I know capitalism works...but

hepcat · Post by **hepcat** » Mon Sep 21, 2015 1:49 pm

This New York Times article on a drug used for treating victims of a parasitic infection (that has been around for 62 friggin' years) and was recently acquired by a start up company (run by a hedge fund manager), only to jump from $13.50 a tablet to $750 per tablet overnight makes my blood boil. I realize technically they're in the right, but morally? These people are no better than pond scum in my book.

Moliere · Post by **Moliere** » Mon Sep 21, 2015 1:56 pm

This kind of action is counterbalanced by bad publicity for the company and competitors entering the market to cut into any excessive profit margins. Now government regulations via patents and FDA requirements will limit or slow down the latter option.

hepcat · Post by **hepcat** » Mon Sep 21, 2015 1:59 pm

From that linked article:

With the price now high, other companies could conceivably make generic copies, since patents have long expired. One factor that could discourage that option is that Daraprim’s distribution is now tightly controlled, making it harder for generic companies to get the samples they need for the required testing.

The switch from drugstores to controlled distribution was made in June by Impax, not by Turing. Still, controlled distribution was a strategy Mr. Shkreli talked about at his previous company as a way to thwart generics.

Pyperkub · Post by **Pyperkub** » Mon Sep 21, 2015 2:05 pm

hepcat wrote:This New York Times article on a drug used for treating victims of a parasitic infection (that has been around for 62 friggin' years) and was recently acquired by a start up company (run by a hedge fund manager), only to jump from $13.50 a tablet to $750 per tablet overnight makes my blood boil. I realize technically they're in the right, but morally? These people are no better than pond scum in my book.

Healthcare for the most part has inelastic demand, at least as you get older. It inherently is a market which doesn't follow most free-market rules, and is thus ripe for abuse.

Post by **ImLawBoy** » Mon Sep 21, 2015 2:05 pm

Moliere wrote:This kind of action is counterbalanced by bad publicity for the company and competitors entering the market to cut into any excessive profit margins. Now government regulations via patents and FDA requirements will limit or slow down the latter option.

That's the theory, and that's how I want it to work, but it's not reality. We had a personal experience with a drug that was needed for my son. It used to run about $2K per 5ml vial, and had limited uses. It's maker was bought, they started marketing the drug for new (questionable purposes), and cranked the price up to about $28K per 5ml vial. This has been the case for at least 5 years now, and neither competition nor bad publicity (including a story in the New York Times) has done anything about it. We were fortunate that my insurance covered this expense, but it's quite the challenge for a lot of families.

I don't know what the answer is to this, but relying on market/publicity certainly haven't done squat (at least not yet - and it's been a decent amount of time).

Isgrimnur · Post by **Isgrimnur** » Mon Sep 21, 2015 2:08 pm

But it hurts their feelings.

Post by **ImLawBoy** » Mon Sep 21, 2015 2:12 pm

Found the NYT article. Turns out I had my dollar figures wrong. It didn't cost $2K per vial previously - it cost $50. I got the $28K right, though!

hepcat · Post by **hepcat** » Mon Sep 21, 2015 2:20 pm

That's an even worse story of rampant greed in the pharmaceutical business.

Post by **ImLawBoy** » Mon Sep 21, 2015 2:30 pm

hepcat wrote:

That's an even worse story of rampant greed in the pharmaceutical business.

It's not that bad when you consider that its main use is to treat a potentially catastrophic form of epilepsy that strikes infants and is likely to cause permanent brain damage if untreated.

Oh, wait. That's makes it even worse, doesn't it?

funnygirl · Post by **funnygirl** » Mon Sep 21, 2015 3:04 pm

Not quite so dramatic but still disgusting, I recently had cataract surgery which requires two kinds of eye drops for post operative care. The drops are $104 and $120. You need 2 of each if you are having both eyes done. The generics previously cost only $10, but the company that makes the brand name purchased the company that made the generics. They still make the generics but charge only $10 less than the brand name. So, if one hasn't a Rx plan with their insurance, $448 for eye drops. This seems criminal.

hepcat · Post by **hepcat** » Mon Sep 21, 2015 3:17 pm

Not criminal per se, but definitely morally repugnant.

LawBeefaroni · Post by **LawBeefaroni** » Mon Sep 21, 2015 3:23 pm

ImLawBoy wrote:Found the NYT article. Turns out I had my dollar figures wrong. It didn't cost $2K per vial previously - it cost $50. I got the $28K right, though!

Looks like you had it right the first time too. It was $50 at one point, per that doctor's recollection, drifted up to $1,650, and then Questcor jacked it up to $23,000 in their cash grab.

In 2007, it raised the price overnight, to more than $23,000 a vial, from $1,650, bringing the cost of a typical course of treatment for infantile spasms to above $100,000. It said it needed the high price to keep the drug on the market.

Jaymann · Post by **Jaymann** » Mon Sep 21, 2015 3:25 pm

So is getting generics in Mexico a thing?

LawBeefaroni · Post by **LawBeefaroni** » Mon Sep 21, 2015 3:26 pm

Incidentally, it worked out well for Questcor, they got bought by Mallilnckrodt for almost $6B. 95% of their revenue was from Acthar.

Acthar generated net sales for Questcor of $761.3 million in 2013, up 49.6% from calendar 2012. Acthar accounted for 95% of Questcor’s 2013 revenues: The company finished 2013 with a 57% jump in net sales, to $799 million, with adjusted net income growing 61% year-over-year, to $337 million.

hepcat · Post by **hepcat** » Mon Sep 21, 2015 3:28 pm

I'd ask how they can sleep at night, but I'm pretty sure they sleep well. There's something fundamentally broken in a person who would do such a thing to begin with.

Semaj · Post by **Semaj** » Mon Sep 21, 2015 3:33 pm

they probably sleep in a waterbed made from money and the tears of those they gouged

hepcat · Post by **hepcat** » Mon Sep 21, 2015 3:34 pm

So...moneybed really?

Isgrimnur · Post by **Isgrimnur** » Mon Sep 21, 2015 3:34 pm

hepcat · Post by **hepcat** » Mon Sep 21, 2015 3:36 pm

Sorry, shouldn't laugh in such a serious thread, but Huell cracks me up every time.

silverjon · Post by **silverjon** » Mon Sep 21, 2015 3:46 pm

hepcat wrote:Sorry, shouldn't laugh in such a serious thread, but Huell cracks me up every time.

I think, since you are the OP of the thread, you are permitted make your own decision with regard to whether or not you are transgressing by being induced to laughter therein.

It's probably covered in the CoC.

LawBeefaroni · Post by **LawBeefaroni** » Mon Sep 21, 2015 3:58 pm

So read OP article in depth. Not suprisingly, this happened when a hedge fund manager created a pharmaceutical company and acquired the rights to the drug.

“This isn’t the greedy drug company trying to gouge patients, it is us trying to stay in business,” Mr. Shkreli said. He said that many patients use the drug for far less than a year and that the price was now more in line with those of other drugs for rare diseases.

“This is still one of the smallest pharmaceutical products in the world,” he said. “It really doesn’t make sense to get any criticism for this.”

This is not the first time the 32-year-old Mr. Shkreli, who has a reputation for both brilliance and brashness, has been the center of controversy. He started MSMB Capital, a hedge fund company, in his 20s and drew attention for urging the Food and Drug Administration not to approve certain drugs made by companies whose stock he was shorting.

In 2011, Mr. Shkreli started Retrophin, which also acquired old neglected drugs and sharply raised their prices. Retrophin’s board fired Mr. Shkreli a year ago. Last month, it filed a complaint in Federal District Court in Manhattan, accusing him of using Retrophin as a personal piggy bank to pay back angry investors in his hedge fund.

Kind of funny that one of the doctors quoted being critical of the company is a chief at the Icahn School of Medicine. Yeah, as in Carl Icahn.

“What is it that they are doing differently that has led to this dramatic increase?” said Dr. Judith Aberg, the chief of the division of infectious diseases at the Icahn School of Medicine at Mount Sinai. She said the price increase could force hospitals to use “alternative therapies that may not have the same efficacy.”

Max Peck · Post by **Max Peck** » Mon Sep 21, 2015 6:16 pm

hepcat wrote:I'd ask how they can sleep at night, but I'm pretty sure they sleep well. There's something fundamentally broken in a person who would do such a thing to begin with.

WYBaugh · Post by **WYBaugh** » Mon Sep 21, 2015 6:27 pm

Here's his justification:

http://www.bloomberg.com/news/videos/20 ... -over-500-

He's stating that no patient will be turned down for the drug and that they would give it away for free to the patient. The exorbitant money is for create a new toxoplasmosis drug to get rid of this current old and outdated drug.

I'm thinking research will last as long as it takes him to pay off his hedge fund crap but I guess we'll see.

Lorini · Post by **Lorini** » Mon Sep 21, 2015 6:42 pm

Yes it's repugnant, but interesting in a business sense. Basically it's not worth the money for generic companies to get this drug because there aren't enough uses for it so the market is too small. They knew that so they went for it. As long they are willing to give it to patients who need it and can't afford it (including insured patients whose payouts would go through the roof) then I'm ok with it.

GreenGoo · Post by **GreenGoo** » Mon Sep 21, 2015 9:59 pm

Nothing like creating an artificial supply curve and then applying it to a demand curve that literally has peoples' lives driving it.

It's morally repugnant, and while I won't say it's the antithesis of capitalism, it definitely goes against the spirit of it.

I'm getting kind of sick of more and more money being made with nothing of value being added to the world.

I went into engineering instead of business to avoid scenarios like this and others with similar outcomes.

em2nought · Post by **em2nought** » Mon Sep 21, 2015 10:19 pm

Meanwhile the Chinese have learned their version of capitalism so well that they're selling plastic rice http://www.naturalnews.com/031344_plastic_rice.html

LawBeefaroni · Post by **LawBeefaroni** » Tue Sep 22, 2015 12:11 pm

Hillary Clinton tweeted about this yesterday. She promised a plan to combat it and biotech stock prices cratered on an overall market up day. Which shows how dependent the industry is on these pricing schemes industry. To keep this out of R&P, it doesn't matter who tweeted that, just that there was at least a minimal threat that there might be regulation coming.

IBT wrote:Consider the power of a mere tweet. Biotechnology stocks plunged Monday after Hillary Clinton, the Democratic front-runner for president, accused drugmakers of “outrageous” price gouging.

On a day when U.S. stocks were headed toward gains for the session, biotechnology stocks were down considerably, and the movement began after Clinton’s Twitter post at 10:56 a.m. EDT.

The iShares Nasdaq Biotechnology exchange traded fund, which measures the performance of 144 Nasdaq-listed biotech firms, plunged about 5 percent. Meanwhile the Standard and Poor’s 500 Index of biotechnology-listed stocks was down more than 3.4 percent. That represents about $15 billion from the value of the industry.

(The inevitable question of whether she is short biotech, please take that to R&P.)

stessier · Post by **stessier** » Tue Sep 22, 2015 12:14 pm

Do you have a guess on how they might regulate it? Do we price fix anything else? I honestly have no idea.

Post by **ImLawBoy** » Tue Sep 22, 2015 12:22 pm

stessier wrote:Do you have a guess on how they might regulate it? Do we price fix anything else? I honestly have no idea.

I have no clue as well. I want these drug makers to be able to make a healthy (pun!) profit, and I know that they often have to pump up prices on things to fund R&D. That's not evil, and that's how it's supposed to work. It's easy to point out the extreme cases (like the ACTH issue I linked to - they cranked up the price to ridiculous levels and really weren't doing any R&D as I understand it), but not all cases are going to be so clear cut. I don't think it would be successful to try to tie pricing into some kind of formula based on manufacturing costs and R&D, either. I'm guessing there are too many variables, and the rules would likely be all set by the pharmaceutical lobby, anyway.

I'm stumped as to a solution, even if it pisses me off on a personal level.

LawBeefaroni · Post by **LawBeefaroni** » Tue Sep 22, 2015 12:28 pm

ImLawBoy wrote:
stessier wrote:Do you have a guess on how they might regulate it? Do we price fix anything else? I honestly have no idea.
I have no clue as well. I want these drug makers to be able to make a healthy (pun!) profit, and I know that they often have to pump up prices on things to fund R&D. That's not evil, and that's how it's supposed to work. It's easy to point out the extreme cases (like the ACTH issue I linked to - they cranked up the price to ridiculous levels and really weren't doing any R&D as I understand it), but not all cases are going to be so clear cut. I don't think it would be successful to try to tie pricing into some kind of formula based on manufacturing costs and R&D, either. I'm guessing there are too many variables, and the rules would likely be all set by the pharmaceutical lobby, anyway.

I'm stumped as to a solution, even if it pisses me off on a personal level.

I just don't understand how they can maintain a lock on an off-patent generic drug. But it seems like the first step would be to fix the distribution. It sounds like other companies can't introduce generics because these companies that buy a particular drug and jack up the price have the distribution locked down. So no one else can get the drugs for testing. Remove that barrier and other companies can enter the market.

If a company is valued at $6B and 95% of their revenue is from one generic drug in the case of Questcor, you'd think there would be incentive enough for a generic manufacturer to come in and take some of that business. Once you have two or more suppliers in true competition and not collusion (see medical devices), then prices should settle to a more reasonable level.

That solves the R&D issue too, since by the time a drug goes off patent most of the R&D recoup has been squeezed out during the exclusivity period. And a company that acquires a drug didn't have to do any R&D in the first place, which seems to be the case with the two examples in this thread.

stessier · Post by **stessier** » Tue Sep 22, 2015 12:30 pm

I don't understand the distribution lock and the articles I read didn't explain it. Anyone know how it works?

Isgrimnur · Post by **Isgrimnur** » Tue Sep 22, 2015 12:35 pm

Here's an EU white paper (PDF) on strategeries.

In short, vertical integration seems to be the preferred method.

LawBeefaroni · Post by **LawBeefaroni** » Tue Sep 22, 2015 12:47 pm

stessier wrote:I don't understand the distribution lock and the articles I read didn't explain it. Anyone know how it works?

Not entirely sure.

This is from Questcor's December 2013 Annual report, before they were bought:

We derive net sales of Acthar from our sales of vials to our distributor, which in turn sells Acthar primarily to specialty pharmacies. These specialty pharmacies place orders with our distributor based on their respective levels of sales and inventory practices. End-user demand for Acthar results from physicians writing prescriptions to patients for the treatment of NS, rheumatology related conditions, MS exacerbations, IS, respiratory manifestations of symptomatic sarcoidosis and various other conditions.

Acthar is a low-volume, specialty pharmaceutical product. Physicians do not purchase Acthar from Questcor for resale to patients. Typically, patients purchase Acthar directly from specialty pharmacies after receiving a prescription and after arranging for third party reimbursement (government or commercial insurance) - most often after satisfying a prior authorization requirement imposed by their insurance carrier or a third-party administrator for a government healthcare program. Alternatively, eligible patients who are uninsured or under-insured, may receive Acthar through a Questcor sponsored patient assistance program. We do not generate any revenue or net sales from the vials provided through our sponsored patient assistance programs. See Business - Reimbursement.

We have no patent protection for Acthar, and existing and potentially competitive products to Acthar may reduce or eliminate our commercial opportunity.

The composition patent for Acthar has expired and we may have no patent-based market exclusivity with respect to any indication or condition we might target.

There are products and treatments currently on the market that compete with Acthar. In addition, the pharmaceutical and biotechnology industries are intensely competitive and subject to rapid and significant technological change, and a number of companies are pursuing the development of products that target the same diseases and conditions that we target. Some of the companies developing products have significantly greater financial resources and expertise in development, manufacturing, obtaining regulatory approvals and marketing than we do. Other smaller companies may also prove to be significant competitors, particularly through collaborative arrangements with large and established companies. In the event we are successful in further developing markets for Acthar, our increasing the overall sales volume of Acthar may lead other companies to dedicate greater resources to attempt to develop and introduce generic or biosimilar versions of Acthar and other competitive therapies for the same diseases and conditions that we target. We cannot predict with accuracy the timing or impact of the introduction of additional competitive products or their possible effect on our net sales. If a competitor did apply to the FDA for a generic or biosimilar version of Acthar or any competitive product not based on ACTH (adrenocorticotropic hormone), we would not receive any notice from the FDA about the existence of the application. Further, the announcement of a filing with the FDA relating to a potentially competitive product could have an adverse effect on our business and share price, regardless of the ultimate outcome of such filing.

We rely on trade secrets and proprietary know-how for Acthar. We currently seek protection, in part, through confidentiality and proprietary information agreements. These agreements may not provide meaningful protection or adequate remedies for proprietary technology in the event of unauthorized use or disclosure of confidential and proprietary information. The parties may not comply with or may breach these agreements. Furthermore, our trade secrets may otherwise become known to, or be independently developed by, competitors.

Our success will further depend, in part, on our ability to operate without infringing the proprietary rights of others. If our activities infringe on patents owned by others, we could incur substantial costs in defending ourselves in suits brought against a licensor or us. In addition, such litigation or the threat of litigation could create substantial distractions for our management, which would decrease our ability to focus on increasing sales of Acthar. Should Acthar or its associated technologies be found to infringe on patents issued to third parties, the manufacture, use and sale of Acthar could be enjoined, and we could be required to pay substantial damages. In addition, we, in connection with the development and use of Acthar and its associated technologies, may be required to obtain licenses to patents or other proprietary rights of third parties, which may not be made available on terms acceptable to us or at all.

Also, they buy up any potential competition.

When Questcor ponied up $135 million for the rights to Synacthen, market-watchers raised their eyebrows. After all, the company had drawn fire for its pricing on Acthar, which brought in $761 million in 2013 after a series of big price hikes. And snapping up that potential rival--which was on the verge of launching at a far lower price, if another bidding drugmaker had succeeded in buying it--essentially elbowed aside the competition.

Rip · Post by **Rip** » Tue Sep 22, 2015 1:27 pm

So I am ok to suggest the they forgot to contribute to the Clinton Foundation?

hepcat · Post by **hepcat** » Tue Sep 22, 2015 1:28 pm

Rip wrote:So I am ok to suggest the they forgot to contribute to the Clinton Foundation?

Someone wanna give the Ripbot a kick?

Moliere · Post by **Moliere** » Tue Sep 22, 2015 4:12 pm

Pope Francis Reverses Position On Capitalism After Seeing Wide Variety Of American Oreos

Max Peck · Post by **Max Peck** » Wed Sep 23, 2015 1:33 pm

Who is Martin Shkreli - 'the most hated man in America'?

Judging by social media, Martin Shkreli, the 32-year-old chief executive of Turing Pharmaceuticals, may be the most hated man in America right now. He's been called a "morally bankrupt sociopath", a "scumbag" a "garbage monster" and "everything that is wrong with capitalism." And those are some of the tamer comments. So how did a rap music-loving, former hedge fund manager suddenly become the target of online ridicule and even death threats?

His company recently acquired the rights to Daraprim. Developed in the 1950s, the drug is the best treatment for a relatively rare parasitic infection called toxoplasmosis. People with weakened immune systems, such as Aids patients, have come to rely on the drug, which until recently cost about $13.50 (£8.80) a dose. But Mr Shkreli announced he was raising the price to $750 a pill. The more than 5,000% increase and his brash defence of the decision has made him a pariah among patients-rights groups, politicians and hundreds of Twitter users.

Other drugs companies have made similar moves raising the price of niche products, but few have so publicly and so unapologetically answered critics. The backlash became so pitched on Tuesday that Mr Shkreli agreed to lower the price of Daraprim to an "affordable level".

They cut him a bit of slack in this article. There's no mention of his Twitter antics in his Retrophin days. Also no mention of his League of Legends career -- the fact that he's an avid LoL player (and team owner) might explain something about his character (or lack thereof).

I'm also loving that almost every major story about him right now is using that "This douchebag!" photo from his twitter account.

Moliere · Post by **Moliere** » Thu Oct 22, 2015 10:12 pm

Drug compounder offers cheap version of costly Turing drug

San Diego-based Imprimis Pharmaceuticals Inc., which mixes approved drug ingredients to fill individual patient prescriptions, said Thursday it will supply capsules containing Daraprim's active ingredients, pyrimethamine and leucovorin, for $99 for a 100-capsule bottle, via its site:

The 3 1/2-year-old drug compounding firm also plans to start making inexpensive versions of other generic drugs whose prices have skyrocketed, Chief Executive Mark Baum told The Associated Press.

"We are looking at all of these cases where the sole-source generic companies are jacking the price way up," Baum said in an interview. "There'll be many more of these" compounded drugs coming in the near future.

Wait, a competitor taking advantage of someone's high prices. What is that called again?

Max Peck · Post by **Max Peck** » Thu Oct 22, 2015 10:30 pm

I'd call it pretty damn cool, so long as their version works the same as the original.

It's interesting to note in that article that Turing still hasn't dropped the price as was promised by Shkreli, but is "capping patient copayments at $10." Does that mean that their "defense" is that they're price-gouging insurance companies rather than individual patients? If so, what about uninsured patients?

LawBeefaroni · Post by **LawBeefaroni** » Thu Oct 22, 2015 10:46 pm

Max Peck wrote:I'd call it pretty damn cool, so long as their version works the same as the original.

It's interesting to note in that article that Turing still hasn't dropped the price as was promised by Shkreli, but is "capping patient copayments at $10." Does that mean that their "defense" is that they're price-gouging insurance companies rather than individual patients?

Pretty much. It just means that the patient portion, if it's a copay, is capped. So say your copay is $150 for non-formulary, non-generic drugs. You'll pay $10 and the insurance company pays the difference of the total price minus $150 (or up to their negotiated amount if they have a deal with the specialty pharmacy). While I'm not sure how it works in pharma, usually you can't charge a different copay. You can always decline to collect the full amount *wink and a nod* but you can't advertise that you're paying part of the copay.

Max Peck wrote: If so, what about uninsured patients?

They don't pay a copay so I'm assuming no cap. Although the company will, I'm sure, give out some discounts and freebies for PR purposes.