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posted by martyb on Friday August 09 2019, @10:16PM   Printer-friendly
from the Good-news-for-cross-border-insulin-shoppers dept.

If you're into going to Canada for lower drug prices, things should get even better after the middle of next year. Canada is going to be changing the way it calculates the price of medication, which will lower costs. Canada can do this because, unlike the USA, Canadian regulators are allowed to determine when a patent monopoly is being abused and act accordingly.

Canada Promises to Save Billions with Tweaks to Patent Drug System:

Canadians can expect to pay less for prescription drugs as early as next summer

The federal government is making changes to the way it will evaluate new drug prices, a tweak it says will save Canadians billions over the next 10 years.

On Friday, the government released changes to the Patented Medicine Prices Review Board, first set up in 1987 as a shield against what the government calls "excessive prices," set to come into force next July.

"The [board] relies on outdated regulatory tools and information that foreign medicine pricing authorities updated years ago. As a result, list prices for patented medicines in Canada are now among the highest in the world," notes a release from Health Canada.

Under the new regulations, the board will no longer compare prices with the United States and Switzerland, which have some of the world's highest drug prices, when figuring out what companies are allowed to charge. It will still compare drug prices to France, Germany and Italy, and has added Japan, Spain, Norway, Australia, Belgium and the Netherlands to the list.

The board will also now have to consider a drug's "value to and financial impact on consumers in the health system" when determining if a price is excessive.

"These bold reforms will both make prescription drugs more affordable and accessible for all Canadians saving them an estimated $13 billion in the next decade and lay the foundation for national pharmacare," the federal health agency said in a statement.


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  • (Score: 2) by JoeMerchant on Saturday August 10 2019, @02:46AM (27 children)

    by JoeMerchant (3937) on Saturday August 10 2019, @02:46AM (#878088)

    you don't pay for the work, you don't get new drugs

    There's a difference between paying back $10B in drug development costs over the 5-10 years after approval and launch, and simply milking a condition for every cent you can get - as has been done, repeatedly, in the last few years.

    Just because investment bankers play long odds and reap insanely huge payouts on the rare occasion when they don't go bust and do hit a runaway best seller doesn't mean it's the best incentive model for every area of human endeavor.

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  • (Score: 2) by The Mighty Buzzard on Saturday August 10 2019, @10:51AM (26 children)

    by The Mighty Buzzard (18) Subscriber Badge <themightybuzzard@proton.me> on Saturday August 10 2019, @10:51AM (#878176) Homepage Journal

    You have a better one that works with long odds and extreme expense?

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    • (Score: 1, Interesting) by Anonymous Coward on Saturday August 10 2019, @03:23PM (1 child)

      by Anonymous Coward on Saturday August 10 2019, @03:23PM (#878278)

      I used to do preclinical research. I assure you that if someone like me was in charge it would become at least 4x more efficient.

      Standards are extremely low among medical researchers. Even the most basic results can only be repeated like 25% of the time... when someone even tries. They come up with excuses ("it isn't novel") not to repeat each others work. If we had higher research standards the entire amyloid-beta alzhiemer's fiasco would have been avoided, the "cancer is many diseases" excuse would not be in play, etc.

      • (Score: 2) by The Mighty Buzzard on Monday August 12 2019, @01:59PM

        I don't at all disagree. Bean counters and lawyers make lousy scientists. Your second paragraph may be more thorough but it's the dead opposite of efficient though. More work means more man-hours, which means more cost. It may mean savings over the long term but that would need to be proven before it could be claimed.

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    • (Score: 2) by JoeMerchant on Saturday August 10 2019, @04:24PM (23 children)

      by JoeMerchant (3937) on Saturday August 10 2019, @04:24PM (#878314)

      When it comes to "gun to your head" medical conditions: price caps. You're researching a lifesaving cure for X (diabetes is a good example, but there are almost unlimited possibilities).... don't expect to be able to charge $10,000 per month per person on treatment for $0.01 per dose manufacturing cost pills.

      Outside oversight (as the Canadian system seems to be implementing) with bias toward cures instead of chronic symptom abatement, bias toward the lowest total lifetime costs of treatment... Right now, the system is too heavily biased by actors who steer patients toward treatments which generate the greatest income for them, rather than the best outcome for the patient.

      Random anecdotal example: 0.3cm Schwannoma on the tongue - see a new ENT for followup evaluation 1 year after diagnosis in a different city. New ENT, first checks insurance coverage, after Aetna calls the receptionist and explains, then it's time to see the patient. "Oh, yes, Schwannoma, very scary stuff, can result in a string of pearls condition, you want to get that completely excised, I have an opening in my surgery schedule next Tuesday - let's get you on the schedule now." 30 seconds on Google confirms: yes, one case of Schwannoma in a Japanese fisherman resulted in an intracostal (ribcage) string of pearls condition - no other references found.

      Not all MDs are like that, but far too many are. Far too many drug reps give lap dances in exchange for high volume prescription writing, and far too many surgeons "accidentally" make future work for themselves while performing a first procedure.

      Transparency, oversight, and at least cull the most outrageously egregious outlier bad actors from the game.

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      • (Score: 0) by Anonymous Coward on Saturday August 10 2019, @04:39PM

        by Anonymous Coward on Saturday August 10 2019, @04:39PM (#878323)

        Yet more wasted breath arguing with the status quo. Things are peachy keen OK?? It is every American's GOD GIVEN RIGHT to rip eachnother off! /s

      • (Score: 2) by The Mighty Buzzard on Monday August 12 2019, @02:09PM (21 children)

        When it comes to "gun to your head" medical conditions: price caps. You're researching a lifesaving cure for X (diabetes is a good example, but there are almost unlimited possibilities).... don't expect to be able to charge $10,000 per month per person on treatment for $0.01 per dose manufacturing cost pills.

        Which is one reason idealists do not run pharmaceutical companies. If the $0.01/dose treatment cost a billion dollars and a decade to develop, you don't sell it for $0.02/dose if you want to stay in business. Likewise, if there aren't many people in the world that even need your drug, you have to increase the price to recoup your investment in a reasonable amount of time.

        Businesses are not charities and business is why we lead the entire world by such a huge margin on drug/treatment creation. Could the industry use some bullshit checks? Absofuckinglutely. Price caps that keep the pharmaceutical companies from being able to afford a serious level of research? Bad fucking idea.

        --
        My rights don't end where your fear begins.
        • (Score: 2) by JoeMerchant on Monday August 12 2019, @02:48PM (20 children)

          by JoeMerchant (3937) on Monday August 12 2019, @02:48PM (#879211)

          If the $0.01/dose treatment cost a billion dollars and a decade to develop, you don't sell it for $0.02/dose if you want to stay in business.

          Clearly, which is why there are things in this world called judges, who exercise judgement in oversight.

          When a previous business had done the development and taken the drug to market and was ready to move on to other things, sold the drug outright to another company, and the new company decides to increase the price of the drug 100x - what's that?

          some bullshit checks? Absofuckinglutely. Price caps that keep the pharmaceutical companies from being able to afford a serious level of research? Bad fucking idea.

          Price caps that keep pharma companies from netting over 100% profit on their endeavor within the next year? Again, judgement. There has to be a limit, because if I've got a liter of water and you're walking through the desert 100 miles from the next town, you'll give me just about everything you've got if you need that water. That's not business, that's extortion.

          A bad analogy comes to mind: after Hurricane Andrew much of South Miami was without drinking water because they used electric pumped wells. A good samaritan loaded up his pickup truck with bottled water from a grocery store, spent something like $0.79 per gallon on the water, plus his gas to drive it 100 miles into the area in need. He was asking the crowd for $1 per gallon and they f'ing rioted on his ass and stole the water. That was wrong, that's not rule of law or commerce or decency in action on the part of the thirsty crowd, that's the thirsty crowd just about guaranteeing that they'll never get water that way again. I'm on the side of the guy in the truck, even if he's charging $2 per gallon for the water - supply and demand, a couple hundred bucks profit might be fair compensation for his time, trouble, and even risk in delivering the water. If the dude was standing there with the National Guard protecting him and demanding $100 per gallon for the water from the thirsty crowd - they damn sure should have called for his lynching.

          Where's the line? $1, $2, $5? I don't know - but long before you get to $100, yeah, there are limits to free enterprise, particularly when you're essentially threatening people's lives if they don't pay up.

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          • (Score: 2) by The Mighty Buzzard on Monday August 12 2019, @04:05PM (19 children)

            Thus my earlier:

            Could the industry use some bullshit checks? Absofuckinglutely.

            If you let idealists decide what constitutes bullshit though, you're going to cost the world a fuckload of medical advances. If a company needs to charge $10,000/month to recoup their investment within half the patent's length, that's what they should charge, even if it means people who can't afford it die.

            That's not heartless either. Putting a company that saves more lives with every dollar it makes out of business so that poor people can have the drug as well would cause far, far more harm than the alternative.

            There's no need to take either position to the extreme though, despite what politicians and talking heads today spout.

            --
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            • (Score: 2) by JoeMerchant on Monday August 12 2019, @04:23PM (18 children)

              by JoeMerchant (3937) on Monday August 12 2019, @04:23PM (#879270)

              needs to charge $10,000/month to recoup their investment within half the patent's length, that's what they should charge, even if it means people who can't afford it die.

              Agreed - if it costs more to save my ass than I can afford, my ass dies. That's business, aka triage, appropriate allocation of resources, etc.

              The question is: need. How much profit does a company need? Any time I've thought about setting up any kind of business, if I can't guarantee a 2x profit margin, it's not anywhere near close to acceptable - there are too many risks, foreseen and unforeseen, to even bother launching a new business with less than 100% profit. I'm cool with 100% profit, maybe 1000% profit in certain circumstances.

              I'm not cool with jacking up profits to cover the cost of yet another corporate jet, monthly junkets to the Caribbean for the executive circle, etc. and crying "poor us, we're hardly making any money at all". You want to pull that bullshit, work in the entertainment industry, or something else not-essential for life. Hollywood accounting is for Hollywood. If I don't want to pay $50 for the family to see Captain Amazingpants when he hits the theaters, I can wait to watch the movies until they come on DVD to the local public library. If I don't have $5,000 per month to pay for basic lifesaving drugs that cost far less to make and distribute, and my millions of dollars of future income/productivity is cut short as a result, putting my dependents on public assistance - that's not good business for society as a whole.

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              • (Score: 2) by The Mighty Buzzard on Monday August 12 2019, @05:09PM (9 children)

                The question is: need. How much profit does a company need?

                Believe it or not, that's not the question. The question is how much non-reinvested profit do the shareholders need. Reinvested profit is something you want the company to have as much of as it can find a use for. The cash doled out to officers and their perks is minuscule compared to the profits the company is bringing in, or at least it had damned well better be. What gets distributed as dividends or just banked cash is where you really want to watch the numbers.

                Believe it or not, none of the above are my major concern with the pharmaceutical industry. My major beef is the "evergreening" of patented drugs. Adding a drug like acetaminophen or an antacid that isn't under patent to a drug whose patent is about to run out should not allow a new patent to be issued for the cocktail.

                --
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                • (Score: 2) by JoeMerchant on Monday August 12 2019, @07:02PM (8 children)

                  by JoeMerchant (3937) on Monday August 12 2019, @07:02PM (#879330)

                  cash doled out to officers and their perks is minuscule compared to the profits the company is bringing in, or at least it had damned well better be

                  So, let's start there... standards? Enforcement? The free market is clearly failing to manage the all too numerous greedy bozos at the top.

                  the "evergreening" of patented drugs

                  If it's good for Mickey Mouse... why not? /s

                  a new patent to be issued for the cocktail

                  I have a little experience here, working with a company that wanted to add GRAS markers to existing drugs as a compliance measure - if you detect the Generally Recognized As Safe compound in the person's breath, odds are pretty good they took the drug. What kind of FDA studies do you think are necessary to approve such a non-interactive, no additional active ingredients cocktail? Why, the full safety and efficacy suite, of course... After jumping that regulatory hurdle, there had better be some carrot on the other side. Maybe not a full patent term, or maybe...

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                  • (Score: 2) by The Mighty Buzzard on Tuesday August 13 2019, @03:09AM (7 children)

                    by The Mighty Buzzard (18) Subscriber Badge <themightybuzzard@proton.me> on Tuesday August 13 2019, @03:09AM (#879465) Homepage Journal

                    The carrot on the other side is higher sales of off-patent medicines than your competitors, assuming your drug is worth the trouble of making and people buy it. Nothing else is warranted.

                    cash doled out to officers and their perks is minuscule compared to the profits the company is bringing in, or at least it had damned well better be

                    So, let's start there... standards? Enforcement? The free market is clearly failing to manage the all too numerous greedy bozos at the top.

                    None needed. Shareholders can deal with that just fine if it becomes other than a tiny fraction of the company's yearly profits. If it doesn't, the people up top are obviously earning it by making the company so much money with the decisions they make.

                    --
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                    • (Score: 2) by JoeMerchant on Tuesday August 13 2019, @11:26AM (6 children)

                      by JoeMerchant (3937) on Tuesday August 13 2019, @11:26AM (#879570)

                      Shareholders can deal with that just fine

                      And, yet, they don't. All too often, a small cabal of shareholders exercises full executive control of public companies, siphoning off profits into their pockets until the company posts returns "in line with 5-6% annual growth" expectations. Why not crank up gross profits to 1100% and get a corporate jet, private island, yacht and staff for each executive board member - hey, we're still posting stronger than market expected returns, and if something hiccoughs, we can always bail the corp to chapter 11 and try again - works for the Prez, why should I be any better?

                      Let's not even get into privately held companies and their total lack of accountability - and many patented drug sellers are this.

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                      • (Score: 2) by The Mighty Buzzard on Tuesday August 13 2019, @01:25PM (5 children)

                        by The Mighty Buzzard (18) Subscriber Badge <themightybuzzard@proton.me> on Tuesday August 13 2019, @01:25PM (#879621) Homepage Journal

                        They don't because it is not an actual problem. It only seems that way to people for whom envy is a way of life. In reality, the compensation of executives is essentially never a significant percentage of a company's profits. When it is, those executives tend to be asked to leave or outright fired because board members are usually also stock holders.

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                        • (Score: 2) by JoeMerchant on Tuesday August 13 2019, @02:47PM (4 children)

                          by JoeMerchant (3937) on Tuesday August 13 2019, @02:47PM (#879667)

                          When it is, those executives tend to be asked to leave or outright fired because board members are usually also stock holders.

                          Speaking from direct personal experience, this is not how it is done in Houston - land of Enron, and they're not the only ones who follow that model.

                          "The Smartest Guys in the Room" documentary could have been about the Houston med device company I worked for as far as executive culture and concepts of accountability are concerned. It's all over town there, NASA contractors are actually the "straight shooters" in the region.

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                          • (Score: 2) by The Mighty Buzzard on Wednesday August 14 2019, @03:31AM (3 children)

                            by The Mighty Buzzard (18) Subscriber Badge <themightybuzzard@proton.me> on Wednesday August 14 2019, @03:31AM (#879955) Homepage Journal

                            And how often does a huge company fall to shit because it was secretly pillaged by its executives and board? Rare criminally bad actors are not an excuse to regulate everyone to within an inch of their lives. Punish the actual criminals and leave everyone else alone.

                            --
                            My rights don't end where your fear begins.
                            • (Score: 2) by JoeMerchant on Wednesday August 14 2019, @11:42AM (2 children)

                              by JoeMerchant (3937) on Wednesday August 14 2019, @11:42AM (#880083)

                              Rare criminally bad actors are not an excuse to regulate everyone to within an inch of their lives

                              I guess that depends on your perspective of what is rare? In my view, rare is exceeding 25%, not only in number of companies, but also corruptly influenced cashflow. That's significant enough to try to do something about.

                              Also: within an inch of their lives? Also a matter of perspective, but I'd say: as long as the impact of regulation is significantly less (say 10% of) than the corruption it actually prevents, that's clearly worth doing.

                              Punish the actual criminals

                              Yeah, like that ever happens when the criminals are in the lizard people class. Too big to fail has the corollary: to big to prosecute.

                              how often does...because it was secretly...?

                              Without enforced transparency, we'll never know, will we?

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                              • (Score: 2) by The Mighty Buzzard on Wednesday August 14 2019, @12:09PM (1 child)

                                by The Mighty Buzzard (18) Subscriber Badge <themightybuzzard@proton.me> on Wednesday August 14 2019, @12:09PM (#880107) Homepage Journal

                                Moved the goal posts there, man. We was talking pillaging a company not buying legal pull. The latter I absolutely agree on. Ditto prosecuting folks no matter how many zeroes their net worth has.

                                --
                                My rights don't end where your fear begins.
                                • (Score: 2) by JoeMerchant on Wednesday August 14 2019, @12:37PM

                                  by JoeMerchant (3937) on Wednesday August 14 2019, @12:37PM (#880128)

                                  So many ways to pillage a company. I watched Credit Suisse First Boston take over a company with $10M in private equity investment, it wasn't a blockbuster, but it built up to about $30M net worth over 5 years... in the meantime, CSFB - with control of the board, had the company take out debt - from CSFB - and when the market dipped a bit, they had the company assessed by "independent" people of their choosing, and lo and behold, on that day, the company's market value was just about exactly equal to the debt they owed to CSFB - so they restructured, and bought out the equity investors for their current net worth in the company: 0.

                                  As a "founding employee" I was gifted stock "worth" about $50K at the time of the gifting, relative to the $10M actual cash invested shares. I and the initial cash investors, some of whom had put in nearly $1M in personal money, all got checks from CSFB in exchange for our shares. Everybody's check was in the amount of $0.01. This is all legal, in Delaware.

                                  That Enron analog CEO did some good and some bad, but his exit move was to completely screw up a product launch and then hand himself $5M on the way out the door, in addition to some $100M of personal compensation he had extracted over the previous 10 years, not to mention many 10s of millions spread around to his buddies on the top floor, many of whom also took platinum parachutes with him on his way out. The company was reeling for the next 5 years, but does live on today.

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              • (Score: 2) by The Mighty Buzzard on Monday August 12 2019, @05:10PM (7 children)

                Scuse the double "Believe it or not". Still fighting a cold and it's not as easy to think as it normally is.

                --
                My rights don't end where your fear begins.
                • (Score: 2) by JoeMerchant on Monday August 12 2019, @07:04PM (6 children)

                  by JoeMerchant (3937) on Monday August 12 2019, @07:04PM (#879331)

                  Something some board members seem not to understand, I'm not paid for this, neither are you - it's not going on a resume for future employment or any other value beyond the experience of thinking about the issues and enjoying the exchange.

                  If I a word, the free message board consuming and discussing audience should really be able to deal.

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                  • (Score: 2) by The Mighty Buzzard on Tuesday August 13 2019, @03:14AM (5 children)

                    by The Mighty Buzzard (18) Subscriber Badge <themightybuzzard@proton.me> on Tuesday August 13 2019, @03:14AM (#879468) Homepage Journal

                    Yeah, I can't put "debating shit you can't even understand" on a resume. I can put coding and admining on it though. Had to get a letter from mrcoolbp to get a TN driver's license when I got here because I'd only received one bill so far. Since you need a driver's license or the same proof you'd need for one to get a fishing license, it was pretty crucial.

                    --
                    My rights don't end where your fear begins.
                    • (Score: 2) by JoeMerchant on Tuesday August 13 2019, @11:29AM (4 children)

                      by JoeMerchant (3937) on Tuesday August 13 2019, @11:29AM (#879571)

                      I just saw a news blurb, our local school district is now requiring certified state ID for on-campus visiting parents/guardians/siblings bringing a forgotten lunch, etc. Purpose being, the ID will be swiped and background checked before letting the potential terrorist on campus. I feel safer already. /s

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                      • (Score: 2) by The Mighty Buzzard on Tuesday August 13 2019, @01:27PM (3 children)

                        by The Mighty Buzzard (18) Subscriber Badge <themightybuzzard@proton.me> on Tuesday August 13 2019, @01:27PM (#879622) Homepage Journal

                        Wonder what metrics they're using for potential terrorist. I mean, by official, published government standards I'm a potential terrorist because I'm a veteran and anti-authoritarian. I'm in fact infinitely more likely to protect children than harm them though.

                        --
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                        • (Score: 2) by JoeMerchant on Tuesday August 13 2019, @02:50PM (2 children)

                          by JoeMerchant (3937) on Tuesday August 13 2019, @02:50PM (#879670)

                          I'm guessing it's for bench warrants, restraining orders, etc. Not going to catch any actual terrorists, but your garden variety "active shooter" depressed dad going to kidnap their kid away from divorced mom, or shoot up the place for whatever reasons might just be dumb enough to think they can get in after showing their DL, and as well as those things seem to work, they still might get in.

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                          • (Score: 2) by The Mighty Buzzard on Wednesday August 14 2019, @03:35AM (1 child)

                            by The Mighty Buzzard (18) Subscriber Badge <themightybuzzard@proton.me> on Wednesday August 14 2019, @03:35AM (#879959) Homepage Journal

                            Why would they not be able to get in? Everyone in the nation is a "potential shooter". You can't reliably tell when or even if someone's going to snap and you can't treat half the nation like criminals at every turn to prevent something less likely to impact you than winning the lottery.

                            --
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                            • (Score: 2) by JoeMerchant on Wednesday August 14 2019, @11:52AM

                              by JoeMerchant (3937) on Wednesday August 14 2019, @11:52AM (#880089)

                              you can't treat half the nation like criminals at every turn

                              No, but as I understand the new system, you can (legally) treat the entire population like criminals at every turn.

                              As I said: bench warrants, restraining orders, the espoused intent is to stop legally barred people from doing things they have been legally barred from doing.

                              Now, how is it actually used? In my experience, if you're a "normal" parent, you can just wave at the desk secretary as you walk in and they buzz you back to the classrooms with a smile. However, if you're a parent of a "special needs" child, or basically anyone who the administration doesn't want to see what's actually going on back in the classrooms, then you "wait here while we tell them you're coming, you're going to need an escort", etc. What are they hiding? I'm not sure what they successfully hid, what they failed to hide included frustrated kids throwing desks and teachers doing nothing to defuse the situation, including actively instructing staff to put the broken desk with exposed sharp pieces back in use in the classroom (against experienced staff's better judgement). There's also the classroom which has a sewer gas problem - they put the kids in diapers in there so they can blame the smell on the kids, but it's actually coming from the plumbing. 250+ pounder staff manhandling 7 year olds, etc.

                              We're in a better school district now, but even here we seem like we're going to need to pitch a battle with the schoolboard to get our student's bus to arrive on-time instead of an hour late every single day. The official instruction to the bus drivers is to not talk with the parents, but as with the classroom information leaks, staff doesn't always comply with the gag orders.

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