The US just has no mechanism to control prices. There isn't really competition for specific drugs.
Can you do it? Sure. Are you going to get an infection from it? Probably not. Is it riskier than having a compounding pharmacy doing it the right way? Absolutely, and in a meaningful amount of risk. The type of infections you get from contaminated injections are not something you want to deal with
Doesn't mean it's safe. Lots of people trade off a small risk of harm for immediate benefits. Hell, look at alcohol.
What you're describing is a adequate for immediate use. Not use and storage.
Wiping the bottle before use is just standard practice to prevent contamination after compounding.
From a quick look earlier this week that's not easy, and I've dealt with research peptide sites before. I was hoping to try one of the ones that's newer than Semaglutide for my IBS - that worked really well the later half of the week but not the first few days where it made things worse. I don't need to lose weight but I'd love to get that under control better.
i.e. The price difference could be reflecting a real qualitative difference such as being produced in different facilities, slightly less pure ingredients, less stringent QC, etc…
We know that these drugs cost roughly $10/dose to produce, and most of that is the auto-injector pens. Hardly seems worth ruining their reputation and getting punished be regulators to save a few dollars on something with a 600-6000% markup.
Can you link the source?
If it really is a 600% to 6000% markup then it does seem unlikely they would try to save a few dollars.
It is like estimating the cost of a rocket based on the price of metal.
The person above was claiming they were using substandard versions of their medication in non-US markets where the retail cost is lower. I was pointing out that the manufacturing cost is so low, that doesn't make sense.
Your point now has nothing to do with the discussion being had.
However, bad data is bad data. If I said the moon creates waves because it is made of cheese, I think it is completely legitimate to point out out that it is in fact not made of cheese.
It can only lower your credibility and the credibility of the associated arguments…
> less pure ingredients, less stringent QC
Why don't you link to a paper or source showing that to be true? If you want to discuss credibility.
You selectively quoted a chunk leaving out “could be reflecting”, implying a probability above 0.
So at most it can be said to imply there will always be a true probability greater than 0.
e.g. Someone could perish from a meteorite hitting them tomorrow. There will always be some non zero probability of that.
One concept is a single firm selling a branded product in multiple markets. Novo Nordisk sells at different prices in different markets, but the product is all of equal quality, and usually comes off of the same manufacturing line globally, or one of a few.
The other is usually generics made by entirely different companies. These can vary greatly in quality, from identical to deadly. It is a bit of a stereotype, but you usually see higher quality control and less fraud in US and western European manufacturing than say India, China, or SEA.
Having worked for US drug manufacturers, they deeply desire to move manufacturing to Asia where they can, but dont because of frequent quality issues when they do.
The marginal cost of an additional batch is relatively small in comparison.
Look at how cheap generics are, that's what it costs to actually make and distribute a drug.
The pharma business model is that you spend incredible amounts of money on doing research, identifying promising drugs, doing trials, and overcoming all the regulatory hurdles you need to overcome to get the drugs to market. You then get a 20-year[1] exclusivity deal on your newly-introduced drug through patents, which you use to recoup your costs.
You don't just recoup the costs of inventing this particular drug, but also all the other drugs that seemed promising, had all that money spend on trials, but ended up just a bit too ineffective to ever be sold.
We could abolish the patent system and genericize everything, and that would instantly bring drug prices down massively, but then we wouldn't ever see any new drugs being researched.
Most other markets with state insurance have purchasing controls. That is to say, if the price is too high, the government doesn't buy it.
Very few places have price controls e.g. "products cant be sold for more than X".
The US government is the outlier in that it situationally states it will pay the price no matter the cost.
Reasonable government policy needs to start with putting a price on human life (QALY), and purchasing goods and services that come in under that price. This is how it works in other state insurance systems.
Instead, we have a divided and fractured jigsaw and heavy lobbying to keep it that way.
The point is that governments won't pay any price, they usually negotiate a (good) price given their buying power. As you say they may not buy it, but countries that dictate a price (generally) cannot force a company to supply it.
Ultimately it comes down to market forces, even if the market looks very strange, with essentially one buyer and one seller.
That isn't really a market.
Suppose you have a government that requires everyone to pay for public health insurance, effectively eliminating the market for private insurance because hardly anybody buys private insurance when they both already have public insurance and have paid the money they'd have used to buy it in taxes. Then the government insurance declares the maximum price they'll pay. Is there any meaningful way to distinguish this from price controls? The vast majority of customers can't afford the drug without insurance and the government is the insurance company and is setting the price through regulation.
In particular, notice that this has all of the problems of price controls. There is no real market to enable price discovery, no effective way for customers to switch insurers and thereby punish insurers who pay too much and have high premiums or pay too little and have poor coverage, it's just regulators making up a number and saying take it or leave it.
And even at that, you shouldn't have a problem for generic drugs because then the insurance can just put it out for bids and still have price discovery (i.e. a lowest bidder). But here we're talking about brand new drugs that are still under patent, which have one supplier because they're supposed to be expensive because that's the incentive for the drug companies to fund the R&D and cause them to exist to begin with.
Note also that this is a feature, not a bug. You don’t want drug companies figuring out what price makes them the most money, because the market for patented drugs is not a competitive market (or a transparent one for the consumer). The price that makes the company the most money is not the same as the one that maximizes welfare.
It's not supposed to be competitive, that's the entire point of a patent. They're supposed to be able to extract nearly the full value of the drug during the patent term, because that's the value of the drug existing, so that's how much incentive you want there to be to create it. After that the patent expires and it becomes a cheap generic, which is what the public gets out of the deal.
It’s far far more efficient to have an expert guess the price that maximizes public welfare. They won’t get it 100% correct, but they’ll do better than monopoly pricing
There is though, because it gives you the price that it's worth to the buyers, which is the amount of benefit the buyers derive from it existing, which is the amount of incentive we want to provide to create it.
For something that wouldn't otherwise exist, the monopoly price for a temporary period of time is a close approximation to what would maximize welfare -- it's proportional to the value of having it exist without being the whole thing, because it becomes a competitive commodity when the patent expires.
It does not. It gives you what it’s worth to the last buyer, sure. All of the buyers before that value it higher than that price, and all of the people that don’t buy it value it lower than that price. In the end, all you’ve really found is the price the company expects will maximize profit.
This may tell you a little bit about what the company believes the demand function is, but it doesn’t confirm or deny their correctness.
But, in Romania, Ozempic was negotiated/price controlled by the government to be for around ~100$/month. First year or two supply was enough, so we got it, this year demand in places with more cash is high, so Romanians don't get any more Ozempic (but we still have Rybelsus)
Where this happens it's basically because the public wants more insurance than the government is providing, e.g. you're required to pay $3000 for $3000 worth of insurance but there are people who want $5000 worth of insurance so they buy another $2000 in private insurance.
But that doesn't really change the problem because the extra insurance covers different stuff. If your coverage from the government covers the drug and your coverage from a private insurer covers longer inpatient stays or hospice care, the latter is unrelated to the former. Meanwhile there are still a lot of people who only have the government insurance and can't switch to a different provider for that coverage because the government plan is required by law. And even if you could get drug coverage from a private insurer, the patient would then be paying for the whole cost of the drug out of the private insurance premiums even though they're still paying for the public insurance, which will deter people from doing that unless the government coverage is not just bad but catastrophically bad.
The way you could make it work is that instead of the government setting the retail price of the drug, they set how much they pay for the drug and the patient pays the rest, which the patient could then have covered by private insurance at their option. Then you actually have price discovery because if the drug is worth more to people than the government is paying, they'll buy the amount of private insurance needed to pay the rest.
> But, in Romania, Ozempic was negotiated/price controlled by the government to be for around ~100$/month. First year or two supply was enough, so we got it, this year demand in places with more cash is high, so Romanians don't get any more Ozempic (but we still have Rybelsus)
Production capacity isn't normally the issue for drugs under patent. The issue is that you need somebody to pay enough to cover the R&D or otherwise you don't get the drug, and drug R&D is crazy expensive because the price has to cover the R&D cost for all the drugs that don't work out.
https://www.fiercepharma.com/pharma/ozempic-shortages-contin...
https://www.tga.gov.au/safety/shortages/medicine-shortage-al...
For one of the most popular drugs in recent years, yeah, production might take some time to ramp up.
The issue definitely isn't R&D cost recuperation: in the US Ozempic is much more expensive, but in Romania nobody would pay that much (government or private).
Which is why it's an outlier.
> The issue definitely isn't R&D cost recuperation: in the US Ozempic is much more expensive, but in Romania nobody would pay that much (government or private).
This has nothing to do with whether the government sets the price. If people in the US would pay $1000 and people in Romania would pay $200 but the government sets the price at $100 in Romania then there is $100 less incentive for R&D.