Drug Goes From $13.50 a Tablet to $750, Overnight


Yet in the OEDC20 countries that’s more than 57% of drugs not having a generic equivalent (or the generic not being prescribed), and the costs are still way lower than in the US.

The issue is not so much the availabilty of generics, but the lack of negotiating power/price controls. Other countries with less generics but better controls don’t suffer so much price inflation.

The problem is that with your current system, generics are about the only way to lower the price. BUT generic use is so high already that keeping going in that direction is going to change little (not that much volume can be shifted). The more effective solution would be to change the system. It’s not a free market, so stop treating it like one.

Again, the US is not that special. Most other countries have found a (very similar between them) solution that works. You can’t get to 95% generic use and keep R&D in pharma running (which is something everybody here agrees should be taken into consideration), because generics are by definition not new drugs.


I can agree with that. Right now the drug companies set the prices, and I guess the only push back is if the insurance companies just flat our refuse to pay for it. There was some concern about allowing Medicaid and Medicare negotiate since those two systems are so large and public that they’d essentially be setting the price for the entire market. A number of insurance companies would only pay Medicare price + xyz, so if Medicare negotiates they set the price for everyone. I understand that concern, but the insurance companies had their chance and squandered it already.


[quote=“Nesrie, post:302, topic:77479, full:true”]There was some concern about allowing Medicaid and Medicare negotiate since those two systems are so large and public that they’d essentially be setting the price for the entire market. A number of insurance companies would only pay Medicare price + xyz, so if Medicare negotiates they set the price for everyone. I understand that concern, but the insurance companies had their chance and squandered it already.

And the same system in other countries has proven to be very reasonable in it’s price setting.


And maintains and supports a private drug industry from the looks of it. I don’t know why we would object to it other than industry itself would see more reasonable profits than they do today.


Nesrie, why the EpiPen doesn’t have generic competitors was explained to you. At length. You either didn’t read it, or don’t want to agree with it. Either way you’re still talking about the generic industry as a whole, as if the specific failings that apply to the market for epinephrine autoinjectors (FDA over regulation) applies to the generic market as a whole. You’re still talking about Mylan being able to launch a ‘competing’ generic equivalent to its own product as being demonstrative of a market failure (it isn’t, many industries sell branded/unbranded products). You’re demonstrating that you don’t understanding the context of the Daraprim case (market was so small that no other companies were willing to enter it).

That isn’t being hostile.

Why are you replying over and over if you are either uninterested in being presented with new information that suggests your opinion needs revising, or uninterested in even reading the replies?


Scott Alexander weighs in:

That’s the end of the post, the rest sets up the analogy with specific examples of how messed up the whole situation is. I particularly liked how Mylar likes to bribe potential competitors to stay out of the business, and bribes senators to make sure such bribing is still legal.


That a very funny and well written article that keeps the “the US is a special snoflake” POV. For all I can see, the author proposes that lifting all regulations would help the situation.

Which it might, and it might also bring a whole lot of other issues and problems. The fact remains that the price regulation of pharmaceuticals in the US runs contrary to the way these things are regulated in almost every other First World country, which keep very strict regulations on medications and work just fine.

Of course, maybe the US can find a solution that is wholly different from everybody else’s and make it work better. But while that solution is found, fought for politically and implemented, prices keep raising.


Even in the 1960s prominent US economists were stating that the US patent system was so broken that the ideal option was to get rid of it entirely.

Prominent economists today are still arguing the same thing.


I don’t think that Scott would be for full lifting of all regulation, but a lot of his writing about his posts based on his medical experience is about how well-meaning regulations seem to end up benefiting entrenched interests and doing precious little to help people. Or maybe the theme is that the FDA is evil. See, for instance, Fish - now by prescription


Well meaning regulation can lead to more problems than solve them. Some of the complaints seem like they could fall on the laps of the providers though. If there is a competing product to he EpiPen system but it works only slightly differently, why can’t the medical community educate their patients on how to use the less expensive but just as effective system? It’s like they’re relying on the marketing to do all the work for them. I also put some of this on the patients too because they can educate themselves with competing products too of course.


There’s a word for monopoly-by-regulation. It’s called a utility. And in most places utilities have price regulation.


They do! But only on basic cable, for example, when many subscribe to digital cable which is not regulated.

How do you regulate something though that’s the difference between life and death, or a life of relative comfort or pain when it’s not a given that the product will be created or made in the first place… the initial answer, as others have pointed out above, seems to be to look at other systems because they’ve managed balance the two better than we have.


‘How do you do something new? Perhaps, look at how someone else has done it’

@Ginger_Yellow you might enjoy this (skip to conclusion) http://www.econjournals.com/index.php/ijeep/article/viewFile/1019/591


I realize I’m being nitpicky here, but that hit a pet peeve of mine. There’s a certain faction of anti-government types amongst conservatives and libertarians who have been building this “regulation doesn’t work” narrative for years in America. They have been aided by the deep pockets of industries that would rather not be regulated and the net result has been both successful and maddening.

Regulation, by and large, works. Like any human endeavor, it can make mistakes because the individuals involved are flawed and imperfect, but there’s nothing inherently more or less flawed about the enterprise of regulating markets than any other human enterprise.

Why it fails in America is because its set up to fail by a legislature that underfunds agencies and puts strict limits on both what and how they regulate. When set up to fail, agencies unsurprisingly fail, but then this is touted as proof that such failures are inevitable. The argument is even fairly persuasive if one isn’t aware that other countries can and do produce much better outcomes for the people using regulation.


Well said!


I guess if I said “regulation doesn’t work” I would understand where you’re coming from; I didn’t though. Knee jerk reactions lead to legislation like DMCA, the power we have the TSA and homeland security and what seems like a half-dozen anti-violent video game attempts. If you look behind some of the meaning though… Make sure content providers get paid, keep us safe and protect children… They don’t seem so bad. The reality turns out to be very different though.


No, you didn’t, and I freely admit I was being nitpicky. You did not deliver a thundering denunciation of regulation. You did you throw out a passing drive by dismissal of regulation without further substantiation though. I realize that’s par for the course in modern political discourse, but it pushed my buttons regardless.

My response really wasn’t directed at you, but rather the fact that so many can casually dismiss regulation as an answer because “everyone knows” it doesn’t work. It’s absolutely frustrating to me how the intersection of small government conservatives and monied business interests have re-written the political dialogue to make it generally accepted wisdom that something they don’t like (regulation) is automatically ineffective and bad. Considering it’s patently and provably not true.

Regulation can work, and there are plenty of examples of it. Heck, in some areas where the public doesn’t mind regulation the U.S. is amazingly effective at it. The CFPB is relatively new but has been doing sterling work at reigning in the excess of retail banks. The NHTSA does fantastic work in pushing automobile manufacturers into developing ever safer cars without crushing the industry. The U.S. leads the world in automotive safety regulations for crying out loud! It’s very possible to regulate an industry sanely and there are plenty of examples even inside the U.S.

Um, neither of your examples is regulation by my understanding of the term. Maybe we are talking past each other on terminology differences here? When I say regulation I refer to a public agency given statutory powers to regulate a particular market or industry. The TSA isn’t regulation for an industry, excepting a few minor powers over airline security practices. It’s mostly a police force. A particularly laughable one that specialized in security theater over results. The DMCA isn’t regulation, it’s a statute itself. Neither represents regulation by the definition I’m used to using.

I freely admit that the U.S. congress is really bad at setting policy in regards to specific industries. They are being tugged between too many interests and their watered down compromises hardly ever work.


I think your definition is a lot more narrow than mine. DMCA is an act that expanded copyright law. I certainly see laws as a means to regulate even if the matter is often handled in civilian court. The department of Homeland Security and the TSA agencies (only one of many agencies under that department), that regulate various aspects of our lives (cyber-security is under there too). Anyway, it’s fine if you use a narrower definition, just know mine is broader. And I think laws in this country are too often crafted in a knee-jerk response to some event without enough thought and consideration into the problem so some group can feel safe again.


I’m not really sure what solutions, if any, you’re proposing here. It’s always easy to sit back and complain. But in an enviroment where our legislative branch is essentially not doing their job, complaining that we’re passing too many laws is just being a solutionless complainer.

Are there bad laws and bad regulations? Of course. How are we to craft a magical system where those don’t exist? Libertarianism, perhaps?