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The Mega Costs Of Miracle Drugs

Super expensive miracle drugs.  How much can we afford to pay? Plus, a look at a powerful new painkiller making headlines.

In this Saturday, Aug. 11, 2012 file photo, employees of the New Hampshire state health department set up a temporary clinic at the the middle school in Stratham, N.H., to test hundreds of people for hepatitis C related to an outbreak at nearby Exeter Hospital. A new drug, Sovaldi, is said to successful treat more than 90 percent of Hepatitis C patients. (AP)

In this Saturday, Aug. 11, 2012 file photo, employees of the New Hampshire state health department set up a temporary clinic at the the middle school in Stratham, N.H., to test hundreds of people for hepatitis C related to an outbreak at nearby Exeter Hospital. A new drug, Sovaldi, is said to successful treat more than 90 percent of Hepatitis C patients. (AP)

We all know drugs can be super-expensive in the USA, but how about this for a pharmacy bill?  The hottest new treatment for hepatitis C costs $1,000 a pill.  Eighty-four thousand dollars for a twelve-week course.  About three million Americans have hepatitis C.  Do the math.  Treat all those people and the whole system topples over.  Billions and billions.  But our system has no automatic brakes.  Americans want the best in drug therapies.  But as new drug prices climb, how far can we go?  When do we hit a wall?  Is it now?  This hour On Point:  super-expensive drugs, and the American way of health care.

– Tom Ashbrook

Guests

James Surowiecki, staff writer at the New Yorker, where he writes the financial page.

Dr. Steve Miller, chief medical officer of the pharmacy benefit management firm, Express Scripts.

Patricia Danzon, professor of health care management at the University of Pennsylvania’s Wharton School of Business.

From Tom’s Reading List

New Yorker: Biotech’s Hard Bargain — “In December the F.D.A. approved the first in a new wave of hep-C drugs, Gilead’s Sovaldi. This is huge news—not just in medicine but on Wall Street. Vamil Divan, a drug-industry analyst at Credit Suisse, told me, ‘Sovaldi and the other new hep-C drugs are great drugs for a tough disease.’ Sovaldi can cure ninety per cent of patients in three to six months, with only minor side effects. There’s just one catch: a single dose of the drug costs a thousand dollars, which means that a full, twelve-week course of treatment comes to more than eighty grand.”

NPR: Costly Hepatitis C Pill Shreds Drug Industry Sales Record — “To make the case for Sovaldi’s price, Gilead put together a chart of hepatitis C treatment costs for a variety of medicines. A combination of Sovaldi, a common form of interferon and the antiviral ribavirin, would cost $94,078 for treatment that would last 12 weeks. Other drug combinations that would take longer for treatment ranged from $64,825 to $106,673.”

New England Journal of Medicine: The Costs of Success — “Unfortunately, not all barriers to treatment will be lifted. The major limitation remaining will be economic. The current cost of a 12-week regimen of sofosbuvir alone is $84,000, or $1,000 per tablet. The addition of ledipasvir will add to the costs, and these estimates do not include expenses for diagnostic assays, monitoring, and physician visits.”

Painkiller Zohydro Sparks Addiction Concerns Anew

Lisa Girion, health and investigative reporter for the Los Angeles Times. (@lisagirion)

Boston Globe: Drugmakers dual role as friend, foe – “Doctors prescribe way too many powerful painkillers in this country. The skyrocketing overdoses are mirrored by rising prescriptions for Oxycodone, Vicodin, and other opioids, especially for middle-aged people in chronic pain. Adding another powerful painkiller to an already saturated market, especially one that is easily crushed and snorted, means more prescriptions, more abuse, and, inevitably, more deaths.”

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  • Expanded_Consciousness

    The should be free. Or, sliding scale based on what the patient makes. Or, generic versions should be available.

    • sam liu

      “Or, sliding scale based on what the patient makes. ”

      What happened to Capitalism. Take care of yourself …

      • Expanded_Consciousness

        Yea, it is great when people die because of “capitalism.”

        • HarryObrian

          Except when the government creates the capitalism like with BarryCare/HillaryCare2… right? and more people eventually die because of the increased costs of insurance and the reduced coverage… unless you’re a rich politician or connected right?…..
          It was a sad day when the government removed the teaching of the definition of hypocrisy from the classroom. Look it up….

          • Shag_Wevera

            OHairbrain.

          • Bigtruck

            small thoughts by HarryO

          • Michael Rogers

            Once upon a time, –long ago, those who had somehow followed Noblis Oblige

            which meant they should help those less fortunate than they. Since then, the dogma of a mainline church that if for any reason you’re not successful it’s YOUR fault has taken over. It’s a compelling justification for doing whatever to become successful.

    • Zack Smith

      “From each according to his ability, to each according to his need” – that it?

  • Matt MC

    Why not change the incentives? The government provides funds for basic research, the private sector fills in the gaps, and projects are awarded lump sums for drugs based on their ability to a) lessen symptoms, b) reduce illness, or c) cure the disease completely. How about $100,000,000,000.00 for curing cancer? After which, the drug becomes public domain. Immediate generics. I don’t know, just an idea.

  • Acnestes

    The pharmaceutical industry is rotten beyond description. Despite their garment rending over being soooo concerned about patient health, they are interested in the bottom line this quarter, period. If they actually benefit any patients along the way it’s merely incidental. If you have any doubts, check the amount the members of PhRMA spend on lobbying and advertising compared to the amount they spend on actual R&D. (most of which is done by academia or the NIH anyway). And they do all sorts of cute tricks with patents and cross licensing. E.g., release a drug for hypertension or whatever in in immediate release form when time release would clearly be superior, cash in on that as long as possible and, when the patent is about to expire, THEN they release the time release form for another term of patent protection.

    Anyone remember Billy Tauzin? They sure took care of him OK!

    The only health they’re interested in is that of their portfolios. At least dope dealers are up front about where they’re coming from.

    • The poster formerly known as t

      Are you just figuring this out? The business of America is business. Businesses exist ton make a profit. Profit serves civilization. Profit, is surplus. Surplus distinguishes civilization from subsistence-based primitive societies where surpluses didn’t exist. Civilization doesn’t really care about people. It cares about laws, abstraction specialization, and those things help to keep surpluses around.

  • Human2013

    Where does it end? When will the government stop allowing this unfathomable, unchecked form of capitalism to seep its way into every corner of this so-called democracy? This is not a rhetorical question, I really want to know.

  • keruffle

    Mom is paying a thousand or so a month for Alzheimer’s medications of unknown effect.
    No I should say YOU are paying.
    Medicare. Despite having a million in the bank.
    Kerry

    • Politheatrics

      I live in a state that offers no-cost healthcare to the poor and elderly beyond Medicare. A friends’ mother was recently diagnosed at 80+ years of age with terminal cancer – no more than 6 months to live. She was offered a full treatment plan of chemo and radiation. Hello? Why in the world would the state plan think to offer a fully paid treatment plan here? I agree with everyone – we have a complicated system that needs a major overhaul to put all available government funding in the right place for the best overall good, while controlling corporate pharma costs with salary caps and advertising bans. I used to run a healthcare clinic – got so fed up I left.

      • Zack Smith

        The elderly vote, and democracy is two wolves and a sheep deciding what’s for dinner.

  • Coastghost

    Three times as many Americans are HCV positive as are HIV positive. The domestic dimensions of the present hepatitis “crisis” were permitted to expand comparatively unacknowledged over the past two decades while the fight against HIV/AIDS commandeered media attention. Granted, research overlap into the roles of antiviral protease inhibitors has benefitted treatment options for both diseases, but hepatitis has received nothing like commensurate media (and public) attention, until now, as an effective though costly treatment regimen becomes available.

  • Jim

    The monstrous expensive drugs are making cities like Boston very rich.

    • Human2013

      The monstrous expensive drugs are making cities like Boston very unequal — even more so than the past.

      • The poster formerly known as t

        Wealth creation is a zero sum game.

    • The poster formerly known as t

      The city is not becoming richer, only select individuals in the are becoming richer, the majority of them I’d bet hard cash don’t live in Boston or Massachusetts.

  • Bigtruck

    Blood money…

  • Emily4HL

    So glad I’m no longer taking Lyrica. Anything without a generic is horribly expensive.

    I think we should put serious limits, if not an outright ban, on pharmaceutical advertising. Most other countries don’t allow advertising of Rx drugs. Advertising is a huge expense when people should learn about medical conditions from professionals, not a 90 second ad (that’s 60 seconds of side affects.)

    • Acnestes

      Amen!

      “Tell your doctor. . . . “

  • Coastghost

    Does the Gilead/Sovaldi phenomenon not illustrate well enough just how first-world economies (where the bulk of biotech R&D occurs) cover and absorb up-front development costs which soon enough permit effective subsidization and lower-cost and/or generic drug regimens in second- and third-world health care economies? (Sofosbuvir will not become available generically until the end of 2020 at the earliest, no?)

  • myblusky

    There is an article on Forbes about the cost of making new drugs: 5 billion. Most drugs fail so that is money down the drain. Then factor in lawsuits that might follow once the drug is on the market. It takes years of development and jumping through regulatory hoops to make a new drug.

    I don’t have an answer – but just saying that
    pharmaceutical companies are evil doesn’t solve anything nor does it even begin to address the real problems of making new drugs.There are a lot of components that drive up the costs and all of these have to be addressed if something is to be done.

    • Human2013

      If Forbes says it $5b than it’s probably more like $10 m. Don’t believe everything you read about corporate costs.

      • myblusky

        I sited it as one article. I am well aware from the several articles I’ve read and from having friends that work in pharmaceuticals that the costs of making new drugs is extremely high and the failure rate is very high.

      • Zack Smith

        It’s probably more like $10M because of your liberal hopium. Can I have what you’re smoking?

  • Scott B

    It’s not just this drug, but there are drugs out there that cost a few dollars (well under $5 to produce) and sell to pharmacies for a couple times more than that, but the pharmacies HAVE to charge hundreds of dollars for it or the drug company will cease to sell any of their products to them. If that’s not extortion of the public and Medicaid/Medicare, I don’t know what is?

  • Scott B

    The drugs makers will all couch the huge price here as paying for the low prices elsewhere, like Egypt’s $900.

  • Bigtruck

    CEO 180 million! Compensation, HA! That focuses on the wrong thing… Don’t pay any attention to the extremely rich guys behind the screen. $180 million and human blood and souls. Its like a buffet at the country club.

    • Zack Smith

      The $180 million can be used by the CEO to fund another biotech startup. If it went to the government it just be frittered away.

      • Bigtruck

        that’s funny.

  • Dereklowe

    As a researcher in the pharma industry, I wanted to add some data to the discussion about R&D costs. I’ve been working in medicinal chemistry since 1989, and I have yet to work on any compound that’s ever made it to the market. Those are the odds, and whatever does make it has to make up the costs for all those others.

    As for spending money on research versus advertising (which always comes up in these discussions), here are some numbers:

    http://pipeline.corante.com/archives/2013/05/20/how_much_do_drug_companies_spend_on_rd_anyway.php

    http://pipeline.corante.com/archives/2013/05/20/but_dont_drug_companies_spend_more_on_marketing.php

    http://pipeline.corante.com/archives/2013/05/23/another_look_at_marketing_vs_rd_in_pharma.php

    I’m not saying that the drug companies are complete angels, of course. There’s plenty of room for complaint, and plenty of room for improvement. But I rarely see any perspective on these issues from the people who actually try to discover new drugs, so I thought I’d add some.

    • Emily4HL

      I appreciate the data, because I know that I don’t really know anything beyond the basics. As a more informed member of the industry, where do you see room for improvement? What do you think would alleviate the problem? Do you think decreasing advertising would help at all?

      • Dereklowe

        Advertising exists to make more money for the company – if it doesn’t do that, you’re certainly not doing it very effectively. Many people look at ad expenditures, from the outside, as a large pile of money that just goes out the door. But if it doesn’t pay for itself, and more, by revenue coming back in, then something’s gone wrong.

        Our biggest problem in the drug industry is the very high failure rate of any new research. Almost all projects die before they get to the clinic, and about 90% of the remaining ones (latest figures) die once they go into the clinic. All the behavior of the drug companies is rooted in those numbers, but changing them has been very hard indeed.

  • WBC_in_MA

    I think that Congress should pass a law that Medicare and Medicaid will automatically get the lowest price for any drug sold in the “1st world countries”. For example, if they find that the French are getting a lower price for a drug, then the difference between what they paid and the French price would immediately be refunded. I’m fed up with other rich countries being subsidized by the American taxpayers.

    • Acnestes

      Medicaid can at least negotiate. Medicare is prohibited because PhRMA paid off Billy Tauzin big time when the drug benefit was put together.

      • WBC_in_MA

        I don’t even want the negotiation. I want this to be automatic … NO DEALS, NO OTHER FORMS OF RECOURSE! Put the rich counties on the same level playing field, only one price. … And do this for medical devices, and any other medical product, if possible.

  • Joe Mahma

    .
    Its not only drugs. The entirety of the healthcare system in America is disproportionately expensive. Why is the same blood test that costs $700. in the US costing $40. in Canada?
    .

    • mapleleaflover

      Remember that hospitals in Canada are non-profit. Private, for-profit companies do out-of-hospital testing as well, but since the government pays the bills, the government basically sets the price. Same with drugs, where the government contracts with the pharma companies. “Bulk buying”, just like WalMart…
      And all of this “government interference”, as some Americans would call it, provides better health outcomes than the free-for-all profit enterprises in the U.S.

    • Isernia

      You know the answer – profits for the stock holders in Big Pharma vs. Canada’s national health system. It’s all about $$$$ in the US.

  • Scott B

    The one guest’s comparing drugs to computers & phone is way off base. It used to be a better computer cost you more, but now an upgrade to a computer or phone will cost you only a little more than what you paid for the price of the one that’s being traded up from. The laptop I’m using now is 4x the one it replaced and was 30% cheaper.

  • Karl

    If a drug costs $84K in the US, and $900, won’t a market quickly develop to benefit those in the US (i.e. either travel to Egypt, or simple smuggling)?

  • WBC_in_MA

    I noticed that most of the potential patients for the new Hep. C. drug are currently incarcerated. Do we, as a country, have an obligation to provide the latest and greatest medical care for prisoners, or are we obligated to provide the level of care considered acceptable at the time that the prisoner was incarcerated, or are we obligated to provide a level of care that will sustain them until their expected release date if possible, or is there some other standard????? We NEED to have this debate, difficult as it may be.

    • dawoada

      In addition to incarcerated people, many others have some personal involvement in catching Hep. C such as drug users and those with multiple sex partners. Should we be funding their recovery?

      • mapleleaflover

        Am I hearing a “death panel” argument here? What you’re suggesting is that some people “deserve” healthcare and life-saving treatment, and other do not. But then again, for a country where many states try to forbid abortion, yet have the death penalty, why should I be surprised…

        • WBC_in_MA

          So you would argue that those who obey the law but can’t possibly pay for their expensive healthcare shouldn’t get the healthcare, but those who break the law should get any healthcare currently available (latest and greatest). Limiting the cost of healthcare, and presumably its application, has always involved choices. I’m picking on the penal system, because it is completely supported by the state, and because it might be possible to be more direct with the concept of cost vs human life. Our society doesn’t want to admit that there is a connection between the two, but there is.

          • The poster formerly known as t

            The business of America is business. Businesses exist ton make a profit. Profit serves civilization. Profit, is surplus. Surplus distinguishes civilization from subsistence-based primitive societies where surpluses didn’t exist. Civilization doesn’t really care about people. It cares about laws, abstraction, specialization, and how those things help to keep surpluses around.

          • mapleleaflover

            Huh? I would never argue (and I didn’t) that access to healthcare should depend on one’s ability to pay, or denied to those who are incarcerated. My belief is that healthcare is a right, not a privilege, and it seems the U.S. is the only first world country that doesn’t agree. More’s the pity.

        • dawoada

          Yes, some people deserve things more than others.

          • mapleleaflover

            Ever heard the phrase “There but for the grace of God go I”? Think about it. How would you feel if you were wrongly accused and convicted of a crime and sent to prison for 25 years — or even sentenced to the death penalty and spent the the next 10 years on death row. Guess what, it happens. Now, would you prefer that life-saving drugs be withheld from you?

          • dawoada

            Ever heard of the phrase: “You’ve made your bed, now sleep in it”?

    • Michael Rogers

      With the large number incarcerated for non victim crimes there DO need to be remediation programs like those at California men’s colony CMC on the central coast.
      In that prisoners have a behavorial deficit–they behaved in a way that was considered undesired so do need to learn legal approches which they WON’T in a punitive institution. The intent SHOULD be to rehabilitate these people to return to the normal environment. To that extent, they will need to have their health maintained.

      • WBC_in_MA

        I’m certainly NOT advocating no healthcare, but there must be limits. If the decision is made that the government is OBLIGATED to provide the latest drugs for everyone incarcerated, then many states might have to drop support for public schools. At $80K/year/patient this drug breaks the bank. It’s time to make choices, and I really don’t want the courts to make these decisions. That’s why I opened up this discussion. What standards should we set? In my original post, I made a couple of possible suggestions. Perhaps, we should legislate a dollar maximum. Or perhaps, we should declare imminent domain for the patent on a very expensive block buster drug. HOW DO WE LIMIT THE COST OF HEALTHCARE? … Our society hasn’t been able to answer this questions, but we might begin with healthcare in our prison system.

  • Heather M

    I have fibromyalgia and am familiar with many people who live with tremendous pain everyday. Chronic pain is an epidemic in this country.

    Why is it ok to deny these patients a useful drug that will help them get off disability benefits and become productive members of society again simply because other might abuse it…How does that make sense?

  • DrTing

    Should Biotech & big pharma make medicines available to the poor, at minimal or no cost.

    Should scientists discover novel cheap medicines to prevent new infections by Hep C or by different viruses (or new viruses) (e.g. http://www.actoKine.com)?

    • Sy2502

      Are there any businesses that just give away their stuff for free? Why don’t you go to the nearest BMW dealer and ask them to give you a free car because you can’t afford one and see what answer you get.

      • The poster formerly known as t

        You’re starting to get it. Businesses don’t exist to serve society, Society exists to serve businesses. Businesses exist to “sell ice to eskimos”. No matter what the field is, the most profit comes from catering to those who don’t really need a product but could easily afford it.

        • Sy2502

          Actually I don’t think either is serving the other, they have mutual advantage from each other. Business provides job opportunity and products that people may want to buy, and therefore tax revenue. Everybody gets something out of it.

      • Susan Watson

        You can choose to buy a less expensive car that will still get you from point a to point b, but some drugs have monopoly on a cure.

        This is already not a normal capitalist market. In this case we usually empower the govt to manage the consumer side with a matching monopoly. e.g. When pilots are landing jumojets at O’Hare they don’t say “hmm I think I’ll try Mom and Pop’s airtraffic control today and see whether we crash or not… They offer better prices.”

        • Sy2502

          Considering the amount of work and money that goes in developing new drugs, I think it’s entirely appropriate for those who undertake this effort to patent their drug and make money from it. According to law, the patent expires after a certain time, which is how you then get generic medications.

          • Susan Watson

            True. Nobody wants to kill the goose that lays the golden egg. I haven’t noticed government contracts putting anybody out of business. That is the point of negotiation… Both sides need to be empowered. At the moment drug companies have 100% control. The alternative isn’t them having zero say in the price. There is a lot of room between 100% and zero percent.

          • Sy2502

            They have 100% control because they do 100% of the work.

          • Susan Watson

            I think an economy is more complex than that. There are many interdependencies. Companies also have an interest in forming a sustainable relationship with their clients. We pay 100% of the expense.

          • Sy2502

            How is it more complex? Everything we buy is made by somebody, that somebody sets the price, and we pay 100% of said price to buy it. Now, if you want we can discuss how the system of health insurances and Medicare encourages the pharmaceutical companies to set a higher price because they know it will be paid to them. But that’s a separate issue.

          • http://susan-watson.blogspot.ca/ West Coast Susan

            We do not actually automatically buy everything produced at 100% of the asking price. That is not how a market works. A market works when the consumer is free to accept or reject a price; free to walk away. Medical needs are not like that.

          • Sy2502

            We don’t buy everything at 100% of the asking price? Well, I guess sometimes you can negotiate, like in the case of a house or a car. But let me know in which supermarket you get to haggle with the cashier at the checkout.

          • http://susan-watson.blogspot.ca/ West Coast Susan

            You can choose to shop at a different store, to go without that product or buy a cheaper equivalent product. If enough people make that choice then excess unsold product goes on sale. (Let me know why you shop at a grocery store that never has sales.)There is, however, no alternative to some drugs. Monopolies are not subject to market forces.

          • Sy2502

            That’s because it’s so expensive to make them. If everybody could do it, you’d have a greater choice. But it’s expensive and very hard and it takes many years. If pharmaceutical companies didn’t have the certainty of recuperating their investment, and make profit, they’d have no incentive whatsoever to make new drugs.

          • http://susan-watson.blogspot.ca/ West Coast Susan

            pharmaceutical companies would make a profit. They would deal directly with the government which would in turn manage distribution and issues of social justice. That is a political decision and not the responsibility of a for-profit company, I agree. Neither of us has been arguing in favor of drug companies playing Santa.

          • Sy2502

            I think be both agree that it’s the system that is favoring over-inflated prices, but I understand we have different views on how this should be solved.

          • Isernia

            Don’t drug companies depend on research funding from the NIH which is a government agency whose revenue comes from us the taxpayers ?

          • Sy2502

            I don’t know, do you have reference for that?

          • Isernia

            http://pharma.about.com/od/Research-and-Development/a/Who-Funds-Biomedical-Research.htm Though the Federal grants have slowed in recent years (i.e. economic crisis ) we tax-payers fund much bio-medical research that is later used to develop, manufacture, advertise drugs that we buy often at exorbitant prices.

          • Sy2502

            I am not in favor of Federal money going to private business. If a business can’t stand on its own legs, it has no reason to exist.

  • Michael Rogers

    The Hep drug is ONLY another example of ‘how things work’ in this country, in other countries there is still the exemption of the tendency to charge every penny you can get for something you have that others want.
    Collector cars sell for multiple millions of dollars for those that can afford them but even in our neighbors Mexico and Canada insure that all receive medical care, as education.
    These illustrate the difference between the US and others!

  • Frank

    Dr Steve miller is trying to protect his own profits. He praises a drug for coming out that is 300 k a year for coming out at a parity price and slams one that is 84k for a one time cure that also came out at parity as mentioned in the broadcast the old treatments ranged from 60 – 110k and were not nearly as effective.

  • Zack Smith

    It never fails to amuse me when progressives complain about the outcome of the regulations they support – high priced drugs.

  • L Martinez

    If everybody were “Saved” from dying with “life saving drugs” then there would have to be another way to kill them. Perhaps let more dangerous criminals out of jail.

  • Regular_Listener

    I would never knowingly purchase anything from a company where the CEO takes home $100 million a year (notice I say “takes home” and not “earns”). Perhaps companies should be required to print the salaries of top execs on the labels of their products.

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