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Comment by malandrew | Hacker News Reader

The only reason these drugs exist is because companies like Gilesd developed them in the first place. You can’t pay $40 for a drug that doesn’t exist.

What we should be pushing for is a change in circumstances that get those in other countries to pay their fair share so Americans don’t bear the entire burden of incentivizing bringing drugs to market.

Preserving incentives matters.

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The US is only 4.29% of the global population. Massively over paying for medication in the US has limited impact on research budgets as much of that is eaten up by advertising etc.

According to this chart[0], world healthcare spending was $7.7 trillion in 2016, of which $3 trillion (39%) was spent by the USA. The USA really does do most of world healthcare spending, disproportionate to its population.

[0] https://www.emergobyul.com/resources/worldwide-health-expend...

Revenue on it’s own is meaningless in this context. All those US drug advertisements are paid for with US heathcare spending along with endless paperwork, insurance profits etc.

(I object to you calling revenue meaningless when you brought up country population.)

World medicine spending[0]: $1.2 trillion

US prescription drug spending[1][2]: $348 billion (29% of world spending)

US drug advertising[3]: $30 billion (1% of US drug spending)

Health insurance net earnings[4]: $23 billion (0.8% of US drug spending)

[0] https://www.statista.com/statistics/280572/medicine-spending...

[1] Median estimate from https://www.healthaffairs.org/do/10.1377/hblog20180726.67059...

[2] Another source puts the US proportion of pharmaceutical revenue at 33%: https://www.statista.com/statistics/784420/share-of-worldwid...

[3] https://www.seattletimes.com/business/us-medical-marketing-r...

[4] https://naic.org/documents/topic_insurance_industry_snapshot...

~$30 billion / 348 Billion is not (1% of US drug spending) Of note prescription drugs are not the only medical advertising, but they do represent a rather large share.

Population creates limits for the amount of useful medication that can be provided, inefficiency is practically unbound. It’s not that on it’s own say Heath insurance overhead and profit is that expensive it’s simply yet another implementation detail unrelated to actually providing heathcare.

If the price of a drug then is 50x in the US (as in this case), and the US buys it at the same rate as the rest of the world, then sales to the US would account for ~70% of the revenue. To attain the same revenue with a constant global price, would require an increase of just over 3x of that lower non-US price point. The original characterization ("What we should be pushing for is a change in circumstances that get those in other countries to pay their fair share so Americans don’t bear the entire burden of incentivizing bringing drugs to market.") doesn't seem particularly incorrect.

Prices and consumption are linked. US drug companies spend a lot on Advertising to promote pill popping, but that’s not free. Further, they rarely collect the full sum from insurance companies or Medicare.

It’s the odd case of people in the US avoiding heathcare due to costs, where others seek it out when unnecessary.

Six months ago, the drug that costs $2k now cost $1800 for a 30-day supply. A year ago it was $1600, and about two years ago it was $1400. The patent expires this year.

Gilead did not develop or discover emtricitabine, university research through NIH grants did. Tenofovir was discovered via university research in Prague.

discovery != bringing a drug to market

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