The leaders in big Pharma have no souls......

I have no idea how they sleep at night.....

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Draw and quarter the executives for the egregious greed!!

...who run the companies that developed the drugs in the first place.

Don't like their prices, develop your own drugs.

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Instead they buy the companies that have the rights to drugs they want,

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They're paying for the R&D one way or another.

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Originally posted by mike28w:
The leaders in big Pharma have no souls......

I have no idea how they sleep at night.....

Probably the same as Wall Street traders, bankers, insurance executives, athletes, etc. There are many highly compensated individuals in this country whose contribution is not readily equated to their contribution. They have something we want. End of story.

I'm in pharmaceutical sales. I just left a company that's business plan is to rape insurance companies.

Actually, a lot of guys from Valeant now work there.

The company I worked for created a pill from two cheap generics, ibuprofen and famotidine (Pepcid) to manage pain from osteoarthritis and rheumatoid arthritis. The famotidine is to protect against GI bleeds. As you know, both can be bought cheaply at the drug store and taken together 3 times daily for about $16 per month.

The pill is a great pill and it's effective. People love it.

It was my job to rep/sell this combo pill to healthcare providers. Doc's could only fill this RX through a specialty pharmacy that our company contracts with, not CVS or Walgreens (because they'd swap out for the individual generics to save the patient money). I'd have the doc fax the script to the specialty pharmacy, and the patient would receive the meds within 24 hours. The insurance company would get the bill. Very slick. No co-pay for the patient as long as they were commercially insured.

How much was the bill sent to the insurance company for one month's worth of medication that can be purchased at the store for $16?

$3,000...for 1 month of medication.

Doctors really have no idea what the cost is of these meds, if they did, or find out, they stop prescribing it. Insurance companies HATE that company. But, hey, pharma companies should also be able to charge what they want.

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Originally posted by Pale Horse:

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Originally posted by jhe888:
I thought we were a bunch of right-wing, laissez-faire, free-market, personal liberty, leave me alone to conduct business as I see fit types.

I guess not.

We aren't? We all aren't?

One guy is complaining. Not the whole forum. I am pretty sure that the majority of us are in fact a bunch of "free-market, personal liberty, leave me alone to conduct business as I see fit types".

And anyway his followup post just above yours seems to say that he is bitching more about capitalism not working the way we would like it to in this case. As Bama points out as well if this was a true free market and there were not a bunch of government interference maybe we could have more competition in the market.

One can be a fan of the free market and despise government interference and still be occasionally upset when the cost of something skyrockets for no apparent reason. It is like that gym in Atlanta that someone posted about the other day where cop are not allowed to be members. Do I think the guy is a piece of shit? Yeah. Do I hope his business fails? Yeah. Do I want government thugs kicking his door in and forcing him to let cops be members? Not a chance.

I agree that the government distorts the market. Sometimes monopolies cause distortions, too. And I understand that sometimes people just want to vent.

But I still want to remind the OP that is what we get with a mostly free-market system.

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Originally posted by jhe888:

But I still want to remind the OP that is what we get with a mostly free-market system.

And of course you are right. Sometimes it is good and sometimes it is bad.

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Doctors really have no idea what the cost is of these meds, if they did, or find out, they stop prescribing it.

Which goes to my main complaint about all things health care related today.

Why can't they tell us what things cost up front?

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The leaders in big Pharma have no souls......

I think you will find that most of these sudden price increases for common generics are from very small pharma, not big pharma.

The multiple barriers to entry certainly are a major factor.
Not only the FDA but the entire distribution and benefit management system are problems.

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Originally posted by a1abdj:

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Doctors really have no idea what the cost is of these meds, if they did, or find out, they stop prescribing it.

Which goes to my main complaint about all things health care related today.

Why can't they tell us what things cost up front?

It's not the Doc's job to tell you the price of the medication.

Plus, it served my purpose better if the patient or the doctor didn't know the prices. The insurance company is the one getting hosed into paying $3000 a month for my product that you can buy OTC for $16.

In the case of medications, you can find out by doing an internet search. Plenty of resources available. But as a patient, why would you want the 2nd or 3rd most efficacious drug?

The doctor's job is to just give you the best medication to treat your condition, even if it will cost a ton of cash. And no, the doctors are not receiving "kick backs" from Pharma companies.

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Originally posted by tanksoldier:

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Draw and quarter the executives for the egregious greed!!

...who run the companies that developed the drugs in the first place.

Well, no, actually. Nitroprusside was discovered in 1849 and first used on human patients in 1922. Isoprenaline was approved in 1947. I think we can safely say no one involved in developing those drugs is an executive at Valeant.

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Originally posted by tanksoldier:

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Instead they buy the companies that have the rights to drugs they want,

They're paying for the R&D one way or another.

Sure, for the R&D that's already finished or close to being finished. When they bought Medicis, for instance, they killed 21/30 projects in the development pipeline and cut the majority of the R&D staff.

The post I was replying to asserted that revenues from selling these drugs was funneled into R&D to come up with new drugs, and that's just not the way that Valeant does business. This approach is why they were a Wall Street/hedge fund darling, until the cracks in this business model began to appear.

I have been working in drug development for 25+ years. I also have a lot of physician type friends, both practicing and in the industry.

From my perspective the problem lies primarily in having various "cartels" involved in health care with lots of middle men and women who add no value to actual patient care. Primarily these folks "push paper" and add costs/skim money. The cartels include the AMA and the various state licensing boards, the insurance industry, the various state legislatures, lobbyist and state government agencies, the big drug companies via organizations like RPharma and of course the massive federal cartel and lobbist that intends to control and take a cut of all buying and selling in the health care space. Think ObamaCare, Medicare, Medicaid, etc. Companies like the one RAMIUS refers to also play in that mix and take a cut. All of these cartels interweave to eliminate true price discovery and restrict individual access to care. For example, when I tried to get the actual charge in advance for a CT scan for myself as an experiment a few years ago, I was told "We can't do that sir, our contracts with the insurance companies will not allow us to share our prices". And of course the AMA has been keen for a long time to keep controls on the #'s of physicians. As it is structured and operates now, the system is far from "free enterprise" but very close to monopolistic on a grand scale.

Drug development is expensive and most of those costs are driven directly by regulatory requirements. Congress has demanded that drugs be shown to be safe and effective for the intended use before they are marketed. That bar has gotten ever higher as medical science and regulatory requirements have advanced. It is easy to spend $100+ million or even a billion $ getting a single drug tested, approved and commercialized today. That is up substantially from when I first started working at FDA.

If I was king for a year, I would take government out of health care entirely and go into the cartel busting business. I don't see that happening so we all get to watch as the system gets more and more expensive and parasitic in nature. The best course for the individual is to take care of yourself, eat and exercise responsibly, and avoid the U.S. system as much as possible.

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Plus, it served my purpose better if the patient or the doctor didn't know the prices. The insurance company is the one getting hosed into paying $3000 a month for my product that you can buy OTC for $16.

Now you're getting the crux of my argument. Like I said, one of the biggest problems with our health care system being the screwy games involved with pricing.

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But I still want to remind the OP that is what we get with a mostly free-market system.

The problem isn't the free-market system.
The problem, well described by RAMIUS, is a 3rd party payer problem. The "use" decision is separated from the "payment" decision so there is no opportunity to shop for the best product at the most reasonable cost.
This isn't a problem with a free-market system, which would be based on competition, it's the problem with eliminating competition.

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Originally posted by chellim1:

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But I still want to remind the OP that is what we get with a mostly free-market system.

The problem isn't the free-market system.
The problem, well described by RAMIUS, is a 3rd party payer problem. The "use" decision is separated from the "payment" decision so there is no opportunity to shop for the best product at the most reasonable cost.
This isn't a problem with a free-market system, which would be based on competition, it's the problem with eliminating competition.

"Doc, if you're on that witness stand because your patient died from a GI bleed, what will you tell the judge when it comes out that you could have given them our combo product, instead of cheaper option that you prescribed?"

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"Doc, if you're on that witness stand because your patient died from a GI bleed, what will you tell the judge when it comes out that you could have given them our combo product, instead of cheaper option that you prescribed?"

Sounds like the line of a damn good pharmaceutical sales rep!

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Originally posted by chellim1:

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"Doc, if you're on that witness stand because your patient died from a GI bleed, what will you tell the judge when it comes out that you could have given them our combo product, instead of cheaper option that you prescribed?"

Sounds like the line of a damn good pharmaceutical sales rep!

I had my moments.

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Originally posted by leavemebe:

Drug development is expensive and most of those costs are driven directly by regulatory requirements. Congress has demanded that drugs be shown to be safe and effective for the intended use before they are marketed. That bar has gotten ever higher as medical science and regulatory requirements have advanced. It is easy to spend $100+ million or even a billion $ getting a single drug tested, approved and commercialized today. That is up substantially from when I first started working at FDA.

In 2014-2015, Valeant increased drug prices on their products an average of 75.6%, including a 608% increase on Cuprimine, a drug that had already gone through development and FDA approval by 1970. Compare this to Allergan's average hike in 2014-2015, which was 8.5%, with their max increase being 185%. Source

Regulations and R&D expense help explain the overall trend of increasing medication costs, but I don't think they can explain Valeant's particular situation.

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Regulations and R&D expense help explain the overall trend of increasing medication costs, but I don't think they can explain Valeant's particular situation.

It does not. Extraordinary greed and lack of meaningful competition covers that I suspect.

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It does not. Extraordinary greed and lack of meaningful competition covers that I suspect.

Exactly. Let me also add that many physicians are aware of the costs of drugs, and will work with you to get the best drug for you. Of course, many are lazy, do not read medical journals and will rely on the Pharma rep to explain everything to them. It is your job as a patient to be educated about these things and to be responsible for your health care.

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Originally posted by RAMIUS:

"Doc, if you're on that witness stand because your patient died from a GI bleed, what will you tell the judge when it comes out that you could have given them our combo product, instead of cheaper option that you prescribed?"

An expert witness/defense counsel could tear apart this line of reasoning pretty easily.

Is there any evidence from a randomized controlled trial that shows the combo product (Duexis in your example, I presume) is more effective at preventing GI-toxicity than than the "cheaper option" of separate pills that contain the exact same ingredients?