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Score hidden · 1 hour ago

Trump says they should be ashamed, while he has caused premiums to skyrocket pretty much offsetting any freeze in price for prescriptions while simultaneously causing the price of more specific types of medications such as biologics to go up. It's not like people are going to be able to afford their prescriptions when their insurance is through the roof.

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Original PosterScore hidden · 1 hour ago

I expect 2019 will be the year Congress/Trump turn from drug prices to insurance premiums. Another tricky situation without a ton of easy answers.

Cutting cost-sharing reduction payments obviously puts upward pressure on price. It will be interesting to see how the repeal of the individual mandate plays out. One thing insurers have to be careful with is creating "death spiral" scenarios where their increasing premiums force healthy people off of their plans, resulting in waves of higher prices and further exodus of healthy pool members.

Score hidden · 51 minutes ago

Lol, that is already happening, it's one reason the awfully neoliberal ACA included the individual mandate.

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Original PosterScore hidden · 37 minutes ago

Yeah, 2019 will be the first year we get to see how it plays out in the market place.

2 points · 2 hours ago

Could it contain the remains of ancient Greek leader Alexander the Great, or (less appealingly) a deadly curse?

According to experts who have now unsealed it, it's a no to both. Instead, it revealed three skeletons and red-brown sewage water, which gave off an unbearable stench.

Well, that's a dissapointment. How do they usually ID the occupants of tombs like this?

16 points · 14 hours ago · edited 5 hours ago

Interestingly, there is a bit of a mismatch between what patients want and what oncologists want when it comes to predicting life expectancy of cancer patients.

Most patients (>70%) want to know how much time they have left. A realistic sense of expected time left can help facilitate end of life discussions, prioritize expenses, avoid potentially heavy side-effect associated care and improve quality of death.

Most oncologists (>80%), though, don’t provide patients with time left estimates. The reasoning being it is difficult to get right (within a few weeks, often impossible; within a year more feasible), is stressful for doctors and he only limited evidence that making any prediction is actually good for the patient.

As for how the oncologist makes the prediction, it’s mostly trying to make sense of the data we have and statistics. Most major cancers have good data sets on survival rates, disease progression rates etc. stratified by stage and basic health status info. That plus personal experience is how the oncologist will attempt to make an estimate about life expectancy. It’s onviously tricky, though, where patient health and support networks can be hard to quantify but have an outsized impact on survival. Further, the data we have is historical, but the field is always - and often rapidly - changing. What was true five years ago may not be true today.

Im sure its a couple of bucks off on a couple of meds. My guess is everything else will continue its steady rise.

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Original Poster-1 points · 20 hours ago

The headliner is 60% off of their HepC drug (which brought in $1.7 billion in revenue last year).

Original Poster-1 points · 20 hours ago

The cynic will say this drug accounted for only 4% of Merck's sales last year, and tis likely to account for even less this year as it faces competition from Abbvie's competing drug. They will write-this off as a move designed to appease Trump that won't fundamentally impact anything.

The optimist will say this is a big deal. No matter what way you slice it, a billion dollars is a lot of money. And this is the third big pharma company in as many days to make a commitment to responsible pricing (counting also Pfizer and Novartis, though others have less publicly made similar claims). They will also point out that drug prices have risen much less sharply this year than they have historically.

I lean towards the latter group. Time will tell, I guess.

Meh, not buying the spin. Zepatier treats type 1,4 and 6 hepC Savaldi treats type 1, Vosevi treats them all, Epclusa treats them all, Viekira Pak treats type 1, Mavyret treats them all, Harvoni treats type 1, 4, 5, and 6 and Technivie treats type 4 without cirrhosis. This is a decision that is being made because of market competition and not because of any sort of altruism. The hepatitis market is getting to be much more competitive now so you can't charge what you could before. Zepatier isn't even a big driver for Merk's profitability either. Sales of $122.5 million per quarter isn't much money as far as a big pharma is concerned. They just see this as a way to get good press for something they would have to do anyway because of market forces.

(I am a Scientist in Big Pharma)

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Original Poster1 point · 20 hours ago

The flip side, is I think this highlights the power of market-forces to lower prices. Even monopolists can face competition, and when they do prices fall. People have historically pointed to HCV as the zenith of pharma greed - but in reality, I think it is a perfect model for how the system should work: high impact drugs having a huge effect on patient outcomes, accessibility improving rapidly over time.

The problem with the model is that the system can't handle that kind of pricing for a disease that is more common than HCV. Imagine if there was a cure for ER+ HER2+ breast cancer and we charged $400k per patient. That would destroy the system because there is such a large patient population with breast cancer, much larger than HCV. These kind of high prices can only be sustained for things like orphan drugs and other small population drugs. It could take years before a competitor is able to get on the market. What if the MoA for the drug is really the only way to target the disease and the company has really carved out a perfect IP space for itself preventing others from getting in and they happened upon this answer 4 years into their patents so they have 16 years left? I am not saying this has happened but it could certainly happen.

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Original Poster1 point · 20 hours ago

I would have to do the math, but I would be surprised if pricing a cure for ER+ HER2+ cancer at $400K didn't save the system money. Between surgery, targeted therapy/chemo, neo-adjuvant therapy you'll rack up a big bill pretty quickly. And that before accounting for all the QALYs a cure adds to the equation.

And, frankly, that's how it should be. Drug price should be tied to value. It was never the Harvoni's that wreak our budgets. It was spending $18 billion per year on Humira in the face of many cheaper, often better options. Or paying $300k/year for a drug that only adds a month or two to mOS.

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I make drugs for the treatment of cancer. Life science and biotech are my passions. Opinions are my own.
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