This whole thing poses such an interesting dilemma.
A private pharmaceutical company should obviously be compensated and allowed to profit from its innovations, but at the same time its market is composed of people in dependent if not desperate circumstances. Obviously you don't want sick people suffering when there's a treatment available, or companies profiteering on the backs of the vulnerable, but at the same time you can't pillage a company for its innovations in a way that discourages or prevents them from having any more.
There's probably a whole slew of different ways to resolve this, it's just a question of what policy would best encourage the company to innovate while at the same time allowing the sick the most access to the benefits of the drug.
I wonder how it would work if the government simply nationalized all pharmaceutical patents after a certain period and then either produced the drugs themselves or issued price-controlled contracts to private companies to do the manufacturing - either way exercising control on the market price and availability of the drug after a certain period of time.
That could result in a situation where the state of (readily available) medicine will always be about, say, 10 years behind the state-of-the-art, which isn't terrible, but which still doesn't resolve the moral issue of life-saving technology being withheld from those with lower incomes.
I find it hard to see how medicine isn't critical national infrastructure, but have a hard time seeing how you nationalize pharmacy without clobbering innovation and development too.
I also have no idea what I'm talking about though.
I have a simple idea that I haven't really thought out but whatever.
If you can get rich selling drugs that help people and fight disease, good for you.
If you decide you can get even richer by increasing the price so much that many people will actually die because they can no longer afford it, you should shoot yourself.
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^ If you were to need to nationalize drug development, funding Universities to do it would probably be the best way to go.
That's what USSR did. As a result, no new breakthrough drugs have been developed there since 1917. I could be wrong on this but I am not aware of a single drug that was patented in USSR first and then copied in the west.
To be fair, there have been some spectacular breakthrough treatments developed by the individual Soviet genius doctors (i.e first ever laser eye surgery, some impressive bone and joint therapies), but very rarely.
You cannot nationalize entrepreneurial spirit, innovation and ingenuity successfully. China has been actively stealing technical and scientific secrets for three decades now but could not do anything new with them until they had partially privatized the industry. Nationalization always leads to the active promotion of undeserving individuals to the top posts in government corporations, corruption and stagnation.
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This whole thing poses such an interesting dilemma.
A private pharmaceutical company should obviously be compensated and allowed to profit from its innovations, but at the same time its market is composed of people in dependent if not desperate circumstances. Obviously you don't want sick people suffering when there's a treatment available, or companies profiteering on the backs of the vulnerable, but at the same time you can't pillage a company for its innovations in a way that discourages or prevents them from having any more.
There's probably a whole slew of different ways to resolve this, it's just a question of what policy would best encourage the company to innovate while at the same time allowing the sick the most access to the benefits of the drug.
I wonder how it would work if the government simply nationalized all pharmaceutical patents after a certain period and then either produced the drugs themselves or issued price-controlled contracts to private companies to do the manufacturing - either way exercising control on the market price and availability of the drug after a certain period of time.
That could result in a situation where the state of (readily available) medicine will always be about, say, 10 years behind the state-of-the-art, which isn't terrible, but which still doesn't resolve the moral issue of life-saving technology being withheld from those with lower incomes.
I find it hard to see how medicine isn't critical national infrastructure, but have a hard time seeing how you nationalize pharmacy without clobbering innovation and development too.
I also have no idea what I'm talking about though.
There's a couple serious flaws here.
First, you can't ignore international patents without serious repercussions. There's no secret what's in new drugs. They publish what they are, you needn't rediscover them. It's producing them against patent law which is the sticky point.
Second, this already is done with the patent system. Drugs become pennies to the dollar cheaper once patents wear off (approximately 10 years of market exclusivity). Then you rely on generics.
The real issue is still supply and demand, as drug ingredients are a global commodity and you can't just ignore that. This idiot shouldn't change Canada's policy, which works fine at the moment (albeit with some minor exceptions)
To me, we're all barking up the wrong tree. Drugs are a very small part of growing and unsustainable health expenditure. You can't pinch pennies when you're bleeding dollars
Last edited by Street Pharmacist; 09-24-2015 at 12:49 AM.
To me, we're all barking up the wrong tree. Drugs are a very small part of growing and unsustainable health expenditure. You can't pinch pennies when you're bleeding dollars
Really?
Quote:
Various studies have pegged Canada-wide savings from national pharmacare at between $4 billion and $11 billion per year, depending on how the program is structured. That’s based on savings seen internationally.
Canada is, in fact, the only country with a universal health care system that doesn’t also cover the cost of prescription medicine.
Administration costs represent another burden. Authors of the report note that every public and private drug plan operating in this country spends money on revenue collection, claims management and other bureaucratic functions. Savings from ending this duplication alone were valued at between $1 billion and $2 billion.
So that's between $5 and 13 billion per year in savings. Taken with this:
Quote:
Our current patchwork of plans does nothing to restrain drug costs. Spending on drugs is increasing by a remarkable 8 per cent a year above inflation, a rate we can’t sustain.
I don't get this. If its a 60+ year old drug, and this guy raises the price to $750/pill, what's to stop a generic manufacturer from coming in and undercutting him? If there are no limits on who can produce something, its price will probably decline to just above the cost of producing it.
Am I missing something here?
I wondered the same and did some (completely high-level) research....
The issue is that you can't quickly ramp up and start producing medications overnight. Building a facility to produce small batch pharmaceuticals is an incredibly expensive proposition.
Realistically, you'd need a couple of years (possibly, even likely more) to get the financial backing arranged and wade through the government paperwork. The amount of paperwork seems staggering, and all of it is linked to government, so you know it ain't fast or logical.
The alternative is to outsource to an existing contract manufacturer. The challenges are theoretically reduced, but there's still plenty of licensing and QA/QC requirements to address.
Now that we've secured our paperwork and source of manufacturing, there's still the little business of actually selling the medication. Assuming that the price is reasonable, this shouldn't be a problem....but it still takes time.
It appears to me that this is what the patent vultures rely on. The fact that it there is no competition and won't be any competition for at least a couple of years guarantees huge profits. 10 cent pills for $750 for a couple years......
As for my exact opinion.....I think that the practice is disgusting.
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I'm with it nearly to the end - and then I have some reservations. It starts somewhere around here:
Quote:
Comparable health care systems around the world
achieve lower prices by using the purchasing power of
a single payer for pharmaceuticals. Manufacturers who
price competitively get the reward of their drugs being
covered for 100% of the population. The savings can be
remarkable.
I am not sure a monopoly should be given to any one manufacturer/developer based on best price versus best efficacy/safety/patient outcomes.
Biologic drugs would be my best example. They are very expensive but can provide incredible benefits and provide quality of life and return dignity to people who otherwise would have no opportunity to enjoy meaningful, productive lives. In most disease areas where these drugs are applicable, there are a few choices and little consensus as to which is 'the best' in terms of safety/efficacy. I am not sure one product should get a monopoly for 100% of the population, simply on the basis of cost.
Depending on the mechanism of this part of the plan, I think it would be entirely fantastic for all Canadians.
Most of those measures have already been done, without most of the savings expected.
In 2014, the provincial governments spent $12.1B on medication. In 2013, 12.2B (both figures from Canadian institute for health information). Drug spending is approximately 13.5% of total health expenditure. To save 5% would be essentially cutting total drug spending almost in half. Maybe there's savings on the operations side, but not in drug costs.
The provincial governments are already doing single source generics (tendering, as described in the article above), and it hasn't provided anywhere near the savings expected. Drug expenditures dropped from 2013 to 2014, but almost all of that drop was because an unprecedented number of molecules became generic. Single source tendering also was responsible for a number of drug shortages.
Secondly, almost all growth in drug expenditures is biologics and novel cancer therapies. The number of prescriptions for drugs costing over $1500 per month has skyrocketed. I dispensed $20,000 in Harvoni to one patient for one month yesterday. There's no way to save via tendering here as there's no generics
Last edited by Street Pharmacist; 09-24-2015 at 12:00 PM.
Reason: Billions, not Millions. Mo money, mo spelling mistakes
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I wondered the same and did some (completely high-level) research....
The issue is that you can't quickly ramp up and start producing medications overnight. Building a facility to produce small batch pharmaceuticals is an incredibly expensive proposition.
Realistically, you'd need a couple of years (possibly, even likely more) to get the financial backing arranged and wade through the government paperwork. The amount of paperwork seems staggering, and all of it is linked to government, so you know it ain't fast or logical.
The alternative is to outsource to an existing contract manufacturer. The challenges are theoretically reduced, but there's still plenty of licensing and QA/QC requirements to address.
Now that we've secured our paperwork and source of manufacturing, there's still the little business of actually selling the medication. Assuming that the price is reasonable, this shouldn't be a problem....but it still takes time.
It appears to me that this is what the patent vultures rely on. The fact that it there is no competition and won't be any competition for at least a couple of years guarantees huge profits. 10 cent pills for $750 for a couple years......
As for my exact opinion.....I think that the practice is disgusting.
This is the also one of the factors exasperating the drug shortages issues we've been having
We've seen enough cases now to see capitalism and highly inflexible demand not working. Should there be more regulation in these case? Not so if American companies have their way. A US company has taken the Canadian government to court over the government's regulator body forcing lower prices for a drug that treats two rare blood diseases. These drugs currently cost $700k/year....
A U.S. drug company is taking the Canadian government to court for its attempt to lower the price of what has been called the world's most expensive drug.
Alexion Pharmaceuticals has filed a motion in Federal Court, arguing that Canada's drug price watchdog has no authority to force the company to lower its price for Soliris.
- Amir Attaran, health law expert
The company says in the court documents that the price of Soliris has not changed since it went on the market about six years ago and that the price difference between the two countries reflects the difference in exchange rates between the U.S. and Canada.
Another thing though that should have people worried. The TPP trade agreement being hashed out right now was previously attempting to kill regulator watchdogs abilities to do price regulation just like this. At least they were planning to slip a lot of provisions for this in back in June, they look they they are dropping it for now though there is no reason US lobby couldn't try to get it back in. That should have a lot of people worried if the current government goes through and approves this thing because how many other "hidden" lobby specific provisions are there? http://www.nytimes.com/2015/06/11/bu...t-reveals.html
EDIT: On further reading the original TPP draft would have force a general regulatory scheme that would override this watchdog specifically. More on this on wikileaks... https://wikileaks.org/tpp/healthcare/
Turing Pharmaceuticals has reported a $14.6 million net loss in their third-quarter, from July to the end of September, this year.
In mid-August, the pharmaceutical company purchased the rights of Daraprim and raised the price by over 5,000 percent, making the cost of the pill rocket from $13.50 (£8.70) a tablet to $750 (£485). The drug is used by patients with AIDS or cancer to fight the Toxoplasma gondii parasite. More than 60 million Americans carry the parasite without coming to harm, but it can lead to seizures, blindness or neurological damage to those with a compromised immune system.
Of course they're not following through here. I suppose they feel invincible to bad PR.
Quote:
After weeks of criticism from patients, doctors and other drugmakers for hiking a life-saving medicine's price more than fifty-fold, Turing Pharmaceuticals is reneging on its pledge to cut the $750-per-pill price.
Instead, the small biotech company is reducing what it charges hospitals, by up to 50 percent, for its parasitic infection treatment, Daraprim. Most patients' copayments will be capped at $10 or less a month. But insurers will be stuck with the bulk of the $750 tab. That drives up future treatment and insurance costs.
Daraprim is a 62-year-old pill whose patent expired decades ago. It's the preferred treatment for a rare parasitic infection, toxoplasmosis, which mainly threatens people with weak immune systems, such as HIV and organ transplant patients, and pregnant women, because it can kill their baby.
Dr. Carlos del Rio, chairman of the HIV Medicine Association, called Turing's changes "just window dressing."
Turing's move comes after a pharmacy that compounds prescription drugs for individual patients, Imprimis Pharmaceuticals, started selling a custom-made version for 99 cents per capsule. Those sales weren't a factor in Turing's pricing strategy, chief marketing officer Nancy Retzlaff said Wednesday.
Del Rio noted that while hospitals treat many patients initially, most are then treated at home for a couple months, so the lower hospital price doesn't help.
Quote:
A furor over Turing's staggering price hike erupted, triggering multiple government investigations and pledges from politicians to rein in soaring prescription drug prices. Those include newly approved medicines costing around $100,000 a year and some old, formerly cheap generics.
Amid the heat, Turing CEO Martin Shkreli said he'd lower the price. Instead, the company just lowered hospitals' price and is offering the option of buying 30-pill bottles instead of 100-pill bottles to reduce their costs to stock it. Shkreli wasn't available for an interview.
Imprimis Chief Executive Officer Mark Baum said Wednesday in an exclusive interview that orders are pouring in for its version of Daraprim from doctors and the company has dispensed more than 2,500 capsules since Oct. 22.
A boyish drug company entrepreneur, who rocketed to infamy by jacking up the price of a life-saving pill from $13.50 to $750, was arrested on securities fraud related to a firm he founded.
Martin Shkreli, 32, ignited a firestorm over drug prices in September and became a symbol of defiant greed. The federal case against him has nothing to do with pharmaceutical costs, however. Prosecutors charged him with illegally taking stock from Retrophin Inc., a biotechnology firm he started in 2011, and using it pay off debts from unrelated business dealings. He was later ousted from the company, where he’d been chief executive officer, and sued by its board.
In the case that closely tracks that suit, federal prosecutors accused Shkreli of engaging in a complicated shell game after his defunct hedge fund, MSMB Capital Management, lost millions. He is alleged to have made secret payoffs and set up sham consulting arrangements.