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elamje commented on FDA intends to take action against non-FDA-approved GLP-1 drugs   fda.gov/news-events/press... · Posted by u/randycupertino
estearum · 7 hours ago
This is not really the correct way to think about this.

Pharma is ultra R&D heavy so yes, medications are deeply profitable on a per-pill cost to manufacture basis. However, drug companies by and large are not extremely profitable. This is because to produce a single drug (which is high-margin from point of production), they have to sink billions of dollars into literally thousands of other drug candidates to figure out which ones are viable.

This is all "real, legitimate cost," as is reflected in their rather abysmal overall profitability.

As for the disparity between US and foreign markets, it's a basic tenet of commercialization to sell to every buyer at the highest price they'll accept, so long as that price is above your price to produce. All sorts of companies engage in "price discrimination" to achieve this. For example, cereal manufacturers will sell their own brand at $4/box, and sell the exact same product in a store brand box for $3.25/box. A lot of products in your local retail stores do this.

Overall, no one is really hurt by this per se. Every consumer is making a transaction they're willing to make, and the company is making the most money it can in aggregate, which actually gives it room to push the price at every price point lower than it would be able to if it could only sell to a single segment.

This is actually extremely important in the drug context due to the aforementioned abysmal profitability.

Let's take Trump's attempt to force a Most Favored Nation (MFN) clause onto drug manufacturers which guarantees US consumers pay the same price as the lowest price internationally. The intended effect is for US prices to come down to the level paid elsewhere.

But here's Pfizer CEO: "When [we] do the math, shall we reduce the US price to France’s level or stop supplying France? We [will] stop supplying France. So they will stay without new medicines. The system will force us not to be able to accept the lower prices.”

Not only does this obviously not result in lower US prices, but it very possibly results in higher US prices (since now there is less net revenue from lower priced consumers) and, more troubling in the pharma case, there is now even less net revenue coming in to justify new drug development.

It's hard to overstate how asinine this entire endeavor is. US consumers certainly pay too-high prices for drugs, but this intervention does very little to actually address that problem. The much more proximal issue is the incredible degree of intermediation in the US market between payers, providers, PBMs, GPOs, and more.

elamje · 6 hours ago
> Not only does this obviously not result in lower US prices

Maybe in Pfizer’s portfolio this is true. However, I just watched the Amazon Pharmacy pricing for GLP-1s drop substantially immediately following this. I think you may be being too black and white on claiming this categorically does not work.

Businesses will adapt pricing models, obviously this hurts Pfizer in some way, but Lilly and Novo found the new system was worth negotiating into. Like most things - when people say “always” or “never” - it’s reducing the spectrum of possibilities

elamje commented on FDA intends to take action against non-FDA-approved GLP-1 drugs   fda.gov/news-events/press... · Posted by u/randycupertino
bonsai_spool · 7 hours ago
I think 'MFN' is almost propaganda (not a term that existed before 2016-2020 administration) so let's leave that aside.

Are you claiming that the new website is offering lower prices than patients are paying after their co-pay? That is not the case outside the example I presented; moreover, the way the website is organized, there will be no pressure for prices to remain competitive after the initial media attention dies away.

I agree that a hypothetical case where we were paying lower prices would be better for us—but this remains an unrealized hypothetical. One way for us to pay lower prices would be to allow our government to negotiate prices for Medicare/Medicaid recipients, and that is exactly the thing that has been hampered.

elamje · 6 hours ago
Not arguing on broken internal pricing dynamics that are skewed by all sorts of gov programs and payors.

It’s about external, global pricing dynamics. The site clearly isn’t going to be able to give clean payor/pbm/gov subsidized pricing tables - that is almost an impossible exercise in our system.

What the agreement does accomplish is saying Americans will not pay $1150/mo while EU pays $400/mo while Argentina pays $120/mo.

It guarantees drugs will be greater than or equal to US pricing abroad which effectively forces pharma to find deeper profits outside of the US, or lower prices for all countries to acquire demand.

That is extremely effective. Now it’s up to a really complex group of people to figure out what that means inside our weird system of pharma/pbm/rebates/insurance/medicare.

But that’s not what trumprx is aiming to solve for right?

elamje commented on FDA intends to take action against non-FDA-approved GLP-1 drugs   fda.gov/news-events/press... · Posted by u/randycupertino
bonsai_spool · 9 hours ago
> I highly recommend checking out the terms of trumprx.gov

The website is very good marketing for people who don't typically follow drug pricing. Here is more about why the only folks who will benefit are those without insurance—but those people will find better prices in several places, sometimes significantly better prices [1]. Further, it's likely that they're already finding those prices, since the website prices are no better than what you can get today outside fertility medication; and fertility medications are neither new, nor the most expensive part of that process.

This site has nothing to do with the effective subsidies that Americans provide to the world, and it will change nothing about that. The major thing that would help all Americans, negotiating for drug prices, has been neutered by the current administration. In fact, an executive order has specifically lengthened the amount of time that new drugs will be able to charge higher prices to Americans [2].

We should all be very careful in parsing news items that are not in our field of expertise.

1. https://www.nytimes.com/2026/02/05/health/trumprx-online-dru...

2. https://www.kff.org/medicare/the-effect-of-delaying-the-sele...

elamje · 8 hours ago
Can you explain from first principles how the US market gaining MFN pricing does not benefit Americans? Open to changing my mind
elamje commented on FDA intends to take action against non-FDA-approved GLP-1 drugs   fda.gov/news-events/press... · Posted by u/randycupertino
elamje · 11 hours ago
The situation is basically this -

Novo and Lilly spent billions making Semaglutide, Tirzepatide, and future formulations/modalities.

They are going to monetize this heavily while they have IP coverage. There is no world they will let HIMS or any compounding pharmacy of scale undercut them.

On the insurance front - expect your insurance to decline this forever unless you are at serious risk of diabetes. It would make you cost them $3-6k/yr more. Insurance premiums would rise for everyone if insurance was subsidizing this - no free lunch.

Fortunately, the prices are coming down. Amazon pharmacy has Wegovy in an auto-injector starting at $199 without insurance. And that’s delivered to your door in under 24 hrs in most major cities.

I highly recommend checking out the terms of trumprx.gov - not endorsing the entire government here, but it is actually working and quite cleverly written to ensure Americans are getting the lowest cost drugs in the world now. Historically, we subsidized R&D globally by allowing pharma to make most profits on Americans then have cheaper prices abroad. That is changing and hopefully that’s a net positive.

elamje commented on Data centers in space makes no sense   civai.org/blog/space-data... · Posted by u/ajyoon
philipwhiuk · 4 days ago
> Chips must be “Rad-hard” - that is do more error correcting from ionizing radiation - there were entire teams at NASA dedicated to special hardware for this.

They don't do RAD hardening on chips these days, they just accept error and use redundant CPUs.

elamje · 4 days ago
Where did you hear this?
elamje commented on Data centers in space makes no sense   civai.org/blog/space-data... · Posted by u/ajyoon
elamje · 4 days ago
I was talking to someone about this the other day. I was part of a team at NASA that developed a cooling system for the ISS and this whole premise makes no sense to me.

1. Getting things to space is incredibly expensive

2. Ingress/egress are almost always a major bottleneck - how is bandwidth cheaper in space?

3. Chips must be “Rad-hard” - that is do more error correcting from ionizing radiation - there were entire teams at NASA dedicated to special hardware for this.

4. Gravity and atmospheric pressure actually do wonders for easy cooling. Heat is not dissipated in space like we are all used to and you must burn additional energy trying to move the heat generated away from source.

5. Energy production will be cheaper from earth due to mass manufacturing of necessary components in energy systems - space energy systems need novel technology where economies of scale are lost.

Would love for someone to make the case for why it actually makes total sense, because it’s really hard to see for me!

elamje commented on OpenAI's H1 2025: $4.3B in income, $13.5B in loss   techinasia.com/news/opena... · Posted by u/breadsniffer
NooneAtAll3 · 4 months ago
> US$2.5 billion on stock-based compensation

um...

elamje · 4 months ago
this hides major dilution until future financings

best to treat it like an expense from the perspective of shareholders

elamje commented on Ask HN: Has anyone quit their startup (VC-backed) over cofounder disagreements?    · Posted by u/stuck12345
elamje · 10 months ago
you’ll be happier on the morning after you leave than you even remembered was possible
elamje · 10 months ago
think about how to start and maintain a better founder dynamic for the next company more than trying to course correct what you already have
elamje commented on Ask HN: Has anyone quit their startup (VC-backed) over cofounder disagreements?    · Posted by u/stuck12345
elamje · 10 months ago
you’ll be happier on the morning after you leave than you even remembered was possible
elamje commented on Honey has now lost 4M Chrome users after shady tactics were revealed   9to5google.com/2025/03/31... · Posted by u/tantalor
elamje · 10 months ago
Have a friend high up at one of the “Big 3” in this space.

The entire business model is predicated on injecting themselves as the last click for attribution even when they weren’t remotely responsible for the conversion. Cool business, but can’t keep going on forever without someone catching on.

u/elamje

KarmaCake day2767January 7, 2019
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