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Comment by daguava | Hacker News Reader

Is that the real COST or the markup "cost"

Probably both, they've got to make back the cost of developing and testing the therapy, but there's probably a profit markup on top of that.

US-based pharmaceutical companies maximise their margins in the US to make up for smaller margins in other markets. In many other countries, most prescription drugs are purchased by the government, which gives the government a lot of bargaining power which it uses to drive margins down. Prescription drug purchasing is much more disjointed in the US (negotiating with many private insurers instead of just the government), giving more bargaining power to the vendors and supporting higher margins.

This doesn’t make sense. Consider two scenarios: company ABC sells only in the USA and Company XYZ is otherwise identical but also sells to Asia.

You are implying that because XYZ has lower profit as a percentage yet higher profit as a nominal dollar amount, that XYZ will charge its American patients more. My intuition says both ABC and XYZ will charge Americans the same, namely the highest amount it possibly can under market/regulatory/PR/competitive considerations.

The same that happens in medicine happens in college textbooks - and other forms of high margin, but relatively fixed/finite initial investment and stable cost to produce.

American scholars write some of the most respected textbooks in the world, they are then sold in US colleges for $100-400/each. The same book is then sold in SE Asia and Africa for $10-40/each.

The madness of the US healthcare aside, CAR-T is really a somewhat complicated therapy. There are no economies of scale there, unlike in pills. Each patient requires a lot of painstaking work that can only be done on specialized machines by highly qualified people, plus the safety requirements are really high.

Activating the immune system is risky. It is strong and it can crush cancer in mere weeks, but it is also very dangerous to friend and foe alike. Basically, you gather a lot of absolutely ruthless and stupid troops and tell them "here is ze Flammenwerfer, burn the enemy to crisp, but don't destroy anything else".

Easier said than done.

Don't forget R&D costs

But please pay no attention to marketing costs.

Also, don't forget government money for funding of research.

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