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Comment by AlbertCory | Hacker News Reader

Drug for discussion:

Bimzelx (for psoriasis). This costs six figures or more per year, from what I can glean. Watching baseball a lot, I see this advertised multiple times per game, and God only knows what else they spend on marketing.

  (I don't have psoriasis or know anyone with it, if that matters)

Looking at UCB's financials (helpfully broken out by drug), they took in $242 million on that drug alone in fiscal 2024. So that's how they can afford all those ads. It's also probably something patients would demand, and maybe even be happy to pay for out of pocket.

> they will help the Medicare program cap what individual patients spend out of pocket on their prescriptions in a year at $2,000.

So if you want clear skin, you probably have to pay big bucks. But maybe these immensely profitable drugs subsidize the life-saving ones.

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Clear skin is the least of the problems with psoriasis. From their website:

    Bimzelx, alone or in combination with methotrexate, is indicated for the treatment of active psoriatic arthritis in adults who have had an inadequate response or who have been intolerant to one or more disease-modifying antirheumatic drugs (DMARDs).

In other words, it's for people with bad cases who don't respond well to other drugs. Keep in mind, other drugs often come with serious complications- constant use of topical steroids will thin your skin, and give you glaucoma if you develop it and use them near your eyes. Many biologics have even worse potential side effects.

On top of that, psoriatic arthritis is degenerative, if you're unlucky enough to get that too, so not treating it means not only constant pain, constant threat of skin infections from scabbing, but permanent joint damage.

I ended up on Taltz, another very expensive biologic, but the eli lily foundation covered almost all of the cost since my insurance wouldn't. Before then, I looked like an alcoholic, because my nose was constantly red and inflamed, and I didn't have anything safe to put on it- glaucoma runs in my family, and I wasn't brave enough to risk anything strong enough.

If that was the only problem, I might not have even gone the route of Taltz, but I was also developing it all over my body, and there wasn't much that was helping.

Assuming this is post-Obamacare, do you know why your insurance didn't cover it? I had this simplified model that insurance covers everything once you hit maximum out of pocket and I'd love to learn how that model breaks down in practice.

Your insurance has a pharmacy benefit manager (PBM) that has a formulary (the list of drugs they cover). Multiple insurers might use the same PBM. New drugs aren't automatically covered, as they haven't necessarily made the calculation that the cost of it justifies using it versus the alternatives.

It's intentionally complicated in order to fracture responsibility, avoid paying out claims and extract payment from publicly funded insurers.

If the medication is on the formulary the max out of pocket is usually somewhere around $12K. It's not capped if it's not on the formulary. And fancy new drugs are often off the list.

My insurance company would have, but wanted me to try an older, cheaper drug first. Since the older drugs have a much more dangerous list of potential side effects, including lymphoma and skin cancer, and since the eli lily foundation would have covered it regardless, it was a no-brainer.

The co-pays on tier 3 (i.e. super spendy specialty drugs) are crazy anyway, so insurance covering it wouldn't have really changed the affordability aspect one way or the other.

The insurer is supposed to cover everything, as long as it is justified by the prevailing evidence and there is no alternative treatment.

However, you may have to fight for it.

https://www.healthcare.gov/appeal-insurance-company-decision...

My insurer wanted me to try a different, older biologic first. My dermatologist recommended going with Taltz instead because

- the eli lily foundation pays for it anyway

- the older biologics have far more serious side effects profiles

Given that, it was kindof a no-brainer. I would have needed to go through the foundation anyway, since the co-pays on these drugs are insane regardless.

Thanks.

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

It may not qualify as a life saving drug, but really it ought to be. The long-term quality of life with untreated and/or resistant psoriatic arthritis is awful.

Also, biologic drugs are money printing machines if they survive the FDA approval process, as they can manage the symptoms but the disease itself is incurable. Since they are brand new, they need promotion to raise awareness, and they pay for themselves after a few years.

Given all of that, irritating as they may be, the major ad spends make a lot of sense.

I mute the commercials anyway, so I wouldn't call them "irritating." They're no worse than the Toyota lady in red.

Looking at all the other messages here, it's interesting that they don't emphasize the "horrible, life-threatening" aspects of the disease. It's all happy people enjoying life, now that their skin is clear.

My feet have had open wounds for the past year due to psoriasis (and I've gone to every dermatologist I can). It's not just clear skin, it gets very bad with quite painful wounds from the scratching. Especially in hot humid conditions, and I play tennis a lot. 3 people I train with have bad cases, as in having to stop playing for a while

But presumably the advertising department pays for itself, right? So if they cut the advertising department, wouldn't they have less total money in the end? The advertising supports the R&D, not competes with it.

(The one exception is when 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, I think government regulation would be valuable.)

You seem to have supplied your own conclusion here. I didn't say UCB should do anything in particular: cut it, increase it, or keep it the same.

If there wasn't a competing drug there would be no need for ads, the only drug would get prescribed anyways.

They want the "ask your doctor about..." bits to be heard and followed, I'm guessing. People who thought they just had to live with it will now go in and ask for Bimzelx.

As someone with psoriasis, I seriously doubt anyone with severe plaque psoriasis is going to go from no treatment to monoclonal antibodies. In fact, your insurance won't even pay for it no matter how good it is unless you try other courses of treatment first. The effect is going to be changing from one course of treatment to the next, asking your doctor about it is a call to action.

To counter a Red Queens race is to spend twice as much in advertisements?

Like many a disease with an old name, Psoriasis refers to a localized cutaneous autoimmune disease usually treated by dermatologists, and a severe family of Rheumatic (autoimmune) diseases, part of the Spondyloarthropathy family, that happens to have a cutaneous element which is the same (and often is the first symptom). This treats the latter, debilitating and possibly life-threatening variety.

Obviously you need to subtract costs from that, not just production costs for this year but development costs, and the development costs of other drugs that didn't even make it to production.

> Obviously

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

> (I don't have psoriasis or know anyone with it, if that matters)

Psoriasis is very common, especially the mild forms. You probably know people who have it.

You seem to be implying the advertising costs are a significant driver of the price for drugs. They are not. The significant driver of the cost in drug is the development costs, including the cost of the many failures along the way. Also, in general and not specific to this case, the prices need to targeted high enough to encourage investors to invest in the first place. If prices are not set at a sufficient premium to offset the volatility and risk, in the future investors will realize biomedical research is a poor investment and put their money in less socially beneficial investments like Facebook.

> You seem to be implying the advertising costs are a significant driver

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

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

Ok good, thanks. I just wanted to clarify that point for other readers.

As an aside, as someone who works in the life sciences field, I’m a bit conflicted about advertising new therapeutics. I see why it is an often necessary practice in order to raise awareness among potential patients. On the other hand, in an ideal world, primary care physicians would be up on the latest therapies and recommend them to their patients as appropriate. Sadly, that is not always the case.

Good, I thought we were about to have a flame war there. People are so accustomed to everything having an ideological point that they infer one if you don't say it.

Putting myself in the place of the doctor: if I say "hey, there's this new drug Bimzelx!" and then I have to tell the patient what it costs, I can imagine being happy to wait until THEY bring it up. Of course, if they just ask "are there any drugs for this?" I'd be duty-bound to answer.

C6552 H10132 N1750 O2029 S42, 147229.87 g·mol, what a monster. Probably not making that one in your garage.

It's apparently a monoclonal antibody (https://en.wikipedia.org/wiki/Bimekizumab). That's just a protein, so it might actually be easier to make in your garage than your average small molecule ;) ... not that either would be practically possible, but it might be available in countries where they don't care too much about patents and such

And if you're really willing to DIY, easier to make in your body than in your garage.

> So if you want clear skin, you probably have to pay big bucks.

The price is determined by what the market will bear. So, yes.

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