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message 1: by Ian (new)

Ian Miller | 12221 comments Trump has just announced that he considers the world is taking advantage of America by paying much less for its pharmaceuticals, and he is going to do something about this, which I assume means force them to pay US prices. He feels they are taking advantage of the "huge US research and development costs". It is not clear what he intends to do, but the assumption is that if the rest o the world does not accept these conditions, he will punish them through their US market access.

At this point, a few facts. First, the big pharma does not do that much primary research. Much of their drug prospects are acquired from other nationally funded research programs. There is nothing wrong with that, but it means they are only buying things that work. The great volume of "dredging, looking for possibilities" usually ends in failures, and the cost of that is borne by the initial labs. Second, research and development is only a relatively minor cost for big pharma - the real "costs" are in marketing - trying to bribe doctors into prescribing their drug as opposed to competitors' drugs. Third, big pharma is hardly oppressed. If we take the drug Gilead, The cost for a course is US $100,000 The historical cost for developing it was, according to US economist Jeffrey Sachs, US $11 billion. In the first fifteen months the company recovered all that cost, and made a profit of $US 6 billion.

Many other countries negotiate prices with big Pharma, and get the drugs much cheaper. NZ runs a tender scheme for the market. Nobody is threatening anyone or extirpating anyone - it merely takes the best price the companies are will to supply at. Nobody has ever said an auction to sharpen competition is bad, surely? Except the US government. Apparently Medicaid is forbidden by US law to negotiate on price.

So, how do you think the rest of the world will react to this? What should they do? How will Trump respond?

message 2: by Nik (new)

Nik Krasno | 16512 comments Didn't hear about this idea, so no comments here, but 'forcing' someone is only possible where there are no alternatives.
Prices of the drugs in the US are indeed astonishing. I was surprised to hear from a friend in the US, that public spending on health is on par or higher than in other developed countries, yet medical services do not cover everyone and there are drastic differences.
Don't know whether the below data is accurate, but it's an interesting food for thought:

It looks like the situ is abnormal in the US and I'd rather think the prices should be much lower than higher.
I have a friend who for two decades worked in a number of big pharma companies on managerial positions. Most of them adapt their prices to a specific country basing on market and paying capacity of the population and the same drug would cost differently when sold in Ukraine, Australia or US and it's not that a manufacturer loses money in the cheapest location. On the contrary. Hence - the grey parallel market, where people engage in reselling drugs bought cheaper in one country in a more expensive one..

message 3: by Denise (last edited May 14, 2018 03:10AM) (new)

Denise Baer Yeah, I haven't heard about this from Trump, but the U.S. does spend A LOT of money on medical and pharmaceutical expenses.

U.S. Government is delusional if they think they can make healthcare affordable for all without doing an overhaul of the medical industry and the pharmaceutical companies. NO INSURANCE will be cheap with little out-of-pocket if the U.S. medical industry is allowed to charge astronomical prices.

ETA: I found an article from Time, which I find to be a reputable source. I don't see anything in regards to targeting other countries. My computer keeps freezing up so I wasn't able to watch the video yet. The only problem I see in this article is that Trump isn't punishing the pharmaceutical companies, but this doesn't surprise me since all politicians have some link to them.

message 4: by Ian (new)

Ian Miller | 12221 comments One of the reasons drugs are cheaper in NZ (and presumably a lot of other countries) than the US is that there is no point in spending lots of money marketing, because there is a single buyer that selects by a tender system. (People can buy on the open market, but the govt only subsidises the drugs it purchases so if I go and get a prescription I pay $5 for whatever - the transactional cost for the paperwork - or computerwork, I suppose.)

Another reason anything associated with medicine is more expensive in the US is the cost and risk of litigation. Finally, some of the price is because they can charge it. If it is a difference between life and death, you tend to pay. Not all companies are like this, but Martin Schkreli (sp?) was a very bad example, buying up the rights to a drug and raising the price from about (from memory, so it may not be quite right) from about $9 to $1500.

message 5: by Leonie (new)

Leonie (leonierogers) | 1579 comments We have the Pharmaceutical Benefits Scheme here in Australia. I'll link to it, as it's a bit of a complicated one, but suffice to say, it subsidises our medications, but not necessarily all of them, depending on their level of evidence.

message 6: by Ian (new)

Ian Miller | 12221 comments Good to focus on evidence. In NZ too, the subsidies require a certain level of evidence of efficacy.

message 7: by Denise (new)

Denise Baer Ian wrote: "One of the reasons drugs are cheaper in NZ (and presumably a lot of other countries) than the US is that there is no point in spending lots of money marketing, because there is a single buyer that ..."

Ian, Some of your reasons for U.S. prescriptions being higher might be correct, but the main driving force for inflated prescriptions is greed. We don't have laws to prevent pharmaceutical companies from charging high prices because government is connected to them. Should government interfere with costs, they will lose endorsements and their own financial stakes.

message 8: by Ian (new)

Ian Miller | 12221 comments Agreed, Denise. However, I think my example of Martin Schkreli exemplifies greed as much as anything :-)

message 9: by Denise (last edited May 15, 2018 03:58AM) (new)

Denise Baer Ian wrote: "Agreed, Denise. However, I think my example of Martin Schkreli exemplifies greed as much as anything :-)"

Das is true. :D I should have looked him up first.

message 10: by Scout (new)

Scout (goodreadscomscout) | 6416 comments Ian said, "Apparently Medicaid is forbidden by US law to negotiate on price." That looks like a big problem to me.

message 11: by Ian (new)

Ian Miller | 12221 comments Scout, it is one of the things I don't understand. America says it stands for business but on the health issue at least the government seems to be against competition. From my point of view, joint bargaining is an obvious approach, and nobody is suggesting the big companies should be pillaged. The prices of drugs are slower here for two reasons only: the companies want to be in the market because they will make money here (which is fair) but they have to compete a bit for the sharpest prices, and they can lower them because they don't have to spend enormous sums of money marketing. By denying the consumers any power, I am afraid that greed also comes into play in the US.

message 12: by Scout (last edited May 18, 2018 11:26PM) (new)

Scout (goodreadscomscout) | 6416 comments I learned something here that I didn't know about Medicaid not being able to negotiate prices. That's just wrong, and I'm going to look into it further. Not that there's anything I can do about it, but at least I'll know what's going on. Thanks, Ian.

message 13: by Ian (new)

Ian Miller | 12221 comments No problem, Scout. Mind you, I think you are right about not getting anywhere, but then again, if people don't try, they most certainly won't get anywhere

message 14: by Holly (new)

Holly (goldikova) I was amazed when I went for my post-natal checkup and the midwife asked me about depression. I'm quite sure that I could have easily asked her to prescribe one of the many anti-depressant, mood elevator drugs that seem to be the gateway to a lifetime of pharmaceutical dependence.

We are a sedated nation and it's kind of scary. It certainly seems to be helping with the "dumbing down" process. Although drunk driving has dropped dramatically, traffic fatalities have been on the rise in our state for the last three a state with a declining population, I wonder what the contributing factors could be?

message 15: by Ian (new)

Ian Miller | 12221 comments Unfortunately, too many doctors seem to feel their patient expects them to do something, so writing a prescription satisfies their want, even though they don't need it.

message 16: by Scout (new)

Scout (goodreadscomscout) | 6416 comments Not my doc. He's no pushover, which I appreciate. My neighbor has a doc that prescribes anything she asks for, and I think she's taking way too many drugs. I need to start a thread about Ambien. We talked last night for 30 minutes, and she doesn't remember the conversation today.

message 17: by Philip (new)

Philip (phenweb) | 3084 comments The UK bulk buys through the NHS on an approved set of drugs that go through the state. Biggest issue is overall costs and funding new drugs. Individuals like in NZ pay per prescription item although children, unemployed etc are exempt from these charges. Generic drugs are the big push. We still have doctors prescribing branded paracetamol and aspirin to a prescription at nearly £9 when tablets can be purchased for <50p in a supermarket.

Over prescription is another major issue with anecdotes of doctors starting to write the prescription as the patient says hello

message 18: by Ian (new)

Ian Miller | 12221 comments Philip wrote: "The UK bulk buys through the NHS on an approved set of drugs that go through the state. Biggest issue is overall costs and funding new drugs. Individuals like in NZ pay per prescription item althou..."

Just to clarify, in NZ people pay per prescription $NZ5, which is essentially the handling/paperwork costs, and that is independent of the cost of the drugs. If you want aspirin or paracetamol, as Philip indicates, you should go to a supermarket here too.

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