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Post by liane on Apr 29, 2016 8:38:48 GMT -5
BTW - Some of us still make house calls even though there no longer is extra reimbursement for the service.  |
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Post by victoria on Apr 29, 2016 9:19:37 GMT -5
Oh that's not a rebate, that's price cap! This is the NHS fixing the amount drug prices can rise year on year for the next few years to what they wanted to pay rather than what the pharmas wanted to charge. It is the same across all pharmas and they cannot negotiate. There is a reason rebate is in inverted commas in the FT headline! The last of those references isn't a rebate either, it is part of the system with the more expensive drugs where the pharma only gets paid if the patient is cured (no cure no pay). To the original point - the Humalog price published in MIMS is correct and there is no rebate against it. All of this is in the open with the numbers published. Aged, I have never looked at MIMS, I would like to. I tried googling MIMS. Can you or some on the board post a link so I can look at these documents? Pep
Peppy: url for MIMS is at www.mims.co.uk/ (free limited subscription) |
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Post by agedhippie on Apr 29, 2016 9:47:30 GMT -5
Oh that's not a rebate, that's price cap! This is the NHS fixing the amount drug prices can rise year on year for the next few years to what they wanted to pay rather than what the pharmas wanted to charge. It is the same across all pharmas and they cannot negotiate. There is a reason rebate is in inverted commas in the FT headline! The last of those references isn't a rebate either, it is part of the system with the more expensive drugs where the pharma only gets paid if the patient is cured (no cure no pay). To the original point - the Humalog price published in MIMS is correct and there is no rebate against it. All of this is in the open with the numbers published. Aged, I have never looked at MIMS, I would like to. I tried googling MIMS. Can you or some on the board post a link so I can look at these documents? Pep
Google using this search term nhs mims humalog to find the Humalog entry. Change humalog to tresiba for example if you want to check that. If you go through MIMS properly you can hit a block but searching from Google sidesteps that. The prices paid compared with the US are quite illuminating. |
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Post by agedhippie on Apr 29, 2016 10:03:08 GMT -5
The US health system is a trainwreck for sure... its capitalism . and it makes me furious.. When the customer is removed from the process of negotiating the fee or price for the service, where is the incentive to control price? It too is removed. So how did we try to fix this? By adding more Gov't controls. And how's that working out? It depends on the politics. In the US the government is not allowed to negotiate, in the UK it is. Guess who has lower prices - government controls work out pretty well in the UK and they would in the US if special interests hadn't paid off the politicians. |
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Post by esstan2001 on Apr 29, 2016 10:56:53 GMT -5
When the customer is removed from the process of negotiating the fee or price for the service, where is the incentive to control price? It too is removed. So how did we try to fix this? By adding more Gov't controls. And how's that working out? It depends on the politics. In the US the government is not allowed to negotiate, in the UK it is. Guess who has lower prices - government controls work out pretty well in the UK and they would in the US if special interests hadn't paid off the politicians. So here in the US, we (the US Gov't) just pay whatever the Pharma wants to charge? that is pure control by the Pharma (as a result of political cronyism), not free market capitalism. In a free market, the Gov't would negotiate, or tell the pharma to take a hike and tehn find an alternate source that results in a better economic tradeoff for the people. But Hey, they are only spending our money, so who cares, right? Now the Brits on the other hand, allow their Gov't to use the tool of negotiation- which IMO is an absence of control- it is a free markets tool. And all they are saying is that the negotiated rate is all they will pay- they are acting as a free agent. And what works better? As you pointed out, the more capitalist solution, being employed by the more socialist society. Pretty ironic IMO. Until our Gov't demonstrates that it can do a better job of representing the people's needs as it was originally set up to do, I say get it the hell out of the way. It only serves the political class, with no discretion to party. I think we agree in principle, but just not on what we are calling it. :-) |
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Post by mnkdfann on Apr 29, 2016 11:33:48 GMT -5
Oh that's not a rebate, that's price cap! This is the NHS fixing the amount drug prices can rise year on year for the next few years to what they wanted to pay rather than what the pharmas wanted to charge. It is the same across all pharmas and they cannot negotiate. There is a reason rebate is in inverted commas in the FT headline! The last of those references isn't a rebate either, it is part of the system with the more expensive drugs where the pharma only gets paid if the patient is cured (no cure no pay). To the original point - the Humalog price published in MIMS is correct and there is no rebate against it. All of this is in the open with the numbers published. Again, here is what the CBC wrote that you took issue with: "drug companies are no longer being transparent about prices. Companies now typically maintain a standard price for a drug across all territories, according to Morgan, then quietly arrange rebates or discounts with each country's regulator. The result? A regulator like the PMPRB will base a drug's maximum price on its listed price in France, Germany and elsewhere, but will have no idea how much money those countries might have been rebated in an undisclosed deal with the drug company." I think you are reading something into this article that is not there. Or just splitting hairs over what the word 'rebate' includes. I believe the examples of rebates / discounts I linked to before are examples of what the CBC article was talking about, except of course those examples were disclosed. We do not know what is NOT disclosed. Except occasionally when a pharma exec lets something slip: www.firstwordpharma.com/node/817973"The National Institute for Health and Clinical Excellence provisionally recommended funding GlaxoSmithKline's Votrient (pazopanib) on the NHS as a first-line treatment for patients with advanced renal cell carcinoma after the company agreed to lower the drug's price and offer a rebate scheme ... GlaxoSmithKline will supply Votrient to the NHS at a discount of 12.5 percent ... The company also agreed to an UNDISCLOSED financial REBATE if results of an ongoing clinical trial show that Votrient is inferior to Sutent" [article cites Simon Jose, the company's UK general manager. Simon Jose himself used the word rebate.] This is a clear example of what the CBC article mentioned: UNDISCLOSED REBATES! And that's all I have to say about that. |
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Post by mnkdfann on Apr 29, 2016 11:45:24 GMT -5
It would be great to see sales in both of those countries by the end of the year, or early 2017. I know Canada has been asking for it. I'm curious where you learned about Canada asking for it (Afrezza). I live in Canada and I've never heard any mention of Afrezza up here, unless it came through some U.S. source (like on CNN or FOX or Reuters or AP). For instance, this Canadian newspaper published an article about it but only because it recycles Washington Post articles: news.nationalpost.com/health/inhaled-insulin-may-eventually-mean-no-more-shots |
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Post by agedhippie on Apr 29, 2016 12:36:57 GMT -5
I think you are reading something into this article that is not there. Or just splitting hairs over what the word 'rebate' includes. I believe the examples of rebates / discounts I linked to before are examples of what the CBC article was talking about, except of course those examples were disclosed. We do not know what is NOT disclosed. Except occasionally when a pharma exec lets something slip: "The National Institute for Health and Clinical Excellence provisionally recommended funding GlaxoSmithKline's Votrient (pazopanib) on the NHS as a first-line treatment for patients with advanced renal cell carcinoma after the company agreed to lower the drug's price and offer a rebate scheme ... GlaxoSmithKline will supply Votrient to the NHS at a discount of 12.5 percent ... The company also agreed to an UNDISCLOSED financial REBATE if results of an ongoing clinical trial show that Votrient is inferior to Sutent" [article cites Simon Jose, the company's UK general manager. Simon Jose himself used the word rebate.] This is a clear example of what the CBC article mentioned: UNDISCLOSED REBATES! And that's all I have to say about that. I think we are going to have to agree to differ over this. The default in the NHS is disclosure. There are corner cases like the one you cite where if the trial fails then they will give a partial refund or rebate on what has already been paid and drop the subsequent price. This is in line with the NHS practice with certain drugs of only paying if the cure works. Arguably that is a rebate as well. There is no general rebate system though, in that sense the CBC article is flatly wrong with respect to the NHS. |
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Post by victoria on Apr 30, 2016 13:25:58 GMT -5
It depends on the politics. In the US the government is not allowed to negotiate, in the UK it is. Guess who has lower prices - government controls work out pretty well in the UK and they would in the US if special interests hadn't paid off the politicians. So here in the US, we (the US Gov't) just pay whatever the Pharma wants to charge? that is pure control by the Pharma (as a result of political cronyism), not free market capitalism. In a free market, the Gov't would negotiate, or tell the pharma to take a hike and tehn find an alternate source that results in a better economic tradeoff for the people. But Hey, they are only spending our money, so who cares, right? Now the Brits on the other hand, allow their Gov't to use the tool of negotiation- which IMO is an absence of control- it is a free markets tool. And all they are saying is that the negotiated rate is all they will pay- they are acting as a free agent. And what works better? As you pointed out, the more capitalist solution, being employed by the more socialist society. Pretty ironic IMO. Until our Gov't demonstrates that it can do a better job of representing the people's needs as it was originally set up to do, I say get it the hell out of the way. It only serves the political class, with no discretion to party. I think we agree in principle, but just not on what we are calling it. :-) Hi Just to chip in on this: the outlook in the UK is that (for the NHS) the taxpayer (lets say, in this case, the English taxpayer for the NHS in England which is in effect a State in the federal UK) is the customer: the local and nation al Government is under democratic control and that's the incentive for them to spend money carefully, since a party wanting to raise more taxes is less likely (generally) to be popular with the voters. There are also independent auditors (the National Audit Office) who report on how well money is managed. Im curious about the discussion that in the US a State the Federal Government is not allowed to negotiate. Is that the case? How do your own socialised industries such as defence, police, and post office for example manage: surely contractors cant just demand whatever they want from taxpayers and get it. Can't the Government on behalf of the people contract with whoever provides the best or most cost effective products and services? I suppose if there is no public sector healthcare provider at all in the market then there is no tool by which the electorate can supply itself with a health product in competition with private offerings. (I commented above that in the UK the impression I have is that comprehensive private insurance for those who want it is rather less expensive here because if it were not, people would not bother with it (and in fact very few do with odd exceptions like me)). Interestingly, my own (rather unusual, I admit) private health insurance entitles me to go to any qualified doctor/surgeon etc anywhere in the world for treatment included in my policy EXCEPT for the USA where (if I wanted coverage) I would have to pay a large extra insurance premium - which I don't do since I just take out travel health insurance if I am visiting for a holiday or whatever). Hence I could (say) go to Canada or Switzerland if the best heart surgeon was there, but not Illinois. Thinking aloud perhaps one solution in the USA would be for private providers to have to compete for 'most preferred insurer' status at State or US level, on a fixed term basis, with the contract value assessed on sensible criteria (not just the cheapest but also quality standards etc) and that provider could get the military and Federal/State employee contracts and perhaps tax rebates in return for a contract to provide certain guaranteed standards in its products, at agreed fixed insurance premium prices. Private people could then choose that or not, depending on what they want, but it would mean at least one product available which is of a specific legally guaranteed standard. One downside of a public sector healthcare product such as the NHS is that if its truly national, you can't opt out of it: you have to pay your taxes for it, just as one has to for defence and police and so on. However that does mean that a reliable income stream is available to fund it long term and the cost is under democratic control. If I could change something here I would make private health insurance premiums tax deductible since they are not at present, but that would be very controversial. Anyhow I'll butt out of this since Im in the UK and probably speaking out of turn. |
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Post by peppy on Apr 30, 2016 13:35:23 GMT -5
So here in the US, we (the US Gov't) just pay whatever the Pharma wants to charge? that is pure control by the Pharma (as a result of political cronyism), not free market capitalism. In a free market, the Gov't would negotiate, or tell the pharma to take a hike and tehn find an alternate source that results in a better economic tradeoff for the people. But Hey, they are only spending our money, so who cares, right? Now the Brits on the other hand, allow their Gov't to use the tool of negotiation- which IMO is an absence of control- it is a free markets tool. And all they are saying is that the negotiated rate is all they will pay- they are acting as a free agent. And what works better? As you pointed out, the more capitalist solution, being employed by the more socialist society. Pretty ironic IMO. Until our Gov't demonstrates that it can do a better job of representing the people's needs as it was originally set up to do, I say get it the hell out of the way. It only serves the political class, with no discretion to party. I think we agree in principle, but just not on what we are calling it. :-) Hi Just to chip in on this: the outlook in the UK is that (for the NHS) the taxpayer (lets say, in this case, the English taxpayer for the NHS in England which is in effect a State in the federal UK) is the customer: the local and nation al Government is under democratic control and that's the incentive for them to spend money carefully, since a party wanting to raise more taxes is less likely (generally) to be popular with the voters. There are also independent auditors (the National Audit Office) who report on how well money is managed. Im curious about the discussion that in the US a State the Federal Government is not allowed to negotiate. Is that the case? How do your own socialised industries such as defence, police, and post office for example manage: surely contractors cant just demand whatever they want from taxpayers and get it. Can't the Government on behalf of the people contract with whoever provides the best or most cost effective products and services? I suppose if there is no public sector healthcare provider at all in the market then there is no tool by which the electorate can supply itself with a health product in competition with private offerings. (I commented above that in the UK the impression I have is that comprehensive private insurance for those who want it is rather less expensive here because if it were not, people would not bother with it (and in fact very few do with odd exceptions like me)). Interestingly, my own (rather unusual, I admit) private health insurance entitles me to go to any qualified doctor/surgeon etc anywhere in the world for treatment included in my policy EXCEPT for the USA where (if I wanted coverage) I would have to pay a large extra insurance premium - which I don't do since I just take out travel health insurance if I am visiting for a holiday or whatever). Hence I could (say) go to Canada or Switzerland if the best heart surgeon was there, but not Illinois. Thinking aloud perhaps one solution in the USA would be for private providers to have to compete for 'most preferred insurer' status at State or US level, on a fixed term basis, with the contract value assessed on sensible criteria (not just the cheapest but also quality standards etc) and that provider could get the military and Federal/State employee contracts and perhaps tax rebates in return for a contract to provide certain guaranteed standards in its products, at agreed fixed insurance premium prices. Private people could then choose that or not, depending on what they want, but it would mean at least one product available which is of a specific legally guaranteed standard. One downside of a public sector healthcare product such as the NHS is that if its truly national, you can't opt out of it: you have to pay your taxes for it, just as one has to for defence and police and so on. However that does mean that a reliable income stream is available to fund it long term and the cost is under democratic control. If I could change something here I would make private health insurance premiums tax deductible since they are not at present, but that would be very controversial. Anyhow I'll butt out of this since Im in the UK and probably speaking out of turn. sad isn't it. The stories abound. Paraphrasing: if pharma could not charge what they want/need these drugs wouldn't be developed. The government in the USA has been bought by large corporations. (The supreme court allowing it.)
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Post by victoria on Apr 30, 2016 13:51:12 GMT -5
I'm thinking, though, that its not all about drug price to enable drug development (which is what Peppy is I think rightly paraphrasing as big pharma's views): if big pharma can't charge what price it wants (but has to offer value) BUT in return it gets exclusive access to very large public health markets then it still makes its money for drug development overall (and drug development is big business in europe and the UK, drugs do get developed). One can't rule out the possibility, though, that by charging large sums in the USA they can offer it cheaper to the rest of the world, though it may just be that companies make money wherever they can, as much as they can, in whatever system they are in. (It would be unfair to the US if big Pharma used high prices in the US to subsidise operations elsewhere but it could happen I suppose if the money received in europe, say, was too low to operate drug development), but I don't know if that's factually the case when one considers the overall equation of cost x volume in europe or its national markets.
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Post by mnkdnewbie on Apr 30, 2016 14:16:34 GMT -5
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Post by mnkdnewbie on Apr 30, 2016 14:25:05 GMT -5
I just posted the article I don't necessarily agree with it, but I do know other agencies like the VA and FBOP do negotiate medical service and drug prices. |
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Post by victoria on Apr 30, 2016 14:48:19 GMT -5
This may be of interest (I have not read all of it) but it is an EU parliamentary report on the relative pricing and costs and so on in EU member states, and a discussion of different approaches within the EU to how drug prices are set. Interesting is that the UK very low in the list in terms of phamaceutical expenditure (figure 1, page 11) with Greece the most expensive, yet (figure 2, page 12) the UK is quite high in the list of 'cost per drug' for a basket of 150 example drugs (and the EU as a whole seems quite even in the 'cost per drug' figure). The USA cost per drug for the same basket of drugs is given in Figure 2 for comparison with the EU, but sadly the 'healthcare per capita' figure for the USA is not in Figure 1 which would have been interesting to see. www.europarl.europa.eu/RegData/etudes/etudes/join/2011/451481/IPOL-ENVI_ET%282011%29451481_EN.pdf |
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Post by mnkdnewbie on Apr 30, 2016 15:02:52 GMT -5
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