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An effective eye drug is $50, but many doctors choose a $2,000 alternative
- mhurron 13y agoBut don't listen to those that say a regulated health care system is needed. These companies are just looking out for their own like good Americans.
- varelse 13y agoIn the long run, the problem takes care of itself when the patent expires in 2019 in the US and 2022 in Europe. http://www.fiercepharma.com/special-reports/avastin http://www.fiercepharma.com/special-reports/avastin Until then it's off-label usage. When the time comes, expect an absolute feeding frenzy to make a similar equivalent (with incrementally higher efficacy or slightly fewer side effects) or an alternative formulation to regain those patent rights. I would expect Genentech is already hard at work here.
- mistercow 13y agoExcept that the problem doesn't take care of itself. By 2019, the same company will likely have on the market a new patented drug in the same family, with roughly the same efficacy as the other two. They can do this pretty much indefinitely.
- yahoo893 13y agoWrong. Pharmacy doesn't work that way.
- ceejayoz 13y agoYes, it does. They add something like calcium carbonate (tums) to an existing med and patent the combo, or they find an isomer of the drug. Happens all the time.
- yahoo893 13y agoNo, it doesn't. Generic companies can make replicates of the original drug easily when the original patent expires.
- ceejayoz 13y agoDrug companies have tackled that in a variety of ways. Outright bribery of generic companies to hold off on production (http://www.usatoday.com/story/news/nation/2013/06/17/supreme-court-brand-generic-drug-profit-sharing-deals/2178489/ http://www.usatoday.com/story/news/nation/2013/06/17/supreme...), scaremongering over safety of the generic (the article being discussed in this thread), paying doctors for prescribing the more expensive versions, etc.
- mistercow 13y agoYes, but those generics will be cheap, whereas the new drug will be expensive. Since the doctors are reimbursed based on a percentage of the cost of the drug, they will choose the more expensive one, just like they do now. A cheap competitor already exists. Adding another cheap competitor won't help when doctors are incentivized to use the most expensive option.
- refurb 13y agoYou're forgettingabout the incentives of the insurers. They will be the ones to require the cheaper alternative, similar to the way many insurers require the use of Avastin for AMD unless there is a good reason to use Lucentis.
- ceejayoz 13y ago> They will be the ones to require the cheaper alternative They likely can't in this situation, as the cheaper alternative is off-label.
- astrange 13y agoInformative replies to this in another comment thread: https://news.ycombinator.com/item?id=6870036 https://news.ycombinator.com/item?id=6870036
- brazzy 13y agoYes, it works exactly that way. Marketing and bribery ensures that both doctors and patients will prefer the "new" and expensive drug.
- mistercow 13y agoYes it does. For example, look at Clarinex. This drug is in no way advantageous over Claritin, and in fact is metabolized into Claritin in vivo. The only reason that it exists is because Schering-Plough's patent ran out on Claritin. Or look at Vyvanse, a prodrug of Adderall. Shire Plc has been intentionally manipulating the market (using government amphetamine quotas) for years in order to push patients away from cheaper generic Adderall (despite the fact that many people find Vyvanse to be substantially inferior). Or take the case of adrafinil, which metabolizes into modafinil (provigil). Adrafinil is just fine (not quite as effective, but nearly so), but its patent ran out. At that point, Cephalon pulled strings to get its approval revoked (this was in France; adrafinil is unapproved and unregulated in the US), so that people would have to move to their newer, patented drug. (And yes, adrafinil does tax the liver some, but no more so than plenty of other drugs).
- varelse 13y agoI'll bet Dr. Reddy is already on the case if you don't mind the occasional moldy smell: http://en.wikipedia.org/wiki/Dr._Reddy%27s_Laboratories http://en.wikipedia.org/wiki/Dr._Reddy%27s_Laboratories With up to 10M cases in the US alone, it seems like an excellent target for competition. http://www.blindness.org/index.php?option=com_content&view=article&id=45&Itemid=55 http://www.blindness.org/index.php?option=com_content&view=a...
- ceejayoz 13y agoNexium versus Prilosec is a great example of that. Same drug, same efficacy, just a mirror image molecule.
- maxerickson 13y agoIsn't that an example where the new drugs don't matter? Prilosec seems to be cheap and widely available. I take the point that some of the motivation (I'm hedging here because I haven't looked into it...) for Nexium is a patent protected drug to market, but the tone of this thread would have me believe that Prilosec and equivalents are disappeared from the market.
- ceejayoz 13y agohttp://en.wikipedia.org/wiki/AstraZeneca#Nexium http://en.wikipedia.org/wiki/AstraZeneca#Nexium It's their most commercially-successful medication, they did misleading studies in order to tout its comparative effectiveness, market it heavily and bribe docs to favour it. Prilosec is still available, but if your doctor prescribes Nexium, you're unlikely to question it. Virtually all of the folks on it could likely be on Prilosec with equal effect and much less cost to the healthcare system.
- maxerickson 13y agoSure. But is the bigger problem that they are allowed to do it or is the bigger problem that it works? It's not like the people criticizing them for it have been bashful or unqualified. (I have a similar "Well, shit." reaction to all sorts of things, politics, etc.)
- cma 13y agoThere will be no feeding frenzy; researching an alternative is a fixed cost, but with a competitor they will only be able to sell the drug for marginal cost. The upstart competitor would make more money investing the fixed cost amounts in treasuries at 1%. (This is a joke; when there are just two companies they price-fix rather than compete. Not with actual price-fixing agreements, instead tit for tat signaling as in the iterated prisoner's dilemma)
- shoyer 13y agoActually, it won't be so easy. Avastin is a biologic drug, so it's not possible for generic manufacturers to produce an exactly equivalent product. Eventually, generic manufacturers may be able to compete (the generic clones of biologic drugs are called biosimilars), but it will take a long time and significant resources, because they will need to run new clinical trials to show that the new drugs are equivalent: Because different manufacturers may produce slightly different products, they consequently cannot guarantee that their version is exactly as safe and effective as the original manufacturer's version. So, unlike most drugs, generic versions of biologics were not authorized in the United States or the European Union through the simplified procedures allowed for small-molecule generics. As a result, nearly all biologics have been brand-name therapeutics and required very extensive testing. http://en.wikipedia.org/wiki/Biologic_medical_product#Biosimilars http://en.wikipedia.org/wiki/Biologic_medical_product#Biosim... The FDA gained the authority to approve biosimilars (including interchangeables that are substitutable with their reference product) as part of the Patient Protection and Affordable Care Act signed by President Obama on March 23, 2010 - none have yet been approved. http://en.wikipedia.org/wiki/Biosimilar#Approval_processes http://en.wikipedia.org/wiki/Biosimilar#Approval_processes
- varelse 13y agoReally? http://www.biopharma-reporter.com/Markets-Regulations/Dr-Reddy-s-looks-to-bring-biosimilars-to-EU-within-five-years http://www.biopharma-reporter.com/Markets-Regulations/Dr-Red... Because at $75M to $250M a pop, they're way cheaper than developing a new Biologic ($1B-$2B) and that's because while none have been approved yet, the pathway in the Patient Protection and Affordable Care Act is shorter than that for a new Biologic. I think Big Pharma will do what it takes to make this happen myself. Just like Google will apparently do just about anything for the bottom line despite their corporate motto.
- cook1929 13y agoExactly. We should regulate grocery too. How dare people choose how to spend their money.
- yahoo893 13y agoMaybe we should regulate grocery too. How dare people think they know how to spend their own money.
- notdrunkatall 13y agoThe underlying problem here is that the consumer doesn't care what the cost of their drugs are; all they do is sign on the dotted line when the doctor recommends something. Insurees are essentially paying a monthly cost for an effectively unlimited pool of medical funds. As long as the bill is above what their copay costs, they couldn't care less how much the drug costs - if anything, they will choose the drug that costs more than what the nearly identical drug costs so they can 'get their money back.' As long as the consumer is separated from the consequences of their choices, costs will continue to rise. Some kind of incentive for people to actually care about the cost of their decisions needs to be engineered into the system. Suppose, perhaps, that instead of mandating that employers provide insurance to full-time employees, the government mandated that employers provide catastrophic insurance and contribute the remainder of the difference between the old system and the new to a kind of Health Savings Account: something that's tax-advantaged, and can only be used to pay for healthcare. Employees would then pay their medical bills directly from this fund, and funds will continuously build if they're not used. The kicker is that this HSA also doubles as a retirement fund, and any funds left over when retirement age is reached can be withdrawn without penalty. People will see the money as theirs, and will be much more careful about how they spend it, thus putting pressure on doctors and healthcare providers to reduce prices, rather than increasing them. This took me ten minutes to think up. Give me half an hour, and I'll work out most of the kinks. Give a team of professionals a few weeks, and I'm sure that we could come up with something that makes infinitely more sense than the ridiculous hodgepodge of special interest legislation and twisted incentives that we have now.
- VLM 13y agoIts the system and its players that overall are corrupt, not just the rules. For example. Someone will be paid a bonus to make sure the average retirement account is emptied. The average american woman has about 2 kids, so we'll charge about 40% of an average lifetime account "earnings". After all we can either directly or indirectly select any price we'd like. Another example would be some weirdness with plastic surgery where the cost would now directly correlate solely with human emotional response to a procedure rather than difficulty of the surgery. Finally I think you'd have some pretty weird and borderline inhumane situations with respect to just barely under retirement age patients getting sick... Feel a lump? Well your grandkids will never go to college, or your kids will never live in a house, etc, if you seek treatment before retirement. Just wait a couple months / years, after all what could possibly go wrong with untreated cancer or heart disease or diabetes? Now if you could roll over the treatment fund directly to your kids, that sounds great until (grand)parents start offing themselves so their kid can afford treatment. "Give a team of professionals a few weeks" Fox guarding the henhouse, you'll end up with something at least as corrupt if not more so than the existing solution.
- patatino 13y agoI live in a small village and whe have two doctors. After visiting doctor A you'll leave with a bag of drugs, doctor B will not give you anything more than you need, even if you ask for it. The crazy part is people prefer doctor A..
- ceejayoz 13y agoThat's a large part of the antibiotic resistance issue. Plenty of doctors realized sending someone with a cold home with antibiotics would shut them up and have them leave happy, even though it has no actual (non-placebo, at least) effect.
- bayesianhorse 13y agoNo lay person (and a lot of 'experts') have no chance of judging the competence of a medical professional. They don't know that though... Instead they will rely on all sorts of proxy indicators, and prescribing lots of tests and drugs is one of them. And no, it's not reliable. On the other hand, doctors have to appeal to these indicators in order to get patients to actually take their advice seriously.
- ronaldx 13y agoI don't find that crazy at all: I would go to see doctor A as well. Doctors should use their expertise to advise patients, but in the end people have to be allowed to make their own health decisions. Even if I did believe that doctor B knows better (which I have no reason to), I know I'll get at least the same treatment from doctor A and I'll be able to openly discuss my options.
- mistercow 13y ago>they are reimbursed for the average price of the drug plus 6 percent. I do not understand why anyone thought this was a good idea, or even one that made sense. What was the purpose here?
- tlb 13y agoIf they were only reimbursed for exactly the cost of the drug, they'd lose money on expensive drugs because of inventory costs. Inventory costs include interest on money for the time they're holding it, damage and spoilage, security, theft, insurance, etc. 6% is probably a reasonable guess at the average costs. Large, high-volume operations can make a profit by keeping their costs below 6%, and that may create a wrong incentive. But the right answer isn't to change 6% to 0%, because nobody will want to handle expensive drugs.
- yaddayadda 13y agoFor the most part prescribing doctors aren't the ones who have to deal with inventory costs, it's pharmacies that have the inventory costs. I've even had doctors send me to the pharmacy to pick up injectable medication, primarily because they didn't want to deal with an inventory. So why should prescribing doctors get 6% of cost?
- dllthomas 13y agoI don't see an interpretation of what was said in the article where reimbursement of the cost goes to a pharmacy and 6% goes to the doctor, though admittedly I skimmed.
- tlb 13y agoPrescribing doctors don't get 6% of the cost unless they're also supplying it. Lucentis is injected with a needle into your eyeball, so you probably want your ophthalmologist to do it in their office.
- aestra 13y ago
- judk 13y agoI thought this sort of thing is what insurance companies are expected to handle: to advise on cost-effective alternatives for standard diagnosis codes.
- ceejayoz 13y agoThe article talks about Medicare, and how it's forbidden by Congress from negotiating prices, among other things. I'll give you one guess on which industry lobbied for that restriction.
- refurb 13y agoThe gov't sure as hell negotiates other price concessions from pharma companies: 1. Medicare only pays "average selling price" which includes all discounts offered to physicians 2. Medicare demands pharma pay 50% of the donut hole gap which is several billion each year 3. Medicaid automatically gets a 23% discount on all drugs 4. DOD, VA and other gov't organizations do negotiation drug prices and they get a 24% discount on top of that There is plenty of price negotiations on the gov't side.
- judk 13y ago> In addition, Genentech offers rebates to doctors who use large volumes of the more expensive drug. But doctors don't buy the drug, patients and Medicare do. So it is straight up bribery of people abusing legally protected positions of trust?
- jrockway 13y agoOr, they don't want to explain in court why they picked the cheap drug and the procedure went wrong.
- kvb 13y agoParticularly when the cheap drug isn't FDA approved for the treatment in question.
- refurb 13y agoIn this case, the doctors actually do buy the drug. Out-patient use of physician administered drugs is done through "buy and bill". The physician purchases the drug and keeps an inventory. When a patient is treated, the doctors bills the insurance company and receives the cost of the drug (usually average selling cost) plus a mark-up. Drug companies are allowed to offer rebates to physicians (it falls under the "safe harbor") as long as it doesn't create perverse incentives for use (as determined by the DOJ). The other thing to keep in mind is that any rebates gets subtracted from the average selling price, so in essence any rebate is clawed back with a few quarters.
- dude3 13y agoThe Post conveniently left out that the Pharm company found that "Avastin patients had a 30% higher risk of serious systemic side effects than Lucentis patients did". Why didn't they include the Pharm company's side? http://www.fiercepharma.com/story/novartis-digs-safety-data-avastin-vs-lucentis-study/2012-05-02 http://www.fiercepharma.com/story/novartis-digs-safety-data-...
- alphaoverlord 13y agoThe article does mention and debuffs it. Its the difference between 32 and 40% Its based off one study of small sample size and is not biologically plausible. >The incidence of what are known as serious adverse events — a catchall category that includes hospitalizations for any reason — was slightly higher in the Avastin group: 40 percent vs. 32 percent. The adverse events included broken bones and urinary tract infections. “The majority of the adverse events would be difficult to imagine being caused by the drug,” Martin said. Martin noted that while small, probably random effects favored Lucentis in some cases and in others they favored Avastin. Neither should be viewed as conclusively related to the drug, he said. >
- pinaceae 13y agoComplicated topic on a global scale. The rest of the world is very grateful for the US pharmaceutical market. Its unregulated and "free" nature, like consumer advertising for prescription drugs - something completely unheard of in civilized countries - allows for massive profits for the pharmaceutical industry. those profits do not happen anywhere else. european agencies control and negotiate prices centrally, emerging markets seems to follow the european model (brazil, china, etc.). those profits do get invested back into r&d, the patent system forces pharma companies to move forward. the recent patent cliff is a great indicator for the system working. pharma r&d would be severly constrainted if not for the profits generated in the US market. on a global scale it looks like a subsidiy by the US people, paying high markups and taking way more drugs than needed - for the good of the rest of the planet. thank you. and keep swallowing pills.
- mdisraeli 13y ago"it’s the same damn molecule with a few cosmetic changes" pretty much tells you everything you need to know about this article. As any chemist worth their salt will tell you, small differences to molecules doesn't necessarily make them just as easily produced. And similarly any biochemist worth their salt will be able to tell you that small differences can indeed matter a lot! Reading the wikipedia article for the more expensive drug (http://en.wikipedia.org/wiki/Ranibizumab http://en.wikipedia.org/wiki/Ranibizumab), it does appear that there are therapeutic differences between the two drugs in terms of associated infections. The real thing, however, to check when talking about medicines is the Specific Product Characteristics sheet. This is, in essence, what doctors refer to when looking up medicines. http://www.medicines.org.uk/emc/medicine/19409/SPC/Lucentis+10+mg+ml+solution+for+injection/ http://www.medicines.org.uk/emc/medicine/19409/SPC/Lucentis+... and http://www.medicines.org.uk/emc/medicine/15748/SPC/Avastin+25mg+ml+concentrate+for+solution+for+infusion/ http://www.medicines.org.uk/emc/medicine/15748/SPC/Avastin+2... . Avastin is used for a lot more than just eye conditions, it seems, and has shall we say a number of issues. Something most people fail to realise is exactly how expensive new drug development actually is. You've got experimental labs doing in-vivo tests of thousands of molecules (at least), animal studies to ensure the human trials will be safe, multiple stages of clinical trials in humans with associated insurance, etc. The sole means of recuperating the cost of all of this is through product sales. There are very few actual grants awarded for developing medicines all the way through to production. No tie-in marketing of lunch boxes. No crowdfunding from patient groups. I do wholeheartedly agree, however, that there are perverse incentives on doctors to prescribe more expensive medication, and the modern pharmaceutical industry is messed up in so many ways. Most doctors too don't even understand properly what it is they are prescribing[1], and the 21st century medical representative system has more in common with jingles and home appliance sales than the clinical educators of the 20th century. Disclosure: I have family and friends working in this field [1] Reasons why people become doctors: money, power and helping people. Good doctors get to chose two of out of three. And to be fair to doctors, they have to remember a hell of a lot of academic material in a constantly changing field, and /then/ have social skills and physical skills to master
- ams6110 13y agoSeveral of the "perverse incentives" are possible because of insurance/medicare hiding the true cost of medications from the consumer, so there is very little rational price-signaling back to the manufacturers. Other perversions are made possible by the very regulatory agencies that originally had the good purpose of ensuring drug safety and preventing snake-oil remedies but which have become complex, ever-expanding nightmares of bureaucracy with vast opportunities for corruption and political favor-trading.
- dekhn 13y agoThe article left out a number of very good scientific reasons why lucentis and avastin are not bioequivalent and should not be subsituted. I found it especially misleading that they used anecdotal evidence to claim that the cheaper drug is equivalent in function and safety. That said, Genentech is on the wrong side of the PR angle here and unfortunately for them, some internal documents got exposed which make them seem less than angelic here. If the cost differential of producing the drugs really is small, then they don't have a strong position, because it makes them appear as if they are using one of the drugs as a profit center to fund future R&D. Anyway, the article really glosses over stuff, but you'd need to spend about 5-7 years getting a PhD in pharmaceutical chemistry, plus working in industry for a few years before you understand the business and science of what genentech does.
- ams6110 13y agothey are using one of the drugs as a profit center to fund future R&D How else are they going to fund future R&D?
- dekhn 13y agoto clarify: they are using one of the drugs moreso than another as a profit center. IE, given no other constraints, I'd expect a pharma to distribute its R&D cost over its drug profit centers weighted by the drug's profit margin, and that all the drug's profit margins would be roughly equal: naively, I'd expect them to raise the price of Avastin and lower the price of Lucentis, assuming the costs of producing them truly are similar. The reality is, likely there are proprietary reasons we're not privy to that causes the cost differential. They could be technical (maybe it does cause much, much more to produce Lucentis), or the could be business (maybe increasing the price of Avastin could cause it to sell poorly against another drug from a competitor)
- kevinpet 13y agoWhat I found most interesting about the article was the complete lack of any idea of the patient paying for the drugs. The word "patient" literally does not appear on the first page, throughout the rest of the article, it only occurs in references to studies, except on the last page, were we find "many decisions are guided by whether the patient’s insurance covers the entire cost or just a portion." It seems that patients aren't agents who have any involvement in anything, in the authors world. They're just objects to be pushed around by insurance companies, doctors, and drug makers. Regardless of the details of these two drugs, right there you have the problem with health care in America.
- naner 13y agoDoctors will typically prescribe the "best" drug to their knowledge which often means the newest drug with the least serious side effects. I don't think they are always out to bilk their patients. If you are ever in a situation where you have to pay for drugs out of pocket or your insurance doesn't cover enough of the drug call your doctor and ask for a lower cost alternative. They can call the pharmacy and often times find a lower cost alternative to fit your budget. At least this has been my experience with my doctors. I have also had my primary physician straight up tell me the price difference between the best choice and second-best choice doesn't justify the benefits.
- ams6110 13y agoThis has been my experience as well. There's almost always a cheaper, effective alternative. In the one case where there wasn't, the benefit of the medication vs. its cost was so out of balance that we just decided not to use it.
- chime 13y ago> If you are ever in a situation where you have to pay for drugs out of pocket or your insurance doesn't cover enough of the drug call your doctor and ask for a lower cost alternative. They can call the pharmacy and often times find a lower cost alternative to fit your budget. I think you hit the nail on the head. Most people just accept what the doctors, insurance companies, and pharmacies tell them, without asking for more affordable alternatives. My pool guy was complaining about how he got one of those "Your insurance is being canceled and your new insurance is 200% the cost" letters from Humana. I got the same exact letter a week ago. I asked him what he was going to do. He said "What can I do? Pay the high cost." I told him I got the same exact letter and I called Humana, talked to an agent for 5 minutes, and they put me on a plan that costs just a few bucks more than my old plan but covers a lot more and with similar deductibles. It is in the best interest of every corporation to up-sell you the most profitable product. In case of insurance, Humana quoted both of us ACA-compatible plans that sound similar (similar/lower deductible) to the old plans but are actually different (no coinsurance, 100% Rx coverage etc.) and thus cost a lot more. I also told him to call up BCBS, Aetna, and Cigna if he really wants to shop around because they all have good, competitive plans now. There is no reason to stick with Humana if they don't have a good plan for him. But I don't think he's going to do anything except blame the ACA law. There really needs to be a nationwide education campaign on healthcare. People really have no idea that there are better/cheaper alternatives, regardless of whether you are for/against ACA.
- lazyjones 13y agoIt's well known that the pharmaceutical industry sends representatives to doctors to persuade them to prescribe their products. Frequently this is achieved with special "incentives" (read: bribery). Some doctors around here have put signs on their doors saying that they do not talk to representatives of pharmaceutical companies.
- naner 13y agoHere's a reply purportedly from an O.D.[1]: Eye doctor here. Avastin is currently used off-lable for eye conditions (most commonly wet AMD and macular edema in diabetes). It is only FDA approved for use in treatment of some colon and lung cancers. Generally speaking, even though it fits standard of care within the field of ophthalmology to use this drug, there are still some inherent risks in doing so for the practitioner, thusly, Lucentis is still preferred by some. Also, I've not encountered this (as MOST insurance companies would prefer practitioners to use the cheaper drug) but I've heard of difficulty with third party payer coverage/ reimbursement when using the off-lable drug. Another thing to consider, as ajrw pointed out, they ARE NOT as the article mentions "the same drug." Some people respond more favorably to one versus the other. Commonly, the two will be used in succession on the same patient as though no double blind clinical trial has been done to confirm this; both drugs tend to exhibit a slight tachyphylaxis over time (diminished effect). Practitioners have found that when one drug starts becoming less effective, switching to the other VEGF inhibitor can show recapture of the previous level of therapeutic benefit. I would advise all to take this article with a huge grain of salt. Most practitioners are not aiming to increase insurance costs (obviously, as generally speaking, the higher the bill, the harder it is to get the reimbursement.) Many are probably apprehensive to use an off-lable drug from a medical-legal stand point. Note: I am not a surgeon. So some of this is slightly presumptive. 1: http://www.reddit.com/r/politics/comments/1sdxz6/an_effective_eye_drug_is_available_for_50_but/cdwmfro http://www.reddit.com/r/politics/comments/1sdxz6/an_effectiv...
- jheriko 13y agomedicine is one of the areas where being economically driven causes problems. medical research is stupidly expensive and companies need to recover their costs for their to be progress at all. incidentally its the /only/ valid argument i have seen for patents. it also explains a lot of the high expenses involved... its a shame, i feel that this is an industry that desperately needs to be nationalised because, even with the best of intentions, a business must be profitable to survive. we regularly see layers of rhetoric and polical manuveuring attacking e.g. Obama care, the NHS and similar initiatives and from this i feel we lose out - they criticise the specifics for a political agenda. imo the spirit of these programs is exactly right - the problem is always sloppy implementation by politicians (as with any case where nationalisation is not effective - which is /provable/ almost in the mathematical sense). We can't expect them to do well though - they are winners of popularity contests which essentially boil down to competitions of rhetoric and salesmanship - they have no reason to have any of the prerequisite skills for us to expect them to do a good job in that arena - or even leadership in general. it is a massive failing of our particular flavour of democracy imo. on the other side doctors are supposed to be bound by the Hippocratic oath. this utterly rules out not helping people because they can't afford it - and yet many physicians have to make that choice regularly - which is not just breaking their word, but against the entire spirit of medicine and morality. all in all its a horrible situation, but one that i believe is incredibly fixable... however articles like this are attacking the institutions which currently allow us to have medicine and portraying it in a way that the common man will empathize with. its just another pile of rhetoric distracting us from being productive imo... if you dig into any of the details as other commenters have mentioned, the factual basis is weak.
- iguana 13y agoWhat isn't mentioned is that these drugs are actually injected directly into the eye. My grand father was prescribed both, and had no improvement in vision. When he switched to the expensive one, there were excellent results, and he can now see again.
- finspin 13y agoIn Finland this is handled in pharmacies. Pharmacist will always inform you if there is a cheaper alternative to the drug you've been prescribed.
- shoyer 13y agoReally? Lucentis is injected into the eye by doctors -- it's not something you're taking at home.
- refurb 13y agoIt's no different in the US when it comes to generics. Most state have laws that force a pharmacist to fill a prescription with the cheap generic alternative unless the Rx specifically say to fill with the branded version. However, in the Avastin vs. Lucentis case, they are no therapeutically equivalent.
- shoyer 13y agoThis article seems to miss the bigger picture -- why is Lucentis 40x more expensive than Avastin? The answer is that drugs aren't priced by how much they cost to manufacture a dose -- nor should they be! Roughly, they're priced by the cost of R&D (a fixed cost) and the benefit to patients (a fixed benefit per patient). So it makes complete sense that Lucentis is more expensive, because the does size is so much smaller. It's still vastly less expensive to get eye treatment with Lucentis than cancer treatment with Avastin, which runs at ~$100,000/year.
- DannoHung 13y agoTop comment from the reddit thread on the same article: "Ophthalmologist here. As a physician responsible for prescribing and injecting these drugs, I can tell you that this article glosses over the single most important factor involved in deciding between the three currently-available Anti-VEGF options: compounding pharmacies, and the lack of regulation thereof. Any Ophthalmologist at this point is very familiar with the results of the CATT study which confirmed the equal efficacy and safety of bevacizumab (Avastin) and ranibizumab (Lucentis). The reality is that the actual drug injected into the patient's eye either comes from the manufacturer in a sterile, ready-to-inject form (Lucentis), or an appropriate amount was prepared for intraocular injection by a local compounding pharmacy (Avastin). Compounding pharmacy regulation is notoriously poor, and the risk of an intraocular infection is not one many retina specialists are eager to take unnecessarily. Endophthalmitis frequently leads to blindness, even with early diagnosis and treatment. As much as everyone wants to think doctors are only interested in lining their pockets, the reality is that most of us simply don't want your grandparent going blind in one eye because a minimum-wage tech at a compounding pharmacy failed to follow appropriate sterile procedure. The American Society of Retina Specialists have been advocating for increased regulation of compounding pharmacies since Lucentis became available. Check out their website. I guess I should also point out that we get paid the same for injecting any medicine into the eye, regardless of the cost of the drug. And we purchase and stock both drugs in the clinic, and bill insurance for whichever is used. So we don't benefit financially for injecting one versus the other." http://www.reddit.com/r/politics/comments/1sdxz6/an_effective_eye_drug_is_available_for_50_but/cdwoh5j http://www.reddit.com/r/politics/comments/1sdxz6/an_effectiv...
- manicdee 13y agoIs the implication here that the technician at the "manufacturer" is not minimum-wage? Or is the implication supposed to be that the minimum-wage technicians who work for the "manufacturer" are magically better at following appropriate sterile procedures?
- rpedroso 13y agoIf compounding pharmacies perform so poorly in this area, then it is certainly in the interest of the manufacturer to provide a better product for at least two reasons. 1) If they know ophthalmologists will prescribe the safer product, and since the demand for this drug is relatively price-inelastic, they are able to raise prices drastically (hence the $1950 discrepancy). 2) If compounding pharmacies are the ones who are under-regulated, perhaps the manufacturer actually faces sufficient regulation. In this case, they face greater liability for sterility issues, and they have a strong incentive to enforce sterile procedures. The problem with the pharmacies is not so much that the worker is paid low wages or under-skilled, but rather, that the lack of regulatory burden limits the incentive to ensure safe procedures.
- lr 13y agoIf this kind of stuff outrages you, please ask your Rep to investigate: http://www.house.gov/htbin/findrep http://www.house.gov/htbin/findrep Since we are talking about taxpayer money, this seems like a great opportunity for a Congressional hearing on the matter.
- timr 13y agoThis is hardly surprising, and it's unfair to try to turn it into a problem with "entitlement programs". There are many examples of this kind of thing -- and private insurers aren't pushing back on the costs, either. Take the anti-viral drugs acyclovir and valacyclovir. They're both anti-virals used to treat diseases caused by the herpes simplex virus (e.g. shingles, chicken pox, cold sores, herpes, etc.), and are both commonly prescribed to patients of all ages. The only difference between them is that valacyclovir is a pro-drug -- it metabolizes to acyclovir -- and has slightly higher bioavailability, which means that patients can take three doses a day, instead of five. Otherwise, they're equivalently effective medications. Granted, three doses a day is easier on patients than five doses a day, but that convenience comes at a cost: valacyclovir costs about five times as much as acyclovir. Your doctor won't tell you this -- she'll just prescribe the valacyclovir, in nearly all cases -- and your private insurance company won't do anything to encourage you to take one drug over the other. About the only way you'd know is if you tried to buy the drug without insurance, and your pharmacist told you that you could use this other, cheaper medication to save a lot of money. Not only are "entitlement programs" not the problem here, they could actually be the solution: a single-payer health system would have an economic incentive to push back on providers, and encourage them to use more cost-effective drugs. Our current, private insurance system is almost totally blind to cost effectiveness, because nobody in the chain has any incentive to care. The final costs of the system get passed back to employers in the form of annual rate increases, when it's too late to do anything about them.
- hga 13y agoErrrm, it's my understanding that "compliance", i.e. people actually taking their prescribed medicines per schedule, is a terrific problem in the real world. The payoff in patient health can be substantial; in one area I'm familiar with, anti-depressants, there's a strong bias towards those that are normally taken once a day (one of the many advantages of Prozac, the first SSRI). So I can see lots of physicians routinely prescribing the valacyclovir ... although for someone like me, to whom the whole idea of compliance was a new, almost unthinkable thing when I first learned about it, they'd like go with the acyclovir (especially after I looked up the drugs in question, read up on their pharmacokinetics, etc.; obviously I'm a special case, e.g. nowadays I tell my doctors what to prescribe me for allergies and sinus infections, having learned what works and what's cheap). Hmmm, come to think of it, when I got an "early" (age early 40s) case of herpes zoster (shingles, and, yeah, it's no fun at all, get the vaccine when you can) in 2003 I was prescribed acyclovir, by a doctor who knew both my financial situation (not great then) and compliance patterns.
- ajtaylor 13y agoI'll take a different angle from most of the comments and talk about the prohibition of Medicare negotiating the price of drugs. The article talks about how two other countries have negotiated discounts of 35-45% off the list $2000 USD price. If you want to help hold down prices, all that's necessary is to actually negotiate a volume discount with the drug companies. It's basically an indirect subsidy to the drug companies via Medicare.