Healthcare going forward

[ballcaphair]

Oops. Should read "tried ...using Zantac"

Okay, got it.

 

[ballcaphair]

Cellphone - Necessity or luxury?
Car - Necessity or luxury?
Big-screen TV - Necessity or luxury?
Food - Necessity or luxury?
Prescription drugs - Necessity or luxury?

Life - Necessity or luxury? (Dead need not respond.)

 

[KaraBulut]

Below is an example of why Congress doesn't get much useful information from Congressional testimony. Because the way that questioning is time-limited, there's really not much useful information exchanged. Instead, it becomes dueling talking points:

 

[gsdx]

^ Wowsers.

That blows apart a whole lot of defences and excuses which are presented here to justify high-priced drugs.

 

[KaraBulut]

^ Wowsers.

That blows apart a whole lot of defences and excuses which are presented here to justify high-priced drugs.

It does. Even the Phrma rep had to admit that the drug companies were able to drag out the exclusivity for 10-12 years and that there was no such thing as a "free market" in the pharmaceutical industry when it comes to brand names.

I just wish that these hearings were more geared toward fact-finding and solutions. Sen Warren knows that her exchange with executives will get into the news and on YouTube, so she gets the facts out there but in her efforts, the other party doesn't get time to answer the questions. That's not an effective use of expert testimony.

 

[Benvolio]

It is not honest on Warren's part. She pretends that the cheaper foreign drugs are not the result of price controlling by foreign governments. Nor does she recognize that government negotiation is essentially price controlling. The Federal government would be negotiating for such a large segment of the market that companies will have little choice but to acquiesce in government demands.

 

[ballcaphair]

It does. Even the Phrma rep had to admit that the drug companies were able to drag out the exclusivity for 10-12 years and that there was no such thing as a "free market" in the pharmaceutical industry when it comes to brand names.

I just wish that these hearings were more geared toward fact-finding and solutions. Sen Warren knows that her exchange with executives will get into the news and on YouTube, so she gets the facts out there but in her efforts, the other party doesn't get time to answer the questions. That's not an effective use of expert testimony.

It is true. Sound bites get attention, but we need to have a unified, loud and clear debate. Our clinic is also in the grip of big Pharma without any choice. We get trinkets and samples from drug peddlers, not options on pricing. One problem with ACA is that it did nothing to give us leverage. That's probably due to lobbying. Rx prices are shameful.

 

[Kulindahr]

Wrong. I am more logical than you. We should not impede the research and production of new drugs because some people cannot afford them. We should not deprive drug companies of the profits they need to do R&D because some people cannot afford them.
Insuring preexisting illnesses does not work because it is like insuring houses that are already on fire.

Once again: they don't need profits in order to do R & D.

 

[Kulindahr]

Below is an example of why Congress doesn't get much useful information from Congressional testimony. Because the way that questioning is time-limited, there's really not much useful information exchanged. Instead, it becomes dueling talking points:

I thought Warren was too smart to not see what the rep kept talking about price controls. I'd concede that other countries have price controls, then ask if it has driven U.S. companies out of those markets -- because if it hasn't, that means they can make a profit without all the advertising spending and without all the lobbying spending (I noticed that the pharmaceutical companies spent about eight times as much lobbying Congress last year as the NRA has spent on that ever).

 

[gsdx]

It is not honest on Warren's part. She pretends that the cheaper foreign drugs are not the result of price controlling by foreign governments.

Please tell us where you got that idea?

 

[Stardreamer]

I thought Warren was too smart to not see what the rep kept talking about price controls. I'd concede that other countries have price controls, then ask if it has driven U.S. companies out of those markets -- because if it hasn't, that means they can make a profit without all the advertising spending and without all the lobbying spending (I noticed that the pharmaceutical companies spent about eight times as much lobbying Congress last year as the NRA has spent on that ever).

To me its the clearest example of the American people being taken advantage of by economic deals with other countries and it's our own government that is doing it to us. Wasn't that what Trump ran on, putting America first?

 

[KaraBulut]

I thought Warren was too smart to not see what the rep kept talking about price controls. I'd concede that other countries have price controls, then ask if it has driven U.S. companies out of those markets -- because if it hasn't, that means they can make a profit without all the advertising spending and without all the lobbying spending (I noticed that the pharmaceutical companies spent about eight times as much lobbying Congress last year as the NRA has spent on that ever).

Senator Warren inherited Teddy Kennedy's Senate seat. Kennedy had a crack staff that were subject matter experts in healthcare law and the complexities of the healthcare system.

Unfortunately, Warren is more of an expert on banking and bankruptcy law. While she's extremely bright, she doesn't have the same level of expertise in healthcare that her predecessor did.

The argument that Warren was making- that in a true "free market" system, there would be more fair negotiation between buyer and seller is a novel argument. But someone who really understands the US healthcare system would know that little of the system is truly "free market".

No one shops around for a cheaper surgeon, cheaper hospital or cheaper brand name drugs. The reality is that our employers choose our insurance plans, our insurance plans choose our doctors and hospitals and often our insurance companies select our drugs by limiting their "formulary" or restrict access by attaching copayments to the drugs.

Usually brand name drugs are only made by one company for the first decade of their market life. So, if your doctor writes a prescription for a brand name drug, you may not have the option of getting a cheap generic. One thing that the Phrma person didn't acknowledge is that drug manufacturers play a game because they know that generic drug companies can file to begin making a generic equivalent after five years. If the owner of the patent ties up the generic drug application with the FDA or they come out with a new formulation, they can extend their patent.

Here's an example of how this works:

Testosterone has been available as a generic drug in pill and injectable form for decades.

About 20 years ago, a drug company developed a gel delivery system that allows testosterone to be delivered transdermally- through the skin- instead with a needle and injection. That company patented the drug in gel form as "Testim"- even though testosterone has been a generic for years and is a hormone that every animal's endocrine system produces.

Another company developed what they said was an improved gel formula and they got a patent for Androgel. AbbVie, the patent holder, started running advertisements for "low T" and started heavy marketing to doctors, encouraging practitioners to test men's testosterone levels and then to prescribe Androgel 1% gel to their patients. AbbVie spent $45 million promoting AndroGel to take advantage of a market for "Low T" supplements that was $5 billion in 2017.

In 2013, Abbvie's patent for testosterone 1% was up to expire. So, AbbVie developed a new version of Androgel that was a 1.62% gel instead of the old 1% gel. AbbVie patented the 1.62% gel in 2011 and immediately began marketing this as "better" to their physician base. They started paying incentive payments to doctors to switch from 1% to 1.62% before the 1% patent expired and generic versions of the 1% gel became available. AbbVie also marketed to insurance companies' pharmaceutical benefit manager to get the 1% GENERIC testosterone gels removed from the insurance companies' formularies and replaced by the new 1.62% Androgel.

Generic 1% testosterone gel costs about $300 for a month supply. Brand name 1.62% testerone gel runs about $750-800 per month.

Currently, AbbVie is suing generic testosterone gel manufacturers in an attempt to extend their patent to the full 20 years and to prevent generic companies from getting a lower priced generic on the market.

^This is what Warren was trying to get into the public testimony but she lacked the expertise and the time to adequately get the Phrma representative on record about the games that the large drug companies play to eliminate their competition, keep their prices high and remove the patient's ability to negotiate for lower prices.

 

[Benvolio]

I thought Warren was too smart to not see what the rep kept talking about price controls. I'd concede that other countries have price controls, then ask if it has driven U.S. companies out of those markets -- because if it hasn't, that means they can make a profit without all the advertising spending and without all the lobbying spending (I noticed that the pharmaceutical companies spent about eight times as much lobbying Congress last year as the NRA has spent on that ever).

I assume the do make a marginal profit in price controlled companies, and any tiny profit on those units is better than none at all. The big question is whether they make enough to recover their R&D expense and then make a profit. A small profit will not keep them in business. And they can make a small profit by investing the company's capital in government bonds without the risk.
They need advertising to sell enough in the patent window to recover investment and to advise the public of potential side effects.

 

[Benvolio]

Senator Warren inherited Teddy Kennedy's Senate seat. Kennedy had a crack staff that were subject matter experts in healthcare law and the complexities of the healthcare system.

Unfortunately, Warren is more of an expert on banking and bankruptcy law. While she's extremely bright, she doesn't have the same level of expertise in healthcare that her predecessor did.

The argument that Warren was making- that in a true "free market" system, there would be more fair negotiation between buyer and seller is a novel argument. But someone who really understands the US healthcare system would know that little of the system is truly "free market".

No one shops around for a cheaper surgeon, cheaper hospital or cheaper brand name drugs. The reality is that our employers choose our insurance plans, our insurance plans choose our doctors and hospitals and often our insurance companies select our drugs by limiting their "formulary" or restrict access by attaching copayments to the drugs.

Usually brand name drugs are only made by one company for the first decade of their market life. So, if your doctor writes a prescription for a brand name drug, you may not have the option of getting a cheap generic. One thing that the Phrma person didn't acknowledge is that drug manufacturers play a game because they know that generic drug companies can file to begin making a generic equivalent after five years. If the owner of the patent ties up the generic drug application with the FDA or they come out with a new formulation, they can extend their patent.

Here's an example of how this works:

Testosterone has been available as a generic drug in pill and injectable form for decades.

About 20 years ago, a drug company developed a gel delivery system that allows testosterone to be delivered transdermally- through the skin- instead with a needle and injection. That company patented the drug in gel form as "Testim"- even though testosterone has been a generic for years and is a hormone that every animal's endocrine system produces.

Another company developed what they said was an improved gel formula and they got a patent for Androgel. AbbVie, the patent holder, started running advertisements for "low T" and started heavy marketing to doctors, encouraging practitioners to test men's testosterone levels and then to prescribe Androgel 1% gel to their patients. AbbVie spent $45 million promoting AndroGel to take advantage of a market for "Low T" supplements that was $5 billion in 2017.

In 2013, Abbvie's patent for testosterone 1% was up to expire. So, AbbVie developed a new version of Androgel that was a 1.62% gel instead of the old 1% gel. AbbVie patented the 1.62% gel in 2011 and immediately began marketing this as "better" to their physician base. They started paying incentive payments to doctors to switch from 1% to 1.62% before the 1% patent expired and generic versions of the 1% gel became available. AbbVie also marketed to insurance companies' pharmaceutical benefit manager to get the 1% GENERIC testosterone gels removed from the insurance companies' formularies and replaced by the new 1.62% Androgel.

Generic 1% testosterone gel costs about $300 for a month supply. Brand name 1.62% testerone gel runs about $750-800 per month.

Currently, AbbVie is suing generic testosterone gel manufacturers in an attempt to extend their patent to the full 20 years and to prevent generic companies from getting a lower priced generic on the market.

^This is what Warren was trying to get into the public testimony but she lacked the expertise and the time to adequately get the Phrma representative on record about the games that the large drug companies play to eliminate their competition, keep their prices high and remove the patient's ability to negotiate for lower prices.

What your have described is competition. In a sense all competition aims to eliminate the competition. While it ain't pretty, even in your example it results in the development of better products, more options, and lower prices. Don't focus on the intent, focus on the result.

 

[Stardreamer]

I assume the do make a marginal profit in price controlled companies, and any tiny profit on those units is better than none at all. The big question is whether they make enough to recover their R&D expense and then make a profit. A small profit will not keep them in business. And they can make a small profit by investing the company's capital in government bonds without the risk.
They need advertising to sell enough in the patent window to recover investment and to advise the public of potential side effects.

And if Trump stood by his America First promise and untied the hands of the agencies to negotiate better prices, the drug companies would have to spread the R&D costs more evenly across all the countries instead of American People getting shafted.

 

[gsdx]

I assume the do make a marginal profit in price controlled companies, and any tiny profit on those units is better than none at all. The big question is whether they make enough to recover their R&D expense and then make a profit. A small profit will not keep them in business. And they can make a small profit by investing the company's capital in government bonds without the risk.
They need advertising to sell enough in the patent window to recover investment and to advise the public of potential side effects.

You just don't get it. You don't.

Show us the proof that your assumptions are correct. Show us the proof that your assumptions killing the drug industries around the world. Show us the proof that there is no R&D in drug countries around the world. Show us the proof that advertising is necessary.

You have yet to justify the millions and millions of dollars in profits to the drug companies. You have yet to justify why the same drugs cost 3 times as much in the United States. You have yet to justify why a drug company spends $7 million on R&D and $14 million on advertising and pulls in $850 million in profits.

Zero justification. Zero proof. None. Nothing.

 

[opinterph]

One thing that the [Pharma] person didn't acknowledge is that drug manufacturers play a game because they know that generic drug companies can file to begin making a generic equivalent after five years. If the owner of the patent ties up the generic drug application with the FDA or they come out with a new formulation, they can extend their patent.

What you are describing is known as “product hopping.” It is a scheme in which minor changes to the original (patented) product, such as dosage per capsule, tablet, etcetera renders the reformulated product not-equivalent to the original and therefore not subject to generic substitution. By combining introduction of the reformulated product with a switch in the market (convincing physicians to prescribe the reformulated drug), pharmaceutical companies can effectively prevent generic substitution for their products and thereby thwart consumers’ access to a lower-priced generic alternatives.

We should also note that there is a price disconnect in the pharmaceutical market, because the consumer of the drug does not choose which product to purchase. The doctor makes that decision and then the consumer (or insurer) pays for the product. By preventing or limiting choices (gaming the system), the pharmaceutical companies remove competition from the marketplace; which increases their profits, reduces options for consumers, and unfairly maintains higher prices.

 

[Benvolio]

You just don't get it. You don't.

Show us the proof that your assumptions are correct. Show us the proof that your assumptions killing the drug industries around the world. Show us the proof that there is no R&D in drug countries around the world. Show us the proof that advertising is necessary.

You have yet to justify the millions and millions of dollars in profits to the drug companies. You have yet to justify why the same drugs cost 3 times as much in the United States. You have yet to justify why a drug company spends $7 million on R&D and $14 million on advertising and pulls in $850 million in profits.

Zero justification. Zero proof. None. Nothing.

False. I have given you all that and you just do not understand. For just one thing I showed that Astra Zeneca spends 11 BILLION for each new drug, and the average for all companies is 4 billion.

 

[Benvolio]

What you are describing is known as “product hopping.” It is a scheme in which minor changes to the original (patented) product, such as dosage per capsule, tablet, etcetera renders the reformulated product not-equivalent to the original and therefore not subject to generic substitution. By combining introduction of the reformulated product with a switch in the market (convincing physicians to prescribe the reformulated drug), pharmaceutical companies can effectively prevent generic substitution for their products and thereby thwart consumers’ access to a lower-priced generic alternatives.

We should also note that there is a price disconnect in the pharmaceutical market, because the consumer of the drug does not choose which product to purchase. The doctor makes that decision and then the consumer (or insurer) pays for the product. By preventing or limiting choices (gaming the system), the pharmaceutical companies remove competition from the marketplace; which increases their profits, reduces options for consumers, and unfairly maintains higher prices.

Once a price goes generic consumers do have a choice, and a large segment of the population does ask for generics. Many doctors prescribe by the generic name and drug stores often advise consumers of the choice.

 

[KaraBulut]

False. I have given you all that and you just do not understand. For just one thing I showed that Astra Zeneca spends 11 BILLION for each new drug, and the average for all companies is 4 billion.

And as in so many of your claims, it was proven to be false because a) you didn't read the full text of story you cited, b) you did no further research to discover that it was based upon industry-financed research and not on the actual numbers they reported to the government and c) it was an inductive conclusion based upon your claim that the pharmaceutical industry is spending enormous sum on R&D (a claim which has been disproved multiple times in this thread).

Here's the text that gsdx quoted for you from your own article:

^ You didn't even read the article, did you? You stopped at the headline and the first paragraph.

If you had read a bit farther, you would have seen the REAL numbers:

From 1997 to 2011, AstraZeneca spent under $58 million on R&D for 5 new drugs. That's $12 million each drug.
From 1977 to 2011, Pfizer spend about $108 million on R&S for 14 new drugs. That's $8 million for each drug.

Once a price goes generic consumers do have a choice, and a large segment of the population does ask for generics. Many doctors prescribe by the generic name and drug stores often advise consumers of the choice.

This depends on the insurance company formulary and the doctor's prescription.

Some insurance companies limit generics to specific manufacturers that are in their formulary. This can result in more expensive generics. Since many hedge funds are buying up generic manufacturers and raising the prices of generics, even the generics are charging much higher prices in the US (because they can).

Different states have different "dispense as written" (DAW) rules. In some states, the pharmacist may dispense a generic if available by default. In other states, the physician must specific that a generic substitution may be made, if available. Because the average exclusivity period for a brand name is 10 to 12 years, it may be a while before a generic is available.