How to fix the pharmaceutical market?

First we dump money into the market.
Then we create monopolies.
Then we complain bitterly about high prices?
Then after waiting an artificial amount of time, we spend enormous resources to literally reinvent the same frickin drugs?
It’s so dumb!

And that’s when it “works”. There’s so much other dumb shit to stop it from working-- negotiation bans, pay-to-delay, evergreening, patent thickets, mergers, and about 100 different middle-men trying to either minimize or maximize leverage through discounts/rebates/contracting…

There has GOT to be a better way, right?

What’s the most realistic better way?

I’d be inclined to start with addressing how best to fund research and ensure ethical practices for that research.

So much pressure to “show (strong) results . . . 'cuz $$$$$”.

  1. don’t dump money into the market.
  2. don’t complain after 1. when monopolies raise prices on their proprietary cures.
    2b if you’re unhappy about high prices, you’re free to develop your own cure on your own
    2c if you’re not able to develop your own cure, then you would’ve died anyway, don’t feel sorry for yourself for missing out on a cure you never developed.

But why literally reinvent the wheel?

Like there’s all sorts of very stupid reasons that biosimilars are failing to reduce prices, but fundamentally, isn’t it just a big waste of time and money to create something that already exists?

If the prices are the problem, then fix the prices.

They just changed quite a bit in the Inflation Reduction Act.

To promote the Progress of Science and useful Arts, by securing for limited Times to Authors and Inventors the exclusive Right to their respective Writings and Discoveries

I think that “make sure patents actually run out on time and others can profit by manufacturing the drug” is a good idea.

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You’re missing one piece:

We have a system in place where the discussion of “what meds should be used” is disconnected from “what do those meds cost”, and for at least some portion of the population, we aren’t always directly impacted by the cost question.

(For that last bit – both my wife and I hit our stop-loss limit in our health plan every year. Aside from complying with our plan’s requirement to use generics & 90-day scripts when possible, and jumping through any other hoops…it doesn’t matter to us whether we opt for “expensive” vs “cheap” meds.)

We’re missing a few links between “cost” and “deciding what should be bought” that would potentially permit free market pressures to have a chance at working to control costs.

I’m a fan, though I’d say it’s less about fixing the fundamental flaw, and more about fixing an extra flaw that we introduced 20 years ago, due to our corrupt system of government.

Sure, I’m not advocating a free market. I’m asking what politically viable alternatives are there to the current already artificial market.

But shouldn’t the question be which meds are most effective at treating the condition and not which drugs are most cost effective?

I realize there is a cost benefit analysis if 2 meds offer similar results at different price points but isn’t the Dr. supposed to worry first about the health of the patient?



If the best med runs $1500/month, but there is a combination of generic meds that may work adequately for $20/month…that’s worth a discussion.

The situation and prices are not hypothetical. They’re from my current situation…except that with my health plan, I don’t have a particular incentive to elect the cheaper option, and the pharmaceutical company doesn’t have a particular incentive to charge less, because of folks like me lacking that incentive.

Yeah I realize that is a potential real life situation. I’m not sure who should be making that call and if Drs should have to know the going market rate for various drugs as well as the general efficacy.

One potential improvement would be introducing the ability for doctors to write “multiple choice” prescriptions (“fill one of these…”), with the doctor providing guidance on the pros/cons of the alternatives.

Admittedly, there is the potential complication of drug interactions, and how having several “multiple choice” prescriptions would complicate pharmacy interactions.

I acknowledge that there are issues with the idea; mostly I’m just speculating on ways to provide some pushback against high drug costs where the current system seems to have failed.

Absent an urgent need, this seems like it used to/should be the purview of the pharmacist. The pharmacist should know the general purpose of the meds, all of the meds a particular person is taking, and is closer to the cost. The pharmacist would then be in a position to recommend alternative options that may fit the bill. The patient and their Dr. could review that recommendation and accept or reject. But we don’t pay pharmacists to do that anymore. I think 99% of the time we pay them to fill a prescription, nothing more, except possibly identifying potential drug interaction issues IF they are aware of the other drugs a particular person is taking. Which may not be the case if someone is not getting all meds filled at the same pharmacy.

Can you summarize what changed? Thanks!

I mean, is there some sort of point at which we say cost should be a factor though?

Suppose I have a condition which can be treated with A or B. A and B work equally well at treating the condition. Clearly I should choose the less expensive option. (I’m not sure this happens in all cases: think of a doctor who prescribes the name brand instead of the generic.)

For a different condition I can choose C or D. C works twice as well as D and costs 10% more. I think most people would say that’s a pretty strong case for spending the extra 10% and getting C.

But for a third condition the choices are E and F. E works 1% better than F and costs 500 times as much. (Let’s say $5,000 for a monthly supply of E vs $10 for a monthly supply of F.) Is there / should there be a point where anyone says “eh, F is good enough; if you want E you can cough up the extra $4,990 yourself”? If you say no, what if E was 0.01% better and cost 10,000 x as much? At some extreme you probably think we shouldn’t pay for the more expensive drug. (Insurance, Medicare. Medicaid, VA, prison healthcare, etc.)

But who should be the arbiter of these decisions?

Anyway, one thing that would help us to make the practice of bribing doctors illegal.

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Yeah I think most people agree with what you are saying twig. What many people disagree on is who should be the arbiter.

oh and folks facing decisions that are mortality related are not interested in reducing their chances 1%, to save an insurance company a few buck at least that’s been my experience anecdotally from the folks I know who have been faced terminal disease.

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If one develops a proprietary drug and it’s the only drug that works, said person/company should have absolute say on what the price should be.

Now, when subsidies come into play, that gets tricky. Since government serves the people, government subsidized cures should be cheap for the people.

If it’s a shareholders, then shareholders should benefit from lower prices, but that’s up to the shareholders to duke it out themselves. After out, someone with 51% control have absolute say.