That essentially means it's literally 10x cheaper to take a two-way ticket to France, have a doctor prescribe it there, buy 3 months worth of treatment and come back to the US.
I wonder how Americans can tolerate this situation.
> I wonder how Americans can tolerate this situation.
Several reasons this terrible system continues to exist but it essentially boils down to entrenchment.
- The private healthcare industry pays politicians to maintain the status quo. The alternative government run solution does not.
- The private healthcare industry creates propaganda and pays the media to spread it. An improved government run solution does not.
- Many Americans have decent coverage from their employer. For them, it’s not worth upending the system for what might be moderate gains. More over, propaganda has made them expect worse coverage from any alternatives.
- ACA gave many without employer coverage a good enough solution. It’s still expensive as fuck but it subdued enough voters.
So, after considering voters who are happy enough with the devil they know, you don’t have enough votes left to overturn the system.
> Many Americans have decent coverage from their employer. For them, it’s not worth upending the system for what might be moderate gains.
Negative gains I may say. In my experience of the Canadian healthcare and US healthcare systems, the latter, IF you are well insured, feels like a Rolls-Royce whIle the former is like driving a Lada in Pothole City.
I remember the first time I called my provider in the US to book an appointment with a dermatologist. She said "Wednesday", I said "What month?" I couldn't believe it was that same week. I used to wait 2-3 months in Canada. And I had to first get a reference from a ER/generalist doctor.
Also don't forget the US spends on medicare/medicaid/VA about the same % Canada spends on healthcare.
It's also worth bearing in mind that the socialized healthcare system the US does have - the VA - does not have a uniformly good track record. This does a poor job of making the case for a larger socialized system all on its own.
I've also been thinking, the population segment in the US most likely to have medical expenses and thus see a problem in the system to be fixed are the older generations. But, these generations are on Medicare and Medicaid and thus don't see the same problem as those with expenses who are younger. This is also a large portion of the population that, "doesn't want socialized medical care". So, they in effect, have socialized medical care and it's benefits but don't want anyone else to have it. Is this kind of accurate or am I being too cynical?
Isn’t the biggest problem in the US health insurers operating on state level only? This is due to some regulation preventing formation of federal insurers.
I never understood why there are no independent national health insurers (read Allianz for example) providing health care for self employed people like in Europe.
The #1 reason we have these crazy expensive drugs is because of our patent system. Ideas are worthless, execution is everything. The free market cannot function when monopolies are arbitrarily granted. End the patent system, and you will end Big Pharma. And we will have more innovation.
One other possibly related point is "free healthcare" (as well as free tuition) are "perks" of enlisting in the military. Take away those and I wonder what the recruitment rate would look like.
As well, employers maintain the status quo because an employee who is literally terrified of losing health care is less likely to even consider quitting.
> More over, propaganda has made them expect worse coverage from any alternatives.
Is it propoganda or lived experience? Everytime someone has come around saying they're going to fix my health insurance for me, it's ended up costing me more for the same service as before.
Come to think of it, I've yet to have an increase in positive experiences concerning my health insurance. Every doctor's visit feels like a new surprise lurking in the dark.
We recently moved to Michigan and a factor in doing so was being near the Canadian border for pharmacies. The University of Michigan's health website even talks about this as a possible strategy. This shouldn't happen in a civilized country.
> That essentially means it's literally 10x cheaper to take a two-way ticket to France, have a doctor prescribe it there, buy 3 months worth of treatment and come back to the US. I wonder how Americans can tolerate this situation.
I believe that this may be what pushes the American system to change.
I know of several not-rich people, sometimes who have decent or good insurance, who have chosen to go abroad for medical care. The care they get abroad is typically cheaper as well as better.
Given the amount of money the US spends on healthcare, this should rarely be true.
The insurance companies have set up a good gig for themselves, but I think that they may be feeding at the trough a bit too aggressively. When the economy has a big downturn, I think some hard questions will be asked.
A quick google has found pharmacies in the UK selling it privately, unsubsidised, for around $40 for a pack of 10. Much more expensive than the quoted price for France, but certainly nowhere near the current US list price.
Study after study has shown that we pay more for medical care + taxes than other countries. As it stands, the excess gets syphoned off to feed the medical industrial complex.
Here in Canada, we have a half dozen competing generic drug manufacturers. They're not subsidized. My province has a public drug insurer that covers the elderly and very poor. It negotiates a common price as a large insurer tends to do. It's public information. It represents roughly the market cost in bulk to purchase these drugs from for-profit companies in Canada.
The US government spends more on health care per capita than the French people and government. The problem is graft, not cost shifting - and it's a lot easier to see when you look at the numbers by % of GDP.
If I was uninsured in the US for whatever reason and needed elective surgery for something with a short enough recovery period, I'd look up UK hospitals.
They're often similarly cheap enough to justify a flight and a hotel stay. Especially as many of them leverage excess capacity at NHS Trusts (some are even operated by NHS Trusts, as the trusts are allowed to offer private services within certain constraints)
FDA production approval for a drug is expensive. If a competitor pays and gets a new line approved, the prize is zero, because of competition from the other line. If no competitor pays the prize is almost unlimited, because of no competition.
The government or a charity should fund another line, and should in general provide incentives to companies to not shut down existing approved lines if it would leave only one company standing.
I don't know if there are laws preventing someone from being physically in france while practicing telemedicine in the US, but surely they'd have to be licenses to practice in the US (which the vast majority of french practitioners won't be).
While I realize that this particular drug is just an example, we could run some numbers here. The current owner of the drug made $27M in sales this year in the US. At $10k per 30 day supply, that implies that there are at most 2700 people in the US who use this drug (if all of them used it only once per year). If this is a drug that most of its users take all year, then we're now talking about a drug that is taken by very few people every year. The $5 French price point wouldn't be worthwhile for any US based pharma company to take on. This isn't a defense of anyone's pricing model, but I could see very easily why pricing models for very rarely prescribed drugs would naturally start to shoot through the roof in the US. Why is it tolerated? Most people don't feel like they are impacted by it.
Or make a quick short trip to Tijuana with a cheap flight, buy the medicine for $4 dollars (for 15 suppositories) [1] without any prescription and go back to your home within the same day.
This article, and discussion here, seem to both assume people pay the list price. In reality, is that the case very often, especially with this kind of drug?
> Indocin's list price (what uninsured patients would pay) was $198 for 30 suppositories in 2008.
I would not be surprised if they've hiked the list price a ton to game the insurance "what we'll pay" formulas and get more money from insurance companies. As trimbo notes [0], if everyone is paying list price then only 225 people are using this drug consistently. That seems unlikely.
Another interpretation: the biggest beneficiaries of high list prices are the insurance companies. After all, they don't pay that price, and the higher the non-insured price, the more attractive it is to buy health insurance.
So perhaps the drug companies are just responding to demand from their biggest customers.
Shouldn't this be illegal / isn't this already illegal?
Two companies reaching an agreement to supply products at reduced price, but not making the terms of that agreement available to a third entity (uninsured customers)?
> I would not be surprised if they've hiked the list price a ton to game the insurance
Seems to be standard business. ONE of my prescriptions for rheumatoid arthritis costs roughly $5000/month without insurance. My insurance, plus additional assistance from the drug maker makes the medication "free" for me. It's clearly a giant, legal insurance scam.
It's almost definitely an insurance scalping strategy, and the number of people needing this drug via this delivery route may actually be that small (or close to it). When companies do this, they usually just hand it out to uninsured patients for cheap or free, not out of the goodness of their hearts but because they want to try and reduce bad PR. The whole Martin Shkreli debacle was incredibly similar, and in the same way that people couldn't seem to talk rationally about the real problem there (high pricing encouraging more high pricing just because insurance will pay for it), the average discussion about this case of pharmaceutical scalping will completely miss the point, too.
It would have been more helpful to pull sales as well.
Indomethicin is an old drug without much use and then narrow it down to suppositories it’s an even smaller market. Plus there are a dozen plus alternatives you could use.
Think of like producing a microprocessor design from 1970 where alternatives exist. Super niche. Demand is maybe 100 units per year. What would you charge?
That doesn't explain why it's available cheaply in other countries, even privately.
E.g. in the UK a quick check shows me I can buy a pack privately online for $40.
(UK online pharmacies can sell a number of prescription-only drugs privately if they have a doctor carry out an online consultation, which means you basically fill in a form and a doctor will look at your answers and provide a prescription as part of the sales process, or you can send them a prescription you already have).
Here’s another way of looking at it: if you need to use this obscure medicine rather than the alternatives because your condition is comparatively rarer, is it just that you should have to pay through the nose for it?
Take it to the extreme: you have a very, very rare life-threatening illness. Since only 20 or so people a year are diagnosed with this, the drugs to treat it would have to cost 1.5MM just to be decently profitable.
Is that a just healthcare system? A kind of inverted lottery in which the “luckier” you are the more likely to go bankrupt.
One might reasonably conclude that trying to run the entirety of the healthcare system as a capitalist enterprise is perverse and trades the misery of the many for the profit of a few. In such cases, we should rightly consider all possible alternatives.
>Since only 20 or so people a year are diagnosed with this, the drugs to treat it would have to cost 1.5MM just to be decently profitable... Is that a just healthcare system?
If it cost 1 trillion to add a year to the life of just one person, should society pay it, even if that trillion is then not able to be used for lots of other societal needs?
Arguing for policy while ignoring opportunity costs leads to more human suffering than would otherwise result.
1 main point to this: true "insurance" could reasonably cover edge cases, including frankly some insurance covered by the state. The US "insurance" market is not really that, it's a price negotiator/health care provider/strange thing that honestly doesn't resemble any other "insurance" product. Even though we use some terms that resemble capitalism, health care is in no way a capitalist market. It's a different beast.
> Demand is maybe 100 units per year. What would you charge?
Perhaps capitalism is not the best strategy to apply to healthcare. Folks in need of healthcare will always be a minority - a niche market - after all. The most prolific diseases typically only have 3-6M cases at any given time in the US.
Should a person go destitute to pay for their care, just so some company's supply/demand curve is properly fitted?
So you’re saying someone who is producing a niche product a minimal units should be forced to charge a low price? Regardless what their cost of goods is?
Just to be clear, the American health care system is in no way "capitalist". It just has some of the trappings of capitalism.
(There are so many examples of this, including for this case that Medicare/Medicaid are government programs where they pay whatever the drug companies ask.)
Does anyone know about this drug? The generic pill is $10, not sure why the suppository would be $10k. I'm guessing some journalist found some drug that few people use.
Is this one of those things where they have to give it a crazy list price due to insurance regulations but no one actually pays that price? Goodrx has it for less than $10
>Same thing with Martin Shkreli's price hikes, and he gave out those drugs for free to those who needed it.
This appears to suggest that there are people who take enormously expensive theraputic drugs who don't need them, and that Martin Shkreli gave away those enormously expensive therapeutic drugs away to those who actually did.
Whether propoganda, misinformation, or a bald-faced lie, that's not what happened. That never happens, and never will. Shame on you for implying that was the case.
Here's the tale: If you have obstruction of your bile ducts below the liver or gallbladder, usually gallstones or sometimes neoplasm, you need an endoscopic retrograde cholangiopancreatography (ERCP) for extraction or sampling.
ERCP is sticking a tube down the throat, stomach, small intestines into a tiny opening at the ampulla of Vater to access the bile ducts. Sometimes this process causes inflammation of the ampulla and associated ducts leading to blockage, and can lead to pancreatitis due to back flow and pressure, because the pancreas also excretes its digestive enzymes via the ampulla).
A few trials circa 2015 showed rectal indomethacin reduced the risk of post-ERCP pancreatitis, and eventually it made its way into the guidelines. It is the only proven preventative treatment, so they have a natural monopoly.
My meaning was that there is no other therapeutic agent available for prevention of post-ERCP pancreatitis. But you're quite right, there must be another reason.
If I had to hazard a guess, it may be the market isn't attractive enough for competitors to establish a national supply chain. Or there's some sort of collusion at play.
To me this represents further evidence why public goods should be left out of the hands of private for profit organizations for whom disease is simply an externality to capitalize on.
Two quick comments: trying to take generic drugs and lock up their rights to jack prices relies on a govt giving the locked rights. Otherwise somebody else can just make it. There’s little profit in generic drugs, so production can be spotty.
For those comparing vs the us health system, include (a) working f/t with good employer benefits, (b) f/t with less benefits and (c) working part time. And remember to include cobra. And include the state/province/country where the comparison is being done. No absolutes here, either.
The generic version is not available as a suppository. The suppository with a Buzzrx coupon is just shy of $5000 for 14 suppositories, which is about the same as the $10k for 30 suppositories given in the article.
Readit News
That essentially means it's literally 10x cheaper to take a two-way ticket to France, have a doctor prescribe it there, buy 3 months worth of treatment and come back to the US.
I wonder how Americans can tolerate this situation.
Several reasons this terrible system continues to exist but it essentially boils down to entrenchment.
- The private healthcare industry pays politicians to maintain the status quo. The alternative government run solution does not.
- The private healthcare industry creates propaganda and pays the media to spread it. An improved government run solution does not.
- Many Americans have decent coverage from their employer. For them, it’s not worth upending the system for what might be moderate gains. More over, propaganda has made them expect worse coverage from any alternatives.
- ACA gave many without employer coverage a good enough solution. It’s still expensive as fuck but it subdued enough voters.
So, after considering voters who are happy enough with the devil they know, you don’t have enough votes left to overturn the system.
Negative gains I may say. In my experience of the Canadian healthcare and US healthcare systems, the latter, IF you are well insured, feels like a Rolls-Royce whIle the former is like driving a Lada in Pothole City.
I remember the first time I called my provider in the US to book an appointment with a dermatologist. She said "Wednesday", I said "What month?" I couldn't believe it was that same week. I used to wait 2-3 months in Canada. And I had to first get a reference from a ER/generalist doctor.
Also don't forget the US spends on medicare/medicaid/VA about the same % Canada spends on healthcare.
Which is to say it's not just propaganda.
I never understood why there are no independent national health insurers (read Allianz for example) providing health care for self employed people like in Europe.
Edit: A classic by John Mackey (Whole Foods Inc.) but still valid: https://www.wsj.com/articles/SB10001424052970204251404574342...
Quote: „Repeal government mandates regarding what insurance companies must cover.“
Is it propoganda or lived experience? Everytime someone has come around saying they're going to fix my health insurance for me, it's ended up costing me more for the same service as before.
Come to think of it, I've yet to have an increase in positive experiences concerning my health insurance. Every doctor's visit feels like a new surprise lurking in the dark.
https://www.uofmhealth.org/health-library/te7832
I believe that this may be what pushes the American system to change.
I know of several not-rich people, sometimes who have decent or good insurance, who have chosen to go abroad for medical care. The care they get abroad is typically cheaper as well as better.
Given the amount of money the US spends on healthcare, this should rarely be true.
The insurance companies have set up a good gig for themselves, but I think that they may be feeding at the trough a bit too aggressively. When the economy has a big downturn, I think some hard questions will be asked.
If so, the cost of medicine is just borne elsewhere: the average tax wedge is 38% in France vs 18% in the USA for a married couple with 2 children:
https://www.oecd.org/tax/tax-policy/taxing-wages-france.pdf
Sales tax is also 20% vs less than 10% in all US states.
https://www.formulary.health.gov.on.ca/formulary/results.xht...
Indomethacin can be bought from four different companies at $C0.12 per tablet.
But even taking that into account, the US still pays more:
https://www.rand.org/news/press/2021/01/28.html
If I was uninsured in the US for whatever reason and needed elective surgery for something with a short enough recovery period, I'd look up UK hospitals.
They're often similarly cheap enough to justify a flight and a hotel stay. Especially as many of them leverage excess capacity at NHS Trusts (some are even operated by NHS Trusts, as the trusts are allowed to offer private services within certain constraints)
The government or a charity should fund another line, and should in general provide incentives to companies to not shut down existing approved lines if it would leave only one company standing.
[1] https://www.fahorro.com/indometacina-100-mg-15-supsension.ht...
Deleted Comment
Dead Comment
> Indocin's list price (what uninsured patients would pay) was $198 for 30 suppositories in 2008.
I would not be surprised if they've hiked the list price a ton to game the insurance "what we'll pay" formulas and get more money from insurance companies. As trimbo notes [0], if everyone is paying list price then only 225 people are using this drug consistently. That seems unlikely.
[0]: https://news.ycombinator.com/item?id=28905920
So perhaps the drug companies are just responding to demand from their biggest customers.
Two companies reaching an agreement to supply products at reduced price, but not making the terms of that agreement available to a third entity (uninsured customers)?
Seems to be standard business. ONE of my prescriptions for rheumatoid arthritis costs roughly $5000/month without insurance. My insurance, plus additional assistance from the drug maker makes the medication "free" for me. It's clearly a giant, legal insurance scam.
Indomethicin is an old drug without much use and then narrow it down to suppositories it’s an even smaller market. Plus there are a dozen plus alternatives you could use.
Think of like producing a microprocessor design from 1970 where alternatives exist. Super niche. Demand is maybe 100 units per year. What would you charge?
E.g. in the UK a quick check shows me I can buy a pack privately online for $40.
(UK online pharmacies can sell a number of prescription-only drugs privately if they have a doctor carry out an online consultation, which means you basically fill in a form and a doctor will look at your answers and provide a prescription as part of the sales process, or you can send them a prescription you already have).
Take it to the extreme: you have a very, very rare life-threatening illness. Since only 20 or so people a year are diagnosed with this, the drugs to treat it would have to cost 1.5MM just to be decently profitable.
Is that a just healthcare system? A kind of inverted lottery in which the “luckier” you are the more likely to go bankrupt.
One might reasonably conclude that trying to run the entirety of the healthcare system as a capitalist enterprise is perverse and trades the misery of the many for the profit of a few. In such cases, we should rightly consider all possible alternatives.
If it cost 1 trillion to add a year to the life of just one person, should society pay it, even if that trillion is then not able to be used for lots of other societal needs?
Arguing for policy while ignoring opportunity costs leads to more human suffering than would otherwise result.
Instead people view health “insurance” as a healthcare plan. Which is not how the us system was designed.
For those with health insurance the idea would be it cover the 10k+ per pill cost for your rare disorder.
Costs are typically socialized by the federal government.
For that you have regulatory upkeep, cost of manufacturing, and legal liability.
It seems pretty clear why several of the past owners of the brand have gone bankrupts or sold off the product line.
https://s28.q4cdn.com/742207512/files/doc_presentations/2021...
Perhaps capitalism is not the best strategy to apply to healthcare. Folks in need of healthcare will always be a minority - a niche market - after all. The most prolific diseases typically only have 3-6M cases at any given time in the US.
Should a person go destitute to pay for their care, just so some company's supply/demand curve is properly fitted?
(There are so many examples of this, including for this case that Medicare/Medicaid are government programs where they pay whatever the drug companies ask.)
I don't know the market, but it appears that it may be patented until 2030 (https://www.pharmacompass.com/patent-expiry-expiration/indom...). That being said, drug patents are complicated, and there might be competitors for this drug.
https://www.goodrx.com/indocin?dosage=50mg&form=capsule&labe...
https://www.goodrx.com/indocin?dosage=50mg&form=suppository&...
Maybe the generic can't be sold as a suppository, and the suppository version works better?
30 50mg capsules of Indomethacin (generic indocin) is $8.87 at Giant Eagle.
60 75mg capsules of Indomethacin ER (generic indocin sr) is $29.08 at Giant Eagle.
Who is paying that much for this drug?
This appears to suggest that there are people who take enormously expensive theraputic drugs who don't need them, and that Martin Shkreli gave away those enormously expensive therapeutic drugs away to those who actually did.
Whether propoganda, misinformation, or a bald-faced lie, that's not what happened. That never happens, and never will. Shame on you for implying that was the case.
Here's the tale: If you have obstruction of your bile ducts below the liver or gallbladder, usually gallstones or sometimes neoplasm, you need an endoscopic retrograde cholangiopancreatography (ERCP) for extraction or sampling.
ERCP is sticking a tube down the throat, stomach, small intestines into a tiny opening at the ampulla of Vater to access the bile ducts. Sometimes this process causes inflammation of the ampulla and associated ducts leading to blockage, and can lead to pancreatitis due to back flow and pressure, because the pancreas also excretes its digestive enzymes via the ampulla).
A few trials circa 2015 showed rectal indomethacin reduced the risk of post-ERCP pancreatitis, and eventually it made its way into the guidelines. It is the only proven preventative treatment, so they have a natural monopoly.
Hope that helps.
The drug was approved in 1965 and the company selling it holds no patents on indomethacin.
If I had to hazard a guess, it may be the market isn't attractive enough for competitors to establish a national supply chain. Or there's some sort of collusion at play.
To me this represents further evidence why public goods should be left out of the hands of private for profit organizations for whom disease is simply an externality to capitalize on.
For those comparing vs the us health system, include (a) working f/t with good employer benefits, (b) f/t with less benefits and (c) working part time. And remember to include cobra. And include the state/province/country where the comparison is being done. No absolutes here, either.
https://www.buzzrx.com/indocin-coupon