
How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India - mataug
http://www.alternet.org/personal-health/84000-hep-c-drug-only-1500
======
corvallis
Something to keep in mind is the population that typically has chronic Hep C
requiring this drug. It's IV drug users who share needles. Think they have
$84K? Nope. Think they have insurance? Nope. Guess who pays for it. Oh that's
right, it's Medicaid! It's you, the taxpayers. Where is there a large
concentration of people that have Hep C? Prisons. Guess who pays for it then?
Still you! The prison systems are obligated to provide health care and
treatments in accordance with community standards of care, which they do. They
have treated many people already who meet the criteria of disease progression
to qualify for it. Still think Gilead should be charging this much for it here
and not elsewhere?

~~~
ubernostrum
Actually a significant population in the US was infected by blood transfusion;
the US didn't start properly/universally screening blood and taking
precautions for hep C until 1992.

This is why there's a spike in infection rate among older people, and why hep
C is considered a looming cost crisis for Medicare -- we don't yet know the
full extent of the infectious disaster that was unscreened blood, but it's
ticking away inside anyone who received a transfusion prior to 1992.

~~~
bunnymancer
There's something rather unsettling about the realization that Jehova's
Witnesses had a point about something once..

~~~
stdbrouw
If you're getting a blood transfusion it's usually because you need it. I'd
take hepatitis C over death any day.

------
cowsandmilk
(1) As someone who was following the market when Gilead paid $11 billion for
PharmAsset, it was not a sure thing that it would be first to market or a
premier drug. They announced $137/share on November 21 for a stock that opened
at $65.49 on November 11. People like to point out how much money Gilead made
on the deal, but that is Monday morning quarterbacking on something where they
easily could have lost billions.

(2) The article claims Harvoni was acquired. That is not really true. Sovaldi
(sofosbuvir) came from the Pharmasset acquisition. Harvoni is a combination of
sofosbuvir with ledipasvir, a drug discovered at Gilead.

The combination of the two is a key part of the treatment; sofosbuvir was
still taken with interferon (and ribavirin) for genotype 1 HCV, the most
common form.

Treatment for genotype 1 HCV, without interferon required ledipasvir. The
notion that Gilead contributed nothing scientifically to Harvoni is false;
they provided a crucial component to the all-oral treatment of HCV genotype 1.

~~~
refurb
_As someone who was following the market when Gilead paid $11 billion for
PharmAsset, it was not a sure thing that it would be first to market or a
premier drug._

This is a fantastic point. I remember when Gilead announced their acquisition
of Pharmasset. They were _ridiculed_ in the press. How could they be so stupid
to pay that much? Many people thought that $11B was as good as gone.

That's the risk involved with drug development. It's like VCs, you spend a ton
of money on a lot of investments, most of which fail. Unless you get a few
huge winners, it's not a feasible business.

------
YPCrumble
Gilead has developed the first drug since penicillin to cure a major disease
and people think the price tag is too expensive.

In the modern world, it's not ideal to create a drug to cure something. Once
people are cured they no longer need your drug. That's why we have so many
drugs like Lipitor and Viagra that treat symptoms but do not cure.

The "problem" with Sovaldi/Harvoni is that the patient only takes it for ~90
days, and then they're cured.

The drugs are cheaper than regular treatment of Hep C - which ends in liver
transplant. Do people think the price tag was just random? No, it's because
this is a price at which the taxpayer saves money by curing the disease vs.
blood transfusions, liver transplants, lost economic value, etc.

Not to mention that the waitlist for a liver transplant is getting halved as
we cure Hep C.

As we slam Gilead the other really evil pharma companies like Pfizer are
taking notes and patting themselves on the back for creating drugs whose end
goal is to addict the consumer.

~~~
swalsh
I worked for a company that developed some PA criteria for these drugs, I can
assure you a lot of debate went into this criteria.. these two specific drugs
are probably the most hotly contested drugs. If we sold them at the 84k price
tag to anyone that COULD use it, the entire insurance industry would go
bankrupt, literally. Not even an exaggeration. While your logic is sound, the
drug is cheaper than a liver transplat... not everyone who has Hep C ends up
getting a liver transplant. There's a huge gap between the number of people
who COULD use the drug (and have a MUCH better quality of life), and the
people who are most qualified for it. The drug companies are not doing the
government a favor here... sorry.

Another side conversation that's interesting, is who takes the $84k hit.
There's sound logic that it's cheaper to give the drug NOW vs paying for
surgery LATER... but what if i'm not your insurer when you need it. With
obamacare, you can't be denied because of pre-existing conditions... so it's
interesting math.

~~~
maxerickson
Do you have a sense of the production costs?

If they aren't very high, the US government could start making the company
look like jerks by offering $50 billion for the patent. I'm pretty sure they
would be able to calculate a nice return based on a payment like that.

The math works fine for that, there's ~3 million people just in the US to
treat, paying $50 billion would save a substantial amount just treating those
patients. Of course, we don't run our government based on math that makes
sense, so it's a pipe dream.

~~~
danielweber
> the US government could start making the company look like jerks by offering
> $50 billion for the patent

Pretend you were in charge of Medicare/Medicaid. The NPV of the lifetime care
cost of the HepC symptoms of each HepC patient on your rolls is $X. You want
to encourage someone to develop a cure for HepC, so you put out a price bid
for what you will pay someone who shows up with a cure. What price do you
offer?

~~~
maxerickson
I offer $Y, the lowest amount I think I can get them to accept.

~~~
danielweber
In the hypothetical, you are offering a price before anyone has developed it.
"You want to encourage someone to develop a cure."

What price do you offer for someone who shows up with a cure?

------
markvdb
This is yet another perverse collision of care and market regulation. Other
examples abound. Why do we accept this? Do we even dare think of alternatives?

What if western governments stop enforcing drug development intellectual
rights? Not going to happen before hell freezes over, but let's have a short
thought experiment.

Quality health care for all would probably blossom thanks to more access to
affordable drugs than ever. Drug development would probably slow down
significantly without compensating measures. But would that be so bad? Medical
research is increasingly a game of diminishing returns... Many but the rarest
disease puzzles have been solved already. And the huge profit margins show the
current drug development system has proven inefficient handling these rare
corner cases. Think
[https://en.wikipedia.org/wiki/Alexion_Pharmaceuticals](https://en.wikipedia.org/wiki/Alexion_Pharmaceuticals)
. With more patents starting to expire, the existing drug development model
will only get more inefficient...

Aren't there more efficient ways to incentivise drug research?

Crazy idea... Bootstrap an open source drug with maecenate and/or public
funding, or market an existing generic with a sympathetic history. Make it
super easy for people to donate something extra on top of the drug price.
Think a tip at the pharmacy, directly to the researcher's drug development
budget. Their drug cured them or their loved ones! Put a picture of the
research team on the packaging. Show people these researchers are heroes.

~~~
KaiserPro
> What if western governments stop enforcing drug development intellectual
> rights?

No new drugs. Pretty simple.

Now you ask, is that a bad thing? well yes, yes it is. Right now, we are
running out of (or have run out of) top end antibiotics.

Partly from over use (I'm looking at you America.) mostly from using them to
get much higher yields in farm animals (yup, thats right, last line
antibiotics are being used on pigs, so they can be packed in much higher
densities. )

So what I hear you say? Well TB thats what. There is a resurgence in TB, the
white death. Now, you might be content with each lung collapsed in turn, in a
vein attempt to cure it[1]. However I'm not.

1 in 3 people get cancer. The survival rates are not good. Loads of people are
diabetic. (mainly because they eat shit and are fat(unless its type1 which is
genetic))

Opensource model is just bollocks. I don't want to be treated by some drug
thats only had patchy test coverage. I don't want to be beholden to some
amateur who thought it'd be good to reinvent for the billions time penicillin.

Who is going to pay for the time? its not like you can provide charge for
support is it?

No, the way forward is actually having a proper handle on insurance. Here in
the UK, drugs are purchased nationally[2] but more importantly you only pay a
nominal upfront fee. Its not more expensive, in fact its hovering around 6% of
GDP compared to 18% for the US (and with much better care too)

[1][http://journal.publications.chestnet.org/pdfaccess.ashx?Reso...](http://journal.publications.chestnet.org/pdfaccess.ashx?ResourceID=2102478&PDFSource=13)
[2][https://www.evidence.nhs.uk/formulary/bnf/current/5-infectio...](https://www.evidence.nhs.uk/formulary/bnf/current/5-infections/53-antiviral-
drugs/533-viral-hepatitis/5332-chronic-hepatitis-c/sofosbuvir)

~~~
phaemon
> No new drugs. Pretty simple.

I doubt that. There's no reason why the same research couldn't be academic
research.

Global spending on drugs research is only $77 billion a year. Take the 20
richest countries in the world and that's less than $4 billion a year each.
That's less than half the UK's EU rebate.

(EDIT: not enough coffee to add correctly)

~~~
ChrisLTD
Bingo. The private profit motive isn't the only way to get things done. Two of
the greatest scientific and engineering feats of the 20th century, the atom
bomb and landing on the moon, were both government run and funded.

~~~
icebraining
Not sure if the war motive is much better than the profit motive, though.

~~~
ChrisLTD
To stretch the analogy, lives are being threatened in war as they are also
threatened by medical illness.

------
surrealvortex
I'm conflicted about this article. On the one hand, the pharmaceutical
companies gouging ordinary Americans is abominable. Doing something to
circumvent their greed is something to support.

On the other hand, if enough people exploit loopholes like this, and the
pharma company actually felt a significant drain in revenue, they may decide
not to license the manufacture of these drugs in India at lower prices. If
$84,000 seems unreasonably high in the US, imagine how out of reach it will be
in India, where the cost of living is much lower.

~~~
rayiner
What exactly is "gouging?" The average wedding in the U.S. is almost $30,000.
Average new car price is $33,000. Is $84,000 one-time an unreasonable price
for a complete cure to a chronic disease?

~~~
vdance
must me nice in your bubble that $84,000 as a one time payment is reasonable.
normal people can't get a loan for something like this, and obviously don't
have cash stored away for something like this, and like the article mentioned,
the op won't get covered by insurance even though he's done his part and paid
insurance premiums. he clearly had no other options. glad you drive a $33k
car. seems like the op doesn't.

~~~
refurb
Do you think charging $300K for a liver transplant is gouging too? Because
that's what this $84K drug just replaced.

~~~
tomc1985
Yes, $300k is even more unconscionable.

Medicine in the US is wwaaaaaaaaaaay overpriced. Things that are critical for
life needs to be priced at a reasonable flat rate above costs, and conducted
with the attitude of public service and human actualization. Let big pharma
reap their R&D costs some other way

~~~
greeneggs
> Let big pharma reap their R&D costs some other way

How?! You think they should create a social network for doctors? A billion
dollars in ad sales is somehow morally better than a billion dollars from
saving lives? They're making their money by saving lives, and being criticized
for it. You're effectively saying that they shouldn't do any R&D, like the
Indian generic drug companies.

Sorry for the exclamation points. I think that you have a particular system of
morality, that is more important than saving lives. To me this is like arguing
for abstinence-only sex education, which demonstrably does not work. I wish in
general people would be more willing to look at data and outcomes.

~~~
tomc1985
I'm not in that industry, I'm sure my ideas aren't very good.

* massive step up in grant funding to front-load R&D costs so they're paid by the time the drug is out, or

* worldwide medical R&D fund, bounties for individual re-searchable issues, or

* move private R&D to universities, have profits gained pay back R&D, send any extras to researchers, and shutter R&D aspect of private medicine

At least I'm trying to think of alternatives, and not just trying to shoot
other commenters down

~~~
greeneggs
I don't have a problem with your ideas. I think the vast majority of drug
development costs are being borne by industry right now. So when you say
"massive step up in grant funding," that might have to be something like a
100x funding increase. And the NIH budget has been flat (when adjusted for
inflation) since 2002 [1], so there doesn't seem to be much political will for
your suggestions. (And that's bad! Even if you could get your suggestions
passed, long-term stagnant government funding for R&D would stall drug
development.)

I think your ideas should be implemented first in another country, such as
India or somewhere in Europe, so that we can see how well they work before
throwing away the baby in the bathwater. Personally, I would prefer more
gradual changes here in the US. For example, the cost of running drug trials
has been increasing. Big pharma companies _like_ this; going through the drug
trial obstacle course is their specialty, and the huge barrier means that
small drug companies that do the pre-trial drug research have to go through
the big companies to get to market. Reducing these costs would lead to more
competition.

[1] [http://www.aaas.org/page/historical-trends-federal-
rd#Agency](http://www.aaas.org/page/historical-trends-federal-rd#Agency)

~~~
tomc1985
Indeed, lack of political will kills many things :/

------
cheriot
Eminent domain is not just for land. In extreme cases like this where a profit
motive is the only thing keeping us from curing huge numbers of people, the US
government should write a single check, take the rights, and start handing out
pills.

As far as the company is concerned, that could even be a preferable outcome.
Cash now and the marketing benefits to promote its other drugs.

Edit: Just a reminder that eminent domain requires paying the property owner.
[https://en.m.wikipedia.org/wiki/Just_compensation](https://en.m.wikipedia.org/wiki/Just_compensation)

~~~
refurb
Let's walk through this. Drug develop is mostly funded with private money.
Yes, the NIH funds basic research that often support drug research, but
private companies fund most of the bill. It's in the hundreds of billions each
year.

Now why would they do that? Well, they expect that they'll give a company
$500M and it will turn into $2B or $3B. However, most of those companies will
fail and the $500M will turn into $0.

So that would mean that the returns on the drugs that are successful need to
be really high. What if they weren't? Well, all that private money would dry
up pretty dam quickly.

Look at the money going into cancer research. It's a huge amount every year.
It's not just because cancer is a terrible disease and affects everyone, it's
because the returns on cancer therapy are _high_.

You could just tell private companies, "stuff it, you don't get to make money"
and try and have the gov't do it on their own. Of course you'd need to
increase the NIH budget by what? 10x?

Our current system isn't perfect, but it does a dam good job aligning the
incentives of people with money and people who need new drugs.

~~~
x5n1
Scientists are not profit motivated. Scientists don't work to produce more
drugs faster just because the CEO is managing better. This is definitely
something that can be funded by the public and should be funded completely by
the public on a not-for-profit basis. Then we can no longer make these sort of
ridiculous economic arguments.

~~~
gaius
Do they hand out sainthoods with PhDs now? A scientist working in the
commercial sector has the same motivations as anyone else.

~~~
x5n1
Then why not make any scientist who discovers any very important drug or
therapy into a billionaire. If they are motivated the same way corporations
are, then that should super motivate them produce more drugs faster. In fact
why don't universities work the same way?

~~~
gaius
Scientists at pharma companies who make breakthrough discoveries _are_ well
rewarded in stock and bonuses.

------
y04nn
The pharmaceutical industry is disgusting me. Their goal is no more to cure
people but to generate that maximum amount of cash for shareholders. To chose
a price point, they don't look at what research has cost, but what people,
government aid and insurance are willing to pay for it and choose chose a
price that max out the benefit. In developed country it becomes ridiculous.

As a note, when they have to make risky research they put the risk into a
spin-off company with investors that share the risk, and this is how you end
up with Gilead buying this probably co-founded research company.

~~~
0bamacare
I give you an A for finally coming w/the right answer.I was falling asleep
reading all this liberal blather.

------
golergka
OK, let me be a devil's advocate for a minute, before we get the pitchforks
once again. Let's remember this:

> Gilead Science was first out the gate, bringing the new hep C drugs Harvoni
> and Sovaldi to market in 2014 and 2015, respectively. And they worked great:
> More than 90 percent of patients taking the new drugs saw the hep C virus
> wiped out in three months, and without the side effects that made interferon
> treatments so intolerable.

So, Gilead is exactly the company that created these drugs from the very
beginning. I'm looking at it this way: in 2013 (situation A), there was no
cure ("cure" is a simplification, of course, but for this kind of analysis
it's not an important detail.). In 2016 (situation B), there is a cure, but it
costs $86k.

Now, the moral question here is very simple: when you change the world (as
Gilead did) from situation A to situation B, is it net good or net evil deed?
In which world of these two would you prefer to live?

------
mirimir
Yes, way to go! There are honest online pharmacies, but finding them is
nontrivial. And there are numerous competent generics manufacturers in India.
They've captured a large share of the global generics market in recent years.

~~~
bedhead
.

~~~
giarc
You should re-read the article.

>Last year, Gilead entered into an agreement with India that would allow
Indian pharmaceutical manufacturers to produce generic versions of Harvoni and
Sovaldi and sell them in 101 developing countries at "a significantly reduced
flat price."

>If you buy Hepcinat from India, Gilead still makes a profit as part of its
licensing arrangement, but it doesn't make the unholy profits the U.S.
government allows it to get away with.

------
PieterH
Surprised no-one has pointed to the real culprit here: the patent system,
which allows individual companies to own knowledge like this and sell it at
any rate it desires... private taxation by and for the rich, on the rest of
society.

~~~
cm127
"Gotta have patents and profits, or there's no reason to fund it."

All testing, research, and funding has to be private for some reason.

------
foxylad
There is obviously something unbalanced in the pharma business, and I think it
is one of the corner cases where unbridled capitalism fails - perhaps because
it is a need, not a want, so it is not discretionary spending.

My instinct is that pharma development should be carried out by universities
(the state), so it's benefits can be shared with all citizens.

~~~
andrewchambers
It sounds more like a lack of real competition.

~~~
rayiner
You can't have "real competition" in the drug industry. While the status of
patents is debatable in software (where actual copying is rare), the generics
manufacturers are always directly copying from the drug inventors. They don't
have the capability to do their own R&D, or often even to develop a lot of the
ancillary protocols themselves.

So you either have a regulated market, or massive free-riding, neither of
which is "real competition."

~~~
refurb
You can't have perfect competition in the drug industry, but you can get
close. Gilead dropped the price of Sovaldi/Harvoni by almost 30% when Abbvie
launched their HCV therapy.

In fact, one of the best way to introduce competition is through "me-too"
drugs. You know, the ones everyone complains about.

------
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------
hyperliner
I really think this article is spot on taking on an issue that I believe will
become more and more pressing over time as baby boomers continue to retire.

However, this line felt of out of place:

\- "And then there's Gilead. It didn't even develop Harvoni itself; it made a
business decision to pay $11 billion to buy the company that did so it could
be first to market and reap the rewards, $26 billion worth. There is something
obscene about that. A billion-dollar profit would have been a very respectable
return on investment, but Gilead is getting much, much more than that"

I mean, why is that obscene? We have seen crazier returns in [insert latest
"stupid" app that made billions]. These drugs are difficult to manufacture AND
to market. I am sure that if the return would have certain, then the seller
would not have sold the company for that amount and would instead reaped the
presumed returns.

I think pharma is entitled to big returns because their business is really
risky.

I don't know where the answer is. Maybe it is government-driven pharma (yeah
like the federal government is ever going to be good at anything), or a SpaceX
for Pharma.

~~~
rayiner
Note that a billion dollar profit would be a 3.8% return over the life of the
drug (~10 years or whatever is left on the patent). You could literally get
better returns with far less risk parking that money in Treasuries.

~~~
Dylan16807
You're doing the math wrong. The suggestion is not a billion dollar profit on
26 billion dollars of costs. Most of the 26 billion dollars is profit.
Chopping the cost tremendously would still leave a healthy profit margin.

As to risk, they bought an already-proven drug. That's not the sort of thing
that earns massive returns.

~~~
rayiner
I did do that math wrong, but to be fair, the article is comparing apples and
kumquats. $26 billion is how much Gilead has in cash, which has little to do
with Sovaldi at this point. $1 billion profit (let's say that's annual, rather
than over the life of the drug) on an $11 billion purchase would be less than
10% annual ROI. That's very low for what was still a very risky investment
(unapproved drug).

~~~
Dylan16807
I think in the author's ideal world, the lowered profit for Gilead would mean
they aren't rushing to provide Sovaldi a multi-billion dollar profit either.
So the price drops well below $11 billion, and you get a solid profit margin
without gouging people that need the drug.

------
hourislate
I was under the impression most Pharma Companies will give it to you for free
if you don't have insurance and can't afford it. Maybe it's different if you
have insurance and they won't pay for it.

The article is unfair mentioning Shkreli. He has always offered his drugs for
free to anyone that couldn't afford them. It has always been his policy and
continues to be so.

I think it was the Insurers and their paid for Politicians that created the
stink. To this day I still haven't heard of one person that had to pay the
$750.00 a pill but just their co-pay and if they had no insurance they got it
for free.

Surprised this drug isn't available for free for those without insurance or is
it?

~~~
pavel_lishin
> _The article is unfair mentioning Shkreli. He has always offered his drugs
> for free to anyone that couldn 't afford them._

[citation needed]

~~~
verroq
>We pledge that no patient needing DARAPRIM will be denied access

>If you are uninsured and meet eligibility critera, you can get DARAPRIM for
no cost

[http://www.daraprimdirect.com/patients](http://www.daraprimdirect.com/patients)

------
MichaelBurge
A quick Google search shows that they paid $11 billion for the company that
sells the drug(Sovaldi), and earned $1.3 billion off of it[1] in 2016. They
make half of that in the US, and something like 10% of it in all places that
aren't the US, Europe, or Japan.

That's a 12% return in 2016, which isn't nearly as good as the comments in
this thread would have you believe. It's an okay return, but it wouldn't
really be a good investment unless they can grow those sales more. It looks
like they have had some growth compared to last year, so maybe it will end up
working out for them. It's certainly not "100x in profits".

A Google search shows the disease is ultimately hard-to-transmit and
preventable[2]. $84,000 seems like a fair price to me for this particular
case. Google says the total cost of raising a child is "$245,340", so paying a
30% premium in rare cases doesn't seem unreasonable.

A separate complaint is that the financial industry isn't covering this case
well. If you expected your insurance to cover it and they don't, that is an
entirely separate issue than the price of the drug. Even if they don't, it
seems like there should be a market for people wanting loans to pay for cures:
It seems really hard to underwrite such a loan, but it could probably be done.

What does good insurance from a reputable insurance provider that reliably
pays out their claims in cases like these cost?

(Edit) I may have misread the earnings report, thinking it was for the
previous year rather than the previous quarter. So the percentage is closer to
50%, and a commenter clarified that they also had another product.

[1] Earnings:

[http://investors.gilead.com/phoenix.zhtml?c=69964&p=irol-
ear...](http://investors.gilead.com/phoenix.zhtml?c=69964&p=irol-earnings)

Purchase price:

[http://investors.gilead.com/phoenix.zhtml?c=69964&p=irol-
new...](http://investors.gilead.com/phoenix.zhtml?c=69964&p=irol-
newsArticle&ID=1632335)

[2] Going down the list on one site that lists transmission methods: Don't
have sex with weirdos carrying diseases; don't share needles with druggies; go
to a licensed upscale commercial tattoo parlor instead of some shady cheap one

~~~
themartorana
Or... $11B was a terrible price to pay, and their desire to recoup their
shitty investment still shouldn't be allowed to bankrupt people who just want
to live.

It's also incredibly obtuse to call $84k a "30% premium" on raising a child.
There are so many people who don't (because they can't) spend close to $245k,
more that can barely pull it off, and even more that shouldn't have pharma
rates kept artificially inflated on their backs.

~~~
MichaelGG
Ultimately if we want companies to do research but not be able to charge
prices, then the government should be involved. It's like the case with Turing
pharma. Everyone's upset at him for buying a (very old) drug for a very rare
condition and raising the prices. Yet... why was he able to buy the drug in
the first place? Look there, don't blame the person that found a golden penny.

~~~
discardorama
> then the government should be involved.

The government _is_ involved. Most of these drugs would not exist were it not
for the NIH.

------
Scoundreller
> took the pills for 83 days (saving one for possible testing just in case)

I would try to arrange testing before starting therapy, or at least at the
point of starting therapy. There are labs that will run the test for a few
hundred dollars (and a lot less if you know someone at a university, it could
even be an analytical chemists' bachelor degree project).

~~~
giarc
I guess you could reason they are safe to take regardless. If they are
counterfeit, they would likely make them out of sugar or flour not harmful
chemicals. It wouldn't be in the best interest of the counterfeiters to make
pills that harm or kill the buyer.

~~~
grumpopotamus
I wouldn't bet my life on that. In fact, counterfeit drugs are estimated to
kill hundreds of thousands of people a year, in many cases directly, not
because they don't provide the necessary treatment. See
[http://www.cnn.com/2012/07/17/health/living-
well/falsified-m...](http://www.cnn.com/2012/07/17/health/living-
well/falsified-medicine-bate/)

>Fakes contained chalk, talcum powder, road paint and occasionally dangerous
heavy metals, instead of the expensive, hard-to-make medicine.

------
seshagiric
Not sure if there is one in the USA, however in India the law does impose a
maximum price for critical and life saving drugs (hypertension, heart related,
diabetes etc.). There is ongoing process for adding some cancer drugs too to
this list. I think the key here is that businesses should be allowed to make a
'reasonable' profit.

------
mhalle
Our medical and social systems are ill-equipped to deal with cures for
widespread diseases, which is what Harvoni and its related drugs are. We are
used to paying for disease on time: relatively small amounts of money for
periodic treatments that might last a lifetime, however long that lifetime may
be. And we (at least in the US) often think more about the value of the
treatment to the patient rather than the value of a healthy person to society.

These questions of cost and value go far beyond HCV. It is a popular, medical,
and entrepreneurial dream to cure cancer wholesale with a single easy course
of treatment. While cancer isn't a single disease, perhaps we should begin
asking now how we could assess the value and pay the price for such a
"miracle" should a cure for any of the most common cancers be developed.

------
walterstucco
Guess who can get them for free? those living in civilized countries with
universal health care systems.

~~~
bandrami
Very few countries offer free prescription drugs. Not even Canada does that.

~~~
scottishfiction
Scotland, Wales and NI do. And England has only a nominal charge.

~~~
bandrami
Right, and I think that's it (SK does the "nominal charge" thing).

~~~
MagnumOpus
Most western countries do the "nominal charge" thing - which in this context
is just about equal to zero.

For instance: German public health insurance buys a course of Sovaldi for
EUR40,000 ($46,000), the patient pays a cost of EUR10 ($11.50).

------
anne-marie37
I had no side effects either. I did 12 weeks with Ledifos (generic Harvoni),
and zero viral load from week 4. I'm SVR4, but still waiting to get SVR12,
fingers crossed! :-)

I bought Ledifos in Hyderabad, through med tour agency. The trip cost me just
over 2600$, tickets included, and I only paid once in India. The guys are
mellow, everything went very smoothly: hotels, doc, prescription, pharmacy,
all is done in 3 days (www.cure-hepc.com). I know you can do cheaper if you
just buy online, but when you pay online you never know if it's a scam.

------
erikpukinskis
Ironically, if the rights were owned by Skreli, Smith could've gotten the
drugs for free.

------
pramttl
I was once prescribed 4 tablets of Albandazole (a drug for worms treatment)
just before my health insurance was active on file. The drug was costing over
700$ without insurance and my health center asked if I would like to wait for
my student health insurance to show up as active. I said, yes (ofcourse)
shocked at the price of the drug (being an international student in US from
India). Even after my insurance I paid 35$ co-pay. The same drug costs <1$ in
India. Even the co-pay is over 35 times the cost of the drug in India. I was
trying to contrast some figures:

Salary ratio: ~5:1 (Software engineer, Google based on Glassdoor); Albendazole
drug cost ratio: ~700:1

------
jfountain2015
There is an excellent Radiolab piece on this:

[http://www.radiolab.org/story/what-year-life-
worth/](http://www.radiolab.org/story/what-year-life-worth/)

------
xbmcuser
I see a good opportunity here build a 40-50 patient facility in touristy place
like Thailand. It would cost about $250-350k then charge patients $4500 for a
3 month stay including medicine, food and board. Because of cheap labour and
food your expenses won't be more than $20k per month. You would me making a
profit with 40% occupancy with 85-95% you could recover your investment in
under a year.

------
fractal618
Hey everyone, look!

We're getting ripped off!

Here's how they're doing it!

We're all in this together!

We have the high ground!

Here's what we have to do!

Look another episode of Game of Thrones is on!!

Who's fucking who?

------
tn13
> In the United States, there is nothing stopping pharmaceutical companies
> from charging whatever they think the market will bear.

That is how it should be. The moment government controls prices, it will slow
down overall capital investment in invention of new drugs. I think $80k price
is perfectly fair given the scenario.

Until Giliad Science invented that medicine the alternative to the medicine
was assured death by cancer. Have you ever paid medical bills for cancer ?
$80k does sound like a reasonable amount to pay for one's life in a developed
country like USA. In India value of life is much less and I am not surprised
Indians are willing to pay much less for their life.

Poor Indians are benefiting at the expense of rich Americans. Indian would
prefer to die than borrow and buy a $80k medicine.

I think if Americans can save money by offshoring the cheap call centers to
India they can also save money by getting their health treatment in India. The
thing to remember here however is that if you die in an operation theater in
USA your family might get millions in compensation. In India you have to say
bad luck and move on. The pills that you buy from India could be nothing but
horseshit packaged in wrappers and you can basically do nothing even if you
find it out.

US is at the forefront of drug inventions because markets are allowed to
function, surely companies are making ton of profits but I suggest you try
setting up a company and invent the same drug and sell it for cheaper price.
Inventing drugs is like a startup, a giant number of research projects fail,
handful of succeed. People remember Facebook and its obscenely rich Zukerberg
they don't remember Bozo inventor of JokerBook, a social network for clowns.

It would be good if Americans learn to appreciate what they have rather than
complain about everything.

------
bradleybuda
Leaps in technology, finance, and engineering cure man of previously incurable
disease. He is pissed.

------
known
Here is current price for Sofosbuvir in India
[http://www.medplusmart.com/compositionProducts/Sofosbuvir-40...](http://www.medplusmart.com/compositionProducts/Sofosbuvir-400-MG/29220)

------
calvinbhai
Health insurance in US charges you 10¢ monthly premium, to provide a $100 pill
for $10, while it is available for $1 in India.

Dental insurance is as bad. Travel to India + dentist costs are often cheaper
than one time treatment costs.

------
WalterBright
Keep in mind that the potential for huge profits was what motivated private
investors to fund development for a cure. Without that, Hep C would still be a
death sentence, regardless of how much money you had.

~~~
maxerickson
Pharmasset spent in the ballpark of $1 billion developing the candidate that
Gilead decided to buy (I'm taking the annual spend on total operations there,
rounding up to $100 million and multiplying by 10 to get the $1 billion).

[https://www.sec.gov/Archives/edgar/data/882095/0001193125113...](https://www.sec.gov/Archives/edgar/data/882095/000119312511331318/d260880dex991.htm)

It sort of looks like they have figured out how to have excellent pricing
power when they are willing to bid $11 billion for the company. Part of that
is probably that looking just at this drug is a facile analysis of the value
of Pharmasset (which did more than develop 1 drug, they built expertise in
creating antivirals). Of course, the expertise story implies that they don't
need to recover the purchase on just this drug.

I guess some of it is the complexity in the medical payments system.

------
ChicagoBoy11
Nobody here is making the pretty obvious point: Yes, it is wonderful to blame
the drug companies (who invented the damn cure in the first place!) for greed
-- it feels great. But the real important question you have to ask is HOW ON
EARTH do they get away with charging $84k for a year of treatment?!?!?!?!

If they are charging this amount of money, it is because someone, somewhere,
in some deep and mischievous and evil place inside those big pharma buildings,
has crunched a lot of numbers and figured out this is the "correct" price for
them to charge for this drug. That is their income-maximizing price. And THAT
is what's insane.

Blaming them for "greed" is idiotic. But you have to scratch your head and
think of how on Earth the best strategy for them is to sell a product with a
price tag that no individual could really afford!!! That's the real mystery,
and when you start asking THAT question, perhaps you end up realizing that the
answer isn't so clear.

For starters, maybe ingenious strategy devised by our hero in the article, and
the Indian government's positions in generic were foreseen by one of the
thousands and thousands... upon thousands of lawyers, and business experts,
and consultants that these companies hire, so they quickly realized that the
name of the game HAS to be that they need to squeeze everything they can out
of the U.S. market to make up for the hits everywhere else.

"But wait, no one will be able to afford the drug," exclaimed one novice
executive at the pharmaceutical. "Not to worry," the senior counsel said, "we
have medicaid in the U.S., and that's where most of our customers will come
from. You see, the government will effectively be our client, and since they
won't have an option not to offer this treatment, all we need to do is ensure
we have amazing terms with this ONE customer and we'll be aaaaaaalllll set."
Etcetera, etcetera, etcetera.

Don't blame the pharma companies. We have ZERO competition in many dimensions
of healthcare. We have a drug approval process that costs billions of dollars
for a single drug to get through, and the academic evidence is quite clear
that it is actually killing more people than it is purportedly saving. I had
back surgery three years ago, and a line item in my medical bill was "juice -
$25." I stayed in the hospital for 19 hours. It cost me $40,000 FOR NO GOOD
REASON whatsoever. I also had shoulder surgery overseas, with a Harvard
medical-school trained doctor who operates on world class professional soccer
players. I was in a phenomenal hospital for two days, in a private room, with
nurses checking on me every hour, the works. The sticker price? $7,000.
Without a penny of gov't subsidy.

Big Pharma isn't the issue. Our policies towards healthcare are crippling us
to no end.

------
nsajko
We could make pharma companies be government contractors so the "intelectual
property" would be a owned by the state. That would probably be a bit better
than what we have now.

------
zaroth
If you remove a bunch of constraints, you can imagine governments paying for
country-wide license to the patent, and then individuals just pay enough to
cover manufacturing and delivery. I'm not sure if there was any payment that
went along with granting India the $1000 price. I know India carries a big-
stick of "invalidating" the patent. Sure, they could have just taken the IP
for themselves, which basically means Americans just bare a larger share of
the overall cost. The fact is that this drug is tremendously valuable for
India, so I'm glad they were able to come to some pricing agreement.

Selling those drugs back into the US market clearly goes against the pricing
agreement. Based on what I read in those articles about Paul Le Roux, these
online drug outfits have _way_ more volume than you might expect, and they
apparently can run for a long time before being shut down. This is partly a
submarine ad in that sense, even naming sources. You also might expect customs
to intercept these packages, but when Le Roux can share the same FedEx account
number across all their pill shipments, clearly inspection is expected to be
lax. So the result is these pills could actually be pouring back into the
country, and hiding within the inventory being sold for consumption actually
inside India. It seems like Gilead revenue is strong for now, I don't know if
they consider this to be a significant risk.

In some cases insurance will not cover if you are not showing symptoms. But if
they do cover it, you will be on the hook for just the out-of-pocket maximum
for that year. Any other health care you receive that year will be free, so
that could also help justify the cost. But in this case the insurance company
didn't want to cover it anyway, so the patient was forced to pursue a gray
market purchase. I'm pretty sure Gilead is pushing hard for insurance
companies to cover anyone with detectable disease regardless of symptoms, and
ultimately that's what we want. There's a huge population that avoided the
prior treatments, but would jump on this in a second.

Everyone who has HepC should get this drug. But if we can't afford to cure
everyone today, how do prioritize access? And how do you limit access to an
FDA approved drug for a diagnosed illness anyway, when the alternatives are
_more_ expensive and less effective? Well I guess in some places, like the NY
AG is requiring coverage for commercial insurance plans. NYT reports that
Medicaid is still denying coverage until the disease has advanced.

We want people to pay the "right" price for this drug, really a miracle cure
which is lowering the cost of treatment actually. So how do you price it? The
price to the insured patient today will vary based on the financial means of
the patient. The revenue to Gilead is negotiated with insurance companies /
benefit management companies, and is far below the sticker price.

------
ptaipale
I actually wouldn't expect that Indian prisons provide any effective
medication against hepatitis C. You might get it if you buy it yourself, and
bribe the prison staff to allow you to have it.

Sorry: this is not based on any real experience or references, just the
overall assessment of how India stands currently.

~~~
dragonmum
> You might get it if you buy it yourself, and bribe the prison staff to allow
> you to have it.

> Sorry: this is not based on any real experience or references, just the
> overall assessment of how India stands currently.

Jeez, you didn't have time to search but had time to fantasize like a
Hollywood script writer hashing out more 3rd world stereotypes? Perhaps we
should look at the treatment and hepatitis morbidity rate in our prison system
and wonder whether your stereotype may more accurately fit our own prisons
rather than Indian ones.

Here: [1]
[http://www.delhi.gov.in/wps/wcm/connect/lib_centraljail/Cent...](http://www.delhi.gov.in/wps/wcm/connect/lib_centraljail/Central+Jail/Home/Medical+Care+and+Hospital+Administration)

[2]
[http://www.legalservicesindia.com/articles/pri.htm](http://www.legalservicesindia.com/articles/pri.htm)

[3]
[http://defensewiki.ibj.org/index.php/Right_to_Medical_Care_i...](http://defensewiki.ibj.org/index.php/Right_to_Medical_Care_in_Prison)

Delhi Prisons have set up an Integrated Counseling and Testing Centre (ICTC)
on 10.06.08 in Central Jail Hospital for detecting HIV positive inmates.
Targeted intervention for HIV detection in inmates like injecting drug abusers
/ sexually promiscuous, inmates suffering from STD and inmates suffering from
multiple / opportunistic infections. Total number of such inmates, tested for
HIV positive test at ICTC from January,2010 to October'2010 were 1399, out of
which 27 were tested HIV positive .Further 2254 inmates were tested for HBsAG
and out of which 66 were found to be +ve for Hepatitis B.

[4]
[https://en.wikipedia.org/wiki/Infectious_diseases_within_Ame...](https://en.wikipedia.org/wiki/Infectious_diseases_within_American_prisons)

While the majority of HCV infections occur outside of prison, the disease is
still widespread within the prison system as a result of drug injection.[15]
According to one Rhode Island prison study, HCV infection was found in 23.1%
of the male prison population.[16] HCV prevention proved to be more
challenging than HIV prevention because inmates partake in high-risk behaviors
such as “front loading” and sharing spoons to prepare drugs like cocaine.[4]
The prevalence of these diseases within prisons is a concern because they pose
a potential public health risk.

[5] [https://represent.us/action/private-
prisons-1/](https://represent.us/action/private-prisons-1/)

~~~
ptaipale
Thank you for correction; grant me at least that I knew I'm commenting based
on prejudices.

Note however that I don't view the American prison system as "our" ("mine")
either (I'm not from the US).

And still, what I read of Indian prison is just way, way worse than what I
read about the American system. Overcrowding, horrible delays in trials,
abysmal hygiene. I doubt that the HCV treatment there is very good, despite
there being a counseling centre.

"In India, overcrowding has aggravated the problem of hygiene. In many jails,
conditions are appalling. At the tehsil level jails, even rudimentary
conveniences are not provided. Prisoners in India are not even tested for
specific infectious diseases, although all prisoners undergo a medical
examination when they begin serving their sentence. No studies of the
prevalence of viral infections among prison inmates have been done at a
national level. India’s prison manuals provide for segregation of prisoners
suspected of having contagious diseases. A few jails have established informal
contacts with medical and social organizations for counseling of inmates to
prevent the spread of infections."

~~~
linuxkerneldev
> way worse than what I read about the American system.

Is it though?

[https://en.wikipedia.org/wiki/List_of_countries_by_incarcera...](https://en.wikipedia.org/wiki/List_of_countries_by_incarceration_rate)

\- the incarceration rate of the United States of America was the highest in
the world, at 716 per 100,000 of the national population.

India is 33/100k. We've got 20 times more of our own American citizens behind
bars than the typical 3rd wordl country.

~~~
ptaipale
Your incarceration rate is a different issue from how prisoners are treated
(or mistreated), particularly regarding health care in prison.

Over here (Finland), there's a popular meme about "let's put elderly people in
prison, so they get a bed of their own, a daily shower, good food and someone
to take care of their mental well-being". Even if our old people's care in
public institutions is probably one of the better-arranged among nations.

------
Scoundreller
The article is already off to a bad start, assuming the existing therapy
they're talking about is Pegetron:

> The interferon-based treatments weren't successful half the time, and the
> side effects were so debilitating few patients could endure the months-long
> punishing protocol.

If the success rate is 50%, I would say that's pretty good, especially since
we're talking about treatment, not just managing the disease (as we can only
do nowadays with HIV). And from the product monograph: "The most frequently
reported adverse reactions were mostly mild to moderate in severity and were
manageable without the need for modification of doses or discontinuation of
therapy. "

But no doubt, the pre-existing therapy sure has a pile of side-effects.

~~~
refurb
I worked on one of the old interferon drugs before Sovaldi/Harvoni came along.

They sucked.

Patient compliance was low due to the side effects. From what I've heard, it
was like having the flu everyday for duration of treatment.

If you any mental health issues (depression, etc) you couldn't take it since
the rate of suicide goes way up.

The new HCV drugs are an amazing breakthrough.

~~~
dannylandau
Does anyone know the prevalence of the most common side effects for Harvoni?

I usually defer to the following site but they don't have info on the drug --
[http://www.healthbee.co/](http://www.healthbee.co/)

~~~
mhalle
There are some reports of side effects of varying degree, but in general
Harvoni's side effects are extremely mild.

When I did the trial, my physician indicated that in previous trials, patients
couldn't reliably distinguish Harvoni from a placebo. My experience aligns
with this statement.

While I was on a 24 week trial (longer than most people today) with ribavirin
(which is only used with a minority of patients today), I experienced nothing
I could directly attribute to the medication. My viral load dropped to
undetectable in six weeks, and has remained so since.

