Do you think there is a way to reduce drug prices?

[fabio]

Personally I do not pay and the price on my meds each box is 600 euros (well at least not directly and get taxed),but I do wonder if there is a way to make antiretrovirals accessible to more people.
What would you think would be a good solution to make that happen? What are the chances?

[Expat1]

More people need to source them as generics or in the grey import market.

You can't take a vacation to Capetown, or Bangkok and get meds.  Probably Brazil also.

[joemutt]

the solution exists in many countries ; the government asks big pharma for compulsory licensing and if not the health organisation of those countries feel free to produce or import generics. a good example is Thailand.
https://en.wikipedia.org/wiki/HIV/AIDS_in_Thailand

[fabio]

Also another thing: are these meds as expensive to make as say a normal aspirin that is sold way less?
I mean having to stay alive shouldn't be a matter of choice.

[Mojito]

In India the generic version of Atripla cost about 40-45 Euro for a bottle for a month supply.

[daveR]

Would be good to see the prices drop, I pay for mine myself, all be it at a reduced cost due to the country I live in.
We do have to remember though when we start comparing original manufactures costs to generic manufactures costs, the later group probably contributed nothing to the development, testing and approval costs.
Very easy to come along after the leg work has been done.

Regards
Dave.

[MadDog125]

Government owned drug manufacturing labs, and or dramatic subsidy of R&D.  Pharmacy companies spend millions sometimes billions on R&D with no guaranty of success.  Drugs may have too many side effects or too severe ones to justify effect.  I can't speak for other countries but in the US 70% per the IRS of government health spending is on drugs.  In America the only one paying list price is the government.  To me either make the drugs, subsidize R&D so risk goes down, or actually leverage mass buying power.

[Expat1]

are these meds as expensive to make as say a normal aspirin

Edurant, one of my drugs costs over $1000 for 30 pill in the USA.  Same exact medicine, same bottle, brand name not generic costs about $8 at the Thai Red Cross Clinic, and I pay about 900 Baht ($28) for the same bottle of 30 pills at a private hospital in Thailand. 
So yes, they are profittering in the USA. 

The new generic Descovy and Tivicay that is used in South Africa is under $100 from pharmacies in India, even cheaper in South Africa.   Doesn't exist in regular pharmacies in USA and the two pill combo is over $3000 for the two bottles of 30 pills.

[fabio]

My pills cost 600 each box,but idk if all that is the actual manufacturing price or a price that greedy company owners have made to take advantage of the need of those meds
It's not just in USA unfortunately. Even though in Greece meds are "free",it still is taken out of the tax money,which is why sometimes they are "out of meds to give" because of shortages. It's quite the nightmare,when I get there myself they are short of one med (usually truvada) and thank god the secretaries of the ward always have extra boxes (which is how I got by the new year time).

[MadDog125]

At the risk of sounding like a total cynic, are we sure that isn't just a copyright rip off.  Getting a drug approved in the US is a long expensive process.  Patents are only permitted for a limited window.  A price tag doesn't just reflect manufacturing cost.  It's R&D, liability, since here in the US drinking bleach is somehow dow industrials fault if they forgot to label the bottle not for human consumption.  Generics are always cheaper by far.  I still say it's simple either manufacture drugs at a federal level, pay for the R&D so effectively new drugs are made generic from word go, or leverage group buying power.  I can speak for other governments but the attitude in America is put out fires by burying them in cash.  There is no emphasis on efficient use of funding.  Not budget cuts just smart use.  For example I use 2" micro membranes for chemical testing.  Why can I buy them from the same manufacturer for a third the price the local compliance office gets them for?

[Expat1]

when we start comparing original manufactures costs to generic manufactures costs, the later group probably contributed nothing to the development, testing and approval costs.

Except that many (perhaps most) of the drugs were already developed for other uses (AZT) or by small research labs, of government scientists or from publicly funded universities, or are copies of other company's drugs intellectual property (Biktarvy see Gilead accused of breaching Irish patent for HIV drug https://www.irishtimes.com/business/health-pharma/Gilead-accused-of-breaching-irish-patent-for-hiv-drug-1.4117043),
ViiV Healthcare Company and Shionogi & Co are suing Gilead and its Irish subsidiary)
, or are evergreening products of there own patent expiring drugs (TAF).

[Expat1]

in the US 70% per the IRS of government health spending is on drugs.  In America the only one paying list price is the government.  T

Did you get that from a tRump speech?  Real figures is:Prescription drug costs are incurred by patients, private payers, and the federal government, including Medicare, Medicaid, and the Department of Defense (DOD).

Spending on prescription drugs (for both brand-name and generic drugs) has increased in recent years. For example:

Retail prescription drug spending was estimated to account for about 11 percent of total personal health care service spending in the United States in 2017, up from about 7 percent in the 1990s.  https://www.gao.gov/key_issues/prescription_drug_spending/issue_summary

Also VA, Medicaid, and DoD buy their own supplies at reduced cost.

[Expat1]

https://www.statnews.com/2019/12/10/large-pharma-companies-provide-little-new-drug-development-innovation/

Do large pharma companies provide drug development innovation? Our analysis says no.

"We scoured the companies’ 2017 annual reports. A total of 62 products — 44 from Pfizer and 18 from J&J — were listed in them. The discovery and early development work were conducted in house for just 10 of Pfizer’s 44 products (23%), as listed in Table 1. Only two of J&J’s 18 leading products (11%) were discovered in house, as shown in Table 2."

[leatherman]

I can't speak for other countries but in the US 70% per the IRS of government health spending is on drugs.

the first results of a google search "government health spending on drugs" came from the CMS

Hospital Care 33%
Physician and Clinical Services 20%
Retail Prescription Drugs 10%
Other Health, Residential, and Personal Care Services 5%
Nursing Care Facilities and Continuing Care Retirement Communities 5%
Dental Services 4%
Home Health Care 3%
Other Professional Services 3%
Other Non-durable Medical Products 2%
Durable Medical Equipment 2%

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/highlights.pdf
The Centers for Medicare & Medicaid Services, CMS, is part of the Department of Health and Human Services (HHS)

In America the To me either make the drugs, subsidize R&D so risk goes down, or actually leverage mass buying power.

America does subsidize drug R&D. Right now, the US has sued Gilead for running a monopoly on Truvada when the CDC has the patent. In part based on that patent dispute lawsuit, Peter Staley (the founder of this site when it was known as aidsmeds.com) is part of a class action suit against Gilead and its collaborators—Bristol-Myers Squibb (BMS), Janssen (a subsidiary of Johnson & Johnson) and Japan Tobacco—for illegally establishing a monopoly on HIV combination pills by restricting generic competition, thereby keeping drug prices artificially high.

https://www.nbcnews.com/feature/nbc-out/u-s-sues-gilead-claiming-it-owns-hiv-prep-patent-n1078346
https://www.poz.com/article/hiv-drug-manufacturers-broke-antitrust-laws-advocates-say

Medicaid and Medicare do leverage mass buying power and that is one of the reasons America needs a universal health care program. Medicaid and the Ryan White ADAP (AIDS Drug Assistance Program) often do not pay list price. For example, since 1992 the 340b program has been purchasing manufacturers-reduced-cost meds for people living with HIV

https://en.wikipedia.org/wiki/340B_Drug_Pricing_Program

[MadDog125]

I am not ready to be told where I must go and who I must see as government buerocracy that works 9-3 Monday through friday, is closed 11-1230 every day and is off 10 holidays a year and every other Tuesday has complete control of my healthcare.  Banning the concept of private industry is the worst idea I have heard in ages.  If socialized, centrally controlled healthcare is so great, then why do I see a dozen medical transports a day carry foreign patients most of which are canadian?  It may be an effective way to cut cost to then end user.  However in my experience dealing with ANYTHING under government control is a model of ineffiency and gross mishandling of public funds.  Central planners are terrible stewards of the people's money.  Why wouldn't they be?  There is zero consequence for figuratively lighting mass piles of money on fire to provide illumination.  Sorry I have seen enough first hand, and dealt with enough government offices on as simple of matters as fixing a traffic light to not want them anywhere near total control of healthcare. 

[Jim Allen]

My two cents, socialized healthcare works for many nations, no single system is perfect though. Privatization is scary shit, seen firsthand what handing over control to companies did to healthcare like in Holland, beyond sick at times.

Getting back on topic

Personally I do not pay and the price on my meds each box is 600 euros (well at least not directly and get taxed),but I do wonder if there is a way to make antiretrovirals accessible to more people.
What would you think would be a good solution to make that happen? What are the chances?

600 euro is no too bad. Companies do need to make money and profits as it's not a charity and they need to be motivated to develop things, that said, I think patent law needs to be revisited and shortened.

I do wonder if there is a way to make antiretrovirals accessible to more people.

Stop wasting money funding and investments on crap like this, petri dish treatments and "cures" - https://forums.poz.com/index.php?topic=73814.0

Instead, treat everyone with current meds, get free to users prep out, reach 90-90-90 goals in 5 years globally, continue to improve on that and wait for those living with HIV to die off and the nasty pandemic with us. Will not suit everyone but the majority and move humanity forward.

[fabio]

I suppose if they were as accessible we wouldn't have any new infections either,since (almost) everyone would be either undetectable or on prep,what's a need for cure then?
I think having those pills at a reasonable price (say 30 or 40 euros) it would be heavenly,just to go to the nearest drug store to get as many boxes as you need. Maybe we will get to that point (hopefully).
About the "cures",it really seems like a far away dream and most of these are an "investment trap" as I've come to realise from the many trials they have made. I'm quite sad that the injectible arv didn't get to pass,I still hope for easier and more treatment options,which seems more realistic.

[leatherman]

I am not ready to be told where I must go and who I must see as government buerocracy that works 9-3 Monday through friday, is closed 11-1230 every day and is off 10 holidays a year and every other Tuesday has complete control of my healthcare.

I'm sorry but those are the words of someone who hasn't used the public health care system. I've been using socialized healthcare (through Ryan White, Medicaid and Medicare) for 21 years. I've never been turned away from any doctor I needed, or wanted to see, nor have I ever had issues getting access to medication. My husband however with his corporate insurance has to jump through hoops to get prescriptions on time and can only see doctors in the "network". I'd choose, and he would choose, my health care access over his any day of the week. And since he just had to fight with two insurance companies and three pharmacies to get his monthly ARVs four days late, this is the day he wishes he had my access.

However in my experience dealing with ANYTHING under government control is a model of ineffiency and gross mishandling of public funds.

You really should visit your local Ryan White Quality Meeting to see how efficiently the Ryan White and Medicaid programs provide HIV health care in America; and how the money is meticulously managed through resource allocation done with city, county, state, provider and consumer input.

personally, I've met very few people who actually "like" their health insurance. In the grand scheme of things, having a middleman who "takes his cut" along with limiting access to certain doctors just doesn't seem like the best way to manage health care for people.

[bocker3]

I am not ready to be told where I must go and who I must see.......

Except you already are told where you must go and who you must see, if you want your private insurance to cover it.  I know of no plan that is so wide open that you can go whereever you please.
You hate government bureaucracy but, I guess, are just fine with the business people in your insurance company overruling your doctor's medical advice to cover test "X".  Why?  Because business man in insurance company doesn't want to spend that money.  The say that they do this "to protect patients"  -- from whom? their doctor???

Besides -- the US government already "controls" most of our healthcare -- Medicaid, Medicare, VA.  All of these are god sends.  Are they perfect?  Nope -- but just try and take them away and see what happens.

 

[MitchMiller]

Here in the USA there is no excuse for the high cost of generic versions of ARV's compared to the cost of the same drug produced by an Indian pharmaceutical company. 

Example:  Efavirenz 90caps 200mg:   
                                  brand name (Sustiva) in USA is $1033 (from drugs.com)
                                  generic in USA is $750 (from drugs.com)
                                  Cipla equivalent $165 (from offshore pharma)

Note the Cipla drug has been approved by the US FDA for PEPFAR. 

It doesn't seem to me this would be very hard to fix.  It seems our representatives in government are more beholden to the pharmaceutical industry than to the constituents they are supposed to be representing.

[Expat1]

Plug the generic names into goodrx.com and several drugs are quite cheap.  Like tenofovir, and abacavir.

[MitchMiller]

Thanks Expat.  The price goodrx quotes is considerably less than the retail price.

However, I wonder if one would actually get that price?  The Goodrx coupon contains this statement:

This is your estimated price at Walmart; the pharmacy will provide the exact pricing.

The total Goodrx price is still $1000/year greater than what I'm paying for Cipla generics (difference is more if I get them on sale due to a near-term expiration date, which is what I often do).

I'm wondering what the negotiated price is when using my health plan?  I'm betting it's higher than the Goodrx price.

It's good to know if the US Customs Svc starts seizing my meds, that I can still afford the Goodrx price here in the US.