Its called “lack of price elasticty”. An economics term. Roughly put, price elasticity is the customers ability to refuse to purchase a product if the price is too high. In the case of a drug necessary for life, this ability does not exist. A consequence of this is that in a market, jacking up prices pays off more than underselling competitors until a significant number of customers have been priced out.
Its often believed to be one of the big reasons market-based healthcare end in market failure.
People with Diabetes 1 must be told, that because the old patents have expired, old fashioned insuline can be had for as little as $10 a month. Not so easy to use, but it keeps you alive.
The drug companies need a certain amount to finance development and production. The exorbitant rise in prices are caused by discounts demanded by the drug wholesalers in the US. I happen to know, that Danish Novo pays more than US$ 15 billion in discounts per year, and the wholesalers who control the sales to US hospitals and health insurance companies have become more and more greedy every year. Check Congress and diabetes.
I’m sure there are other issues for other drugs. For instance, as best as i can tell, the problem with the EpiPen boiled down to not many drug companies, and none that really wanted to make a cheaper version. I tried to talk a friend into just buying some epinephrine and a syringe (which, you know, people used to use.) but he was too squeamish and insurance was paying.
As far as point 2, insulin prices have been creeping up over the last 10-20 years. If anything production costs should go down due to advances in productivity and patents should be expiring. Both should drive prices down instead of up.
An easy cure for this issue is to make it legal and easy for Americans to buy insulin from overseas and have it shipped here. But obviously that is illegal.
Yeah, I’m sure you’re right. Epipens are another weird one. I’ve worked on these types of devices - fraught with problems. But that’s another story.
This FDA statement gives some clues as to what the issues are with Epipen generics.
I assume what they mean by this is that it’s difficult to replicate the performance of the device (first generic was 30 years after launch of originator). There’s a whole debate here about health economics - these devices are (believe it or not) low cost affairs powered by a spring. So try making a non-infringing, low-cost, spring-powered device that matches the performance of the original.
It appears that the other pens on the US market before 2018 were not generics. This might partially explain high cost - but then look at this:
Hmmm. I just took a look in an old BNF on the shelf here, and in the UK these devices have a unit cost price of about $40.
I observed upthread that you need a better health system. Actually, Kobal 2 put it much better:
Ouch. Vicious but fair.
Hijack over.
j
Aside: a single generic isn’t going to make the price plummet - that only happens when you have multiple competing generics.
Second Aside: the word “generic” is used throughout by the FDA - correctly, I assume, as epinephrine, though a “biological” molecule is actually a very simple structure.
I said “even” because while Europe, Japan or Israel might be construed by your average American as some far away, exotic places with weird alien customs and cultures altogether Other ; and the majority of Americans will probably go their entire lives without going there.
Canada on the other hand is right there ; many, many Americans regularly hop across the border ; and apart from a funny accent and a general propensity towards civility which may seem alien to your average southern neighbour y’all mostly share the same post-colonial culture ever since Nouvelle France stopped being a thing. Therefore it’s all the more puzzling that Canadians healthcare like this, while Americans healthcare more like this attempt to mime a nuclear trashcan fire.
Using a vial of drug and syringe requires a certain hand-eye coordination that just might not be there in an anaphylactic emergency. Having had that level of allergic reaction myself I am not at all convinced that I could physically manage that task, and with watering, swelling eyes it is entirely possible I could not see well enough to measure out the proper dose.
An epi-pen is a pre-measured dose in a delivery system that requires minimal hand-eye coordination or dexterity. It’s also designed to punch through things like clothing that might get in the way of dose delivery. It is also simple enough that an untrained bystander has a chance of delivering the proper dose properly. The housing for the device is also pretty sturdy and unlikely to break even while being hauled around by active teenagers and the like.
The last time I was in a life-threatening allergic reaction - Halloween night, 1995 - the nice EMT/paramedic used a vial and a syringe to give me the epinephrine, but he was a trained professional unlikely to panic in a life-or-death situation.
Even without an emergency, bad syringe design makes it very difficult to control the syringe with one hand. The manufacturers could correct this with a simple change… but they don’t.
It was for his kid. There are other people in the household. There are other people everywhere he goes. They could have gotten fewer epi-pens and some back-up syringes.
I dunno, when I was a kid, before epipens were invented, my father had a life-threatening bee allergy. And he showed me the three places where he had stashed syringes and bottles of epinephrine, and told me how to jab him with it if he had a reaction too bad to jab himself. It might be too hard to do it if you are struggling to breath, but it’s not very hard, and I think I could have done it with that 5 minutes of training.
(As an adult I briefly had a job where I injected mice with epinephrine. It was easy, even with uncooperative subjects.)
Fortunately, it never came up. Shortly after that he had desensitizing treatments for bee venom, and they worked.
The whole epi-pen price gouging story left me with a very bitter taste in my mouth re our health system in general and the pharmaceutical industry in particular.
That is a different situation than mine - I live alone and seldom have backup.
The last time I had a life-threatening allergic reaction I had projectile vomiting, explosive diarrhea, swelling pretty much everywhere that was both reducing my manual dexterity and seriously interfering with my vision, shaking, and I started to black out every time I sat up. All simultaneously. It was a bit more than just “struggling to breathe” although that was also a component - I dug some pretty impressive gouges in my own neck somewhere in there (definite feeling of strangulation going on) although at the time I was not aware of doing so. Jabbing an epi-pen into my own thigh under such circumstances would be a struggle and quite a physical feat although I’m pretty sure I could manage that much.
Would be nice to have a nearby family member with syringes and medication on hand just in case I can’t save my own life but alas, I’ve outlive most of my family at this point.
I don’t have a problem with filling a syringe and injecting someone (including myself - OK, maybe a tiny twinge) for the most part - but I just don’t think I could physically do it during an episode of severe anaphylaxis. It’s not a lack of training or willingness to do it, it’s a matter of being physically incapacitated.
Epi-pens also have the advantage that anyone could be coached into using one over, say, the phone. 1) grasp epo-pen pointed end away from you, 2) jab pointy bit into allergic person’s thigh muscle. Can’t get much simpler than that.
Except for the whole “this costs a shit-ton of money” complication.
Don’t know if Doc Mercotan could add to what I’ve described but maybe he could give a bit more input on how impairing it can be, and how much worse than what’s often depicted in the media (hell, half the time it’s treated as a joke).
Not all allergic reactions, not even all severe ones, are as bad as that but some are. It’s frightening as hell to watch it happen to someone else, it’s even worse to experience it (unless you’re unconscious and therefore not aware of anything). It’s the difference between TV/movie CPR and the real deal with bodily fluids oozing out and the sound of ribs breaking.
Oh, yeah, I had five years of desensitizing treatments and they did me a world of good. Unfortunately, the treatment is not perfect and not effective for all allergies.
Oh, epipens are great – if you can afford them. But when the maker jacked up the price (basically because they thought they could) I hoped the encourage people who could buy fewer to do so – to reduce the profits of gouging, and to encourage them to drop the price again.
Naw, with fewer units sold they use that as a justification to jack up the price on individual units because they will claim they aren’t reaping the price-savings of volume sales.
When setting up the price of a product there’s two basic ways to get as much total benefit: high volume at low price, or low volume at high price.
For luxury items, people will either not give a shit, pay the price or get a lookalike (which may even be legal, if it doesn’t look too alike). For items viewed as necessary such as medication, the instinct of people who aren’t pharma execs is “try to sell as much as possible”, because that means more people getting better; this improves both the lives of the patients and of those who care about them, and the economy of society as a whole. But for pharma execs there can be multiple benefits to going the low-volume route: among other things, it means you don’t need to have the facilities and the people to make and distribute as much as you can sell, something which depending on the process can mean shipping stuff to and fro between a lot of different factories*. So, price your stuff to sell as much as you’ve decided you wanna make: not more, because if you sell too much you need more machinery and more trained people.
One of my pharma clients had a process for a very common analgesic which used 20 steps in 20 different factories (including one that appeared in the list twice at different points) and every continent except for Anctartica. And I think they didn’t have a factory there because they couldn’t.
I still say that, while I do certainly admit to the “Hispanic” bit, if you’re a whore and you’re fucking you’re getting paid for the job you do, so what’s the stupid bit supposed to be?
As I mentioned above, in this case, it was a kid and there would be a parent around to administer the drug. I understand that injecting yourself with a syringe is not something you want to do when you are having a reaction.
This is actually one of the big picture issues that Canadian poli-sci types wonder about: why are Canadians more generally accepting of a stronger government presence than our southern cousins?
Without hijacking this thread, the general thought is that the US Revolt created not just one North American nation, but two, the US and Canada. As well, the inhabitants of the two countries self-sorted for ideologies: the southerners for suspicion of government, the northerners for reliance on government, particularly for domestic security. Those initial differences then got magnified by the settlement patterns, and also by immigration and political ties to the UK for the northerners.
OK, Nava, you got my attention. Twenty? This has to be the synthesis, right? And presumably done principally to apportion added value to favourable tax regimes? And I still can’t think of a common analgesic which could match the description.
And note that the $45 is not for revenue generation, it’s simply to discourage people from using the ambulance instead of a taxi for non-emergency trips to the hospital.