4 ms·

Wrong. Pharmacy doesn't work that way.

ceejayoz 13y ago
Yes, 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 ago
  No, it doesn't. Generic companies can make replicates of the original drug easily when the original patent expires.
  - ceejayoz 13y ago
    Drug 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 ago
    Yes, 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 ago
      You'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 ago
      Informative replies to this in another comment thread: https://news.ycombinator.com/item?id=6870036 https://news.ycombinator.com/item?id=6870036
brazzy 13y ago
Yes, it works exactly that way. Marketing and bribery ensures that both doctors and patients will prefer the "new" and expensive drug.
mistercow 13y ago
Yes 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).

Yes, 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 ago
No, it doesn't. Generic companies can make replicates of the original drug easily when the original patent expires.
- ceejayoz 13y ago
  Drug 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 ago
  Yes, 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 ago
    You'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 ago
    Informative replies to this in another comment thread: https://news.ycombinator.com/item?id=6870036 https://news.ycombinator.com/item?id=6870036

brazzy 13y ago

Yes, it works exactly that way. Marketing and bribery ensures that both doctors and patients will prefer the "new" and expensive drug.

mistercow 13y ago

Yes 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).