7 ms·

The world should hope we don’t fix it. Most of the R&D is done here because the market opportunity is huge. But if that dries up, then costs will go up for ev

The world should hope we don’t fix it. Most of the R&D is done here because the market opportunity is huge. But if that dries up, then costs will go up for everyone else.

s5300 4y ago
Doesn’t like. Cuba, of all places, have pretty great medical R&D? Don’t think your statement means too much.
wnevets 4y ago
how much R&D are these companies doing for insulin?
- uoaei 4y ago
  Yeah, if anything, the explosive profit opportunity is all the more reason to effectively subsidize insulin for the general public. Since pharma folks are already so greedy, go ahead and get a government contract for it, those are always hugely overinflated anyway!
  - anonuser123456 4y ago
    Most of the markup is not done by big pharma. It’s done by PBMs. The fictional ‘list’ prices exist as a marketing scheme to get private insurance to pay high prices ‘at a discount’. Cash buyers are a casualty caught in the middle of this scheme.
- lotsofpulp 4y ago
  Whatever amount it is, US politicians are not willing or able to pay for it with US taxpayer’s money.
- lhl 4y ago
  Sounds like anonuser needs to read about the insulin's history: https://en.wikipedia.org/wiki/Insulin#Patent https://en.wikipedia.org/wiki/Insulin#Patent
  - anonuser123456 4y ago
    Snarky comments only work when you are factually correct. Modern insulin analogs were not invented 100 years ago.
    - CarbonCycles 4y ago
      That is very true...Insulin now of days is very different then when it was first introduced. For example, there are now "long-lasting" and "fast-acting" insulin that has been molecularly modified for different outcomes. Diabetes is a very old disease that ironically is pushing the limits of sensor fusion, but it is very poorly understood by people outside of the Type 1 community. I personally wish these two diseases were completely renamed as it does a disservice to both Type 1 and 2 patients.
    - lhl 4y ago
      sigh, sure let's give a more than 1-line answer to your original (pretty worthless, let's be honest) 1 line comment. "Unlike many pharmaceutical markets, which see the entry of generic competitors, no generic or biosimilar insulins have been approved in the United States.68 This is not due to patent protection of the existing products.69 The patents for the majority of human and analog insulin products have expired or are about to expire.70 At the end of 2015, 11 insulin products had no associated patents or exclusivities.71 This number has since risen to approximately 17 by July 2019 (including those products where only the insulin pen device is protected), shown in Table 2." Knox, Ryan. “Insulin Insulated: Barriers to Competition and Affordability in the United States Insulin Market.” Journal of Law and the Biosciences 7, no. 1 (July 25, 2020): lsaa061. https://doi.org/10.1093/jlb/lsaa061 https://doi.org/10.1093/jlb/lsaa061. This is corroborated by Health Access International's deep dive from several years ago: "There are no patents on any formulations of human insulins. Based on the filing date and a 20 year patent period, patents on analogue insulins already on the market in the US and Canada have expired or will soon expire in these countries and elsewhere (Figure 1)." https://haiweb.org/wp-content/uploads/2015/05/HAI_ACCISS_factsheet_insulinpatent.pdf https://haiweb.org/wp-content/uploads/2015/05/HAI_ACCISS_fac... https://haiweb.org/wp-content/uploads/2016/04/ACCISS-PatentReport-FINAL.pdf https://haiweb.org/wp-content/uploads/2016/04/ACCISS-PatentR... And yet, despite this, the US remains alone in having prices not only multiple times the cost of any other country, but increasing at an alarming rate (tripling over the past deacde) while prices stay the same or fall elsewhere. There's zero shortage of analysis and ink spilled in both the popular press or in academic analysis/ peer-reviewed press on why markets are so fucked in the US pharmaceuticals, so I just assume any talk about how R&D cost recovery happens to only be a thing in the US (and somehow accelerating despite new products not being released) to be either extreme low effort or just plain bad-faith (which are you anon?), but for those reading along that might be interested, a few places to start to do their own research if they really care about the topic: Mulcahy, Andrew W., Daniel Schwam, and Nathaniel Edenfield. “Comparing Insulin Prices in the United States to Other Countries: Results from a Price Index Analysis.” RAND Corporation, October 6, 2020. https://www.rand.org/pubs/research_reports/RRA788-1.html https://www.rand.org/pubs/research_reports/RRA788-1.html. Hirsch, Irl B. “Insulin in America: A Right or a Privilege?” Diabetes Spectrum : A Publication of the American Diabetes Association 29, no. 3 (August 2016): 130–32. https://doi.org/10.2337/diaspect.29.3.130 https://doi.org/10.2337/diaspect.29.3.130. Schneider, Tyler, Tara Gomes, Kaleen N. Hayes, Katie J. Suda, and Mina Tadrous. “Comparisons of Insulin Spending and Price Between Canada and the United States.” Mayo Clinic Proceedings 97, no. 3 (March 1, 2022): 573–78. https://doi.org/10.1016/j.mayocp.2021.11.028 https://doi.org/10.1016/j.mayocp.2021.11.028. Herman, William H., and Shihchen Kuo. “100 Years of Insulin: Why Is Insulin So Expensive and What Can Be Done to Control Its Cost?” Endocrinology and Metabolism Clinics of North America 50, no. 3S (September 2021): e21–34. https://doi.org/10.1016/j.ecl.2021.09.001 https://doi.org/10.1016/j.ecl.2021.09.001. Luo, Jing, and Aaron S Kesselheim. “Evolution of Insulin Patents and Market Exclusivities in the USA.” The Lancet Diabetes & Endocrinology 3, no. 11 (November 2015): 835–37. https://doi.org/10.1016/S2213-8587(15)00364-2 https://doi.org/10.1016/S2213-8587(15)00364-2.
- anonuser123456 4y ago
  A lot. Insulin is a category of human insulin analogs. Each analog has unique properties. You can have the ‘old insulin’ for something like 25$ / 1k units. But it’s very hard to use relative to modern analogs, so people prefer modern analogs. Edit: Minus points for facts that disrupt the narrative. I love it.
  - zackees 4y ago
    My family member uses Humalog and it's patent expired in 2014 yet it's hundreds of dollars: https://medcitynews.com/2019/03/lilly-to-introduce-lower-priced-version-of-insulin-product-humalog/ https://medcitynews.com/2019/03/lilly-to-introduce-lower-pri... The problem is that there isn't competition on the market for this product. The Open Insulin people were trying to make it available to the public but they are stuck trying to get through the regulation. It's entirely possible that if we got rid of the regulation then the whole problem takes care of itself and it becomes a non issue.
    - CarbonCycles 4y ago
      IMO it's not the regulation that is the problem...it's the entire healthcare system we have in the US. Humalog and other types of the same exact insulin are pennies on the dollar in other countries with very different healthcare compensation programs between the vendors and purchases. It's bizarre to say the least.
      - anonuser123456 4y ago
        This is precisely because the US market pays for all of the risk. Once the risk is paid for by the US market, it’s very cheap to sell extra capacity to other countries. All the fixed costs are already paid for and the risks are low.
    - anonuser123456 4y ago
      You can buy generic novolog at Walmart for 75$ for 1000 units vs. 550$ list for the same of branded humalog. But basically you are correct that regulation is the largest barrier to price reductions. Patients pay the price of FDA regulation (for better or worse). That’s not really the drug companies fault.
Afforess 4y ago
I wonder how many lives all that R&D costs in the US. Seems like a strange trade to let US citizens die due to lack of healthcare to fund the world's R&D. I doubt anyone here would vote to ratify such a deal, formally.
- anonuser123456 4y ago
  The drugs have to be developed, and no other mechanism seems to produce them. Clinical trials are extremely expensive and very risky. In the long run, these drugs go off patent and become low cost and highly available. Yes, people today will struggle, maybe even die today. But in a generation more people will thrive.
  - mrguyorama 4y ago
    Ah yes, which is why the US was the only place to quickly develop effective COVID vaccines.
    - munch117 4y ago
      BioNTech SE An der Goldgrube 12 55131 Mainz, Germany I'm all for giving the US credit for healthcare R&D, there's a lot of credit due. But don't just take it for granted, or you'll miss the signs that point in other directions. Specifically with COVID-19, there was a lot of global collaboration.
      - anonuser123456 4y ago
        I think parent is being sarcastic. But that said, the key point remains; the US is where the money is. The US underwrote the mRNA platforms with a guarantee of 10 billion in revenue while the EU haggled with AZ for like 1 billion. In the process, the US developed an entire scalable delivery pipeline for mRNA that didn’t exist prior.

The world should hope we don’t fix it. Most of the R&D is done here because the market opportunity is huge. But if that dries up, then costs will go up for everyone else.

s5300 4y ago

Doesn’t like. Cuba, of all places, have pretty great medical R&D? Don’t think your statement means too much.

wnevets 4y ago

how much R&D are these companies doing for insulin?

uoaei 4y ago
Yeah, if anything, the explosive profit opportunity is all the more reason to effectively subsidize insulin for the general public. Since pharma folks are already so greedy, go ahead and get a government contract for it, those are always hugely overinflated anyway!
- anonuser123456 4y ago
  Most of the markup is not done by big pharma. It’s done by PBMs. The fictional ‘list’ prices exist as a marketing scheme to get private insurance to pay high prices ‘at a discount’. Cash buyers are a casualty caught in the middle of this scheme.
lotsofpulp 4y ago
Whatever amount it is, US politicians are not willing or able to pay for it with US taxpayer’s money.
lhl 4y ago
Sounds like anonuser needs to read about the insulin's history: https://en.wikipedia.org/wiki/Insulin#Patent https://en.wikipedia.org/wiki/Insulin#Patent
- anonuser123456 4y ago
  Snarky comments only work when you are factually correct. Modern insulin analogs were not invented 100 years ago.
  - CarbonCycles 4y ago
    That is very true...Insulin now of days is very different then when it was first introduced. For example, there are now "long-lasting" and "fast-acting" insulin that has been molecularly modified for different outcomes. Diabetes is a very old disease that ironically is pushing the limits of sensor fusion, but it is very poorly understood by people outside of the Type 1 community. I personally wish these two diseases were completely renamed as it does a disservice to both Type 1 and 2 patients.
  - lhl 4y ago
    sigh, sure let's give a more than 1-line answer to your original (pretty worthless, let's be honest) 1 line comment. "Unlike many pharmaceutical markets, which see the entry of generic competitors, no generic or biosimilar insulins have been approved in the United States.68 This is not due to patent protection of the existing products.69 The patents for the majority of human and analog insulin products have expired or are about to expire.70 At the end of 2015, 11 insulin products had no associated patents or exclusivities.71 This number has since risen to approximately 17 by July 2019 (including those products where only the insulin pen device is protected), shown in Table 2." Knox, Ryan. “Insulin Insulated: Barriers to Competition and Affordability in the United States Insulin Market.” Journal of Law and the Biosciences 7, no. 1 (July 25, 2020): lsaa061. https://doi.org/10.1093/jlb/lsaa061 https://doi.org/10.1093/jlb/lsaa061. This is corroborated by Health Access International's deep dive from several years ago: "There are no patents on any formulations of human insulins. Based on the filing date and a 20 year patent period, patents on analogue insulins already on the market in the US and Canada have expired or will soon expire in these countries and elsewhere (Figure 1)." https://haiweb.org/wp-content/uploads/2015/05/HAI_ACCISS_factsheet_insulinpatent.pdf https://haiweb.org/wp-content/uploads/2015/05/HAI_ACCISS_fac... https://haiweb.org/wp-content/uploads/2016/04/ACCISS-PatentReport-FINAL.pdf https://haiweb.org/wp-content/uploads/2016/04/ACCISS-PatentR... And yet, despite this, the US remains alone in having prices not only multiple times the cost of any other country, but increasing at an alarming rate (tripling over the past deacde) while prices stay the same or fall elsewhere. There's zero shortage of analysis and ink spilled in both the popular press or in academic analysis/ peer-reviewed press on why markets are so fucked in the US pharmaceuticals, so I just assume any talk about how R&D cost recovery happens to only be a thing in the US (and somehow accelerating despite new products not being released) to be either extreme low effort or just plain bad-faith (which are you anon?), but for those reading along that might be interested, a few places to start to do their own research if they really care about the topic: Mulcahy, Andrew W., Daniel Schwam, and Nathaniel Edenfield. “Comparing Insulin Prices in the United States to Other Countries: Results from a Price Index Analysis.” RAND Corporation, October 6, 2020. https://www.rand.org/pubs/research_reports/RRA788-1.html https://www.rand.org/pubs/research_reports/RRA788-1.html. Hirsch, Irl B. “Insulin in America: A Right or a Privilege?” Diabetes Spectrum : A Publication of the American Diabetes Association 29, no. 3 (August 2016): 130–32. https://doi.org/10.2337/diaspect.29.3.130 https://doi.org/10.2337/diaspect.29.3.130. Schneider, Tyler, Tara Gomes, Kaleen N. Hayes, Katie J. Suda, and Mina Tadrous. “Comparisons of Insulin Spending and Price Between Canada and the United States.” Mayo Clinic Proceedings 97, no. 3 (March 1, 2022): 573–78. https://doi.org/10.1016/j.mayocp.2021.11.028 https://doi.org/10.1016/j.mayocp.2021.11.028. Herman, William H., and Shihchen Kuo. “100 Years of Insulin: Why Is Insulin So Expensive and What Can Be Done to Control Its Cost?” Endocrinology and Metabolism Clinics of North America 50, no. 3S (September 2021): e21–34. https://doi.org/10.1016/j.ecl.2021.09.001 https://doi.org/10.1016/j.ecl.2021.09.001. Luo, Jing, and Aaron S Kesselheim. “Evolution of Insulin Patents and Market Exclusivities in the USA.” The Lancet Diabetes & Endocrinology 3, no. 11 (November 2015): 835–37. https://doi.org/10.1016/S2213-8587(15)00364-2 https://doi.org/10.1016/S2213-8587(15)00364-2.
anonuser123456 4y ago
A lot. Insulin is a category of human insulin analogs. Each analog has unique properties. You can have the ‘old insulin’ for something like 25$ / 1k units. But it’s very hard to use relative to modern analogs, so people prefer modern analogs. Edit: Minus points for facts that disrupt the narrative. I love it.
- zackees 4y ago
  My family member uses Humalog and it's patent expired in 2014 yet it's hundreds of dollars: https://medcitynews.com/2019/03/lilly-to-introduce-lower-priced-version-of-insulin-product-humalog/ https://medcitynews.com/2019/03/lilly-to-introduce-lower-pri... The problem is that there isn't competition on the market for this product. The Open Insulin people were trying to make it available to the public but they are stuck trying to get through the regulation. It's entirely possible that if we got rid of the regulation then the whole problem takes care of itself and it becomes a non issue.
  - CarbonCycles 4y ago
    IMO it's not the regulation that is the problem...it's the entire healthcare system we have in the US. Humalog and other types of the same exact insulin are pennies on the dollar in other countries with very different healthcare compensation programs between the vendors and purchases. It's bizarre to say the least.
    - anonuser123456 4y ago
      This is precisely because the US market pays for all of the risk. Once the risk is paid for by the US market, it’s very cheap to sell extra capacity to other countries. All the fixed costs are already paid for and the risks are low.
  - anonuser123456 4y ago
    You can buy generic novolog at Walmart for 75$ for 1000 units vs. 550$ list for the same of branded humalog. But basically you are correct that regulation is the largest barrier to price reductions. Patients pay the price of FDA regulation (for better or worse). That’s not really the drug companies fault.

Afforess 4y ago

I wonder how many lives all that R&D costs in the US. Seems like a strange trade to let US citizens die due to lack of healthcare to fund the world's R&D. I doubt anyone here would vote to ratify such a deal, formally.

anonuser123456 4y ago
The drugs have to be developed, and no other mechanism seems to produce them. Clinical trials are extremely expensive and very risky. In the long run, these drugs go off patent and become low cost and highly available. Yes, people today will struggle, maybe even die today. But in a generation more people will thrive.
- mrguyorama 4y ago
  Ah yes, which is why the US was the only place to quickly develop effective COVID vaccines.
  - munch117 4y ago
    BioNTech SE An der Goldgrube 12 55131 Mainz, Germany I'm all for giving the US credit for healthcare R&D, there's a lot of credit due. But don't just take it for granted, or you'll miss the signs that point in other directions. Specifically with COVID-19, there was a lot of global collaboration.
    - anonuser123456 4y ago
      I think parent is being sarcastic. But that said, the key point remains; the US is where the money is. The US underwrote the mRNA platforms with a guarantee of 10 billion in revenue while the EU haggled with AZ for like 1 billion. In the process, the US developed an entire scalable delivery pipeline for mRNA that didn’t exist prior.