6 ms·

The US drug market is out of control. Some time ago a friend I was travelling with had a recurrence of a skin complaint that she would usually treat with a par

by Nursie 6y ago

The US drug market is out of control. Some time ago a friend I was travelling with had a recurrence of a skin complaint that she would usually treat with a particular product. In the UK it's an over-the-counter med, non-prescription, with a cost of about £7. We were informed in the pharmacy at (I think) a Walgreens that it would be a prescription-only med in the US, and cost $200 for the same product. Is this because insurers can be billed?

jseliger 6y ago
Another reading is, "The US drug market subsidizes the R&D for the entire rest of the world." One possible alternative to selling new, novel drugs for market prices is not having those drugs at all. We really ought to be thankful that some entities are willing to bear the billion-dollar cost of developing a new drug. https://en.wikipedia.org/wiki/Cost_of_drug_development https://en.wikipedia.org/wiki/Cost_of_drug_development
- CuriouslyC 6y ago
  You come off like a shill. The majority of new drug development is the result of publicly funded research. Drug companies mine that research, and in many cases their main contribution is ramming the drug through the FDA approval pipeline. The university will also take a big cut, even though they were given (mostly public) grants to do the research. Drug development is probably one of the best targets for socialization. That would reduce the number of stupid, pointless drugs that get developed. How many billions have been wasted to produce ~20 different anti-depressants, none of which does more than slightly outperform placebo?
  - sdinsn 6y ago
    > The majority of new drug development is the result of publicly funded research. Drug companies mine that research Isn't the entire point of publicly funded research to spur scientific and economic development? Are you proposing that public research should be hidden away so that private companies don't do anything useful with it?
    - licebmi__at__ 6y ago
      No, but it's to take in account where the high price (in certain poorly regulated geographies) is justified by the cost of research.
- Redoubts 6y ago
  That sounds like a worst-possible world, and something we really shouldn't be tolerating.
- username90 6y ago
  The profits from selling drugs in EU is more than enough for the cost of research. The US market prices are higher since the US market has higher sales costs (need to spend more ads and marketing dollars, and need to negotiate with all the insurers etc). Banning prescribed medicine ads and fixing the overly complicated healthcare system would help a lot keeping costs down and it wouldn't affect how much there is left over for research at all. https://truecostofhealthcare.org/wp-content/uploads/2019/03/PharmBG2018.png https://truecostofhealthcare.org/wp-content/uploads/2019/03/... https://truecostofhealthcare.org/the_pharmaceutical_industry/ https://truecostofhealthcare.org/the_pharmaceutical_industry...
- JimTheMan 6y ago
  Yes, because all of Europe isn't doing any research on drugs... And Japan and the UK and China and so on... That's an extremely US centric view. The market in the US is inelastic and inefficient. There's a reason why the prices are so high relative to care provided in other western countries.
- Nursie 6y ago
  > Another reading is, "The US drug market subsidizes the R&D for the entire rest of the world." There's no way that a decades-old, cheap to produce tropical ointment falls under that category. If you feel that a massively high price on generics is some sort of worthwhile cross-subsidy to other things... I'm not sure I agree.
- Nursie 6y ago
  In the case of aciclovir, which I was talking about there, it's of UK origin.
toast0 6y ago
Prescription drugs in the US have weird pricing incentives. Not a lot of people are paying the list prices. Insurers separately negotiate prices and insured people often pay much less out of pocket (but sometimes not very much less). There are a lot of free/low cost prescription plans that will get you discounts -- some pharmacies will be happy to sign you up for those at the counter. Drug manufacturers generally offer rebate/discount programs to consumers for their expensive drugs in order to drive sales. It's a mess like most of healthcare in the US. Too little price transparency, too many companies between the patient and the care, too much complexity.
gridlockd 6y ago
It's because the government can say "this drug shall cost no more than X units of currency" and if that is above marginal cost, it can still makes sense to sell it. The flip side is that drugs in the US are extra-expensive because the expected recuperation of R&D rests on the US market. If the US government started doing price fixing, existing drug prices would come down, but new drugs would be less likely to be developed. On the other hand, much of regulatory burdens that make drug development more costly are also due to the US government.
- Nursie 6y ago
  > It's because the government can say "this drug shall cost no more than X units of currency" and if that is above marginal cost, it can still makes sense to sell it. Not really for generic, over-the-counter stuff in the UK. Meds that are funded by the public purse and given out on prescription, sure. But £7 is the market price for that over the counter drug in the UK. There's no entity doing price fixing there.
  - gridlockd 6y ago
    Without better information, I have no way to look into the details of your anecdote, but if it really is a generic drug then the US price probably is that of a brand for which no FDA-licensed competitor exists, likely due to regulatory cost. If it's over-the-counter in the UK, it might also be the same brand but two different drugs. It might also be two different drugs entirely, and you just mixed things up.
    - jen20 6y ago
      I suspect the GP has mixed up several things here. Many drugs in the UK are available “over the counter” in the UK for pennies - next time you’re in Heathrow Airport, if that ever happens again, check out a “Boots” store and you’ll find you can buy Ibuprofen for £0.25 for 24 tablets. I have never seen even a drug such as Ibuprofen for sale in the US for a price remotely comparable. However, if a GP or secondary care doctor _prescribes_ Ibuprofen and you fulfill it via an NHS-servicing pharmacy, the price is whatever the prevailing rate of the NHS prescription charge is - currently £9.15 - though substantial discounts are available in many situations. Further, a friendly pharmacist will often advise patients not to fill the prescription at all and to buy the over-the-counter equivalent in such cases. Also in the UK, generic drugs are issued _by default_ where possible, and only if the bioavailability of a particular medicine is important is it considered acceptable to dispense specific brands upon request.

by Nursie 6y ago

jseliger 6y ago

Another reading is, "The US drug market subsidizes the R&D for the entire rest of the world." One possible alternative to selling new, novel drugs for market prices is not having those drugs at all. We really ought to be thankful that some entities are willing to bear the billion-dollar cost of developing a new drug. https://en.wikipedia.org/wiki/Cost_of_drug_development https://en.wikipedia.org/wiki/Cost_of_drug_development

CuriouslyC 6y ago
You come off like a shill. The majority of new drug development is the result of publicly funded research. Drug companies mine that research, and in many cases their main contribution is ramming the drug through the FDA approval pipeline. The university will also take a big cut, even though they were given (mostly public) grants to do the research. Drug development is probably one of the best targets for socialization. That would reduce the number of stupid, pointless drugs that get developed. How many billions have been wasted to produce ~20 different anti-depressants, none of which does more than slightly outperform placebo?
- sdinsn 6y ago
  > The majority of new drug development is the result of publicly funded research. Drug companies mine that research Isn't the entire point of publicly funded research to spur scientific and economic development? Are you proposing that public research should be hidden away so that private companies don't do anything useful with it?
  - licebmi__at__ 6y ago
    No, but it's to take in account where the high price (in certain poorly regulated geographies) is justified by the cost of research.
Redoubts 6y ago
That sounds like a worst-possible world, and something we really shouldn't be tolerating.
username90 6y ago
The profits from selling drugs in EU is more than enough for the cost of research. The US market prices are higher since the US market has higher sales costs (need to spend more ads and marketing dollars, and need to negotiate with all the insurers etc). Banning prescribed medicine ads and fixing the overly complicated healthcare system would help a lot keeping costs down and it wouldn't affect how much there is left over for research at all. https://truecostofhealthcare.org/wp-content/uploads/2019/03/PharmBG2018.png https://truecostofhealthcare.org/wp-content/uploads/2019/03/... https://truecostofhealthcare.org/the_pharmaceutical_industry/ https://truecostofhealthcare.org/the_pharmaceutical_industry...
JimTheMan 6y ago
Yes, because all of Europe isn't doing any research on drugs... And Japan and the UK and China and so on... That's an extremely US centric view. The market in the US is inelastic and inefficient. There's a reason why the prices are so high relative to care provided in other western countries.
Nursie 6y ago
> Another reading is, "The US drug market subsidizes the R&D for the entire rest of the world." There's no way that a decades-old, cheap to produce tropical ointment falls under that category. If you feel that a massively high price on generics is some sort of worthwhile cross-subsidy to other things... I'm not sure I agree.
Nursie 6y ago
In the case of aciclovir, which I was talking about there, it's of UK origin.

toast0 6y ago

Prescription drugs in the US have weird pricing incentives. Not a lot of people are paying the list prices. Insurers separately negotiate prices and insured people often pay much less out of pocket (but sometimes not very much less). There are a lot of free/low cost prescription plans that will get you discounts -- some pharmacies will be happy to sign you up for those at the counter. Drug manufacturers generally offer rebate/discount programs to consumers for their expensive drugs in order to drive sales. It's a mess like most of healthcare in the US. Too little price transparency, too many companies between the patient and the care, too much complexity.

gridlockd 6y ago

It's because the government can say "this drug shall cost no more than X units of currency" and if that is above marginal cost, it can still makes sense to sell it. The flip side is that drugs in the US are extra-expensive because the expected recuperation of R&D rests on the US market. If the US government started doing price fixing, existing drug prices would come down, but new drugs would be less likely to be developed. On the other hand, much of regulatory burdens that make drug development more costly are also due to the US government.

Nursie 6y ago
> It's because the government can say "this drug shall cost no more than X units of currency" and if that is above marginal cost, it can still makes sense to sell it. Not really for generic, over-the-counter stuff in the UK. Meds that are funded by the public purse and given out on prescription, sure. But £7 is the market price for that over the counter drug in the UK. There's no entity doing price fixing there.
- gridlockd 6y ago
  Without better information, I have no way to look into the details of your anecdote, but if it really is a generic drug then the US price probably is that of a brand for which no FDA-licensed competitor exists, likely due to regulatory cost. If it's over-the-counter in the UK, it might also be the same brand but two different drugs. It might also be two different drugs entirely, and you just mixed things up.
  - jen20 6y ago
    I suspect the GP has mixed up several things here. Many drugs in the UK are available “over the counter” in the UK for pennies - next time you’re in Heathrow Airport, if that ever happens again, check out a “Boots” store and you’ll find you can buy Ibuprofen for £0.25 for 24 tablets. I have never seen even a drug such as Ibuprofen for sale in the US for a price remotely comparable. However, if a GP or secondary care doctor _prescribes_ Ibuprofen and you fulfill it via an NHS-servicing pharmacy, the price is whatever the prevailing rate of the NHS prescription charge is - currently £9.15 - though substantial discounts are available in many situations. Further, a friendly pharmacist will often advise patients not to fill the prescription at all and to buy the over-the-counter equivalent in such cases. Also in the UK, generic drugs are issued _by default_ where possible, and only if the bioavailability of a particular medicine is important is it considered acceptable to dispense specific brands upon request.