The price differences between domestic and international medicines can be truly outrageous. I just got back from a work trip to a hospital in Sierra Leone, where the anthelmintic medicine Albendazole costs the equivalent of $1 USD at a private pharmacy (or even less if you don't care about packaging). The same treatment in the US (a single dose) cost me $430 USD (before insurance). This medicine is out of patent; the R&D costs have been recovered. There's no reason for it to cost as much as is does in the US, apart from greed. It's more of a niche drug in the US than it is in sub-Saharan Africa, but it is shelf stable unlike say the antibodies of an immunotherapy, or the rabies vaccine, so it's not perishable. I trust the purity of the US version more than the version sold internationally, but that is probably an irrational fear. Even with added costs of laboratory purity testing and import tariffs, those in the US would still be better off if we could import drugs from overseas.
Some medicines are expensive for a reason: they're new and need to have R&D (and FDA) costs recovered (this is why we have patents), they have niche use and are produced in small quantities (cancer immunotherapies), they're perishable (biologicals), or all three. Many others are expensive because we have no regulatory protections against price gouging. Epi-Pens are another example. A 1mL vial of epinephrine costs ~$5, and the syringe to inject it costs pennies. Auto-injectors add some value, but not the $700 Mylan charges. They're fundamentally a pre-filled syringe a spring, and an injection molded case.
I wonder what the system would look like if we granted longer pharmaceutical patents (say, 30 years), with the change that upon expiration of the patents medicines would be produced by the government and sold at cost (or provided for free).
> There's no reason for it to cost as much as is does in the US, apart from greed.
The reason is people don't "pay" for it. Insurance does, and so nobody cares.
Edit: Well, the insurance companies should care, but if it's something that's rarely prescribed, it might be easier to just pay the claim instead of devoting people to negotiating a lower price.
What truly upsets me is that not a single politician really knows or wants to see how to fix healthcare!
Right now its like pulling a rope - we keep Obamacare at cost of billions of dollars, or we lose it at cost of millions lives affected, eventually.
Meanwhile big pharma thrives and examples like yours prove how corrupted US system is!
I'm still waiting for one single politician (not its not Trump) to actually start fixing healthcare from the bottom up! Fix the cost of drugs, therapies, etc, and all of sudden we need 1/10,000th of the initial costs.
You'd expect just that to happen. The domestic market for human-rated albendazole is so small that it will sustain just one manufacturer, it's effectively a monopoly, and the monopolist can set prices to whatever he wants. We know what to do in such a situation (turn the monopolist into a regulated utility), but the current political climate won't permit this action.
> This medicine is out of patent; the R&D costs have been recovered. There's no reason for it to cost as much as is does in the US, apart from greed.
So apparently this medicine is used for treating parasitic worm infections, which I imagine is a vanishingly small market in the United States. That means that the costs of tooling up to produce the drug (and producing it to the standards of safety and purity demanded of any medicine produced in the U.S.) must be amortized over a tiny population of customers.
To make a comparison: a commercial Common Lisp IDE runs nearly $1,000 for a hobbyist edition, while you can get professional versions Clion or Jetbrains for $100-400. But there's no patent or other protections limiting competition in the development tools industry. It's simply the economics of making a product that caters to a tiny niche of potential customers.
Since my wife works in pre-fills and other things I can tell you for a fact that you still have to go through FDA approval. If you change something slightly, you go through approval. There are often clinical trials if the change is not incremental, sometimes even if it is. Change the packaging? FDA review. Change the color of the label? FDA approval. Change suppliers? FDA review.
So yes, the syringe and container themselves don't cost that much on a per unit basis (no clue but it's not nothing.) The regulatory costs are astronomical and have to be paid for over time. The general inanity of this stuff is mind boggling. The amount of paperwork insane.
If you happen to be in NYC (USA), stop by any major Chinese grocery store in Flushing, Queens. You'll find albendazole and other anthelmintics for about $10/pack.
> The wholesale cost in the developing world is between 0.01 and 0.06 USD per dose. In the United States, however, it is very expensive as of 2015 at about 201 USD per dose.
>This medicine is out of patent; the R&D costs have been recovered.
Do you think the financial analysis involved with a new drug stops at "costs recovered"? Why should it?
I find it completely bizarre that, instead of getting behind the fact that the US is essentially subsidizing drugs for the 3rd world, people think rich first worlders should be paying sub-Saharan rates.
This is a pretty standard play inside the beltway. Many, many advocacy non-profits, some you have heard of, are really vehicles for increasing the ROI on corporate lobbying dollars. A humorous example: http://www.motherjones.com/mojo/2012/03/fight-save-paper-dol...
In India most of the Doctors go on a vacation to foreign countries at least twice a year, these are sponsored trips by non profit orgs of big pharmaceutical brands. There is also a massive lobby working in india to block generic drugs ; the present government thankfully did not yield to their lobby , the price of Stunt is now reduced by 80% , thats how much the price was marked up !
This is such an oblique position for legitimately grassroots activism to take. I mean, it's not like people are dropping dead en masse in Canada, out of all places, from taking supposedly sketchy, industrially-produced medication. Meanwhile, importing copycat generics from India is fine [1] (taken from an article with an obvious slant against Walmart, one major importer of such medications).
On the regulatory front, the difference is that India lets the US FDA work there and inspect plants that export to the US [2], while Canada doesn't, and although the US and Canada have been slowly easing into formally trusting the other's regulatory frameworks [3] by working up from food safety [4], they are not quite there on the medical front. How much of this is legitimately grounded in science, logistics, diplomacy, and protectionism are up for debate.
This is good investigative journalism. It certainly raises some additional questions that would have been difficult for an average person to learn on their own -- including questions about this nonprofit, about whether both parties' past attempts to allow Canadian drug imports have been comparable or different, about whether an organic movement concerned about drug safety exists at all, about the author's motivations for writing this piece; all good questions worthy of more research and conversation.
Unfortunately, insurance is the reason we have this health care issue in the US. There is no one to fight these special interest lobbys in the health care world. The hospitals don't care and a good number of patients don't care because of insurance. From what I see , people without insurance are treated as losers and their voice is not heard. Without insurance hospitals and doctors would fight the drug manufacturers on the patients' behalf.
People looking to save money aren't buying branded drugs, they're buying generics. Which are still far too expensive in the US, compared to other OECD markets.
The manufacturer is the same, but manufacturers rarely sell directly to consumers. They sell to pharmacies, and medications at Canadian pharmacies are (surprise) generally priced based on whatever price controls and negotiated rates apply to Canadians. When those rates are 1/10th of the USA cost for the same drug from the same factory the same lot number, either someone's getting the drugs at less than cost or someone else is getting screwed on price.
Or put differently, "Why does the USA fund so much of basic drug research and drug company profits daddy?" "Regulatory capture and bought politicians, son."
There was a story on NPR awhile back about how, if I remember correctly, the U.S. government gives money away to drug companies to help fund drug research in exchange for a license to manufacture the resulting drug in case there's some kind of shortage or the drug is too expensive for anyone to buy it. This right has never been exercised, but there are some who think that they should start doing so to bring drug costs down.
If you allow imports of drugs that are already approved by the FDA, then the objections are mostly about economic incentives (i.e. high prices reward the companies that made the drug, etc..)
If you allow imports on drugs that are approved in other countries but not by the FDA (iirc this was advocated by Ted Cruz in his debate against Bernie Sanders on health care a few months back), then the objection is that it basically neutralizes the ability of the FDA to block dangerous drugs and makes it easier to push drugs to market that aren't ready by promoting the drug in whichever country has the loosest standards or is most corrupt.
[+] [-] tomkinstinch|9 years ago|reply
Some medicines are expensive for a reason: they're new and need to have R&D (and FDA) costs recovered (this is why we have patents), they have niche use and are produced in small quantities (cancer immunotherapies), they're perishable (biologicals), or all three. Many others are expensive because we have no regulatory protections against price gouging. Epi-Pens are another example. A 1mL vial of epinephrine costs ~$5, and the syringe to inject it costs pennies. Auto-injectors add some value, but not the $700 Mylan charges. They're fundamentally a pre-filled syringe a spring, and an injection molded case.
I wonder what the system would look like if we granted longer pharmaceutical patents (say, 30 years), with the change that upon expiration of the patents medicines would be produced by the government and sold at cost (or provided for free).
[+] [-] ams6110|9 years ago|reply
The reason is people don't "pay" for it. Insurance does, and so nobody cares.
Edit: Well, the insurance companies should care, but if it's something that's rarely prescribed, it might be easier to just pay the claim instead of devoting people to negotiating a lower price.
[+] [-] joering2|9 years ago|reply
Right now its like pulling a rope - we keep Obamacare at cost of billions of dollars, or we lose it at cost of millions lives affected, eventually.
Meanwhile big pharma thrives and examples like yours prove how corrupted US system is!
I'm still waiting for one single politician (not its not Trump) to actually start fixing healthcare from the bottom up! Fix the cost of drugs, therapies, etc, and all of sudden we need 1/10,000th of the initial costs.
[+] [-] HarryHirsch|9 years ago|reply
See the vet, get fenbendazole for huge dogs.
[+] [-] rayiner|9 years ago|reply
So apparently this medicine is used for treating parasitic worm infections, which I imagine is a vanishingly small market in the United States. That means that the costs of tooling up to produce the drug (and producing it to the standards of safety and purity demanded of any medicine produced in the U.S.) must be amortized over a tiny population of customers.
To make a comparison: a commercial Common Lisp IDE runs nearly $1,000 for a hobbyist edition, while you can get professional versions Clion or Jetbrains for $100-400. But there's no patent or other protections limiting competition in the development tools industry. It's simply the economics of making a product that caters to a tiny niche of potential customers.
[+] [-] wheaties|9 years ago|reply
So yes, the syringe and container themselves don't cost that much on a per unit basis (no clue but it's not nothing.) The regulatory costs are astronomical and have to be paid for over time. The general inanity of this stuff is mind boggling. The amount of paperwork insane.
[+] [-] finid|9 years ago|reply
[+] [-] wereHamster|9 years ago|reply
Source: https://en.wikipedia.org/wiki/Albendazole
[+] [-] overcast|9 years ago|reply
[+] [-] walshemj|9 years ago|reply
[+] [-] bigtimeidiot|9 years ago|reply
Do you think the financial analysis involved with a new drug stops at "costs recovered"? Why should it?
I find it completely bizarre that, instead of getting behind the fact that the US is essentially subsidizing drugs for the 3rd world, people think rich first worlders should be paying sub-Saharan rates.
[+] [-] dougmwne|9 years ago|reply
[+] [-] sureshn|9 years ago|reply
[+] [-] niftich|9 years ago|reply
On the regulatory front, the difference is that India lets the US FDA work there and inspect plants that export to the US [2], while Canada doesn't, and although the US and Canada have been slowly easing into formally trusting the other's regulatory frameworks [3] by working up from food safety [4], they are not quite there on the medical front. How much of this is legitimately grounded in science, logistics, diplomacy, and protectionism are up for debate.
This is good investigative journalism. It certainly raises some additional questions that would have been difficult for an average person to learn on their own -- including questions about this nonprofit, about whether both parties' past attempts to allow Canadian drug imports have been comparable or different, about whether an organic movement concerned about drug safety exists at all, about the author's motivations for writing this piece; all good questions worthy of more research and conversation.
[1] http://www.huffingtonpost.com/al-norman/india-wal-marts-drug... [2] https://www.fda.gov/forconsumers/consumerupdates/ucm333944.h... [3] http://trade.gov/RCC/ [4] https://www.fda.gov/food/newsevents/constituentupdates/ucm49...
[+] [-] yalogin|9 years ago|reply
[+] [-] developer2|9 years ago|reply
[deleted]
[+] [-] panzagl|9 years ago|reply
[+] [-] twothamendment|9 years ago|reply
[+] [-] refurb|9 years ago|reply
They do realize that for branded drugs, the "Canadian drug manufacturer" is the same as the US drug manufacturer, right?
[+] [-] dublinben|9 years ago|reply
[+] [-] fencepost|9 years ago|reply
Or put differently, "Why does the USA fund so much of basic drug research and drug company profits daddy?" "Regulatory capture and bought politicians, son."
[+] [-] elihu|9 years ago|reply
[+] [-] unknown|9 years ago|reply
[deleted]
[+] [-] EGreg|9 years ago|reply
[+] [-] elihu|9 years ago|reply
If you allow imports of drugs that are already approved by the FDA, then the objections are mostly about economic incentives (i.e. high prices reward the companies that made the drug, etc..)
If you allow imports on drugs that are approved in other countries but not by the FDA (iirc this was advocated by Ted Cruz in his debate against Bernie Sanders on health care a few months back), then the objection is that it basically neutralizes the ability of the FDA to block dangerous drugs and makes it easier to push drugs to market that aren't ready by promoting the drug in whichever country has the loosest standards or is most corrupt.
[+] [-] OliverJones|9 years ago|reply