14 ms·

The Price of Remission

89 points by danso 1y ago

planck_tonne 1y ago
Crazy how they managed to restrict the competing researchers from obtaining the drug. How did they do that? Why is the sale of a super expensive drug used exclusively to treat a super specific type of cancer even controlled in the first place? What is even the argument? I couldn't think of any argument before. After reading, I can only think of "to restrict competition".
- throwanem 1y ago
  The argument in essence is that only permitting pharmaceutical companies these outrageous profits will induce them to continue investing the likewise outrageous costs of new drug development now that all the low-hanging fruit like antibiotics, and sildenafil and other antihypertensives, has been picked. This extends (usually by implication) to trivial variations in molecular chemistry which have no functional effect on a medication but which are used to extend patent protections solely on the basis of a structural change - a practice also visible in the history of one family of drugs I have mentioned, and one which without some sort of justification might be taken for an example of a law's letter being abused to violate that same law's intent. Look, I didn't say I buy it. But you asked for the basic argument advocates make in support of such practices, and here it is.
  - throwawaymaths 1y ago
    it's not a great argument since iirc half of pharmaceutical company spending is on marketing; far far outstripping r&d
    - smt88 1y ago
      And a lot of pharma research is based on publicly-funded research in the first place.
      - deleted 1y ago
        [deleted]
      - nradov 1y ago
        Sure, but that's a bit of a red herring. The largest expense in bringing a new prescription drug to market is the phase 3 clinical trial, which now costs on the order of $1B each. Those often fail, so it's a huge gamble. There is very little public funding for type of research.
        throwanem 1y ago
        And a drug like Revlimid makes its manufacturer tens to hundreds of billions; the "legacy" portfolio in which BMS classes it pulled in a cool $5.6b just in Q1 '25, of which Revlimid itself was about a sixth, or just under a billion - down by almost half year on year. See https://www.bms.com/assets/bms/us/en-us/pdf/investor-info/doc_presentations/2025/BMY-2025-Q1-Results-Investor-Presentation.pdf https://www.bms.com/assets/bms/us/en-us/pdf/investor-info/do..., pp. 8-9. It is as if VCs in the tech industry demanded the taxpayer guarantee them a healthy rate of profit, to a standard of health the VCs themselves are privileged to define. Indeed, as with Allred and the regional airlines, perhaps now we see whence Altman has cribbed his "innovation."
        nradov 1y ago
        I don't understand your point. Some drugs are enormously profitable. Others lose money. There are no taxpayer guarantees. Pharmaceutical companies on average don't generate higher shareholder returns than other industrial sectors. A few like K-V and Dendreon have even gone bankrupt. One could make an argument that taxpayer subsidized health plans which include prescription drug coverage such as Medicare Part D or Medicaid should limit the prices they are willing to reimburse on a QALY basis. And Medicare has started a limited drug price negotiation program. But generally, voters have been unwilling to accept the trade-offs inherent in drug price controls. https://www.cms.gov/newsroom/fact-sheets/medicare-drug-price-negotiation-program-negotiated-prices-initial-price-applicability-year-2026 https://www.cms.gov/newsroom/fact-sheets/medicare-drug-price...
    - tough 1y ago
      the argument might be, the more profits the pharma's make, the more available cash to buy out poltiicians or create SuperPAC's or whatever they have at hand.. America, the land of the dollar
      - ricksunny 1y ago
        >America, the land of the dollar Correction: America, the land of the rent-seeking.
    - bschne 1y ago
      2024 numbers -- Selling, General & Admin vs. R&D Roche (Pharma Division): 7533 MCHF vs. 11096 MCHF Novartis: 12566 MUSD vs. 10022 MUSD Pfizer: 14730 MUSD vs. 10822 MUSD Eli Lilly: 8594 MUSD vs. 10991 MUSD AstraZeneca: 19977 MUSD vs. 13583 MUSD Johnson & Johnson: 22869 MUSD vs. 17232 MUSD The left side here contains more than just marketing, and already "far far outstripping" seems like a mischaracterization. For comparison, the average R&D spend between these firms is bigger than the 2024 NSF budget (~9bn) and bigger than 1/4 of the 2024 NIH budget (~37bn).
      - deleted 1y ago
        [deleted]
      - dgacmu 1y ago
        I think you meant to say NIH for the second budget number?
        bschne 1y ago
        correct, edited, thanks
      - derektank 1y ago
        Also worth considering that this only includes internal R&D, not R&D acquired through acquisition of smaller biotech firms (known as in process R&D). VC investment in biotech startups is, at least in part, built around the assumption that acquisition by a larger pharmaceutical company is a viable exit strategy. To take the example of Eli Lilly, I think they spent an additional 10-20% of their R&D budget on IPR&D in 2024, though this obviously can fluctuate more year to year. They acquired Morphic, which produces a pharmaceutical that treats IBS, and Scorpion Therapeutics, which produces a precision oncology treatment, this year and I'm guessing neither spent much on consumer sales.
    - tptacek 1y ago
      That's part of it, but pharma is also a portfolio business, like VC or music; the winners have to pay for the losers. (I don't know how much that matters in this case, where a tiny company lucked into a blockbuster and then used every lever in the system to protect their exclusivity).
      - throwanem 1y ago
        Yeah, nobody serious is really arguing the winners shouldn't pay for the losers. How many times over, though?
        tptacek 1y ago
        I sort of don't care, as long as investor value isn't being protected abusively, by anticompetitive schemes with the patent system and exclusivity. We pay lots of money for all sorts of things, most of which don't actually matter to our lives; pharmaceuticals matter a great deal, and I'm OK with the idea that advancements are incentivized by a time-limited lane for nosebleed pricing. (Pharmaceutical costs, all in, across the board, are a relatively small component of total health spending in the US. They're not why your health insurance is so expensive.) This is mostly a story about anticompetitive abuses, so that question isn't super relevant to the story. I'm just answering the claim that invisible marketing/SG&A costs are why drugs cost so much. They also cost a lot because most drugs fail, sometimes after billions invested.
        throwawaymaths 1y ago
        well but the portfolio managers in this case could really do a much better job at picking hits. we wouldn't have 20 years of failing Alzheimer's drugs if pharma identified that the protein hypothesis was junk (which people were talking about in the aughts)
        throwanem 1y ago
        That's a really interesting point, yeah. Not that I'm really equipped to evaluate the technical arguments, but it's striking on reflection how absent from the discussion the question seems to be of how efficiently on average the funding to trial a given drug and indication is allocated. The governing assumption appears to be that the status quo is acceptably close to optimality.
  - leereeves 1y ago
    > This extends (usually by implication) to trivial variations in molecular chemistry which have no functional effect on a medication but which are used to extend patent protections solely on the basis of a structural change How does that work? Does it extend patent protection on the original molecule? Or if not, what stops generic copies of the original version?
    - throwanem 1y ago
      I found a menu. https://www.obrienpatents.com/extending-life-patents-pharmaceutical-drugs/ https://www.obrienpatents.com/extending-life-patents-pharmac...
    - s1artibartfast 1y ago
      It doesnt. A competitor can make generics of the original. What is does is stagger coverage with version release so that you have coverage for latest and greatest version. Generics are extremely common following patent exclusivity. By then, patients and doctors usually want the shiny new drug.
  - jmward01 1y ago
    This is trickle down economics for healthcare. It is stupid. No, it is worse than that, it is evil.
- photochemsyn 1y ago
  Bayh-Dole legislation in the 1990s allowed universities to exclusively license researcher inventions to private parties. Hence: > "Celgene had acquired the rights to thalidomide patents held by researchers at Rockefeller University in 1992." Change Bayh-Dole law to non-exclusive licensing, but with some level of royalties paid to institution that originated the patent, and other corporations could have made the drug - and it would be a competitive market, so costs would drop due to lack of a monopoly on the drug. This one simple change to Bayh-Dole - 'non-exclusive' - would upset the academic-corporate apple cart well beyond pharmaceuticals. Eg the PageRank algorithm created at Stanford could not have been exclusive licensed to Google - any American corporation or person could have applied for a license to the invention, entirely erasing the benefits of a monopolistic patent to the corporation. One great benefit of this change is that corporations who wanted exclusive patents would have to finance their own private R & D divisions, instead of just capturing the output of taxpayer-financed researchers.
y-curious 1y ago
It makes me wonder, is there a way to get this drug from a Chinese or Indian lab? I'm sure there are severe legal repercussions, but purely theoretically. It reminds me of the film The Dallas Buyers' Club
- deleted 1y ago
  [deleted]
- the_pwner224 1y ago
  Yes, it's readily available to buy online from India for <$1/pill. In practice there aren't legal repercussions. If you import scheduled drugs (adderall, opioids, etc.) and get caught that's obviously going to be a big issue. But with most prescription medications, the worst case scenario is that Customs will just toss your package. And the likelihood of that is low; the majority of the time it makes it through undetected. I've done this in the past with another drug. In the US it was $30/month but from India I got 1000 pills for $30 + $40 expedited shipping. For me the big factor wasn't cost, but rather the convenience of not needing to go through the process of getting a prescription.
  - imperfect_light 1y ago
    How do you know you're actually getting what you bought?
    - hiAndrewQuinn 1y ago
      At least in theory, you can take a random sample of those 1000 pills to your friendly neighborhood chemist, and slip them a $20 to run them through e.g. a mass spectrometer or something to ensure they actually have the goods. And maybe also to ensure they don't have any bands you might be concerned about.
csours 1y ago
Remember the time that Florida fought the federal government for access to socialized medicine? https://www.flgov.com/eog/news/press/2024/florida-becomes-first-nation-have-canadian-drug-importation-program-approved-fda https://www.flgov.com/eog/news/press/2024/florida-becomes-fi... > "Today, the DeSantis administration received U.S. Food and Drug Administration (FDA) approval of its Canadian Prescription Drug Importation Program. The Agency for Health Care Administration (AHCA) submitted this first-of-its-kind plan to safely import cheaper drugs from Canada to the FDA nearly 37 months ago, and after filing a lawsuit against the FDA due to delays, has finally received approval. This approval will save Florida up to $180 million in the first year."
- bloomingeek 1y ago
  Talk about irony! Ron hates trump, but is afraid to open his mouth too much. Now trump's tariffs might (who knows for sure, he can't seem to make up his mind.) make their cheaper drugs not so cheap.
eterm 1y ago
> But Revlimid is also, I soon learned, extraordinarily expensive, costing nearly $1,000 for each daily pill. Thanks to the bargaining power of my nationalised healthcare, my government pays around 1/5th of that, and I'll pay nothing myself. Revlamid is listed under it's generic name Lenalidomide, price is in pence: https://www.drugtariff.nhsbsa.nhs.uk/#/00791628-DD/DD00791454/Part%20VIIIA%20products%20L https://www.drugtariff.nhsbsa.nhs.uk/#/00791628-DD/DD0079145...
- jonplackett 1y ago
  Even that is still an obscene amount if money for something that cost 20p per pill.
  - tptacek 1y ago
    The manufacturing cost of a 20p pill has literally nothing to do with its price.
    - jonplackett 1y ago
      Yes I know. And that is, in my opinion, a problem.
      - tptacek 1y ago
        So people who figure out how to make 20p drugs and get them approved should make... 20p/dose. People who figure out how to target ads 1% more effectively should make billions, but people who cure diseases should do so at cost, less their R&D costs. I'm trying to remember who it was who said you could sum all of economics up with the sentence "people respond to incentives."
        cpach 1y ago
        Was it Charlie Munger perhaps?
- pstuart 1y ago
comrade1234 1y ago
My wife’s company developed a multiple myeloma immunotherapy that is for people that have had previous treatments of other drugs but then go into remission. It works so well that their efficacy reports have caveats like “not enough patients that were treated have died yet” to provide meaningful statistics. The drug was initially developed in china. They presented results at a conference in the USA but no one believed them other than a skeptical Pfizer who sent a big team to china to confirm the data. Pfizer soon invested billions into the company and drug to bring it to market. The drug’s sales are on track to be $1 billion this year but the stock is heavily depressed because of the china connection.
- foundry27 1y ago
  What kind of focus do biopharma companies put on their stock prices? If a company like the one you described had a great treatment option that could genuinely help people and was raking in money by the boatload, is that “enough” for them as a “winning” business strategy regardless of how outside investors might perceive it?
  - comrade1234 1y ago
    It leaves them vulnerable to takeover, for one. They have over $1B cash right now to pay for clinical trials in other markets as well as new indications but their valuation is about 5x that. Someone could leverage the $1B as part of a hostile takeover.
  - missedthecue 1y ago
    Biotech companies raise money by selling shares. That's they go public so early compared to any other sector. The more suppressed your share price is, the harder it is to raise the money you need to do research and clinical trials. Selling $1B of drugs might no necessarily mean they have sufficient free cash flow to do the things they want to do.
- theflyingelvis 1y ago
  Any chance you could share what therapy this is or at least a hint?
A_D_E_P_T 1y ago
> But Revlimid is also, I soon learned, extraordinarily expensive, costing nearly $1,000 for each daily pill. (Although, I later discovered, a capsule costs just 25 cents to make.) That daily pill is 25mg. You can buy 5g of Revlimid's active ingredient for $352. > https://www.sigmaaldrich.com/US/en/product/aldrich/901558 https://www.sigmaaldrich.com/US/en/product/aldrich/901558 200 doses at less than $2/ea. If you want to get adventurous, you can probably buy 1kg from China or India for $900. Find a university or commercial lab with HPLC and LC/MS and run your own QC for a few hundred bucks. Store the powder in a vacuum-sealed container in a refrigerator. You're set for life. I've done this sort of thing before, and a lot of people are doing it for GLP agonist drugs. (To say nothing of sports doping, nootropics, etc.) Sometimes you've gotta take matters into your own hands.
- collingreen 1y ago
  We agree that, while it's nice this is an OPTION, it's a crazy state of affairs, right? I'm tired of the phrase "free market" since it isn't really either of those words.
  - missedthecue 1y ago
    No one would take the drug for this condition unless the company spent years and a billion dollars proving to the FDA that it was sufficiently safe and effective. It's hard for me to get my mind around the controversy here.
est31 1y ago
There is some light at the end of the tunnel. I suppose the patent runs out early next year, as the drug was released in 2005 and the generic which is already available but volume limited also has that volume limitation until January 31, 2026. The press release formulates this as if Celgene did this out of graciousness but I suppose it's just that the government granted monopoly ends. https://web.archive.org/web/20220811173542/https://ir.celgene.com/press-releases-archive/press-release-details/2019/Celgene-Settles-US-REVLIMID-Patent-Litigation-with-Alvogen/default.aspx https://web.archive.org/web/20220811173542/https://ir.celgen... > Celgene has agreed to provide Alvogen with a license to Celgene’s patents required to manufacture and sell an unlimited quantity of generic lenalidomide in the United States beginning no earlier than January 31, 2026.

89 points by danso 1y ago

Crazy how they managed to restrict the competing researchers from obtaining the drug. How did they do that? Why is the sale of a super expensive drug used exclusively to treat a super specific type of cancer even controlled in the first place? What is even the argument? I couldn't think of any argument before. After reading, I can only think of "to restrict competition".

throwanem 1y ago
The argument in essence is that only permitting pharmaceutical companies these outrageous profits will induce them to continue investing the likewise outrageous costs of new drug development now that all the low-hanging fruit like antibiotics, and sildenafil and other antihypertensives, has been picked. This extends (usually by implication) to trivial variations in molecular chemistry which have no functional effect on a medication but which are used to extend patent protections solely on the basis of a structural change - a practice also visible in the history of one family of drugs I have mentioned, and one which without some sort of justification might be taken for an example of a law's letter being abused to violate that same law's intent. Look, I didn't say I buy it. But you asked for the basic argument advocates make in support of such practices, and here it is.
- throwawaymaths 1y ago
  it's not a great argument since iirc half of pharmaceutical company spending is on marketing; far far outstripping r&d
  - smt88 1y ago
    And a lot of pharma research is based on publicly-funded research in the first place.
    - deleted 1y ago
      [deleted]
    - nradov 1y ago
      Sure, but that's a bit of a red herring. The largest expense in bringing a new prescription drug to market is the phase 3 clinical trial, which now costs on the order of $1B each. Those often fail, so it's a huge gamble. There is very little public funding for type of research.
      - throwanem 1y ago
        And a drug like Revlimid makes its manufacturer tens to hundreds of billions; the "legacy" portfolio in which BMS classes it pulled in a cool $5.6b just in Q1 '25, of which Revlimid itself was about a sixth, or just under a billion - down by almost half year on year. See https://www.bms.com/assets/bms/us/en-us/pdf/investor-info/doc_presentations/2025/BMY-2025-Q1-Results-Investor-Presentation.pdf https://www.bms.com/assets/bms/us/en-us/pdf/investor-info/do..., pp. 8-9. It is as if VCs in the tech industry demanded the taxpayer guarantee them a healthy rate of profit, to a standard of health the VCs themselves are privileged to define. Indeed, as with Allred and the regional airlines, perhaps now we see whence Altman has cribbed his "innovation."
        nradov 1y ago
        I don't understand your point. Some drugs are enormously profitable. Others lose money. There are no taxpayer guarantees. Pharmaceutical companies on average don't generate higher shareholder returns than other industrial sectors. A few like K-V and Dendreon have even gone bankrupt. One could make an argument that taxpayer subsidized health plans which include prescription drug coverage such as Medicare Part D or Medicaid should limit the prices they are willing to reimburse on a QALY basis. And Medicare has started a limited drug price negotiation program. But generally, voters have been unwilling to accept the trade-offs inherent in drug price controls. https://www.cms.gov/newsroom/fact-sheets/medicare-drug-price-negotiation-program-negotiated-prices-initial-price-applicability-year-2026 https://www.cms.gov/newsroom/fact-sheets/medicare-drug-price...
  - tough 1y ago
    the argument might be, the more profits the pharma's make, the more available cash to buy out poltiicians or create SuperPAC's or whatever they have at hand.. America, the land of the dollar
    - ricksunny 1y ago
      >America, the land of the dollar Correction: America, the land of the rent-seeking.
  - bschne 1y ago
    2024 numbers -- Selling, General & Admin vs. R&D Roche (Pharma Division): 7533 MCHF vs. 11096 MCHF Novartis: 12566 MUSD vs. 10022 MUSD Pfizer: 14730 MUSD vs. 10822 MUSD Eli Lilly: 8594 MUSD vs. 10991 MUSD AstraZeneca: 19977 MUSD vs. 13583 MUSD Johnson & Johnson: 22869 MUSD vs. 17232 MUSD The left side here contains more than just marketing, and already "far far outstripping" seems like a mischaracterization. For comparison, the average R&D spend between these firms is bigger than the 2024 NSF budget (~9bn) and bigger than 1/4 of the 2024 NIH budget (~37bn).
    - deleted 1y ago
      [deleted]
    - dgacmu 1y ago
      I think you meant to say NIH for the second budget number?
      - bschne 1y ago
        correct, edited, thanks
    - derektank 1y ago
      Also worth considering that this only includes internal R&D, not R&D acquired through acquisition of smaller biotech firms (known as in process R&D). VC investment in biotech startups is, at least in part, built around the assumption that acquisition by a larger pharmaceutical company is a viable exit strategy. To take the example of Eli Lilly, I think they spent an additional 10-20% of their R&D budget on IPR&D in 2024, though this obviously can fluctuate more year to year. They acquired Morphic, which produces a pharmaceutical that treats IBS, and Scorpion Therapeutics, which produces a precision oncology treatment, this year and I'm guessing neither spent much on consumer sales.
  - tptacek 1y ago
    That's part of it, but pharma is also a portfolio business, like VC or music; the winners have to pay for the losers. (I don't know how much that matters in this case, where a tiny company lucked into a blockbuster and then used every lever in the system to protect their exclusivity).
    - throwanem 1y ago
      Yeah, nobody serious is really arguing the winners shouldn't pay for the losers. How many times over, though?
      - tptacek 1y ago
        I sort of don't care, as long as investor value isn't being protected abusively, by anticompetitive schemes with the patent system and exclusivity. We pay lots of money for all sorts of things, most of which don't actually matter to our lives; pharmaceuticals matter a great deal, and I'm OK with the idea that advancements are incentivized by a time-limited lane for nosebleed pricing. (Pharmaceutical costs, all in, across the board, are a relatively small component of total health spending in the US. They're not why your health insurance is so expensive.) This is mostly a story about anticompetitive abuses, so that question isn't super relevant to the story. I'm just answering the claim that invisible marketing/SG&A costs are why drugs cost so much. They also cost a lot because most drugs fail, sometimes after billions invested.
      - throwawaymaths 1y ago
        well but the portfolio managers in this case could really do a much better job at picking hits. we wouldn't have 20 years of failing Alzheimer's drugs if pharma identified that the protein hypothesis was junk (which people were talking about in the aughts)
        throwanem 1y ago
        That's a really interesting point, yeah. Not that I'm really equipped to evaluate the technical arguments, but it's striking on reflection how absent from the discussion the question seems to be of how efficiently on average the funding to trial a given drug and indication is allocated. The governing assumption appears to be that the status quo is acceptably close to optimality.
- leereeves 1y ago
  > This extends (usually by implication) to trivial variations in molecular chemistry which have no functional effect on a medication but which are used to extend patent protections solely on the basis of a structural change How does that work? Does it extend patent protection on the original molecule? Or if not, what stops generic copies of the original version?
  - throwanem 1y ago
    I found a menu. https://www.obrienpatents.com/extending-life-patents-pharmaceutical-drugs/ https://www.obrienpatents.com/extending-life-patents-pharmac...
  - s1artibartfast 1y ago
    It doesnt. A competitor can make generics of the original. What is does is stagger coverage with version release so that you have coverage for latest and greatest version. Generics are extremely common following patent exclusivity. By then, patients and doctors usually want the shiny new drug.
- jmward01 1y ago
  This is trickle down economics for healthcare. It is stupid. No, it is worse than that, it is evil.
photochemsyn 1y ago
Bayh-Dole legislation in the 1990s allowed universities to exclusively license researcher inventions to private parties. Hence: > "Celgene had acquired the rights to thalidomide patents held by researchers at Rockefeller University in 1992." Change Bayh-Dole law to non-exclusive licensing, but with some level of royalties paid to institution that originated the patent, and other corporations could have made the drug - and it would be a competitive market, so costs would drop due to lack of a monopoly on the drug. This one simple change to Bayh-Dole - 'non-exclusive' - would upset the academic-corporate apple cart well beyond pharmaceuticals. Eg the PageRank algorithm created at Stanford could not have been exclusive licensed to Google - any American corporation or person could have applied for a license to the invention, entirely erasing the benefits of a monopolistic patent to the corporation. One great benefit of this change is that corporations who wanted exclusive patents would have to finance their own private R & D divisions, instead of just capturing the output of taxpayer-financed researchers.

y-curious 1y ago

It makes me wonder, is there a way to get this drug from a Chinese or Indian lab? I'm sure there are severe legal repercussions, but purely theoretically. It reminds me of the film The Dallas Buyers' Club

deleted 1y ago
[deleted]
the_pwner224 1y ago
Yes, it's readily available to buy online from India for <$1/pill. In practice there aren't legal repercussions. If you import scheduled drugs (adderall, opioids, etc.) and get caught that's obviously going to be a big issue. But with most prescription medications, the worst case scenario is that Customs will just toss your package. And the likelihood of that is low; the majority of the time it makes it through undetected. I've done this in the past with another drug. In the US it was $30/month but from India I got 1000 pills for $30 + $40 expedited shipping. For me the big factor wasn't cost, but rather the convenience of not needing to go through the process of getting a prescription.
- imperfect_light 1y ago
  How do you know you're actually getting what you bought?
  - hiAndrewQuinn 1y ago
    At least in theory, you can take a random sample of those 1000 pills to your friendly neighborhood chemist, and slip them a $20 to run them through e.g. a mass spectrometer or something to ensure they actually have the goods. And maybe also to ensure they don't have any bands you might be concerned about.

csours 1y ago

Remember the time that Florida fought the federal government for access to socialized medicine? https://www.flgov.com/eog/news/press/2024/florida-becomes-first-nation-have-canadian-drug-importation-program-approved-fda https://www.flgov.com/eog/news/press/2024/florida-becomes-fi... > "Today, the DeSantis administration received U.S. Food and Drug Administration (FDA) approval of its Canadian Prescription Drug Importation Program. The Agency for Health Care Administration (AHCA) submitted this first-of-its-kind plan to safely import cheaper drugs from Canada to the FDA nearly 37 months ago, and after filing a lawsuit against the FDA due to delays, has finally received approval. This approval will save Florida up to $180 million in the first year."

bloomingeek 1y ago
Talk about irony! Ron hates trump, but is afraid to open his mouth too much. Now trump's tariffs might (who knows for sure, he can't seem to make up his mind.) make their cheaper drugs not so cheap.

eterm 1y ago

> But Revlimid is also, I soon learned, extraordinarily expensive, costing nearly $1,000 for each daily pill. Thanks to the bargaining power of my nationalised healthcare, my government pays around 1/5th of that, and I'll pay nothing myself. Revlamid is listed under it's generic name Lenalidomide, price is in pence: https://www.drugtariff.nhsbsa.nhs.uk/#/00791628-DD/DD00791454/Part%20VIIIA%20products%20L https://www.drugtariff.nhsbsa.nhs.uk/#/00791628-DD/DD0079145...

jonplackett 1y ago
Even that is still an obscene amount if money for something that cost 20p per pill.
- tptacek 1y ago
  The manufacturing cost of a 20p pill has literally nothing to do with its price.
  - jonplackett 1y ago
    Yes I know. And that is, in my opinion, a problem.
    - tptacek 1y ago
      So people who figure out how to make 20p drugs and get them approved should make... 20p/dose. People who figure out how to target ads 1% more effectively should make billions, but people who cure diseases should do so at cost, less their R&D costs. I'm trying to remember who it was who said you could sum all of economics up with the sentence "people respond to incentives."
      - cpach 1y ago
        Was it Charlie Munger perhaps?
pstuart 1y ago

comrade1234 1y ago

My wife’s company developed a multiple myeloma immunotherapy that is for people that have had previous treatments of other drugs but then go into remission. It works so well that their efficacy reports have caveats like “not enough patients that were treated have died yet” to provide meaningful statistics. The drug was initially developed in china. They presented results at a conference in the USA but no one believed them other than a skeptical Pfizer who sent a big team to china to confirm the data. Pfizer soon invested billions into the company and drug to bring it to market. The drug’s sales are on track to be $1 billion this year but the stock is heavily depressed because of the china connection.

foundry27 1y ago
What kind of focus do biopharma companies put on their stock prices? If a company like the one you described had a great treatment option that could genuinely help people and was raking in money by the boatload, is that “enough” for them as a “winning” business strategy regardless of how outside investors might perceive it?
- comrade1234 1y ago
  It leaves them vulnerable to takeover, for one. They have over $1B cash right now to pay for clinical trials in other markets as well as new indications but their valuation is about 5x that. Someone could leverage the $1B as part of a hostile takeover.
- missedthecue 1y ago
  Biotech companies raise money by selling shares. That's they go public so early compared to any other sector. The more suppressed your share price is, the harder it is to raise the money you need to do research and clinical trials. Selling $1B of drugs might no necessarily mean they have sufficient free cash flow to do the things they want to do.
theflyingelvis 1y ago
Any chance you could share what therapy this is or at least a hint?

A_D_E_P_T 1y ago

> But Revlimid is also, I soon learned, extraordinarily expensive, costing nearly $1,000 for each daily pill. (Although, I later discovered, a capsule costs just 25 cents to make.) That daily pill is 25mg. You can buy 5g of Revlimid's active ingredient for $352. > https://www.sigmaaldrich.com/US/en/product/aldrich/901558 https://www.sigmaaldrich.com/US/en/product/aldrich/901558 200 doses at less than $2/ea. If you want to get adventurous, you can probably buy 1kg from China or India for $900. Find a university or commercial lab with HPLC and LC/MS and run your own QC for a few hundred bucks. Store the powder in a vacuum-sealed container in a refrigerator. You're set for life. I've done this sort of thing before, and a lot of people are doing it for GLP agonist drugs. (To say nothing of sports doping, nootropics, etc.) Sometimes you've gotta take matters into your own hands.

collingreen 1y ago
We agree that, while it's nice this is an OPTION, it's a crazy state of affairs, right? I'm tired of the phrase "free market" since it isn't really either of those words.
- missedthecue 1y ago
  No one would take the drug for this condition unless the company spent years and a billion dollars proving to the FDA that it was sufficiently safe and effective. It's hard for me to get my mind around the controversy here.

est31 1y ago

There is some light at the end of the tunnel. I suppose the patent runs out early next year, as the drug was released in 2005 and the generic which is already available but volume limited also has that volume limitation until January 31, 2026. The press release formulates this as if Celgene did this out of graciousness but I suppose it's just that the government granted monopoly ends. https://web.archive.org/web/20220811173542/https://ir.celgene.com/press-releases-archive/press-release-details/2019/Celgene-Settles-US-REVLIMID-Patent-Litigation-with-Alvogen/default.aspx https://web.archive.org/web/20220811173542/https://ir.celgen... > Celgene has agreed to provide Alvogen with a license to Celgene’s patents required to manufacture and sell an unlimited quantity of generic lenalidomide in the United States beginning no earlier than January 31, 2026.