Canada wants to build a wall: to keep out US insulin buyers

[MillCreek]

https://www.washingtonpost.com/world/the_americas/as-price-of-insulin-soars-americans-caravan-to-canada-for-lifesaving-medicine/2019/06/14/0a272fb6-8217-11e9-9a67-a687ca99fb3d_story.html?utm_term=.708738955560

We have certainly heard the complaints of many patients who are having issues with being able to afford insulin, without which, they will die.

[MikeB]

Shouldn’t the ACA i.e. Obamacare have solved this type of issue, it was the promise.

I’m guessing and they briefly mention in the article that price controls are part of the reason it is cheaper in Canada. Being the Post, I noticed they don’t explore the other side of that which is that most likely higher prices in the US are probably subsidizing the lower prices in Canada. This is a common issue for a lot of the price differences between the US and other countries on drug pricing.

[dogmush]

I read the article, and I confess, I don't know a whole bunch about diabetes, but this stood out to me:

In the United States, you can buy some types of insulin without a prescription. But to get the newer analog insulin on which Type 1 diabetics rely, you need to visit or call your doctor.

Wait, what?  There's been well controlled diabetics for decades.  How do they rely on a "newer" drug?

So first I checked, and you can buy 1000 units of Human Insulin at Walmart for $25.  There's some online options for you as well.

OK, so what's the difference between Human Insulin and Insulin Analog? there are a bunch of studies, it seems like Analog insulin works faster, and is a little better regulated.

On average, people with type 1 diabetes who injected an insulin analog had slightly lower—one-tenth of 1 percent —blood sugar levels than those who used regular insulin, according to the review of 49 studies.

For type 2 diabetes patients, there was no real difference in blood sugar levels between those who used analog or regular insulin. There were also a similar number of low blood sugar episodes in both sets of patients, regardless of the type of insulin used, said Dr. Andrea Siebenhofer of the Medical University of Graz and colleagues.

“Our analysis suggests only a minor benefit of short acting insulin analogs in the majority of diabetic patients treated with insulin,” Siebenhofer said

I have little doubt that the newer medicines work better.  That said, anytime you want the newest, best of something you have to ask yourself if it's worth the cost.  These folks seem to have decided it's not worth the cost, they just want it cheaper so they'd like other folks with guns to institute price controls for them.  I'm not sure I have a lot of sympathy for that outlook.

I would add that the lady wearing the shirt that says "Access to Insulin is a Human Right" can GTFO of here.  She has no right to other folks labor.  If you want to claim a right to a physical something, you better have made it.

[HankB]

Insulin isn't the only drug that's really expensive. A few years back my ophthalmologist prescribed some eye drops for my allergies. A small vial of dilute solution was pretty expensive, so just out of curiosity, I tried to compute how much they were charging for the actual drug itself, making due allowance for packaging, saline dilution, etc.

How's $30,000,000.00 a gallon grab ya?

What bothers me is that some legacy drugs - things like antibiotics for which the patents expired decades ago - are seeing enormous increases in price. At least one TV talking head said that's because in some cases, only 1 company is allowed to make that legacy off-patent drug; unfortunately that talking head didn't explore why.

[brimic]

Insulin isn't the only drug that's really expensive. A few years back my ophthalmologist prescribed some eye drops for my allergies. A small vial of dilute solution was pretty expensive, so just out of curiosity, I tried to compute how much they were charging for the actual drug itself, making due allowance for packaging, saline dilution, etc.

How's $30,000,000.00 a gallon grab ya?

What bothers me is that some legacy drugs - things like antibiotics for which the patents expired decades ago - are seeing enormous increases in price. At least one TV talking head said that's because in some cases, only 1 company is allowed to make that legacy off-patent drug; unfortunately that talking head didn't explore why.

Sounds about right.
We made an eye medication/solution in 500 gallon batches on a contract in my last place of employment. It was pretty cheap to make, but absurdly expensive.
Some of the best profit to investment things to make are relatively simple pharmaceutical grade solutions.

[AmbulanceDriver]

What bothers me is that some legacy drugs - things like antibiotics for which the patents expired decades ago - are seeing enormous increases in price. At least one TV talking head said that's because in some cases, only 1 company is allowed to make that legacy off-patent drug; unfortunately that talking head didn't explore why.

You can thank the FDA for that nonsense.  Essentially, how it works is like this.  You find a generic drug that's old enough to not have gone through the formal FDA approval process as it exists in modern medicine.  You run that drug through the formal approval process (including all the human trials for it). But it's a relatively low risk operation because this drug has been in the market and in common use as a generic for decades.  So it's a pretty safe bet.  In return, the FDA grants you exclusive rights to market that drug as if it were a new drug.  Voila, *LARGE* profit for relatively low risk.  

ETA: here's a better explanation that I could give, by a medicinal chemist.  https://blogs.sciencemag.org/pipeline/archives/2018/12/14/blame-the-fda-for-this-fiasco

[HankB]

You can thank the FDA for that nonsense.  Essentially, how it works is like this.  You find a generic drug that's old enough to not have gone through the formal FDA approval process as it exists in modern medicine.  You run that drug through the formal approval process (including all the human trials for it). But it's a relatively low risk operation because this drug has been in the market and in common use as a generic for decades.  So it's a pretty safe bet.  In return, the FDA grants you exclusive rights to market that drug as if it were a new drug.  Voila, *LARGE* profit for relatively low risk.  

ETA: here's a better explanation that I could give, by a medicinal chemist.  https://blogs.sciencemag.org/pipeline/archives/2018/12/14/blame-the-fda-for-this-fiasco

I smell kickbacks to FDA bureaucrats . . . BIG kickbacks.

[brimic]

I smell kickbacks to FDA bureaucrats . . . BIG kickbacks.

All a pharma company needs to do is find a new indication for the drug.

The other one is when a company starts qualifying drugs coming off patent, often investing millions on stockpiling the material for an upcoming short term exclusivity as a generic producer, and the FDA suddenly has a ‘manpower shortage’ and your drug master file review gets delayed by months or years, while your drug supply is ticking down towards its expiration.

Big pharma is happy to throw bones to small pharma in the way of process/chemistry development, but they will try to crush you if you go after a more lucrative slice of the pie.

I used to be a huge cheerleader for pharma, but the further I get away from chunk of my career, and the more I learn, the more I despise them.

[Boomhauer]

bUt WiTHoUt tHE fDa hOw wOULd wE Be saFE!!!???!!!???



They wanted more government so we all got more government good and hard. But they don’t get that part instead they will demand the .gov “do something” and when the bureaucrats screw it up even more they will screech more about it.

[Ron]

The answer is always to “government” harder.

[brimic]

bUt WiTHoUt tHE fDa hOw wOULd wE Be saFE!!!???!!!???



They wanted more government so we all got more government good and hard. But they don’t get that part instead they will demand the .gov “do something” and when the bureaucrats screw it up even more they will screech more about it.

Moar FDA/EPA/<insert regulatory bureacracy> is pushed for and driven by the big industry players to protect their own interests.

[TechMan]

You can thank the FDA for that nonsense.  Essentially, how it works is like this.  You find a generic drug that's old enough to not have gone through the formal FDA approval process as it exists in modern medicine.  You run that drug through the formal approval process (including all the human trials for it). But it's a relatively low risk operation because this drug has been in the market and in common use as a generic for decades.  So it's a pretty safe bet.  In return, the FDA grants you exclusive rights to market that drug as if it were a new drug.  Voila, *LARGE* profit for relatively low risk.  

ETA: here's a better explanation that I could give, by a medicinal chemist.  https://blogs.sciencemag.org/pipeline/archives/2018/12/14/blame-the-fda-for-this-fiasco

The FDA did the same thing with gout relief drug, colchicine.  The price per pill went from $0.09 to $4.85.  If you want a read look at this: https://en.wikipedia.org/wiki/Colchicine#History

[Firethorn]

The FDA did the same thing with gout relief drug, colchicine.  The price per pill went from $0.09 to $4.85.  If you want a read look at this: https://en.wikipedia.org/wiki/Colchicine#History

That's nothing compared to a lot of them. 

And I agree with the others - this is primarily a problem with excessive government control.  I mean, I like the idea of some sort of control ensuring that the drug I buy is actually the drug on the label, but it shouldn't cost $100M-$1B to put a generic drug on the market.

[sumpnz]

My pd meds are an extended release version of Sinemet, which is a mixture of carbidopa and Levodopa.  The original version has been around since the 1960's.  Granted, the extended release takes some special equipment to make, but regular generic carbidopa/Levodopa is a few pennies per pill, so at my current dose it's maybe $10-15/month.  The extended release version, if I wasn't getting it free through their patient assistance program, would be almost $1100/month.

[Scout26]

That's nothing compared to a lot of them. 

And I agree with the others - this is primarily a problem with excessive government control.  I mean, I like the idea of some sort of control ensuring that the drug I buy is actually the drug on the label, but it shouldn't cost $100M-$1B to put a generic drug on the market.

Given the number of lawyers on TV, just about every drug will kill you outright, if it doesn't just maim you for life.   IN my mind if the FDA says "This drug is safe", then if it isn't, all the daytime TV lawyers ought to be suing the FDA.

[Firethorn]

Given the number of lawyers on TV, just about every drug will kill you outright, if it doesn't just maim you for life.   IN my mind if the FDA says "This drug is safe", then if it isn't, all the daytime TV lawyers ought to be suing the FDA.

I think the problem here is perception.  The FDA doesn't say that any drug is safe, not really.  The most they really say is that the risks are consimurate with the benefits.  Anti-cancer drugs, for example, the cost of not using them is death.  So they can be nastier, considerably, than a minor pain killer.  Then you have drugs like insulin that are fine for those with the condition in proper doses but dangerous for healthy people.

You also have older drugs that set a baseline - new cancer drugs today have to either shrink tumors more or have fewer bad side effects than existing drugs to be approved.  The older drugs set a baseline allowable risk based on their effectiveness.

Drugs that have low enough effects can be made over the counter, but even then ODs can be fatal.

[WLJ]

If Canada builds a wall can we build a big trebuchet and use it to send over it all the Hollywood people  that said they were going to Canada if Trump won but for some strange reason are still here?

[Perd Hapley]

Shouldn’t the ACA i.e. Obamacare have solved this type of issue, it was the promise.

I thought the ACA solution was to take painkillers and die.

[cordex]

I thought the ACA solution was to take painkillers and die.

Updated for 2019:  Opiates might kill you while you're dying.  Take CBD and die.