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Wholesale importation from india would probably do a lot to lower costs. India makes a ton of the active pharmaceutical ingredients used in western pills already and pretty much the entire global south depends on indian pharma for affordable medications. Smart boomers are already taking advantage of indian pharmacies and ordering their refills from there. Unlike American pharma, the price is printed on the blister pack or box for each medication. It is well worth the while for online pharmacies to buy up ventolin that costs the equivalent of 30 cents and mark it up for the American consumer at $5.
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Dec 18, 2019 19:22
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CAPS LOCK BROKEN posted:Wholesale importation from india would probably do a lot to lower costs. India makes a ton of the active pharmaceutical ingredients used in western pills already and pretty much the entire global south depends on indian pharma for affordable medications.
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Dec 18, 2019 19:39
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Gobbeldygook posted:Allowing hospitals and pharmacies to legally YOLO it with Krazy Kumar's Discount Drugs is not an acceptable solution. Yeah no, India already supplies a huge amount of medication to the US. The 'free' antibiotics from Walmart are sourced from Dr. Reddy's or Cipla. Many urgent cares run their own indian generic pharmacies that stock glenmark products.
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Dec 18, 2019 19:42
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Gobbeldygook posted:Allowing hospitals and pharmacies to legally YOLO it with Krazy Kumar's Discount Drugs is not an acceptable solution. 1) API gets made at Dr. Reddy's, India, then gets shipped to Las Piedras, PR. 2) Dosage form gets tableted and put into primary package at Las Piedras, tossed onto pallets and sent to the USA mainland. 3) Bottle labels and secondary packaging are performed at a factory in Pennsylvania, J&J label slapped on box, marked "Made in Fort Washington, PA." 4) Drug ships to distributors and pharmacies, is totally not KKDD YOLO medications because we labeled it in Pennsylvania.
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Dec 18, 2019 19:46
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Whew, that was a close one! Surprise billing was almost outlawed at the federal level with bipartisan backing till both parties' leaders stripped it from the budget bill: quote:Leaders from both parties had unveiled legislation to stop surprise medical bills, the often exorbitant bills faced by patients when they go to a hospital that takes their insurance but are treated by a doctor who does not. The White House and major consumer groups had also endorsed the plan, which was to be included in the year-end spending bill. Of course, the lesson taken away from this by the NYT is that this augurs poorly for M4A--not the absurdity of both parties being captured by special interests strong enough to defeat a proposal that has 78 percent of Americans' backing.
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Dec 18, 2019 21:37
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Willa Rogers posted:Whew, that was a close one! Lol that this failed to pass the house.
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Dec 18, 2019 21:43
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Willa Rogers posted:Of course, the lesson taken away from this by the NYT is that this augurs poorly for M4A--not the absurdity of both parties being captured by special interests strong enough to defeat a proposal that has 78 percent of Americans' backing. Well I mean they're not wrong, because if you can't pass something as easy as this against such an obviously evil practice it doesn't bode well for sweeping industry-changing reconstruction.
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Dec 18, 2019 23:47
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I'm just glad someone is thinking of those poor poor Doctors who can barely afford their third or fourth vacation homes.
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Dec 19, 2019 00:12
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Gobbeldygook posted:Allowing hospitals and pharmacies to legally YOLO it with Krazy Kumar's Discount Drugs is not an acceptable solution. CAPS LOCK BROKEN posted:Yeah no, India already supplies a huge amount of medication to the US. The 'free' antibiotics from Walmart are sourced from Dr. Reddy's or Cipla. Many urgent cares run their own indian generic pharmacies that stock glenmark products. And there are regular fda reports on how the Indian manufacturers are garbage and often warning letters are issued. That said gently caress the ban on importing drugs. I'll take my chances on Krazy Kumar. I can sometimes buy the same drug from the same manufacturer as the US generic at 1% (yes) the price
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Dec 19, 2019 01:01
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Any thoughts or good analysis on the 5th circuit court case decision made recently about the ACA? https://www.usatoday.com/story/news/politics/2019/12/19/affordable-care-act-democrats-supreme-court/2699850001/
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Dec 21, 2019 00:46
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Malcolm XML posted:And there are regular fda reports on how the Indian manufacturers are garbage and often warning letters are issued. Even if importation from India was 100% safe it would still be short-sighted policy that throws a bunch of wrenches into long-term drug development decision process. No biotech VC is going to invest in the initial clinical development/regulatory process for novel small molecule drugs knowing the launch price will be set at India manufacturing cost. Think recent examples like TKIs in hematology/oncology, DAAs in Hep C, ARIs in prostate cancer, etc. Allocation of development dollars will shift to biologics and personalized cellular/gene therapies where importation is less of a threat. If argument is then that the current system for allocation of capital in development/regulatory process following initial drug discovery/research costs, fair enough. But it's magical thinking to believe that importation or 75% cuts to the wholesale cost of novel branded drugs wouldn't have a meaningful impact. Decent recent article from industry perspective here.
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Dec 26, 2019 16:09
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KingNastidon posted:Even if importation from India was 100% safe it would still be short-sighted policy that throws a bunch of wrenches into long-term drug development decision process. No biotech VC is going to invest in the initial clinical development/regulatory process for novel small molecule drugs knowing the launch price will be set at India manufacturing cost. Think recent examples like TKIs in hematology/oncology, DAAs in Hep C, ARIs in prostate cancer, etc. Allocation of development dollars will shift to biologics and personalized cellular/gene therapies where importation is less of a threat. if kingnastidon can't keep charging people a 50000% markup on insulin, and killing those who can't pay, how can his masters be expected to invest in other drugs with a much lower profit margin??? please do not ask what incentivizes them to do that under the current system, that question is communism.
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Dec 26, 2019 16:35
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Yeowch!!! My Balls!!! posted:if kingnastidon can't keep charging people a 50000% markup on insulin, and killing those who can't pay, how can his masters be expected to invest in other drugs with a much lower profit margin??? Thanks for reading the first two sentences in the article, Yeowch. Always great to see your thoughtful contributions.
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Dec 26, 2019 16:41
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KingNastidon posted:Even if importation from India was 100% safe it would still be short-sighted policy that throws a bunch of wrenches into long-term drug development decision process. No biotech VC is going to invest in the initial clinical development/regulatory process for novel small molecule drugs knowing the launch price will be set at India manufacturing cost. Even if true, why is that bad. How does the hypothetical future novel small molecule drug help me if I can't afford it anyway.
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Dec 26, 2019 16:43
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Maybe a world where the US enjoys lower drug prices (and thus more equality in access to drug and medical treatments) but also has a lower rate of development of new drug and medical technologies is still one we would want to live in? But no, on this forum, everybody’s preferred political policies are perfect in every way, and have zero downsides.
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Dec 26, 2019 16:50
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KingNastidon posted:Thanks for reading the first two sentences in the article, Yeowch. Always great to see your thoughtful contributions. tremendous fan of any article that starts with "yeah, sure, we're corpse-eating monsters grown morbidly obese on the flesh of the weak, -BUT-" the counterargument remains the same it was last time you tried pushing this garbage. people on a poverty wracked island that's been the subject of constant trade war for decades figured out how to prevent mother-child AIDS transmission. all that delicious blood money that you assure us you use for Helping People (tm) couldn't get there, for reasons you assure us had nothing to do with it not being profitable. you are complaining that your masters going on a diet would make them less fat. no more. no less.
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Dec 26, 2019 16:51
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KingNastidon posted:Even if importation from India was 100% safe it would still be short-sighted policy that throws a bunch of wrenches into long-term drug development decision process. No biotech VC is going to invest in the initial clinical development/regulatory process for novel small molecule drugs knowing the launch price will be set at India manufacturing cost. Think recent examples like TKIs in hematology/oncology, DAAs in Hep C, ARIs in prostate cancer, etc. Allocation of development dollars will shift to biologics and personalized cellular/gene therapies where importation is less of a threat. Pretty awful opinion piece from a MIT-educated ghoul. No wonder pharma people hate India so much-- the thought of a nonwhite country providing affordable drugs to the global south probably sends you into conniptions
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Dec 26, 2019 17:00
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silence_kit posted:Maybe a world where the US enjoys lower drug prices (and thus more equality in access to drug and medical treatments) but also has a lower rate of development of new drug and medical technologies is still one we would want to live in? No, that's a perfectly reasonable stance. It's worth asking whether many of the incremental benefits of expensive novel medications are worth their price. Even when considering if those incremental improvements can contribute to significant advances. Acknowledging that lower prices will lead to lower rate of development is more honest than most. Yeowch!!! My Balls!!! posted:you are complaining that your masters going on a diet would make them less fat. no more. no less. Who are my masters again, Yeowch? I think VCs and other investors would shift their funds away from small molecule development or biotech in general if drug importation and/or 75% branded price cuts were implemented. Do you disagree? It's okay to agree and say that ______ alternative should happen, even if it's not currently being proposed. CAPS LOCK BROKEN posted:Pretty awful opinion piece from a MIT-educated ghoul. No wonder pharma people hate India so much-- the thought of a nonwhite country providing affordable drugs to the global south probably sends you into conniptions Where are you gathering that "pharma people" hate India or Indians? They're extremely well represented in biopharma in the US, especially in NJ. You don't have to hate India to say there have been API issues or hate China to say the rigor of their clinical trials have been less than stellar. What does the lack of whiteness of India have to do with the discussion? Do you think India is motivated to produce and sell drugs by anti capitalism and solidarity with their brown global south brothers or something? KingNastidon fucked around with this message at 17:32 on Dec 26, 2019 |
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Dec 26, 2019 17:22
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KingNastidon posted:Who are my masters again, Yeowch? I think VCs and other investors would shift their funds away from small molecule development or biotech in general if drug importation and/or 75% branded price cuts were implemented. Do you disagree? It's okay to agree and say that ______ alternative should happen, even if it's not currently being proposed. the core mistake you are making- if I am being charitable, and it's not you actively lying to obscure the reality- is in the assumption the people you kill to keep your profit margins high die in the service of reinvestment into r+d. that is, empirically, not where your masters put that money. that money goes to you. Yeowch!!! My Balls!!! posted:you are extremely concerned about the drag on the system provided by the "free-riders" on pharmaceutical research. and that is a worthy concern! which renders this conversation not an impassive discussion of how to "preserve innovation," but a parasite wheedling in terror about how DARE someone cut off the stream of human misery from which he derives his sustenance. Yeowch!!! My Balls!!! fucked around with this message at 17:37 on Dec 26, 2019 |
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Dec 26, 2019 17:35
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KingNastidon posted:No, that's a perfectly reasonable stance. It's worth asking whether many of the incremental benefits of expensive novel medications are worth their price. Even when considering if those incremental improvements can contribute to significant advances. Great if you agree it's an irrelevant concern, you can stop bringing it up every month
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Dec 26, 2019 17:52
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KingNastidon posted:Thanks for reading the first two sentences in the article, Yeowch. Always great to see your thoughtful contributions. Ah, a lesson in reading comprehension from the poster who can't read his own rap sheet and stop committing the behavior that has gotten him repeatedly banned. You are the embodiment of "It is difficult to get a man to understand something, when his salary depends upon his not understanding it" and your perspective has no purpose in a debate about how to fix healthcare, because keeping healthcare broken is making you lots of money. e: vvv lol at going full calm hitler "hey everyone i'm just trying to keep my sweet pharma gig going, can we be less rude about desiring Medicare For All?" WampaLord fucked around with this message at 18:46 on Dec 26, 2019 |
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Dec 26, 2019 18:06
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VitalSigns posted:Great if you agree it's an irrelevant concern, you can stop bringing it up every month Didn't quite say it's an irrelevant concern, just that it's more logically consistent than the usual "NIH did the research, clinical development, and regulatory process for every drug in the past 20 years." WampaLord posted:Ah, a lesson in reading comprehension from the poster who can't read his own rap sheet and stop committing the behavior that has gotten him repeatedly banned. Yet I've still managed to acquire less than half the probations/bans as Yeowch in this calendar year given his very, very bad posting. Of which his original response was yet another example of. WampaLord posted:You are the embodiment of "It is difficult to get a man to understand something, when his salary depends upon his not understanding it" and your perspective has no purpose in a debate about how to fix healthcare, because keeping healthcare broken is making you lots of money. Given that I don't repeat the same well tread lines on big pharma as 98% of people here, I've always thought it important to disclose that I work on finance/data side of pre-launch biotech. Feel no shame in that really, given the binary choice presented to me I've always chosen the option that would regulate the industry more. But let's stop posting about posters and return to my original comment before the usual crew arrived: KingNastidon posted:Even if importation from India was 100% safe it would still be short-sighted policy that throws a bunch of wrenches into long-term drug development decision process. No biotech VC is going to invest in the initial clinical development/regulatory process for novel small molecule drugs knowing the launch price will be set at India manufacturing cost. Think recent examples like TKIs in hematology/oncology, DAAs in Hep C, ARIs in prostate cancer, etc. Allocation of development dollars will shift to biologics and personalized cellular/gene therapies where importation is less of a threat. Do you disagree with anything? Do you think more capital would be allocated to small molecules if importation of branded and/or generic importation was encouraged? Do you see caveat at the bottom where I say "fair enough" if you believe that current system of allocating money for drug development is flawed? Otherwise why are you here?
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Dec 26, 2019 18:42
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KingNastidon posted:Didn't quite say it's an irrelevant concern, just that it's more logically consistent than the usual "NIH did the research, clinical development, and regulatory process for every drug in the past 20 years." Yes my post was directed more to the majority opinion posters in this thread, not really you.
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Dec 26, 2019 19:03
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KingNastidon posted:Didn't quite say it's an irrelevant concern, Same diff. You said reasons people gave for not caring about it are reasonable. KingNastidon posted:Do you disagree with anything? Do you think more capital would be allocated to small molecules if importation of branded and/or generic importation was encouraged? Do you see caveat at the bottom where I say "fair enough" if you believe that current system of allocating money for drug development is flawed? Otherwise why are you here? Maybe, maybe not. If the rate of profit still exceeds a savings account (or at most an index fund) then it still makes sense to invest the capital, even if the rate is lower than it was previously. We could also let pharma companies own slaves, that would increase the rate of profit, and therefore according to this argument more research would be done. We could force prisoners to be free test subjects. We could also do away with trials altogether and just let them pocket the money and sell whatever. More profits = more cures, right. And anyway even if research did decrease who cares, what use is a novel small molecule to me if I can't afford it anyway. I still die, but also a bunch of diabetics who can't afford their insulin go bankrupt and die so their savings can go to develop another drug that's only for the rich. VitalSigns fucked around with this message at 19:11 on Dec 26, 2019 |
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Dec 26, 2019 19:06
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One solution to forcible caps being imposed on USA drugs causing lower profits and lower investment into R&D is to throw our hands up and do nothing, for the free market hath spoken its punishment and nothing can or should be done about it. Another solution is to raise taxes and have the government make up the difference. You know, as governments nominally do when the private sector fails as magnificently as ours does. It might even be more efficient - it depends on how much pharma 'research' money is spent on things like evergreening their drugs and how much is truly spent on things that'll help.
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Dec 26, 2019 19:11
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It also should be mentioned that universities (many of which are public) do most of the research, and the US government should be pouring money into the NIH instead of letting pharma companies do whatever they feel like. It is both a brutal and inefficient system. 1. Institute price controls on essential drugs (along with Medicare for All) 2. Heavily tax non-essential/designer drugs 3. Pour that tax money into the NIH to fund further research in US research universities 4. Allow at least some importation to keep domestic drug companies honest. Ardennes fucked around with this message at 20:29 on Dec 26, 2019 |
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Dec 26, 2019 20:17
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It’s loving thievery is what it is. Our money should be managed and used by us to research and study medicine that is going to make us better.
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Dec 26, 2019 20:29
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This is an interesting KFF chart about who's uninsured by income range. While it's likely that the chunk of the under-100-percent-of-FPL (and a portion of the next income bracket) uninsured are living in non-expanded-Medicaid states, it's sort of surprising that the two income levels with the highest rates of uninsured are among those groups that receive the ACA subsidies. Also, just lol that anyone's making anti-M4A arguments based on cost, or claiming that the ACA's medical-loss ratio did anything to ameliorate private-insurance costs: 
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Dec 26, 2019 20:33
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VitalSigns posted:I still die, but also a bunch of diabetics who can't afford their insulin go bankrupt and die so their savings can go to develop another drug that's only for the rich. Insulin is a perfect example of what's wrong with US drugs today. Synthetic insulin was developed by a university and released into the public domain for anyone to use royalty free. Big pharma added the zest of a lemon, patented it, and that's what you pay a fortune for. It's why it's so cheap everywhere else.
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Dec 26, 2019 21:19
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KingNastidon posted:Even if importation from India was 100% safe it would still be short-sighted policy that throws a bunch of wrenches into long-term drug development decision process. No biotech VC is going to invest in the initial clinical development/regulatory process for novel small molecule drugs knowing the launch price will be set at India manufacturing cost. Think recent examples like TKIs in hematology/oncology, DAAs in Hep C, ARIs in prostate cancer, etc. Allocation of development dollars will shift to biologics and personalized cellular/gene therapies where importation is less of a threat. Lol gently caress them vcs. You do realize that the gross margins on drugs are so high that a 90% cut wouldn't do poo poo? Especially if you account for the publicly funded basic research that is rolled into the "costs" for drug making. The only country that has absurd drug prices is the US. You are a fool it you think that pharma companies don't make bank in Europe or Asia or Canada. They make only slightly less than the US. They also spend most of their capital on m&a and marketing, not basic research. It's the difference between a successful drug making $1B vs $10B. For orphan drugs and rare diseases maybe. But for insulin?
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Dec 26, 2019 21:58
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What is the formula under the ACA that sets allowable deductibles for each year's bronze plans?Because it's gone from $6,000 in 2014 to $8200 in 2020 and at that rate it'll be over $10k/person in no time. If the Medicaid threshold had risen at the same rate over the same period of time, people earning almost $23,000/year would now qualify for expanded Medicaid instead of the static FPL multiplier of $16,600 or so.
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Dec 27, 2019 23:07
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Working as intended obviously. The whole thing will collapse soon without a mandate.
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Dec 27, 2019 23:13
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Willa Rogers posted:What is the formula under the ACA that sets allowable deductibles for each year's bronze plans?Because it's gone from $6,000 in 2014 to $8200 in 2020 and at that rate it'll be over $10k/person in no time. Isn't it just pegged to actuarial value? iirc bronze is 60/40 premium vs deductible for actuarial value. But no, there's actually an ACA out of pocket maximum allowed, which is 8,150 individual/ 2x that family. Bronze plans just tend to 'happen' to have the OOP max as their deductible. Here, maybe? https://www.federalregister.gov/doc...meters-for-2020 So here's how the calculation worked for 2020: We divide the average 2019 private insurance premiums (employer-sponsored and individual market) by the average from 2013. That's 6,436 divided by 4,991, which equals 1.2895. That means premiums have increased by an average of about 29%. HHS then multiplies the out-of-pocket maximum from 2013 ($6,350) by 1.2895 in order to increase it by about 29%. That comes out to $8,188, and the result is then rounded down to the nearest $50 (under the terms of the regulations that govern this process). This results in $8,150 as the out-of-pocket maximum for 2020. In a nutshell, the idea is that average private insurance premiums increased by about 29% from 2013 to 2019, so out-of-pocket maximums had to also increase by roughly the same percentage from 2014 to 2020 (because they round down, the effective increase in out-of-pocket maximums was slightly smaller). Pegging the deductible to the OOP maximum is incredibly scummy, but sadly unsurprising. Above is from: https://www.verywellhealth.com/why-are-health-insurance-out-of-pocket-maximums-going-up-again-3962860
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Dec 28, 2019 02:23
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Zauper posted:incredibly scummy, but sadly unsurprising mods retitle please
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Dec 28, 2019 03:26
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Zauper posted:Isn't it just pegged to actuarial value? iirc bronze is 60/40 premium vs deductible for actuarial value. Jesus christ. So those $10k/year deductibles aren't that far off then, especially given the rate of increase in private, for-profit insurance:  And that's not even taking into account the new normal of narrow networks and surprise/balance billing, for which one assumes all out-of-network costs at the provider's rack rate--and not counting toward deductibles or OOP maximums. Thanks for finding that execrable formula.
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Dec 28, 2019 03:40
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In the family glitch and our insurance went up 200 dollars a month for next year. This is loving insane, so insane that I've been applying for every lateral move job at Disney Parks (for the past year) so I can have a union job with benefits, I've given up the idea of having holidays and weekends off at this point just so I can have good insurance. Uni healthcare cant come fast enough.
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Dec 29, 2019 07:38
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Have you seen my apex seals? I seem to have lost them.
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Just to show another charming intricacy of the incredibly free (unless you are talking about cost) US system, I received recently one of those sort of coupons for a medicine of mine that is normally $300-$400 per month where I get it for free if I use commercial insurance. They specifically say "commercial insurance" and specifically rule out Medicare or Medicaid. I can't speak for Medicare, but I was on Medicaid for two years and it was free there. In any event, it says something about the health care system where a company realises that even with "good" commercial insurance they can sucker people in by offering to pay the ludicrous co-pay ($70-$100) for them, but only if they don't have dirty government insurance that doesn't shovel enough money at them. I'm fortunate, so to speak, that I can live without this medicine, I just don't so good some days. One of my colleagues had to take in a room-mate because her have-it-or-die post-transplant medication costs $1000 a month; she's counting the four years to go until she is Medicaid illegible, because it's free then.
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Jan 1, 2020 23:21
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JustJeff88 posted:Just to show another charming intricacy of the incredibly free (unless you are talking about cost) US system, I received recently one of those sort of coupons for a medicine of mine that is normally $300-$400 per month where I get it for free if I use commercial insurance. They specifically say "commercial insurance" and specifically rule out Medicare or Medicaid. I can't speak for Medicare, but I was on Medicaid for two years and it was free there. In any event, it says something about the health care system where a company realises that even with "good" commercial insurance they can sucker people in by offering to pay the ludicrous co-pay ($70-$100) for them, but only if they don't have dirty government insurance that doesn't shovel enough money at them. I'm fortunate, so to speak, that I can live without this medicine, I just don't so good some days. One of my colleagues had to take in a room-mate because her have-it-or-die post-transplant medication costs $1000 a month; she's counting the four years to go until she is Medicaid illegible, because it's free then. Iirc it's illegal for those coupons on Medicare and such because it's a kickback. Ftr the copay cards do drive people to more expensive drugs.
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Jan 2, 2020 01:21
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Hurrah, today's the 10th anniversary of the ACA being signed into law! Where's my dnd peeps who are celebrating? All hail the predictions of 2010 dnd that the bill would result in Dem majorities for the following decade! All hail the soothsayers who said $7,000/year deductibles for people making $21k/year would only come into play for "serious illnesses"! All hail those who contended that "healthcare reform" had been achieved, and it was the first step toward single-payer, which would certainly be the next step in just a few years! All hail those who supported the Obama administration making all Medicaid funding contingent upon all states expanding Medicaid! All hail the contention that tying the medical-loss ratio to profit percentages instead of dollar amounts wouldn't incentivize provider-insurer-pharma collusion that led to higher medical prices! All hail those who welcomed the "bending of the cost curve" because people couldn't afford to actually use the insurance for which they paid! And now that we're in the midst of the greatest pandemic known to the country, all hail this marvelous piece of legislation that will result in millions of Americans dying because it was more important to listen to lobbyists when crafting the bill than listening to single-payer advocates!
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Mar 24, 2020 03:01
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evilweasel posted:Furthermore, the law has successfully bent the cost curve and kept medical inflation low even given this new surge of people able to afford health care, reduced medical errors and readmissions, and the fundamental mechanic of the exchanges (market competition) is working. I am hearing the ACA has also kept American troops from taking Saddam's glorious capital of Baghdad
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Mar 24, 2020 03:08
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