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> It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system ... The wholesale cost

> It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system ... The wholesale cost in the developing world is about US$0.04. In the United States, it costs about US$5.30 per dose. [1] That's a little over 132x more expensive. Compared to other common medicines like ibuprofen ($0.04 in the developing world, $0.05 in the USA [2]), what makes chloroquine so uniquely pricey in the USA? (or, I suppose, ibuprofen so uniquely cheap?) [1] https://en.wikipedia.org/wiki/Chloroquine https://en.wikipedia.org/wiki/Chloroquine [2] https://en.wikipedia.org/wiki/Ibuprofen https://en.wikipedia.org/wiki/Ibuprofen

NullPrefix 7y ago
Ibuprofen can be sold on somewhat recurring cycle.
baybal2 7y ago
Not uniquely. USA is famous for very high prices of essential medicines, and being an expensive country in general.
- vinay427 7y ago
  This was already implied in the question. They're asking why something like ibuprofen is different.
  - baybal2 7y ago
    Maybe because it's one of few medicines being sold by foreign companies in USA? America doesn't have a lot of opportunities for foreign players, let alone in such militantly overregulated sector like medicines.
  - shermozle 7y ago
    I'm assuming because ibuprofen is OTC and chloroquin is prescription.
  - projektfu 7y ago
    If a medicine isn’t used very often usually only one manufacturer will continue making it. They then can set monopoly pricing. I also have a belief that there is some actual or implicit collusion where they are dividing the market for generic drugs into monopolies by strategically dropping out. FDA rules make it expensive to start new production or enter from abroad, so a new manufacturer is in for as price war they will probably lose. There are lots of super cheap prescription meds. Many for a penny a dose wholesale. They have robust competition but still make money at that price point, although some makers may be selling fraudulent drugs. In theory, when the patent on a popular medication is over, new players should pull the price down to marginal cost. These days that is not happening for many products and I’d like to know why. Any economists know?
codebolt 7y ago
I have in-laws in Nigeria. We just tipped them off a couple of days ago that now might be a good time to buy some Chloroquine and keep at the house, in case the situation gets worse. This is a commonly known medicine down there, that you can get from pharmacies without prescription. But based on what we're seeing so far, it seems plausible that this virus prefers cooler northern climates. So hopefully it will turn out to be an unnecessary precaution.
- WhiteSage 7y ago
  In the east coast of Spain we have had great weathee (25+ degrees celsius) and it didn't seem to greatly influence transmission speed :(
  - devdas 7y ago
    The numbers so far suggest you need tropical heat and humidity to slow down transmission speed. That would need to be 35C+ weather, and no air conditioning.
    - whatch 7y ago
      Before I've read you message I was sure that dry air slows down transmission speed. But indeed, it's humidity https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3551767 https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3551767
- stareatgoats 7y ago
  The rapid transmission in industrialized countries is most likely helped by the daily indoor concentration of people in the big cities, during commute, in large schools and workplaces. Large cities in Africa will surely get it to some extent, but the spread might be slower since Africans don't spend as much time indoors, and the rural communities are already practicing "social distancing" to some degree.
  - kabouseng 7y ago
ArnoVW 7y ago
The Lancet has published a study this week that anti-inflamatory drugs may help Ncovid penetrate cell walls and actually speed up the process. France has stopped over-the-counter sales of Ibuprofen as of mid January. https://www.afrinik.com/anti-inflammatory-drugs-can-make-coronavirus-infection-worse/ https://www.afrinik.com/anti-inflammatory-drugs-can-make-cor...
- IAmGraydon 7y ago
  Not only anti inflammatory drugs but also ACE inhibitors used to treat hypertension.
- woodpanel 7y ago
  This has been disputed: "This speculation about the safety of ACE-i or ARB treatment in relation to COVID-19 does not have a sound scientific basis or evidence to support it. Indeed, there is evidence from studies in animals suggesting that these medications might be rather protective against serious lung complications in patients with COVID-19 infection, but to date there is no data in humans. The Council on Hypertension of the European Society of Cardiology wish to highlight the lack of any evidence supporting harmful effect of ACE-I and ARB in the context of the pandemic COVID-19 outbreak. The Council on Hypertension strongly recommend that physicians and patients should continue treatment with their usual anti-hypertensive therapy because there is no clinical or scientific evidence to suggest that treatment with ACEi or ARBs should be discontinued because of the Covid-19 infection. " [1] There are also the brilliant MedCram updates, where the issue of ace inhibitors et. al just happened to be discussed yesterday. In it he describes the mechanics of ACE-i and ARB treatment: https://www.youtube.com/watch?v=1vZDVbqRhyM https://www.youtube.com/watch?v=1vZDVbqRhyM [1] https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang https://www.escardio.org/Councils/Council-on-Hypertension-(C...
  - DagAgren 7y ago
    That is not actually a refutation.
sandGorgon 7y ago
btw, not sure if you cited the ibuprofen example merely as a comparison. I hope you are aware that early data is indicating that NSAIDs including ibuprofen have shown high degree of correlation with mortality in younger patients. To an extent that the French govt has officially released it as a statement. https://edition.cnn.com/2020/03/16/health/coronavirus-ibuprofen-french-health-minister-scn-intl-scli/index.html https://edition.cnn.com/2020/03/16/health/coronavirus-ibupro...
joncrane 7y ago
Ibuprofen can be manufactured by almost any company and sold in almost any store. So open competition in the sector drives down prices. Chloroquine exists in a walled garden where pharmaceutical companies and the government have rigged it so that rent-seeking behavior is the optimal financial strategy.
- onetimemanytime 7y ago
  Why can't Chloroquine ? Maybe there's not as much money in it, unless it requires special permissions. Does anyone know if there's a lot of supply in hand and if it can be made in large quantities fast?
  - gridlockd 7y ago
    The price reflects opportunity cost, there is low demand for Malaria treatment in the US. Ibuprofin is a staple drug.
    - londons_explore 7y ago
      Except drugs can be shipped around the world very cheaply, even in small doses, so demand alone can't explain price difference.
      - onetimemanytime 7y ago
        exactly. My point was this is prob a demand issue, not a government intervention. I wonder how fast they can make it...shipping can be done via charter planes this time.
        Lldjjxnn 7y ago
        False. Government prohibits importation of most medicines from abroad. It's corruption hidden in the form of "please just think of the children." "FDA cannot assure the safety and efficacy of unapproved drugs" is the main excuse used in drug importation court cases. Reference: https://www.pharmacycheckerblog.com/online-pharmacies-personal-drug-importation-and-public-health-laws-governing-online-pharmacies https://www.pharmacycheckerblog.com/online-pharmacies-person...
rb808 7y ago
Its a prescription drug in the US, and pharmacists get paid a bunch. Most developing countries you can buy OTC.
- rb808 7y ago
  https://rxsaver.retailmenot.com/drugs/chloroquine-phosphate/coupons https://rxsaver.retailmenot.com/drugs/chloroquine-phosphate/... has it at 60c/dose in my area.
hippich 7y ago
For what it is worth - on my surgery bill one tablet of ibuprofen was billed at $40+. Insurance accepted $20+. So I would guess it will heavily depends on provider as well.

NullPrefix 7y ago

Ibuprofen can be sold on somewhat recurring cycle.

baybal2 7y ago

Not uniquely. USA is famous for very high prices of essential medicines, and being an expensive country in general.

vinay427 7y ago
This was already implied in the question. They're asking why something like ibuprofen is different.
- baybal2 7y ago
  Maybe because it's one of few medicines being sold by foreign companies in USA? America doesn't have a lot of opportunities for foreign players, let alone in such militantly overregulated sector like medicines.
- shermozle 7y ago
  I'm assuming because ibuprofen is OTC and chloroquin is prescription.
- projektfu 7y ago
  If a medicine isn’t used very often usually only one manufacturer will continue making it. They then can set monopoly pricing. I also have a belief that there is some actual or implicit collusion where they are dividing the market for generic drugs into monopolies by strategically dropping out. FDA rules make it expensive to start new production or enter from abroad, so a new manufacturer is in for as price war they will probably lose. There are lots of super cheap prescription meds. Many for a penny a dose wholesale. They have robust competition but still make money at that price point, although some makers may be selling fraudulent drugs. In theory, when the patent on a popular medication is over, new players should pull the price down to marginal cost. These days that is not happening for many products and I’d like to know why. Any economists know?

codebolt 7y ago

I have in-laws in Nigeria. We just tipped them off a couple of days ago that now might be a good time to buy some Chloroquine and keep at the house, in case the situation gets worse. This is a commonly known medicine down there, that you can get from pharmacies without prescription. But based on what we're seeing so far, it seems plausible that this virus prefers cooler northern climates. So hopefully it will turn out to be an unnecessary precaution.

WhiteSage 7y ago
In the east coast of Spain we have had great weathee (25+ degrees celsius) and it didn't seem to greatly influence transmission speed :(
- devdas 7y ago
  The numbers so far suggest you need tropical heat and humidity to slow down transmission speed. That would need to be 35C+ weather, and no air conditioning.
  - whatch 7y ago
    Before I've read you message I was sure that dry air slows down transmission speed. But indeed, it's humidity https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3551767 https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3551767
stareatgoats 7y ago
The rapid transmission in industrialized countries is most likely helped by the daily indoor concentration of people in the big cities, during commute, in large schools and workplaces. Large cities in Africa will surely get it to some extent, but the spread might be slower since Africans don't spend as much time indoors, and the rural communities are already practicing "social distancing" to some degree.
- kabouseng 7y ago

ArnoVW 7y ago

The Lancet has published a study this week that anti-inflamatory drugs may help Ncovid penetrate cell walls and actually speed up the process. France has stopped over-the-counter sales of Ibuprofen as of mid January. https://www.afrinik.com/anti-inflammatory-drugs-can-make-coronavirus-infection-worse/ https://www.afrinik.com/anti-inflammatory-drugs-can-make-cor...

IAmGraydon 7y ago
Not only anti inflammatory drugs but also ACE inhibitors used to treat hypertension.
woodpanel 7y ago
This has been disputed: "This speculation about the safety of ACE-i or ARB treatment in relation to COVID-19 does not have a sound scientific basis or evidence to support it. Indeed, there is evidence from studies in animals suggesting that these medications might be rather protective against serious lung complications in patients with COVID-19 infection, but to date there is no data in humans. The Council on Hypertension of the European Society of Cardiology wish to highlight the lack of any evidence supporting harmful effect of ACE-I and ARB in the context of the pandemic COVID-19 outbreak. The Council on Hypertension strongly recommend that physicians and patients should continue treatment with their usual anti-hypertensive therapy because there is no clinical or scientific evidence to suggest that treatment with ACEi or ARBs should be discontinued because of the Covid-19 infection. " [1] There are also the brilliant MedCram updates, where the issue of ace inhibitors et. al just happened to be discussed yesterday. In it he describes the mechanics of ACE-i and ARB treatment: https://www.youtube.com/watch?v=1vZDVbqRhyM https://www.youtube.com/watch?v=1vZDVbqRhyM [1] https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang https://www.escardio.org/Councils/Council-on-Hypertension-(C...
- DagAgren 7y ago
  That is not actually a refutation.

sandGorgon 7y ago

btw, not sure if you cited the ibuprofen example merely as a comparison. I hope you are aware that early data is indicating that NSAIDs including ibuprofen have shown high degree of correlation with mortality in younger patients. To an extent that the French govt has officially released it as a statement. https://edition.cnn.com/2020/03/16/health/coronavirus-ibuprofen-french-health-minister-scn-intl-scli/index.html https://edition.cnn.com/2020/03/16/health/coronavirus-ibupro...

joncrane 7y ago

Ibuprofen can be manufactured by almost any company and sold in almost any store. So open competition in the sector drives down prices. Chloroquine exists in a walled garden where pharmaceutical companies and the government have rigged it so that rent-seeking behavior is the optimal financial strategy.

onetimemanytime 7y ago
Why can't Chloroquine ? Maybe there's not as much money in it, unless it requires special permissions. Does anyone know if there's a lot of supply in hand and if it can be made in large quantities fast?
- gridlockd 7y ago
  The price reflects opportunity cost, there is low demand for Malaria treatment in the US. Ibuprofin is a staple drug.
  - londons_explore 7y ago
    Except drugs can be shipped around the world very cheaply, even in small doses, so demand alone can't explain price difference.
    - onetimemanytime 7y ago
      exactly. My point was this is prob a demand issue, not a government intervention. I wonder how fast they can make it...shipping can be done via charter planes this time.
      - Lldjjxnn 7y ago
        False. Government prohibits importation of most medicines from abroad. It's corruption hidden in the form of "please just think of the children." "FDA cannot assure the safety and efficacy of unapproved drugs" is the main excuse used in drug importation court cases. Reference: https://www.pharmacycheckerblog.com/online-pharmacies-personal-drug-importation-and-public-health-laws-governing-online-pharmacies https://www.pharmacycheckerblog.com/online-pharmacies-person...

rb808 7y ago

Its a prescription drug in the US, and pharmacists get paid a bunch. Most developing countries you can buy OTC.

rb808 7y ago
https://rxsaver.retailmenot.com/drugs/chloroquine-phosphate/coupons https://rxsaver.retailmenot.com/drugs/chloroquine-phosphate/... has it at 60c/dose in my area.

hippich 7y ago

For what it is worth - on my surgery bill one tablet of ibuprofen was billed at $40+. Insurance accepted $20+. So I would guess it will heavily depends on provider as well.