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Old 07-14-2022, 12:04 PM   #61
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My understanding is that there is much more to it than just the patents in some of these cases. What information about the drug and its manufacturing process must AbbVie provide to competitors who want to manufacture generic Humira? Without a large "show and tell," it could be extremely expensive to gear up, pass all government regulations and go into production.

I wonder what level of detail must AbbVie provide and what qualifications must potential manufacturing competitors have to obtain it?

In other words, for difficult and complicated drugs to manufacture, how will our government get past the "data dump" issues regarding the former patent holder being compelled to help competitors get up and running?
I don't think AbbVie will have to tell the manufacturers of the generic Humira anything. I understand there are 5 companies in the U.S. right now that have perfected the biosimilar of Humira and are ready to start manufacturing the drug. Some are already doing it in other countries. The only hold up is that AbbieVie somehow got their patent extended by another 5 years. AbbieVie has made $200 BILLION dollars on Humira, which is just obscene. They have fought tooth and nail and filed many lawsuits to keep generics out of the US. They got their 20 years of exclusive patents, it is way past time for those patents to expire so there can be generics. Yes I am bitter about this. My DH is paying $8000 out of pocket in this year alone to obtain Humira.
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Old 07-14-2022, 12:59 PM   #62
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So, if we are successful in sharply limiting the ability of Big Pharma to charge high prices for recently developed and patented "wonder drugs," how do we convince Big Pharma and their stock holders to keep spending big bux on R and D? Or, could we successfully substitute research work by public labs (universities, national labs, etc.) funded exclusively by tax dollars? Or perhaps rely more on developments by research labs in other countries?

No Big Pharma CEO worth her salt is going to spend zillions on developing drugs which they'll only be able to sell at manufacturing costs + some small profit.

Not trying to defend Big Pharma here. But I am trying to understand who will fund and push research once we're successful in taking the profit motive out of it.

Would the folks in Washington be better at making allocation decisions and determining funding for drug R and D than our current private enterprise system?

I honestly dunno....... But I do think that even if the current situation sucks, we better understand the replacement before we toss it out.
I get your point. But, based on the drug prices in different countries, it sure seems like American consumers are being asked to bear the burden of the R&D costs while consumers around the world get the benefits.
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Old 07-14-2022, 01:34 PM   #63
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I get your point. But, based on the drug prices in different countries, it sure seems like American consumers are being asked to bear the burden of the R&D costs while consumers around the world get the benefits.
Don't fall for the false choice argument. The US never signed up to fund research for the entire world and Big Pharma spends more money on advertising here (not allowed anywhere else in the world except New Zealand) than they do on research. In sum, bogus argument.
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Old 07-14-2022, 01:42 PM   #64
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Don't fall for the false choice argument. The US never signed up to fund research for the entire world and Big Pharma spends more money on advertising here (not allowed anywhere else in the world except New Zealand) than they do on research. In sum, bogus argument.
And why do we in the US pay significantly more for drugs that are no longer under patent?
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Old 07-14-2022, 02:12 PM   #65
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Don't fall for the false choice argument. The US never signed up to fund research for the entire world and Big Pharma spends more money on advertising here (not allowed anywhere else in the world except New Zealand) than they do on research. In sum, bogus argument.
How much would it reduce the cost of drugs in the U.S. if all advertising were eliminated? In the U.S. alone drug companies spend over 7 BILLION dollars per year in advertising. Eliminate that and I bet the cost of drugs goes down significant. No one should ask their doctor for a drug just because they see it advertised on TV.
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Old 07-14-2022, 02:56 PM   #66
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I get your point. But, based on the drug prices in different countries, it sure seems like American consumers are being asked to bear the burden of the R&D costs while consumers around the world get the benefits.
I agree. Peeves me too.
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Old 07-14-2022, 03:16 PM   #67
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Don't fall for the false choice argument. The US never signed up to fund research for the entire world and Big Pharma spends more money on advertising here (not allowed anywhere else in the world except New Zealand) than they do on research. In sum, bogus argument.
I think the view that the rest of the world is taking advantage of US R&D without paying for it has merit. The evidence is prices for the same medicines are higher in the US than elsewhere.

However, it’s not the only explanation. The pharma industry has successfully engaged in regulatory capture, enabling it to limit competition for extended periods of time. There’s also a profound conflict of interest, as drug manufacturers pay physicians to write prescriptions for their products. In addition, the largest payer, Medicare, doesn’t negotiate price and pays list.

Which has a bigger impact on price? Difficult to say, but if I had to bet it would be Medicare, followed closely by regulatory capture.
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Old 07-14-2022, 09:43 PM   #68
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I think the view that the rest of the world is taking advantage of US R&D without paying for it has merit. The evidence is prices for the same medicines are higher in the US than elsewhere.

However, it’s not the only explanation. The pharma industry has successfully engaged in regulatory capture, enabling it to limit competition for extended periods of time. There’s also a profound conflict of interest, as drug manufacturers pay physicians to write prescriptions for their products. In addition, the largest payer, Medicare, doesn’t negotiate price and pays list.

Which has a bigger impact on price? Difficult to say, but if I had to bet it would be Medicare, followed closely by regulatory capture.
I totally agree. Congress is constantly grubbing for money because every two years Congress persons have to raise and spend millions to keep a $176,000 job. One easy way to raise money is to take corporate cash and screw constituents who can't begin to understand what is going on.
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Old 07-15-2022, 03:31 AM   #69
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I agree too. When the Medicare part D was created in 2003 and enacted in 2006, Medicare was not allowed to negotiate drug prices. Other government agencies can, such as the VA and Medicaid, with huge cost savings.

According to Wikipedia, the Congressman who steered the Medicare bill through Congress retired right after that, and subsequently got a $2M/year job as president of PhRMA. Hmmm… The same article cited sources estimating that the govt alone could have saved over half a trillion these past 20 years if Medicare had been able to negotiate drug prices.

Regarding research and development costs, I’m somewhat skeptical. Many “new” drugs are tweaks on old ones, resulting in a new 20 year patent. I had to learn so many brands and types of intermediate and long-acting insulin working in the hospital over the years, and I treated relatively few diabetic patients as a pediatrician.

The biggest cost to the companies is probably the three phases of clinical trials needed to bring medications to market. That is quite expensive.
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Old 07-15-2022, 10:58 AM   #70
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..........The biggest cost to the companies is probably the three phases of clinical trials needed to bring medications to market. That is quite expensive.

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Well expensive is relative. Ever try to buy a whole Congress?

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Old 07-15-2022, 01:40 PM   #71
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But Medicare has this dumb rule that says you can't use drug manufacture's cards once you are on Medicare.
To be clear, this is not a Medicare rule, dumb or otherwise. This is due to federal law. There is an Anti-Kickback Statute that makes it illegal for a company to give something of value (like a prescription discount) in order to get more business that would be reimburses by a federal healthcare program. This statute has a valid purpose but there should be exception (IMHO) for drug prescription cards that are available to everyone else.

For some people, it can be cheaper to use a manufacturer's discount program rather than use Part D benefits at all.

For people in the coverage gap there is a Medicare Coverage Gap Discount program that makes manufacturer discounts available to for some drugs for people in the coverage gap. Here is the page talking about all this:

https://www.cms.gov/Medicare/Prescri...ovGenIn/Pharma

Anyway, TL; DR

Medicare is not being dumb or mean or anything else is not allowing drug discount programs. Blame a federal statute.
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Old 07-15-2022, 04:18 PM   #72
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To be clear, this is not a Medicare rule, dumb or otherwise. This is due to federal law. ..........Medicare is not being dumb or mean or anything else is not allowing drug discount programs. Blame a federal statute.
Those laws and statures are written by lobbyists. It is not an oversight or unintended consequence.
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Old 07-15-2022, 07:36 PM   #73
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OK not a dumb Medicare rule, but a dumb federal rule. But isn't Medicare a federal program? In any event before he went on Medicare my DH could get Humira for $5 a month by using the manufacture's discount card. Now that DH is on Medicare he can no longer use the card and Humira will cost him $8000 year. It is an awful dumb rule.
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Old 07-16-2022, 10:18 AM   #74
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$75 during which coverage stage? For 30 or 90 pills?


Each year I go with the Part D plan which offers the best coverage for Xarelto or Eliquis (they're priced and covered almost identically.) This has usually meant changing insurance companies each year, a pita. Switching from one drug to the other wouldn't help.

I just spent $615 yesterday for 90 Xarelto as I still had to cover my annual deductible. Retail would have been about $1,500. Next fill, it'll be about $200. Then I'll go into the doughnut hole and it heads back up into the $500 range. If I ever hit the catastrophic coverage range, it becomes cheap. For the year, I'm estimating my total cost for Xarelto will in the $mid-teens.

I asked doc about ordering the generic equivalent from an international source (such as manufactured in India). He said he couldn't recommend doing that or warn against it as he has seen no reliable data showing that there is no risk of receiving meds that are lower/higher potency or just placebos. But he also hasn't seen data showing that there were known risks. He didn't say yes. He didn't say no. But he made it clear he wasn't part of the decision and his prescription would continue to be written for brand name Xarelto.


Xarelto is such an important drug ( risk of stroke without it) for those taking it that I wouldn’t want to risk an off brand either. I can see why the doctor doesn’t want to change. It’s one of those drugs where you really don’t ever know if it’s doing its job..you can’t really test it. If it’s too weak you’re risking stroke, too strong and you’re risking bleeding.
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Old 07-16-2022, 01:20 PM   #75
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OK not a dumb Medicare rule, but a dumb federal rule. But isn't Medicare a federal program? In any event before he went on Medicare my DH could get Humira for $5 a month by using the manufacture's discount card. Now that DH is on Medicare he can no longer use the card and Humira will cost him $8000 year. It is an awful dumb rule.
Yes, Medicare is a federal program. And it isn't a "rule" that we are talking about. It is a statute passed by Congress. Rules and statutes aren't the same thing. Like many statutes, this one actually has a purpose. It is to stop Kickbacks. You don't want companies giving kickbacks in order to entice the federal government to do business with the company.

Let's say there is a medicine where the cost for it would be $3000 for it. The patient is not in the donut hole yet and so Medicare pays most of it. The patient however can get a prescription card from the manufacturer and pay $200 for the medicine. Now, on the surface this is good for the patient and for Medicare. Yay!

Now, let's imagine there is a competitor medicine which costs, say, $1500. And, let's imagine that this medicine is better than the $3000 medicine. It is more effective with less side effects. If the choice is between $3000 and $1500 it is a win/win for the patient and Medicare for the $1500 medicine to be used. It is less money and better.

But, the second medicine has no prescription card. But the patient knows the first medication has a prescription card and Medicare knows it too. So the patient and Medicare want the first medicine because it is so much less expensive (with the card). But, the patient is now getting a less effective medicine.

The purpose of the statute is theoretically (among other things) to stop this. The idea is to not have the choice distorted by the prescription card. If the manufacturer can get along with the amount from the discounted prescription card then maybe the manufacturer should just charge less for the medicine.

The point is that the statute does have a legitimate reason for the rule. In an ideal world though he solution is not to have Medicare recipients get prescription cards. Prescription cards can distort drug pricing. For example, I was recently prescribed something (I only had to take it once) that was almost $200 without a card. I would have paid it all since I hadn't met my Part D deductible. With the card it was $35. So, people who don't have Medicare get the medication for $35. The manufacturer knows that Medicare recipients can't get the medication for $35. So the manufacturer can give the $35 cards for non-Medicare recipients knowing Medicare recipients would pay far more. Without the cards, perhaps the cost would be spread out more evenly among others. Also, even people eligible for prescription cards don't always have them because no one tells them about the cards. That is also a problem.

The real solution to the problem here is not so much to let Medicare recipients use prescription cards. It is for Medicare to be able to negotiate drug prices like regular insurers can do.
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Old 08-05-2022, 06:17 PM   #76
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I ran across this today and was shocked at the cost of drugs using Cost Plus Drugs!

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The cost of prescription medicines has many Americans in a bind. Inflation is at a record level, but drug prices have risen even faster over the past decade, increasing 35% since 2014, compared to 19% for all goods and services, according to Healthcare Finance.
...
How does Mark Cuban Cost Plus Drugs work, why are its prices so cheap and how can you take advantage of those low prices? We'll give you all the details on a service that could potentially save you hundreds or more per year on needed medications
https://www.cnet.com/personal-financ...-how-it-works/
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Old 08-05-2022, 07:51 PM   #77
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I ran across this today and was shocked at the cost of drugs using Cost Plus Drugs!...........

The small time crooks wear hoodies, the big time crooks wear suits. It looks like we may finally have legislation to allow Medicare to negotiate drug prices.
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Old 08-05-2022, 08:08 PM   #78
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The small time crooks wear hoodies, the big time crooks wear suits. It looks like we may finally have legislation to allow Medicare to negotiate drug prices.
It's only for a handful of very expensive drugs for which there are no generics. That is my understanding.
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Old 08-05-2022, 08:41 PM   #79
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It's only for a handful of very expensive drugs for which there are no generics. That is my understanding.


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Old 08-05-2022, 09:10 PM   #80
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It's only for a handful of very expensive drugs for which there are no generics. That is my understanding.
From my link:

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CBO estimates $101.8 billion in Medicare savings from the drug negotiation provision.
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