'Clinton Proposes $250 Monthly Cap on Prescription Drug Costs'

[W19]

https://www.yahoo.com/health/clinton-proposes-250-monthly-cap-on-prescription-115946920.html

Watch out big Pharma...

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[Mad Jack]

I have mixed feelings.

 

[mimelim]

Wonder how they plan to make that work with chemo or other drug regimens that are thousands of dollars per treatment.

Yes, lets just set an arbitrary cap on how much something is worth. I'm sure it will work.

 

[Doctor Bob]

This idea would work...

... if we also federalized the manufacture of medications. If drug companies can't get paid for making the meds then they just won't make them. It happens all the time leading to various drug shortages; manufacturers stop producing the meds for whatever reason. This would be a very strong financial disincentive. Or they just wouldn't get marketed in the US.

Or the government could step in and pay the difference... which is also unfeasible.

 

[Mad Jack]

This idea would work...

... if we also federalized the manufacture of medications. If drug companies can't get paid for making the meds then they just won't make them. It happens all the time leading to various drug shortages; manufacturers stop producing the meds for whatever reason. This would be a very strong financial disincentive. Or they just wouldn't get marketed in the US.

Or the government could step in and pay the difference... which is also unfeasible.

Most of these drugs are sold for a tenth the cost, or less, in other countries. I think the best way to handle this is not through an arbitrary cap, but by allowing US citizens to purchase drugs from other first-world countries, as prices are artificially inflated in the United States compared with the rest of the world.

 

[ERK123]

Wonder how they plan to make that work with chemo or other drug regimens that are thousands of dollars per treatment.

Yes, lets just set an arbitrary cap on how much something is worth. I'm sure it will work.

Does the article not say that the $250 is on what insurance companies can charge patients out of pocket? This would not cap what insurance companies are required to actually pay for the drugs. I wonder how many insurance plans already have monthly caps for out of pocket expenses that are somewhat close to this number?

 

[mimelim]

Does the article not say that the $250 is on what insurance companies can charge patients out of pocket? This would not cap what insurance companies are required to actually pay for the drugs. I wonder how many insurance plans already have monthly caps for out of pocket expenses that are somewhat close to this number?

Then insurance companies will simply not cover those drugs. Nobody is in the business of losing money.

 

[Mad Jack]

Then insurance companies will simply not cover those drugs. Nobody is in the business of losing money.

Or they won't change deductibles but they'll just increase their premiums.

 

[Stagg737]

Exactly to the above 2 posts. Insurance companies only stay in business if they turn a profit. People can only get insurance, if companies stay in business. So the average person has to pay more into insurance than they will ultimately receive back. It's just basic business, but it blows my mind how many people don't understand that or seem to forget that when talking about healthcare.

 

[Doctor Bob]

This would be just as unfeasible an idea as say... limiting the amount a car dealer can charge for a car.

"Ok, the car is $250... but the tires are $5000 apiece."

 

[charmiedermie]

https://www.yahoo.com/health/clinton-proposes-250-monthly-cap-on-prescription-115946920.html

Watch out big Pharma...

I'm ok with that. See the Pyrimethamine story. Cost controls make sense.

 

[Slack3r]

Wonder how they plan to make that work with chemo or other drug regimens that are thousands of dollars per treatment.

Yes, lets just set an arbitrary cap on how much something is worth. I'm sure it will work.

This idea would work...

... if we also federalized the manufacture of medications. If drug companies can't get paid for making the meds then they just won't make them. It happens all the time leading to various drug shortages; manufacturers stop producing the meds for whatever reason. This would be a very strong financial disincentive. Or they just wouldn't get marketed in the US.

Or the government could step in and pay the difference... which is also unfeasible.

The idea is to get elected, not propose reasonable/realistic solutions.

 

[Bryan O’Blivion]

That seems like a clumsy overreach by Ms. Clinton for the sake of capitalizing on the publicity surrounding this. But it does bring up some interesting points.

What is worth investigating is why some 1950's/60's antimalarial is granted a patent and exclusivity for a whole phylum of parasites (in 2002),and why there is exclusivity beyond the usual 7 year period? I looked up the patents for pyrimethamine, and the patents that seemed relevant, use as an anti-parasitic against apicomplexa, and the manufacturing process. This seems reasonable, if say, it hadn't been discovered and developed 60 years ago, and the original patents held by someone else, presumably Glaxo-Smith-Kline. Per my cursory search, pyrimethamine seems to be produced in India for a cost of around 10 cents a pill. Why then is this process patentable in the US as if it is a new idea?

Another question, why is Medicare as a buying entity prohibited from exercising price negotiation with manufacturers?

These sound like better targets of legislation, and at the root of why price gouging can develop in this country.

As an interesting aside, the person who developed pyrimethamine also developed acyclovir, trimethoprim, allopurinol, azathioprine, 6-mercaptopurine, and was working on zidovudine. Received a Nobel in 1988.

 

[Mad Jack]

I'm ok with that. See the Pyrimethamine story. Cost controls make sense.

It's more about the law of unintended consequences. If you set a $250 limit on drugs, there's going to be a lot of investment cash pulled out of cancer drug development, for instance, as cancer drugs need to sell for astronomical amounts to be profitable since they aren't exactly something you can sell to the public at large like antidepressants or stimulants.

 

[cbrons]

https://www.yahoo.com/health/clinton-proposes-250-monthly-cap-on-prescription-115946920.html

Watch out big Pharma...

she should propose a cap on how often we have to see her ugly face on TV

 

[cbrons]

What is worth investigating is why some 1950's/60's antimalarial is granted a patent and exclusivity for a whole phylum of parasites (in 2002),and why there is exclusivity beyond the usual 7 year period?

Oligarchy gets what the oligarchy wants. Blame the "free market" (free insofar as government regulators actively work for a very select group of corporate pirates).

 

[Psai]

250 a month is still a ton of money

 

[PL198]

Then insurance companies will simply not cover those drugs. Nobody is in the business of losing money.

libs just can't grasp that concept

 

[PL198]

I'm ok with that. See the Pyrimethamine story. Cost controls make sense.

hell just nationalize it all. let's just move to communism, that works so well for all involved, as history has shown

 

[DokterMom]

Sure, a drug company won't make a drug that won't make them money. But it's hard to conceive that Daraprim's former manufacturer was able to make and sell a drug for $13.50 a pill (formerly $1), but the new company can't make that same drug profitably for less than $750? And the new company DOESN'T have the R&D investment to write off.

 

[charmiedermie]

It's more about the law of unintended consequences. If you set a $250 limit on drugs, there's going to be a lot of investment cash pulled out of cancer drug development, for instance, as cancer drugs need to sell for astronomical amounts to be profitable since they aren't exactly something you can sell to the public at large like antidepressants or stimulants.

It is "$250 monthly cap on prescription drugs for patients with chronic or serious medical conditions." Again, see the case behind the jacking up of Pyrimethamine from $13.50 a pill to $750 a pill (a 5,500% increase). So lay off the R&D line, because the drug works perfectly fine for the condition it treats for decades and are happy with it. She has other ideas too, like letting Medicare negotiate over drug prices. The cap isn't the only idea in the article.

Every law has unintended consequences. The same was said for FMLA, but I'm glad it exists, in case it is needed.

hell just nationalize it all. let's just move to communism, that works so well for all involved, as history has shown

I think you need to adjust your tinfoil Tea Party hat. Medicare and Medicaid, which are government programs, pay for these drugs. Feel free not to take icky communist government student loans for med school.

 

[Mad Jack]

It is "$250 monthly cap on prescription drugs for patients with chronic or serious medical conditions." Again, see the case behind the jacking up of Pyrimethamine from $13.50 a pill to $750 a pill (a 5,500% increase). So lay off the R&D line, because the drug works perfectly fine for the condition it treats for decades and are happy with it. She has other ideas too, like letting Medicare negotiate over drug prices. The cap isn't the only idea in the article.

Every law has unintended consequences. The same was said for FMLA, but I'm glad it exists, in case it is needed.

I think you need to adjust your tinfoil Tea Party hat. Medicare and Medicaid, which are government programs, pay for these drugs. Feel free not to take icky communist government student loans for med school.

In this particular case, it is pretty messed up, as this should be an easily obtainable, generic drug at its current age. But new drugs are where the problem comes in. Cancer, for instance, falls under the umbrella of "chronic or serious medical condition" for sure, and a $250 limit would certainly cut private investment into new cancer treatments.

 

[charmiedermie]

Sure, a drug company won't make a drug that won't make them money. But it's hard to conceive that Daraprim's former manufacturer was able to make and sell a drug for $13.50 a pill (formerly $1), but the new company can't make that same drug profitably for less than $750? And the new company DOESN'T have the R&D investment to write off.

I'm sure they'll say it is R&D for future drugs. When even the CNBC anchors look at him like he's a disgusting person, you know he is a pig.

 

[Bryan O’Blivion]

@DokterMom Right. The research for pyrimethamine was done in the 1950's by Gertrude Elion, and the development cost was borne by Burroughs-Wellcome, later part of GlaxoSmithKline. The move was made to increase profits for a small pharmaceutical company to appease investors over previous misappropriations. So basically a small captive market of patients and their insurance companies, and Medicare/Medicaid are being used to pay for someone's questionable business decisions. Of course, indirectly, that means that the rest of us pay for this as well, in increased premiums and a proportion of taxes.

 

[Mad Jack]

I'm sure they'll say it is R&D for future drugs. When even the CNBC anchors look at him like he's a disgusting person, you know he is a pig.

The other option is the drug just stops being made, as has happened with things like antivenoms as of late, as it wasn't profitable enough, so rather than jacking up the price 5,000% they just stopped making it entirely.

http://www.iflscience.com/health-and-medicine/snakebite-anti-venom-track-run-out-next-year

http://www.houstonchronicle.com/new...e-antidote-shortage-poses-ethical-6352084.php

 

[charmiedermie]

In this particular case, it is pretty messed up, as this should be an easily obtainable, generic drug at its current age. But new drugs are where the problem comes in. Cancer, for instance, falls under the umbrella of "chronic or serious medical condition" for sure, and a $250 limit would certainly cut private investment into new cancer treatments.

Same thing happened with a gout drug, Colchicine. Pyrimethamine isn't the only example. Like I said, in the article, she has other ideas. If patients can't afford the drug thats a problem, and for some drugs its only a few more months of life.

 

[Mad Jack]

@DokterMom Right. The research for pyrimethamine was done in the 1950's by Gertrude Elion, and the development cost was borne by Burroughs-Wellcome, later part of GlaxoSmithKline. The move was made to increase profits for a small pharmaceutical company to appease investors over previous misappropriations. So basically a small captive market of patients and their insurance companies, and Medicare/Medicaid are being used to pay for someone's questionable business decisions. Of course, indirectly, that means that the rest of us pay for this as well, in increased premiums and a proportion of taxes.

What I'm not getting is how this drug isn't just generic by now- there's no way it's still under patent protection. Is it just difficult to produce and only GSK had the process to make it?

 

[charmiedermie]

The other option is the drug just stops being made, as has happened with things like antivenoms as of late, as it wasn't profitable enough, so rather than jacking up the price 5,000% they just stopped making it entirely.

http://www.iflscience.com/health-and-medicine/snakebite-anti-venom-track-run-out-next-year

http://www.houstonchronicle.com/new...e-antidote-shortage-poses-ethical-6352084.php

Pyrimethamine was made by Impax, but since their market isn't parasitic drugs they sold it to Turing Pharmaceuticals, founded by a former hedge fund guy. Don't compare a once in a lifetime need for antivenom to this drug.

 

[charmiedermie]

What I'm not getting is how this drug isn't just generic by now- there's no way it's still under patent protection. Is it just difficult to produce and only GSK had the process to make it?

i believe it is generic.

 

[Bryan O’Blivion]

What I'm not getting is how this drug isn't just generic by now- there's no way it's still under patent protection. Is it just difficult to produce and only GSK had the process to make it?

Okay, me too. Like I said above, I really don't get that part. I posted what I posted above hoping someone here understood the process. I googled the patents on it, and I found one for the process of manufacture, and one for the use of it as an anti-parasitic, in addition to some about formulation, whihc did not seem applicable. Based on my very limited understanding of this subject, patents are only good for 20 years, and exclusivity for only seven.

I might have misunderstood what I read, but that's the gist of it.

Looking at the synthesis process in the patents, it doesn't look all that difficult. It is made in India cheaply.

 

[Mad Jack]

Pyrimethamine was made by Impax, but since their market isn't parasitic drugs they sold it to Turing Pharmaceuticals, founded by a former hedge fund guy. Don't compare a once in a lifetime need for antivenom to this drug.

i believe it is generic.

I think it's fully appropriate to compare it to antivenom, which has a much larger prescriptive need (5 million people a year) than this medicine, and the loss of which will cause potentially millions of deaths. What's the difference between a company jacking up the price of antivenom to, say, $250,000 a dose (a 5,000% increase) and this guy charging $750 a tablet for this drug? Well, there is a big difference- rather than jack up prices and deal with public backlash, GSK just let the drug die, because they knew that jacking the price up by 5 or even 10 times, which would make it profitable enough to keep around to investors, would cause a massive public backlash and be a PR disaster.

 

[Mad Jack]

Okay, me too. Like I said above, I really don't get that part. I posted what I posted above hoping someone here understood the process. I googled the patents on it, and I found one for the process of manufacture, and one for the use of it as an anti-parasitic, in addition to some about formulation, whihc did not seem applicable. Based on my very limited understanding of this subject, patents are only good for 20 years, and exclusivity for only seven.

I might have misunderstood what I read, but that's the gist of it.

Looking at the synthesis process in the patents, it doesn't look all that difficult. It is made in India cheaply.

Looking into it, it's non-scheduled, but here's the problems with another company making it:

http://www.vox.com/2015/9/22/9373557/daraprim-competitor-turing

 

[jdh71]

I have mixed feelings.

I have patients who can't buy their inhalers. Which are all expensive. No generics. When the patent is up the companies just change things around and continue charging an arm and a leg. Most prescription drug benefits require high out of pocket expenditures before kicking in.

With that said blanket price controls are a bad idea and cause shortages in product and distortion in the market in general.

Not everyone needs price controls on out of pocket drug costs and to cap this for everyone in all plans would be stupid. This would lead to higher premiums as everyone would need to further subsidize this cost.

I might humbly suggest out of pocket caps, if any, based on income. You could apply for special programs. The cost for these populations who need help for mess could be paid in part by higher premiums and also in part government subsidies.

 

[Bryan O’Blivion]

@Mad Jack : Yeah, I read that too. First of all, I think that she's wrong, in that there are still patents. A trivial point, since the economic argument is the crux, but I think it should be pointed out.

Secondly, it doesn't require building a new factory to synthesize an organic molecule. Another pharmaceutical company could produce it without a huge re-allocation of resources. I get her point, but I think that she's making a gross generalization to convey the issue.

EDIT: I found another article about this that at least to me, explains it better: http://blogs.sciencemag.org/pipelin...martin-shkreli-has-one-idea-and-its-a-bad-one

 

[Mad Jack]

I have patients who can't buy their inhalers. Which are all expensive. No generics. When the patent is up the companies just change things around and continue charging an arm and a leg. Most prescription drug benefits require high out of pocket expenditures before kicking in.

With that said blanket price controls are a bad idea and cause shortages in product and distortion in the market in general.

Not everyone needs price controls on out of pocket drug costs and to cap this for everyone in all plans would be stupid. This would lead to higher premiums as everyone would need to further subsidize this cost.

I might humbly suggest out of pocket caps, if any, based on income. You could apply for special programs. The cost for these populations who need help for mess could be paid in part by higher premiums and also in part government subsidies.

The easiest way to fix this would seriously be to just let us order our drugs from Canadian, British, or Australian pharmacies. Then we don't have to deal with blanket price controls or higher premiums or special programs- just give people freedom of choice and everything will correct itself.

 

[Mad Jack]

@Mad Jack : Yeah, I read that too. First of all, I think that she's wrong, in that there are still patents. A trivial point, since the economic argument is the crux, but I think it should be pointed out.

Secondly, it doesn't require building a new factory to synthesize an organic molecule. Another pharmaceutical company could produce it without a huge re-allocation of resources. I get her point, but I think that she's making a gross generalization to convey the issue.

This drug is way off patent though. It's so old it's not even scheduled.

 

[deleted480308]

The government shouldn't be setting prices on anything. An item is worth whatever the customer is willing to pay on any given day....no more, no less. A third party arbiter isn't good

 

[jdh71]

The easiest way to fix this would seriously be to just let us order our drugs from Canadian, British, or Australian pharmacies. Then we don't have to deal with blanket price controls or higher premiums or special programs- just give people freedom of choice and everything will correct itself.

The out of pocket expense for many drugs would still be out of reach for a lot of folks even with that kind of system. Which Clinton is also interested in potentially implementing.

I simply don't think the "free market" can fix this mostly because there isn't one. So probably a bit naive to pretend there is one.

The more and more I think about it, there just isn't one economic philosophy that can fix every problem. Healthcare and drugs are too expensive, for better or worse, not to have everyone subsidize them either through the government or insurance. The free markets can't fix any of this. At least it can't and maintain the level of technology we've come to expect from our current system of healthcare.

 

[DokterMom]

The other option is the drug just stops being made, as has happened with things like antivenoms as of late, as it wasn't profitable enough, so rather than jacking up the price 5,000% they just stopped making it entirely.

I know this sounds like communism (Heck, didn't the communists actually DO this?) -- But wouldn't it make sense for the government to pay a company to make these necessary drugs at a reasonable profit, then resell them at a reasonable cost to the people that need them?

 

[cbrons]

What I'm not getting is how this drug isn't just generic by now- there's no way it's still under patent protection. Is it just difficult to produce and only GSK had the process to make it?

Because of government regulations that allow politically connected scum to regulate away all competition.

Or blame the non-existent scapegoat called the "free market" or "capitalism."

 

[PL198]

I know this sounds like communism (Heck, didn't the communists actually DO this?) -- But wouldn't it make sense for the government to pay a company to make these necessary drugs at a reasonable profit, then resell them at a reasonable cost to the people that need them?

yeah that's not communism or anything. why not just have the government set an acceptable price on all goods.

why even deal with prices, why not just have the government distribute all goods as they see fit?

 

[cbrons]

yeah that's not communism or anything. why not just have the government set an acceptable price on all goods.

why even deal with prices, why not just have the government distribute all goods as they see fit?

Because literally every major historical example of this type of system failed completely and utterly

 

[Psai]

There is no free market when it comes to healthcare. Prices are unknown until after you receive your care. If I ever ended up in the ER, I would probably refuse some of what they would do because a good portion of it is medicolegal nonsense forced upon them by outside forces

 

[deleted480308]

There is no free market when it comes to healthcare. Prices are unknown until after you receive your care. If I ever ended up in the ER, I would probably refuse some of what they would do because a good portion of it is medicolegal nonsense forced upon them by outside forces

It should be free market

 

[Bryan O’Blivion]

This drug is way off patent though. It's so old it's not even scheduled.

There are patents on it. It isn't clear if any of those patents are held by any of the companies that have had ownership of this drug in recent years (it has changed hands a few times since GSK sold it), or if the ones within the 20 year limit are applicable to its manufacture and sale as a pharmaceutical. I am not sure what you mean about the other part.

According to the list of Orphan Drugs that I downloaded from the FDA, pyrimethamine wasn't specifically noted, except as an adjunct to be used with sulfadiazine to be used in the treatment of toxo. I am not sure how this bears out in terms of maintaining exclusivity, if at all. It seems like the person who did this has a history of buying orphan drugs and increasing their prices, so it may be the reason why it was chosen in the first place.

EDIT: Thanks for your effort to respond. I am genuinely confused about how this process works, so I appreciate any links or thoughts on it, even if it means wading through knee jerk Ayn Rand vomit that emerges out of these sort of discussions.

 

[Mad Jack]

I know this sounds like communism (Heck, didn't the communists actually DO this?) -- But wouldn't it make sense for the government to pay a company to make these necessary drugs at a reasonable profit, then resell them at a reasonable cost to the people that need them?

I would be okay with that. If we had a government owned company that made off-label, unprofitable drugs and sold them at cost it would be perfectly reasonable, as corporations have no incentive to do so for their shareholders.

 

[Stagg737]

I know this sounds like communism (Heck, didn't the communists actually DO this?) -- But wouldn't it make sense for the government to pay a company to make these necessary drugs at a reasonable profit, then resell them at a reasonable cost to the people that need them?

Someone else can correct me, but I don't believe the government can directly sell someone a good. So they could buy a product from an individual and 'redistribute it' via medicaid/medicare/subsidies to people with government plans for healthcare, but not directly sell it to individuals (obviously they would pay from taxes). It would also open a Pandora's box of political issues and questions about the government legally being a business and acting as a competitor.

Plus, you have to think about what is considered 'reasonable'. The cost of making the product would have to be reasonable for them to eventually sell it to people at a reasonable price, which is feasible for some drugs and probably not so feasible for others. You'd also have to have enough people to make it worth the financial undertaking. If a drug is only going to be used by 3,000 people per year, is it appropriate to spend tens of millions, or maybe billions on a drug that will affect a small amount of people when they might not get a great level of utility out of it? I'm sure there are plenty of times one could justify the decision either way, but it anytime the government starts 'selling a product' things get murky really fast.

 

[Mad Jack]

http://www.drugpatentwatch.com/ultimate/generic-api/pyrimethamine

There are patents on it. It isn't clear if any of those patents are held by any of the companies that have had ownership of this drug in recent years (it has changed hands a few times since GSK sold it), or if the ones within the 20 year limit are applicable to its manufacture and sale as a pharmaceutical. I am not sure what you mean about the other part.

According to the list of Orphan Drugs that I downloaded from the FDA, pyrimethamine wasn't specifically noted, except as an adjunct to be used with sulfadiazine to be used in the treatment of toxo. I am not sure how this bears out in terms of maintaining exclusivity, if at all.

No patent currently exists for the drug. All he bought was the brand name and supply chain for it, anyone else could manufacture it right now.

 

[PL198]

Because literally every major historical example of this type of system failed completely and utterly

sarcasm...

 

[W19]

I would be okay with that. If we had a government owned company that made off-label, unprofitable drugs and sold them at cost it would be perfectly reasonable, as corporations have no incentive to do so for their shareholders.

Some people will argue government is already too big and they should not get in the business of making drugs... If healthcare cost is keeping the trajectory it is on right now for another 10-15 years, I think that even people who are against a nationalized system will say: fvvck it, lets do it!