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  #231  
Old 05-30-2018, 11:46 AM
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How many more do we need?
Well at the rate that viruses are mutating and becoming resistant to antibiotics, it's pretty important that we are continually developing new ones to replace the ones that no longer work.

And there are literally thousands of maladies which have no cure, or no treatment, or the only treatments either don't work all that well and/or have significant negative side effects. I couldn't possibly list them all. But there's always improvements to be made.

And then there's development of new vaccines. I hear there's work being done on a universal influenza vaccine, for example. If developed and safe & effective, that has the potential to save millions of lives.

The 1919 influenza pandemic resulted in roughly 40 million deaths worldwide against a population of roughly 1.8 billion... over 2% of the global population perished and 20% were infected.

Apply that to today's population and a similar pandemic would kill roughly 170 million people in one year and infect 1.5 billion.
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  #232  
Old 05-30-2018, 12:45 PM
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Just lower the time frame on patents for drugs. 20 years is far too long.
One other approach would be to limit payment based on outcomes. You have a drug that cures cancer? Sure, we'll pay for that. You have a drug that improves overall survival by 30 days compared to other treatments? Sure, we'll pay you a bit more for that, but we aren't paying you $10k/month for that drug.

The CAR-T cell manufacturers are actually doing this. If the drug doesn't work, then they fully refund the cost. You (or your insurance company) would still be on the hook for costs associated with the treatment, but it's a pretty novel pricing model. Now, these drugs are $500k, so if they refund 20% of pts... it's still a high PMPM cost on average.

But this is a political mine field. CMS currently cannot negotiate drug prices, would require congress to act on something like this. And a lot of these drugs are released with fairly limited data, so it might take time to accrue credible data to set pricing. And I'm sure however the rubric is built to set prices, it would be imperfect. So it's my pipe dream, but it's not gonna happen anytime soon.
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  #233  
Old 06-28-2018, 04:39 PM
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So, modern drugs are very complex. Aspirin is comprised of 21 atoms, for example. Cyclophosphamide, a chemotherapy drug commonly used in oncology for decades, has 29 atoms. Many modern drugs are orders of magnitude larger - tens of thousands of atoms.

And that makes the concept of a generic drug very difficult. It's not easy to replicate such a large molecule from scratch. But, what we often find is that if we can make a molecule that is 'substantially similar' to the original molecule, the efficacy and toxicity can be made clinically equivalent. Such a molecule is called a biosimilar. Once a patent expires, a competitor can create a biosimilar molecule. If it passes muster with the FDA, then it can go to market. It's the modern equivalent of a generic drug.

There is a pipeline of biosims building, to replace some very expensive drugs. Notably, biosimilars for Remicade and Humira have been out for a while. In the oncology space, biosim Neupogen came out first but it's just not a blockbuster drug. There are biosims for Herceptin and Avastin that I think are tied up in the courts. But the big one is biosim Neulasta just got approved... for two different manufacturers. Neulasta is the single biggest drug in oncology, in terms of total spend. If you're on the health side, look for proc code J2505 and you should see some massive dollars.

In my limited experience, biosims seem to come out priced fairly close to the price of the original drug, and then erode. Neupogen’s biosim is about 30% cheaper than the brand-name drug currently. With two competitors coming on-line, the price for these drugs could come down rather quickly.

Should be an interesting time, in the world of ever-increasing drug prices, a bit of competition to maybe deflate costs for at least a few $$$ drugs.

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  #234  
Old 06-28-2018, 11:08 PM
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https://newrepublic.com/article/1494...paign=sharebtn


I found that today. It's a good read and has a lot of history that I didn't know. It mentions how much cheaper drug prices are overseas, but doesn't make it the central argument for why US prices suck.

It also has a misconceived notion that government regulation under one regime can fix this. Most companies flat our don't care (Mylan and EpiPen rebates) and will just ignore regulations.
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  #235  
Old 06-29-2018, 12:41 AM
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https://newrepublic.com/article/1494...paign=sharebtn


I found that today. It's a good read and has a lot of history that I didn't know. It mentions how much cheaper drug prices are overseas, but doesn't make it the central argument for why US prices suck.

It also has a misconceived notion that government regulation under one regime can fix this. Most companies flat our don't care (Mylan and EpiPen rebates) and will just ignore regulations.
Good article. For years the R&D costs were the go-to argument for high drug prices. That schtick is wearing thin. Quite a few new drugs are $$$ and not any better than existing therapies (see: Provenge, very limited clinical benefit). And then there is Valeant, at the forefront of the new model. Their motto is basically: we charge what we want, because f*** you.

The question is slowly pivoting to: what is the drug worth? Thatís a really hard question, but a really, really important one.
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  #236  
Old 06-29-2018, 09:38 AM
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Good article. For years the R&D costs were the go-to argument for high drug prices. That schtick is wearing thin. Quite a few new drugs are $$$ and not any better than existing therapies (see: Provenge, very limited clinical benefit). And then there is Valeant, at the forefront of the new model. Their motto is basically: we charge what we want, because f*** you.

The question is slowly pivoting to: what is the drug worth? That’s a really hard question, but a really, really important one.
So what if drug prices were regulated like insurance premiums? (Preferably at the federal level though) It adds a lot of red tape, but it seems like there might be a case for it.
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Old 06-29-2018, 10:04 AM
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So what if drug prices were regulated like insurance premiums? (Preferably at the federal level though) It adds a lot of red tape, but it seems like there might be a case for it.
To me, it would make the most sense to just ease import/export rules between US customers and other countries. It would work better than additional regulations - there's always a way to skirt regulations.
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  #238  
Old 06-29-2018, 10:40 AM
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To me, it would make the most sense to just ease import/export rules between US customers and other countries. It would work better than additional regulations - there's always a way to skirt regulations.
So for Americans to get decent prices on Rx drugs manufactured in the US, the drugs must first be shipped to Canada and then sold back to Americans?

Or is the assumption that once this is allowed, the drug companies will just lower their US prices to match the Canadian prices (since that would presumably mean slightly more margin for them in that the Canadian middle men would not need to be paid)?
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Old 06-29-2018, 11:02 AM
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Pharmaceutical companies essentially set prices in each country by choosing the highest number they can get away with.

If consumers have the option of importing from another country (primary argument against this is quality control - for some reason, politicians are convinced that Rx sold in London aren't good enough for America), I'd assume that manufacturers will set prices on a global scale rather than a national scale. For example, EpiPen being $70 in other countries and $600 here. I'd assume the global price would be somewhere in the middle. And, the possibility of importing generics that are available overseas and not in the USA would also help.
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  #240  
Old 06-29-2018, 11:14 AM
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So what if drug prices were regulated like insurance premiums? (Preferably at the federal level though) It adds a lot of red tape, but it seems like there might be a case for it.
The UK does this, via the NICE commission. They evaluate the clinical benefit of the drug, and look at the price, and decide whether or not itís covered. I donít know if there is any negotiation or not. That is, Amgen might say they want $5,000, and NICE says no, and maybe Amgen comes back at $3,000 and the deal gets done.

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