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  #241  
Old 06-29-2018, 11:15 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.
This. No way pharma tolerated importing significant quantities from countries with lower prices. Because f*** you.
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  #242  
Old 06-29-2018, 11:19 AM
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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.

You know, a DEATH PANEL!!!1!!1!!1!
I was envisioning something more like a rate filing, but for Rx drug prices rather than insurance premiums. And at the national level so the drug companies don't have to go through 56 "state" agencies like the insurance companies do.
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  #243  
Old 06-29-2018, 11:25 AM
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I was envisioning something more like a rate filing, but for Rx drug prices rather than insurance premiums. And at the national level so the drug companies don't have to go through 56 "state" agencies like the insurance companies do.
I've never done rate filings, but my gut reaction is that the money, influence, resources, talent that Pharma companies have would bamboozle whoever in government is making these decisions into agreeing to a shitty deal.

I guess the Feds could outsource it to a consulting firm, but that would result in conflicts of interest and probably still bamboozling the Feds into agreeing to a shitty deal.
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  #244  
Old 06-29-2018, 03:16 PM
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I don't know why you'd even need regulators. If the goal here is to stop pricing from being wildly higher than expenses, just tax all profits past some pre-set margin (sound familiar?).

You could include depreciation of research costs, too (maybe, call them capital investments and then depreciate over time).

All that would just require a law, and the only regulator would be the IRS.
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  #245  
Old 06-29-2018, 03:29 PM
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I don't know why you'd even need regulators. If the goal here is to stop pricing from being wildly higher than expenses, just tax all profits past some pre-set margin (sound familiar?).

You could include depreciation of research costs, too (maybe, call them capital investments and then depreciate over time).

All that would just require a law, and the only regulator would be the IRS.
You're adding a 20% tax on profits beyond $X? Great, we'll increase prices a bit to offset that.
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  #246  
Old 06-29-2018, 03:33 PM
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The commercial payers are getting more savvy, they are starting to push harder on prior auth and establishing more formularies for specialty drugs, for example.

I suspect some might move to either cutting out the innovator drugs in favor of biosims, or reimbursing the innovator drugs very poorly so there is incentive for providers to use biosims. Just an example. They've already done things like this for generics and so-called 'therapeutic interchange' drugs. A therapeutic interchange is drugs that aren't the same compound, but are very comparable in terms of what they do. So, ibuprofen is a generic form of Advil, they are the same compound. But Advil vs acetaminophen, different compound, but both generally work well for a headache - therapeutically equivalent. So if you're a payer, you might favor generic acetaminophen over Advil - they both work well enough and the former costs less. You might even up the reimbursement rate for the cheaper drug to increase utilization, and/or decrease the reimbursement for Advil. (I understand both are over-the-counter, just an analogy)

Pharma is going to fight you every step of the way, in case you were wondering. They'll go to bat with providers to get them to want to keep using the innovator drugs.

All that to say, it's going to get ugly.

Last edited by George Frankly; 06-29-2018 at 03:41 PM.. Reason: Grammar is hard.
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  #247  
Old 06-29-2018, 03:35 PM
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A therapeutic interchange is drugs that aren't the same compound (like Advil vs ibuprofen)
Wait, I thought that Advil *was* ibuprofen???
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  #248  
Old 06-29-2018, 03:36 PM
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Wait, I thought that Advil *was* ibuprofen???
It is... I need to fix that sentence, it reads very poorly. I was in a bit of a rush on that one.
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  #249  
Old 06-29-2018, 03:56 PM
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Wait, I thought that Advil *was* ibuprofen???
YES

Advil vs Tylenol
OR
ibuprofen vs. acetaminophen

ETA - "aren't" vs. "are"
brand and generic.
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  #250  
Old 06-29-2018, 04:09 PM
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I was envisioning something more like a rate filing, but for Rx drug prices rather than insurance premiums. And at the national level so the drug companies don't have to go through 56 "state" agencies like the insurance companies do.
there isn't really another way I can think of. we hear of many other countries that pay much less for drugs. kind of like how in a rate filing you can't use Fl cat exposure as a reason for increasing rates in some other state, it is hard to argue that the US isn't making up for lost profits in other countries.

but I am not a fan of more regulation, so would greatly prefer some sort of competitive pressure to get there.
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