US Insulin prices 8 times higher than in other nations
eurekalert.org
eurekalert.org
26-year-old recently removed from his parent’s insurance plan, was found dead in his home because he couldn't afford $1,300 per month for insulin. [2]
This is basically white-collar looting. It is sad that this allowed to happen in USA.
[1] https://www.cbsnews.com/news/the-problem-with-prescription-d...
[2] https://www.nytimes.com/2018/06/22/well/diabetes-patients-at...
I know if I wasn't upper middle class I'd likely be skipping medicine right now.
NHS style healthcare should be a human right
No one should die due to an inability to pay. Even if you have a great job , you can still lose it
Especially likely if you're distracted or impaired by an illness - even if not yet diagnosed.
An EU Greece is probably best option.
The NHS doesn't offer free non-emergency healthcare to non-UK residents. In general, you would have to prove that you are a legal UK resident before you'd be admitted. Obviously, in an emergency they would treat you no matter what (but potentially send you a bill afterwards).
Just about anyone can register for primary care. There isn't an "ordinarily resident" test for primary care. P142 of this: https://www.england.nhs.uk/publication/primary-medical-care-...
Ordinarily resident applies to secondary care, but not including detention in a mental health hospital under the mental health act and not including A&E treatment in the A&E unit.
---begin quote---
8.4 Who can register for free primary care services?
8.4.1 A patient does not need to be “ordinarily resident” in the country to be eligible for NHS primary medical care – this only applies to secondary (hospital) care. In effect, therefore, anybody in England may register and consult with a GP without charge.
8.4.7 It is important to note that there is no set length of time that a patient must reside in the country in order to become eligible to receive NHS primary medical care services.
8.4.8 Therefore, all asylum seekers and refugees, students, people on work visas and those who are homeless, overseas visitors, whether lawfully in the UK or not, are eligible to register with a GP practice even if those visitors are not eligible for secondary care (hospital care) services.
Of course it's absolutely not practical, but if I ever wake up as a refugee in London I'll register with a gp
Edit : I almost want to see a SNL skit with a man who decides to have a mental breakdown, but prefers to do so in London vs the US
They have leaflets with information tailored to homeless people, asylum seekers and refugees, gypsy Roma and traveller communities, and visitors from abroad.
Gotcha, I will ask for the nearest surgery ;)
I know if you just got something in your eye and it only needs to be irrigated to dislodge the debris you'll probably not be billed.
Or walk into any Canadian pharmacy (if you can get into the country). Insulin doesn’t require a prescription here.
Dunno why almost everything else does though.
Moralizing about health issues feels good, but these issues are created by simple economics (market and regulatory issues), not ethical deficiencies.
That is false. The insulins sold today are MUCH better than the ones sold 50 years ago. They're much better than the ones sold 25 years ago. Admittedly, the ones sold 25 years ago are effective, but it is much more convenient using an insulin that kicks in in 15-20 minutes and has a relatively short peak than one that kicks in in 30-60 minutes and has a long peak. It's doable either way, but the quality of life is much different.
A balance must be found between ensuring fair access at affordable prices, and ensuring fair returns to the pharma industry. This is precisely the goal of pharmaceutical price regulation in the UK:
https://en.wikipedia.org/wiki/Pharmaceutical_Price_Regulatio...
Healthcare is complicated, and we need to simplify it as much as possible; this is a great example of a situation where we could use 'simple rules for a complex world'.[1]
[1] https://hbr.org/2012/09/simple-rules-for-a-complex-world
The US manages to pick and choose socialistic policies in some areas, and I'm more or less just waiting for them (us) to come around to the view that basic healthcare is just one of those things that everyone needs in order to have a decent shot at life so you might as well just provide it as a blanket service.
The US healthcare system is among the most heavily regulated industries in the US economy. Among those regulations are FDA policies that give Big Pharma monopolies on new drugs. The FDA extends these monopolies for decades, allowing companies to operate as state-created monopolies. Once the state-created monopoly times out, competitors face a years-long approval process before they can market a generic version of an already approved drug.
https://www.theonion.com/no-way-to-prevent-this-says-only-na...
>" Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith. "
> Your comment and the one higher in this chain makes it sound like a hard problem when it's only a problem for the United States and no other (1st world) country. I don't really understand how that's possible.
Yes, healthcare is byzantine in the US, but it's not less complex in any other first world country, yet America is a dramatic outlier -- in a bad way -- in terms of price to performance. Countries that do markedly better on such measures are also countries which tend to have some kind of price controls built into their healthcare system.
While I understand the temptation to bristle at the more needling comment, it's hard not to see debating over whether someone whose username is "Asshat" is being unfairly sarcastic as a bit beside the point. (Also, the good admiral did not, as far as I can tell, attack you, he attacked what he perceived to be your argument.)
I wouldn't otherwise argue for price controls, but if you give these companies the gift of keeping competition from the bottom out, you need to account for that, because competition is the only thing keeping a lid on prices in a free market.
Price controls - at least with a Democratic administration - are more realistic, because the FDA doesn't care about that and the pharmaceutical companies at least get to keep their moat, which they will prefer over some lost profits from generics.
I don't think price controls will work quite as well as you do, and I disfavor solutions which require a benevolent bureaucracy (and executive branch).
Generally, Pharma companies charge a lot for medications in the US _because they can_ - because no one stops them. Lots of other countries have systems which limit price, or set drug prices according to value, or similar.
Why doesn’t the US? Fundamentally, it’s got to come back to allowing money and thus big business to influence the US political system so directly. Until this is fixed, sadly little is likely to change.
If you're looking for a contrasting inelastic market (one with a simpler regulatory landscape), I'd look for other industries with high capital costs, such as semiconductor manufacturing.
While that is true, you are not including the option of switching to a cheaper insulin. The older insulins (R/N/L) were, the last time I checked, something like $25 per bottle, over the counter.
The problem for you is that you can't do what I do. And maybe the problem for you is also that I can't sell you what I get this way.
So in America you have 'shortages'. I do not. And if you wanted, you could also choose not to have 'shortages'.
I remember the same thing happening when Chloroquine was 'in short supply'. I could always get some. You never could. This is by choice. You live by rules that the universe does not require of you. These are probably for other reasons like perhaps you believe in living by the categorical imperative. But there are predators in this forest who do not believe in that.
¹ Even insulin can come here stably and safe. But drugs for other conditions are easier. And what I'm saying here is not strictly true if you're familiar with the details: it's not actually a generic, etc. etc. The important thing is that it's cheap and available.
To expand slightly (all IM opinion/observation):
a) Often, there isn't a 'market', as there might not be multiple competitive options for each disease.
b) Even in situations where there are (say) two roughy similar treatments for a disease, market forces don't always apply - manufacturers differentiate via other routes and try to avoid price erosion.
c) It's uncertain how often price directly influences prescribing decisions (in the US, or indeed in many countries).
Is there something other than regulatory capture going on here? If not it's less a case of "because they can" and more a case of "because others can't".
Just to give you an example how ridiculous the US health care is. I used to live in California and I had an inflamed wisdom tooth. It cost me so much to get it out (fully insured, premium+, high income insurance) that the amount I had to pay __after__ insurance (out of pocket) would have been enough to buy a ticket to go to Europe, visit a random country get the operation done, fully pay for (without insurance coverage) it and fly home to Cali.
https://www.pharmacist.com/article/utah-sends-employees-mexi...
This isn't even uncommon among people in Europe. A lot of people from Western Europe get on a 50 bucks Ryanair flight to Hungary or Romania, get their dental work done and fly back home.
But, the mafioso in-bed-with-the-gov-and-politicians absolutely corrupt elitist-owned system that we have in America is ruining this country.
And to all the people downvoting the "regulation" comments: You are being COMPLETELY intellectually dishonest, and you know it. Game theory validates that regulatory capture is 100% the issue. The Universe and nature work by a set of laws that has been investigated since the 50s with Von Neumann, Nash, etc. It is time that we stop telling ourselves that some politicians in government are going to magically create legal algorithms that outperform the laws of the nature. It is dangerous, immoral, and stupid and it ends up only protecting and embedding the existing corrupt elite for life.
> Game theory validates that regulatory capture is 100% the issue.
Regulatory capture cannot be the issue because it exists pretty much everywhere (in the Western world, I guess), yet US prices/insurance/medical spending is higher than in e.g. Europe.
Maybe it's the US flavour of regulatory capture - that's an option - but then you should be railing against that, not pulling a fake reductio ad game theory argument out of your sleeve - I mean, what do you propose as the alternative, an unregulated drug market? I mean, I'm very much in that direction - I believe all drugs should be legal and accessible, the only restriction I'd put on the "freely" part of "freely accessible" (e.g. new/experimental drugs only if you're dying, hard drugs like heroin only if you go through 6 months of classes & psychiatric evaluation, etc.) - but even that's clearly still a "regulated market" (e.g. disallows misleading advertising).
https://www.healthcare.gov/health-care-law-protections/rate-...
* https://en.wikipedia.org/wiki/Healthcare_in_Germany#Health_i...
* https://en.wikipedia.org/wiki/Healthcare_in_Switzerland#Comp...
Both usually rank quite well in various international comparisons.
The US has a great healthcare system, but abysmal health insurance.
The US Health insurance industry spends on average, 86% of premiums on healthcare costs[0], which means they can increase their profits by reducing those costs, since 80% is the floor.
12% of the left over premium gets spent on operating expenses, which leaves the industry with a 2-3% profit margin[0]. So another way of increasing profits is for the companies to become more efficient.
These figures are for the industry as a whole. Any individual company will have other avenues of increasing profit, such as growing their market share.
[0] https://content.naic.org/sites/default/files/inline-files/20...
When you read some of the inspection reports from White Oak you wonder: what would pharma manufacturing in <insert faraway country here> look like if they knew the FDA didn't exist!
Even if your product is comparable to the brand-name medication, the cost, time, and uncertainty of getting a permit is so prohibitive that many smaller medications are left with well protected monopolists.
That's at least what I hear. I don't work in the industry.
Aside from modern insulin variations under patent, but that's different.
I suspect the barrier to entry that creates these monopolies is again the access to FDA approval. You can only really make money in the US market, due to the price controls elsewhere.
The high US drug prices subsidizes the world to a big extent, and I wonder how much of a drug industry would survive if the US also went for price controls.
It's the confluence of the low profit margin, high barrier to entry (FDA) and inelastic demand. The market does not support more than five or six players worldwide. It's like that for any generic.
That's common to all commodity medical supplies. Remember the IV saline shortage after Hurricane Maria took out the manufacturers on Puerto Rico? That doesn't need FDA approval (the facility does need inspection though), but you don't spin up a sterile bulk manufacturing facility in 6 months because of upfront costs that will take an eternity to recover.
You can only really make money in the US market
{{citation needed}}
You can fleece the US citizen only so much. Elizabeth Warren showed in 2004 how stretched he is, and it has only gotten worse since. The rest of the world may pay less but it's bigger. Also, when you can justify the cost to the public authorities it will be paid - note that a course of glecaprevir/pibrentasvir Hep C protease inhibitor is 26 kUSD in the US and a comparable 27 kGBP in Britain. A heap of money, but beats the liver transplant, both in cost and quality of life.
The bigger threat to pharma is the poor return on investment. Information technology pays off faster and with lower risk. Goldman Sachs suggested the government step in, they are the only ones with big enough pockets. The suggestion is sound.
That's precisely what I'm saying!
If we agree on the facts, our difference seems to be that I don't consider FDA regulations "natural". They can be reformed, and then we'd see many suppliers cranking out cheap plentiful insulin.
That's just nonsense. The other highly inelastic market is oil, there are massive price excursions when supply and demand are not matched. Have you seen what happened when oil demand dropped this spring? Prices completely fell off a cliff! Demand will not increase just because new capacity enters the market, instead prices will drop to make everyone unprofitable, including the new entrant, who will never be able to recover the initial investment.
Since the problem we're talking about is the very high prizes for insulin etc in the US, does that mean we agree this would be a solution for that problem?
Why the market fetishism? The state of affairs needs price controls.
Prices do drop with innovation. Consider the praziquantel story. The compound was discovered in the early 1970s by a Bayer-Merck joint venture as part of a discovery effort for tranquilizers. It wasn't psychoactive but very efficaceous against flatworms (schistosoma and tapeworm) and then promptly shelved because of its high price, the synthetic route was complicated.
South Korea had a schistosoma problem at that time and couldn't pay Bayer for the compound or patent license, in the early 1970s Korea was still a threshold country, so at first they pirated it and then, because the original isoquinoline route required expensive starting materials the Koreans developed their own route. The glycine route made it possible to produce it cheaply for their own people and also opened up the worldwide veterinary market. This was actually the foundation for the Korean chemical industry.
The market works. It's well understood, just it works not in the way you think.
Thanks for the chat!
Walmart charges what they do because they can as well. Pretty much everyone charges what they can and nobody stops them. There aren't many business out there pricing stuff lower than what they can get away with.
There is a billion dollar opportunity here for whoever sells insulin at half price to the US market. Looking at the enormous price differences, it seems very likely that the opportunity exists. These are manufacturing prices; presumably before subsidy [0]. Unless I've really misunderstood what they are saying there is a huge opportunity for someone to get rich here. The most likely reason the prices are high is because the US government has somehow made it illegal to sell cheap insulin.
[0] "First, the manufacturer prices available in the MIDAS data do not reflect rebates or other discounts that might have been applied after drugs left the factory; we expect that, in many countries (and particularly in the United States), the net price paid for drugs was lower than the reported manufacturer prices shown in our results tables." - In the linked report
https://diabetesstrong.com/walmart-insulin/
It's an older formulation, and not commonly prescribed, unless you're cost sensitive.
I don't think that "because economics" is a card that can be played to completely nullify any questions about ethics. We can and do make decisions at many different levels (from individual to nation-state) over how the economy works and how markets are regulated, and ethics are relevant any time decisions are made which affect other people.
I usually only care about the “real” price, which is the price I actually paid, rather than the prices from an article.
Maybe there’s difference between a type 1 patient, but this is my personal experience.
This is actually addressed in the article though:
> The study used manufacturer prices for the analysis. The final, net prices paid for insulins are likely to be significantly lower than manufacturer prices in the U.S. because rebates and other discounts often drive down the price paid by individuals in the U.S.
Patient education is a necessary step to decreasing prices and encouraging innovative medications at the same time. As is decreasing the inevitable fury at diabetics like myself who dare to look inward.
This is a classic case when some ridiculous example, where it's clearly patient's fault, is presented as the fault of the system.
Blood glucose levels are really hard to get right with old insulin. Literally everything you do pushes your blood sugar demand up or down (sleep, stress, activity, macronutrient load/timing).
Modern insulin analogs tent to smooth out these variables.
The law says that the private insurance negotiates the prices rather than the government.
So the implication, that drug prices are not negotiated, is incorrect.
Here's an article about children and babies paying lots for Acthar too:
https://www.cnn.com/2018/06/29/health/acthar-mallinckrodt-qu...
They aren't on Medicare!
Of course, the conclusion that the entire insurance system is broken is just as bad or worse.
https://www.goodrx.com/humalog
$68.38 for five 3ml cartridges of 100 units/ml.
So if you need 100 units/day (that's on the high end), that's two weeks worth.
You also need a basal insulin for Type-1 diabetes (unless you're on an insulin pump, which is an entirely different class of expense), so something like Tresiba ($505) (https://www.goodrx.com/tresiba) or Lantus ($357).
Still not $1300/mo, but your price is also using temporary rebates and coupons, which certainly aren't always available.
$250 for five 3ml at 100 units/ml (1500 units total).
$324 for three 1.5mL at 300 units/ml (1350 units total).
$357 for five 3ml at 100 units/ml (1500 units total).
I suspect this gives a hint to one contributing factor. Suppliers probably list much higher prices so that they can negotiate lower prices with insurance companies without losing profit. But then the consumer needs to use an "in-network" supplier to get those reduced prices, which removes competition and drives prices up even further.
CVS is more expensive then my warehouse club price.
The price charts are on page 10.
For a full year and a half before that, I had to go to the pharmacy every 20 days to pick up more insulin because my insurance didn't want to risk paying for medicine that I could still use after leaving my job / insurance.
How does that sort of thing affect you? I can't imagine the pressure of knowing you 'can't' get ill for a period of time!
Do you stop biking to work, avoid DIY projects, skip the 5-a-side sessions that month...?!
> Do you stop biking to work, avoid DIY projects, skip the 5-a-side sessions that month
On the contrary, at the time I had to drive a two hour round trip daily on 285* where I was often graphically reminded of the dangers of traffic. I mentioned this point specifically when talking to HR, but ultimately I didn't really have any recourse
*(edited to remove reference to spaghetti junction, didn't realize there were multiple spaghetti junctions out there)
https://www.forbes.com/sites/avikroy/2020/07/24/trumps-most-...
All other countries price the drug at around 1 to 1.5k per month.
I'd been getting it from other countries over the years but, due to covid, it's not an option really.
The medical industry and its regulatory support by the government are doing a lot to destroy this country.
HIV transmission could be virtually eradicated within the US if at-risk populations had access to the medications at the same price as people in the UK do.
I've been led to believe that a large fraction of pharmaceuticals consumed in the US are produced either entirely overseas, or else active ingredients are (and this causes challenges for the FDA to actively regulate those overseas producers).
Is it the case that in some Sanofi site in Frankfurt, the same insulin meeting the same standards is put into vials, some intended for the US market, some intended for other markets around the world ... and regulations prevent someone from buying vials in the EU and selling them in the US? Like, the regulation is not only about the production methods or quality control?
In case of insulin the problem is that currently it's a mess, supply is low, demand is high, so price is high too.
It's useful to compare prices between CVS in the US and Boots in the UK. They're the same company.
https://www.indexmundi.com/facts/indicators/SH.STA.DIAB.ZS/r...
Some quick stats about the medication from wikipedia [0] - The medication was generally available in the UK 1969 (1982 for USA), and in 2017 was the tenth most prescribed medication in the USA.
When I saw news popping up over the last year or so about how exciting it was for a generic inhaler to be approved and available I was surprised and appalled by the whole ordeal, to be honest. It's an essential medicine. Generics have been available for ages here.
How on earth can companies and the government be allowed to do this to people? I mean, the literal answer is probably the oligarchy. I would have thought that people who can manage their chronic health conditions and avoid becoming disabled (or dead) would be infinitely more exploitable than those who can't, but I guess the numbers have been crunched and that mustn't be the case. It's unspeakably awful.
Product Names:
Novalin N - XR for basal
Novalin R - fast acting for bolus
Novalin 70/30 - just a premix of the two shown 70% N 30% R.
It may not be the best formulation out there but so long as you pay close attention to how your body responds to it (ie. Typical bolus duration, Blood Glucose mg/dl lowered per unit of insulin etc) when you first start using it, it can be just as effective as the name brand anologues.
Sure, it has a longer duration and takes a bit longer before it takes effect, but those shortcomings can be addressed by simply making adjustments to when you are dosing.
I typically need to bolus about 1unit/12g of carbs 20-25 minutes prior to eating with Novalin vs 1unit/15g 10-15 minutes before using an analogue.
I've actually used Novalin R in lieu of analogues in my insulin pump now for about a year with no issues. I realize getting these devices may be financially out of reach for many since they are expensive, even with insurance. If you're interested in using one but are not able to afford the cost of initial cost, Medtronic used to offer a payment plan that did not require good credit at all (mine was a complete dumpster fire) back when I got mine 6 years ago so people who are interested and could possibly afford to make monthly payments it's worth taking to your doctor and the manufacturers reps about the options they have available.
Sorry in advance for any grammatical/spelling errors, on mobile topping in a text box ~6 lines tall and 32 characters wide.
Also I understand there are newer Insulins which may have a patent, but the original is 100 years old and patent was not an issue. Why aren't there more manufacturers?
The newer, patent protected versions are safer and more effective. Again, AIUI, patent protection for at least one form is expiring or expired recently.
I seriously doubt this. Type 1 diabetes is _a lot_ harder to manage than simply taking long acting insulin and you can go about your day regularly. Almost anything you ingest has the ability to raise your glucose levels and a single dose of insulin is not enough.
Having long lasting insulin can be potentially deadly if not administered properly as it can tank your glucose levels and make you hypoglycemic. You need to be aware of your glucose levels and eat something to increase it if it starts going down below healthy levels. For example, if you take too much of the long acting insulin late at night, it's possible your insulin levels drop during the night and you're not awake to do anything about it (this is one of the reasons people use sensors, it'll ring an alarm if your glucose levels are too low/high).
Some people also use a combination of a 1 or 2 long-lasting insulin doses as a base and use short-lived insulin for small adjustments throughout the day.
Much more planning involved, and a big adjustment compared to Humalog and Humulin. My A1Cs are also a bit higher (6.1 instead of 5.9) to give myself more safety margin.
-----
Why'd I switch? First I pay less out of pocket than I did compared to insurance co-pays for the name brand stuff. That is, $90/mo for short-acting, long-acting, lancets, test strips and syringes... compared to $170/mo in insurance co-pays for the Eli Lilly and Abbott equivalents, and probably around $800 MSRP.
The second is I no longer need to wait for refill authorizations which too many doctor offices drag their feet on, in addition to insurance companies enforcing only a tiny number of refills per auth (as in, requiring a physician's authorization for the insulin you'll use until you die EVERY SINGLE MONTH) which creates yet more delays and sometimes numerous phone calls to get a prescription refilled since you constantly need an authorization from the prescribing doctor. "If they keep messing up, why not switch doct--" I have. Four times, across three different HCOs, and three different insurance companies. They all screw up and fail to respond to the pharmacy on occasion, sometimes for several months (and a dozen plus phone calls) in a row.
It wasn't even about the cost anymore. The ridiculous bureaucracy with the ultimate position of, "it's the patient's fault" held by every other party forced my hand.
And the bureaucracy is ridiculous. I'm the most financially responsible person I know in my age group, yet I annually get letters threatening to send me to collections for charges I was not warned about by a weird middleman company that I get automatically charged through for medical supplies for my pump. Haven't heard from them this year, and I've called them 4 times so far trying to figure out where the charges went. It turns out they have 3 accounts registered under my name for these things and none of them are the account that my orders have been going to. At this point I'm just going to wait for the annual letter I guess.
Good job on the A1C though. I want to get there someday, but I get sudden massive drops in blood sugar out of nowhere about once every two weeks and it scares the crap out of me. I'm optimistic I'll figure it out eventually though
A story like that really puts into context what expensive insulin means. When it's expensive, they want to make sure you don't sell it. So even people who can get it through insurance are affected.
For contrast an experience from a rich European country: My doc writes me a yearly prescription. I forgot to renew it once, and had to pay out of my pocket to get my insulin. He sent me a backdated prescription I could use to get the cost reimbursed.
Hey this is Blue Cross, does Bill still need insulin this month?
Yea, he has type 1 diabetes, it’s a chronic and lifelong condition he will need insulin every month.
Cool, cool, we will check back in next month to see if he needs more.
Do you expect me to come up with a cure for type 1 diabetes by next month?
No, that would be ridiculous.
Well why check every month?
In case he doesn’t need it anymore.
How would that happen?
Hmm.... good point, we can talk about it more next month when we check in to see if Bill needs more insulin.
head slamming into desk sound
People often say that expensive insulin leads to "deaths". How accurate is this statement? It's hard to get a straight answer because the word "death" is so politicized and its meaning can be stretched extremely far. I'm not trying to make a statement either way about what the price of insulin should be, just trying to quantify how much "death" it causes.
Low profits and a giant moat. The civilized world keeps prices down because their governments do the buying, and meanwhile any new entrant needs to prove bioequivalence.
It's not that the market was totally innovation-free. Human insulin was a gigantic breakthough when Genentech brought it to market back in 1978.
If its low profits how come other countries' prices are much lower? Either the manufacturers there have lower costs or they're charities.
>and a giant moat
I'd think all the VC money sloshing around should be able to figure something like this instead of another social media platform.
Would be nice , but unless you convinced VCs to invest in a non profit this startup would be sold within 3 years to big pharma.
NHS style healthcare is the only way to go
> The final, net prices paid for insulins are likely to be significantly lower than manufacturer prices in the U.S. because rebates and other discounts often drive down the price paid by individuals in the U.S.
Here in Russia price can only go up from manufacturer’s price. Simpler world.
[1] https://redapteka.ru/catalog/lekarstva/endokrinologiya/sakha...
What matters most is what are the prices in countries with equally strict quality controls, which would be, unless I'm mistaken, the EU, the British Commonwealth, Japan, and a few other places.
And the answer to that question seems to be >6x which is bad enough.
One of the things I've learned about persuasion is that I'm never, ever, going to persuade some people. What I can do is persuade people who can do it for me. In many cases, then, my time and effort is best spent on recruiting the folks who are good at explaining to others. In my experience most of these people can smell bullshit coming a mile away, and so if the first 'fact' out of my mouth is reproachable, I've already put them on the defensive.
I often hear, "we should be doing better than second and third world countries, so I'll list them too", that's a dangerous gambit. You're effectively appealing to nationalism and/or racism - we can't let 'those people' beat us. It's ugly, and if you have to stoop to that, is it really worth winning? It's no good living forever if you can't live with yourself.
I don’t think anyone’s complaining about the price due to nationalism or racism... they just want to be able to afford insulin to keep themselves alive like they’d be able to in other countries.
There's a fine line between "France did X and the sky did not fall," and evoking Us-vs-Them emotions. Some people will bring that energy no matter how you state it, but let's try not to invite it in.
It's a silly argument to compare countries on a single issue though. Insulin is probably cheaper in Germany (I have no clue since I've never bought any), but our taxes are much higher as well. For somebody who has no money to buy insulin, that doesn't matter much, as they wouldn't pay any taxes. For most people however, that means something, as it would cut deeply into their budget.
All of these things are trade-offs, you can't view them isolated and expect to gain any insights.
If you can't afford to buy drugs you need to keep yourself alive, what other issues matter for you?
Not sure who the "our" is in your comment, but:
"So there you have it, if you are wealthy and live in California you are paying more income tax than people who live in the European Unions’ largest economy. Of course this is only one facet of the tax system. There are many others, like the value added tax of 19% in Germany, but Germany’s corporate tax rate is 15% while ours in 35%. If you live in California and are paying these high rates you can’t even take solace in the fact that you’re working less. In Germany the average work week is 35 hours with 24 paid vacation days and 10 paid holidays!"
http://bvcocpas.com/how-the-united-states-tax-rates-compares...
[0]: https://taxfoundation.org/publications/comparison-tax-burden...
Yeah maybe you shouldn't be making opinions out of pure ignorance of the situation at the factual and emotional level.
Looks like for human insulin Germany is 1/12th the cost.
There's a lot of pricing theater going on in the US too. The MSRP seems to be a game of psychological anchoring the manufactures are playing with the insurance companies, who always get a discount. But that is a whole other kettle of fish.
"First, the manufacturer prices available in the MIDAS data do not reflect rebates or other discounts that might have been applied after drugs left the factory; we expect that, in many countries (and particularly in the United States), the net price paid for drugs was lower than the reported manufacturer prices shown in our results tables."
There was a job opening I looked at about ten years back where the whole responsibility was writing bin packing algorithms to allocate batches of medications to countries based on the quality control guidelines of that country and the tolerances achieved in manufacturing a particular batch. [Edit] I suspect the rationale is that both products are fine, and the regulations represent overreach, so we're going to mollify them. But the banking and finance industries were complaining about overreach right up until the crash (as they have before every single crash). The money it costs you to comply also costs you your objectivity.
You might be able to overclock the hell out of an Intel processor that was binned several notches down from the top, but that depends on how good the yields were that week. It's possible you just got a slightly shittier processor.
They effectvely operate in a 'white list' basis, where a product has to be shown to be safe to be allowed, while the US operates in a 'black list' basis, where anything can be used until it is shown unsafe, and banned, which usually gets banned too late.
That's why you have so many cancerogenic products that are banned in the EU, while they are still used here in the states.
I'm not sure where you got this impression, since I started with the opposite at the top of the thread.
>..."we should be doing better than second and third world countries, so I'll list them too", that's a dangerous gambit. You're effectively appealing to nationalism and/or racism
Not really, what we're really saying is that with our tech resources, talent, governance and supplier pipelines we should be able to do better.
Insulin itself would be simple and cheap to produce, but getting through the approval process is so expensive, it wouldn't make economical sense to then sell the product near cost. Insulin isn't the mass-market product it once was, because it has fallen out of favor for Type II diabetes and Type I diabetes is relatively rare.
The way other countries get around this is price controls. They just tell the companies what drugs are allowed to cost, so profits are limited not by competition, but by fiat.
The capitalist market driven research only creates expensive drugs that treat wealthy people. India is coming up with a cheap paper based covid test, using governemnt backed research. Other countries are leaving us in the dust on results and research.
You'd have to break that supply chain, and I don't know if there's any easy way to do that.
But because this is a multiheaded beast with no clear villain to blame, nothing really happens. Congress are to blame.
I wish someone would do something about it. Like an executive order or something.
As a diabetic I was excited to hear when Trump said that he had made Insulin as cheap as water.
However it still looks like it costs around $300 per vial at my pharmacy.
As one might expect, the pharma companies are fighting his executive order in the courts. Here's one article with some details.
I have a lot of hope for his ambitions to enact a favored nation's policy wrt Medicare's drug pricing, but since his administration's seemingly been lackluster on executing his order limiting insulin markups by federally funded clinics, I doubt his policies are anything other than paper tigers.
This won't help everybody. It has the same flaw as price-matching at Best Buy. The manufacturer could sell a different model in each country. For example, the USA gets one set of pill sizes (20 mg, 40 mg, 80 mg) and the rest of the world gets a different set of sizes (25 mg, 50 mg, 75 mg).
To combat that obvious maneuver, the orders make it easier to import drugs. Americans had been getting in trouble for importing drugs, even if the same ones are sold here. This made it easy to have different prices in different countries. It was like DVD region enforcement. The orders change that, making it really hard for manufacturers to keep the USA price high.
The type of insulin you get for "$300 per vial" might only be available in the USA, or it might actually cost that much (and seldom be prescribed) outside the USA. You might also be facing the issue of retail prices lagging behind wholesale prices. Check other retail locations.
1.) https://www.whitehouse.gov/presidential-actions/executive-or...
1. Other countries achieve lower drug prices because their governments regulate those prices.
2. The US (especially a particular political party) is anti-government regulation, especially when it comes to price controls, so drug prices are MUCH higher in the US.
3. Thus, the US president has issued an executive order to allow reimportation of drugs so that the US can take advantage of other countries' lower drug prices.
In other words, we won't pass our own regulations, so we are explicitly delegating our regulatory authority to other nations so that we can take advantage of the effects of their regulations.
Honestly, whether or not you are pro or anti regulation, this current state is just f'ing insane. You certainly can't consistently state that you are anti-regulation and be for this policy.
>The second reason, the authors noted, is that there isn't significant competition in the U.S. insulin market. Price competition typically comes from the introduction of a generic drug that directly competes with a branded product.
>But the authors said that current insulin makers have blocked the entry to such products by getting new patents based on things such as a new delivery device.
https://www.usnews.com/news/health-news/articles/2019-11-07/...
Patent reform would help bring generics on the market and reduce prices.
I don't see them gnashing their teeth over the ethical considerations of that.
Is there any merit in this argument?
Or chemist diabetics making their own insulin at home.
And what is the "fair and free" price of insulin?
Almost all wealthy countries except the US, use a single payer system where the government sets the price of drugs.
> And what is the "fair and free" price of insulin?
Free as a victim of diabetes, some marginal cost to the countries budget based on a negotiation with the pharma company.
Typically, because the country has enough scale, it is cost effective for the government to design and estimate costs for a government run facility to produce the drug and use that as a bargaining chip including if needed voiding the IP rights of that foreign entity for national defense reasons.
You got a link about that because I am super interested to read into that more. I believe india doesn't respect medical IP but I'm surprised first world countries that produce medical IP do and that the US apparently isn't ripping off foreign countries medical IP who do that in retaliation.
I haven't cross checked it, but it seems to state similar things to what I've heard before, like “compulsory licensing” which was only un-done because of NAFTA, but that just means its a political bargaining chip that is not currently cashed.
I'm sure other countries have different rules, Canada is more beholden to the US than any other country.
The problem is not that insurers in the US are not "big enough" to negotiate prices effectively.
Why are there not dozens of silicon valley startups springing up to 'disrupt' this market - clearly there are large margins to be made given the price is so much higher at the moment.
It sounds more like some regulatory capture has happened which is keeping prices artificially high, than that all other countries are artificially low.
This. Not sure if it's a system bug, or a feature: the system may have been designed for this to happen.
One price is set artificially and it ain't the one you're thinking of.
Prices are always set to maximize profit, and what the customer is willing to pay you is the biggest factor in the equation.
Seriously asking.
People have different thoughts about economic policy with regards to healthcare. Additionally, there are some cultural concerns.
For one, conservatives feel that liberals are too idealistic and don't have a good plan for actually paying for socialized healthcare. This is most commonly used against Bernie Sanders. Liberals argue that "competition drives down cost" is equally, if not more, idealistic.
Second, in places with "socialized" healthcare, health is thought of as society's responsibility, not the individual's responsibility. This conflicts with the American notion of individuality. Conservatives argue that the US's culture makes socialized healthcare infeasible without costs ballooning out of control, because people are selfish and don't care to protect their health. There is plenty of debate on this matter.
I'm guessing that healthcare is not the most important reason that conservatives vote Republican. Although it seems like a huge issue, there are other issues that might make someone choose one side over the other, even if they disagree with their side's healthcare policy.
1. Healthcare is actually hard at scale.
2. The incentive structure in the US (read, follow the money) is one which is against the public good.
3. There are many many many landmines of technical debt within the current US system which cannot be papered over or solved easily even if you waved a magic wand and got full buy-in for single payer universal healthcare tomorrow.
It's true in some respect that Republicans have taken a general stance against universal healthcare in American politics, but the idea that Democrats have any meaningful and decent strategy for fixing it is a misnomer. At best, we have some politicians who have said the correct words to convey the right sentiments, but no meaningful plans.
As to why this issue is so much worse in the US than elsewhere, that's its own separate essay, but largely comes down to the structure of healthcare mandated by the government since the 1920s, especially after the formation of Medicare and the passage of Part D combined with first mover disadvantages as much of the rest of the world had the opportunity to radically structure their healthcare infrastructure differently post WW2 while rebuilding inclusive of the cost of rebuilding, while the US did not. In a fit of irony, the US footed the bill and drove economic levers to help cement universal healthcare into much of Europe while failing to implement it at home. Even now, part of the complication is that the outsized pricing of healthcare in the US acts as a partly disconnected subsidy on the cost of healthcare elsewhere in the OECD.
After having worked in this space and seeing how completely and utterly fucked the US healthcare system is internally from a technology/records keeping perspective, to the entire payment processing flow, to the way we track and report healthcare incidences, the entire system is broken badly and needs a total overhaul, but that's a much bigger ask than incremental improvements which don't really move the needle much. The US healthcare system is (literally) a legacy codebase written in an esoteric language held together with fears and sorrows because the hopes and dreams already died. The only feasible way to fix its myriad bugs is a complete rewrite, but doing so will form it's own set of technical debt and bugs.
This particular problem is due to heavy regulation creating a moat for large pharmaceutical companies to arbitrarily set prices. Republicans generally want to de-regulate, Democrats don't. Republicans generally want the free market to work things out, Democrats generally want the government to work things out.
Each side has been taking turns and as a result, we have had the government prevent the free market from working things out. We want everyone to be able to get healthcare, but we don't (or can't) force anyone to pay for insurance. We effectively incentivize people to not get insurance until they are sick, then we force insurance companies to take them on when they've never paid into the system. Somebody has to pay for all of it, and it ain't the government.
They are basically both hampering competition where they can, and not allowing the gov. to be able to negotiate.
I am sorry but your comment doesn't hold water...
As for banning imported drugs, this is a bipartisan issue, both parties have called for allowing it, but both parties are effectively against it.
The Republican controlled Senate spent the other 7.5 years blocking most of the bills by the Democrats. They also attempted to repeal the ACA 70 times.
As to your "We effectively incentivize people to not get insurance", that was the point of the individual mandate which was repealed by the Republicans in 2017.
> As to your "We effectively incentivize people to not get insurance", that was the point of the individual mandate which was repealed by the Republicans in 2017.
There never was an effective individual mandate, but if there had been, it most likely would've been ruled unconstitutional. Whether you pay a small fine or no fine whatsoever, you are ultimately incentivized to defer paying the far higher insurance premiums.
Additionally, the RAND Corporation appears to have a high factual reporting with a slight left political bias, according to mediabiasfactcheck.com. https://mediabiasfactcheck.com/rand-corporation/