5 ms·
It’s priced based on ability to pay. US it will be 100,000 other countries it will be less.
by ohyes 7y ago
It’s priced based on ability to pay. US it will be 100,000 other countries it will be less.
- Cougher 7y agoIt isn't priced on the customer's ability to pay: it's priced on the companies' ability to gouge.
- ohyes 7y agoWell, it is discriminatory pricing. If someone isn’t saying it is too expensive you haven’t priced the product aggressively enough. In the US market the profit was maximized at 100k, in other markets the profit is maximized at a lower price level because almost no one can afford 100k.
- r_singh 7y agoYup, the generic version of the drug is price at $384 per bottle of 28 pills in India Here's an article on how the patent did not affect it's price in India: https://m.economictimes.com/industry/healthcare/biotech/pharmaceuticals/patent-not-to-affect-hepatitis-c-drug-price-in-india-gilead-sciences-inc/articleshow/52228499.cms https://m.economictimes.com/industry/healthcare/biotech/phar...
- lawn 7y agoAbility to pay? Is that a joke? Considering that 40% of Americans can't cover a $400 emergency expense[0], what makes you think they can pay $84,000 for a 12-week treatment? [0]: https://money.cnn.com/2018/05/22/pf/emergency-expenses-household-finances/index.html https://money.cnn.com/2018/05/22/pf/emergency-expenses-house...
- jacquesm 7y agoMaximized for the total bottom line it isn't a joke. That some people die is not a consideration for those that control access to these drugs, the question is how many people should die in order for them to make the most money of the ones that stay alive. Think of the ones that die as marketing.
- claudeganon 7y agoThis is the only sincere appraisal of the healthcare industry in the US I’ve seen on HN in months. Thank you for your clarity.
- lol2143651 7y agoThe way it generally works for these drugs is the insured get it covered and the uninsured get it cheap or free.
- nkozyra 7y agoAs with most commercial goods there's a market identified and the goods priced accordingly to maximize profit. This means that somebody is priced out no matter what. Given the state of American healthcare it's easier to reconcile if you remove the emotional part and view a drug treatment as, say, a television. If I make a 50" television and price it at $500, I accept that some people will not buy it and target my television to my intended market. What I'm saying is the drug companies are probably fine saying "ok, some people can't afford it, but we maximize profit by selling at a premium to those that can." All that said, if it's life saving you might be surprised what people can and will do, savings notwithstanding.
- chmod775 7y ago> All that said, if it's life saving you might be surprised what people can and will do, savings notwithstanding. Withholding a life-saving treatment has to be criminal in some way. I just can't imagine a hospital sending people home to die because they can't pay.
- lotsofpulp 7y agoClosest thing is called EMTALA: https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_an...
- kenneth 7y agoExcept it isn't. You can debate the moral questions behind drug pricing. But it's entirely legal for pharma companies to set the price for the drugs to maximize their profits. It's logical.
- chmod775 7y agoWhat exactly is logical about letting someone who figuratively has you by the balls decide the price for a drug? The logical thing would be having your insurance negotiating on your behalf ahead of time. Also "but it's legal!" is not a valid argument in a debate about whether something should be legal.
- ameister14 7y agoMost Americans wouldn't end up paying the 84k. Their insurance would pay for most of that, and negotiate it down further - the other day I was picking up a drug that without insurance would cost over $1,000. I paid $34.
- dpark 7y agoThat’s garbage. People without insurance are utterly fucked. The uninsured are sacrificed as a negotiating point against insurers. “List price is $5000. We’ll cut you a deal at only $2000!”
- ameister14 7y agoYep, that's all true. It's worse, actually - the government sets reimbursement rates as well, so when they tell a hospital 'we are only going to pay you 60% of what you charge' what do you think a hospital is going to do in response?
- sp332 7y agoThis is a valid thing to be concerned about, but it appears to be false. Gilead has programs that help uninsured people get their drugs, including Harvoni. https://www.gilead.com/purpose/medication-access/us-patient-access https://www.gilead.com/purpose/medication-access/us-patient-...
- deleted 7y ago[deleted]
- Cyph0n 7y agoIt depends on your plan. If you’re on a HDHP, chances are that prescriptions are not covered until you hit your deductible.
- ameister14 7y agoEven if that's the case, unless your deductible is $40k, which I have never seen before, the insurance would still cover the majority of the cost. Plus if you have chronic Hep C, you're likely spending thousands a year as it is and will continue to do so indefinitely.
- nradov 7y agoThe vast majority of Americans have some form of medical insurance so a patient's out of pocket expense would typically be far lower.
- Retric 7y agoInsurance increases net costs via added overhead. So, it’s ~80k * ~1.30 * (number receiving treatment) / (people paying insurance). Aka, it’s both more expensive and more affordable.
- lotsofpulp 7y agoHealth insurance in the US has overhead capped at a maximum of 20%, or 15% in large employer groups. https://www.healthcare.gov/health-care-law-protections/rate-review/ https://www.healthcare.gov/health-care-law-protections/rate-...
- phonon 7y agoWhat percentage of the recepients costs are insurance related overhead as well? (Yes, that includes the time doctors spend arguing with insurers).
- lotsofpulp 7y agoSurely, there is room for optimization, but in the alternative case of taxpayer funded healthcare, I'm sure the government is going to ask doctors for justifications for the same reasons insurers do. Someone needs to provide a second opinion on whether or not procedures and medications are appropriate for accountability purposes.
- Retric 7y agoGovernments add far less overhead in this area because they have more data and can thus use random inspection of bills for validation. Further, when setting rates every insurer has a separate negotiation involving even more overhead.
- kaybe 7y agoThat really should be an argument for collective payment so the mean ability to pay counts and nobody is priced out. I'll never understand how people can support the US health care system.
- ohyes 7y agoAmericans tend to go into massive medical debt, still they can have that credit extended to them because over their careers they’ll make more than 84,000 and probably pay it off if they live. Collecting part of that amount is still profitable because there’s no basis in the actual cost of treatment rendered. Compare to someone in (poor country) who is lucky to collect a few hundred dollars a year, no one will ever extend that person 84,000 in debt, because they don’t have any chance of making that amount over the course of their entire career. Ability to pay is significantly different from “savings.” The $400 emergency expense number is about having savings (extra money in the bank) which is really a complicated issue relating to financial literacy and debt to income ratios. You could have someone making 6 figures living in an expensive house, driving a nice car, who can’t come up with $400 because he’s overextended himself. It’s a question of liquidity rather than ability to pay. If his wages get garnished, maybe he loses the house and has to sell the car, but the medicine still gets paid for.
- chmod775 7y agoIn many other countries getting treated for hepatitis C won't cost you a dime besides your regular health insurance payment. Prices are often negotiated by health insurers and are pretty much guaranteed to be lower for that reason. Depending on what system you are in, you might never even learn what your treatment cost. Not that you should care.
- twoodfin 7y agoThat depends on the treatment and politicians’ willingness to pay for it. Take cystic fibrosis in England: Until this year, modern, highly effective (and, yes, expensive) treatments available for years in the US—covered at low out-of-pocket cost by insurers there—were unavailable through the NHS.
- 3fe9a03ccd14ca5 7y agoThe exception or the rule?
- makomk 7y agoThe same was true of hepatitis C in England - even though NICE, the body responsible for assessing what drugs should be available on the NHS, found that the new treatments were cost effective at the price they were being sold for, the NHS balked due to the total cost of curing everyone and refused to offer it to anyone except a handful of patients who already had severe liver damage.
- refurb 7y agoThis is true. The new HCV drugs, even at the outrage inducing price of $90k, easily met the NICE cost effectiveness threshold. The issue was really volume. There wasn’t enough money to treat everyone.