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Making Drugs Cheaper Without Stifling Innovation -- Euro Style

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Can we keep drug prices low without hurting innovation? Well, drugs are a lot cheaper in Europe than in the US, and there's still plenty of innovation over there. So what's going on? It's called reference pricing, and it's pretty much genius. Those of you who want to read more can go here: http://theincidentaleconomist.com/wordpress/?p=72475 John Green -- Executive Producer Stan Muller -- Director, Producer Aaron Carroll -- Writer Mark Olsen -- Graphics http://www.twitter.com/aaronecarroll http://www.twitter.com/crashcoursestan http://www.twitter.com/johngreen http://www.twitter.com/olsenvideo And the housekeeping: 1) You can support Healthcare Triage on Patreon: http://vid.io/xqXr Every little bit helps make the show better! 2) Check out our Facebook page: http://goo.gl/LnOq5z 3) We still have merchandise available at http://www.hctmerch.com
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Текстовые комментарии (237)
kailas Narale (16 дней назад)
Aaron Squire (18 дней назад)
This only works for drugs that are currently on the market though- what about all the drugs that are being developed? Where are they supposed to get that money without costing taxpayers any more money?
Malika Thueler (3 месяца назад)
Is this used in Switzerland? I live there and meds are pretty expensive to me (like everything here ^^')
Joel (5 месяцев назад)
Brian Thompson (5 месяцев назад)
What a crock of BS. Drugs prices in the US are high for two reason and two reason only. LAWSUITS and FDA approval cost .There were no Canadian lawsuits over VIOXX resulting in billions being put aside to pay claims like in the US. The difference between the US and the rest of the world, we allow for damages over known side effects. Billions have been set aside for the Morena IUD for causing unterine wall perforations. I learned about that side effect back in Jr High health class. It was even listed in their ads as a known side effect. That didn't stop an America jury from awarding millions to a woman. I am not arguing for or against, I am merely pointing out that our drug prices reflect this value. FDA approval cost is another biggie. There is no reciprocity when It comes to drug approvals in the US. A cancer drug may get approval in the EU but still has to be approved by the FDA with all the same cost as a domestic approval . A drug developed in the US with FDA approval doesn't required the same testing for approval in say Japan. Therefore the drugs price can be lower. This videos are over simplifications of serious issues
Anthony Nacrelli (7 месяцев назад)
Peoples problem is not that their costs are not in line with the benefits of treatment. If a certain drug is less effective in treating pancreatic as opposed to lung cancer, this is certainly a tragedy, but most people are quite aware that the universe is by no means perfect, and so tragedy does occur. What enrages them most is that pharmaceutical companies are pricing drugs at higher rates than they need to in order make more money off the drugs that they sell and that the money made from the cost of medication is not used to provide better care but to be spent of frivolous luxuries. In short, people do not expect to purchase increased longevity at a fixed rate; they wish to be given an option to purchase the best available cure at a fair price.
habibygun (1 год назад)
Regarding drug and medical device pricing, why does no one mention the cost of raw materials? Are they negligible? Consider the following: A pharmaceutical company must have the money to purchase glassware, purchase and maintain GCMS, NMR, and spectroscopic facilities, purchase receptor proteins, synthesize drug candidates, pay pharmaceutical chemists and clinical researchers, and run series of clinical trials. When a researcher needs a bunch of raw chemicals, resins, flasks, enzymes/receptor proteins to assay inhibitors, they get it from some distribution or manufacturer like Sigma-Aldrich. Is it assumed that these manufacturers fall into the pharmaceutical company side of things? Is that aspect out of the control of federal regulation? Look at the issue from where it begins: the chemical manufacturers and technology manufacturers. Can that side of things be managed?
92axelmaster (1 год назад)
I think Price referencing should be made between the options of treatment for each case/patient.
Adolf Obama (1 день назад)
not feasible due to the "long" pipeline in drug distribution
Sally Lee (1 год назад)
What if we require new drugs/ therapy/ biological to show superiority over the existing standard of care for the condition, rather than just to prove non-inferiority. That way, all new therapeutics on the market will be better than existing ones. Just a thought.
PoseidonXIII (1 год назад)
Thanks, this helped me understand this complex issue a lot more!
Steve RX4 (1 год назад)
Nexium $28aud - http://www.chemistwarehouse.com.au/buy/42596/Nexium-40mg-Tablets-30 Australia - single payer healthcare.
John Strzempa (1 год назад)
It seems like this has been studied and it doesn't have a great impact on pricing http://www.rand.org/pubs/research_reports/RR240.html
pisse3000 (1 год назад)
If it weren't for reference pricing I'd be out on the street.
Dheeraj Sethi (1 год назад)
Reference pricing assumes that there is no difference in effect of each drug. Theoretically, mesalazine is mesalazine, but some patients may not get on with Mezavent, but do get on with Pentasa (two different preparations of the same drug). They would then need to pay extra for Pentasa, but only as the alternative is ineffective or intolerable. Also, some doctors may preferentially prescribe Asacol (another mesalazine) as it is the one they have most experience with. Patients can not be expected to then select a different medication because it is cheaper, as it would not be concordant with their doctor's advice. Thoughts?
grantcivyt (1 год назад)
I think you're very much correct. Perhaps I don't understand reference pricing fully, but it sounds very much like the sort of pricing that insurance companies have been doing for decades: generics are covered more fully than brand medications. This results in complications for some patients that do not tolerate the generic well. Reference pricing sounds like it simply uses broader categories. If it worked as effectively as +Healthcare Triage suggests, I imagine insurers would immediately jump on it. Of course, people don't like it when insurers implement cost control measures. I wonder if this video would have as many "likes" as it does if reference pricing were being suggested by an insurer rather than as a government plan.
Timothy Dingman (1 год назад)
Why are there so many "trolls" on this page? It is a good and informative site wherein the content producer seems to comply with the established rules of scientific inquirey and to understand statistical analysis. Who is so afraid of this content that they have to post obscenities here?
Germán Felipe Barbosa Hernandez (1 год назад)
Thank you for your podcasts, one criticism is that although I think is a great way for cost savings from the third party payer point of view, codifying into law will bring the problems associated with price controls and government regulated markets, meaning shortages of the medications that are underpriced when grouped together... remember that even though medications might have the same pharmaceutical principal, people switch to other medication for other reasons than economic incentives, for example, allergic reactions, different pharmacodynamics. The other problem will be who makes the decision in government of grouping the medications and what counts as an innovation, corruption, kickbacks regulatory capture, and monopoly are all the usual results when one agency, let's say the FDA decides how all third payers should deal with pharma ... great idea as long as is not mandated to all third party payers.
Christian Libertarian (1 год назад)
I don't believe that creating some bureaucracy will reduce prices in the medium or long run. Such bureaucracies simply get captured by interest groups. However, we need not wait for such a thing, or even create the thing. Right now, insurance companies can spread this kind of information to physicians on their panels. Physicians can, by discussing the issue with their patients, cause the same kind of downward price pressures. Insurance companies have motivation to do this, and would also have motivation to let pharmaceutical companies know they are doing it.
rebel yano (1 год назад)
Christian Libertarian
Allen Finn (1 год назад)
But almost the majority of drug research is in the united states, isn't this misleading?
Vineet Bhagwat (2 года назад)
1. How are drugs that are on-patent classified? In a separate class? 2. How would the Epipen be classified?
alexthemonsterwithit (2 года назад)
I have a question. Wouldn't the cost difference between the lung cancer patient and the pancreatic cancer patient be naturally controlled because the Panc. Patient would be paying for the drug for a shorter amount of time? Great vid! Keep up the good work!
I_walmart Letgo (2 года назад)
Why is this not something in the United States? This reference pricing could revolutionize the prices of many brand drugs as well as make a set price for average everyday drugs. Not only that it also allow other drug companies to still set their own prices if they so choose too. Placing drugs into their type of classes based on their active agent. The ideal that life is more important than drugs so relay people to this ideal. Looking not many people have jobs or are injured and cannot work to obtain the money required to purchase certain drugs but this might allow them to. Also, I am curious about if this will affect other places in where prices are outrageous such as gas prices or others like it? Making a universal price could lead to many new advancements in medication and amount of money paid for a specific drug dramatically.
Haley Elizabeth (2 года назад)
The United States could definitely take a page out of Europe’s book. They have chosen to use a procedure called reference pricing that prices the pharmaceutical drugs based on many different things and it is pretty smart. People are unaware that they are being charged an obscene price for their needed medications. In Europe they divide the drugs into different classes and the customer has a choice to spend more on the drugs but it is up to them. The new drugs that are newly created are first put into the higher classes but will eventually be priced down so that the patients can afford to use them, thus increasing the use of the new drugs from more patients. The also chose to price their drugs based on the drugs’ effectiveness and not the condition of the drug. The do not think that a generally effective pharmaceutical medication should be charged a flat rate and if the customers want more they can pay out of pocket for that. I believe that our ridiculously high prices of our newest and most well-known drugs are only prices this high because we are told we have to pay that much. There are many people who chose to go without a certain medication because they simply cannot afford to use it. The inability to afford a needed medication should not be an issue that people have to worry about. The United States should begin to find a way that they can lower the prices of medications to better accommodate the people who need them.
Sierra Avery (2 года назад)
Using this type of systems would benefit patients extremely. Grouping drugs by their abilities and pricing them accordingly makes logical sense. In the United States if you are prescribed a medicine that has no generic, it'll cost you much more. Generic medications bring the prices down exponentially but unfortunately not every drug has a generic. Even with insurance these medication can cost an obscene amount of money, and with out of insurance you're lucky if you can afford your medications. This system will even help bring all the prices down over time. Like he said, a company can make their drug cost more but over time they will lose buyers and be forced to lower their price as well. The drug industry makes enough money to lower its price and create a reference price for each classification of drugs. The incentive for creating new drugs will not be lost and more people will be able to afford the medications they need.
justin norwood (2 года назад)
All I have to say about this topic is that drugs in the U.S. are overpriced compared to other countries. Like some of the comments I see on here, people buy their drugs overseas for a cheaper price. This also affects insurance companies and how much they actually do for the patient when buying drugs. Reference pricing to me seems a little chaotic. Drugs in general make the healthcare systems so much money. Its to the point where healthcare isn't looking to benefit the buyer, just make the most money. I know that was a little over the edge, but that's how it seems.
Max Meier (2 года назад)
Yet another proposed government policy which refuses to cite specific evidence of its effectiveness. The theoretical implications of a policy and strong belief in its intended consequences are not a replacement for empirical evidence. Examples show that innovations in treatment of previously untreatable diseases (like MS) start with expensive, relatively-ineffective drugs which are later supplanted by better drugs. It does not matter if you believe price controls will not stifle innovation. You need evidence to back up your claim.
Oscar Smith (11 месяцев назад)
The problem with that argument is that any medication targeting new diseases will be in their own class, and therefore it is hard to see how this would reduce innovation.
Eva Winkler (2 года назад)
It's true, that the prices in Germany are lower than in the US. Nevertheless this system has it's own downsides. There are only a few drugs that require no additional payment by the customer. It also often happens, that the cheap drugs are out of stock, because there's a high demand for these brands. In addition to that your health insurance has contracts with the pharmaceutical companies, that change up to several times a year, that predetermine which 1-3 different brands the customer would get. As a result the customer has to switch brands regulaly. In addition to that these contracts are not necessarily with the cheapest brands. (In the last months a few drugs were excluded from this regulation, because switching brands might affect the even drug level in your body.) The costs for healthcare increases and the insurance companies try to lower their expenses constanly. Sadly it's usually on the cost of the customer or the pharmacy, rarely at the cost of the pharmaceutical companies. Not every company does excessive research or innovation. Alltogether the German healthcare system is an enormous construct of regulations and paperwork with it's own upsides and downsides.
LReBe7 (2 года назад)
Oh the irony! Got a milk commercial by the EU on this vid of HT!
Aubree Desgranges (2 года назад)
My question is..WHY ISN'T THE U.S. USING REFERENCE PRICING? I think the pharmaceutical companies should be more concerned on saving as many patients as they can instead of trying to make the highest profit. The lower cost of drugs makes them more accessible to a more variety of people. Every social class can benefit from cheaper drugs. Many common illnesses can be cured and this will lead to a healthier America. I believe it is a selfish act upon pharmaceutical companies that they would rather profit than have others profit. It is understandable that medicine is a business but overpricing medicine shows poorly on the companies.
Kevin Chiem (1 год назад)
We'll move forward when we are free of corporate interests inside of our government, seeking bills and laws that suit their own purposes. That is the reason.
がに (2 года назад)
part of the problem with US drug costs is down to the restrictive patent laws. anyone makes a drug that's even vaguely similar to one already on the market and they have to watch out for costly lawsuits and lobbyists lobbying against their competition.
Antonio Tejada (1 год назад)
がに That's the same pretty much everywhere...
Tarathiel123 (2 года назад)
Some healthcare innovations are also majority funded by the state yet somehow still gets marked up to the tax payers who pay for them.
Da Hai Zhu (2 года назад)
Nice idea. Good luck getting it to fly in America where corporations own the government...
lilkoo93 (2 года назад)
External Link to "read more" didn't work. It said "Cannot find what you are looking for. Try searching again !"
Nic Forster (2 года назад)
I think this misrepresents EU standard models for pharma pricing quite considerably. The largest economies in Europe heavily subsidise personal pharmaceutical costs for one; even at USA standard prices. It also seems to neglect the need for a diversity of heavily subsidised pharmaceuticals with differing properties, pharmacokinetics, and vectors of administration for the same conditions in order to provide better tailored treatment regimes for individuals. I think that the greatest difference between the USA and other countries with regards to pharmaceuticals is that there is government funding for necessary but unprofitable research in Europe, but pharma research is left entirely to the market in the USA.
RRRooooDDDD (2 года назад)
How much does a box of paracetamol cost there in the US?
Antonio Tejada (1 год назад)
RRRooooDDDD Practically nothing; a bottle of 100 pills is just a few dollars. But anything prescription costs way more in USA.
r15u5k00 (2 года назад)
finally, this video was long overdue :)
Xikes Emi (2 года назад)
This is the main reason I'm avoiding moving to US.
Ben Harman (2 года назад)
so why don't people just buy the cheapest drug in a class anyway, given that the therapeutic effect is similar within the class?
grantcivyt (1 год назад)
The "similarity" among the drugs is a subjective call made by someone. You could say that a Toyota Camry and Honda Accord are similar cars by some definition. You could say that a Tesla S and Hyundai Accent are also in the same class by some broader definition. We're a country of over 300 million people and the planet is 7.5 billion. The idea that a single criterion is applicable to everyone is not only farcical; it is dangerous.
marlonyo (1 год назад)
because people are stupid and are move by brands and the superstition that because it has a brand and cost more it must be better.
TacComControl (2 года назад)
I think one of the strongest arguments in terms of affordable prescriptions would be a ban on unnecessary price gouging on inelastic goods, such as life-saving medications, arrestive medications, and the like. This could be a direct ban, or it could come in the form of state-supported wrongful death lawsuit pursuit. In cases wherein a drug was priced far outside of market value, a strong incentive could be created to drop the price down to safe levels if the District Attorney's office began pursuing wrongful death lawsuits against pharmaceutical companies that overprice their drugs, especially in cases where the drug could have saved a life, could have significantly increased the quality of life during the time remaining, or could have increased a remaining lifespan by over a month or so. Payouts on these lawsuits could reflect the remainder of life involved as regards economic value(Yes, there is one), as well as value to a family, such as income lost by prolonged illness due to costs being too high to treat, or income and time lost due to having to care for a loved one during a similar time. The incentive could also be created by pitting businesses against one another. For instance, establishing a system wherein life insurance providers would be required, even in cases of outside forces acting on the death of an individual, to pay out in full the amount of the plan to the next of kin, but also creating a system wherein life insurance could more easily legally pursue the responsible parties, could easily create a system wherein pharmaceutical companies would either reduce costs, or find more ways to deliver low-cost vouchers or waive the cost of prescriptions for individuals at or below 4 times the poverty line, simply out of fear that a rash of wrongful deaths due to cost could easily result in dozens of lengthy lawsuits that could, even if they weren't won outright, cost the company millions.
Sathesh Krham (9 месяцев назад)
https://seller.indiamart.com/product/manageproduct/ best price Pharmacy INDIA
lohphat (2 года назад)
The problem is that corporations and industry control the legislature. Regulations are bad for racketeering
Timothy Dingman (2 года назад)
This is a story I tell too often. I have asthma, I use symbacorte. There is no generic in the U.S. I buy foracort, a generic made overseas, from a pharmacy in Canada. Symbacort in the U.S is between $350 and $399 for a 30 day supply. Foracort, mail order from Canada is $99 for a three month supply.. This is not insane. It is obscene.
37VQV (1 год назад)
So would you say that it causes relaxation or contraction of smooth muscles that express Beta2?
ihartevil (1 год назад)
they are never prescribed as muscle relaxers though and they are not classified as muscle relaxers
ihartevil (1 год назад)
i am not a troll i have the facts right here from google that clearly states that LABAs arent muscle relaxers you retard https://www.aaaai.org/conditions-and-treatments/treatments/drug-guide/long-acting-bronchodilators-(labas) see they are only used for asthma NOT ANYTHING ELSE YOU RETARD SO THEY CANT BE MUSCLE RELAXERS http://www.consumerreports.org/cro/2009/12/treating-muscle-spasms-and-spasticity/index.htm MUSCLE RELAXERS DONT WORK BECAUSE THEY ARE ALL PLACEBOS
grantcivyt (1 год назад)
I suggest muting +ihartevil on this thread. He sure sounds like a troll, but troll or not, he's just about the only one shouting and cursing here. If nothing else, it shows he doesn't know how to calm his emotions and argue with civility. Also, his user name is pretty telling! :D
Polarbaerchen (2 года назад)
I live in one of the countries you mentioned (Germany) and just ran into a problem with this system. The new anti-depressant I tried out is no longer on the market here because the company wouldn't settle for the price of comparable products. Which sucks at the moment because it seems the medication wasn't effective only for me but also for other people who have already tried the alternative medicines without much success. Of course, this is just one medication, and I guess you could import it for a higher price if the insurance company/your wallet agrees, but it seems to me that this could be the beginning of companies fighting back and holding patients' health hostage.
Exeggcuter Timur (2 года назад)
Depression sucks man. I have Bipolar so I'm well aware. My advice, while you're waiting for some new kind of medication, would be to regularly visit your friends and family, especially if they have a dog.
Temperance Raziel (2 года назад)
Hillary would never allow for more competition and lower prices for drugs after having her campaign financed by mega-pharmaceutical companies.
steveh46 (2 года назад)
And if you believe Donald Trump even has a written policy to lower drug prices, you probably do own a batch of counterfeit Epipens.
Temperance Raziel (2 года назад)
+steveh46 If you believe she is going to take all that money in donations and give speeches not allowed to the public, and then lower drug prices, I have some $3 Epipens to sell you.
steveh46 (2 года назад)
Hillary Clinton Unveils Plan to Address ‘Excessive’ Increases in Drug Prices http://www.nytimes.com/2016/09/03/us/politics/hillary-clinton-epipen-mylan.html
Xavi Ondoño (2 года назад)
Don't know much about the rest of the countries, but spain's healthcare is awful. Pretty much everyone I know that has some chronic problem (as minor as mild alergies) has private insurance.
Aveline De Grandpré (2 года назад)
I feel like Europe is pretty much more progressive than America on every single issue.
Cameron Haskins (14 дней назад)
Yeah, and look where that got them.
Correction Guy (4 месяца назад)
also, any racially based laws on employment (positive discrimination) is pretty much a nono.
Antonio Tejada (1 год назад)
Aveline De Grandpré On many, but not all. The US has better laws on employment and housing discrimination, as well as MUCH stronger protections for people with disabilities. (That's why the US does so well in making public buildings wheelchair-accessible, for example.)
Paul Jacob (2 года назад)
Can you guys do an episode on generic drugs in India ? @healthcare Triage
Air Quotes (2 года назад)
This won't happen because of greed.
Mairead Bartlett (2 года назад)
I like the idea of the paying for life gained as opposed to the medication itself. However, because Tarceva is an oral drug, doesn't that already effectively happen? If someone takes a medication on a daily basis for a week and a half wouldn't they pay less for that drug overall than someone who takes it for 3 months? Perhaps it isn't a daily medication, or maybe you're suggesting that each pill itself be less expensive because they are less effective at treating the disease at hand, but it's certainly something to think about.
WeAreGRID (2 года назад)
hilary said she wanted to reduce perscription drug prices? hah. ill believe it when i see it. obama care was supposed to make things cheaper, but its just a burning wreck. good thing shillary wont get elected! hashtag tentatively trump
RustyDust101 (1 год назад)
+WeAreGRID So how's your take on Trump this day? Still so proud of his ideas? Or his extensive support for changing medicare or Obamacare? Just wanted to know how reality feels when it comes knocking on your door.
Teagan P (2 года назад)
Trump is an idiot. Look up his policy on vaccines.
steveh46 (2 года назад)
If she lives to November, vote for her. If not, you won't have to.
WeAreGRID (2 года назад)
+steveh46 yeah i know bernie was paid to say that, but that doesnt change the fact that hillary is to trump what trump is to a homeless man, that is, the 1% of the 1%, hillary will change nothing. She will make it easier for her backers to make money, and thats it. If she can even live to november.
steveh46 (2 года назад)
I voted for Bernie too. But either Clinton or Trump will be President. Trump is a huge disaster waiting to happen. Bernie is quite clear on who would be better for the USA. "Hillary Clinton understands that we must fix an economy in America that is rigged and that sends almost all new wealth and income to the top one percent. Hillary Clinton understands that if someone in America works 40 hours a week, that person should not be living in poverty." http://thehill.com/blogs/pundits-blog/presidential-campaign/287370-transcript-bernie-sanders-formally-endorses-hillary
tiger lily (2 года назад)
My only concern is based on my experience with birth control. I've tried many different types of oral birthcontrol that would technically fall in the same category but many did not work. The type I am on now is more expensive but I do not experience breakthrough bleeding.
- KoperKat (2 года назад)
The way it works in my country the insurance covers for the more expensive version if the doctor gives an objective reason for it. In your case it would be history significant undesirable side effects on standard birth control, so you'd have a right to the more expensive option without additional co-pay. The same goes if you're allergic to something in the cheaper option, have a specific form of disease for which the more expensive option brings significant benefits in contrast to the base standard drug in that category, have pre-existing conditions or prescribed drugs that don't play well with the cheaper option, but work well with a more expensive one, ... Of course there's no way to see how US would implement it or how your insurance would choose to interpret the law if it were loosely worded.
ShopTalk (2 года назад)
I would propose a much simpler system. make it impossible to patent drugs so that competition is maximised and at the same time the government awards companies discovery prize money for inventing the drug that covers development costs plus a bit of profit. That way everyone benefits from a big drug discovery and the company isnt left without its shirt.
gnomer cutler (2 года назад)
allurrennvotur (2 года назад)
Really interesting. How does this fit in with medication in the United Kingdom? We just pay £8.40 for any prescription regardless of the actual cost, but it's difficult to know what that actual price is (and who's paying it).
Sathesh Krham (9 месяцев назад)
https://seller.indiamart.com/product/manageproduct/ best price Pharmacy INDIA
George Cataloni (2 года назад)
I think this reveals how much insurance companies (or a government equivalent) aren't good for us, since they basically have to stop doing their job (paying for drugs) to get good results.
spikedwk (2 года назад)
I keep hearing how much better the healthcare is over there until I talk to those who actually use it....they tend to dislike the government allowing them to be wait listed years for normal doctor visits
Kevin Geurts (2 года назад)
From Belgium here: 1-2 days for my own doc and a few hours for the intern in his practice. Few hours when I had to go to the doctor on vacation in Sweden and in Germany. Debunked for western EU.
David Wood (2 года назад)
That isn't a thing. Either you're making things up, or the people you talked to are. If they have right wing political views, that might explain why. Now technically Europe is a big place, so I guess I can't say for sure about the entire region. But it certainly isn't true in France, the UK, Germany, Italy, Netherlands, Belgium, Spain, or Scandinavian countries.
mythologiefan (2 года назад)
The only thing I hate is that our government thinks that the USA does everything so well, even if they alreade proved that expensive system didn't work. I never have problems with doktersvisits. Depending on what I need the dokter for, I can plan visits that suit it. GP visits usually in 1 or 2 days. Specialists plan according to the severity of the problem. If you need acute medical attention, you will most likely get an appointment quiet soon, otherwise you may need to wait a couple of months. If the situation changes and becomes more severe, they will probably act to it. But this is in the Netherlands. I have no clue how everything works in other countries in Europe. Even though friends in Germany seem to be able to plan doctor's visits within a couple of days.
Suzie Chhouk (2 года назад)
Thanks! Can you do an episode on therapy/psychiatry? Watching every week. Cheers.
Scolding Mime (2 года назад)
3:43 to "Is better than the existing therapies": pardon my naïveté, but what is the sort of metric being used for the therapies in this proposition to decide which therapy is better? Amazing videos as always, HT.
Scolding Mime (2 года назад)
I think they should, to succor the less enlightened into some of his relatively advanced videos using clinical trials as evidence. Thanks, helpful!
mythologiefan (2 года назад)
This is tested in comparative clinical trials. Double blinded. Usually with at least the old drug(s) and the new drug, sometimes a placebo. Then a statistical T-test or, depending on the research another statistical method is used to look at the outcomes. The stuff that is measured can differ from general outcome to certain side effect, how often they occur and/or what the physiolgical effects are (usually in the trials with healthy people and animals). The metrics can be anything health related, from heartproblems to concentration of certain proteins/chemicals in the blood depending on the med. They could make a miniseries on this, next to the miniseries on statistic posted earlier on this channel.
1marcelo (2 года назад)
If you cut the revenue of pharmaceutical companies, they are going to cut investments in research. As simple as that. Anything else is just wishful thinking.
steveh46 (2 года назад)
Drug companies spend many times more on marketing than they do on research. Maybe they should cut their ad budgets and increase research while cutting prices. https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-pharmaceutical-companies-are-spending-far-more-on-marketing-than-research/
DJBsLectures (2 года назад)
Aspirin and ibuprofen differ. Some people can take one and not the other
DJBsLectures (2 года назад)
+- KoperKat Thanks for the clarification!
- KoperKat (2 года назад)
The way it works in my country is that a more expensive drug can be prescribed by the doctor without added cost to the patient if there's an objective reason for it. If you're allergic to a component pf the cheaper drug, have a condition or take medication that doesn't play well with the cheaper option or if the cheaper option isn't working for you. The last one is a bit complicated. For one you need documented history. But for instance (I'll need to be vague) a teenager had an autoimmune disease that's traditionally very well managed by corticosteroids but he had a very rare reaction to them so the state insurance on recommendation of the doctors approved a weekly IV treatment with biological drug that costs 10.000 per month (basically for life). State insurance must provide for a treatment that supports a minimum standard of quality life and in this case it just came to a very expensive treatment.
Mr. NPC (2 года назад)
Healthcare in Europe takes years to receive.
Roel den Oudsten (1 год назад)
How long ago were you in Portugal?
roothik (2 года назад)
+Derek Cliff Crane Ok, then you mean healthcare in Portugal takes years to receive. In most european countries it's not really like that.
Mr. NPC (2 года назад)
+roothik I've lived there. Surgeries are never close to when they need to be. People have crutches for months waiting to set foot injuries. Step off a plane in Portugal and you'll see how many untreated leg injuries leave people with twisted feet. As a service volunteer, we weren't allowed to go to public healthcare because they were so terrible.
roothik (2 года назад)
What do you mean it takes years to receive? Based on what?
David Wood (2 года назад)
Europe's a big place with lots of different healthcare systems, but generally speaking that isn't remotely true.
sion8 (2 года назад)
This is so cool, however, if the Canadian Province of British Columbia can do it, what's stoping the U.S. states of California, Texas, or New York (among others) from applying this within their own state borders? Their residents could benefit from these better pricing options and U.S. politicians can point out at a domestic version of this skim, so that xenophobic idiots can't say is not possible in the USA, unhindering it in the process for the rest of the U.S. states. As for the version to be used of this pricing skim I kind of like the average pricing option that Germany and Spain follow as well the average can seem fairer to pharmaceutical companies, but the lowest price possible would be awesome to have!
sion8 (2 года назад)
This is so cool, however, if the Canadian Province of British Columbia can do it, what's stoping the U.S. states of California, Texas, or New York (among others) from applying this within their own state borders? Their residents could benefit from these better pricing options and U.S. politicians can point out at a domestic version of this skim, so that xenophobic idiots can't say is not possible in the USA, unhindering it in the process for the rest of the U.S. states. As for the version to be used of this pricing skim I kind of like the average pricing option that Germany and Spain follow as well the average can seem fairer to pharmaceutical companies, but the lowest price possible would be awesome to have!
Sam Anderson (2 года назад)
Innovation within a class would be stifled as new techniques require higher costs. Take as an example gel capsule vs powder capsule they would be in the same class, but have different outcomes. Innovation within a class then becomes only focused on cost reduction, not fractional improvement. As noted in other comments, patients who are not 'standard' such as those with drug interactions, allergies, or other needs for alternative formulations are penalized by class pricing policies. Perhaps each class could have 2 costs: one reference cost for the standard formulation and one alternate reference cost for the 'non-standard' patients who have to deal with drug interactions, allergies, etc. Lastly, what defines a new class would needs to be be carefully legislated or else legal challenges to the system would be quite common, costly, and result in prior levels of inefficiency.
Clorox Tree (10 месяцев назад)
And that's why Singapore system is the best
Sam Anderson (2 года назад)
what I guess I'm saying is: if I'd asked what they wanted ... "they would have told me to make a better horse" - Henry Ford (likely misquoted either then or by me)
Sam Anderson (2 года назад)
I don't believe there is a utilitarian vs alternate theories debate to be had here. 'Efficient resource allocation' (read: utilitarianism) for 'a maintenance process' (read:medicine) must treat 'all outcomes' (read: people) as 'outcomes of interest' (read: people that matter). Or I'm arguing from a utilitarian perspective: It make no sense to provide medicine that can't be used due to side effects or to arbitrarily punish the right answer for being a later answer. doing so leads to inefficient use of resources which is counter to utilitarian goals. The issue of utilitarianism comes into play far more with end of life care, pain management (with addictive drugs), and reasonable cost issues than it does with this pricing structure issue. That said: John Doe well written comment. May I suggest PhilosophyTube another YouTube channel that discusses philosophy? I couldn't help but draw parallels from your comment and a recent video (iirc a reading list video) on the concept of 'king' or how to make/alter the law without using law to justify the creation/change. That seems rife for obligation and duty based analysis.
Chandler Grier (2 года назад)
Your comment highlights the very foundation of the utilitarian viewpoint in ethics. You point out that a minority of people would not benefit from a change in the current system of pharmaceuticals in this country, while a vast majority would enjoy the benefits of the system change. Utilitarians are only concerned with the good outcome for the majority of people involved. Whether or not this kind of change can be considered ethical by another way of thinking is another discussion. Deontological thinking is more focused on whether or not there is a duty to make a decision. So this could be argued either way. A person may have a duty to change the system to benefit the most people. In this case the system could be changed. However, a person who considers it their duty to only make changes that benefit everyone would not be in favor of making a system that only benefited people with certain qualifications.
Michael Romeo (2 года назад)
Excellent comment. It would definitely be better than the current system, but not taking varying formulations into account is a huge drawback. Intricate formulations cost a lot more to develop and manufacture and often have astounding improvements over the regular formulations, what benefit would there be to the manufacturer/developer if they were in the same pricing class as the less efficient formulation?
RainbowBomber (2 года назад)
I had a hard time understanding this video. I felt like the examples were a little complex.
- KoperKat (2 года назад)
Say you want an Aspirin which has the active ingredient of acetylsalicylic acid. The drug catalogue includes ALL drugs that include that active ingredient in that dose and covers only for the cheapest option. If you want the Aspirin brand you need to co-pay. Let's go further, you're in minor pain. You need a mild painkiller. Both Aspirin or Tylenol would do the trick. Which is cheaper? What about Actamin, Apra, Daleron, Lekadol, .... ? They all contain either acetylsalicylic acid or acetaminophen. The insurance would cover the drug shown effective for your pain, but you could choose something else available and co-pay the difference. In reality (where I leave) this means a collegiate of specialist designs treatment protocols for a particular disease or condition and they list options for first choice, second choice (if the patient is allergic or has a condition/drug that doesn't work with the first option, first choice doesn't work as it should,...), third choice of treatment drugs. A selection of cheaper drugs within each option are then labelled as reference and are fully payed by the insurance. If the patient wants another brand name or drug from that group, they need to co-pay the difference in price. Most of the time patient don't even bother. But sometimes... Let say the doctor says that they'll give you #THISPILL for your pain. You ask why not Tylenol? Then the doctor say #THISPILL is FDA approved, has the same dosage and the same active ingredient but costs 30% less. You can get Tylenol, but you'll have to cover those 30% yourself. It makes little difference to you, but the manufacturer of Tylenol might need to lower their price or see their sales drop dramatically.
Phil Heaton (2 года назад)
You talk about how other countries reduce drug prices without reducing innovation, but you neglect talking about the impact on innovation if the US followed suit. I believe that most of the profits generated from drugs come from the US. If those are cut significantly, no matter what the means, wouldn't that impact innovation? Please note, I'm playing Devil's advocate here.
Adolf Obama (1 день назад)
+Mandragara Investment in drug development can reach beyond 500 M Dollars. So the profit on already developed drugs has to be very large to support future innovation. Furthermore, innovation management often requires multiple drugs to be investigated simulatinously- increasing the active cost even more (beyond 1 billon Dollars) which further increases the price of the released drug. Due to affordability it's no easy for pharma companies to release cost effective drugs without relatively high drug prices
mythologiefan (2 года назад)
+Diana, the Inorganic Vegan What I learned is that the patent on a drug holds for 30 years. But since the research process usually takes up around 15 years, before there is enough proof that the drug is safe enough to approve, then only 15 years of patent are left. In these 15 years the drug is crazy expensive (so the R&D costs can be covered and a smaller or larger profit can be made) and after 15 years it becomes cheaper, because more companies can produce it. Oh hail the drug innovation pipeline.
Phil Heaton (2 года назад)
Drug companies, like all other other companies, have as there primary goal to make money for the owner(s) of that company. The only reason that companies spend money on innovation is so that they will continue to make money as the years go by.
Mandragara (2 года назад)
If the drug companies are generating profit there's excess money for innovation.
D P (2 года назад)
There is a legit case to make for that for newer meds, but definitely not older meds when opportunities to make back money are long passed. A good part of price reduction is FDA approval streamline. The average approval time according to a previous healthcare triage video is about 15 years. That's pathetic.
Johnathan Gross (2 года назад)
You forgot another reason European and Canadian drug prices are so low compared to US prices: the US basically subsidizes other markets' drug prices. Companies can charge exorbitant prices in the US and use the massive profits to soften the blow of low prices elsewhere.
Adolf Obama (1 день назад)
Actually, the investment gets covered quicker if more doses of the drugs are sold (even at a lower price) which increases the profit by pharaceutical companies- increases innovation bugets- enables more research. Often the countries they deliever their drugs to made deals with the insurance companies, which made deals with the pharma company to present a affordable product.
Chris Lewis (2 года назад)
While its true we don't pay for all research, we do pay for the majority of it, 63.4% to be exact. http://object.cato.org/sites/cato.org/files/pubs/pdf/pa654.pdf
M FK (2 года назад)
Most profit doesn't actually go to R&D. It ends up trying to convince you buying the drug from one specific brand/manufacturer, which doesn't actually matter because they all are mostly fabricated under licence. I've been in marketing for a pharmaceutics manufacturer. That department is the most useless waste of resources. It does not only consume most of the profits but also tons and tons of paper. But they can't stop it now because everybody else is doing it and lowering expenses in marketing will reduce market share. Now this shit goes on as long as pharmaceutical drugs don't get completely regulated, and the average Joe WITHOUT Health insurance is basically paying for every marketing job there is in pharma. I had to quit, else I would have killed myself...
Surma Sampo (2 года назад)
Drug research is performed worldwide with the the pharma company's local subsidiary licensing out new drugs to the other subsidiaries in other countries. Research is done anywhere that is capable of supporting the skills and infrastructure needs of the labs, often in partnership with universities. The idea that the USA pays for the entire world's drug research is an objective fallacy and shows no understanding of how the global industry works.
MaxFist (2 года назад)
I don't really think that's accurate. I mean, here in EU, we get very few drugs from the US.
Camilo Jara (2 года назад)
Susan (2 года назад)
The CEO of Mylan, producers of the EpiPen, responded to the criticisms of high pricing in the US. She basically said that higher prices, in the US, was subsidizing lower costs in Europe and Canada. While is sounds like she's trying to divert the blame, is there any truth in this?
digital_nomad42 (2 года назад)
@caliph20 The Epipen isn't protected under patents. It's the FDA not approving other companies that is standing in the way of competition. She (CEO of Mylan) explained a lot in an article in the WSJ recently. Most interestingly, that she is trying to charge insurance companies more, not individuals, so as to capture a higher % of the money available in the healthcare market.
caliph20 (2 года назад)
For the Epipen no. The price of them in Canada has increased but more in line with inflation.The fact that they increased it arbitrarily by over 500 percent years after production tells the lie. They have a monopoly position, and are abusing it like all other patent covered drug companies.
leadfoot9x (2 года назад)
Of course there is. It's a common practice called price discrimination (or differential pricing): charge different people different amounts based on their willingness and ability to pay in order to maximize profit. Drugs, textbooks, and who knows what else are always cheaper in poorer countries. Drugs sold in Africa might make only a small profit over production costs, while the same thing sold in the US has a massive markup to cover the millions of dollars of R&D costs that the company incurred while creating the drug. It's important to note, however, that the company isn't LOSING money by selling drugs at a lower price elsewhere. They're just relying more heavily on rich countries for their profit. Nobody in Bumfukistan is going to pay $50 for a few pills, and it's better to make a little money than none at all. If the pills cost $2 to make once they're invented, the company might charge Bumfukistanians $3. Presumably, reforms suggested in this video would lower the amount Americans are willing to pay for drugs and bring us more in line with other countries. We'd still be rich, but less willing to waste money. Other extremely common examples examples of differential pricing are student/military/senior discounts and coupons/sales (charge the housewife or retiree who takes the time to bargain-hunt less than the busy businessperson who buys what they can when they need to). Student discounts have the added benefit of indoctrinating life-long customers at a young age. Any time a company can break its customer base up into separate groups willing to pay different amounts, it stands to make out.
Cameron Alexander (2 года назад)
I think I know what Fridays episode will be on....
PrimevalDragon (2 года назад)
I tend to be more on the conservative side of dealing with paying for medicine, but this is a fantastic idea. It opens up information on prices so consumers can understand what they are getting. Encourages smart choices. And encourages innovation. Of all the medical reforms, this should be the least controversial.
PrimevalDragon (2 года назад)
+Jachim Soyer Congress ruins everything. Cheap political points are worth more than sound decisions.
GreyGryphon (2 года назад)
Not only smart choices by drug companies, but also responsible purchasing on the part of patients too. A win/win really. Why isn't this seeing bipartisan suppo--oh wait. Congress.
Casey Broughton (2 года назад)
Hooray for my home province of British Columbia supporting affordable drugs!
dilydan (1 год назад)
Additionally, prescriptions are entirely free in Scotland if you happen to know someone living over the border. This is regardless of your income, number of items or type of prescription.
dilydan (1 год назад)
It's capped at £8.40 per item. In practice pharmacies, if provided with a multi-item prescription to fill, will charge £8.40 for the entire prescription regardless of the number of items. There are some, though few and far between, who will charge per item but this is incredibly rare.
Anjali Mehra (1 год назад)
dilydan I though it was £8 per prescription item? I've never actually had more than 1 item per prescription so wouldn't know.
dilydan (2 года назад)
+caliph20 meanwhile in the UK...maximum price for unlimited items on a prescription: £10 ($13/15) regardless of the amount of pills or types of drugs
caliph20 (2 года назад)
script of what? Champix is 102 dollars a month. 26 dollars for cipro. for a 1 day supply
Lucid Moses (2 года назад)
Interesting ideas. How do these systems handle people not being able to take the cheapest drug because they are in the "possible side affects" group?
RustyDust101 (2 года назад)
Summing it up for Germany (in effect identical to Sweden): Any drug that can not be administered to a patient due to significant proven side effects showing up in that patient, allergies, cross incompatibilities with other drugs, etc is not eligible for that patient. Therefore, the drug that *is* applicable for that patient is used instead of the reference drug at *no additional cost*, in this case even if it is a lot more expensive. In this case the cheapest applicable drug is used as the new reference drug. For all other patients the standard reference drug is used. As was stated in the video, Germany already uses an average cost of all drugs of one class as the possible reference cost. This already covers almost all possible non-standarized cases where high cost versions have to be prescribed alternatively. Only very special cases will inflate the actual cost for the insurance companies. Yet the doctors themselves as well as the drug stores (Apotheken) will tend to look for the lowest cost version because they only have a standardized pool of prescription drugs costs covered. If they exceed this amount due to negligence or not applying the cheapest version of drug possible they are liable for exceeding their practices drug cost allocation and can be held responsible (ie the doctors themselves have to pay for excessive drug costs prescribed by them, unless there was no alternative). Yes, bureaucratic as hell, but heck, Germany is all red tape and a loooong paper trail anyway. ;-)
daddyleon (2 года назад)
*+Lucid Moses* Then it's clear that those drugs are not in the same category for that patient, and they should not pay the difference.
Lucid Moses (2 года назад)
+OMGshinyobject Ok, Interesting. A non specific but systematic solution. I see how that is somewhat unfair but I also can't see how it would be possible to make it fair. At least that answer is close enough.
OMGshinyobject (2 года назад)
hi I feel like I am qualified to answer this because I work in this industry. in the event of allergies or intolerance to the reference standard the doctor is able to apply for full coverage of the medication for the patient. Of course the downside of this is the increased volume of work for doctors and the beauracy that patients have to navigate through.
Lucid Moses (2 года назад)
+Johan Winqvist Oh, I thought you guy had socialized medicine. But it seems more of a mixed bread.
sleepydood (2 года назад)
I'm assuming that link up there is referring to this: http://theincidentaleconomist.com/wordpress/upshot-to-reduce-the-cost-of-drugs-consider-reference-pricing/
lilkoo93 (2 года назад)
D P (2 года назад)
This is interesting, but it's not going to happen anytime soon. There are so many things we could do in the US, but don't. Also, can you make an episode on end-of-life care's out-of-control costs?
Merry Machiavelli (2 года назад)
That's a very interesting question! I find it's particularly significant in the case of dementia, where additional medical problems seem to just pile up and individuals can linger for a long time, even after they become unresponsive and bedridden.
D P (2 года назад)
+Benjamin Franklin I told you I was doing yoga. :D
D P (2 года назад)
+Benjamin Franklin Okay.
D P (2 года назад)
+Benjamin Franklin Sweetie, I love you, but I can defend myself. :P Nonetheless, I have made plenty of more academic comments. I'm a loser.

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