Prescription drug pricing insanity

[Brian Henderson]

Are you saying we're covering the money drug companies lose selling in other countries? Not likely. Those companies are not in business to cover their costs. Their goal is to make money for their shareholders. They are entitled to do that. In fact if you have drug company stock in a mutual fund, you want them to do that but it's gotten out of hand.

See episode 3 ("Drug Short") of the Netflix series "Dirty Money" or Google Valeant Pharmaceuticals.

Drug prices are not the only way our sytem is broken. We're 11th out of 11 countries in one organization's ranking of overall health care. According to the World Health Organization's 2018 report, maternal mortality in the US is 14 deaths per 100,000 births. In 33 European countries it's between 3 and 11. 12 in Kazakhstan, 16 in Turkey. IIRC, we're paying 3 to 4 times as much for our heath care as anyone else.

There are many dedicated, hard-working, honest people in the health care system. It's not their fault. I still say it's broken.

Of course they want to make money for their shareholders, that's the purpose of any publicly held company. But the fact still remains that there are a lot of countries out there that are putting artificial limits on how much drug companies can charge in their country and that doesn't stop these drugs from costing a tremendous amount to bring to market. The vast majority of drugs put through development never reach market at all. but their cost still needs to be paid for. The point is, drug development is insanely expensive, these are not mustache-twirling villains trying to screw widows and orphans, they are business people doing the best they can with what they're given and the overwhelming majority of drug development on the planet comes from the U.S. The fact that U.S. health care is broken, and I agree that it is, that doesn't change the costs for drug development. People complaining about how much it costs don't get how much it actually costs.

[Scott Donley]

Considering this thread started out about GoodRX I thought I would mention that most of the coupons are not good if you are 65 or older and on Medicare, at least none of the meds I take Good RX will help.

[Edwin Santos]

Of course they want to make money for their shareholders, that's the purpose of any publicly held company. But the fact still remains that there are a lot of countries out there that are putting artificial limits on how much drug companies can charge in their country and that doesn't stop these drugs from costing a tremendous amount to bring to market. The vast majority of drugs put through development never reach market at all. but their cost still needs to be paid for. The point is, drug development is insanely expensive, these are not mustache-twirling villains trying to screw widows and orphans, they are business people doing the best they can with what they're given and the overwhelming majority of drug development on the planet comes from the U.S. The fact that U.S. health care is broken, and I agree that it is, that doesn't change the costs for drug development. People complaining about how much it costs don't get how much it actually costs.

Brian,

There's cost and then there's cost. And then there's price.

From your comments, I'm thinking your definition of cost would be the hard development costs associated with the drug i.e. research, equipment, testing, clinical trials, etc.
Yes, this is one category of cost.

But wait, there's another - between the drug company and the patient, there is a complex labyrinth of players including distributors, brokers, drug wholesalers, pharmacy benefit managers. These are not some guys, they are all billion dollar companies. This chain and the cost that goes with it is unique to the US healthcare system, whether the drug was created by an American company or a foreign company like Roche, GlaxoSmithKline or Novartis.

Ultimately all these costs trickle down to you and I as end user/patients. I will predict from your post that you accept the first layer of cost. Are you as comfortable with the second?

Then there is price. A federally mandated pricing tier system fixes pricing categories that result in vastly different prices among insurers, hospitals, retail pharmacies, wholesale pharmacies, indigent care providers and end users. Generally speaking, the largest of these categories (in terms of industry leverage and lobbying power) gets the best pricing tier and the smallest of them pays full boat. It is illegal to give the benefits of one pricing tier to another. There is also a dark system of rebates that comply with the pricing rules on the surface, and then opaquely circumvent them by rebating money back from the drug company to the favored buyer on the back end. By rebates, don't think $5 bucks here and there, think billions.
I "think" GoodRx has found ways to extend best pricing to consumers partly using the rebating system to pass savings on that would otherwise be usurped by someone in the distribution chain. When you hear of someone going across the border to obtain the same drugs made by the same manufacturer for radically lower prices, it is usually because in doing so, they are essentially circumventing the domestic distribution channel and pricing tier system.

By the way, of the 10 largest pharmaceutical companies in the world, 5 are from the US. The other five are from France, Switzerland (2), Israel, and the UK. So I think it's fair to say the US is #1 in terms of drug development but it is not accurate to call it an overwhelming majority. But again, the distribution system paraphrased above is uniquely American.

Not trying to criticize you or your post Brian, but just adding another dimension on the subject. My perspective comes as a veteran of the industry, admittedly from the provider services side more so than the pharma side.

Edwin

[Mark Bolton]

Welcome to the world of self pay. I have been prescribed a medication that when landing at the pharmacy the pharmacist says "you dont want this". For instance an earache and prescribed a medication that was $380 dollars a dose and when the pharmacist called the doc he said "oh I didnt realize he was self pay" and then its $11.

Our system is completely fragged. And its fragged by the flippant users of the system. The people who are on 15 medications a day. Who believe that a life worth living is determined by how many "specialists" you see weekly. These people live their lives day in and day out by their doctor and medication schedule.They usually have great payment options, which is why they continue to uphold a half dozen doctor visits daily. They are the people that when confronted with a lifestyle change... uhhh.. nope... Ill take the meds.

We live in a medicated world in the US. And the people who truly need them suffer for those who are too lazy to get themselves off them.

There are a lot of people with no other recourse than medication. And there are the bulk of people funding the advertisements we all see on TV daily who run in to their doctor to add another script to their list.

When there is so much that can be done individually to NOT have to be on a script we have a society that is far more willing to sit in the recliner and take another med as opposed to getting out, moving, getting your blood pumping, to get OFF a med or two on your list.

Its rampant. And those of us who are healthy *by the grace of god* bear the burden.

[Ron Citerone]

Of course they want to make money for their shareholders, that's the purpose of any publicly held company. But the fact still remains that there are a lot of countries out there that are putting artificial limits on how much drug companies can charge in their country and that doesn't stop these drugs from costing a tremendous amount to bring to market. The vast majority of drugs put through development never reach market at all. but their cost still needs to be paid for. The point is, drug development is insanely expensive, these are not mustache-twirling villains trying to screw widows and orphans, they are business people doing the best they can with what they're given and the overwhelming majority of drug development on the planet comes from the U.S. The fact that U.S. health care is broken, and I agree that it is, that doesn't change the costs for drug development. People complaining about how much it costs don't get how much it actually costs.

Brian, there is no doubt drug development is expensive. However the issue at hand is not about that on 2 counts. #1, the drug rosuvastatin is a generic drug. Drug companies get payed for their development cost by having exclusive rights prior to the drug going generic. The company that developed Crestor tried everything it could to keep delaying the generic substitute. Companies also buy up generic drug makers and raise the price after the exclusive rights run out. e.g. epipen and vytone.

#2, The price variances seem to be more about insurance and drug retailers than the cost of the drug development as was illustrated in the original post.

[Malcolm McLeod]

And when totaling the various costs, don't forget to include the drug companies legal bills. USA is a bit litigious. ...Maybe more so than other nations???

Also fascinating that some from places not-USA, seem to think their cost is what they paid to the pharmacy; ignoring their tax contribution for same.

[Wade Lippman]

Considering this thread started out about GoodRX I thought I would mention that most of the coupons are not good if you are 65 or older and on Medicare, at least none of the meds I take Good RX will help.

I found it worked twice, and I am on medicare.
The first was not covered by insurance and I got about 90% off.
The second was covered and was a half dollar less then my copay.

[George Bokros]

Considering this thread started out about GoodRX I thought I would mention that most of the coupons are not
good if you are 65 or older and on Medicare, at least none of the meds I take Good RX will help.

We are on Medicare and it works for my wife and me. We DO NOT have Medicare Part D.

[Scott Donley]

This discount has some eligibility requirements. Please review below.
Learn more
I agree to the following statements:

• I am less than 65 years of age
• I am not filling a prescription for a pet
• I have been prescribed or am a caregiver of someone taking Advair® Diskus®, Advair® HFA, Anoro® Ellipta®, Arnuity® Ellipta®, Breo® Ellipta®, Incruse® Ellipta®, Flovent® Diskus®, Flovent® HFA
• I am a resident of the United States or Puerto Rico
• I am not currently eligible for prescription coverage from any state or federally funded programs, including but not limited to Medicare, Medicaid, VA, DoD, or Tricare

If you meet the requirements you may access the discount using the button below.

[Bruce Wrenn]

Had a colonospy today. The Suprep bowel prep kit costs $120, It's mainly EPSOM SALTS, with two other salts. Total cost to make is most likely less than five bucks, based upon cost of epsom salts in drug store. Wonder how much of a kick back doctor gets for prescribing it?

[Brian Henderson]

Considering this thread started out about GoodRX I thought I would mention that most of the coupons are not good if you are 65 or older and on Medicare, at least none of the meds I take Good RX will help.

I was picking up some prescriptions a couple of days ago and a couple were asking about GoodRX. They wanted to combine the coupons with insurance and they couldn't do it. I checked a while back and even with the coupons, most of my prescriptions would still be prohibitively expensive without insurance, they might take $10-15 off the cost, but that's all.