[stevebmark]

Will your company become obsolete once the US removes the ridiculous law that US citizens can't buy drugs from other countries? Every modern country has solved the low price drug problem except the US because of criminal and fraudulent healthcare laws.

[alexosh1]

Ideally yeah, would be good if we didn't need to exist. There are a variety of policy initiatives the US could likely implement to bring costs down. My kind of mindset with the company though is I am a nobody from nowhere, and congress isn't going to listen to me. I can make cheap / sell medicine at an affordable price though. So I will do that.

I'm not sure drug importation will work though, not because it's a bad policy per se, but I'm not sure that other countries will let the US import their low-cost medicines if US law changes in order to protect their domestic supplies.

There's Canada as an example case. We have ~10x the population of Canada, and California alone could use up all of Canada's medicines. Not sure Canada would go for it.

Think it's worth a shot though. I know there are some trial programs going into place in Colorado and Florida around allowing drug importation. Will be cool to follow and see how they play out.

[stevebmark]

Makes sense, I always appreciate healthcare companies that capitalize on bad laws saying that ideally they wouldn't exist and they're trying to work within the existing framework.

Cross-border drug buying works well in the EU, where any European country can buy drugs from any other European country, so whoever has the lowest price usually wins the market.

As a private company, your incentive is to maximize profit for shareholders. Since all you have to do is undercut high drug prices a little, what will stop you from the same price gouging that all other US drug companies perform?

[alexosh1]

Well, there's some technical measures we've taken and some practical ones to ensure we work to be profitable but remain focused primarily on improving public health and helping patients.

On the technical level, we incorporated as a public benefit corporation, so we are judged not only on how profitable we are for shareholders, but how well be maintain our social mission. That is actually in our charter documents and is a legal requirement.

On a practical level, Mark Cuban is our lead investor and his interest is very much focused on helping people and fixing system issues in healthcare. We also did some screening to ensure our other investors are socially minded and prioritize social benefit as well as profits.

My mindset is that we need to be profitable to be sustainable and grow enough to help the overall system, but we won't be extortionate.

[peteretep]

> On a practical level, Mark Cuban is our lead investor and his interest is very much focused on helping people and fixing system issues in healthcare.

Also he got to write his name on it

[Tuna-Fish]

Probably more "the company begged someone of high visibility to write their name on it".

Cost of advertising is a serious problem for generic drug makers. There are a lot of drugs where there exists an identical, cheaper, generic version, but the more expensive one gets sold because neither the doctors nor the patients have any idea that it exists. Hence all the "ask your doctor for x" ads, but the problem is that advertising on that scale, especially for low-incidence conditions, is very expensive compared to the amount of money you make, an so will result in just another expensive drug.

A celebrity putting their name on a drug company and then maybe mentioning it a few times publicly in places where normal people hear about it may make people who are facing very expensive drug bills look up the site and see if they make something useful for them.

[coredog64]

If there’s an actual generic (e.g. Naproxen Sodium :: Alleve), then your doctor just has to ensure that the Rx isn’t “fill as written”. The pharmacist can then offer you options (Namebrand at X times 5 or generic at X)

If it’s the case where there’s an older generic and a newer product still under patent, that’s a discussion with your doctor: Is the newer product worth the money, or should I stick with the older thing?

[bsimpson]

I wonder how much credibility his name adds in the short term. People might take it more seriously if it's backed by someone with a reputation.

In the longer term, success in the health space could add prestige to his name, ala the Nobel prize.

[peteretep]

Yes, I agree with both. Seems win/win, and a much better claim to fame than putting radio on the internet! ;-)

[po]

The only reason I clicked and am reading these threads right now is because I was curious why he put his name on a drug company.

[fuzzfactor]

Even more importantly, the company got to put his name on it.

[nojvek]

Nice! We had Obamacare, now we get MCubanocare?

[DevKoala]

Obamacare actually increases the cost of drugs. Here is a study showing the comparison adjusted for inflation.

https://pubmed.ncbi.nlm.nih.gov/28224469/

[tonyhb]

Can you put your email in your profile please? Reaching out from working at a healthcare company now.

[m3at]

You can find it at the top of the thread: [e-mail]

[freddyfx]

In Italy our representatives negotiates the prices of the important drugs with the pharmaceutical industry, and they have little or no cost for the individual. There are always some very annoying exceptions, of course, but that's the general rule. We all take it for granted and demand it, doesn't matter the political orientation. I think your representatives are not doing a good job (not that ours are better, eh;), and makes me wonder what you vote for, if not for this basic things.

[CuriousNinja]

> There's Canada as an example case. We have ~10x the population of Canada, and California alone could use up all of Canada's medicines. Not sure Canada would go for it.

Depends on the country. For example India is the largest generic drug manufacturer and has a population of over 1 billion, and they already export their drugs to many countries.

[pjanoman]

Would it not be somewhere in the middle though? Instead of completely saying yes or no, maybe Canada would say "We'll allow you to purchase X% of all drugs produced in the country, as we need to hold onto some, but we'd love it if you'd buy the surplus."

[refurb]

Canada produces very little. They are importing it from the big manufacturers. Last time importation from Canada became an issue the companies just said to Canada “we’ll sell you what you bought last year plus 5%.”. Then Canada got to choose - give those drugs to Canadians or sell them to the US. But they can’t do both.

[jmckib]

> We have ~10x the population of Canada, and California alone could use up all of Canada's medicines. Not sure Canada would go for it.

Couldn't Canadian drug companies increase supply if the demand was there? In the short term, sure, they would not be able to handle our level of demand, but unless there's some constraint I'm not aware of they could always just scale up and make more animal insulin or whatever.

[TylerE]

They don’t make the drugs in Canada. They buy them in the open market, likely from us.

[Scoundreller]

It's sort of the open market.

The history is that Canada used to have "compulsory licensing" for patented drugs. Anyone could manufacture a patented drug in Canada and pay a ?6?% or whatever royalty to the patent owner and they just had to deal with it.

Over the years, first 4, then 10 years of exclusivity were provided to the patent owner.

Then the WTO came along, and presently, everyone has agreed to ~20y exclusivity and charge/pay the median price of OECD countries before it's a royalty-free free-for-all.

http://publications.gc.ca/Collection-R/LoPBdP/BP/prb9946-e.h...

Canadian generic drugs today aren't usually cheaper than US generics, except where patent exclusivity mismatches.

[antman]

India would go for it without even noticing I guess.

[arcticbull]

Other countries don't solve the problem via re-importation.

Re-importation shouldn't be illegal, but it shouldn't be necessary - it's really kinda dumb. Other countries have solved this problem by making healthcare universal, and forming a bulk purchasing group which strong-arms providers into charging something the system can bear. The end user doesn't have to care how much that is, because most developed countries simply pay for the drugs people need in the first place.

The ideal way to obsolete this problem is to follow their lead - get Medicare for All to happen and restore Medicare's ability to negotiate the price of drugs directly with manufacturers.

Then nobody has to pay for the drugs directly in the first place.

[refurb]

Strong arming is the right term. United Healthcare in the US has 40 million members. Bigger than the entire population of Canada. Yet they can’t negotiate prices anywhere as low.

[kwhitefoot]

> Yet they can’t negotiate prices anywhere as low.

Can't or won't?

[smabie]

the bulk prices developed countries in Europe are paying is still much greater than some countries that have a truly free market system. For example, I lived in Tanzania and all drugs were imported and all of them over the counter. Drugs that literally cost thousands of dollars a month in America without insurance would usually come to around $5-10.

I doubt the American people (or American industry) would ever allow such a truly free market system to transpire, but I know for a fact it can work.

Labor is cheaper in Tanzania obviously, but even if you adjusted for the more expensive labor, a free market system (vs the crony capitalist system we have now) would probably be 10-100x cheaper.

Also, even controlling for median wage, the drugs are vastly cheaper in Tanzania vs America. A median worker there might make around $5-10 in wage, so most drugs for a month supply would be only a day of work. Median hourly wage in America of $15 would correspond to drug prices between $60-120 dollars, much cheaper than most medications without insurance. In reality, it should be much cheaper, as the marginal cost can be reduced a lot through online pharmacies (remember that $5-10 cost in Tanzania not only factors in product cost and labor cost, but a staggeringly inefficient distribution network).

In short, I don't believe there's any theoretical reason why generic drugs couldn't be dirt cheap and affordable by all in a free market system. After all, capitalism has done a stellar job at reducing the cost of consumer goods over time, and medication should be no different.

If everyone could buy lightly regulated pills from alibaba, it would definitely be a win from a utility standpoint. But of course such a thing would never fly, as maximizing total utility doesn't get people elected. Everyone might win except one guy who died from bad pills and the whole gig would be up, even though the total utility function of every citizen in aggregate was being correctly maximized.

The strong needs of the few always trumps the weak needs of the many. If everyone paid one $1 dollar per day in order to prevent one death, I'm sure some politician would call it a massive win, even though that's an aggregate loss of 100bn dollars annually and the money saved generated more utility than the utility lost by that one guy dying.

Unfortunately, human beings are unable to make correct statistical/utilitarian decisions and support so many policies that are a net negative utility wise.

[arcticbull]

Drugs in countries like Tanzania are cheap because drug companies don’t think they can get more money out of it, it’s more of a charity project. They offer them to developing countries well below cost - Tanzania is the 15th poorest country in the world with a GDP per capita of $500 (2011). It’s not an example of a free market.

[smabie]

I'm not sure that's true. Most of the medication I came across came from third rate Russian or Indian suppliers. I highly doubt the sales of drugs from these countries (also poor countries) to another poor country (Tanzania) was charity.

[necovek]

It ain't a charity: after the initial development, drug production is usually very cheap.

Aligning prices with purchasing power allows pharmaceutical companies to get _something_ out of the markets they'd get nothing out of. And with large numbers, that something might turn out to be a bit more.

[_jgdh]

Third rate Indian suppliers? I’m not sure if you’re implying that the price is low or the quality is poor. If it’s the latter, you don’t know much about Indian pharma companies. Btw, Indian pharma companies selling high quality anti retro viral drugs to African countries at low prices is why HIV is relatively under control right now.

[phonon]

https://www.fraud-magazine.com/article.aspx?id=4294983341

[ganafagol]

You need to distinguish between drug development and production.

Sure production cost is usually low and that technically allows to sell to poor countries essentially at cost plus a tiny margin.

But that's only half the story. Drugs need to be developed. From idea to market only a tiny fraction of medication makes it. You need studies ovet studies, and most of the time a drug does not make it through that process because it's ineffective or dangerous or both. The few that make it need to compensate for the cost of this process, not just their own but all of those that didn't make it.

So, in "rich" countries, a pill that costs $0.10 to produce can easily cost $1000. That's a necessity to finance the whole process of getting there.

After that is all done and established, sure, you may get that same pill for $1 since it's either that or no sale. But that does not mean the whole system would work for $1 per pill everywhere in the world. Then the pill would not exist in the first place.

[thw0rted]

See also: region locking in video games. Again, the development costs vastly outweigh the marginal cost of producing an extra unit to sell, so they sell the product at whatever the local market will bear, which breaks down if richer markets have access to supply from poorer ones.

[jariel]

The laws regarding importation from other countries are odd, but they are not what you think they are.

In effect, it's about 're-importation' of drugs, not so much regular import.

The Government of Ontario negotiates drug prices for it's citizens, as to other entities elsewhere.

By selling to XYZ regime at ABC price, drug companies create a situation wherein 'the resulting price will be the lowest price we sell to any regime' - because of course everyone will want to import from there.

In many cases, the price sold to XYA regime isn't quite a very good measure of net market prices.

Ergo, it's a weird law, but it's rational on a level.

To start - there could be a slew of laws requiring transparency on pricing for everything in the medical domain. That would be a good start.

More challenging - Americans could actually get together and start negotiating hard on prices. This may require some legislation.

So the 're-importation' issue is an artifact of an odd system, not in and of itself the issue.

[arcticbull]

Ontario's a great example of how this problem is usually solved in developed countries.

OHIP negotiates the prices of all drugs on behalf of Ontarians by being the sole purchaser, and then drugs are sold at that rate (cost plus, I believe) in pharmacies. Further, the cost of all services is listed on the OHIP website. [1] Not that anyone needs to worry about that as they are fully covered for everyone - not the drugs (yet, fingers crossed), the procedures.

[1] http://www.health.gov.on.ca/en/pro/programs/ohip/sob/physser...

[inter_netuser]

Tons of new drugs are never even marketed in Canada due to this, or marketed much later.

Almost all expensive drugs end up being on a special permission list, where you must to beg the government for access.

Not any different than dealing with an insurance company, really. At least you can sue an insurer.

[arcticbull]

You can sue the province too.

However of course consider delays in getting a drug to market aren’t always provincial; Health Canada has their own timelines and schedules for approvals, sometimes it’s faster than in America and sometimes it’s slower.

The difference is frequently you’re forced to sue insurers as they have a profit motive to screw you. The province only cares about getting you healthy within their means.

[jariel]

It has benefits but also obviously drawbacks.

Ambien is not available in Canada for example.

One of the things about hard negotiations is that sometimes the other side will call the bluff and walk away.

And of course in rationed systems you don't get things that 'the masters' decide you don't need, like Ambien.

In the case of Ambien, I don't care, I question the real medical value of it, but you can see how that could get out of hand with other things.

It would better to solve the 're-import' problem with better regulation - and of course, initiatives such as the the MC Company here.

I think the Cleveland Clinic and some others like it are technically non-profits, there are models that work.

[arcticbull]

The thing about MC company is they have no obligation to keep their pricing or business model moving forward. They can sell to an insurer or pharma company or just raise their margins. This is good but shouldn’t be integral.

[IfOnlyYouKnew]

This would just screw over poor countries. See the example of Tanzania someone gives below: selling drugs cheaper in such a country will stop immediately if it risks undercutting the US market.

[simias]

While the general idea that rich countries should help poorer ones has some merits, the idea that poor people in rich countries should be shafted in order to provide cheaper drugs for everybody else doesn't quite make sense to me.

I've heard the argument that Americans effectively subsidize drugs for everybody else. While it may be true, it still seems like a terrible situation to me, even as a non-american. There's got to be a fairer way to work this out.

[sumedh]

> This would just screw over poor countries.

Lot of drugs are manufactured and exported from India.