do think sane ceilings and floors ceilings for prices have a place in certain situations, but I wouldn't be the best person to characterize what this sanity would be.
pstrateman 7y ago
Something like this is expensive because... it's actually expensive to do. Typically that means single payer systems simply will refuse to pay for it at all. i.e. this medication will not be available anywhere except the US
- pkaye 7y ago
  Even within the US it will out of reach to most people even with insurance.
buildzr 7y ago
Is this actually going to be available anywhere but the US? Expensive, rare treatments like this often aren't paid out in socialized systems.
s1artibartfast 7y ago
I expect that the countries covering Spinraza will also cover the new Novartis treatment as it will cut costs. https://www.treatsma.uk/treatments/spinraza/spinraza-access-by-country/ https://www.treatsma.uk/treatments/spinraza/spinraza-access-...

Do payers in other countries agree to cover 2.1M bill or is it only the US?

tzakrajs 7y ago

waits for generic treatment to surface for 1/10000 of the price in another market

jtmcmc 7y ago
this is not just synthesizing a chemical - this is using an engineered virus to deliver a newly functional gene. There is a reality here that these therapies are really fucking expensive to produce. If we want them to be cheap or free their discovery needs to be subsidized and funded in a non-profit driven manner
- bilbo0s 7y ago
  Actually, tzakrajs is correct. These therapies are just like any other medication as far as their discovery and production are concerned. It requires enormous amounts of resources to discover them. The problem is that once you know the process for an effective therapy, it's relatively easy. So it's critical that access to any information regarding the process used to produce the therapies be as restricted as humanly possible. This is not because drug companies are dastardly profit mongers. (Although that is certainly part of it.) But it's more because we have to fund the research that found that process somehow. People laud places like Cuba because their health care is head and shoulders above the rest of Latin America. (Above even the US in some cases.) But here's the thing, the Cubans simply take all of the research that everyone has done and give it away for free. I understand. Their duty is to their people, not Pfizer. I get that. Here's the thing is though, if everyone does that then the research funding dries up, and the rate of discovery slows. (And yes, I understand that Cuba does its own research and contributes drugs to the global knowledge base as well. Drugs for Hep being a notable example.) But the balance of value is in the drugs researched and discovered by everyone in the world, not just the drugs researched and discovered in Cuba. So what happens when the rest of the world slows down? Well, Cuba gets less overall value too. That, eventually, would hurt the Cuban people just as much as it hurts everyone else. It's relatively easy to take any therapy and use it on your own if you are a state level actor. As someone who had to do business in the health care sector for a long time, I can tell you that with authority. If the Cubans, for example, want to use this badly enough, they will. No amount of complexity will confound Cuban researchers. That's just life. At the same time, it's a very destructive practice under the present circumstances that drug research finds itself in. A more responsible approach would be some sort of global conventions on how to proceed if we want such a system.
  - jedberg 7y ago
    > if everyone does that then the research funding dries up, and the rate of discovery slows. Does it? Or do we go back to the system where universities use government money to do drug research with no profit motive?
    - candiodari 7y ago
      Well it took $8.7 billion to build this drug (granted, most of that was for any viral genetic treatment, and so probably can be amortized in the future. I would point out that that doesn't change that that money was required to get to this treatment). How long until government university research amasses that kind of money ? We all know the answer: more than a century. And now you might say "yes, but half the research was done at universities". That's true, probably more than half, but a significant portion of that was still paid by Novartis. Furthermore Novartis helps professors coordinate, pays for conferences, ... Novartis profit margin is about 20%. In their best years it was 30%. So even in a communist system, this drug would only be 20%-30% cheaper, and take another century before it became available. That would bring it from 1.2 million to, let's round off and say a million. Would that solve your problem with this drug ?
      - jedberg 7y ago
        I never actually said I had a problem with this drug or the price. (I do, but I never said that) Imagine we live in a world where all drug research must be given away freely. Chances are private companies would no longer do the research, since any of their competitors could pick up the research and make it. In which case almost all funding for drug research would revert to universities and drug companies would simply be manufacturers, and would have to compete on manufacturing efficiency. Now, we know that the 8 billion came from somewhere in our economy, so at this point it would be an academic exercise to figure out how to extract that from the economy and transfer it to universities to do the research. What I'm saying is that we need to remove the profit motive in health care, because there is no elasticity in the market. People will pay infinity to keep living. There is no price point where someone says, "that's too much" when it comes to health care, so the market doesn't operate like any other.
- deleted 7y ago
  [deleted]
- deleted 7y ago
  [deleted]

tareqak 7y ago

Payers in other countries can use their countries' negotiating power to negotiate with Novartis. The United States is definitely capable of doing the same in theory.

arkades 7y ago
No, it’s not. Medicare is legally restricted from negotiating drug prices. Yes, that’s a ridiculous law. Edit: to clarify, Medicare does not only cover seniors. Other important groups include those with end-stage renal disease and those with significant disabilities. Those often also receive Medicaid, and are known in industry jargon as “dual-eligible.” Medicare becomes their primary payor, with Medicaid picking up the balance of what Medicare won’t cover. Both programs are ultimately overseen by CMS (center for Medicare and Medicaid services). Pay negotiations for Medicaid occur on a state level, but a huge chunk of the tab is picked up federally, so they tend to weigh in. Newborns with SMA will almost certainly be initially covered by parental private insurance (pre-dx), and transition to dual coverage afterwards. Please note that there are a combination of gene therapies under discussion, only one of which will be given once at birth- the rest will entail ongoing costs that will be borne by Medicare and Medicaid.
- tareqak 7y ago
  Thanks for that 'arkades: I'll update my comment to add "in theory".
- phkahler 7y ago
  I dont think any insurance company should be able to negotiate prices.
  - tareqak 7y ago
    Might I ask why not? On a personal level, I don't like negotiating myself e.g. I don't like stores that have posted prices. On a macro level, negotiating prices is how large transactions clear such that the buyer and seller get something closest to what they want (hopefully). I do think sane ceilings and floors ceilings for prices have a place in certain situations, but I wouldn't be the best person to characterize what this sanity would be.

pstrateman 7y ago

Something like this is expensive because... it's actually expensive to do. Typically that means single payer systems simply will refuse to pay for it at all. i.e. this medication will not be available anywhere except the US

pkaye 7y ago
Even within the US it will out of reach to most people even with insurance.

buildzr 7y ago

Is this actually going to be available anywhere but the US? Expensive, rare treatments like this often aren't paid out in socialized systems.

s1artibartfast 7y ago

I expect that the countries covering Spinraza will also cover the new Novartis treatment as it will cut costs. https://www.treatsma.uk/treatments/spinraza/spinraza-access-by-country/ https://www.treatsma.uk/treatments/spinraza/spinraza-access-...