$1,000 a pill. Worth it?

[RxMonkey]

http://www.sfgate.com/health/article/1-000-hepatitis-C-pill-a-tough-miracle-to-swallow-5455230.php

TL;DR: A new Hepatitis C Drug with excellent tolerability has a 90+ % cure rate after a 12 week regimen. But it comes at an expected cost of 84,000 dollars.

I'm curious to see how the cost of the med is handled by prescribers, payers, policy makers, etc.

Any opinions?

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[PharmEcon]

The Sovaldi story has been huge. Lots of great opinion pieces out there. Payers are threatening to limit payments/access until cheaper alternatives are available, providers are pushing back, and Gilead is really testing the market. Will be interesting to see where it all goes.

 

[radio frequency]

Payers are freaked out by the huge costs. It's getting prescribed all over and has a bunch of coupons that mean patient use isn't deterred by drug tier...but it's cheaper than a liver transplant. Similar meds are coming to market soon though so prices will likely have to come down.

Like PharmEcon said, this has been all over the news. Search Google News to find out more.

 

[anewmanx]

It's a despicable indictment of the American medical system and one reason I, even as a hard-line conservative, believe in socialized medicine (with the freedom of cash private practice like they have here in Costa Rica.)

To make a drug that people will likely die without, or need organ transplant, and charge an eye for it is disgusting. There is no possible way that it is a justifiable cost for the drug. We regulate the amount of money that can be made on a transaction in the Real Estate and Mortgage industry; why not the prescription drug industry?

Shame on our culture. Blood money.

 

[zelman]

It's a despicable indictment of the American medical system and one reason I, even as a hard-line conservative, believe in socialized medicine (with the freedom of cash private practice like they have here in Costa Rica.)

To make a drug that people will likely die without, or need organ transplant, and charge an eye for it is disgusting. There is no possible way that it is a justifiable cost for the drug. We regulate the amount of money that can be made on a transaction in the Real Estate and Mortgage industry; why not the prescription drug industry?

Shame on our culture. Blood money.

I'm sure all the Costa Rican multimillion dollar drug development results are sold for pennies.

 

[deleted480308]

It's a despicable indictment of the American medical system and one reason I, even as a hard-line conservative, believe in socialized medicine (with the freedom of cash private practice like they have here in Costa Rica.)

To make a drug that people will likely die without, or need organ transplant, and charge an eye for it is disgusting. There is no possible way that it is a justifiable cost for the drug. We regulate the amount of money that can be made on a transaction in the Real Estate and Mortgage industry; why not the prescription drug industry?

Shame on our culture. Blood money.

you aren't a conservative if you believe in socialized medicine

and no, we don't regulate how much you can sell your house for....

 

[anewmanx]

I'm sure all the Costa Rican multimillion dollar drug development results are sold for pennies.

What an idiotic statement. I've yet to hear of a major discovery here; this is not a country large enough to support significant research. What I can tell you is they do not allow ridiculous price gouging on medical care.

 

[anewmanx]

you aren't a conservative if you believe in socialized medicine

and no, we don't regulate how much you can sell your house for....

We differ on opinion regarding that. I don't believe in spending more than you make. That is the very definition of fiscal conservative. It took witnessing first hand how superior socialized medicine was to realize how idiotic our insurance/healthcare system in the United States is. Just to clarify, Obamacare is not socialized medicine. It is an insurance scheme and tax grab written by lobbyist that is destroying the country.

Yes, they do regulate how much a real estate agent can charge in commission. Same with mortgage brokers and the origination fee.

 

[deleted480308]

Yes, they do regulate how much a real estate agent can charge in commission. Same with mortgage brokers and the origination fee.

apples and oranges to selling a pill you create... it's the seller and not the broker that is more relevant.... I build a house and sell it for what I want, I build a pill and sell it for what I want

 

[radio frequency]

It's a despicable indictment of the American medical system and one reason I, even as a hard-line conservative, believe in socialized medicine (with the freedom of cash private practice like they have here in Costa Rica.)

To make a drug that people will likely die without, or need organ transplant, and charge an eye for it is disgusting. There is no possible way that it is a justifiable cost for the drug. We regulate the amount of money that can be made on a transaction in the Real Estate and Mortgage industry; why not the prescription drug industry?

Shame on our culture. Blood money.

Disagree. This is a medication that saves people from a very expensive transplant. The R&D costs were not free; the company is trying to recoup their investment before other meds come on the market.

Frankly, $84k is not that much when comparing the benefits. Yes, it's expensive, and could be hard on the payers (note that payers =/= patients), but if I had Hep C, I would gladly line up to pay cash for a drug like this if it wasn't available through my insurer. Really, it would be worth it.

 

[anewmanx]

apples and oranges to selling a pill you create... it's the seller and not the broker that is more relevant.... I build a house and sell it for what I want, I build a pill and sell it for what I want

And if you bought all the houses in a town, refused to sell any of them, and charged every last penny people had in rent I'd call you a dispicable slum lord. I don't see the difference in the two situations. Both are corrupt and shameful practices.

 

[anewmanx]

Disagree. This is a medication that saves people from a very expensive transplant. The R&D costs were not free; the company is trying to recoup their investment before other meds come on the market.

Frankly, $84k is not that much when comparing the benefits. Yes, it's expensive, and could be hard on the payers (note that payers =/= patients), but if I had Hep C, I would gladly line up to pay cash for a drug like this if it wasn't available through my insurer. Really, it would be worth it.

I highly doubt research and development came anywhere close to the amount of money they are going to rake in.

You think 84k isn't much, but then again as a Pharmacist you can make six figures.

 

[deleted480308]

And if you bought all the houses in a town, refused to sell any of them, and charged every last penny people had in rent I'd call you a dispicable slum lord. I don't see the difference in the two situations. Both are corrupt and shameful practices.

people would just leave and I'd have no renters, just like if I charge too much for a pill no one will buy it....you've seen an economics textbook so I'm sure you understand this...

 

[radio frequency]

In a capitalist economy, if the R&D came out to be similar in cost to the amount of money they were taking in, the company would go under. This is how things work here.

Until we have government-run medication development and manufacturing, it is what it is and shareholders need payback for the risks they take in investing.

Moreover, I think you can view this through multiple lenses.
Lens 1: This company is charging us too much money for this necessary pill!
Lens 2: This company made a necessary pill and is saving lives! Of course, it's expensive!

 

[anewmanx]

In a capitalist economy, if the R&D came out to be similar in cost to the amount of money they were taking in, the company would go under. This is how things work here.

Until we have government-run medication development and manufacturing, it is what it is and shareholders need payback for the risks they take in investing.

It's a shame. With all of our out of control spending, that it doesn't get put towards that.

 

[radio frequency]

Do they do both R&D and manufacturing of medications in CR through government-funded enterprises?

 

[anewmanx]

people would just leave and I'd have no renters, just like if I charge too much for a pill no one will buy it....you've seen an economics textbook so I'm sure you understand this...

I used to live in a little town called Big Stone Gap. Nearly all of the rentals were owned by one family. People were poorly educated, and only had a small subset of jobs they could perform. It was a backwards area that everyone was afraid to move away from. That family price gouged. Few moved. What eventually happened? Everyone ended up on government assistance who was living in his apartments. The apartments degraded into slums, and good old Steve(the owner) got richer.

Theory doesn't always match up with reality. In this case, people can't simply "move away" from their Hep C.

 

[deleted480308]

I used to live in a little town called Big Stone Gap. Nearly all of the rentals were owned by one family. People were poorly educated, and only had a small subset of jobs they could perform. It was a backwards area that everyone was afraid to move away from. That family price gouged. Few moved. What eventually happened? Everyone ended up on government assistance who was living in his apartments. The apartments degraded into slums, and good old Steve(the owner) got richer.

Theory doesn't always match up with reality. In this case, people can't simply "move away" from their Hep C.

the theory matches up perfectly in a capitalistic system. In big stone gap, without a government to come in and help pay the artificially high rates, people would be forced to move out and with no one to replace the renters the landlord would have to lower rent or take a loss. in terms of medical needs, people who can't afford a pill that is priced too high for the market move on to the other options they would have had if the pill never existed....and if enough people do so, the company notices they aren't making enough sales to pay back their R/D and the lower costs to find the "sweet spot" of the market.

 

[anewmanx]

Do they do both R&D and manufacturing of medications in CR through government-funded enterprises?

The only research company I know of is InBio and it's a non-profit. They more than likley have significant government backing. They are cataloging the plants and insects in the massive rain forests here.

 

[anewmanx]

the theory matches up perfectly in a capitalistic system. In big stone gap, without a government to come in and help pay the artificially high rates, people would be forced to move out and with no one to replace the renters the landlord would have to lower rent or take a loss. in terms of medical needs, people who can't afford a pill that is priced too high for the market move on to the other options they would have had if the pill never existed....and if enough people do so, the company notices they aren't making enough sales to pay back their R/D and the lower costs to find the "sweet spot" of the market.

I will remind you that the "other option" most of them will move on to, who cannot afford the drug, is death.

 

[deleted480308]

I will remind you that the "other option" most of them will move on to, who cannot afford the drug, is death.

I'm aware of the dangers of that disease

 

[radio frequency]

I think you both could do some research on how Hep C works and the treatment options available other than Sovaldi.

 

[anewmanx]

I think you both could do some research on how Hep C works and the treatment options available other than Sovaldi.

I can agree with that. My only experience with the disease was an elderly friend with Hep C who lived with it a long time. She was in her fifties. While she was still alive, I would not call her quality of life anything worth living. Her health was severely damaged by the disease and it clearly contributed to shortening her life. She did not make it to her late sixties.

 

[Carboxide]

Do any of you think it matters that Hep C is almost always contracted via intravenous drug usage?

 

[radio frequency]

Do any of you think it matters that Hep C is almost always contracted via intravenous drug usage?

No. Hep C is indolent for a LONG time in patients; patients could be older and not even realize they contracted the virus when much younger.

Patients could have contracted it sexually or through blood transfusions before 1992. They could have gotten it through dialysis, sex with an infected person (who likely also didn't know they were infected due to the long indolent period), medical treatment (inadvertently) or just being born to an infected mother.

I'm not here to judge patients, I'm here to help.

 

[deleted480308]

Do any of you think it matters that Hep C is almost always contracted via intravenous drug usage?

in terms of the right for a producer to charge what they want for their product....nothing matters

 

[eagles22]

No. Hep C is indolent for a LONG time in patients; patients could be older and not even realize they contracted the virus when much younger.

Patients could have contracted it sexually or through blood transfusions before 1992. They could have gotten it through dialysis, sex with an infected person (who likely also didn't know they were infected due to the long indolent period), medical treatment (inadvertently) or just being born to an infected mother.

I'm not here to judge patients, I'm here to help.

There are exceptions to every rule, but the vast majority of the people who have hep C have it due to a poor choice they made at one point or another.

 

[radio frequency]

There are exceptions to every rule, but the vast majority of the people who have hep C have it due to a poor choice they made at one point or another.

See sb247's post above.

Also: lots of things are the result of poor choices. Do you turn patients away in the ER when they had an auto accident for which they're at fault? What if they were speeding? I just think when you start bringing your morals into these decisions, things get very murky. I don't have time for that. I'll leave the moralizing to others.

 

[anewmanx]

No. Hep C is indolent for a LONG time in patients; patients could be older and not even realize they contracted the virus when much younger.

Patients could have contracted it sexually or through blood transfusions before 1992. They could have gotten it through dialysis, sex with an infected person (who likely also didn't know they were infected due to the long indolent period), medical treatment (inadvertently) or just being born to an infected mother.

I'm not here to judge patients, I'm here to help.

Quite right. My friend got it during a heart surgery. Bad batch of blood.

 

[StephenCurry]

It may cost 84k per duration of treatment but we should compare it to the current therapy right? Peg Interferon + Ribavirin + Protease Inhibitors (for some) which doesn't have that great of a cure rate to begin with compared to this new Gilead drug. The current therapy is expensive too, if i'm not mistaken, around 50 to 60k?

 

[zelman]

What an idiotic statement. I've yet to hear of a major discovery here; this is not a country large enough to support significant research. What I can tell you is they do not allow ridiculous price gouging on medical care.

When foreign governments refuse to pay fair market value for drugs, they are encouraging price gouging...elsewhere...the USA, specifically.

 

[WVUPharm2007]

If I'm these insurers, I fly patients to the third world, allow them to be issued meds where it probably costs $1000 for the whole course, complete the treatment while at a nice resort, then fly back. It would save them millions, patients get treatment, doctors are happy, patients are really happy. Win, win, win.

 

[KARM12]

Hep C treatment has been poor for years. Exciting to have something new on the market!

 

[confettiflyer]

Yeah I'm tired of The US subsidizing drug prices for the rest of the world.

 

[anewmanx]

When foreign governments refuse to pay fair market value for drugs, they are encouraging price gouging...elsewhere...the USA, specifically.

I call bull****. They price gouge because they can. It costs pennies to produce the drugs and the R&D is paid back within months of a product being on the market. Their are over 7,000,000,000 people in the world.

 

[anewmanx]

Yeah I'm tired of The US subsidizing drug prices for the rest of the world.

Statements like this make my brain hurt.

 

[confettiflyer]

Statements like this make my brain hurt.

Yeah the truth hurts, doesn't it? haha

 

[confettiflyer]

I highly doubt research and development came anywhere close to the amount of money they are going to rake in.

It didn't, but the price of research failure is bundled in that price.

It's like buying eggs at the grocery store, or pants at the Gap...the price you pay takes into account the food they throw out that goes unsold and employee shrink, respectively.

 

[metrarx]

I call bull****. They price gouge because they can. It costs pennies to produce the drugs and the R&D is paid back within months of a product being on the market. Their are over 7,000,000,000 people in the world.

You're generalizing way too much here.

Drug discovery is not easy. Do you think that if a company makes 10 drugs, 8-10 will have revenue that will match or exceed R&D? Not even close. Now think about their need for rainy day funds. Do you remember Exubera? What about Vioxx lawsuits?

What about marketing? That's a pretty big chunk.

Also, how do you know how long it will be before drug cost is recouped? You don't actually think it's the same for every drug right?

Stop generalizing so much.

 

[confettiflyer]

You're generalizing way too much here.

Drug discovery is not easy. Do you think that if a company makes 10 drugs, 8-10 will have revenue that will match or exceed R&D? Not even close. Now think about their need for rainy day funds. Do you remember Exubera? What about Vioxx lawsuits?

What about marketing? That's a pretty big chunk.

Also, how do you know how long it will be before drug cost is recouped? You don't actually think it's the same for every drug right?

Stop generalizing so much.

It's called being delusional....not to be confused with run of the mill liberalism.

It's a world where 100% of drugs ever made a bajillion dollars in profit.

Oh, and it's a world where drugs discover themselves and cost ZEERRRO dollars.

And everyone sings kumbaya around a bonfire passing their freebie Hep C drugs around.

 

[anewmanx]

It's called being delusional....not to be confused with run of the mill liberalism.

It's a world where 100% of drugs ever made a bajillion dollars in profit.

Oh, and it's a world where drugs discover themselves and cost ZEERRRO dollars.

And everyone sings kumbaya around a bonfire passing their freebie Hep C drugs around.

Degenerating a conversation into personal insults is a key sign of weakness (or lack of character) on the part of the offending party. To simply disagree with someone is one thing. To degenerate their character publicly with statements such as "delusional," or God forbid "liberalism" (the one that actually offended me) is entirely uncalled for.

 

[anewmanx]

You're generalizing way too much here.

Drug discovery is not easy. Do you think that if a company makes 10 drugs, 8-10 will have revenue that will match or exceed R&D? Not even close. Now think about their need for rainy day funds. Do you remember Exubera? What about Vioxx lawsuits?

What about marketing? That's a pretty big chunk.

Also, how do you know how long it will be before drug cost is recouped? You don't actually think it's the same for every drug right?

Stop generalizing so much.

http://www.who.int/trade/glossary/story073/en/

300 billion dollar industry with a 30% profit margin. Crunch those numbers. You're telling me they are not price gouging simply for the sake of profit? I think that is way, way, way more each year than is needed for the rainy day slush funds.

I respectfully choose to disagree with you on this matter.

Furthermore: http://healthcareforamericanow.org/2013/04/08/pharma-711-billion-profits-price-gouging-seniors/ <---- this is dispicable.

Also, voluntary price regulation agreements have worked in the UK since 1957

http://www.abpi.org.uk/our-work/commercial/pprs/Pages/default.aspx

Why can't it work in the States?

 

[confettiflyer]

Degenerating a conversation .......

Didn't bother reading the rest.

Jesus Christmas, it's SDN. That's the whole point.

 

[confettiflyer]

Why can't it work in the States?

It worked because there's a bottomless wallet/benefactor across the pond.

If price controls went into effect, investors would pull money out of pharma companies so fast, you'd hear a giant sucking noise. I know I would....i'd put my investment money in something that would actually make me money and not satisfy some utopian free medicine wet dream.

 

[metrarx]

http://www.who.int/trade/glossary/story073/en/

300 billion dollar industry with a 30% profit margin. Crunch those numbers. You're telling me they are not price gouging simply for the sake of profit? I think that is way, way, way more each year than is needed for the rainy day slush funds.

I respectfully choose to disagree with you on this matter.

Furthermore: http://healthcareforamericanow.org/2013/04/08/pharma-711-billion-profits-price-gouging-seniors/ <---- this is dispicable.

Also, voluntary price regulation agreements have worked in the UK since 1957

http://www.abpi.org.uk/our-work/commercial/pprs/Pages/default.aspx

Why can't it work in the States?

Read your first link, it talks about where some of that money goes. A company needs chronic meds (like Lipitor) on its portfolio to continue research on other meds (most of which will bust and cost hundreds of millions in discovery costs). It needs to market those meds as well.

Your second link is from a 'Healthcare for America Now!' article. A sensationalism piece and nothing else. Pass.

As for your third link, yes, price regulation definitely works.
http://www.telegraph.co.uk/health/h...st-of-profits-on-drugs-that-cost-pennies.html



Sorry, pharmaceutical companies can't be charaties as you so desperately want them to be.

 

[confettiflyer]

Your second link is from a 'Healthcare for America Now!' article. A sensationalism piece and nothing else. Pass.

It was a press release from some lefty special interest group using the words "taxpayer" and "senior" in the same way you can make someone feel guilty using pictures of kittens and babies. Kind of pathetic.

 

[metrarx]

It was a press release from some lefty special interest group using the words "taxpayer" and "senior" in the same way you can make someone feel guilty using pictures of kittens and babies. Kind of pathetic.

Nice. Glad I skipped right over it.

 

[297point1]

Do any of you think it matters that Hep C is almost always contracted via intravenous drug usage?

No more so than the person who comes to your counter looking for refills on their Lipitor and Humalog while munching on a double cheeseburger with bacon and slurping a Big Gulp.

 

[Ackj]

Sales over $2 billion first quarter. Gilead knocked it out of the park. Sure it's expensive, but Incivek and Victrelis aren't cheap either. This has a great cure rate, plus you can possibly spare somebody from going through interferon treatments.

 

[anewmanx]

Jesus Christmas, it's SDN. That's the whole point.

I have to admit, this comment made me smile.