8 ms·
Open Letter from Gilead CEO: Remdesivir Pricing
- forgingahead 6y agoWhat's the price of equivalent doses of Hydroxychloroquine + Zinc?
- rbinv 6y agoVery low, but obviously not comparable at all.
- chrisco255 6y agoDo you have a randomized clinical trial comparing the two treatments?
- strstr 6y agoI’m not certain it matters. The hydroxychloroquine paper was retracted: that’s not a great sign for it’s effectiveness as a treatment.
- ageitgey 6y agoThere are hundreds of trials in various states of completion for hydroxychloroquine [1]. At least 10 of them specifically call out using it in combination with zinc, though some completed trials that don't specifically call it out in the title also used zinc if you read the papers. There are about 35 trials in various states of completion of remdesivir [2]. If hydroxychloroquine actually does anything, we'll eventually find out. But the cold hard truth is that all the evidence so far is that remdesivir is a weakly effective treatment (shortens length of stay in hospital slightly, not a miracle cure) while hydroxychloroquine hasn't been shown to do much of anything useful in COVID. Both aren't as big a deal as Dexamethasone, which significantly reduces mortality in the sickest patients. Most facilities have settled on using remdesivir + dexamethasone as the standard treatment for the sickest patients and have totally ditched hydroxychloroquine. Many are still administering zinc and other low-risk treatments like vitamin C and D to patients because while the evidence isn't there, there's no cost or safety reason not to try it. The problem with talking about hydroxychloroquine is that it has become the rallying cry of the conspiracy theorist, so any talk about it results in someone saying you are "testing it wrong". The most common response is "it is a preventative treatment, not a treatment of already sick people! they are testing the wrong patients in trials!" or "it only works in combination with zinc!" or whatever. The good news is all those combinations are being trialed and if it actually does anything, we'll eventually find out. Whether anyone ever comes up with evidence that hydroxychloroquine does anything useful in COVID patients, it will definitely be one of the most studied drugs ever. [1] https://clinicaltrials.gov/ct2/results?cond=covid&term=hydroxychloroquine&cntry=&state=&city=&dist= https://clinicaltrials.gov/ct2/results?cond=covid&term=hydro... [2] https://clinicaltrials.gov/ct2/results?cond=covid&term=remdesivir&cntry=&state=&city=&dist=&Search=Search https://clinicaltrials.gov/ct2/results?cond=covid&term=remde...
- chrisco255 6y agoHere's a recent study from France on 3700 patients treated with HCQ+AZ and it shows a 66% reduction in hospitalizations: https://www.sciencedirect.com/science/article/pii/S1477893920302817 https://www.sciencedirect.com/science/article/pii/S147789392...
- ageitgey 6y agoI would love for HCQ to be shown to be effective, but this pre-print study is not super convincing. First, this is not a randomized trial with a control group. It's a retrospective look at patients in Marseille where they gave HCQ+AZ by default to all patients who would take it and then compared those patients against the small number of people who either refused it or were too at risk of side effects to get it. If you look at the breakdown of the groups, it's comically unbalanced. Of the 3,737 people they tracked, only 162 didn't receive HCQ or AZ. And the rate of heart disease in those 162 untreated people was 2.7x the rate in the group treated with HCQ+AZ (11.1% vs 4%)! Furthermore, only 28 of the 162 untreated people were in the high risk >= 65 age group. No deaths in any group were reported under the age of 60. In other words, if you compare a couple tens of people with 2.7x the rate of chronic heart disease to a random assortment of other people, you get numbers that may or may not mean anything. Meanwhile, there are other studies with proper control groups and balanced patient enrollment that show no benefit of HCQ and lots more studies still in progress that test it in different doses and times of administration. At the end of the day, you have to follow the best evidence.
- cjhopman 6y agoGood question. Also what's the price of an equivalent dose of Cheerios?
- ohazi 6y ago> In the U.S., the same government price of $390 per vial will apply. Because of the way the U.S. system is set up and the discounts that government healthcare programs expect, the price for U.S. private insurance companies, will be $520 per vial. Sigh How many years of normalizing and internalizing the utter insanity that is the US medical industrial complex does it take to be able to just say that with a straight face?
- _pmf_ 6y ago> How many years of normalizing and internalizing the utter insanity that is the US medical industrial complex does it take to be able to just say that with a straight face? I hate to tell you, but it's not better in Europe just because the racket is obfuscated by several more layers.
- nix23 6y agoNot sure why they down-vote you, you didn't said anything about 'free' healthcare, and you are absolute right, the 'customer' does not see much of those layers, but ask any Healthcare-worker that has to work with insurance...they can tell you story's!
- flumpcakes 6y agoVery few people have private health care in Europe, at least in the UK - they are either comparatively very rich or have a job that provides it (again, very rare and probably a job that pays very well to begin with). You will see a lot of buying power from free health care providers as they represent tens-hundreds of millions of people - they will most likely pass on a price gouging drug in favour for others. They won't pay market rate, whatever the drug manufacturers say.
- mathieuh 6y agoThe most relevant industry to this board (IT) usually provide private healthcare though. I’ve had BUPA from work since I graduated. Granted this is across only two jobs but when I’ve been applying for jobs in the past private health has always been one of the perks Maybe it’s different in the start up world but larger companies all seem to offer private health insurance.
- mesozoic 6y agoGood thing we bailed them out bought their bonds and now get to pay way too much for a drug that don't work! Yay!
- udba 6y agoThey say the goal is to help as many people as possible, and that this principle has guided their development and pricing of the drug. How do they reconcile this principle with the huge price difference between the USA and the rest of the world? Or between the developed world and the developing world? I assume they are still making a profit selling doses at low costs to developing countries. If the goal is to help as many people like they say, why not extend that pricing to everyone? It’s disappointing that taxpayers fund the development of these drugs and then get screwed by the same companies when it comes time to make a profit.
- alimw 6y agoThere must be a thousand ways to codify their stated objective 'to help as many people as possible', but I can't imagine why you'd think a completely flat pricing structure would be optimal for any of them.
- cwyers 6y ago> I assume they are still making a profit selling doses at low costs to developing countries. Why would you assume that, instead of assuming that the high prices in the developed world are subsidizing losses elsewhere? (Or, at least, that they are amortizing R&D costs with the prices in the developed world, and doing so allows them to make a profit selling more of it above the marginal cost of producing more.)
- retSava 6y agoThe message from the CEO which this is about, says they have the exact same price across the globe, ie no subsidizing losses by that means, or there are no losses. The US price is in practice the same - they just had to account for the always-expected discount which will push it down to the same as others.
- hans_castorp 6y ago> with the huge price difference between the USA and the rest of the world That doesn't really matter as the Trump administration has bought essentially the whole production capacity of Remdesivir for July, August and September. https://www.theguardian.com/us-news/2020/jun/30/us-buys-up-world-stock-of-key-covid-19-drug https://www.theguardian.com/us-news/2020/jun/30/us-buys-up-w...
- hasperdi 6y agoWhat this letter did not address is the fact that the US is hoarding almost all of Gilead's Remdesivir in the upcoming few months. Leaving the rest of the world with almost nothing. Source: https://www.theguardian.com/us-news/2020/jun/30/us-buys-up-world-stock-of-key-covid-19-drug https://www.theguardian.com/us-news/2020/jun/30/us-buys-up-w...
- supergirl 6y agonot sure if totally accurate but if it is then it serves the rest of the world right for playing nice with the US while the US screws them over anytime it is convenient
- tonyedgecombe 6y agoI'm not sure there is much the rest of the world can do given that Gilead is an American corporation.
- supergirl 6y agothe rest of the world can do the same. stockpile their own products, e.g. ventilators, masks, etc. then everyone dies, cause you need all the parts for a full cure. anyway, it's more about the attitude of the US. I doubt stockpiling this drug has any consequence on the rest of the world. the just bought the first batches I guess. more will be produced.
- godzillabrennus 6y agoIsn’t the welfare of its citizens basically the primary job for any government? Hopefully now that this is determined as effective the manufacturing can ramp up and the whole world can get access.
- flak48 6y agoGeneric versions of Remdesivir are already available in India for $70 (under license from Gilead). I hope other countries ramp up production too. https://www.hindustantimes.com/india-news/india-s-hetero-prices-generic-remdesivir-for-covid-19-treatment-at-rs5-400-per-vial/story-kvqLE7vfjarEaj8Y1ad5lJ.html https://www.hindustantimes.com/india-news/india-s-hetero-pri...
- trowawee 6y agoAmerican taxpayers contributed at least $70m to the development of this drug[0] and our reward is to be gouged by Gilead. It's the exact same shit they've pulled with Truvada[1] and it's grotesque. [0]: https://www.citizen.org/article/the-real-story-of-remdesivir/ https://www.citizen.org/article/the-real-story-of-remdesivir... [1]: https://www.nytimes.com/2018/07/16/opinion/prep-hiv-aids-drug.html https://www.nytimes.com/2018/07/16/opinion/prep-hiv-aids-dru...
- kenhwang 6y agoIt typically costs ~$2B to develop a new drug. Taxpayer contributions are practically negligible.
- number6 6y agoHas anyone checked the $2B or is this what pharma tells?
- kenhwang 6y agoHere's what our government says about it: https://www.ncbi.nlm.nih.gov/books/NBK50972/ https://www.ncbi.nlm.nih.gov/books/NBK50972/
- zimpenfish 6y agoDerek Lowe has an article about it that might help. https://blogs.sciencemag.org/pipeline/archives/2017/10/18/drug-development-costs-revisited https://blogs.sciencemag.org/pipeline/archives/2017/10/18/dr...
- TheOtherHobbes 6y agoHow much did the Fed spend buying Gilead's bonds? And how much more/less effective is Remdesivir compared to the generic Dexamethasone anti-inflammatory?
- Tinyyy 6y agoIf you think Remdesivir is not effective you could simply choose to not take it.
- kennywinker 6y agoIf it is an effective treatment, tell me why we should pay $2,340 per patient, and not just invalidate their patent on the grounds of public good? The US gov partially paid for its development in the first place.
- deleted 6y ago[deleted]
- auggierose 6y agoMaybe so that next time we need them, they don't just say, naahh, gonna do something instead that actually pays?
- TheOtherHobbes 6y agoThat worked so well for opioid crisis victims.
- auggierose 6y agoCare to convert that sentence into a coherent argument?
- listenallyall 6y agoSeems expensive for a drug with "no significant benefits" https://www.barrons.com/news/antiviral-remdesivir-showed-no-significant-benefit-in-virus-patients-01588174805 https://www.barrons.com/news/antiviral-remdesivir-showed-no-...
- tluyben2 6y ago> In normal circumstances, we would price a medicine according to the value it provides. Which makes medicine so expensive that it provides no value to the many people who are in a bad position and cannot afford it. Pricing by the value something provides is only relevant for those who can afford that value in the first place (they assume you stay for the duration; you are lucky if you do not); for the rest it provides no value at all because they don't get into that position in the first place. As I read online, the entire treatment in India is well under $100[0]. I am all for getting the R&D money back, but charging medicine based on value (who determines that value anyway; that's highly subjective) it may provide is a recipe for disaster. Especially in this case; they stand to sell 10s of millions of these vials (even though they don't really seem to 'provide value' as clearly as advertised as others have mentioned here), so the R&D/investment story is... not very good. [0] https://www.hindustantimes.com/world-news/european-regulator-recommends-remdesivir-for-covid-19-treatment/story-r0rQr687STv1xcTvDGd3UK.html https://www.hindustantimes.com/world-news/european-regulator...
- SomeoneFromCA 6y agoThey did not know what to do with this drug, because it turned to be flop almost for every virus they tried. They would have scrapped it, if not for covid. Now they are telling us they need to recover R&D price. Very funny.
- deleted 6y ago[deleted]
- continuational 6y agoI don't really understand the outrage. Surely, the price is only too high in the event that they can't sell their product? It's a business, not a charity. Other companies will be looking hungrily at these earnings and invest in developing their own antivirals---which is exactly the desired outcome. Sure, it would be great to have this drug available to everyone right here, right now, for cheap. But investing on those terms is not very attractive; hence the drug simply wouldn't exist.
- flumpcakes 6y agoThat sounds like an argument that only people with money should get medicine.
- flak48 6y agoIndian companies have already started manufacturing Remdesivir (under license from Gilead) and selling them at a price of ~$70. I wonder how other countries are going to respond since the US seems to have bought up the entire global stockpile from Gilead (who are charging $390 - $520 to Americans). [1] https://www.hindustantimes.com/india-news/india-s-hetero-prices-generic-remdesivir-for-covid-19-treatment-at-rs5-400-per-vial/story-kvqLE7vfjarEaj8Y1ad5lJ.html https://www.hindustantimes.com/india-news/india-s-hetero-pri... [2] https://www.indiatvnews.com/business/news-covid19-drug-cipremi-price-dosage-cipla-remdesivir-cipremi-price-covid-19-treatment-drug-covifor-fabiflu-628798 https://www.indiatvnews.com/business/news-covid19-drug-cipre...
- Tinyyy 6y agoAt $2340 a patient, the drug is an expensive treatment plan but not overpriced imo. If the claimed reduction in time to recovery is true, then around $600 a day of reduced recovery time is probably worth the hospitalization and long term health costs. Besides having to recoup the costs of development of Remdesivir, as well as the costs to trial various drugs that never make it to market, Remdesivir is currently in short supply and probably costs a significant amount to produce. It seems unreasonable to expect a good in such short supply to be sold for cheap. The overall cost of $2k isn’t prohibitively expensive such that many lives would be lost over this anyways.
- josefrichter 6y agoAside from the sensitive topic of pricing the new drug, I'd like to take this opportunity to remember the late Czech scientist Antonin Holy. His lifelong research led to creation of many groundbreaking drugs against HIV, hepatitis and now Covid. This humble "invisible" guy's work literally saved millions of lives and is behind many of current Gilead drugs. See https://english.radio.cz/antonin-holy-one-countrys-most-renowned-scientists-8591332 https://english.radio.cz/antonin-holy-one-countrys-most-reno...
- jjeaff 6y agoWhen you need a whole letter to explain the new price, you know it's going to be loaded with crap and the price will be excessive. This one doesn't disappoint.
- cjhopman 6y agoThat's bullshit. Companies have "whole letter"s for pretty much everything they do. Gilead had a "whole letter" when they said they'd provide 1.5 million doses for free. Was that also loaded with crap and the "$0" price excessive?
- jjeaff 6y agoThat's fine if you want to make a PR splash with a donation. But don't do the same while you are gouging consumers. In other words, don't piss on me and call it rain.
- apsec112 6y agoThis isn't just paying for the R&D on remdesivir itself. It's paying for all of the other antivirals which were developed and then failed clinical trials, and all the other antivirals that turned out to be largely useless because (like SARS, MERS, and Ebola) there was never a large-scale outbreak. If you require remdesivir to be sold at cost, then any company developing antivirals will reason out: Scenario A: There's a huge pandemic and massive demand, but the drug can only be sold at cost, so we break even. Scenario B: The drug fails clinical trials. We lose a bunch of money. Scenario C: The drug works, but no pandemic ever happens. We lose a bunch of money. .... and then no one will develop antivirals, because on average, you can only come out behind. As to why the government can't do everything itself, I'll quote Paul Graham on venture investing, which (like drug development) is a highly technical, winner-take-all business where most projects fail: "Why not just have the government, or some large almost-government organization like Fannie Mae, do the venture investing instead of private funds? I'll tell you why that wouldn't work. Because then you're asking government or almost-government employees to do the one thing they are least able to do: take risks. As anyone who has worked for the government knows, the important thing is not to make the right choices, but to make choices that can be justified later if they fail. If there is a safe option, that's the one a bureaucrat will choose. But that is exactly the wrong way to do venture investing. The nature of the business means that you want to make terribly risky choices, if the upside looks good enough."
- danaris 6y agoYou know what government is really good for? Expensive projects for the public good with no mandate to turn a profit. If you're part of a government agency whose entire purpose is to develop and research new drugs, you're not going to be unduly risk averse. You're going to be doing your job, trying new things, working on getting new, effective, efficient treatments and cures developed, tested, and released to the public. Personally, I don't know to what extent I believe that pharmaceutical companies have actively suppressed research on cures for diseases, in favour of life-long treatments, but the incentives definitely support the theory. Publicly-run pharmaceutical research would also be much more likely to do a proper, thorough investigation of the kinds of treatments that can come out of well-known natural/easily-synthesized substances (as opposed to the existing pharmaceutical industry, which is incentivized to do research into things that require more specialized expertise & equipment, so the people who want the drugs must but them from them).
- sub7 6y agoI do in $20 or less what costs $800 there. Americans pay probably $200 of that $800 and think "oh insurance covered it" when really they just payed 10x the price. The US is so full of morons they must love being ripped off or something.
- jjeaff 6y agoFew pay that much. It's the insurance companies who for some reason can't negotiate better. But also, note that you get it for $20 because americans are subsidizing you.
- Pick-A-Hill2019 6y agoThis Open Letter is bullshit (purely personal opinion obviously). I note they are transparent about the pricing in specific markets but that the CEO fails to be so transparent about the pricing for generics in other markets. I’m aware of the studies regarding its effectiveness but hate hand-wavy B.S. like this so here's some snippets taken from Gilead's own website. "All descriptive printed matter, including advertising and promotional material, relating to the use of the remdesivir clearly and conspicuously shall state that: :the remdesivir have not been approved [sic] :the remdesivir have been authorized by FDA under an EUA [sic]" page 6 https://www.gilead.com/-/media/files/pdfs/remdesivir/eua-fda-authorization-letter_01may2020.pdf https://www.gilead.com/-/media/files/pdfs/remdesivir/eua-fda... and "Remdesivir is an investigational drug that has not been approved by the FDA for any use." https://www.gilead.com/remdesivir https://www.gilead.com/remdesivir I was in two minds about correcting the grammar but since they are all snips from the links decided to leave as is. [Edit to clarify] My main point was that if they were pricing generics at a reasonable price they would have been trumpeting in the same press release as this. eg. if one is so reasonable that they openly discuss it then why not the pricing of generics.