Hacker News new | past | comments | ask | show | jobs | submit login
[dupe] 80k dollars almost certainly cures hepatitis C (wikipedia.org)
27 points by tbarbugli on April 24, 2014 | hide | past | favorite | 32 comments

Interestingly, according the the manufacturer, they will be offering it in Egypt at 99% off of this price.


Apparently the price is...whatever they think you, combined with your insurance company, can come up with.

My wife works for a doctor that handles hep c patients. We had a recent rise in drug activity in my area and she sees new patients coming in all the time. I can't really believe how common hep c is. This is good news and gives some hope that maybe it will be affordable one day. Also medicaid covers this treatment from what I understand.

I know one treatment I was looking at used to cost $20 a dose. Now is $1500 for a dose and treatment costs totals $30,000.

While I understand innovation costs money, some of the pricing models around pharma is ridiculous.

should we be happy about the invention or mad because of another example of corporation grief?

Reading 'corporation grief' as 'corporate greed' -

To play devil's advocate here for a moment, the drug development and approval processes are crazy expensive, and the pharmacos basically charge what the market will bear for each product, and spread the revenue to all costs - not necessarily allocated by individual drugs. IOW, drug A costs a little and sells for a lot, drug B the reverse, but the total revenue covers the cost and some profit.

At least that's the argument the pharmacos make in public. If this situation is not as it should be, someone should articulate what's wrong and how to fix it. E.g. patients can't afford something they're dying without, but if the vendors are forced to discount for some drugs or some buyers, how is the whole business to be financed?

I can think of arguments for and against various possible reforms, but won't bore you here. We do need something more specific tho.

I'm sure people infected with Hepatitis C are happy about this.

You mean infected people with 80k dollars to pay for the treatment :)

Some countries have other models than the US one. E.g., in Scandinavia we don't pay [directly] for medical treatment.

I bet you could count on two hands the number of U.S. patients who will pay for this drug directly, and they could all afford it 10x over. Yet Gilead will still sell plenty of it here.

So I'm not sure what you're saying about the U.S. "model".

I'm saying about the US model for medicare that you either have to pay for your treatment or you have to have a health insurance that will pay for you.

This is in contrast to e.g. the Scandinavian countries where you get treated whether you have an insurance or not, no matter what your income level is.

Those are two “models” of paying for your medicare, and I'm sure there are even other ways.

I'm sure people with poor health insurance with Hepatitis C are a little upset. I doubt they could get an insurance company to pay for the better drug.

The existing treatment is a $150,000 liver transplant. In addition to being more expensive than the new drug, it isn't as good a treatment (among other things, anti rejection medications for life).

This drug really brings to focus the various issues and interests involved in developing new drugs. It's a better, cheaper treatment (that cures!) and still the price tag is easy to balk at.

liver transplant is not a treatment of hep c, as far as I know, it's a treatment of liver failure as a consequence of chronic hep c (~30% of chronic hep c patients end up in with cirrhosis), the patient still has hep c.

Generally the drug companies selling "important" but expensive drugs also run their own "access programs" to give the uninsured or other people access to the drug at a much more reasonable price. The whole pharma industry is about price discrimination.

As long as they can keep the list price high, they are ok with selling some units at production cost -- this prevents a major backlash based on a media report of a pretty young white girl dying because her disabled war veteran parents missed a payment. True, it is harder to get into these programs the less "sympathetic" your case would be to the media, and a lot of Hep C patients won't be. From what I've read it is actually easier to get the really expensive high margin drugs for nearly free than the moderately expensive ones.

Medicare/Medicaid would be the true payer for most poor people, though. (Meaning ultimately the taxpayer)

> Generally the drug companies selling "important" but expensive drugs also run their own "access programs" to give the uninsured or other people access to the drug at a much more reasonable price. The whole pharma industry is about price discrimination.

Very true. I'm more familiar with the the costs of Cystic Fibrosis medications, but those are similar to this. Most people with Cystic Fibrosis take medications that would total over $10k/month at full price. This is something they do every month because the disease is not curable. However, with insurance, numerous manufacturer "access programs", and numerous private assistance programs targeted at Cystic Fibrosis, most patients pay much much less, often under $1k/year in total. Depending on the combination of medications and programs, these programs may cover all medication costs entirely.

It's all based on how much you can pay. If you have a lot of money (you need to have well over $100k/year income to be disqualified from many of these access programs) and no insurance, you're going to pay a lot. Otherwise, not so much. I'm sure some people fall through the cracks, but there's a lot of options out there for paying for these types of expensive medications. The more expensive the medication, the more likely there are access programs or assistance programs and the more likely they will cover a larger portion of the cost.

Even in countries like Denmark, where we don't pay for medical treatment (instead we pay exorbitant taxes), I'm unsure how those in power will prioritize treatment of Hep C.

> should we be happy about the invention or mad because of another example of corporation grief?

Happy, no question. Medicine this effective doesn't come along often and bodes very well in two ways:

(1) a treatment that works but is expensive today will continue to work but be vastly cheaper within a decade.

(2) the fact that a real cure exists for this disease suggests we may knock out cures for other "incurable" diseases in the future.

Thanks. I think we'll bury this item as a dupe.

All: Also, please don't editorialize titles. It's against the site guidelines.

It should be noted that this isn't an option if you're aleady late stage and have cirrhosis of the liver. Hep C isn't really curable past the point where they can longer administer to you the interferon it is mixed it, which requires a relatively healthy liver to handle.

Developing countries will abolish medical patents and will start making generic replacements.

There have been laws in place for that in Brazil for more than a decade:


This has come up on HN before: https://news.ycombinator.com/item?id=7531858

Brazil's Article 71 eventually led to TRIPS Article 27 § 2 and § 3(a), which affirm the rights of WTO member nations to exclude medical patents from protection; and Article 31, which allows for what has become known as "compulsory licensing" -- use of a patent without the consent of the patent holder.

It's been a pretty effective club for developing nations to wield against pharmas, as drug companies know that if they don't provide or license their meds at favorable terms the states can just start manufacturing them without consent.

The flip side, of course, is that the pharmas end up wanting to increase the pricing in developed nations, because the healthcare markets (especially in the US) can bear much higher costs. That's why Gilead is charging $900 for an HCV cure in Egypt (which has horrifically high rates of HCV infection), and almost $90K for it in the US.

Now, there's a lot of drug coming online for HCV over the next few years, but right now Gilead has the market to itself and, at current pricing, it's basically a $1 trillion market in the US, EU and Japan. Gilead paid about $11b for Pharmasset (the drug developers) and needs to recoup its investment, so aggressive pricing in the developed world is unsurprising, if distressing.

It shouldn't stop at the developing countries.

This is why I'd like all medical research to be public.

No gang of government bureaucrats will produce the same results at a lower cost than lots of people with the profit motive. The US Government spent $3,000,000,000 trying to map the human genome. Celera spent one tenth that much to do the same thing, at a faster pace.

Celera was able to take advantage of the research the Government performed while attempting to map the human genome.

No gang of government bureaucrats will produce the same results at a lower cost than lots of people with the profit motive

Patently untrue. By definition, a profit motive means that the costs aren't the lowest possible, because they include a markup for profits (or contrapositively, they cut corners to reduce expenses).

I don't get why people are turning to a drug, when a Paleo-esque high fat diet may do more than any drug ever would.

Theres a rather popular blog about one dude's struggles with Hep C, and hes been through a Sofosbuvir+GS-5816 trial, but otherwise has been fighting Hep-C with a high fat no grain diet: http://hopefulgeranium.blogspot.com/

Edit: Don't know why people are downvoting me. I'm not even going to hazard a guess on this one. Its a rather scientific blog that frequently links to studies being done on Hep-C, ran by a guy that has Hep-C, and I've been following it for over a year.

you mean a diet can get rid of it for good? because thats what this drug does (well for most of the people at least)

The drug cures HepC. As in, it provably wipes it out completely.

A diet could possibly wipe out HepC, but there's no research showing that it is possible. At best, the current state of research is that diet could minimize the progression of HepC, which is definitely not "more than any drug ever would."

anecdote from a guy with hep c != evidence

Someone I know had Hep C, had the treatment, now it's gone. The treatment wasn't pleasant (lots of extreme migraines, lethargy, etc. over a period of months) but it worked. They now eat and drink very carefully also, but more of a fresh leaves focus (salads, green smoothies) with some but low carbs and definitely not high fat. Doing very well after nearly 10 years. (They were in an initial trial)

Go read the blog now. He did the drug trial, and it went well.

Guidelines | FAQ | Lists | API | Security | Legal | Apply to YC | Contact