17 ms·
Arthritis drug that cost $198 in 2008 is now more than $10k
- refurb 5y agoIt would have been more helpful to pull sales as well. Indomethicin is an old drug without much use and then narrow it down to suppositories it’s an even smaller market. Plus there are a dozen plus alternatives you could use. Think of like producing a microprocessor design from 1970 where alternatives exist. Super niche. Demand is maybe 100 units per year. What would you charge?
- Luc 5y agoDepends on what competitors are charging, right? In this case it seems to indicate market failure.
- ncallaway 5y agoAre competitors charging for the product, or is it covered under patent? I don't know the market, but it appears that it may be patented until 2030 (https://www.pharmacompass.com/patent-expiry-expiration/indomethacin https://www.pharmacompass.com/patent-expiry-expiration/indom...). That being said, drug patents are complicated, and there might be competitors for this drug.
- s1artibartfast 5y agoThe original drug was approved in 1965[1], and there are more than a hundred competitors[2], and the average price is somewhere around $2/day [3]. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/017814s044lbl.pdf https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/01... https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=indomethacin https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=a... https://clincalc.com/DrugStats/Drugs/Indomethacin https://clincalc.com/DrugStats/Drugs/Indomethacin
- ordinaryradical 5y agoHere’s another way of looking at it: if you need to use this obscure medicine rather than the alternatives because your condition is comparatively rarer, is it just that you should have to pay through the nose for it? Take it to the extreme: you have a very, very rare life-threatening illness. Since only 20 or so people a year are diagnosed with this, the drugs to treat it would have to cost 1.5MM just to be decently profitable. Is that a just healthcare system? A kind of inverted lottery in which the “luckier” you are the more likely to go bankrupt. One might reasonably conclude that trying to run the entirety of the healthcare system as a capitalist enterprise is perverse and trades the misery of the many for the profit of a few. In such cases, we should rightly consider all possible alternatives.
- mchusma 5y ago1 main point to this: true "insurance" could reasonably cover edge cases, including frankly some insurance covered by the state. The US "insurance" market is not really that, it's a price negotiator/health care provider/strange thing that honestly doesn't resemble any other "insurance" product. Even though we use some terms that resemble capitalism, health care is in no way a capitalist market. It's a different beast.
- s1artibartfast 5y agoThis isn't a hypothetical. There are numerous rare diseases which cost several million per year. Spinal muscular atrophy (SMA) is a prime example. Costs are typically socialized by the federal government.
- bushbaba 5y agoThis is what health “insurance” is supposed to cover. Where people pay a monthly premium to cover the small chance of a horrible disease. Instead people view health “insurance” as a healthcare plan. Which is not how the us system was designed. For those with health insurance the idea would be it cover the 10k+ per pill cost for your rare disorder.
- ChrisLomont 5y ago>Since only 20 or so people a year are diagnosed with this, the drugs to treat it would have to cost 1.5MM just to be decently profitable... Is that a just healthcare system? If it cost 1 trillion to add a year to the life of just one person, should society pay it, even if that trillion is then not able to be used for lots of other societal needs? Arguing for policy while ignoring opportunity costs leads to more human suffering than would otherwise result.
- falcolas 5y ago> Demand is maybe 100 units per year. What would you charge? Perhaps capitalism is not the best strategy to apply to healthcare. Folks in need of healthcare will always be a minority - a niche market - after all. The most prolific diseases typically only have 3-6M cases at any given time in the US. Should a person go destitute to pay for their care, just so some company's supply/demand curve is properly fitted?
- mchusma 5y agoJust to be clear, the American health care system is in no way "capitalist". It just has some of the trappings of capitalism. (There are so many examples of this, including for this case that Medicare/Medicaid are government programs where they pay whatever the drug companies ask.)
- falcolas 5y agoThe pharmaceutical market - specifically this company who is charging $10,000 for a medication in one market and under $200 in another - is certainly following capitalist methodologies: "Charge what the market can bear."
- refurb 5y agoSo you’re saying someone who is producing a niche product a minimal units should be forced to charge a low price? Regardless what their cost of goods is?
- Spivak 5y agoThat's almost never what people arguing for government intervention in healthcare pricing actually want. They want an affordable price at the point of sale to the patient while the government uses tax dollars to and fees collected at the pharmacy to smooth out prices and have standing buy orders so that medications are always available to people that need them. i.e. don't let the supply chains fall over and provide "insurance" for everyone. This really isn't that crazy in the grand scheme of things. The US right now today does basically this with dairy products.
- vidarh 5y agoThat doesn't explain why it's available cheaply in other countries, even privately. E.g. in the UK a quick check shows me I can buy a pack privately online for $40. (UK online pharmacies can sell a number of prescription-only drugs privately if they have a doctor carry out an online consultation, which means you basically fill in a form and a doctor will look at your answers and provide a prescription as part of the sales process, or you can send them a prescription you already have).
- s1artibartfast 5y agoSales are around $2 mil/year for oral and suppository combined [1]. For that you have regulatory upkeep, cost of manufacturing, and legal liability. It seems pretty clear why several of the past owners of the brand have gone bankrupts or sold off the product line. https://s28.q4cdn.com/742207512/files/doc_presentations/2021/10/Assertio-Holdings-Investor-Presentation-LD-Micro.pdf https://s28.q4cdn.com/742207512/files/doc_presentations/2021...
- jimmyvalmer 5y agoSuddenly betting my ass got a lot more serious.
- otagekki 5y ago... And in the meantime, the same medicine (commercialised there as Indocid) costs €3.78 in France (https://www.vidal.fr/medicaments/gammes/indocid-4902.html https://www.vidal.fr/medicaments/gammes/indocid-4902.html) provided you pay the full price. That essentially means it's literally 10x cheaper to take a two-way ticket to France, have a doctor prescribe it there, buy 3 months worth of treatment and come back to the US. I wonder how Americans can tolerate this situation.
- warent 5y ago[flagged]
- throw8932894 5y agobrainwashing that everyone needs health insurance paid by government. So printing presses can keep rolling... edit: an explanation; Activists never demand cheaper (or more transparent) health care. They demand state to pay for it! Same as with student loans.
- revolvingocelot 5y agoThere are, uh, several different first-world countries in which health insurance is paid by the government which you could scrutinize to see if your assumption is worth assuming. Or you could scrutinize the projected numbers, which conclude that it would be less expensive, in terms of government healthcare funding, to eliminate all of the ravenous middlemen causing all of the costs. Kinda like how it'd be cheaper to just give all the homeless people housing, rather than burn shitloads of social and criminal justice funding to keep them on the streets. These are ideological positions, though, so good luck changing any of them. So are the rolling presses -- they're not there to prop up a healthcare system, they're there to refill the troughs of irresponsible rich people whose enterprises have become "too big to fail". The problem is that the rich people have come to expect this windfall. Maybe we can save some money for them by cleaning up the healthcare and criminal justice systems!!
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- tnorthcutt 5y agoThis article, and discussion here, seem to both assume people pay the list price. In reality, is that the case very often, especially with this kind of drug? > Indocin's list price (what uninsured patients would pay) was $198 for 30 suppositories in 2008. I would not be surprised if they've hiked the list price a ton to game the insurance "what we'll pay" formulas and get more money from insurance companies. As trimbo notes [0], if everyone is paying list price then only 225 people are using this drug consistently. That seems unlikely. [0]: https://news.ycombinator.com/item?id=28905920 https://news.ycombinator.com/item?id=28905920
- dmurray 5y agoAnother interpretation: the biggest beneficiaries of high list prices are the insurance companies. After all, they don't pay that price, and the higher the non-insured price, the more attractive it is to buy health insurance. So perhaps the drug companies are just responding to demand from their biggest customers.
- puzzledobserver 5y agoShouldn't this be illegal / isn't this already illegal? Two companies reaching an agreement to supply products at reduced price, but not making the terms of that agreement available to a third entity (uninsured customers)?
- krageon 5y agoIf you carefully craft all incentives to create the strong impulse in all participants to do things everyone benefits from without actually phoning them up and saying (let's do it this way), it's not illegal. This describes the why for a lot that is wrong with the world.
- dmurray 5y agoIt's definitely not illegal in general to charge different prices to different customers, or to keep the terms of your business agreements private. As for "should it be illegal", most people seem to agree the healthcare industry should be regulated more tightly than commerce in general, but there's plenty of debate about exactly how far we should go.
- deleted 5y ago[deleted]
- wyager 5y agoIs this one of those things where they have to give it a crazy list price due to insurance regulations but no one actually pays that price? Goodrx has it for less than $10
- JohnWhigham 5y agoThat's what it looks like. Same thing with Martin Shkreli's price hikes, and he gave out those drugs for free to those who needed it.
- revolvingocelot 5y ago>Same thing with Martin Shkreli's price hikes, and he gave out those drugs for free to those who needed it. This appears to suggest that there are people who take enormously expensive theraputic drugs who don't need them, and that Martin Shkreli gave away those enormously expensive therapeutic drugs away to those who actually did. Whether propoganda, misinformation, or a bald-faced lie, that's not what happened. That never happens, and never will. Shame on you for implying that was the case.
- JamesBarney 5y agoI think your misinterpreting his use of the word need. He meant "needs it for free" not "needs the drug".
- revolvingocelot 5y agoGiven the prices at issue, that's most people. Worse yet, who decided the cutoff? When does one make enough money to pay insane life-improving drug prices? How much money is left over afterwards? "‘My other piece of advice, Copperfield,’ said Mr. Micawber, ‘you know. Annual income twenty pounds, annual expenditure nineteen nineteen six, result happiness. Annual income twenty pounds, annual expenditure twenty pounds nought and six, result misery."[0] [0] David Copperfield, Charles Dickens
- cityzen 5y agoI have gout and have learned quite a bit about how fucked this whole system is. I will find some sources but if my recollection serves me right there was an arthritis medication that was developed before FDA approvals. In order to bring it up to FDA approval, companies can assume the burden of approval (clinical trials, etc) and then they basically get the drug. Well, in the time since this has happened a common drug used by many people (many later in life) is now costing medicare tons of money because, well, people are greedy. I would say this system needs to change but considering the democrats can't even escape from a wet paper bag, i don't see that happening.
- refurb 5y agoPeople are greedy? The FDA asked that colchicine go through the FDA approval process. A company did so and footed the cost. That’s not greed, that’s a public service.
- cityzen 5y agolol... public service... yes, they are greedy AF: https://www.medpagetoday.com/rheumatology/generalrheumatology/89927 https://www.medpagetoday.com/rheumatology/generalrheumatolog... Colchicine, the old gout drug often cited as a cheap anti-inflammatory, hasn't been such a good deal since FDA approval, a study showed. The inflation- and rebate-adjusted Medicaid price per pill jumped from $0.24 in 2008 to $4.20 after the FDA officially approved a branded form, Colcrys, through the agency's Unapproved Drug Initiative pathway in 2009. and Accordingly, Medicaid spending on single-ingredient colchicine rose 2833%," they wrote, and "58% of this increase was attributable to price increases alone." and "Only a fraction of an investment was required for Colcrys, a product that has provided no increased value and an unnecessary, long-term cost burden to the health care system," argued B. Joseph Guglielmo, PharmD, of the University of California San Francisco, in an accompanying editorial. "The current study findings illustrate that we can never allow such an egregious case to take place again." say what you will but this is just stupid american bullshit.
- refurb 5y ago
- mavsman 5y agoThis is the kind of thing that would cause people to distrust government and major pharmaceutical companies when they say a new vaccine should/must be taken by everyone.
- jandrese 5y agoHuh? Are you concerned that the government is being ripped off when they pay for the shot?
- zz865 5y agoDoes anyone know about this drug? The generic pill is $10, not sure why the suppository would be $10k. I'm guessing some journalist found some drug that few people use. https://www.goodrx.com/indocin?dosage=50mg&form=capsule&label_override=indomethacin&quantity=30&sort_type=popularity https://www.goodrx.com/indocin?dosage=50mg&form=capsule&labe... https://www.goodrx.com/indocin?dosage=50mg&form=suppository&label_override=Indocin&quantity=30&sort_type=popularity https://www.goodrx.com/indocin?dosage=50mg&form=suppository&...
- devoutsalsa 5y agoProbably so someone can say “10K for a pill?! You can shove it up your ass!”
- bogwog 5y agoI think the $10000.00 one is the branded one, and the $10.00 is the generic (read the generated descriptions on the pages you linked). Maybe the generic can't be sold as a suppository, and the suppository version works better?
- klaussilveira 5y agoWell, the generic version is pretty affordable: https://www.buzzrx.com/indocin-coupon https://www.buzzrx.com/indocin-coupon
- tzs 5y agoThe generic version is not available as a suppository. The suppository with a Buzzrx coupon is just shy of $5000 for 14 suppositories, which is about the same as the $10k for 30 suppositories given in the article.
- jleyank 5y agoTwo quick comments: trying to take generic drugs and lock up their rights to jack prices relies on a govt giving the locked rights. Otherwise somebody else can just make it. There’s little profit in generic drugs, so production can be spotty. For those comparing vs the us health system, include (a) working f/t with good employer benefits, (b) f/t with less benefits and (c) working part time. And remember to include cobra. And include the state/province/country where the comparison is being done. No absolutes here, either.
- dantheman 5y agoBlame the FDA and patents.
- DanBC 5y agoCost of this medication to the English NHS: https://bnf.nice.org.uk/medicinal-forms/indometacin.html https://bnf.nice.org.uk/medicinal-forms/indometacin.html Active ingredients Indometacin 25 mg Drug tariff price £1.36 Active ingredients Indometacin 50 mg Drug tariff price £1.64
- s1artibartfast 5y agoIt is about the same price in the US. Apparently the suppository form which is more expensive. Annual sales for oral and suppository are around 2 mil/year. Barely worth the liability and ongoing regulatory cost.
- rdmirza 5y agoAhh, the pricing of rectal indomethacin. Here's the tale: If you have obstruction of your bile ducts below the liver or gallbladder, usually gallstones or sometimes neoplasm, you need an endoscopic retrograde cholangiopancreatography (ERCP) for extraction or sampling. ERCP is sticking a tube down the throat, stomach, small intestines into a tiny opening at the ampulla of Vater to access the bile ducts. Sometimes this process causes inflammation of the ampulla and associated ducts leading to blockage, and can lead to pancreatitis due to back flow and pressure, because the pancreas also excretes its digestive enzymes via the ampulla). A few trials circa 2015 showed rectal indomethacin reduced the risk of post-ERCP pancreatitis, and eventually it made its way into the guidelines. It is the only proven preventative treatment, so they have a natural monopoly. Hope that helps.
- s1artibartfast 5y agoHow does that lead to a natural monopoly? The drug was approved in 1965 and the company selling it holds no patents on indomethacin.
- rdmirza 5y agoMy meaning was that there is no other therapeutic agent available for prevention of post-ERCP pancreatitis. But you're quite right, there must be another reason. If I had to hazard a guess, it may be the market isn't attractive enough for competitors to establish a national supply chain. Or there's some sort of collusion at play. To me this represents further evidence why public goods should be left out of the hands of private for profit organizations for whom disease is simply an externality to capitalize on.
- Guereric 5y agoDoesn't retrograde imply that the procedure goes up the colon?
- frumper 5y agoCoscto is selling this prescription for $8.