12 ms·

I wonder how much this will cost? A drug you take 2 times a year could be much cheaper than one you take 365 times a year, and that's a big deal. The existing

I wonder how much this will cost? A drug you take 2 times a year could be much cheaper than one you take 365 times a year, and that's a big deal. The existing daily pill is really expensive. Australia knew that PrEP would practically eliminate HIV transmission. Even so, the decision to pay for it took years and was fiercely contested. That was before COVID, and people are more willing to pay for public health today. But cheap PReP would make a big difference in the poor countries where HIV prevention really matters.

argonaut 2y ago
The shot will likely be exorbitant in the USA. Gilead charged almost $2k/month for Truvada (list price, of course) and Descovy is the same. Generic Truvada is like $30/month now, so the price was never about the cost to manufacture. Obviously Gilead is developing these new drugs/shots for when Descovy's patent expires. They rely on the government mandating that health insurance companies cover the shots. This drives up the price.
- ortusdux 2y ago
  The price is rarely ever about the manufacturing cost. "A new study in 2020 estimated that the median cost of getting a new drug into the market was $985 million, and the average cost was $1.3 billion, which was much lower compared to previous studies, which have placed the average cost of drug development as $2.8 billion.[4]" https://en.wikipedia.org/wiki/Cost_of_drug_development https://en.wikipedia.org/wiki/Cost_of_drug_development
  - chimeracoder 2y ago
    > "A new study in 2020 estimated that the median cost of getting a new drug into the market was $985 million, and the average cost was $1.3 billion, which was much lower compared to previous studies, which have placed the average cost of drug development as $2.8 billion.[4]" PrEP repurposed Truvada, an existing blockbuster drug that had already reaped immense profit for Gilead for use in HIV treatment by the time the trials for PrEP began. The trials for PrEP were funded by the government, not Gilead. Gilead, however, got to retain all profits earned from PrEP.
    - HideousKojima 2y ago
      Did Gilead fund the R&D? There's a lot more to developing a new drug than just trials (though I think Gilead should have foot the bill for the trials too).
      - roughly 2y ago
        I don’t know if it’s the case here, but very, very, very often in biotech you’ve got the primary foundational research happening at university labs funded by grants, and it’s the productionization of the research (and then clinical trials, etc) that are what the biotech companies are doing. I’m not sure where that shifts the “who deserves what” conversation, but without university research labs, there’s no pharma industry.
        pfdietz 2y ago
        If the university owned the IP, then its value should have been reflected in what was bid for it. If the knowledge was not restricted by IP law, then any drug company could use it, and compete for new drugs based on it. As such, it would not provide any of them with a competitive advantage, and so would not be reflected in what they could charge. What universities typically produce is not a chemical that can serve as an actual drug, but is only a starting point for a long and expensive process of producing such a chemical. And then, it's often found that the target of the class of potential drugs isn't actually a good one. One can't determine that until drug candidates are available to test on real patients.
        Jensson 2y ago
        > What universities typically produce is not a chemical that can serve as an actual drug, but is only a starting point for a long and expensive process of producing such a chemical Remember you need to include all the failed attempts at finding useful things at university labs to see how much governments spend on research (just like you did failed pharma attempts), and if you add that up you see governments actually contribute a massive part of the cost to bring medicines to market. What they produce is necessary to even begin the work pharma does, currently it is basically a gift from the people to the pharma industry.
  - pfdietz 2y ago
    It should be pointed out that looking at the average cost of developing a drug is misleading, since one has to include the cost of all the drugs that failed to make it to market. One also has to include the money spent by small companies that failed and were not bought out, not just the money the big companies spend buying the successful ones.
    - Nifty3929 2y ago
      This is critical, and exactly the sort of thing someone will gloss over, intentionally or not. The numerator is the total cost of developing ALL the drugs, even (especially) the failed ones, but the denominator is only those drugs that are successful.
      - FireBeyond 2y ago
        On the contrary, often pharma proponents will gloss over the fact that most “failures” are discovered and canned at a small fraction of the investment of getting a drug to market (when it’s obvious it won’t do what you need or has other challenges). Actually not in the contrary - you are right. It’s just that the failures often cost a small fraction. They don’t get to 95% testing and approval before “nope, not even close”.
        pfdietz 2y ago
        I understand 60% of drug candidates fail in phase 3, the last and most expensive phase of testing. There are of course lots of chemicals ruled out early, but that's before you have something you'd call a drug.
        FireBeyond 2y ago
        No, that's not quite accurate - the phases are effectively additive. 37% fail in Phase 1. Of those that make it through, 69% of those fail in Phase 2, and of those, 42% fail in Phase 3. So, of 1,000 possibles, you have 630 make it through Phase 1, and 195 that make it through phase 2, i.e. 80.5% of your drug candidates didn't even make it to Phase 3, that "most expensive phase". A more accurate phrasing would be that 42% of the drugs that made it through Phase 2 fail to make it through Phase 3.
  - hanniabu 2y ago
    Also the government, aka the public, subsidizes a lot of those costs
  - rishav_sharan 2y ago
    Talking of studies, from the same wiki A 2022 study invalidated the common argument as is for high medication costs that research and development investments are reflected in and necessitate the treatment costs, finding no correlation for investments in drugs (for cases where transparency was sufficient) and their costs.[20][21]
    - mortehu 2y ago
      The Wikipedia editor was a bit naive to think such a basic study could invalidate that whole claim. They measured the correlation between the list price, adjusted for use amount, and development cost. As far as I can tell they didn't take into account number of customers each drug would have, how long the drug would stay on the market before profits are cannibalized by competitors (see e.g. Wegovy), and definitely not the cost of failed drug development.
  - gomox 2y ago
    These original $3B numbers are highly misleading, to the extent that I deem them to be bordering on a straight up lie. See: https://news.ycombinator.com/item?id=18693177 https://news.ycombinator.com/item?id=18693177
- Analemma_ 2y ago
  I'm no fan of pharma industry but there's an unfounded and troubling assumption embedded in this comment: that any drug price over cost-to-manufacture can only be extortion. How do people recoup R&D costs (which are the vast majority of costs in getting a new drug onto the market)?
  - asveikau 2y ago
    Doesn't the government also fund a lot of pharma R&D? Here's a 2019 article that came up in a Google search: Taxpayers funded this HIV research. The government patented it. Now a company profits https://www.latimes.com/business/la-fi-gilead-sciences-truvada-hiv-prep-20190327-story.html https://www.latimes.com/business/la-fi-gilead-sciences-truva...
    - tptacek 2y ago
      Taxpayers fund all sorts of stuff that is ultimately commercialized!
      - kiba 2y ago
        The outcome for taxpayer ROI should be about the benefit to the public at large regardless of who commercialized it. Commercialization should eventually lead to better and cheaper version of the technology, which increases benefit to the public. Of course, the people who worked to commercialize it deserve pay for their work, so the question is exactly how much.
      - asveikau 2y ago
        So that's an argument that the government and the public should get a return on that investment, or profits should be constrained. Or an argument against exclusive rights being in private hands.
        sroussey 2y ago
        Universities certainly do. IP transfer is big business. Subsidies for oil, not so much.
- reducesuffering 2y ago
  Like the other commenters allude to, how would you like software mandated to cost just 10% margin over COGS? Do you think selling cloud services for 10% more than the cost of server parts is going to be a business when there's thousands of software engineers in R&D needed?
  - LeifCarrotson 2y ago
    I would love that, as long as the cost includes that R&D and those engineers, the actual bits might be immaterial but the engineer salaries are part of the cost of the goods. The problem is that we're being told that the cost of insulin is $270 per vial, or that Daraprim used to estimate its cost per dose at 90% of $13.50 and then Shkreli decided to raise it to $750.
    - vasco 2y ago
      The Shkreli case has nothing to do with the rest. He was playing the insurance companies and there isn't a single person that went without the medicine due to the cost. Almost nobody takes this medicine. In fact, it still costs $750 today.
  - pdntspa 2y ago
    That would be amazing! More businesses need a costs-plus gun held to their head.
    - renewiltord 2y ago
      It's true. Harvard education costs $300k, so that engineer's lifetime earnings can be $300k plus some small margin so that he does not price gouge. Community college engineer can be paid $2k+small margin.
      - pdntspa 2y ago
        Businesses are not people (despite what the law tries to make you think), and people should not be bound by the same limits as businesses.
- bobthepanda 2y ago
  There is a two-month shot now (Apretude) and I was quoted $4K a shot when I asked about it. Health insurances in the US mostly only cover Truvada. Some cover Descovy but not many.
- renewiltord 2y ago
  Same with software. I saw IntelliJ costs $250/year but it costs almost nothing to send that file (it's like maybe 1 GB max, cents). You can get it from generics manufacturer on TPB but updates are not as frequent.
  - Cthulhu_ 2y ago
    Are you insinuating that the only expense the company behind intellij has is the data transfer?
    - namdnay 2y ago
      It was clearly sarcastic
  - consteval 2y ago
    The difference here is that: 1. Pharmaceuticals actually don't do all their own research. Universities find the drugs and what they can treat, pharmaceuticals research the product viability. They make medicinal products, they're not research labs 2. The research is often majority funded by the government, i.e. your taxpayer dollars. So the costs are often socialized, but of course the revenue is not. IntelliJ actually develops they're stuff, they don't just take existing code, test it a bit, and then make a product. And IntelliJ is a truly private company, pharmaceuticals are not because they get huge sums of money from the gov.
- isoprophlex 2y ago
  Crony capitalism at its best.
- modeless 2y ago
  The patent system literally grants monopolies, on purpose. I don't know why people are surprised when patented things are priced like there's a monopoly exploiting their customers, because that's exactly what's happening and everyone knows it. But somehow people never seem to come to the conclusion that granting monopolies is not the ideal way to incentivize things.
  - vasco 2y ago
    Maybe it is if the alternative is those things you granted monopoly on wouldn't exist. With drugs especially it's a difficult proposition to spend time researching if the day after you make your pill and sell the first one the next guy can just sell it too. So we need a larger change than just modifying the patent system for medicines, we'd also need to change the way we fund pharma research and after having thought about it a lot I don't have a solution. I agree with the problem you mention, but the solution isn't simple.
    - amrocha 2y ago
      There’s no reason pharma research should be for profit. The researchers aren’t doing it for profit, they would do it either way, the only thing private pharma brings to the table is price gouging.
      - vasco 2y ago
        Citation needed on "the researchers aren't doing it for profit". All drug companies have a bunch of them, more than wall street types running around. Most of them enrich themselves with biotech stock bets, insider trading, regulatory capture of national agencies etc. Why do you think somehow people that go into pharma research are different from people in any other industry? Look, random example https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10370755/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10370755/ - explain why if they are not motivated by profit, how is it possible that the outcome of this paper happens? If you speak to anyone in the field, their goal to get to a point where you having a patent or two giving you a passive income stream. You can't do it if you just public domain your work.
- paulmist 2y ago
  In the Netherlands until recently you could get it for ~$10/mo (now ~$20). We have a whole website naming prices in different pharmacies around the country. https://prepnu.nl/users/price-list/ https://prepnu.nl/users/price-list/
- barfingclouds 2y ago
  Well we have a hiv prep shot already that’s every two months. I forgot the name, but yeah I think it’s very expensive
refurb 2y ago
> A drug you take 2 times a year could be much cheaper than one you take 365 times a year, and that's a big deal. Dosing doesn't impact price. Pharmaceuticals aren't based on "cost-plus" pricing.
hadlock 2y ago
Why would they give up the profit? What's your rationale here? Cure = $X If the treatment is daily then it's $X/365 if it's monthly the price is $X/12 if it's twice a year it's $X/2 Imagine being an exec at that company and being like "let's give up 50/52 of our profit because it's more convenient for the patient"? How many hours would it take between giving that speech and getting fired, do you think?
barryrandall 2y ago
If it's like every other IP-encumbered drug, the price will be approximately "the value the recipient places on HIV resistance," which is probably close to what's being charged now.
michaelcampbell 2y ago
> I wonder how much this will cost? If history is any guide, as much as it possibly can. Probably more.

argonaut 2y ago

The shot will likely be exorbitant in the USA. Gilead charged almost $2k/month for Truvada (list price, of course) and Descovy is the same. Generic Truvada is like $30/month now, so the price was never about the cost to manufacture. Obviously Gilead is developing these new drugs/shots for when Descovy's patent expires. They rely on the government mandating that health insurance companies cover the shots. This drives up the price.

ortusdux 2y ago
The price is rarely ever about the manufacturing cost. "A new study in 2020 estimated that the median cost of getting a new drug into the market was $985 million, and the average cost was $1.3 billion, which was much lower compared to previous studies, which have placed the average cost of drug development as $2.8 billion.[4]" https://en.wikipedia.org/wiki/Cost_of_drug_development https://en.wikipedia.org/wiki/Cost_of_drug_development
- chimeracoder 2y ago
  > "A new study in 2020 estimated that the median cost of getting a new drug into the market was $985 million, and the average cost was $1.3 billion, which was much lower compared to previous studies, which have placed the average cost of drug development as $2.8 billion.[4]" PrEP repurposed Truvada, an existing blockbuster drug that had already reaped immense profit for Gilead for use in HIV treatment by the time the trials for PrEP began. The trials for PrEP were funded by the government, not Gilead. Gilead, however, got to retain all profits earned from PrEP.
  - HideousKojima 2y ago
    Did Gilead fund the R&D? There's a lot more to developing a new drug than just trials (though I think Gilead should have foot the bill for the trials too).
    - roughly 2y ago
      I don’t know if it’s the case here, but very, very, very often in biotech you’ve got the primary foundational research happening at university labs funded by grants, and it’s the productionization of the research (and then clinical trials, etc) that are what the biotech companies are doing. I’m not sure where that shifts the “who deserves what” conversation, but without university research labs, there’s no pharma industry.
      - pfdietz 2y ago
        If the university owned the IP, then its value should have been reflected in what was bid for it. If the knowledge was not restricted by IP law, then any drug company could use it, and compete for new drugs based on it. As such, it would not provide any of them with a competitive advantage, and so would not be reflected in what they could charge. What universities typically produce is not a chemical that can serve as an actual drug, but is only a starting point for a long and expensive process of producing such a chemical. And then, it's often found that the target of the class of potential drugs isn't actually a good one. One can't determine that until drug candidates are available to test on real patients.
        Jensson 2y ago
        > What universities typically produce is not a chemical that can serve as an actual drug, but is only a starting point for a long and expensive process of producing such a chemical Remember you need to include all the failed attempts at finding useful things at university labs to see how much governments spend on research (just like you did failed pharma attempts), and if you add that up you see governments actually contribute a massive part of the cost to bring medicines to market. What they produce is necessary to even begin the work pharma does, currently it is basically a gift from the people to the pharma industry.
- pfdietz 2y ago
  It should be pointed out that looking at the average cost of developing a drug is misleading, since one has to include the cost of all the drugs that failed to make it to market. One also has to include the money spent by small companies that failed and were not bought out, not just the money the big companies spend buying the successful ones.
  - Nifty3929 2y ago
    This is critical, and exactly the sort of thing someone will gloss over, intentionally or not. The numerator is the total cost of developing ALL the drugs, even (especially) the failed ones, but the denominator is only those drugs that are successful.
    - FireBeyond 2y ago
      On the contrary, often pharma proponents will gloss over the fact that most “failures” are discovered and canned at a small fraction of the investment of getting a drug to market (when it’s obvious it won’t do what you need or has other challenges). Actually not in the contrary - you are right. It’s just that the failures often cost a small fraction. They don’t get to 95% testing and approval before “nope, not even close”.
      - pfdietz 2y ago
        I understand 60% of drug candidates fail in phase 3, the last and most expensive phase of testing. There are of course lots of chemicals ruled out early, but that's before you have something you'd call a drug.
        FireBeyond 2y ago
        No, that's not quite accurate - the phases are effectively additive. 37% fail in Phase 1. Of those that make it through, 69% of those fail in Phase 2, and of those, 42% fail in Phase 3. So, of 1,000 possibles, you have 630 make it through Phase 1, and 195 that make it through phase 2, i.e. 80.5% of your drug candidates didn't even make it to Phase 3, that "most expensive phase". A more accurate phrasing would be that 42% of the drugs that made it through Phase 2 fail to make it through Phase 3.
- hanniabu 2y ago
  Also the government, aka the public, subsidizes a lot of those costs
- rishav_sharan 2y ago
  Talking of studies, from the same wiki A 2022 study invalidated the common argument as is for high medication costs that research and development investments are reflected in and necessitate the treatment costs, finding no correlation for investments in drugs (for cases where transparency was sufficient) and their costs.[20][21]
  - mortehu 2y ago
    The Wikipedia editor was a bit naive to think such a basic study could invalidate that whole claim. They measured the correlation between the list price, adjusted for use amount, and development cost. As far as I can tell they didn't take into account number of customers each drug would have, how long the drug would stay on the market before profits are cannibalized by competitors (see e.g. Wegovy), and definitely not the cost of failed drug development.
- gomox 2y ago
  These original $3B numbers are highly misleading, to the extent that I deem them to be bordering on a straight up lie. See: https://news.ycombinator.com/item?id=18693177 https://news.ycombinator.com/item?id=18693177
Analemma_ 2y ago
I'm no fan of pharma industry but there's an unfounded and troubling assumption embedded in this comment: that any drug price over cost-to-manufacture can only be extortion. How do people recoup R&D costs (which are the vast majority of costs in getting a new drug onto the market)?
- asveikau 2y ago
  Doesn't the government also fund a lot of pharma R&D? Here's a 2019 article that came up in a Google search: Taxpayers funded this HIV research. The government patented it. Now a company profits https://www.latimes.com/business/la-fi-gilead-sciences-truvada-hiv-prep-20190327-story.html https://www.latimes.com/business/la-fi-gilead-sciences-truva...
  - tptacek 2y ago
    Taxpayers fund all sorts of stuff that is ultimately commercialized!
    - kiba 2y ago
      The outcome for taxpayer ROI should be about the benefit to the public at large regardless of who commercialized it. Commercialization should eventually lead to better and cheaper version of the technology, which increases benefit to the public. Of course, the people who worked to commercialize it deserve pay for their work, so the question is exactly how much.
    - asveikau 2y ago
      So that's an argument that the government and the public should get a return on that investment, or profits should be constrained. Or an argument against exclusive rights being in private hands.
      - sroussey 2y ago
        Universities certainly do. IP transfer is big business. Subsidies for oil, not so much.
reducesuffering 2y ago
Like the other commenters allude to, how would you like software mandated to cost just 10% margin over COGS? Do you think selling cloud services for 10% more than the cost of server parts is going to be a business when there's thousands of software engineers in R&D needed?
- LeifCarrotson 2y ago
  I would love that, as long as the cost includes that R&D and those engineers, the actual bits might be immaterial but the engineer salaries are part of the cost of the goods. The problem is that we're being told that the cost of insulin is $270 per vial, or that Daraprim used to estimate its cost per dose at 90% of $13.50 and then Shkreli decided to raise it to $750.
  - vasco 2y ago
    The Shkreli case has nothing to do with the rest. He was playing the insurance companies and there isn't a single person that went without the medicine due to the cost. Almost nobody takes this medicine. In fact, it still costs $750 today.
- pdntspa 2y ago
  That would be amazing! More businesses need a costs-plus gun held to their head.
  - renewiltord 2y ago
    It's true. Harvard education costs $300k, so that engineer's lifetime earnings can be $300k plus some small margin so that he does not price gouge. Community college engineer can be paid $2k+small margin.
    - pdntspa 2y ago
      Businesses are not people (despite what the law tries to make you think), and people should not be bound by the same limits as businesses.
bobthepanda 2y ago
There is a two-month shot now (Apretude) and I was quoted $4K a shot when I asked about it. Health insurances in the US mostly only cover Truvada. Some cover Descovy but not many.
renewiltord 2y ago
Same with software. I saw IntelliJ costs $250/year but it costs almost nothing to send that file (it's like maybe 1 GB max, cents). You can get it from generics manufacturer on TPB but updates are not as frequent.
- Cthulhu_ 2y ago
  Are you insinuating that the only expense the company behind intellij has is the data transfer?
  - namdnay 2y ago
    It was clearly sarcastic
- consteval 2y ago
  The difference here is that: 1. Pharmaceuticals actually don't do all their own research. Universities find the drugs and what they can treat, pharmaceuticals research the product viability. They make medicinal products, they're not research labs 2. The research is often majority funded by the government, i.e. your taxpayer dollars. So the costs are often socialized, but of course the revenue is not. IntelliJ actually develops they're stuff, they don't just take existing code, test it a bit, and then make a product. And IntelliJ is a truly private company, pharmaceuticals are not because they get huge sums of money from the gov.
isoprophlex 2y ago
Crony capitalism at its best.
modeless 2y ago
The patent system literally grants monopolies, on purpose. I don't know why people are surprised when patented things are priced like there's a monopoly exploiting their customers, because that's exactly what's happening and everyone knows it. But somehow people never seem to come to the conclusion that granting monopolies is not the ideal way to incentivize things.
- vasco 2y ago
  Maybe it is if the alternative is those things you granted monopoly on wouldn't exist. With drugs especially it's a difficult proposition to spend time researching if the day after you make your pill and sell the first one the next guy can just sell it too. So we need a larger change than just modifying the patent system for medicines, we'd also need to change the way we fund pharma research and after having thought about it a lot I don't have a solution. I agree with the problem you mention, but the solution isn't simple.
  - amrocha 2y ago
    There’s no reason pharma research should be for profit. The researchers aren’t doing it for profit, they would do it either way, the only thing private pharma brings to the table is price gouging.
    - vasco 2y ago
      Citation needed on "the researchers aren't doing it for profit". All drug companies have a bunch of them, more than wall street types running around. Most of them enrich themselves with biotech stock bets, insider trading, regulatory capture of national agencies etc. Why do you think somehow people that go into pharma research are different from people in any other industry? Look, random example https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10370755/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10370755/ - explain why if they are not motivated by profit, how is it possible that the outcome of this paper happens? If you speak to anyone in the field, their goal to get to a point where you having a patent or two giving you a passive income stream. You can't do it if you just public domain your work.
paulmist 2y ago
In the Netherlands until recently you could get it for ~$10/mo (now ~$20). We have a whole website naming prices in different pharmacies around the country. https://prepnu.nl/users/price-list/ https://prepnu.nl/users/price-list/
barfingclouds 2y ago
Well we have a hiv prep shot already that’s every two months. I forgot the name, but yeah I think it’s very expensive

refurb 2y ago

> A drug you take 2 times a year could be much cheaper than one you take 365 times a year, and that's a big deal. Dosing doesn't impact price. Pharmaceuticals aren't based on "cost-plus" pricing.

hadlock 2y ago

Why would they give up the profit? What's your rationale here? Cure = $X If the treatment is daily then it's $X/365 if it's monthly the price is $X/12 if it's twice a year it's $X/2 Imagine being an exec at that company and being like "let's give up 50/52 of our profit because it's more convenient for the patient"? How many hours would it take between giving that speech and getting fired, do you think?

barryrandall 2y ago

If it's like every other IP-encumbered drug, the price will be approximately "the value the recipient places on HIV resistance," which is probably close to what's being charged now.

michaelcampbell 2y ago

> I wonder how much this will cost? If history is any guide, as much as it possibly can. Probably more.