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My wife and I recently decided to do IVF. The doctor specifically told us that we needed to order the medicine (menopur, Gonal F, etc) from an American pharmacy

My wife and I recently decided to do IVF. The doctor specifically told us that we needed to order the medicine (menopur, Gonal F, etc) from an American pharmacy. That alone made me suspicious, so I looked at foreign options. Altogether, the medication required would have cost us about $5000 from American pharmacies. We found out that we can just buy the exact same stuff from a German pharmacy for about $1000. So yes, Americans get wrecked by drug prices.

deadbabe 1y ago
[flagged]
- badosu 1y ago
  Seems like an interesting hypothesis to explore. You didn't provide any context of why you think that could be the case or the mechanism through the alleged subsidies happen.
- 9question1 1y ago
  The problem with this argument is that pharmaceutical companies are private businesses trying to make a profit, not charities. If it were truly unprofitable to sell drugs in, say, Canada or France, pharmaceutical companies would just not sell their drugs in those countries. It is _less_ profitable to sell drugs in those countries than America but still profitable, which is why they still try to capture those markets. If America fixed this imbalance by forcing a lowering of drug prices in the American market, there's no reason to believe that this would cause raising of prices elsewhere. The only way this would be possible is if it were truly unprofitable to sell the drugs elsewhere, which can't be the case since these are corporations not charities. The real impact would be to slow down new drug development, since existing drugs are already profitable to sell everywhere in the world even in countries with more regulation, but if America fixed its market by lowering drug prices for Americans, the total profitability of pharmaceuticals would decrease, decreasing the incentive to create new pharmaceuticals. That's a totally different and very plausible impact. Rising drug prices for existing drugs in other countries is not a plausible impact.
  - smallnix 1y ago
    I think they are not saying it's unprofitable, but rather that the current government should shape the market so the environment levels more over US vs the rest. (of course please in a laissez-faire change the market style not the bad socialist stuff)
  - JumpCrisscross 1y ago
    > If it were truly unprofitable to sell drugs in, say, Canada or France, pharmaceutical companies would just not sell their drugs in those countries You’re confusing capital and operating costs. Once you’ve developed the drug, selling everywhere you can makes sense. When considering whether to develop a drug or invest in something else, America’s biotech market absolutely turns keys. (But not as uniquely as we think. Europe has a thriving R&D market, it’s just directly subsidised.)
    - jacobgkau 1y ago
      I don't think they're "confusing" it, considering they specifically said what you said elsewhere in their comment.
  - deadbabe 1y ago
    So basically if this true, you prove my point. If Americans weren’t paying these high costs then R&D would slow down and the whole world wouldn’t get these drugs. America subsidizes these drugs for the rest of the world, which does not pay its fair share into R&D costs. If we’re to fix our healthcare system, this kind of thing can’t continue.
- mothballed 1y ago
  You think pharma companies won't bill the rest of countries whatever the market can bear? I can't think of why they possibly would lower their prices even if the American government stops subsidizing their businesses via using their monopoly on violence to enforce our perverted IP regimes.
  - CharlesW 1y ago
    For anyone reading not familiar with this, "America's drug prices are high because we're subsidizing the rest of the world" is MAGA propaganda, and is not based on logic. https://www.msn.com/en-us/news/politics/pfizer-agrees-to-deal-on-lowering-drug-prices-amid-trump-pressure/ar-AA1NBySq https://www.msn.com/en-us/news/politics/pfizer-agrees-to-dea...
    - retr0rocket 1y ago
      [dead]
    - carlosjobim 1y ago
      What's the problem with talking points? Talking is the purpose of an open forum like this one. Let's argue against the points and not against the commenters.
      - CharlesW 1y ago
        Fair point, I’ve corrected "talking point" to "propaganda" above. Not only does it not make any logical sense, but there is zero evidence that Big Pharma isn't pricing drugs to maximize profitability in every market in which they operate. Drug companies aren’t charities.
        rockercoaster 1y ago
        Besides, it also invites the immediate and rather fatal rejoinder of, "OK? So how about we... don't do that?" Any negative response to that must suppose that everyone else would just give up on trying to advance drug R&D if the US stopped unilaterally self-sacrificing to subsidize it for the entire world... and when you lay it out like that, it seems like that must not actually be what's going on in the first place, because why the hell would we be do that, for that reason? So, very probably, we aren't, and further, if we are we should definitely stop.
- Der_Einzige 1y ago
  The sad reality is that if Americans stopped paying inflated prices the 40% of drugs discovered here would shrink to about 10% and world wide drug discovery would be massively reduced. You literally have to get fucked or the world get fucked harder and drags you down with them. Same reason why NATO and the farm bill are good for America. The greatest trick from the wealthy is to not just exploit you to get it, but to destroy any possibility of resistance to them. Even trying to resist does nothing but harms the under class even more than if you simply accept it. “If you want a picture of the future, imagine a boot stamping on a human face—forever.“ - George Orwell, a communist/socialist Edit: To the guy who claimed Orwell wasn't a communist, the POUM who he fought for in the Spanish Civil war was communist (https://en.wikipedia.org/wiki/POUM https://en.wikipedia.org/wiki/POUM) and according to the soviet union was specifically trotskyist. If you fight for them you are a communist, even if and especially if you claim you weren't later in life.
  - tptacek 1y ago
    Orwell was not a communist. Later "Orwell was a communist even if he said otherwise" is a telling argument.
  - nemo 1y ago
    Orwell was an anti-Communist, though especially anti Stalinist. He fell into the POUM, he didn't choose them, "I knew that I was serving in something called the POUM. (I had only joined the POUM militia rather than any other because I happened to arrive in Barcelona with ILP papers), but I did not realize that there were serious differences between the political parties." He actually said "As far as my purely personal preferences went I would have liked to join the Anarchists." After the Stalinists illegalized the POUM, killed and tortured Orwell's friends and tried to kill him, forcing him flee Spain, his view on Communism grew ever more dim, and after that he grew more strongly anti-Communist than his earlier anti-Fascism.
- gruez 1y ago
  >If America prohibited such gouging, would the rest of the world accept price increases on their drugs? If the current administration is so interested in inflicting harm on the rest of the world, maybe they should be convinced to lower drug prices. I doubt governments elsewhere are itching to increase their healthcare spending even more. Realistically speaking the actual result will be cost cutting from pharma companies, mostly in the form of lower R&D spending for new drugs.
JumpCrisscross 1y ago
> doctor specifically told us that we needed to order the medicine (menopur, Gonal F, etc) from an American pharmacy Why do they care? Referral bonus? Did you report them?
- apwell23 1y ago
  what do you mean? you expect american doctors to prescribe you medicines from german pharmacies?
  - deleted 1y ago
    [deleted]
  - antisthenes 1y ago
    I actually do expect doctors to have even a tiny concern for not making their patients go bankrupt, yes. Is that really such a high bar?
    - digdugdirk 1y ago
      You need to understand that the system is deliberately so opaque that doctors don't even know what your costs would be. Sure there's a sticker price, but for most medications that's so high as to be absurd. From there, it's entirely dependent on your insurance, coinsurance, pharma benefits, etc, etc. They try, but they're not in a position to do anything about it.
      - jacobgkau 1y ago
        > They try, but they're not in a position to do anything about it. Well, somebody's got to be, and the doctors seem like the ones with the most leverage to get those people to do something about it, right? Customer/patient pressure obviously isn't working.
      - antisthenes 1y ago
        > the system is deliberately so opaque that doctors don't even know what your costs would be. You're telling me professionals who make $300k after 20 years of education have 0 clue about what their patients might pay, or have never had patients who expressed concern over costs? Or don't have friends or relatives who expressed dissatisfaction with a high-deductible plan? Or aren't complicit in getting kickbacks for prescribing opioids? We gotta stop absolving people of accountability. And that includes EVERYONE in the chain who benefits. Yes, this includes doctors. Btw, I have had doctors who do try, and many more now will accept reasonable cash prices for their services. That should be encouraged and commended.
viccis 1y ago
When my wife needed a rabies post-exposure shot course, it would have been around $25000 range for the shots without coverage. Our (expensive high end) insurance brought it down to "only" $2500 out of pocket for us. The alternative is to take the gamble of a possible horrible death. In the UK? Around £150-£300 total.
- jen20 1y ago
  > In the UK? Around £150-£300 total. For whom? I can't imagine this in particular would not be free at the point of use like almost everything else. That said, the UK has famously been free of (classical) rabies since the 1920s, so it's unclear if it would be easily available if there aren't other uses.
  - viccis 1y ago
    Was talking about from a private clinic [1]. Obviously it's free via NHS. It's a good example of a system in which the government in incentivized to not tolerate drug price gouging. https://www.citydoc.org.uk/conditions/rabies https://www.citydoc.org.uk/conditions/rabies
    - giantg2 1y ago
      Is it a good example of drug price gouging? I would bet the major part of the price is that provider.
      - viccis 1y ago
        Yes, it's the drug.
        giantg2 1y ago
        So what's the breakdown of that $25k for the provider?
    - ed_elliott_asc 1y ago
liquid_thyme 1y ago
YouTube Premium is also cheaper in Bangladesh.
- hshdhdhj4444 1y ago
  Is it cheaper in the UK, Canada, Germany, etc?
  - liquid_thyme 1y ago
    Pricing in healthcare is very tightly regulated and there isn't a simple one line answer for why certain prices are they way they are. Its easy to scapegoat bigpharma for being greedy, but they're just as greedy as any other US corporation. https://en.wikipedia.org/wiki/External_reference_pricing https://en.wikipedia.org/wiki/External_reference_pricing I only brought up YouTube because when a company is free to set their price, you will still end up with a pricing model where the pricing is different based on region.
hshdhdhj4444 1y ago
The only reason Americans complain about drug prices is because that’s the one they usually pay directly. The other parts of the healthcare system are hidden behind taxes and insurance.
- bruce511 1y ago
  Not to be unnecessarily sparky here, but are we limiting this discussion to legal drugs? Drugs like Oxy are both "legal" yet also consumed illegally. Made by a perfectly legit pharma company. And that's before we discuss the river of fentanyl apparently flowing across the Canadian border...
- duxup 1y ago
  I think insurance prices are very much a part of the overall healthcare conversation too though.

deadbabe 1y ago

[flagged]

badosu 1y ago
Seems like an interesting hypothesis to explore. You didn't provide any context of why you think that could be the case or the mechanism through the alleged subsidies happen.
9question1 1y ago
The problem with this argument is that pharmaceutical companies are private businesses trying to make a profit, not charities. If it were truly unprofitable to sell drugs in, say, Canada or France, pharmaceutical companies would just not sell their drugs in those countries. It is _less_ profitable to sell drugs in those countries than America but still profitable, which is why they still try to capture those markets. If America fixed this imbalance by forcing a lowering of drug prices in the American market, there's no reason to believe that this would cause raising of prices elsewhere. The only way this would be possible is if it were truly unprofitable to sell the drugs elsewhere, which can't be the case since these are corporations not charities. The real impact would be to slow down new drug development, since existing drugs are already profitable to sell everywhere in the world even in countries with more regulation, but if America fixed its market by lowering drug prices for Americans, the total profitability of pharmaceuticals would decrease, decreasing the incentive to create new pharmaceuticals. That's a totally different and very plausible impact. Rising drug prices for existing drugs in other countries is not a plausible impact.
- smallnix 1y ago
  I think they are not saying it's unprofitable, but rather that the current government should shape the market so the environment levels more over US vs the rest. (of course please in a laissez-faire change the market style not the bad socialist stuff)
- JumpCrisscross 1y ago
  > If it were truly unprofitable to sell drugs in, say, Canada or France, pharmaceutical companies would just not sell their drugs in those countries You’re confusing capital and operating costs. Once you’ve developed the drug, selling everywhere you can makes sense. When considering whether to develop a drug or invest in something else, America’s biotech market absolutely turns keys. (But not as uniquely as we think. Europe has a thriving R&D market, it’s just directly subsidised.)
  - jacobgkau 1y ago
    I don't think they're "confusing" it, considering they specifically said what you said elsewhere in their comment.
- deadbabe 1y ago
  So basically if this true, you prove my point. If Americans weren’t paying these high costs then R&D would slow down and the whole world wouldn’t get these drugs. America subsidizes these drugs for the rest of the world, which does not pay its fair share into R&D costs. If we’re to fix our healthcare system, this kind of thing can’t continue.
mothballed 1y ago
You think pharma companies won't bill the rest of countries whatever the market can bear? I can't think of why they possibly would lower their prices even if the American government stops subsidizing their businesses via using their monopoly on violence to enforce our perverted IP regimes.
- CharlesW 1y ago
  For anyone reading not familiar with this, "America's drug prices are high because we're subsidizing the rest of the world" is MAGA propaganda, and is not based on logic. https://www.msn.com/en-us/news/politics/pfizer-agrees-to-deal-on-lowering-drug-prices-amid-trump-pressure/ar-AA1NBySq https://www.msn.com/en-us/news/politics/pfizer-agrees-to-dea...
  - retr0rocket 1y ago
    [dead]
  - carlosjobim 1y ago
    What's the problem with talking points? Talking is the purpose of an open forum like this one. Let's argue against the points and not against the commenters.
    - CharlesW 1y ago
      Fair point, I’ve corrected "talking point" to "propaganda" above. Not only does it not make any logical sense, but there is zero evidence that Big Pharma isn't pricing drugs to maximize profitability in every market in which they operate. Drug companies aren’t charities.
      - rockercoaster 1y ago
        Besides, it also invites the immediate and rather fatal rejoinder of, "OK? So how about we... don't do that?" Any negative response to that must suppose that everyone else would just give up on trying to advance drug R&D if the US stopped unilaterally self-sacrificing to subsidize it for the entire world... and when you lay it out like that, it seems like that must not actually be what's going on in the first place, because why the hell would we be do that, for that reason? So, very probably, we aren't, and further, if we are we should definitely stop.
Der_Einzige 1y ago
The sad reality is that if Americans stopped paying inflated prices the 40% of drugs discovered here would shrink to about 10% and world wide drug discovery would be massively reduced. You literally have to get fucked or the world get fucked harder and drags you down with them. Same reason why NATO and the farm bill are good for America. The greatest trick from the wealthy is to not just exploit you to get it, but to destroy any possibility of resistance to them. Even trying to resist does nothing but harms the under class even more than if you simply accept it. “If you want a picture of the future, imagine a boot stamping on a human face—forever.“ - George Orwell, a communist/socialist Edit: To the guy who claimed Orwell wasn't a communist, the POUM who he fought for in the Spanish Civil war was communist (https://en.wikipedia.org/wiki/POUM https://en.wikipedia.org/wiki/POUM) and according to the soviet union was specifically trotskyist. If you fight for them you are a communist, even if and especially if you claim you weren't later in life.
- tptacek 1y ago
  Orwell was not a communist. Later "Orwell was a communist even if he said otherwise" is a telling argument.
- nemo 1y ago
  Orwell was an anti-Communist, though especially anti Stalinist. He fell into the POUM, he didn't choose them, "I knew that I was serving in something called the POUM. (I had only joined the POUM militia rather than any other because I happened to arrive in Barcelona with ILP papers), but I did not realize that there were serious differences between the political parties." He actually said "As far as my purely personal preferences went I would have liked to join the Anarchists." After the Stalinists illegalized the POUM, killed and tortured Orwell's friends and tried to kill him, forcing him flee Spain, his view on Communism grew ever more dim, and after that he grew more strongly anti-Communist than his earlier anti-Fascism.
gruez 1y ago
>If America prohibited such gouging, would the rest of the world accept price increases on their drugs? If the current administration is so interested in inflicting harm on the rest of the world, maybe they should be convinced to lower drug prices. I doubt governments elsewhere are itching to increase their healthcare spending even more. Realistically speaking the actual result will be cost cutting from pharma companies, mostly in the form of lower R&D spending for new drugs.

JumpCrisscross 1y ago

> doctor specifically told us that we needed to order the medicine (menopur, Gonal F, etc) from an American pharmacy Why do they care? Referral bonus? Did you report them?

apwell23 1y ago
what do you mean? you expect american doctors to prescribe you medicines from german pharmacies?
- deleted 1y ago
  [deleted]
- antisthenes 1y ago
  I actually do expect doctors to have even a tiny concern for not making their patients go bankrupt, yes. Is that really such a high bar?
  - digdugdirk 1y ago
    You need to understand that the system is deliberately so opaque that doctors don't even know what your costs would be. Sure there's a sticker price, but for most medications that's so high as to be absurd. From there, it's entirely dependent on your insurance, coinsurance, pharma benefits, etc, etc. They try, but they're not in a position to do anything about it.
    - jacobgkau 1y ago
      > They try, but they're not in a position to do anything about it. Well, somebody's got to be, and the doctors seem like the ones with the most leverage to get those people to do something about it, right? Customer/patient pressure obviously isn't working.
    - antisthenes 1y ago
      > the system is deliberately so opaque that doctors don't even know what your costs would be. You're telling me professionals who make $300k after 20 years of education have 0 clue about what their patients might pay, or have never had patients who expressed concern over costs? Or don't have friends or relatives who expressed dissatisfaction with a high-deductible plan? Or aren't complicit in getting kickbacks for prescribing opioids? We gotta stop absolving people of accountability. And that includes EVERYONE in the chain who benefits. Yes, this includes doctors. Btw, I have had doctors who do try, and many more now will accept reasonable cash prices for their services. That should be encouraged and commended.

viccis 1y ago

When my wife needed a rabies post-exposure shot course, it would have been around $25000 range for the shots without coverage. Our (expensive high end) insurance brought it down to "only" $2500 out of pocket for us. The alternative is to take the gamble of a possible horrible death. In the UK? Around £150-£300 total.

jen20 1y ago
> In the UK? Around £150-£300 total. For whom? I can't imagine this in particular would not be free at the point of use like almost everything else. That said, the UK has famously been free of (classical) rabies since the 1920s, so it's unclear if it would be easily available if there aren't other uses.
- viccis 1y ago
  Was talking about from a private clinic [1]. Obviously it's free via NHS. It's a good example of a system in which the government in incentivized to not tolerate drug price gouging. https://www.citydoc.org.uk/conditions/rabies https://www.citydoc.org.uk/conditions/rabies
  - giantg2 1y ago
    Is it a good example of drug price gouging? I would bet the major part of the price is that provider.
    - viccis 1y ago
      Yes, it's the drug.
      - giantg2 1y ago
        So what's the breakdown of that $25k for the provider?
  - ed_elliott_asc 1y ago

liquid_thyme 1y ago

YouTube Premium is also cheaper in Bangladesh.

hshdhdhj4444 1y ago
Is it cheaper in the UK, Canada, Germany, etc?
- liquid_thyme 1y ago
  Pricing in healthcare is very tightly regulated and there isn't a simple one line answer for why certain prices are they way they are. Its easy to scapegoat bigpharma for being greedy, but they're just as greedy as any other US corporation. https://en.wikipedia.org/wiki/External_reference_pricing https://en.wikipedia.org/wiki/External_reference_pricing I only brought up YouTube because when a company is free to set their price, you will still end up with a pricing model where the pricing is different based on region.

hshdhdhj4444 1y ago

The only reason Americans complain about drug prices is because that’s the one they usually pay directly. The other parts of the healthcare system are hidden behind taxes and insurance.

bruce511 1y ago
Not to be unnecessarily sparky here, but are we limiting this discussion to legal drugs? Drugs like Oxy are both "legal" yet also consumed illegally. Made by a perfectly legit pharma company. And that's before we discuss the river of fentanyl apparently flowing across the Canadian border...
duxup 1y ago
I think insurance prices are very much a part of the overall healthcare conversation too though.