
Non-profit’s $300 hepatitis C cure as effective as $84k alternative - lnguyen
https://www.theguardian.com/science/2018/apr/12/non-profits-300-hepatitis-c-cure-as-effective-as-84000-alternative
======
avar
The latest episode of Econtalk "Vincent Rajkumar on the High Price of Cancer
Drugs" is relevant to this subject:
[http://www.econtalk.org/archives/2018/04/vincent_rajkuma.htm...](http://www.econtalk.org/archives/2018/04/vincent_rajkuma.html)

It discusses structural issues relating to why drugs are so expensive (mainly
in the US). Some of it's regulatory (e.g. Medicare not being allowed to
negotiate drug prices), or there being no ceiling on prices related to
efficacy as in many other countries.

But some of it's because nobody in the system seems to have a real incentive
to reduce costs, even when the benefits are worth it. E.g. an example that's
mentioned is that doctors will usually describe the latest brand medicine
that's outrageously expensive, instead of a generic that's cheap and
statistically almost exactly the same thing when it comes to efficacy.

~~~
jseliger
_But some of it 's because nobody in the system seems to have a real incentive
to reduce costs, even when the benefits are worth it_

This is a _really_ underrated point and part of the reason I'd like to start
by seeing price transparency: [http://seliger.com/2018/03/27/preventive-care-
doesnt-save-mo...](http://seliger.com/2018/03/27/preventive-care-doesnt-save-
money-bankruptcies-arent-widely-caused-lack-insurance-fqhcs) . Bizarrely (or
at least, bizarrely to me) this doesn't seem to be part of the political
discussion at all.

~~~
maherbeg
I am very strongly with you here. Why can’t we get an exact cost upfront
before Abby services are rendered? A doctor can make orders and should be able
to get the exact cost to you before submitting them.

These prices should all be public and comparable. Common reasons to go to the
doctor should be shown alongside their costs.

We got a surprise $19k bill that we were told would be $160 and our insurance
would cover the rest. We’re letting them fight it out but would be very
disappointed if we had to pay that out of pocket. We would never have ordered
the test then, or would have tried to shop around

~~~
kbart
Wow, so do I understand right, that in USA you _don 't know_ the cost of
medicine before buying them? What's the reasoning behind that?

~~~
hackeraccount
Third parties payers is the reason. As a general matter if you have insurance
- private, medicare, medicaid - and the reason isn't anything crazy / chronic
then the price is never out of the world. Chronic conditions add up but the
people in those cases generally know what the cost is ahead of time. And if
you don't have insurance either you're able to pay out of pocket or you just
don't pay and then get care anyway.

Which is to say it's all madness.

------
greeneggs
I would also like to recommend this _Nature_ article, from August 2016, on the
same Drugs for Neglected Diseases initiative (DNDi) discussed here.

"Busting the billion-dollar myth: how to slash the cost of drug development"

[https://www.nature.com/news/busting-the-billion-dollar-
myth-...](https://www.nature.com/news/busting-the-billion-dollar-myth-how-to-
slash-the-cost-of-drug-development-1.20469)

> In just over a decade, the group has earned approval for six treatments,
> tackling sleeping sickness, malaria, Chagas’ disease and a form of
> leishmaniasis called kala-azar. And it has put another 26 drugs into
> development. It has done this with US$290 million — about one-quarter of
> what a typical pharmaceutical company would spend to develop just one drug.
> … In that vein, the DNDi has started research on alternatives to pricey
> drugs for hepatitis C…

~~~
refurb
_It has done this with US$290 million — about one-quarter of what a typical
pharmaceutical company would spend to develop just one drug_

What a poorly researched article.

Of course they have. If you only measure the successful drugs, the cost of R&D
is much lower. The question is, how do you identify those drugs?

Plus, DNDi is not creating brand new molecules. Their molecules are either:(1)
old drugs that we already know work but were never formally approved, (2)
cast-off drugs where someone already spent a shit-ton of money, but never took
them to the finish line or (3) me-too drugs, where they just tweak a known
drug. All of those are _much lower risk_ than creating a brand new drug with a
new MOA.

When they come up with a new drug with a truly novel mechanism, then we can
find out how much it cost them.

Derek Lowe from the "In the pipeline" blog put it well:

 _" As pointed out in that previous post, the initiative, for the most part,
is repurposing drugs that were discovered and at least partially developed by
someone else, using someone else’s time, money, expertise and
infrastructure."_[1]

[1][http://blogs.sciencemag.org/pipeline/archives/2016/08/26/gos...](http://blogs.sciencemag.org/pipeline/archives/2016/08/26/gosh-
fellows-theres-a-better-way)

~~~
jopsen
Isn't most drug developments just incremental improvements on previous drugs?

Don't most drug companies stand on the shoulders of giants, starting of from
public basic research?

~~~
refurb
It's very rare that someone does everything from the basic science to
approval.

However, there are varying degrees of incremental. I would say DNDi is on the
very incremental end.

------
dfee
I worked with a hepatologist once who donated his services to low-income
patients with hep c. Encouraged by his selfless act, I called him to learn
more about how our services could help him (he was asking for a discount).

Well, it turns out that while his services were donated, he also owned a
pharmacy and stood to make a lot more by using the donated time as what we
might call a “customer acquisition cost”.

I would be surprised if he continues treating patients if the payout for
treatment really goes down 30 fold. For what it’s worth, that’s a pretty
typical physician I’ve worked with and I’ve worked with hundreds.

I don’t know why I expect more from physicians, but I do and they usually let
me down.

~~~
neuro_imager
I'm guessing you're in the US where this type of behaviour is typical.

Fortunately that is not the case in many other parts of the world where
incentives are not as perverse.

(physician here)

~~~
chimeracoder
> Fortunately that is not the case in many other parts of the world where
> incentives are not as perverse.

Incentives absolutely are structurally perverse in other parts of the world.

They're just perverse in different ways, which often mask the effects to
patients.

------
cowsandmilk
My immediate question was "how are they getting sofosbuvir for $300?" That is
literally Sovaldi and one of the components of Harvoni, which is what the
article is comparing this to?

Well, they are getting it that cheap because Gilead (the company selling HCV
drugs for $84k in the US) licensed it as a generic for sale for this
purpose[1].

So, no, this nonprofit didn't discover some cure out of nowhere, they created
a combination therapy that uses one of the components of the $84K drug that is
available inexpensively due to the owner of the $84k drug licensing that
component for generic manufacture in that area of the world.

[1] [https://in.reuters.com/article/gilead-sciences-
india/gilead-...](https://in.reuters.com/article/gilead-sciences-india/gilead-
licenses-hepatitis-c-drug-to-cipla-ranbaxy-five-others-idINKBN0HA0TI20140915)

~~~
aaavl2821
From what I understand, Gilead and many other companies do provide some meds
at cost to countries that don't have a system to pay for high priced drugs,
especially if they are important drugs for large groups of sick patients

Part of this is a corporate social responsibility thing, but part of it is
because many of these drugs are purchased and distributed by entities that
sometimes cut and dilute expensive drugs and resell them. This hurts patients
and tarnishes the brand of the company. Selling their products at cost removes
this incentive and allows patients to access the medicines in their
unadulterated form

So the pharma companies incentives aren't entirely altruistic but it helps
patients in the end

~~~
erkkie
This and just the economics of it. It makes sense to sell at what price the
market can handle, as long as it's above direct production cost (which it is).
It's basically cheap marketing that happens to align with patient interests.

edit: A lot of it is also politics with the host country. India for example
has said it will produce cheap generics of drugs if it wants to, ignoring
patents:
[https://www.forbes.com/sites/johnlamattina/2013/04/08/indias...](https://www.forbes.com/sites/johnlamattina/2013/04/08/indias-
solution-to-drug-costs-ignore-patents-and-control-prices-except-for-home-
grown-drugs/)

------
firefoxd
One day, we will look back and not understand how this was even possible. You
come up with a cure for something and you make the price so high that it is
cheaper to die from the disease.

~~~
xyzzyz
The alternative is to have no cure at all. The businesses need that money as
incentive to develop new cures. If we don’t want it to work this way, we need
government to spend much more on research, otherwise we will just get fewer
new drugs.

~~~
cma
That's not really always the case. In the case of orphan drugs it would often
be much cheaper overall to have the government fund production instead of
granting new exclusive rights to out of patent medications to entities like
Skhreli.

Aside from that, more than half of pharma budgets are spent on spent on
marketing and patent-workaround redevelopment than on actual productive drug
research (even after accounting for new discoveries that sometimes come out of
workaround research).

> If we don’t want it to work this way, we need government to spend much more
> on research,

NIH already funds something close to half of drug research. Even more if you
include basic research that has a longer time horizon.

Overall spending would go down, with the side-effect that there would be less
penis pill popup ads and way less funding for the Super Bowl halftime show.

~~~
darawk
> That's not really always the case. In the case of orphan drugs it would
> often be much cheaper overall to have the government fund production instead
> of granting new exclusive rights to out of patent medications to entities
> like Skhreli.

You're conflating two things. Orphan drugs are drugs that aren't profitable to
produce, for whatever reason. Shkreli did something a bit different and more
complex:

[https://en.wikipedia.org/wiki/Pyrimethamine#Availability_and...](https://en.wikipedia.org/wiki/Pyrimethamine#Availability_and_price)

> NIH already funds something close to half of drug research. Even more if you
> include basic research that has a longer time horizon.

The NIH spends 32[1] billion per year, whereas the global spending is ~160[2]
billion. So around 20%. That's a lot, but not nearly half.

> Overall spending would go down, with the side-effect that there would be
> less penis pill popup ads and way less funding for the Super Bowl halftime
> show.

That's a fairly simplistic interpretation of the world. In general, companies
tend to be much more efficient at spending their money than governments. We
should expect a substantially higher level of productivity per dollar from
businesses than we get from government spending.

There's definitely a reasonable debate to be had about public funding models,
but it ought to be properly contextualized by the realities.

[1] - [https://www.nih.gov/grants-funding](https://www.nih.gov/grants-funding)

[2] - [https://www.statista.com/statistics/309466/global-r-and-d-
ex...](https://www.statista.com/statistics/309466/global-r-and-d-expenditure-
for-pharmaceuticals/)

The global R&D spend is

~~~
rectang
> _We should expect a substantially higher level of productivity per dollar
> from businesses than we get from government spending._

Private industry has been very effective indeed at hooking millions of people
on opiates. Meanwhile, where are all those new antibiotics?

Market competition is an important element missing from government research,
but commercial entities have their own pathologies.

> _There 's definitely a reasonable debate to be had about public funding
> models, but it ought to be properly contextualized by the realities._

I favor acknowledging that all markets are constructed, even supposedly
"unregulated" ones. The trick is then to construct hybrid models incorporating
marketplaces and informed by the limitations of both government and industry.

~~~
pitaj
I love how you managed you blame the opiate crisis on pharma companies, when
it's directly tired to the consequences of drug prohibition by governments.

~~~
rectang
Oxycontin is legal.

Many of those who became addicts would not have save for sinister machinations
by Purdue Pharma. See this article on "Oxycontin's 12-hour problem":

[http://www.latimes.com/projects/oxycontin-
part1/](http://www.latimes.com/projects/oxycontin-part1/)

I don't like prohibition and the recreational drug market is ripe for reform.
There are better and worse ways to do that -- see Mark Kleiman's writings for
strategies to construct legal marijuana markets where the incentives for
companies to manufacture addicts are minimized.

But the opiate crisis is not an example of supply inadequacy due to
prohibition. The pharmaceutical industry has artificially increased _demand_.

~~~
pitaj
They've increased demand for _their_ drugs by limiting supply of other drugs.

~~~
rectang
Who is "they" \-- government or industry?

If you believe that we should be skeptical of _both_ , perhaps there's common
ground where we can agree. Power corrupts, power collects within both
government and industry, and they constantly reinforce each other through
corruption and regulatory capture. The state has the monopoly on violence so
it deserves special care, but commercial entities (especially multi-national
corporations) have plenty of power to threaten and ruin individuals.

------
chris_va
People always get really upset with drug pricing, which makes for great
headlines but not for rational decision making.

In 2030, would we as a society rather have a generic, cheap, openly available
HepC cure or not? That is the question you need to ask, and I don't think
anyone would say no to that. The $84K drug will fall off patent by then, which
means the system we currently have, flawed as it is, will produce that
outcome.

It doesn't cost $84,000 to manufacture that drug compound. That $300 one even
has the expensive drug formulated in it! The $84,000 covers the cost of
developing the drug, along with the 56/57 other drugs that generally fail for
every one that hits the market, along with a profit incentive to run a
pharmacuetical company in the first place. And yes, it's grossly unfair for
the patients currently requiring expensive treatment, though solving that
through insurance is almost certainly a better idea than regulating prices. If
you start regulating drug prices, as have many other countries outside of the
US, you disincentivize development.

If there is a better way to create cures, that would be wonderful, and I think
we would all welcome suggestions. However, there is a reason the US invents
the majority of the world's pharmaceuticals. Nothing to date (everything from
regulating prices aggressively to prolifigate government spending projects)
has worked as well as what we have now for long term results.

~~~
JangoSteve
I think you kind of gloss over the core issue that most people have with drug
prices. I don't think most people have a problem with pharmaceutical companies
pricing drugs such that they pay for the R&D costs (or more generally the
overhead) of the company plus some reasonable profit margin.

The problem is that with the inelastic demand inherent in life-or-death
treatments, there is no incentive for pharmaceutical companies to stop there.
If pricing a pill at $200 could cover costs and provide 30% profit margin, why
not double the cost and make a 50% profit margin? Or triple the cost and make
a 60% profit margin? With inelastic demand that is governed only by a person's
ability to pay, rather than their willingness to pay or competition, the
demand drops far slower relative to the increase in price compared to normal
supply-and-demand economics. It's the tendency (or at least perceived
tendency) of taking advantage of someone's desire to live to extract as much
money from them as possible in order to increase profit margins that people
tend to have a problem with. This is called exploitation.

I think it's a bit disingenuous to spin outcry over _how_ expensive a drug is
(in a relative sense) as being a simplistic outcry over a drug just _being_
expensive (in an absolute sense).

That said, it's possible that some of it comes from the fact that R&D is so
expensive, and a pharmaceutical company never really knows how long their drug
will be bought before some other company discovers something that outperforms
it. I am by no means an expert on pharmaceutical company economics.

EDIT: And the above argument is just one possible argument to make if you
assume that drug development should be a function of capitalism in the first
place. There's another viewpoint that drug development shouldn't be a
responsibility of capitalism at all, in part because perverse incentives often
times unavoidable in capitalism are especially unethical when applied to
people's health.

~~~
stevenwoo
It kind of feels inevitable in America, but Goldman Sachs analysts questioned
the wisdom of using gene therapy to cure people - because that cuts off
pharmaceutical companies from a steady income stream keeping them alive
through selling them drugs. [https://www.cnbc.com/2018/04/11/goldman-asks-is-
curing-patie...](https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-
patients-a-sustainable-business-model.html)

------
solidangle
These price comparisons are almost always disingenuous. One price only
includes the cost to produce the medicine, and the other also includes years
of R&D, 10+ years of trials, marketing, and distribution. Sure, the $84000
probably still includes a hefty profit margin, but with all those extra costs
the $300 medicine becomes a lot more expensive.

~~~
snarfy
No, this is the common lie they tell you.

The majority of money spent in R&D is public money. When they say "It cost $10
million to develop" it doesn't mean that's what they paid out of pocket. Most
of it is research done at universities through grants.

My wife was treated for MS using a cancer drug developed in the 50s. If you
have cancer, the drug costs about $20. If you have MS, the drug costs
$450,000+ (that was my bill). The only difference is FDA approval.

~~~
chimeracoder
> The majority of money spent in R&D is public money.

No, most of the money spent on R&D in the _entire world_ is funded though
pharmaceutical sales in the US. The amount that comes from truly exogenous
sources is vanishingly small.

> My wife was treated for MS using a cancer drug developed in the 50s. If you
> have cancer, the drug costs about $20. If you have MS, the drug costs
> $450,000+ (that was my bill). The only difference is FDA approval.

You're proving the point. It's more expensive because they have to go through
the research and approval process all over again for the new usage of the
drug. The marginal cost of producing the medicine isn't the issue.

~~~
phaemon
> most of the money spent on R&D in the entire world is funded though
> pharmaceutical sales in the US.

This is not true, and I've already told you this.

Pharmaceutical R&D spending in 2015: USA $47B, Europe: $33B.

Total drug sales Europe 2015: $190B

~~~
chimeracoder
> This is not true, and I've already told you this.

And as I've already told you, those statistics aren't remotely relevant to
this discussion. That tells you the amount of money that's spent on research
inside each region, not where the money actually comes from.

You've used that statistic in the past to "prove" that European drug sales
could cover the R&D expenditures in the US, because $190B > $47B, but that's
not a mathematically valid analysis. The profit margins in the industry are
nowhere near large enough to absorb a $400B hit, which is what it would be if
the US drug market had the same price levels as Europe.

Based on previous discussions, I can predict where you're trying to to lead
this next, which is to claim that they _could_ absorb that massive loss,
because they could just take it away from excessive compensation and marketing
expenses. Except, the numbers don't add up there either. SG&A is the largest
expense in pretty much every industry, and pharmaceuticals are naturally
reliant on personnel. Executive compensation is a drop in the bucket.

And, as you've already been told by others, pharmaceutical companies spend
much _less_ on marketing or SG&A expenses than most comparable tech companies
do. Even if you assumed that marketing has zero impact on revenue (hint: it
doesn't), or that pharmaceutical companies have a lower return on investment
for marketing expenses than Google does (hint: they don't), cutting all
marketing expenses would still not account for the difference, and that's
_before_ the massive drop in sales that would result.

Of course, once again, this set of statistics all entirely irrelevant to the
original point at hand: regardless of where the R&D physically takes place,
and regardless of the headquarters of the company that's conducting the R&D,
the underlying flow of funds is disproportionately and predominantly reliant
on the US market.

~~~
phaemon
> And as I've already told you, those statistics aren't remotely relevant to
> this discussion.

No you didn't. I posted those figures exactly once in this comment:
[https://news.ycombinator.com/item?id=16585982](https://news.ycombinator.com/item?id=16585982)

which you did not reply to. Stop lying.

> You've used that statistic in the past to

Another lie.

> Based on previous discussions, I can predict

Not had previous discussions with you. Exactly one, the previous one which you
did not reply to.

And seriously, you think $70 Billion is a massive cost for the world's
governments? You really need to learn some basic arithmetic.

I suggest you stop and _think_ instead of posting these mindless talking
points. Go look up the numbers for yourself.

------
chiefalchemist
"Harvoni now costs about $48,000 for a 12-week course in Malaysia and $12,000
in Chile. Gilead’s previous Sovaldi treatment cost $1,000 a pill, or $84,000
over 12 weeks. Prices vary around the world and tend to be highest in the US."

I can understand slight differences, but this is disturbing.

That said, does anyone know the effects on (US) taxes if a drug company lists
a cost as $X but has various programs to sell that product at some fraction of
$X?

Between insurance and such, does anyone really pay full price? So is there
some (unknown?) incentive for companies to inflate the list price?

~~~
opencl
How do you think everyone gets it below list price? The insurance companies
are paying the difference. Medicaid pays 85% of list price.

~~~
chiefalchemist
I presume the hospitals and insurance companies negotiate "volume discounts"
or similar, effective paying less (but call it whatever you want.)

For example, a hospital stay. The insurance company would pay $Y and that's
accepted by the hospital - no questions asked.

On the other hand, you, without insurance, would pay the "list price" which
isn't $Y but $Y+ $Z.

This type of price "confusion" only benefits those with the resources and
desire to exploit it.

------
kyaghmour
The price difference is so staggering that it'll just be cheaper to buy a
plane ticket to the countries where the cheap one is available and take it
there; especially since some countries (Egypt for instance) don't necessarily
require a doctor's prescription to allow you to buy some medication from the
pharmacy.

~~~
bvinc
I actually know a good friend that had Hep C that did exactly that. He flew to
Egypt and walked into a pharmacy and bought it. I forget how much he paid, but
it was closer to $1,000 instead of $84,000.

------
refurb
Of course it's cheaper if you ignore all the R&D costs.

A good analogy would be software. If I copy a DVD that has AutoCAD on it, I
could go out and claim "I'm only charging $5 for my software vs those greedy
manufacturers charging $500".

~~~
slim
So when they recover the cost of R&D they should align with the the cheaper
price?

~~~
refurb
Would you make an investment if there was a risk you lost it all, but the best
you could expect would be all your money back, not a dime more?

Probably not.

------
StudentStuff
This is great for public health, leaving people with untreated diseases due to
artificially high drug prices is literally killing people needlessly.

------
refurb
I'm a little confused. The "new" drug is combination treatment of two
hepatitis C tablets, ravidasvir ­(a new drug)­ and sofosbuvir.

Ravidasvir is novel, but sofosbuvir is the active ingredient in Sovaldi and
Gilead has IP protection on it. How do they plan to get around that?

The article hints they will work with an Egyptian company to produce it, but
Gilead aleady offers Sovaldi for $900 in Egypt. Do they think the Egyptian
gov't will turn a blind eye to violating the IP?

~~~
philipkglass
_Do they think the Egyptian gov 't will turn a blind eye to violating the IP?_

I wouldn't be very surprised if they do. Egypt doesn't have powerful domestic
IP-reliant industries lobbying for the enforcement of IP. No doubt there are
international obligations of some sort, but the benefit of "slash costs for
curing a serious disease" is a lot more concrete than the penalty of "the
country could face a protracted legal case." It's happened before, with e.g.
antiretroviral drugs for HIV in South Africa. Ultimately the pharmaceutical
companies backed down, both because they had limited material leverage and
because "trying to make poor countries pay more for medicine" is judged in the
court of public opinion.

~~~
refurb
But the Egyptian gov't already entered into a deal with Gilead to sell Sovaldi
for only $900. I assume that was negotiated in good faith.

If that hadn't happened I would agree that the Egyptian gov't could probably
care less if someone broke the patent.

~~~
philipkglass
Saving an additional $600 per patient is significant for a country as poor as
Egypt. The existence of an even cheaper alternative strengthens the Egyptian
government's negotiating position for agreements going forward. Prices may be
re-negotiated further downward in light of this new development.

As a rough analogy: consider the effect of sci-hub on recent negotiations
between universities subscribing to academic journals and the journals'
publishers. Even if the universities do not openly embrace/endorse sci-hub,
the existence of an unlicensed near-substitute for the licensed product has
strengthened the negotiating position of the universities.

~~~
refurb
That's true, but pissing off someone who cut you a deal usually ensures you
won't get a similar deal like that again in the future.

It's a risk.

------
tim333
Now look forward to its use being blocked for a decade or two by FDA
regulations and lawsuits.

------
yread
Similar story: 'Coffee filter' helps make new cancer drug Z-endoxifen 1000
times cheaper

[https://www.sciencedaily.com/releases/2018/04/180405120401.h...](https://www.sciencedaily.com/releases/2018/04/180405120401.htm)

------
exabrial
If the new company did the r&d costs then great! That'll force competition
into the market and drive prices down.

It they stole the IP I'm very sad to see that. Drugs are incredibly expensive
to prove they work and they're safe. If we want to continue to receive new
cures, we have to let drug companies recoup their costs.

The drug patent process definitely needs reform. Eventually these drugs ought
to become public domain as everything does so we can advance humanity. I feel
a lot better patent system for drugs would be 10-15 years after the drug is
_approved_ , with a capped provisional during the process. I feel like the
strikes a balance between allowing companies to safely research and protect
their cost but also will allow generics to enter the market eventually.

------
slim
When you're ill, you have no choice but buying medication whatever the price
asked. $84000 represents more than an entire life of salary in Africa. So
essentially giving a monopoly on medication to a company is equivalent to
giving them slaves

~~~
owlmirror
The absurdity of intellectual property. Artificially inducing scarcity with
state violence

------
bigjimslade
Competition drives prices down? Bloated, protectionist government regulations
drive prices up? Wow! Stop the presses!

This same story in umpteen other contexts has been written time and time and
time again, throughout modern history.

Get government out of the way. Let people put themselves to work in ways they
feel most capable, and watch innovation happen, cost effectively, and to the
benefit of mankind! What's old is new again.

------
chrisweekly
I had to hunt for the article URL from the linked page, so c/p the actual
article URL here:

[https://www.theguardian.com/science/2018/apr/12/non-
profits-...](https://www.theguardian.com/science/2018/apr/12/non-
profits-300-hepatitis-c-cure-as-effective-as-84000-alternative)

------
itissid
Here is a thought, for those who have insurance. The insurance company can
just give you an all expenses paid 12 business class trips (one per week
@~3000$ a pop on the web and much cheaper if purchased in bulk) to go to
Malaysia and get the 300$ treatment along with hotel stay for a day or two.

And It would still be cheaper by 50%...

------
RcouF1uZ4gsC
That is awesome. If non-profits can research and get a drug approved, they
should be able to charge what they want. If for profits can research and get a
drug approved, they should be able to charge what they want.

------
Rotdhizon
I wonder how long it will be before this non-profit is bought out by a multi-
billion dollar pharmaceutical company and that drug price magically
skyrockets.

------
shadowtree
Great news, the market is working.

I don't get the vitriol in the comments, tech plays outs exactly the same.
What once cost millions in a data center is now pennies in AWS.

Pharco is a normal for-profit pharma company and attacking an established
market. Good for them. This hasn't gone through FDA approval yet though, so
this is a long time off and a lot of things can happen on the way (nasty side
effects killing people, etc).

Isn't it great that humanity found a way to cure Hep-C?

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perseusprime11
$300 still sounds good money for most folk to afford. When can we make these
free?

~~~
chapium
It depends on your country’s politics of course. What level of care do you
want to be publicly funded? I have my doubts that the price can remain this
low even if the nonprofit controls the IP. If that IP changes ownership or if
the nonprofit prices the drug closer to the market value it will likely
change. Edit: Also, the price cannot be contained on the fair market unless
competitors who can produce the drug are allowed to exist.

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soVeryTired
So did GDP just go up or down?

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einselbst
Great info about this very topic from a recent 'Blätter für deutsche und
Internationale Politik' Magazin.
[https://www.blaetter.de/archiv/jahrgaenge/2018/februar/gewin...](https://www.blaetter.de/archiv/jahrgaenge/2018/februar/gewinn-
vor-gesundheit) Unfortunately in german:

I have no time to translate but will give this one info from it: They
calculated that the costs for a 3-month-treatment would be 75 Dollars
including profit and logistics.

Eindrucksvoll zeigt dies das Beispiel des Medikaments Sofosbuvir (Sovaldi®)
zur Behandlung der chronischen Hepatitis C, das Ende 2013 in den USA erstmalig
zugelassen wurde und hochwirksam ist. Hepatitis C ist eine virusbedingte
Leberentzündung, die durch Blut und Blutprodukte übertragen wird. Weltweit
sind etwa 150 Millionen Menschen infiziert. Bei den Patienten entwickelt sich
mit den Jahren eine Leberzirrhose, die zu Leberversagen und Leberkrebs führen
kann. Die Zulassung von Sofosbuvir stellte einen Durchbruch für die Behandlung
von Hepatitis C dar: Zuvor gab es nur geringe Heilungschancen und die bisher
eingesetzten Medikamente zeigen starke Nebenwirkungen. Mit dem neuen Präparat
können die meisten Infizierten binnen zwölf Wochen vollständig geheilt werden.

Im November 2011 übernahm der US-Pharmakonzern Gilead in einem
Bieterwettbewerb für 11,4 Mrd. US Dollar bei einer jährlichen Gewinnerwartung
von 20 Mrd. Dollar das Start-up Pharmasset, das den Hepatitis-C-Wirkstoff
entwickelt hatte. Pharmasset hatte für die Forschung bis dahin 188 Mio. US-
Dollar ausgegeben und 2012 den Preis für die Behandlungsphase mit Sofosbuvir
auf 33 000 Dollar berechnet. Gilead investierte zwischen 2012 und 2014 noch
einmal 880 Mio. Dollar für klinische Studien bis zur Markteinführung Anfang
2014. Inzwischen macht Gilead mit Sofosbuvir 55 Prozent Gewinn pro Jahr. Zum
Vergleich: Der Gewinn der größeren US-Pharmakonzerne lag laut der
„Forbes“-Liste der größten US-Unternehmen in den Jahren 2005 bis 2015 im
Durchschnitt bei 17,44 Prozent, jener der anderen Industrieunternehmen bei
4,34 Prozent im Jahr. Der Wert der Gilead-Aktie hat sich seit dem Aufkauf von
Pharmasset in 2011 verfünffacht. Während unter einer sogenannten Zwangslizenz
– also einer Lizenzvergabe, die anderen Herstellern die Produktion und
Vermarktung gegen eine angemessene Gebühr erlaubt – ein Herstellerpreis von 75
Euro für eine dreimonatige Behandlung inklusive Vertrieb und Gewinn möglich
wäre, lag der Preis für eine achtwöchige Behandlung in den USA tatsächlich
zwischen 84 000 und 168 000 US-Dollar.[11] Damit hatte Gilead die
Übernahmekosten, mit denen es auch die hohen Kosten für die Therapie
begründete, in nur einem Jahr weitgehend refinanziert. Der
Markteinführungspreis von Sofosbuvir in Deutschland betrug 60 000 Euro, der
schließlich verhandelte und von den Krankenkassen erstattete Preis nach einem
Jahr bei etwa 45 000 Euro pro Behandlungsphase. In der Bundesrepublik sind von
Hepatitis C 400 000 bis 500 000 Menschen betroffen, etwa 300 000 gelten als
behandlungsbedürftig. Würden alle mit Sofosbuvir behandelt, entstünden Kosten
von 13,5 Mrd. Euro. Das entspricht einem Drittel der gesamten
Arzneimittelausgaben der gesetzlichen Krankenkassen im Jahr 2015.

Die Aufwendungen der Unternehmen zeigen, dass diese nicht auf die hohen Preise
angewiesen sind, um die Entwicklung der Medikamente zu refinanzieren: Gerade
die großen Unternehmen geben oft doppelt so viel für Marketing aus wie für
Forschung und Entwicklung. Außerdem machen sie 70 Prozent ihres Umsatzes mit
Produkten, die von anderen Firmen – oft kleineren Start-ups – entwickelt
wurden, also mit solchen, bei denen sie selbst keine Entwicklungskosten
hatten.[12] Rund drei Viertel der Umsatzrendite der größten 20
Pharmaunternehmen gehen in die Auszahlung von Dividenden und den Rückkauf von
Aktien, um den Aktienwert zu steigern. 16 Prozent werden in Übernahmen und
Fusionen investiert und 10 Prozent in Anlagegüter und Sachanlagen.[13] Zudem
versuchen die Pharmaunternehmen, durch Übernahmen und Zusammenschlüsse ihre
Forschungskosten zu senken oder Steuern zu sparen – etwa indem sie Firmen in
Ländern mit niedrigen Steuern wie Irland aufkaufen und ihren Unternehmenssitz
formell dorthin verlegen. Ihre Innovation und Forschungsproduktivität erhöht
sich dadurch nicht. Schließlich fließt auch viel Geld in die Lobbyarbeit der
multinationalen Konzerne – zu „Big Pharma“ zählen Unternehmen wie Jonson &
Jonson, Pfizer, Novartis, und Roche. Sie geben in den USA mehr für Lobbying
aus als alle anderen Branchen. Pharmageld fließt also hauptsächlich in
Marketing und Maßnahmen, mit denen der Monopolstatus verteidigt und ausgedehnt
wird – und nicht in die Entwicklung neuer, möglichst wirksamer Medikamente.

~~~
mft_
I'm absolutely not defending the high price of Solvadi, but that article is
naive in the extreme, as the low figure given would (obviously) fail to: 1)
Amortize the costs (~$1.1Bn) incurred in the development of the drug in
question 2) Amortize the costs of the manufacturer's other development
failures

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jlebrech
Companies should be able to charge what they want.

But also other companies should be able to copy the drugs (shorter patents),
especially non-profits.

Maybe lab should have to second source production to others and then compete
with each other on price.

