
Why Should Americans Be Grateful for $137 Insulin? Germans Get It for $55 - pseudolus
https://www.nytimes.com/2019/03/21/opinion/diabetes-insulin-generics-humalog.html
======
no1youknowz
You want to see a bigger differential?

When I was in the US, I needed an inhaler. It cost $250 to see the doctor and
the inhaler was $150.

In the UK. It costs £0 to see the doctor and for the inhaler now is £8.80.
Although I remember a time when it was £4.

Americans pay way too much for healthcare.

~~~
polote
We pay for healthcare every month, even if we dont go the doctor. Last year I
paid 500€ per month for healthcare, and I went one time to the doctor

~~~
eastendguy
In other words: The direct cost of the insulin for the average German is not
$55, but $0 - since it is covered by the mandatory health insurance.

That said, don't worry that you do not get enough back from your health
insurance. This will come soon enough when you get older ;-)

~~~
basch
Are people not understanding how drug prices work?

Intellectual property law is a way for government to grant exclusivity to one
firm. This whole "you can get it for x in Canada and y in Germany" is a silly
conversation. It's not like it costs 1000x to manufacturer the drug here vs
there. The R&D and marketing costs are amortized over the period of
exclusivity. Saying "you can just go to Canada to get it" just means "im going
to circumvent intellectual property law." It's kind of like, but not quite,
piracy. You're choosing where and when which laws apply to you. It also kicks
the can down to the rest of the people buying the drug, because we know the
pharma actuaries arent going to price their drug at a loss. And then on top of
that, like you say, these prices people pay AFTER insurance arent what the
cost of the drug is to the population, its an already subsidized price.

Germans and Canadians are getting the drug cheaper not only because they have
different laws, but because the R&D recovery isnt evenly split between
country, they take their money where they can get it.

Insulin SHOULD be generic by now (the patent on long-acting synthetic insulin
expired in 2014), but the companies continually improve it and always sell the
latest variant. And of course Doctors are going to prescribe what works best.

~~~
DanBC
> but because the R&D recovery isnt evenly split between country,

This point, which always comes up in these threads, has already been debunked
both in those other threads, but it was even debunked here before you made
this comment.

~~~
basch
You're saying drug companies make an equal amount of extra money, after
manufacturing costs, in every country?

------
ckastner
Because that's a direct consequence of the system their elected
representatives have burdened them with?

Edit: To be completely fair, that probably explains why they _have_ to pay it,
not why they _should_.

~~~
nervousvarun
Correct and as a reminder, these elected representatives receive health care
benefits that exceed those available for the majority of their constituents.

[https://www.snopes.com/fact-check/members-congress-health-
ca...](https://www.snopes.com/fact-check/members-congress-health-care/)

------
adityapatadia
Let's check it in India:

Sanofi sells it at $3 (208 INR) [https://www.medindia.net/drug-price/insulin-
lispro/insuman-r...](https://www.medindia.net/drug-price/insulin-
lispro/insuman-rapid-100iu-ml.htm)

Humalog(3ml) sells at $7 (544 INR) [https://www.medindia.net/drug-
price/insulin-lispro/humalog-3...](https://www.medindia.net/drug-
price/insulin-lispro/humalog-3ml.htm)

Humalog (3ml) sells at $94 in USA: [https://www.drugs.com/price-
guide/humalog](https://www.drugs.com/price-guide/humalog)

------
chiefalchemist
Pardon the editorial here but this is a sloppy opinion piece.

\- It would be helpful (and honest) if the article discussed the rate of
demand in both / any / all countries.

\- Why only Germany?

\- Why only Insulin?

No doubt, the USA healthcare systems has issues that need to be addressed.
However, that's not where the problem starts. The truth is, it's no worse than
the (attention to personal) health of the majority people using the system.

BTW, I caught bit of the (new?) PBS feature on Cancer a couple nights ago. At
one point, one of the doctors being interviewed said (paraphrasing): "We could
reduce the rate of cancer by 50% if we were willing to adopt the changes[1]
that have already been recommended. No additional research required. 50%!"

[1] Diet, lifestyle, etc.

~~~
vgoh1
The American lifestyle/diet and healthcare costs are two separate issues that
both desperately need to be solved. What a lot of people don't know outside
the U.S., is that the obesity crisis exists in upper class and upper-middle
class, but is a completely different animal among the poor and working poor. I
grew up in a working-poor family, and kept that same social group until about
10 years ago.

The culture around food is completely destroyed. Social gatherings revolve
around unhealthy food. There is generally not the understanding that the
choices for what you eat is the major reason for obesity. The poor are lied to
so much, they don't know what to believe, and the prevailing opinion tends to
be that it is mostly due to genetics (how could that be, we have the same
genes as 1-2 generations ago) or character (laziness, but I was obese in the
past and worked a full time job and two part time jobs). In the past, the poor
would get info from cable news, or not at all. Today, they get their news from
Dr. Oz feeds on Facebook telling them to lose weight with various forms of
snake oil.

While there is quite the gym culture in the U.S. in upper middle class, lower
class does not have money for the gym, but mainly their metabolism is so shot
from the foods they eat that they don't have the energy to go to the gym.

The government and the medical field in general could do a lot to move the
needle on the terrible food culture, but they don't. They in fact made the
terrible food pyramid, that tells people to eat grains above all else, and
says nothing about the processing of the foods that they eat. And the foods
they eat are processed to the nth degree. When I eat with some of my old
friends or family that are still a part of my old culture, I am always amazed
by how terrible the cheap food is here. It really doesn't even taste like
food. Potato chips, rubbery chicken nuggets, soda, Totinos pizza, TV dinners,
Hamburger Helper, I could go on...

~~~
chiefalchemist
> "The government and the medical field in general could do a lot to move the
> needle on the terrible food culture, but they don't."

I wanted to reply to this directly.

Yes and no. Nothing is more personal than what you put in your mouth. It's not
just to blame others for those decision(s) / action(s). Could more be done?
Yup. But gov + med are not the only ones dropping the ball. How many times
does a doc have to say "You've got to lose weight" before they give up, and
are "forced" to write a script for meds X, Y and Z?

I mean, when you step up to the toilet, you look down and can't see over your
belly and see where your pee is coming from, isn't that a red flag? Maybe the
trip to the all you can eat buffet isn't a good idea?

------
mnm1
The patent laws need changing, especially the laws that allow companies to
slightly change the process and re-patent the same thing over and over again.
Barring that, Congress could invalidate patents. It's ridiculous that they
hold hearings on high drug prices when they could fix this issue themselves in
a few days. Barring that, they could allow imports from other countries.
Barring that, I hope a proper black market for such drugs pops up because
Congress refuses to act on behalf of the people even when they are dying so
that these drug companies can get richer. To me that's murder. Like the
classic ethics 101 dilemma asks, should one steal life saving medicine to save
oneself or one's loved ones? This is not a hypothetical situation in the US,
it is everyday life for millions. And the answer is yes. I would say at this
point, there is no unethical action one could commit to this end. The truly
unethical and monstrous actions are the drug companies greed driven prices and
worse, Congress' unwillingness to act while people suffer and die. That's akin
to murder, imo.

------
bastih
Is there an analysis of "all" prices somewhere, maybe even combined with the
sales numbers? Just as an example, some more common drugs like Ibuprofen are
much more expensive in Germany. I get that we can always point to drug X or Y.

There's probably also an interesting conversation about effective cost: what
does average Joe pay after taking deductions into account?

~~~
TulliusCicero
> some more common drugs like Ibuprofen are much more expensive in Germany.

What's stranger to me as an American living in Germany is that you can't get
it at "drug stores" like DM, Rossman, etc. that are the equivalent of
CVS/Walgreens, let alone grocery stores. You have to get it at an apotheke
(pharmacy) that's a separate business. In practice that means it's both more
annoying (due to more limited business hours) and more expensive. No going to
Costco to get a bigass bottle of more ibuprofen than any one family could
reasonably use here.

But you _can_ order it online at Amazon, oddly enough, though it's still much
more expensive than in the states, and it looks like the largest size on offer
is 50-count.

I get that German society is somewhat more regulated than in the US, but I
just don't see what's the threat with basic medicines like ibuprofen that
necessitates them being sold at specialist stores.

~~~
cleansy
Even though ibuprofen is considered a basic medicine, it's still a medicine.
Ibuprofen is not totally risk free and therefore needs to be sold by
"professionals". Either way, Americans tend to overuse this drug as a pain
killer for every little bit of ache they may have, which is dangerous. The
first time I took ibuprofen was when I broke my arm with 12-13 for the first
day. The next time was with 24 after I got a root canal removed.

~~~
benj111
"it's still a medicine. Ibuprofen is not totally risk free and therefore needs
to be sold by "professionals""

I don't know if you're using medicine as an _official_ term here.

There are plenty of things that are medicine like, plenty of things that
aren't risk free.

Peanut butter isn't risk free if you're allergic to nuts. Honey isn't risk
free for young children. Alcohol isn't risk free.

------
bitxbit
They need to overhaul the industry and it must start with how the FDA approves
new and old drugs. For example, drugs should have hard expiry regardless of
patent claims. No more generic exclusivities. More importantly, scrap
biosimilars and make all biologic manufacturers turn over the specific details
to produce identical products.

------
pcvarmint
Walmart sells old-school insulin for $25 / vial:

[https://www.walmart.com/ip/Novolin-ReliOn-
Insulin-R/12978348...](https://www.walmart.com/ip/Novolin-ReliOn-
Insulin-R/129783484)

[https://www.walmart.com/ip/Novolin-ReliOn-
Insulin-N/16767244...](https://www.walmart.com/ip/Novolin-ReliOn-
Insulin-N/167672445)

------
norin
I pay into the system and have no issues doing so, when you think about it, at
some point you too will be at the mercy of some(let's hope not) disease or
someone you know will and you'd be glad you won't be going bankrupt. A healthy
society is a productive society. if that's socialism then I'm all for it.

~~~
maze-le
And even if you don't need it, the people surrounding you (friends, family,
co-workers, people you share a seat with in the tram) are probably in a better
general state of health, which is also good for you.

------
saagarjha
> Imagine if Apple sold a $500 iPhone for $250 if it was called, say, a
> yPhone, and simply lacked the elaborate white box and the little Apple on
> back. That would be patently absurd. An iPhone in a brown paper bag is still
> an iPhone.

To be fair, Apple already does this. If you buy a refurbished Apple device,
you are essentially getting a cheaper iPhone with slightly worse packaging.

~~~
medof
> To be fair, Apple already does this. If you buy a refurbished Apple device,
> you are essentially getting an iPhone with slightly worse packaging.

This is not the same, because the device will still be Apple with the same
design and logo. But the article is making different point that if Apple would
sell also yPhone with same technical specs and slightly different design and
half the price then it would be outragous.

P.S. They are paying that price the same reason why they pay 20x more for
university than Europeans. It is the system that they live in.

~~~
leereeves
> if Apple would sell also yPhone with same technical specs and slightly
> different design and half the price then it would be outragous.

Would it? Companies do this all the time; it's called differential pricing.

------
apta
The argument I heard it's that it's the USA that's disproportionately funding
R&D in the medical field, so naturally the costs are higher than for someone
just replicating the formula and selling it. Is there any truth to this?

------
mikl
You can thank the FDA (plus the patent system) for that. If it wasn't so
fantastically expensive to bring generic, age-old, drugs to the market in the
U.S., there would be a lot more competition.

~~~
sithlord
Not really sure why this matters in the case of insulin - the "good" modern-
day insulins will never fall into generics because the companies have a
backlog of incremental changes they hold on to until they need to renew a
patent.

~~~
majewsky
That agrees with mikl's claim that "you can thank [...] the patent system
[...] for that".

------
theredbox
Ridiculous and pointless comparison. Germans pay 2 times as much for
healthcare that is inferior to the one i get in Korea.

And guess where the korean specialists go to ? Yes it is the US of A.

------
notus
Why should someone have to pay for insulin at all?

------
philliphaydon
NZ I believe is $100 per year total.

~~~
Taniwha
yes $100 per household, we pay $5 per prescription item, with a limit of 20
items/year per household

~~~
eythian
To clarify, a limit after which you no longer have to pay. Not that that's all
you can get :)

------
geggam
I just ran into this during a business trip. Extended my work trip and needed
medication. Had the Dr fax me the prescription.

With insurance my cost is 68$ US ... here in Germany without insurance it was
13$ EU

Insurance is socialism for profit and they are raking it in.

~~~
acdha
We had someone get sick on a trip to Iceland. They walked into the emergency
room, talked with a doctor a few minutes later, and got some antibiotics. They
were very apologetic because the U.S. wasn’t part of the E.U. reciprocity
agreement and they would have to charge them for the costs and the total came
to — cue Americans raised on medical news stories bracing in expectation –
less than what their major university insurance copay would have been for the
visit + prescription.

~~~
masonic

       a few minutes later, and got some antibiotics
    

... which is improper care. They could not properly diagnose a bacterial cause
that quickly -- they gave that patient antibiotics _to make them go away_.
Indiscriminate use of antibiotics has lead to resistant strains worldwide.

~~~
acdha
Antibiotic misuse is a problem but in this case you are completely wrong, and
you really should think twice before making accusations of professional
misconduct when you have no idea of the facts.

------
europsucks
Why don't they just buy it in Germany, then? Shipping can't be 80$?

In fact I just checked, DHL ships a parcel of 2kg from Germany to the USA for
18$, A 5kg parcel is 42$.

~~~
majewsky
Pharmacies are heavily regulated. They're probably only allowed to sell to
domestic customers.

~~~
europsucks
Then that's one thing to look at for reasons. And maybe deals can be struck.

------
reallymental
(Disclaimer: Not American)

I've been reading NYT for a long while now, and I've been noticing more and
more of these "medicines are more expensive here" trope.

There's half an answer isn't there? The US is subsidizing the development of
these new drugs to the world, at the cost of it s citizens, as these companies
operate all over the world and not just in US. The _relatively_ richer people
in Cali can afford to pay $x more than the people in Bali.

Sure, the exploiting the people under the marketing guise of "patented"
paracetamol varieties is _very_ unethical, and just slimy. That we can all
agree on.

But every time such an article is posted, the only question in my mind is,
"isn't the problem half explained?".

What's the alternative, not innovate and let everyone die? As opposed to
innovate, and some people who live better than the others pay a bit (or in
this case, ~2.49x) more ?

Is there an alternative where everyone pays equally ? Sure, you can lower the
cost for an American and subsidize it (which comes from their tax again, so
they're being more/less charged the same amount).

or you can increase the price for the rest of the world until the death toll
vs affordability ratio looks good for the company that decides this is a good
idea.

The problem is half explained.

The rest of the problem's explanation must lie here.

\--- From the article:

Part of insulin’s price rise in the United States is because of the middlemen
who buy the drugs on behalf of insurers and hospitals and negotiate discounts
off the list price for their clients. So Lilly often doesn’t make the full
$275 a vial (though, since rebates are secret, we don’t know how much less).

By selling an authorized generic, rather than merely lowering the brand’s
price, Lilly is essentially doing an end-run around those middlemen and giving
patients who don’t purchase through an insurer another option.

\---

It's also a supply chain problem, not the manufacturing supply chain, but the
business to customer supply chain.

I guess margins are not that wide enough for middle men to make anything
significant in other countries except the states.

My tone in this comment is very inquisitive, not aggressive in any way, I
don't mean to come across like that.

~~~
cyborgx7
The trope of "the US subsidizes healthcare for everyone else" has no basis in
reality. Drug production is not operating at a loss in Germany.

~~~
rticesterp
Drug production does not equal drug development. The later is much more
expensive and not guaranteed to go to market.

~~~
cyborgx7
Fair enough, but the way I meant it, included R&D in the production costs.

