Big Pharma claims lower prices means giving up miracle medications. Ignore them

From a profit point of view, presumably the advertising department pays for itself; in other words, the advertising department generates money for the R&D department, rather than taking money from the R&D department.

But, the advertising presumably increases the number of people taking the drug. If it's teaching patients/doctors about a valuable new drug that will make peoples' lives better, then it's a social good. But if it's persuading patients/doctors to buy the drug unnecessarily, then it's a waste.

(Also, sometimes two pharma companies have competing drugs that are basically equivalent. So they get trapped in a "Red Queen's race" where they both spend money on advertising to try to gain market share. In the end they've both spent a bunch of money on ads and ended up back where they started. For those cases, banning marketing would be a clear win.)

Edit: Also, keep in mind that "ban/regulate pharma advertising" is a different proposal than "medicare negotiation".

It comes back to the same thing--where is the money going to come from? Few medicines actually have a high per-unit production cost. The cost is usually mostly amortizing R&D and the production equipment. (And looking at R&D overall--you have to count the spending on the failures as well as on the successes.) Sell fewer pills and you don't cut that R&D cost, you just distribute it across fewer pills.

That said, where this currently seems to fall apart is the pharamacies.. most only stock a single "brand" and pricepoint for many drugs, two at most. Most pharamcies aren't online so you can't easily compare prices. In practice, I have frequently observed over many different prescriptions a price different of 1-2x between pharamcies in the same area for the exact same thing and dosage. Additionally, the way we fill scripts here you don't even get the price until you go to pay and theyve already labelled your box with your script, etc.

There's also largely no pricing on the shelves, even if you can see the behind the counter ones.

The only thing that saves us, is that "many" but not all drugs are subsidised by our public health care and the government negotiates the price. But for any non-subsidised drug it's open season and also much of the pricing is "per dispense" and not at all related to the drug quantity.

e.g. 4x10mg or 28x5mg of the same drug has the same price.

Also recently the much-publicised Ozempic which is used for weightloss and diabetes which is $150/dose here, because the price is fixed by that government negotiated price for diabetic patients but off-label prescribers get the same price even when not subsised by the government and they actually have to pay the full $150. They launched the literal exact same drug for weight loss as "Wegovy" but they vary the recommended dosages a little so that in practice you can't cross-fulfill the prescription. The exact same 1mg is $150 when sold as Ozempic and $250 when sold as Wegovy :) And for some straight reason the weight loss dose is "2.8mg" but the diabetic doses are 1mg and 3mg.

Drug manufacturers regularly take approved medicines, which are off-patent and non-exclusive, due to safety reasons (side-effects, risks to patients) or due to commercial reasons: high cost of production, low demand, or possibly to increase demand for an exclusive alternative.

The FDA maintains a list of "List of Off-Patent, Off-Exclusivity Drugs without an Approved Generic": https://www.fda.gov/drugs/abbreviated-new-drug-application-a...

See also: https://en.wikipedia.org/wiki/List_of_withdrawn_drugs

There are also perverse incentives at play and it often isn't easy to get a generic approved, especially if the original drug was already removed from market, under biosimilar regulations:

https://prospect.org/health/2024-03-14-novo-nordisk-disconti...

The trick here is that you exclude fundamental research by definition when you talk about "drug development". But the fundamental research is necessary for drug development, and it's just as if not more expensive.

I finally realized I was seeing this ad constantly and decided to look into it.

Yes, it is. I didn't say it was all profit.

No, I'm not. That's in your mind.

The advertising costs can be justified by their return. Business 101.

Just compare the small and mid cap bio market of the USA to the rest of the world. These are the companies that get acquired by the large caps once they’ve gone through a P1 or P2 successfully. But most die before acquisition. This is where the real work happens in most cases.

In reality you have a very big bill for developing it. A substantial bill for tooling up to actually be able to produce it. And typically a small bill for each unit you produce.

Now, I would like to see the developed world all pay the same price. But it wouldn't end up being the UHC-negotiated rates. I actually consider negotiation (or this dictate pretending to be negotiation) a bad thing. Instead:

You must sell to the US market at a rate no greater than you sell to any developed country. This is measured as net $ vs doses. No playing games with rebates, no playing games with giving them some for free. Reciprocity is encouraged, make the playing field level.

The US would benefit, the rest of the developed world would be screaming bloody murder.

One plant has a problem and a whole bunch of patients don't get what they need. The government has caused chronic supply problems this way before and I do not trust them not to do so again.

But that’s how the IRA works.

Also, the way Medicare Part D was set up, the government doesn’t buy the drugs in the first place. Private insurers negotiate their rates and then are reimbursed. They already have significant market incentive and power to negotiate lower prices.

The issue with drugs under patent is that the alternatives are often not as good. If the FBI needs a vehicle, it doesn't really matter if it's a Ford or a Chevy, but sometimes a drug under patent is quite a lot better than the available generic and then the seller can command a much higher price than the competition. Which is whole point of the patent system. In exchange for funding the research/trials you get a temporary monopoly on the drug and get to charge the monopoly price until the patent expires.

They're now proposing a different system where instead of taking bids, the government dictates the price and can blacklist the entire drug company if they don't accept the government's price for every individual drug. That's price controls and the result is consistently under-production. For commodities that means shortages, for R&D it means fewer new drugs.

https://www.aarp.org/politics-society/advocacy/info-2024/rx-...