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How the pharmaceutical industry is dealing with the increasing price of insulin

jaeger19 said:
Yep.. all true.. just like any other country.



Yep.. if possible... but often they take lower payments from the insurance companies.

].

Absolutely. Just like any other business. Just like you would not want to work your way out of a job.



Actually that's pretty much not true anymore.. 30 years ago? Definitely,, now..not so much. Obamacare had lots of incentives and punishments that changed the practice patterns of physicians and ordering medications.



Why? You think insurance companies are benevolent entities that don't mind a four fold increase in their costs?
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I don't think pharmaceutical companies are benevolent entities, but they definitely don't mind a four fold increase in their costs. They applaud it, in fact.

According to a sixty minutes episode that aired last Sunday, the cost has actually gone up a lot more than four fold. That statistic is just in the past ten years or so.

Diabetics are taking less insulin than they should due to cost, and so risking complications. One person died from lack of insulin he could not afford.

Of course, big pharma doesn't care about that.
 
Dittohead not! said:
I don't think pharmaceutical companies are benevolent entities, but they definitely don't mind a four fold increase in their costs. They applaud it, in fact.

.
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Sure.. but apparently you think that insurance companies that pay for these meds don't care about their bottom line and have no issues with paying 4 times the price????

Not happening.

Diabetics are taking less insulin than they should due to cost, and so risking complications. One person died from lack of insulin he could not afford.
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Yeah.. I want to see exactly WHO these "diabetics are".... because I would bet the issue was NOT the "cost of insulin"... but was whether they had insurance and had chosen not to have insurance.

Look man.. I am just trying to inject some facts and logic into the discussion. WE have to much of the emotional rhetoric on both sides of the medical /healthcare issue.

I could find you multiple examples of people dying of heat stroke.. because they didn;t have air conditioning. No one expects frigidair to care.. and no one complains about the national cost of air conditioning.

I can find you people that died because they couold not "afford heat"..

Or because they got a heart attack because they could not afford a car to take them to work.. and so on. ...
 
jaeger19 said:
Sure.. but apparently you think that insurance companies that pay for these meds don't care about their bottom line and have no issues with paying 4 times the price????

Not happening.



Yeah.. I want to see exactly WHO these "diabetics are".... because I would bet the issue was NOT the "cost of insulin"... but was whether they had insurance and had chosen not to have insurance.

Look man.. I am just trying to inject some facts and logic into the discussion. WE have to much of the emotional rhetoric on both sides of the medical /healthcare issue.

I could find you multiple examples of people dying of heat stroke.. because they didn;t have air conditioning. No one expects frigidair to care.. and no one complains about the national cost of air conditioning.

I can find you people that died because they couold not "afford heat"..

Or because they got a heart attack because they could not afford a car to take them to work.. and so on. ...
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Yes, the people who die from lack of insulin are people who don't have adequate health insurance.

Those who do, the insurance companies will either negotiate a lower price with the pharmaceutical companies, or will pass the increase on to the customer in the form of copays.

Having adequate health insurance has become both a necessity, and a very difficult thing for most of the working poor. While Obamacare helps a lot, it still isn't the whole answer.

Before the ACA, which the current administration is doing everything it can to kill, people with pre existing conditions like diabetes had an even more difficult time having heath care.
 
Dittohead not! said:
Yes, the people who die from lack of insulin are people who don't have adequate health insurance.

.
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Bingo.. so the issue is insurance.. and not necessarily "what these horrible pharmaceutical charge".

Those who do, the insurance companies will either negotiate a lower price with the pharmaceutical companies, or will pass the increase on to the customer in the form of copays
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Bingo.. and lets think about this for a minute..

IF a person with diabetes can't afford his medication because they don't have insurance...

Lets think about who benefits from the following narratives.

"THAT pharmaceutical company charged 4 times the amount and killed that guy.. they don't care.. something must be done to lower the cost of medication"///

So.. the cost of medication is lowered.. the insurance companies make more money.. and the fellow without health insurance? HE STILL CAN"T AFFORD HIS DIABETIC CARE and DIES.

Now.. if the narrative is "insurance is the problem.. we need to get the price of insurance lower so people can afford insurance when they get sick,., like with diabetes".

Suddenly.. insurance companies cost less.. pharmaceutical will cost less.. (because insurance companies make money by controlling costs), and the fellow with diabetes is still alive.


I am just trying to inject some thought into the healthcare and insurance discussion.

.
 
Dittohead not! said:
That sounds like a pretty big if. Medications in general have soared in price, and continue to do so. The insulin story is just an illustration of why that is.



So, publish it in medical journals. I don't need to see constant pill ads on TV, and they don't need to spend money on such ads. Doctors and pharmacists need to know about new meds. The general public doesn't.





If no one is paying the price, what's the point of jacking up the price?
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https://www.nbcnews.com/health/health-news/several-probes-target-insulin-drug-pricing-n815141

There are already state investigation going on as to why.

Here is the thing i get sick of hearing. We are keeping track of market prices and being competitive.
being competitive means your price is going down as others are going up.

your not raising your price to match other people. that is stupid.
As you say there is no excuse in the 400% jump.


we then get to the core of the issue.

The PBM defendants play a central role in the scheme — selling formulary access in exchange for ‘rebates’ or other payments” from the manufacturers.

Rebates, or negotiated discounts, occur when a manufacturer sets a list price and then agrees to pass money back to the PBMs in return for something, generally a spot on the formulary that determines which drugs can be purchased.

the PBM's.

https://www.nytimes.com/2017/12/09/health/drug-prices-generics-insurance.html

cash is king it always has been it always will be.
 
jaeger19 said:
Bingo.. so the issue is insurance.. and not necessarily "what these horrible pharmaceutical charge".



Bingo.. and lets think about this for a minute..

IF a person with diabetes can't afford his medication because they don't have insurance...

Lets think about who benefits from the following narratives.

"THAT pharmaceutical company charged 4 times the amount and killed that guy.. they don't care.. something must be done to lower the cost of medication"///

So.. the cost of medication is lowered.. the insurance companies make more money.. and the fellow without health insurance? HE STILL CAN"T AFFORD HIS DIABETIC CARE and DIES.

Now.. if the narrative is "insurance is the problem.. we need to get the price of insurance lower so people can afford insurance when they get sick,., like with diabetes".

Suddenly.. insurance companies cost less.. pharmaceutical will cost less.. (because insurance companies make money by controlling costs), and the fellow with diabetes is still alive.


I am just trying to inject some thought into the healthcare and insurance discussion.

.
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Totally agree that the insurance industry is a huge part of the problem.

Now, had the pharmaceutical companies not managed a four fold increase in the cost of insulin in the first place, then the insurance industry would still be paying the original price, which would improve their bottom line.

So, what did they gain by increasing the price, then negotiating it lower once again?

And why is it, I wonder, that the cost of insulin is not controlled the same way the cost of cabbages is controlled? If supermarket A decides to sell at four times the market rate, the customers will just go somewhere else. Why is it that the customer doesn't go somewhere else? Is there some sort of price fixing going on? Sounds to me like a trust, or a cartel.
 
ludin said:
https://www.nbcnews.com/health/health-news/several-probes-target-insulin-drug-pricing-n815141

There are already state investigation going on as to why.

Here is the thing i get sick of hearing. We are keeping track of market prices and being competitive.
being competitive means your price is going down as others are going up.

your not raising your price to match other people. that is stupid.
As you say there is no excuse in the 400% jump.


we then get to the core of the issue.

The PBM defendants play a central role in the scheme — selling formulary access in exchange for ‘rebates’ or other payments” from the manufacturers.

Rebates, or negotiated discounts, occur when a manufacturer sets a list price and then agrees to pass money back to the PBMs in return for something, generally a spot on the formulary that determines which drugs can be purchased.

the PBM's.

https://www.nytimes.com/2017/12/09/health/drug-prices-generics-insurance.html

cash is king it always has been it always will be.
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Being competitive should mean your prices aren't higher than those of the competition. That's how the cost of airplanes to zithers is kept in check.

So, why doesn't it work that way with medications?
 
Captain Adverse said:
I agree with your general sentiment, but I am going to address this one point.

R & D in the pharmaceutical field is divided, with the least amount assigned to improving the current drug (in this case insulin) while the rest is used to develop OTHER drugs to combat OTHER medical issues. You know, all those other diseases that exist with little or no treatment options?

So your assertion that there is no need for funding R & D via increases on costs for sales of existing drugs simply because THOSE drugs are already on the market misses the mark.
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Judging from the many examples of new drugs approved and released for public use that are subsequently the targets of class action suits, the R&D process, or at least the approval process of FDA, are very deficient.
 
Thoreau72 said:
Judging from the many examples of new drugs approved and released for public use that are subsequently the targets of class action suits, the R&D process, or at least the approval process of FDA, are very deficient.
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That is a different issue entirely, and one I find problematic as we've seen with all those advertising efforts to create "ills" (like restless leg syndrome) so that otherwise dead-end research can still be turned to a profit.
 
Captain Adverse said:
That is a different issue entirely, and one I find problematic as we've seen with all those advertising efforts to create "ills" (like restless leg syndrome) so that otherwise dead-end research can still be turned to a profit.
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My favorite example of how corrupted the system has become is the case of colchicine, a drug that has been around for many centuries. Derived from some plant, it has long been just pennies a dose.

About 10 years ago our illustrious FDA "granted" a private company "rights" to produce the drug. It is now Colcrys (I think) and costs considerably more, maybe $10 a tablet. Thanks FDA.
 
RSHERMR said:
yup. The pharma industry is corrupt, and has nothing to do with capitalism, free markets, or normal pricing issues. Pharma is a group of companies in this country who are essentially oligopolies. They have a great deal of monopoly power in terms of controlling prices. And there is nothing being done about it by politicians, who are very well paid by those companies.
I am a diabetic, type 2. My doctor put me on a drug recently to try to help me stay away from insulin. Just another pill. I said good deal, and went to fill the prescription. And found out the cost of the drug was $700 for a month supply. So, I went back to the doctor, asked for options, and he told me the ONLY option was insulin. There is no generic for this drug. So they charge $700 for 30 pills.
My next stop was talking to others fighting the high cost of drugs. And found that one of the only ways around the problem is overseas prescription, and most wee buying from Canada. Because Canada has good safety laws, and buys from the same source as US pharmacies buy from. And you can check out the safety of individual pharmacies in Canada. I did so. Long story short, I have been paying $31 per month for the exact same pills that come from an international manufacture of the pills, which is owned and operated by Merck, the developer of the pills. So, I stay off of Insulin, get the pills from the manufacturer delivered via mail to my house, and save $670 per month. I simply have my local doctor fax a new prescription as needed to keep the prescription coming.
For me, problem solved.
But the issue is, why do I have to pay $700 for US pharmacy pills, and only $31 for the pills purchased from Canada. In neither case are these pills made in either the US or Canada. But it turns out you can buy those pills from lots of countries for the price I pay or less. So, apparently Merck believes we should provide their desired profit margin because the rest of the world not do so. ONLY IN AMERICA!!!
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If you’re commercially insured, virtually all branded diabetes medications have copay cards from the manufacturer that brings the monthly price down to anywhere between $0 and $25.

Sounds like you’re on Januvia, and their card is $5/mo.

Of course, if you’re on Medicare, the cards can’t be used.

It also sounds like you need a new doctor... there are several non-insulin options these days for T2DM, and the first line therapy is metformin, which is a super cheap generic.
 
Dittohead not! said:
Being competitive should mean your prices aren't higher than those of the competition. That's how the cost of airplanes to zithers is kept in check.

So, why doesn't it work that way with medications?
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You’re laboring under the illusion that pharma companies view the patient as the consumer.

You’re not!



The customers are the people who actually buy the drugs from the manufacturers. The PBMs and insurers , and often hospitals or hospital buying groups buy the drugs (the cash paying patients for branded drugs are few and far between), and there is fierce competition on pricing there.

You don’t see this openly, because the prices are discounted (often heavily) but the discounts are proprietary and secret.

But the thing is, many of these new drugs save lots of costs to insurers-less hospital admissions, for example. If you have a drug that doesn’t seem much better than a cheap generic, it won’t be used, no matter what the price.
 
Captain Adverse said:
That is a different issue entirely, and one I find problematic as we've seen with all those advertising efforts to create "ills" (like restless leg syndrome) so that otherwise dead-end research can still be turned to a profit.
Click to expand...

Restless leg syndrome is a very real thing. It was not invented...

The market opportunity there was withdrawal of quinine from the market, since it was the drug of choice for decades, but almost no research was ever done on it.
 
Thoreau72 said:
My favorite example of how corrupted the system has become is the case of colchicine, a drug that has been around for many centuries. Derived from some plant, it has long been just pennies a dose.

About 10 years ago our illustrious FDA "granted" a private company "rights" to produce the drug. It is now Colcrys (I think) and costs considerably more, maybe $10 a tablet. Thanks FDA.
Click to expand...

I don’t think this is a good example of ‘corruption’ of the system.

It’s just a bizarre case of an FDA loophole (similar to quinine, except not OTC) that forced any drug in the US being sold to undergo efficacy and safety trials. A very good idea with a couple legacy drugs leading to bad outcomes for consumers.

The allowable patent exclusivity was pretty short, and it’s now available generically for $4 again.
 
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Threegoofs said:
You’re laboring under the illusion that pharma companies view the patient as the consumer.

You’re not!



The customers are the people who actually buy the drugs from the manufacturers. The PBMs and insurers , and often hospitals or hospital buying groups buy the drugs (the cash paying patients for branded drugs are few and far between), and there is fierce competition on pricing there.

You don’t see this openly, because the prices are discounted (often heavily) but the discounts are proprietary and secret.

But the thing is, many of these new drugs save lots of costs to insurers-less hospital admissions, for example. If you have a drug that doesn’t seem much better than a cheap generic, it won’t be used, no matter what the price.
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So, the real losers in all of that are the patients who don't have insurance.

And so many people screamed about Obamacare requiring people to have insurance or pay a tax.
 
Dittohead not! said:
So, the real losers in all of that are the patients who don't have insurance.

And so many people screamed about Obamacare requiring people to have insurance or pay a tax.
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Yep.

But there’s ways around the system if you don’t have insurance, too.

Many branded drugs will give you the drug for free directly if you have a low income (which, theoretically, is the reason you’re uninsured).

It’s all unnecessarily complex because of the crazy regulations in place in healthcare, and the fact that the government pays half of the bills.

If govt paid all of the bills, it would all work much much more smoothly. But, we probably would severely hurt things like pharma innovation.
 
Threegoofs said:
Yep.

But there’s ways around the system if you don’t have insurance, too.

Many branded drugs will give you the drug for free directly if you have a low income (which, theoretically, is the reason you’re uninsured).

It’s all unnecessarily complex because of the crazy regulations in place in healthcare, and the fact that the government pays half of the bills.

If govt paid all of the bills, it would all work much much more smoothly. But, we probably would severely hurt things like pharma innovation.
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That could be, maybe. It depends on how much the government decided to cut the R and D budget. On the other hand, medications with less potential for profit could get a boost.
 
Dittohead not! said:
That could be, maybe. It depends on how much the government decided to cut the R and D budget. On the other hand, medications with less potential for profit could get a boost.
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Maybe. But I think having a profit motive really goes a long way in spurring innovation and productivity.

I think putting pharma completely in governments hands is such a bad idea, no one has ever really considered it before.
 
Threegoofs said:
Maybe. But I think having a profit motive really goes a long way in spurring innovation and productivity.

I think putting pharma completely in governments hands is such a bad idea, no one has ever really considered it before.
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I wonder just how much of that profit actually gets to the people doing the research, and how much goes to the top brass?
 
Dittohead not! said:
I wonder just how much of that profit actually gets to the people doing the research, and how much goes to the top brass?
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Well, the top brass are the ones who direct the research... I can tell you the decision to move a molecule into Phase 3, or even into humans, is always approved by the CEO, after very extensive deliberations.
 
Dittohead not! said:
Being competitive should mean your prices aren't higher than those of the competition. That's how the cost of airplanes to zithers is kept in check.

So, why doesn't it work that way with medications?
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the PBM's and everyone is out for their cut of the pie.

So i develop a drug. I can sell that drug on the open market for say 50 bucks for a perscription.
Now the issue is i have an insurance company or drug company that has a PBM. he wants his cut because he gets a cut of the difference.

https://www.newsweek.com/big-pharma-villain-pbm-569980

There is also the doctor that gets a cut from the drug company as well.

So the PBM goes i want a discount on your 50 dollar drug or i am not going to list it.

the drug company goes ok i will give you 5 dollars off and another 5 dollars if you sell 5m dollars of the drug.
So now the drug costs the PBM 40-45 dollars.

Well now they have to make their money as well. so they go to the pharmacy with a % charge and markup.
in come cases it is 11% or more. so that 50 dollar drug that i was selling is now 55-60 dollars to the pharmacy.
The pharmacy has to make money so by the time it gets to you that 50 dollar drug is now 70 bucks.

The problem with our medical costs is transparency in the system.

That is like the charge masters at the hospitals. one charge master could charge you 4k for an MRI while another at a different hospital will charge you 40k.

it is all smoke and mirrors and there is little to no control over what gets charged or not.
most people don't care because they simply go my insurance will pay it and i will cover the rest.

this has lead to a cycle of constant. price increases.

while us the patients take it up the rear end.

when 75% on average of every dollar is spent on defensive medicine and on administrative costs that is why our healthcare is so high.
there are ways to lower these costs. The first step is treating health insurance like car insurance.

You are responsible for the day to day care and insurance is only there if something bad happens.
 
Threegoofs said:
I don’t think this is a good example of ‘corruption’ of the system.

It’s just a bizarre case of an FDA loophole (similar to quinine, except not OTC) that forced any drug in the US being sold to undergo efficacy and safety trials. A very good idea with a couple legacy drugs leading to bad outcomes for consumers.

The allowable patent exclusivity was pretty short, and it’s now available generically for $4 again.
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What I meant was that the system has abandoned any idea of working for the people, in favor of working for industry. A pill that used to cost pennies and now costs dollars is not indicative of a system that works on democratic principles. That was all I meant.

Big Pharma is real, and the FDA is as corrupt as any other federal agency. Rather in an odd way, the case about Oxy that 60 Minutes did showed how screwed up the system is.
 
Thoreau72 said:
What I meant was that the system has abandoned any idea of working for the people, in favor of working for industry. A pill that used to cost pennies and now costs dollars is not indicative of a system that works on democratic principles. That was all I meant.

Big Pharma is real, and the FDA is as corrupt as any other federal agency. Rather in an odd way, the case about Oxy that 60 Minutes did showed how screwed up the system is.
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I disagree. The example you have is really a special case. The FDA granted a fairly short period of market exclusivity as an incentive to do the clinical trials. Within the system we have, this made sense. Who else would have done the trials? Are you advocating for the FDA to start doing them? Who’s gonna fund that?

The end result? We have data, we know how to use it better, and the drug, once again, costs pennies.

And the FDA definitely is not corrupt. The people I know there are all very ethical health care professionals, working to ensure safe and effective drugs.
 
Threegoofs said:
I disagree. The example you have is really a special case. The FDA granted a fairly short period of market exclusivity as an incentive to do the clinical trials. Within the system we have, this made sense. Who else would have done the trials? Are you advocating for the FDA to start doing them? Who’s gonna fund that?

The end result? We have data, we know how to use it better, and the drug, once again, costs pennies.

And the FDA definitely is not corrupt. The people I know there are all very ethical health care professionals, working to ensure safe and effective drugs.
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The Colchrys case is effectively the same case as the thread topic, insulin. A quick check for Colcrys prices shows 30 tabs for $221, so it doesn't cost pennies. What advantage did the consumer gain when the FDA facilitated that price increase?

The FDA is as corrupt as any other federal bureaucracy. Even the mainstream media, 60 Minutes and even Sharyl Attkisson, have documented that.
 
Thoreau72 said:
The Colchrys case is effectively the same case as the thread topic, insulin. A quick check for Colcrys prices shows 30 tabs for $221, so it doesn't cost pennies. What advantage did the consumer gain when the FDA facilitated that price increase?

The FDA is as corrupt as any other federal bureaucracy. Even the mainstream media, 60 Minutes and even Sharyl Attkisson, have documented that.
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Maybe you should check the cost of generic colchicine.

The colchicine case is not the same case of insulin. Not even close. Insulin is available from a variety of manufacturers, and I believe pharmacies like Walmart have had basic R,NPH, and 70/30 available for $25 for years.

There was a definite advantage- we got clinical trials showing colchicine was safe and effective, and clear label guidance from the FDA on how to use the drug based on randomized trial data instead of anecdotes. It’s not my area of expertise, but I believe the trials showed that a low dose strategy was just as effective as the old, traditional high dose strategy (where you give the drug every hour until the patient either feels better or blows chunks. Fun!), and I’m sure it clarified it’s adverse event profile better.

So now, consumers can get a drug that has been studied to the standards of every single other FDA approved prescription drug, which is the primary goal of the FDA.

It may seem silly and wasteful to you, but making sure an old, grandfathered drug actually works and is safe is kinda important in medicine.
 
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