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Comment by ascorbic | Hacker News Reader

Meanwhile, in single-payer Britain the NHS pays £26 ($35).

https://www.evidence.nhs.uk/formulary/bnfc/current/3-respira...

Even at retail (i.e. just walk into pharmacy with your prescription and buy it like you'd buy a coffee) they are £50 per pen/£90 for two [1] ($66/$118 at today's USD-GBP rate)

The weird healthcare system in the US is one of the main reasons I've resisted calls to relocate there for work. Stories like this are just really off putting.

1 - https://onlinedoctor.lloydspharmacy.com/uk/allergy/epipen

You know what's weird about this situation is that often I've been told by people here in the US that the price NHS and other single payer systems pay is only possible because we here in the US supposedly pay for it at the free market price. I don't believe that myself since it wouldn't make much sense to say that the prices would plummet to such a degree as to be unprofitable. But I do wonder how much of the price would be affected if every country in the world were under single payer systems. Would it be even marginally higher? Would it be possibly lower for all? I'm not sure. But I would love to see someone analyze this to see if this is statement I keep hearing is 100% bunk.

> we here in the US supposedly pay for it at the free market price

The free market price system does not work in American healthcare because we do not have a free market. Healthcare is one of the most heavily regulated industries and the third-party payment system means that consumers are divorced from the price mechanism.

As a consumer of epipens, I can assure you that we are not divorced from the price mechanism. We are talking about $300+ a unit for a dispenser (the drug itself costs pennies). The time needed for competition to manifest in the market will cause much suffering.

It is possible that both can be true. The price for medicine is cheaper because you have a single entity, the NHS, negotiating for a large group of people. On the the other hand, it is possible that we subsidize the development of new medicine to an extent. An epipen would otherwise exist regardless because it is a requirement for many people. More advanced medicine that requires a large capital investment for research and development could be another story.

> The price for medicine is cheaper because you have a single entity, the NHS, negotiating for a large group of people.

Wellpoint and its subsidiaries insure more than 70 million people, which is slightly more than the current population of the UK.

https://www.thebalance.com/the-big-five-health-insurance-com...

You can be sure that Wellpoint has also negotiated a good rate on Epi-pens. This price-gouging affects people who don't have prescription drug coverage or those who are enrolled in HSA plans that force you to pay for the first few thousand dollars worth of prescriptions at retail prices. And there are a lot of people being funnelled into HSAs by their employers.

My children have a need for epipens. With our insurance, it is still prohibitively expensive. After hearing about the cost in GB, I'm considering making a trip to London to stock up

Don't the pens expire after a year?

Yes, they do. Unfortunately, you tend to need several per child (minimum one for school, one for home). So, these costs quickly multiply.

Their negotiating position is probably limited by the fact they can't say that they just won't buy it. NICE evaluates all treatments bought by the NHS for value for money. If it was too expensive they'd just not buy it. It's not like there are no alternatives.

Actually, the big problem in the US is that there are no alternatives. The last Mylan competitor making a similar product folded six months ago. If you want to blame anything about the US system for the current situation, blame the regulatory capture that is generic drug approval.

What does the NHS do about drugs that are sole source?

Insurance companies are consistently profitable, it's hard to look at that profit as anything other than a net drain. Especially when a public healthcare option was not included in the US specifically because these companies could not compete.

Looking at direct and indirect costs insurance adds ~20+% to healthcare spending. Remember insurance commercials for example are yet another cost.

"Unfortunately this site is only available from Great Britain." - but the Google Cache works: https://webcache.googleusercontent.com/search?q=cache%3Ahttp...

Same thing with Asthma inhalers.

http://www.nytimes.com/2013/10/13/us/the-soaring-cost-of-a-s...

Damned socialists. They need some free-market goodness over there!

B-b-but socialism!

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