
Humira’s Drug Formula: Start at a High Price, Go Higher - stablemap
https://www.nytimes.com/2018/01/06/business/humira-drug-prices.html
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cnewey
Humira really is a life-changing drug - but it is offensively, eye-wateringly
expensive. Each auto-injector pen costs approx. £500; and I have to take one
every 2 weeks. To put that in perspective, that's a cost of about £1000 per
month - which is _considerably_ more than my mortgage. _My house costs less
than my medical treatment_.

Fortunately for me, I live in the UK, where the NHS is able to help absorb
these costs. In the US, I guess they aren't so lucky - if I lived there, my
Humira treatment would financially destroy me - and probably my entire family,
too. It's morally reprehensible for a company to have access to such a life-
changing treatment and then proceed to charge such disproportionately vast
sums of money (certainly, far beyond the cost of R&D).

I suppose you could say that instead of crippling its patients physically
(like their medical problems do), Humira cripples its patients financially -
and I'm not sure that's a great deal better.

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phonon
> In the US, I guess they aren't so lucky - if I lived there, my Humira
> treatment would financially destroy me - and probably my entire family, too.

What makes you say that?

Either private insurance would cover it, or Medicaid (for low income people)
or they essentially give it away to uninsured people through a non-profit
foundation. (AbbVie Patient Assistance Foundation)

[https://www.humira.com/humira-complete/cost-and-
copay](https://www.humira.com/humira-complete/cost-and-copay)

~~~
cnewey
I'm not especially familiar with the structure of the US health insurance
system, but I think that the lower costs mentioned on the page you linked
largely depends on either receipt of considerable amounts of state aid, or
having pretty high-quality insurance.

Certainly, if you were to flick through various forums for those with Crohn's
disease (e.g. [1]), you'd find many stories of people paying hundreds (or even
thousands) of dollars for a month's Humira treatment.

[1]:
[https://www.healingwell.com/community/default.aspx?f=38&m=22...](https://www.healingwell.com/community/default.aspx?f=38&m=2272681)

~~~
maxerickson
Under current law (the ACA), the maximum annual payment would be $7,350 (on
top of monthly insurance premiums).

That's for the lowest benefit, qualifying ACA plans and assuming the
prescription is covered. The "cash" price is ~$4000 a month
([https://www.goodrx.com/humira](https://www.goodrx.com/humira) ) so even the
lowest benefit plans are kicking in quite a bit of support (but probably also
negotiating the price down quite a bit).

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olefoo
For added corruption under the American model:

AbbeVie runs what is called a co-pay assistance program where they pay the
difference between your insurance coverage and your copay. So they book a sale
at full-price, paying (full price - (amount covered + $5 )) and they get to
deduct the money they payed to themselves as a "charitable contribution".

Which is so many flavors of shady. For a drug that costs literally pennies per
dose to manufacture.

~~~
notlob
> For a drug that costs literally pennies per dose to manufacture.

Pennies per dose for a biologic?

~~~
olefoo
I may have been using rhetoric; but I would be surprised if the direct cost (
lab time, process control, packaging, etc. ) were more than $40/dose.

And consider that most of the research on which Humira, Embrel etc. came from
was sponsored by the US Taxpayer.

~~~
notlob
I don’t have specific knowledge on Humira or its biosimilars, but $40 is more
reasonable.

To be specific, Humira was developed from research by BASF Bioresearch (bought
by Abbott) and a research consortium in the UK, so credit to the UK taxpayers
is warranted; I’m not sure about the US side.

Nevertheless, government sponsored research largely does not cover the
development of the drug, and those costs are somewhere in the hundreds of
millions USD range on up.

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Gatsky
This is old hat. The USA's process for pricing drugs is totally in service of
the drug company - even that much is obvious to mercenary financiers like
Shkreli.

The deeper problem is that we aren't getting newer better drugs. Once a
blockbuster like Humira happens, it seems to kill off the field. This is
mostly because you need to spend a lot to do a massive trial to show your
Humira 2.0 is better, with no guarantee it will actually be better. The
economics are very hostile. Pharma tends to do smaller trials with their new
drug in more select populations eg those not responding to Humira, and
therefore end up having a much smaller market if the drug works.

Drug pricing should be re-engineered to encourage more development rather than
the opposite. If better alternatives exist then pharma obviously won't be able
to charge extortionate prices.

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remontoire
Reduce costs of getting FDA approval and reduce patent lengths?

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mcny
I think I read here about the problem of

1\. Patent a drug 2\. Make inconsequential changes 3\. Patent it again 4\.
Repeat

I don't have any first hand experience in the industry so I don't know if this
is a serious problem. I don't even know if it has a name!

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adrianN
What's stopping a third party from doing 2 and 3?

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celticninja
The original patent.

~~~
adrianN
Does the original patent apply if the compound is sufficiently different to
warrant a new patent? That seems strange to me, but I know nothing about
patent law.

~~~
kgwgk
Exclusivity is extended with patents covering new formulations, manufacturing
processes, alternative dosings, injection devices, risk evaluation and
mitigation strategies... When the molecule itself becomes “free” to copy,
there may be still several patents more or less enforceable that prevent
competitors from entering the market. Often the validity of patents is decided
in court (see Copaxone for a recent high-profile case study).

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jakub_g
Also interesting link within the article:

[https://www.bloomberg.com/news/articles/2017-09-07/this-
shie...](https://www.bloomberg.com/news/articles/2017-09-07/this-shield-of-
patents-protects-the-world-s-best-selling-drug)

TL;DR Humira is protected by over 100 patents, covering how it's produced etc.
That's partially what's preventing other companies from coming up with a
replacement, despite the main patent having already expired.

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jinpa_zangpo
The solution to overpriced patent protected drugs is forced licensing of
patents at a royalty rate set by the government.

~~~
beisner
I think an interesting solution to consider is a sort of drug bounty program
run by the government. Right now, companies put up their own capital to fund
drugs, and get a big payout (via patent exclusivity) if they succeed. This is
a bit problematic, because regardless of the expense of the cost to develop
the drug, it is in the interest of the drug companies to charge as much as
possible for the longest amount of time to maximize return on investment
(personally why I think there are so many long-term treatments for diseases
like HIV rather than full-on vaccines). But if the government were to say “we
will give $X billion to the corporation that provides a drug that meets Y
conditions, with the caveat that that drug will then be sold for $Z per course
of treatment or immediately go generic”, then public health policy could
direct certain aspects of drug discovery, and lead to more affordable
outcomes. There are still issues with this sort of plan, but I think it has
the potential to be workable.

