Perhaps more countries should follow Thailand's approach:
On January 25, 2007, Thailand’s interim government issued compulsory licenses–which require
manufacturers to license generic versions of their patented drugs–for two Western medicines:
Kaletra, an advanced anti-AIDS medicine manufactured by Abbott; and Plavix, a blood-thinning
treatment to help prevent heart disease, produced by the France-based Sanofi-Aventis and U.S.
firm Bristol-Myers Squibb. These attacks were preceded in November 2006 by a violation of
Merck’s patent on the anti-AIDS drug Stocrin.[5] The government threatened to break
patents on eleven more drugs.[6] Explaining the rationale behind Thailand’s decision, health
minister Mongkol Na Songkhla said that “the move is permissible under international trade
rules in the event of national public health emergencies. . . . We have to do this because we
don’t have enough money to buy safe and necessary drugs for the people under the government’s
universal health scheme.”[7]
> On January 25, 2007, Thailand’s interim government issued compulsory licenses–which require manufacturers to license generic versions of their patented drugs–for two Western medicines: Kaletra, an advanced anti-AIDS medicine manufactured by Abbott; and Plavix, a blood-thinning treatment to help prevent heart disease, produced by the France-based Sanofi-Aventis and U.S. firm Bristol-Myers Squibb. These attacks were preceded in November 2006 by a violation of Merck’s patent on the anti-AIDS drug Stocrin.[5] The government threatened to break patents on eleven more drugs.[6] Explaining the rationale behind Thailand’s decision, health minister Mongkol Na Songkhla said that “the move is permissible under international trade rules in the event of national public health emergencies. . . . We have to do this because we don’t have enough money to buy safe and necessary drugs for the people under the government’s universal health scheme.”
Are you using an app such as Materialistic or Hews, or just using your browser? For what it's worth I don't recall any problems reading quote blocks on Materialistic.
I've checked and it's € 50 a month in the Netherlands for the pills. There is something else going on with that pricing. There are doctor fees on top of that, but a few checks a year will never consitute the $15k difference.
I can confirm in the US it is truly that expensive (which is fucking crazy). I have pretty good insurance (or at least the best I can get self-buying) but I still have to pay 30% of meds costs. That is something like $400 /month. Luckily Gilled will reimburse up to 7500 /year.
Fucked up private insurance in US, they charge that much and then do the reimbursement so they can bill the huge monthly cost to plans / government that will cover it.
We should be giving this out for free.
My MD said Truvada might go generic next year, so perhaps there's hope.
In the US, we’re paying obscene prices because no other country pays their fair share to recoup the cost of development plus bringing the drug to market plus a reasonable margin for the effort.
The US should establish an agreement whereby US patients pay a LOT less but that the foreign patients need to pay the same.
The amount the industry earns should be low enough to make it reasonably financially accessible to patients but high enough to prompt our best and our brightest to pursue new drug development as a career.
> During the quarter [2019 Q2], Gilead generated $2.2 billion in operating cash flow, repaid $500 million of debt, made dividend payout of $800 million and spent $588 million on share buybacks.
> Adjusted product gross margin was 87.3% compared with 84.2% in the year-ago period. Research & development (R&D) expenses were relatively flat at $916 million. Selling, general and administrative (SG&A) expenses increased 20.8% to $1.01 billion.
You're basing your argument on cherrypicking one single pharmaceutical company that is doing exceptionally well recently because it had the second best selling drug of 2018, Harvoni, a drug to treat Hep C.
What about when you take all the pharma companies and average how well they do over several years? The average net profit margin for the industry is 14.05% according to a January 2018 study by New York University’s Stern School of Business.
14.05%, not great, not terrible.
In addition, the overwhelming majority of those dividends and share buybacks from one company are subsequently plowed back into the industry in different companies depending on which of those companies are working on the most profitable drugs.
source: I have several friends that control a lot of AUM that specialize in pharma investments.
> You're basing your argument on cherrypicking one single pharmaceutical company that is doing exceptionally well recently because it had the second best selling drug of 2018
Well, the discussion was about the atrocious cost of HIV medication, and Gilead is the company that holds the patent on Truvada. You didn't provide a link, but http://pages.stern.nyu.edu/~adamodar/New_Home_Page/datafile/... suggests it's actually lower in 2019 at 10.94%.
From the linked Excel sheet there, there are 28 industries with higher net margins, and 65 with lower net margins. They're still doing just fine :).
14.05% Is FUCKING GREAT considering they make their money over the misery of people. It's actually a disgrace that the profit margin is anything over 2%.
I once presented to the monthly board meeting of one of the biggest global pharma companies. The audience was the top execs plus the top-10 country heads.
All they talked about during the dinner was price fixing, tricky deals to block generics, and schemes to maximise the amount they could get each country to pay. Nothing about the science, medicine behind the drugs, or benefits to patients.
Not just pharma. Most industries care about increasing profits and blocking competitors. Hardly surprising since Top execs are measured on such metrics.
Pricing is always and inevitably what the market can bear, not anything about “fairness”. If prices are too high or communities are too poor (communities not countries), those communities go without. Right now, the US is so expensive that in cases like this it makes sense for patients to fly to another country to get the medicine. That’s unsustainable.
It fundamentally is about fairness albeit in a peripheral sense - the market doesn't exist in a vaccuum - those high prices depend upon granted monopoly rights and regimes which are a bargin wrongly conflated with property and treated like an entitlement instead of the contracts they are. Nothing is owned - only the ability to stop others from doing things. An unfair contract is increasingly likely to be ripped up because there is nothing more to be lost by doing so.
That people are flying abroad is the start of ripping up their local monopoly along with uncertifified online pharmacy importation and grey market sales - taking risks to avoid costs is a sign that the market /isn't/ bearing it.
The reason markets don't really work well for healthcare is that 2 things efficient markets require are competition and symmetrical information. Drug companies have exclusive patents. Doctors require extensive licensing that limits the labor supply. Prices are not transparent from providers. And maybe most importantly, in many cases people don't really have a choice whether they want to participate in the market or not; it's sometimes a choice of "pay whatever they say for treatment" and "die".
Since when the market knows the word fair? You charge as much as you can, in this case Americans are the suckers, but if it makes you feel any better for yourself and natural pride keep calling it as you pay for the whole worlds market.
Oh look you created an incredibly inefficient, expensive and corrupted system to research drugs and now you claim you spend more on drug research than anybody. Have a pat on the back.
Monosopy doesn't depend upon anything the US does. They have local control of IP even if they tied it to others.
There would be costs involved but they can always tell them to get stuffed and manufacture their own if they won't be reasonable. Notably there is a lack of pharmaceutical companies who decide to abandon world markets entirely because positive N is always greater than 0.
I am not sure this explains the discrepancy between the healthcare cost between US and Switzerland.
More in depth analysis:
"There were two causes of this massive increase: government policy and lifestyle changes.
First, the United States relies on company-sponsored private health insurance. The government created programs like Medicare and Medicaid to help those without insurance. These programs spurred demand for health care services. That gave providers the ability to raise prices. A Princeton University study found that Americans use the same amount of health care as residents of other nations. They just pay more for them. For example, U.S. hospital prices are 60 percent higher than those in Europe. Government efforts to reform health care and cut costs raised them instead.
Second, chronic illnesses, such as diabetes and heart disease, have increased. They are responsible for 85 percent of health care costs. Almost half of all Americans have at least one of them. They are expensive and difficult to treat. As a result, the sickest 5 percent of the population consume 50 percent of total health care costs. The healthiest 50 percent only consume 3 percent of the nation's health care costs. Most of these patients are Medicare patients. The U.S. medical profession does a heroic job of saving lives. But it comes at a cost. Medicare spending for patients in the last year of life is six times greater than the average. Care for these patients costs one-fourth of the Medicare budget. In their last six months of life, these patients go to the doctor's office 29 times on average. In their last month of life, half go to the emergency room. One-third wind up in the intensive care unit. One fifth undergo surgery. "
You can read the rest it is very informative. I still don't think that healthcare cost in the US is caused by the rest of the world not paying their fair share in drug discovery.
But that's the payment after co-payment by insurance or third party (in case of GGD the municipality). For a fair comparison I looked up the over the counter price of the generic medicine (or to be fair, public news about that price, I didn't look in the price register). My conclusion is that in the US case it's somewhat unfair to blame the insurer if the base price of a medicine is amplified about 20 times.
My friend who’s on a high-deductible plan says they reimburse you for the portion that’s before your deductible. It’s actually kind of a sweet deal because you hit your deductible without being out any money. Then you don’t have to worry about paying for medical care for the rest of the year.
Who is “they”? There’s a copay card you can use from Gilead that helps pay your co-pay but not aware if that helps you hit out of pocket expenses before you hit your deductible or if that counts as your copay.
The way it was explained to me is: you use the Gilead card to pay you copay, and that counts toward your deductible. So, my last post was wrong to use the word “reimburse”.
That's insane. In Kenya, PrEP is offered free of charge in all public hospitals while in private hospitals, brand name drugs will set you back about $35, while generic equivalents cost about $4.
WHAT!? Here in Germany, my PrEP costs me €40 per month, and I only have to pay that because it’s one of the rare things that insurance doesn’t cover here.
yeah, shocking. if you have diabetes or a thyroid issue or hiv or really any chronic disease that requires medication you are out 12k a year easy, 6 for your insurance premiums and 6 for the deductible and copays. if you are broke there are some provisions, but if you are above the poverty line you gotta pay.
Is this true for health insurances paid by the employers too? I am just curious since people say if you have a tech job you have nothing to worry about healthcare in the US.
In many cases the premium is paid for by your employer entirely, and the max out of pocket is lower, like $4k a year. But it depends on the employer and what plans afte offered.
Also about 20% of Americans are on medicaid, and generally do not pay any premiums, deductibles, or copays
I have 20 years in c++ dev experience at an f500, in silicon valley I probably would get double the pay and full health benefits, but I probably would be too old to work there. so it depends on what you mean by tech.
That's insane. In the UK the NHS doesn't supply it yet, and GPs won't officially recommend it. But you'll find the NHS clinics quite often recommending prep purchase through international websites and referring you to HIV charities.
It costs about £30 pm in that case which is about $40
Often they'll be running studies at the same time to assess the feasibility of Prep on the NHS.
Perhaps "evergreening" is also an issue in the USA that might keep prices high for a long time?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680578/