Prescription cost conundrum

[Arizona_928]

Originally Posted by 908/930

So they are not overworked? just incompetent? You forgot a couple other details from your list.

The ones that have a reputation to not fill the correct RX… would be incompetent and i would point that towards the complete take over of the field from DEI implementation.


What else do you have to add to the list? Consults, customer service?

Overworked is relative. If one gets into a good store. Everyone vibes and it runs like a well oiled machine. Further incompetence of broken stores leads to this bs. Fire the dead weight and hire good talent…. If you are a pharmD, you know exactly what I’m talking about… my ex was a fixer. She would get sent to regional stores to fire and hire. Put sops in place and move on to the next one…

[Tobra]

Compounding can be sort of a boutique thing, and as with many things, economies of scale are for real.

PM Sent

good to know about Costco pharmacy

[craigster59]

Also, you don't need a Costco membership to use their pharmacy.

[Superman]

Originally Posted by Arizona_928

Overworked my ass. Incompetent. …

Did you see the dart hustling scene in Ted Lasso? Probably not.

Pharmacy staffs, all of them, everywhere, work very hard and are under a fair bit of stress.

Also, any business, Costco or otherwise, that carelessly mis-fills prescriptions at a rate outside the industry norm will fairly quickly be in a conversation with their liability insurance carrier.

Costco has been so inept that their stock price has tripled in the last five years. Now at $633/share. There will be a split, I predict.

Asking questions is fruitful, I find. Doing research. But that's harder than making assumptions.

Research is particularly appropriate when shopping for expensive things. Shaun knows that and some others here do also.

[lindbhr]

Even better.....Costco $682.80

[Superman]

Ah. My bad.

[jyl]

Originally Posted by Turbo_pro

That seems to be a pretty common misconception. Big Pharma is a business and as suck can expense research on their tax returns.
We pay for their research in the form of tax breaks. Every dollar they spend on research is deducted from taxes owed.
They also write off the bribes (I mean lobbying money) they spend on K street influencing politicians for favorable regulation.

Your math or understanding of taxes is off.

If you or a drug company spend $1,000 and deduct it as R&D, that reduces your tax bill by your tax rate x $1,000, typically around 25% x $1,000 = $250. So your spend after the tax deduction is still $750.

Now suppose a drug company spends $10 billion a year on R&D. Even after tax deductions, that’s still $7.5 billion or so (depends on their tax rate).

Why do they spend so much on R&D? Because almost none of the drugs they develop ultimately succeed. Millions of possible compounds are studied, a tiny fraction of 1% get as far as initial human trials, called Phase 1 trials. Of the drugs that start Phase 1 trials, about 1% make it to the second stage, called Phase 2 trials. Of the drugs that start Phase 2 trials, about 1% make it to the third state, called Phase 3 trials. Of the drugs that start Phase 3 trials, about 1% ever get approved by the FDA. And the large majority of those end up as minor drugs, not commercial successes. These percentages are approximate and from memory, I looked up the numbers several years ago.

Anyway, a drug company that spends $10 billion a year on R&D might HOPE to develop, each year, one very successful drug, several modestly successful drugs, and thousands of failed programs. What’s a very successful drug? Over $1 billion in sales per year - until the patent expires, typically 5 to 7 years.

As a result, the industry overall is about average in its profitability. The most successful companies are more profitable, the rest are mediocre or lose money.

[Turbo_pro]

Originally Posted by jyl

Your math or understanding of taxes is off.

If you or a drug company spend $1,000 and deduct it as R&D, that reduces your tax bill by your tax rate x $1,000, typically around 25% x $1,000 = $250. So your spend after the tax deduction is still $750.

Now suppose a drug company spends $10 billion a year on R&D. Even after tax deductions, that’s still $7.5 billion or so (depends on their tax rate).

Why do they spend so much on R&D? Because almost none of the drugs they develop ultimately succeed. Millions of possible compounds are studied, a tiny fraction of 1% get as far as initial human trials, called Phase 1 trials. Of the drugs that start Phase 1 trials, about 1% make it to the second stage, called Phase 2 trials. Of the drugs that start Phase 2 trials, about 1% make it to the third state, called Phase 3 trials. Of the drugs that start Phase 3 trials, about 1% ever get approved by the FDA. And the large majority of those end up as minor drugs, not commercial successes. These percentages are approximate and from memory, I looked up the numbers several years ago.

Anyway, a drug company that spends $10 billion a year on R&D might HOPE to develop, each year, one very successful drug, several modestly successful drugs, and thousands of failed programs. What’s a very successful drug? Over $1 billion in sales per year - until the patent expires, typically 5 to 7 years.

As a result, the industry overall is about average in its profitability. The most successful companies are more profitable, the rest are mediocre or lose money.

After reading my post, you are correct. My wording was awkward. Research is an expense. It applies against profits at a one to one rate.
If you have a capital loss, (IE: a failed drug trial) that loss can be directly applied over following years reducing if not eliminating tax liabilities.

Take a minute and tell me the last time big pharma paid any real taxes on their billion dollar profits.

Big Pharma's big tax dodge

At this point, profit shifting is the industry norm: Of the eight biggest US pharmaceutical companies, only Gilead reports earning the majority of its income in the US. The other seven companies appear to have paid the US government just over $2 billion on their $108 billion global profit in 2022 (this sum includes Eli Lilly, which reports the distribution of its tax payments but not the distribution of its earnings). Governments outside the US actually collected more tax revenue from these seven "American" pharmaceutical companies than the US government: $11.5 billion.

https://www.businessinsider.com/big-pharma-companies-taxes-american-billion-dollar-profits-drugs-healthcare-2023-8?op=1

[dennis in se pa]

Originally Posted by Shaun @ Tru6

My doctor just prescribed a medication that they thought my health insurance would cover but they don't, cost is $1000/month. I asked about alternatives. They sent the prescription to an out of state compounder that my insurance would honor, cost is $45/month.

How does that work?

So much BS in the Pharmacy industry. I recently saw a drug that’s supposedly listed at $400 for a 90 day supply. Under Medicare it was $40, and with Good Rx it was $18. How is that possible if you can buy something for $18 And the provider makes a profit, how can they possibly charge somebody else $400? That should be illegal. But our lawmakers are profiting off of the Pharmacy industry, so this goes on.

[Arizona_928]

It’s an opaque economy and it’s purposely constructed for little to no transparency…

[Superman]

Originally Posted by dennis in se pa

So much BS in the Pharmacy industry. I recently saw a drug that’s supposedly listed at $400 for a 90 day supply. Under Medicare it was $40, and with Good Rx it was $18. How is that possible if you can buy something for $18 And the provider makes a profit, how can they possibly charge somebody else $400? That should be illegal.

Insurance companies. It is the insurance companies, more than any other industry participant, that controls both the medical services and the prescription drug industries. More than the service providers. More than the drug companies. Insurance companies pay $18. The uninsured pays $400. Another interesting question is why Medicare (the largest of all insurance companies) has to pay $40. Well....it's because the government was prohibited from negotiating prices. Until just recently.

Originally Posted by dennis in se pa

But our lawmakers are profiting off of the Pharmacy industry, so this goes on.

Not unless they own stock. Their political "campaigns" get money from Big Pharma lobbyists, though. Which, as we know, they use to to defend themselves from lawsuits and criminal trials.

Originally Posted by Arizona_928

It’s an opaque economy and it’s purposely constructed for little to no transparency…

All private industries are as opaque as they can possibly be. In sharp contrast with government agencies whose documents and communications are all 100% subject to public disclosure laws with only narrow exceptions for things like our social security numbers and other personal information, certain law enforcement files, etc. If the health care industry (or any other industry for that matter) were subject to the same public disclosure laws, then there would be much for us to discuss. And government would look like a paragon of ethics and virtue.

[dennis in se pa]

Originally Posted by wdfifteen

Have you checked the price on Good Rx?
Their web site is a real eye opener. They show you the price at various chain pharmacies. The price can vary by 1000 per cent.

Can you imagine going car shopping and finding prices anywhere from $25,000 to $250,000 for the same car?

To answer your question "How does that work?"
Who the hell knows.

Yes, I have noticed this also. How much you wanna bet our so-called lawmakers are heavily invested in big Pharma and profit immensely when people end up paying the full list price

[WPOZZZ]

Originally Posted by 908/930

I think the difference is the $1k is from the original manufacturer, who did all the work to develop the drug and bring the drug to market and once the patent for that drug runs out all the generic copies arrive for $45. If they could not make some return on investment for the initial cost they would just stop the research. Think of the cost per year for all the chemists and doctors and other support staff.

$1k a month is not too bad compared to some of the more exotic drugs at $30k + month.

My gf had HepC and her liver was at Stage 3. The Liver Center doctor prescribed Harvoni for a course of 12 weeks. My gf was worried about the cost and I told her not to worry about it. I was prepared to pay the $100k, but worked with the manufacturer, Gilead. Some friends were also drug reps, so they looked into the coupon program. In the end, all I had to pay was $5 a month for my gf's Harvoni. So $15 for $100k of meds.

[red 928]

Sorry in advance for hijacking the hijack,
but this reminds me of something
I saw on a news channel recently that pissed me off
enough to a little research on the subject:

There are many versions of drugs on the market
developed to treat type 2 diabetes.

People found out that these drugs can also cause weight loss,
and fat lazy people are making a run on them causing a
temporary shortage and significant price increases.
Some (like Ozempic) can be covered by insurance for weight loss,
which BTW raises EVERYONE'S premiums.
Others like mounjaro are not yet approved for weight loss
and may not be covered by insurance unless you really
have the disease it was developed to treat.
Which most people trying to get it don't.

These same people, who don't have enough personal
discipline or maturity to control their eating habits,
then complained that it was big pharma's fault because
the drugs were too hard to find or were too expensive.
Many cost well over $1000 per month even with those discount
things like goodrx, thanks to people trying to get it who shouldn't.
They should not look to big pharma to solve
their bad habits and then criticize pharma for the cost that they are
themselves causing.
Sometimes I don't like people.

[1990C4S]

Originally Posted by red 928

These same people, who don't have enough personal
discipline or maturity to control their eating habits,
then complained that it was big pharma's fault because
the drugs were too hard to find or were too expensive.

Add smokers and drinkers to your list if you want to cut premiums, right? Those are personal choices too. That's a slippery slope you've stepped on.

[Flatbutt1]

Originally Posted by red 928

Sorry in advance for hijacking the hijack,
but this reminds me of something
I saw on a news channel recently that pissed me off
enough to a little research on the subject:

There are many versions of drugs on the market
developed to treat type 2 diabetes.

People found out that these drugs can also cause weight loss,
and fat lazy people are making a run on them causing a
temporary shortage and significant price increases.
Some (like Ozempic) can be covered by insurance for weight loss,
which BTW raises EVERYONE'S premiums.
Others like mounjaro are not yet approved for weight loss
and may not be covered by insurance unless you really
have the disease it was developed to treat.
Which most people trying to get it don't.

These same people, who don't have enough personal
discipline or maturity to control their eating habits,
then complained that it was big pharma's fault because
the drugs were too hard to find or were too expensive.
Many cost well over $1000 per month even with those discount
things like goodrx, thanks to people trying to get it who shouldn't.
They should not look to big pharma to solve
their bad habits and then criticize pharma for the cost that they are
themselves causing.
Sometimes I don't like people.

Many of those people will take that pill along with a Big Mac, large fries and vanilla shake.

[creaturecat]

somewhat related: jumping on expired patents - producing generics? it certainly didn't work out well for Barry and Honey Sherman. probably never know the truth behind that mystery.

[Flatbutt1]

Originally Posted by creaturecat

somewhat related: jumping on expired patents - producing generics? it certainly didn't work out well for Barry and Honey Sherman. probably never know the truth behind that mystery.

I did some time in generics just after what was known as the Barr scandal.

https://law.justia.com/cases/federal/district-courts/FSupp/812/458/1762275/

I made my cGMP bones working for one of Barr's competitors which was in a heap of trouble themselves and I made a name for myself within the District as a guy who knew how to do it all correctly.

While there I wrote a training manual which ended with "At the end of the day I want you to ask yourself this "did I do my job well enough that I would not hesitate to let my family use our products?" If you can't honestly answer yes then you need to do better...much better." What I didn't tell them was I'd fire their azzes if they didn't adhere to the regs and their training.

I only lasted 18 months. Senior management made my life much too difficult. Generics was (maybe still is) so competitive that the competition could undercut you by charging a few pennies less per dose.

[Alan A]

Originally Posted by red 928

Sorry in advance for hijacking the hijack,
but this reminds me of something
I saw on a news channel recently that pissed me off
enough to a little research on the subject:

There are many versions of drugs on the market
developed to treat type 2 diabetes.

People found out that these drugs can also cause weight loss,
and fat lazy people are making a run on them causing a
temporary shortage and significant price increases.
Some (like Ozempic) can be covered by insurance for weight loss,
which BTW raises EVERYONE'S premiums.
Others like mounjaro are not yet approved for weight loss
and may not be covered by insurance unless you really
have the disease it was developed to treat.
Which most people trying to get it don't.

These same people, who don't have enough personal
discipline or maturity to control their eating habits,
then complained that it was big pharma's fault because
the drugs were too hard to find or were too expensive.
Many cost well over $1000 per month even with those discount
things like goodrx, thanks to people trying to get it who shouldn't.
They should not look to big pharma to solve
their bad habits and then criticize pharma for the cost that they are
themselves causing.
Sometimes I don't like people.

If that pisses you off imagine how people that need insulin feel. That ought to be almost free by now.

On 23 January 1923, Banting, Collip and Best were awarded U.S. patents on insulin and the method used to make it. They all sold these patents to the University of Toronto for $1 each. Banting famously said, “Insulin does not belong to me, it belongs to the world.” He wanted everyone who needed it to have access to it.

Source:

https://www.diabetes.org.uk/our-research/about-our-research/our-impact/discovery-of-insulin#:~:text=On%2023%20January%201923%2C%20Bant ing,to%20have%20access%20to%20it.