Why does Health Care Cost So Much? Musk and Cuban

[Exquisitor]

Why does Health Care Cost So Much? Musk and Cuban

MSN

Cuban laid out seven ways those contracts are keeping drug prices high and hurting employees. His exact list stated:

• Don't control your claims data
• Don't control your formulary
• Have to pay more for "Specialty Drugs" that have nothing special about them
• Get rebates that are paid for by your sickest and oldest employees and result in higher deductibles and co-pays that impact the wellness of your workers and their families.
• Cause independent pharmacies to be reimbursed for less than their costs for brand drug scripts for your employees and families, causing them to go out of business.
• Can't talk to manufacturers to put together wellness programs for things like GLP1s.
• Signed a PBM contract with an NDA which prevents you from publicly discussing your PBM contract, resulting in an opaque, inefficient market, which leads to higher prices and lower quality of care for the entire country.

"All of this allows the big PBMs to continue to distort the pharmacy market for literally EVERYONE," he wrote.

 

[BirdinHand]

Because the US cares more about profits than people.

 

[Loulit01]

American citizens subsidize Big Pharma with tax dollars and pay more for those subsidized drugs than people in other countries.

 

[Threegoofs]

American citizens subsidize Big Pharma with tax dollars and pay more for those subsidized drugs than people in other countries.

And that money fuels the innovation in drug development.

It wouldn’t happen without that incentive- it just wouldn’t.

 

[Rexedgar]

And that money fuels the innovation in drug development.

It wouldn’t happen without that incentive- it just wouldn’t.

Shouldn’t that burden be shared by all countries they use the drug?

 

[Threegoofs]

Shouldn’t that burden be shared by all countries they use the drug?

That would be nice, but its not. And theres no way to force that to happen.

But the people in the US are the wealthiest in the world - by far, when you consider the size. Healthcare becomes more valuable than a fifth television or a second jacked up pickup truck, and we choose to divert the funds to cutting edge medical research- drugs and devices. For certain people at a certain time, having a valuable cancer treatment is more important than anything else in the world. I guess we could direct those funds over to better transportation, or a better military, or a more solid park system, but I think the public prefers cutting edge therapeutics.

 

[Rexedgar]

That would be nice, but its not. And theres no way to force that to happen.

But the people in the US are the wealthiest in the world - by far,

We are also the greediest, by far. PBMs, insurance companies, lobbyists, stockholders and others, have tunnel vision when it comes to their wallets.

when you consider the size. Healthcare becomes more valuable than a fifth television or a second jacked up pickup truck, and we choose to divert the funds to cutting edge medical research- drugs and devices. For certain people at a certain time, having a valuable cancer treatment is more important than anything else in the world. I guess we could direct those funds over to better transportation, or a better military, or a more solid park system, but I think the public prefers cutting edge therapeutics.

 

[Gaius46]

Why does Health Care Cost So Much? Musk and Cuban

MSN

Cuban laid out seven ways those contracts are keeping drug prices high and hurting employees. His exact list stated:

• Don't control your claims data
• Don't control your formulary
• Have to pay more for "Specialty Drugs" that have nothing special about them
• Get rebates that are paid for by your sickest and oldest employees and result in higher deductibles and co-pays that impact the wellness of your workers and their families.
• Cause independent pharmacies to be reimbursed for less than their costs for brand drug scripts for your employees and families, causing them to go out of business.
• Can't talk to manufacturers to put together wellness programs for things like GLP1s.
• Signed a PBM contract with an NDA which prevents you from publicly discussing your PBM contract, resulting in an opaque, inefficient market, which leads to higher prices and lower quality of care for the entire country.

"All of this allows the big PBMs to continue to distort the pharmacy market for literally EVERYONE," he wrote.

Because we treat healthcare like a free market when it is in fact the most unfree market, both by design and it's very nature, possible.

 

[Gaius46]

That would be nice, but its not. And theres no way to force that to happen.

But the people in the US are the wealthiest in the world - by far, when you consider the size. Healthcare becomes more valuable than a fifth television or a second jacked up pickup truck, and we choose to divert the funds to cutting edge medical research- drugs and devices. For certain people at a certain time, having a valuable cancer treatment is more important than anything else in the world. I guess we could direct those funds over to better transportation, or a better military, or a more solid park system, but I think the public prefers cutting edge therapeutics.

How much does the taxpayer subsidize the development of therapeutics?

 

[Threegoofs]

How much does the taxpayer subsidize the development of therapeutics?

Not a huge amount, usually - the government does the basic science research - finds the druggable target molecule. Pharma then finds out how to target the enzyme/receptor, etc with a drug, and brings it through trials. If a compound is discovered by academics, they usually get the patent and any future profits usually go back to the academic institution.

 

[Gaius46]

Not a huge amount, usually - the government does the basic science research - finds the druggable target molecule. Pharma then finds out how to target the enzyme/receptor, etc with a drug, and brings it through trials. If a compound is discovered by academics, they usually get the patent and any future profits usually go back to the academic institution.

I read a paper in JAMA on this subject and the paper contends that the NIH spent about $187 billion on drug research into approved drugs from 2010-2019 and that amount was "not less" than what the industry spent.

It doesn't seem that the feds concentrate on drugs for rare diseases that won't generate a decent ROI at prices humans can afford because they did research on 90+% of the drugs approved during that time period.

Do I take away from that that "if not for the government the average pharmaceutical would cost twice as much?"

Comparison of Research Spending on New Drug Approvals by the NIH vs the Pharmaceutical Industry

This cross-sectional study examines National Institutes of Health and pharmaceutical industry investments in recent drug approvals.

jamanetwork.com

 

[Threegoofs]

I read a paper in JAMA on this subject and the paper contends that the NIH spent about $187 billion on drug research into approved drugs from 2010-2019 and that amount was "not less" than what the industry spent.

It doesn't seem that the feds concentrate on drugs for rare diseases that won't generate a decent ROI at prices humans can afford because they did research on 90+% of the drugs approved during that time period.

Do I take away from that that "if not for the government the average pharmaceutical would cost twice as much?"

Comparison of Research Spending on New Drug Approvals by the NIH vs the Pharmaceutical Industry

This cross-sectional study examines National Institutes of Health and pharmaceutical industry investments in recent drug approvals.

jamanetwork.com

That study, like most, is messy, because it’s not really clear what ‘development’ means. Having a prodrug that works on a target in cells is not the same as a developed drug.

As an example, GLP-1 was been looked at for decades. But it took a drug company to develop it into a once weekly product and prove it works on diabetes, obesity and heart failure. GLP-1 by itself lasts about one minute in the bloodstream, and would have to be given by continuous infusion. So is that GLP research counted as development, or not?

Again, a lot of NIH funding is for basic science, which has lots of benefits unrelated to drug development.

Also, the NIH will fund expensive clinical trials to look at treatment- often studies that go beyond patent lives and world not be funded by industry. Sometimes those studies are done in combination with industry- with the company supplying drug, logistical and statistical expertise.

 

[Lord Tammerlain]

Shouldn’t that burden be shared by all countries they use the drug?

Pharma sales reps in the US make big bucks. They also take groups of doctors on " business trips" to discuss new drugs and or new ways to use older ones.

Said sales reps are often young and very attractive. Those costs are likely quite large,

 

[Threegoofs]

Pharma sales reps in the US make big bucks.

Some do. Device sales people especially. Pharma - I’d guess 100K.

They also take groups of doctors on " business trips" to discuss new drugs and or new ways to use older ones.

No they dont. Not allowed to do trips- and has been that way for about 20 years. Can’t even hand out pens anymore.

Said sales reps are often young and very attractive.

Not that much anymore. They tend to be people with experience, since the industry has been cut down substantially in the last few decades.

Those costs are likely quite large,

They are large, but the thing is that eliminating those costs will not change a thing on drug development - the investment in sales forces makes the prospect of losing lots of money on an unsuccessful drug worthwhile, because you can really ramp up a successful one.

 

[Lord Tammerlain]

Some do. Device sales people especially. Pharma - I’d guess 100K.

No they dont. Not allowed to do trips- and has been that way for about 20 years. Can’t even hand out pens anymore.


Not that much anymore. They tend to be people with experience, since the industry has been cut down substantially in the last few decades.


They are large, but the thing is that eliminating those costs will not change a thing on drug development - the investment in sales forces makes the prospect of losing lots of money on an unsuccessful drug worthwhile, because you can really ramp up a successful one.

My info was from 20 years ago, thanks for the update