Comment by rayiner | Hacker News Reader

Comment by rayiner | Hacker News Reader

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> All the other details aside, this doesn't feel okay and I cannot believe that elected officials voted against legislation to prevent this sort of a markup situation. Whatever happened to them needing to represent the interests of the people

Note that those markup figures are based on production cost, excluding capital investment. Lilly is profitable, but not any more profitable than Google or Facebook or Apple.

Making critical products less profitable than less critical ones is often contrary to “the interests of the people.” It drives investment from stuff like new pharmaceuticals to stuff like dating apps.

Insulin is actually a perfect example of that. The first generation insulins now are relatively cheap. The “insulin” we’re talking about here are second-generation insulin analogs, which are easier to administer and help better control blood sugar levels. We are at the tail end of the patents on those and we are already starting to see generic insulin analogs being made at Wal-Mart.

You have to think about the system in terms of how humans work and their motivations. Brilliant people who can make new, better insulin aren’t born any more altruistic than the people whose talents are better suited to coming up with new advertising algorithms. They want to make a bunch of money from their work. If you make it so that smart people can make more money doing an ad-tech startup rather than a bio-tech startup, that’s what they’ll do.

There are lots of articles about individuals in the US who have died because they were rationing or otherwise couldn't afford insulin.[1][2] How can this be the case if first-generation insulins are cheap? Are they rationing second-generation insulin analogs instead of using the more affordable first-generation insulins? If so, why?

[1] https://www.npr.org/sections/health-shots/2018/09/01/6416158...

[2] https://nymag.com/intelligencer/2019/07/another-person-has-d...

The first article says $1,300 per month for insulin. That almost certainly is a second generation insulin. Wal-Mart’s first generation insulin is $25/vial for the 2-3 vials a month a typical person needs: https://diatribe.org/paying-insulin

As to why people try to ration more expensive insulin is I suspect the “donut hole.” The young man in the first article aged out of his parent’s insurance, which was probably paying for his second-generation insulin. He probably had no idea what other options were available, or was concerned the first generation insulin was less safe.

A lot of people have limited executive functioning and our society isn’t good about helping them access the options available to them. A close family member of mine had a heart attack and was saddled with a $50,000 hospital bill. He had been eligible for Medicaid for years, but just never signed up.

This.

How does this jive with the fact that they increased the price of these insulin more than 10x over the last decades[0]? Poor souls must've just been keeping up with inflation over there at the pharma lot.

[0] https://www.google.com/search?q=humalog+price+chart+usa

It's a game of discounts with insurance companies in order to be a "preferred" product. Manufacturers provide big rebates (~80%).

The net price (what the manufacturer actually gets for Humalog) has dropped 16% since 2015. In 2019 the list price is $275 but the net price is $60.

https://1.bp.blogspot.com/-VfnPjfmmwUY/XzFtgfU87XI/AAAAAAAAq...

You are being downvoted but you are entirely correct. Pricing for medications in the US, including insulin, follows an absolutely nightmarish set of rituals due to the need to gain access through insurers. Eli Lilly’s financials are publicly available, their revenue per unit of insulin has largely kept pace with inflation. The skyrocketing costs of the sticker price of insulin is entirely due to the lack of a universal public insurance option in the US leading to the horrific rebate system we currently have, which largely benefits insurers and PBMs. Pharma companies come out neutral (from a revenue perspective, definitely negative from a PR perspective), and consumers, particularly those on high deductible plans or without insurance, are gutted.

I haven't downvoted, but if you look there the original price was ~$20, now the net that the other user shared was ~$60. Even like that it's still a 3x for no reason.

When was it $20? It hasn't been less than $60 since 2009.

https://www.businessinsider.com/insulin-price-increased-last...

You're treating social conventions like fundamental of human nature. Altruism, including kin selection is just as natural as greed. Kin can be socialised to tribe, tribe to national. There are numerous countries where this has been successfully done. Where the incentive structure is not narrow self interest at literally any cost. Greed as the only motivator is reductive and a narrative that can be used to justify literally any behaviour, no matter how exploitative. It's an easy out for bad actors and broken systems. Healthcare in other developed countries simply does not work like this.

My understanding is that the Nordic countries, which tend to be known for being much further up the socialism scale, have significant investment in research.

They’re not socialism for their exports! Novo Nordisk, one of the three insulin makers, is a Danish company. They’re as profitable as Eli Lilly. Guess where they make all their money?

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