Posted on 08/17/2018 8:33:01 AM PDT by Kaslin
As the article and the comments note, there are various ways we can make the market for drugs more competitive, but the underlying problem of high development costs, and the patent system that is necessary to induce companies to bear them, will remain. What’s the alternative to the patent system? A nationalized pharmaceutical industry with government in charge of developing drugs? More Marxist rhetoric against drug companies is not going to help.
These “Big Pharma” threads never fail to smoke out the socialists on Free Republic.
I’ll go you one better.
“Free Enterprise” as we have known it (i.e. the Laissez-Faire Capitalism of Reaganomics and the Chicago School) is a political dead-letter for the foreseeable future.
Thanks to decades of stupid, short-sighted and destructive decisions on the part of business, the electorate decided they’d had enough, and in 2016 they voted it out and replaced it with POPULISM.
The new battle is between Trump’s brand of populism and Leftist Nutball Socialism, because the proponents of classic Milton Friedman free markets lost too much credibility with voters over those three decades.
It won’t be coming back anytime soon, as there are now simply not enough voters who support it.
The success rate for new drugs from the preclinical stage to commercialization is something like 1 in 25. It costs, on average, about $2 billion to bring a new drug to market and takes, on average, 13 years. Yeah, those US government bureaucrats are really giving those patents away.
You want drug companies to make tons of money from their massive R&D investments, but you don't want them to price their products at what the market will bear, so they can recoup their investment and make enough profit to drive more R&D? Sure you do.
You're all for free enterprise, and the protection of intellectual property, except when it comes to Big (BAD) Pharma. Government couldn't be the problem here, it has to be those greedy SOB's in the drug industry. Got it.
That is one of the liabilities of socialized medicine. Government will not, actually cannot, pay those prices for medicine and decree that the prices must be at generic level from the initial sale. Once the whole world goes to socialized medicine (that is, once the USA does) there will be no more new drugs.Some liberals know this and rationalize it by thinking we are advanced enough as we are already far ahead medically of any time in the past. What they don't seem to think of is antibiotics. They have to be continually replaced as the bugs get immune to the old ones. Once we "socialize" we will be on the path to medicine as it was a century ago i.e. you get sick you die. It won't happen suddenly but the existing antibiotics will fade, not just quit. and there will be no outcry until it is too late to resurrect R&D.
What would be the cost to your friend for the drug therapies available before the drug companies cured Hep C?
What was the prognosis for those afflicted with Hep C before Harvoni and Sovaldi? Did you ever see someone suffering through Interferon treatments or waiting and hoping for a liver transplant? Ever see someone recovering from a transplant and dealing with anti-rejection drugs?
But you're complaining about $1,000 for a pill that cures it? What a bunch of crap.
I was simply repeating what he told me - not complaining at all. So lighten up a little, huh?
The drug companies hold drug patents which provide for federal monopoly protection.
The drug companies can charge really high prices because US insurers are required by law to pay for medically necessary drugs pretty much regardless of price.
States are absolutely required to pay for Medicaid drugs regardless of price.
This legal scheme creates a ladder of ever escalating drug prices.
My health care payment reform plan:
1. a Federal Drug Marketplace to allow vendors to easily offer drugs and implantable devices at affordable, income-based prices
2. insurer offered (drug company negotiable) percentage of drug coverage premium drug plans
3. Medicare Part D based drug plans
4. grandfathered PPACA plans would get somewhat higher drug coverage subsidies for two years
Please.
With any medicine, a simple cost/benefit calculation will provide a great deal of insight. Now you know.
My health care cost coverage plan (not currently online) respects drug maker intellectual property, but gives drug coverage plan builders the ability to set fixed formularies based on market force principles.
My health care cost coverage plan would give drug coverage plan builders the option to offer Medicare Part D plan copies (including the plan ability to mix/match from different Part D plans) and fixed formulary plans that offer shares of drug coverage premiums to participating drug makers for all-the doctors prescribe drug coverage, no appeals necessary or allowed. Drug makers would chose to participate, or not participate.
Consumer default co-pays would be comparable to existing co-pays, with the ability of plans/drug makers to negotiate different co-pays.
My health care cost coverage plan also would create an income-based Federal Drug Marketplace for drug makers to offer drugs to consumers at income-based discounts if a patient needs a drug not in their fixed formulary drug coverage plan. Drug maker participation would be voluntary.
My health care cost coverage plan allows for both care and drug subsidies so consumers could select an national drug plan and an in-state care plan.
Glad I could help with information you didn’t know. Maybe, in the future, it will prevent you from throwing shade on the companies that end up saving your life. Like your friend.
FEDERAL DRUG MARKETPLACE
[The Federal Drug Marketplace would be run by HHS with FDA help.]
[Drugs on offer via the Federal Drug Marketplace would be generally affordable to consumers and makers of premium drugs would get paid pretty much what the “market” buyers could afford to pay.]
[The Federal Drug Marketplace would be]
[a. an exchange website drop-down financial payment calculator using postal service and federal tax system data ]
[b. provide a 6-digit alphanumeric code to registered exchange users.
[c. provide federal tax system data for the registered exchange user to an exchange registered ]
[ drug maker patient assistant program website that provided patient data and the code to the exchange website. ]
[The actual discounts would be provided voluntarily by drug maker participants.]
[Payment would be taken at drug maker websites or at dispensing pharmacies.]
[Depending on individual drug maker policy, drugs would:]
[1. be sent to your doctor]
[2. picked up at a pharmacy after showing your prescription and payment page (and that page has been confirmed by the pharmacist)]
[3. paid for and picked up at a pharmacy using your prescription and a special discount code]
An FDA registered US drug maker may list their FDA-approved drug on the Federal Drug Marketplace as the Secretary of HHS shall specify.
If the drug is:
a. an FDA-designated breakthrough and “orphan” drug, or
b. a recombinant drug, or
c. an anti-neoplastic drug adding at least 60 days of life expectancy against cancer.
the drug may be offered on the Federal Drug Marketplace with a patient daily treatment cost of $2 plus one of the following:
e. $0, if the patient is in an Obamaphone qualifier program or is an Obamaphone subscriber (or officially their child or ward) [Betty Babymaker: total $2/day -> $720/year], or
f. the higher of:
I. (a drug supplier-set multiple less than 1)*(the patient’s lastest IRS processed federal income tax 1040/1040A/1040EZ return “Tax”)/(100*(number of filers))
II. (a drug supplier-set multiple less than 1)*(2*FICA + self-employment tax payments going back three years)/1,000
III. if the patient lives in a house, $8
IV. if the patient lives in another type of housing, $6
A house shall be considered to be a detached dwelling or an attached housing unit with no housing unit above or below.
The system shall assume that any zip+4 address with a unique numeric part of a street address is a house.
[Mr. & Mrs. Big Bucks: $10,000 annual federal income tax, .8, two filers~ = $52/day of treatment activity -> ~$18,980/year]
[Mr. Joe Six-Pack: $30,000/year income, .8, ~$14,000 3-year total 2*FICA&SE tax ~= $14/day of treatment activity -> ~$4,000/year]
[Mr. Robert Retired Houseowner: total $10/day -> $3,650/year]
[Bob Burgerflipper: total $8/day -> $2,920/year]
[Remember, that might be $2,920/year for a drug an employer might now pay $10,000/year for.]
[If an apartment dweller flips burgers for $17,000/year pre-tax, that $2,920/year may seem steep.]
[A patient quoted $18,980/year might pay $10,000/year locally or fly off to Canada or Europe.]
[Yes, market-like pricing can be unpleasant, but market pricing actually is the natural order of things without government meddling.]
[Limiting the number of drugs that may be sold at high pricing via a federal government portal is meant to prevent ignorant consumers from overpaying for drugs.]
[As you well know, there are lots of really stupid people in the USA.]
[People can still go to a corner drug store and overpay for drugs.]
For insulin and other recombinant drugs, the federal government shall pay a 100% match on Obamaphone price purchases.
Any other drug (product) may be offered via the Federal Drug Marketplace for no more than
(a drug supplier-set multiple less than 4)*
($1 plus,
30 cents per molecular ring in any key drug, up to 4 total per USP class, plus,
10 cents for each known atom in a drug molecule other than of carbon or hydrogen, up to 10 total per USP class)*
(’normally attainable annual income estimate’/$30,000)
per day of treatment level activity
Drug makers may insist on:
a. a $20 per order minimum
b. delivery to a doctor in the US
Implantable medical devices may also be vended via in the Federal Drug Marketplace at or below 200-day pricing, with a supplier-set multiple less than .4 for any electronic-driven device and less than .2 for any mechanical-only device.
Listing would be until the start of the second year after listing.
DRUG COVERAGE PLANS
[Part 1 of 2]
The Commissioner of the FDA shall around June of each year draw up and publish a list of no more than 100 drugs and drug categories.
Any ‘insurer’ offering a drug plan via the federal exchange may notify the Secretary of HHS in writing of its coverage of those in a manner the Secretary of HHS shall specify.
The federal exchange may provide drug coverage information on drugs by offered plan as the Secretary of HHS may specify.
Federally recommended subsidized drug coverage co-pays shall be as follows:
a. generic chemical $4/30-day supply, $10 90-day/course supply
b. patented chemical, other in USP class $20/30-day supply, $50 90-day/course supply
c. patented chemical, no other in USP class $50/30-day supply, $100 90-day/course supply
d. large volume (>=$200 million in penultimate year US sales) recombinant, other in USP class $10/vial
e. small volume recombinant, other in USP class $20/vial
f. large volume (>=$200 million in penultimate year annual US sales) recombinant, no other in USP class $20/vial
g. small volume recombinant, no other in USP class $50/vial
A lower co-pay may be set by the plan sponsor.
A drug supplier may ask for a higher co-pay and the plan sponsor may accept that.
[Recombinant drugs will often have higher co-pays since they are expensive to manufacture.]
On recombinant drugs and drugs covered under Medicare Part B, the federal government would match states 50/50 up to $2/day of drug patient treatment level activity for Medicaid (plan) covered persons.
[The federal match is capped at $2/day so co-pays for the middle class plan purchasers won’t commonly be set at unaffordable amounts.]
On recommended co-pay drugs coverable under Medicare Part D, the federal government would match states 50/50 so Medicaid (plan) covered persons could generally have a co-pay of the next smallest dollar amount, i.e. $10->$4.
Each state may cap its co-pay assistance under its statutory law.
The FDA-approved drug maker/US sales rights holder and pharmacy could set a lower co-pay.
To be federal subsidy eligible, all the drug purchase contracts of a non-PPACA plan must be on an all-the-doctors prescribe basis, subject to drug supplier prior authorization when their drug is in short supply.
[A $150/hour doctor shouldn’t waste an hour of time begging for one authorization from a $10/hour phone rep.]
DRUG COVERAGE PLANS
[Part 2 of 2]
To be federal subsidy eligible, a non-PPACA drug plan must be built by one of the following methods:
MEDICARE PART D PLAN COPY
A plan formulary must include the same drugs as a plan sponsor’s Medicare Part D plan, locked into the plan formulary for the entire policy term.
MEDICARE PART D PLAN SOURCED PLAN
Each USP class in the plan formulary must include the drugs of one or more then current Medicare Part D formularies, locked into the plan formulary for the entire policy term.
[This allows upstarts to easily create plans picking coverage from among existing Medicare Part D ‘insurers’.]
PLAN OFFER/DRUG MAKER ACCEPTANCE PLAN
1. The plan sponsor must decide on a drug-only plan drug_age_factor dollar multiplier between $5 and $9
[If a dollar multiplier of $8 is chosen, a 64-year old would have a drug-only premium of $168.80/month (i.e. $8*21.1/month).]
2. The plan sponsor must then draw up a proposed list of drugs and their apparent drug makers and list the percentage of premiums that will go to the maker of each drug for an all-the-doctors prescribe supply with the recommended drug co-pay above, or a drug plan set lower co-pay amount.
3. The initial acceptance period must be open for at least 14 days.
4. If accepted, the drugs will be locked into the plan formulary for the entire term of the plan (and its policies).
5. The plan sponsor must then draw up another list of drugs and their apparent drug makers and list the percentage of premiums that will go to the maker each drug for an all-the-doctors prescribe supply with the recommended drug co-pay above, or a drug plan set lower co-pay amount.
6. The subsequent round acceptance period must be open for at least 14 days.
7. If accepted, the subsequent round drugs will be locked into the plan formulary for the entire term of the plan (and its policies).
8. Steps 5 through 7 may be repeated as often as desired by the plan sponsor, as may be possible
9. The premium amounts would be reduced by the total percentage unallocated and the participating drug maker percentages raised to equal 100%.
[If a dollar multiplier of $8 was chosen and 4% of possible premiums remained unallocated, a 64-year old would have a drug-only premium of $162.05/month.]
Plan sponsors may set percentages to be split between two or more drugs based on their prescription volume (and other plan sponsor rules) and subject to acceptance by more than one drug maker.
No federal subsidy for a drug maker acceptance plan shall be issued for a person unless:
a. the plan was purchased by a care plan on the person’s behalf, or
b. the person’s doctor/physician assistant/nurse practitioner or an RN employed by the person’s state approved enrollment, in the manner the Secretary of HHS shall specify.
[Coverage under a drug maker acceptance plan might be far less than of a Medicare Part D type plan.]
[There would be no appeals or ‘insurer’ prior authorizations under these bulk purchasing plans. All ‘insurer’ premium money would already be fully allocated.]
[Some drug makers may require prior authorizations if their drug is in short supply.]
[A patient in need of a drug not in their plan might go to CVS, Walgreens, the Federal Drug Marketplace or directly to a drug maker patient assistance website/phone line.]
Drug plans may offer locked-in access to [Part B cancer] drugs with percentage discounts earned by monthly premium payment off Federal Drug Marketplace level pricing, at the patient’s lowest contracted drug supplier-set multiplier, good for eight years from the start of the premium month.
Drugs in FDA Phase III trials may be included in monthly percentage discount programs, using up to 10% of the plan premiums.
[This is to allow drug developers to get income for a drug in development and for plan buyers to buy potential discounts for drugs in development.]
[If a plan buyer bought 24 months of 2% discounts and 12 months of 1.5% discounts, a $4,000/year Federal Drug Marketplace level priced drug would only cost the plan buyer $1,360/year upon FDA approval.]
Drug makers shall track all their monthly percentage discounts by the name of the covered person (and the taxpayer ID) associated with the policy.
[For example: If you had sixty premium months of 1% discounts and your drug would normally cost you $14/day, you would pay $5.60/day for the drug.]
Plan sponsors to pay for drugs and drug discounts within 60 days of premium receipt or as otherwise agreed to.
Drug-only plan sponsors must spend all their drug plan premium money on drugs and drug percentage discounts for covered persons (or pay a federal loss ratio tax).
Drug-only plan sponsors may annually charge each covered person a fully-earned overhead/profit fee of not more than $25.
Non-PPACA drug plans vended via the exchange shall be subject to (extraordinary) mandatory issue.
To be federal subsidy eligible, drug-only drug maker acceptance plans costing at least $5.40 times the person’s drug_age_factor must include some drugs of each of the following types:
FDA-designated breakthrough, orphan, recombinant and anti-neoplastic adding at least 60 days of life expectancy against cancer.
Co-pays must be less than:
a. 50% of Federal Drug Marketplace levels on those drugs for Obamaphone household-covered persons on such plans costing at least $5.40 times their drug_age_factor
b. 40% of Federal Drug Marketplace levels on those drugs for FICA&SE tax price/Obamaphone household-covered persons on such plans costing at least $6.30 times their drug_age_factor
c. 30% of Federal Drug Marketplace levels on those drugs for FICA&SE tax price-covered persons on such plans costing at least $7.20 times their drug_age_factor
d. 20% of Federal Drug Marketplace levels on those drugs for FICA&SE tax price-covered persons on such plans costing at least $8.10 times their drug_age_factor
e. 50% of Federal Drug Marketplace levels on those drugs for income tax price-covered persons on such plans costing at least $8.10 times their drug_age_factor
for the plans to be federal subsidy eligible.
[That’s to help lower-income people and to encourage people to buy more expensive plans.]
[Since $5 multiplier plans may be independently built, the two provisions above can’t cause total drug plan subsidy lockout.]
PPACA-CLASS “GRANDFATHERED” PLAN DRUG COVERAGE
PPACA-class “grandfathered” plans shall be subject to PPACA drug coverage scope, appeal and prior authorization regulations.
The federal PPACA-class monthly drug coverage subsidy amount shall be 20% more than the federal monthly drug coverage subsidy base amount for two calendar years.
[PPACA “grandfathered” plans would generally cover all needed prescription drugs.]
It’s good you can admit your faults, but to overcome them successfully will require extensive therapy. Let me know how it goes. On second thought, don’t - because I’m not interested.
Generic Viagra is $10/pill. get the 100mg strength and cut it in half and you're down to $5/pill for the getaways.
“A friend just went through the 12 week cure for Hepatitis C - cost per pill? $1000.“
Oddly enough, that treatment might be priced fairly. Cheaper than a new liver and better than being dead from rampant cancer. Now if they would put a works or your money back guarantee on it, I’d have no problem with the pricing. And it actually CURES something.
Ive seen medicines that are 100k/yr and don’t even pretend to cure anything, they MIGHT keep you alive a while longer.
It’s the FDA that is the real culprit. They prevent generic competition. Corrupt to the core.
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