[khuey]

> Something is systemically wrong in the US when we are cutting off people’s access to meds, like GLP-1s, which have profound health benefits.

Are we cutting off people's access to meds or do they just not want to pay what they cost?

[ronsor]

To be fair, most medication in the US is overpriced due to patents and what not. The "cost" is hardly the real, legitimate cost and generally inflated 1000%+ compared to other countries.

[estearum]

This is not really the correct way to think about this.

Pharma is ultra R&D heavy so yes, medications are deeply profitable on a per-pill cost to manufacture basis. However, drug companies by and large are not extremely profitable. This is because to produce a single drug (which is high-margin from point of production), they have to sink billions of dollars into literally thousands of other drug candidates to figure out which ones are viable.

This is all "real, legitimate cost," as is reflected in their rather abysmal overall profitability.

As for the disparity between US and foreign markets, it's a basic tenet of commercialization to sell to every buyer at the highest price they'll accept, so long as that price is above your price to produce. All sorts of companies engage in "price discrimination" to achieve this. For example, cereal manufacturers will sell their own brand at $4/box, and sell the exact same product in a store brand box for $3.25/box. A lot of products in your local retail stores do this.

Overall, no one is really hurt by this per se. Every consumer is making a transaction they're willing to make, and the company is making the most money it can in aggregate, which actually gives it room to push the price at every price point lower than it would be able to if it could only sell to a single segment.

This is actually extremely important in the drug context due to the aforementioned abysmal profitability.

Let's take Trump's attempt to force a Most Favored Nation (MFN) clause onto drug manufacturers which guarantees US consumers pay the same price as the lowest price internationally. The intended effect is for US prices to come down to the level paid elsewhere.

But here's Pfizer CEO: "When [we] do the math, shall we reduce the US price to France’s level or stop supplying France? We [will] stop supplying France. So they will stay without new medicines. The system will force us not to be able to accept the lower prices.”

Not only does this obviously not result in lower US prices, but it very possibly results in higher US prices (since now there is less net revenue from lower priced consumers) and, more troubling in the pharma case, there is now even less net revenue coming in to justify new drug development.

It's hard to overstate how asinine this entire endeavor is. US consumers certainly pay too-high prices for drugs, but this intervention does very little to actually address that problem. The much more proximal issue is the incredible degree of intermediation in the US market between payers, providers, PBMs, GPOs, and more.

[elamje]

> Not only does this obviously not result in lower US prices

Maybe in Pfizer’s portfolio this is true. However, I just watched the Amazon Pharmacy pricing for GLP-1s drop substantially immediately following this. I think you may be being too black and white on claiming this categorically does not work.

Businesses will adapt pricing models, obviously this hurts Pfizer in some way, but Lilly and Novo found the new system was worth negotiating into. Like most things - when people say “always” or “never” - it’s reducing the spectrum of possibilities

[phil21]

GLP-1s are already under immense pricing pressure due to competition, direct to consumer sales outside of the insurance system (to the point of forging entire new markets for drug companies never possible before - what other drugs have millions of customers paying $300-400/mo for prescription medications?), compounding pharmacies end-arouding patent law like this article is about, and outright black market sales that dwarf any other prescription medication classes outside of opioids and benzodiazepines.

It has nearly nothing to do with government action. These will be the most profitable medications ever invented once the dust settles and it’s a game of price optimization right now.

[estearum]

GLP-1 prices are ultra-competitive and in an honest-to-god price war.

Not only are there multiple current-generation GLP-1s on the market (Novo's and Lilly's), but there are at least 2 or 3 more generations approaching the market.

[dataflow]

> Not only does this obviously not result in lower US prices, but it very possibly results in higher US prices

Here's the thing: yes, you may "very possibly" be right, but that means you may also "very possibly" be wrong. The truth is, we don't know, and we can't really trust the CEO of any business to openly admit that they could tolerate a policy disadvantageous to them. So how would you suggest testing the case where you're wrong?

[estearum]

There is no world in which an MFN clause does anything other than reduce the overall revenues to the pharma companies.

There is no world in which lower overall revenues does not reduce R&D spend.

There is no world in which lower R&D spend does not reduce the number and quality of new drugs.

This doesn't require trusting anyone about anything other than trusting that pharma companies are generally profit-seeking and therefore an MFN clause imposed by USG will create less optimal pricing (for the pharma companies' own incentives) than currently exists.

The exact price changes that happen in different localities that net out to "less revenue → less R&D → fewer drugs" is hard to predict, but the fact that it will be lower and it nets out to "less revenue → less R&D → fewer drugs" is absolutely predictable.

Please suggest an alternative outcome, if you can think of one.

[nozzlegear]

> But here's Pfizer CEO: "When [we] do the math, shall we reduce the US price to France’s level or stop supplying France? We [will] stop supplying France. So they will stay without new medicines. The system will force us not to be able to accept the lower prices.”

This person is a less than neutral source in an industry that's already infamous for lying through its teeth to grind out every red cent from its customers. I would lend precisely zero credence to what he says when he's trying to justify why his poor billion dollar company wouldn't be able to lighten up on its wholesale fleecing of American customers.

[estearum]

"Poor billion dollar company" cannot possibly be a slur in an industry that requires $2 billion in investment (and rising!) to make each subsequent product. Maybe if the product were a luxury good that the world could do without, but it's not, and we cannot.

You don't need to trust anything except that left to their own devices, those greedy pharma companies will price as efficiently as possible in order to maximize revenues. Despite this revenue maximization, the industry as a whole is nearly uninvestable.

Any deviation from the optimal pricing will reduce their overall revenues, which will obviously make the industry even less investable.

In an R&D heavy sector means they will no longer make new products, i.e. no new breakthrough medications that you or I or our parents or children may need.

Sure, I doubt Pfizer et al will just outright stop selling medications to France. Far more likely they will both reduce US prices and raise EU+ prices, but this still ultimately results in fewer drugs for fewer people today, and definitely much slower innovation toward new drugs by virtue of having less cash on hand and much worse expected ROI.

You do not need "trust" whatsoever, this is just basic logic.

If you want to understand how Americans should actually reduce drug prices, you can start to get an idea here: https://news.ycombinator.com/item?id=46933520

[nozzlegear]

> Sure, I doubt Pfizer et al will just outright stop selling medications to France. Far more likely they will both reduce US prices and raise EU+ prices

This is my point – quoting the man on what he says will happen is pointless because he's just using scary hypotheticals to make the best case to keep the cash hose turned on. He's not some altruistic saint bestowing new formulations upon the world if only he had more money, he's a slimeball pharma CEO trying to balance that R&D with reaping maximum profits.

Would lowering prices for Americans mean the world has less R&D bankrolled by American consumers? Probably. But the current situation is untenable.

[estearum]

Please engage with the substance of the argument put in front of you.

The thrust of the comment above is that you do not need to trust him.

[snovv_crash]

Americans are willing to pay higher prices because direct to consumer advertising is allowed, making people more willing to pay a higher price because an ad convinced them it will be worth it. If people wouldn't pay, then pharma companies would lower the prices.

Fix the demand side and the supply side will adjust.

[estearum]

I would suggest it's the reverse. Americans accept higher prices because they have many many layers of intermediation.

Americans pick their employer. Their employer picks their health plan. Their health plan picks which drugs are covered and which doctors and pharmacies they can use.

With the "innovation" of vertical integration between insurers, healthcare providers, and PBMs, there is effectively zero incentive for health insurers to manage costs, because those costs show up as revenue for their own subsidiaries. This is actually hugely advantageous for insurers because they are required by law to spend a certain percentage (~80%) of their members' premiums on healthcare goods and services, not profit or business development.

Well... if you own the pharmacies, the PBMs, the GPOs, and especially the healthcare providers... you can arbitrarily siphon money at any % rate you want while increasing the gross dollar intake by simply raising prices at your subsidiary companies!

All of this is well documented. Here are a few places to start:

https://www.statnews.com/unitedhealth-group-investigation-he...

https://hntrbrk.com/pbmgpo/

https://www.wsj.com/health/healthcare/unitedhealth-medicare-...

[mhb]

Do you have some information on the relationship between advertising and the willingness to pay higher prices for the advertised product?

[wan23]

At some point when the compounding was ramping up it was difficult to get the drugs even with a prescription and being willing to pay the full no-insurance price. Nowadays you can mostly get it, but insurance coverage is spotty. Because of weird incentives, the no-insurance prices of drugs are highly inflated so the amount that they cost isn't a realistic price for most people to afford. The manufacturers offer coupons but the conditions on them, and the fact that they still leave you with a pretty inflated price tag means that the compounded versions like what HIMS sell are the most cost effective option for a lot of people - it's still highly marked up, but to a level that is manageable for way more people.

[sixothree]

Were people not previously paying what they cost? It sounds like that's the concept we're getting rid of here.

[ridgeguy]

A distinction without a difference...