The Trump Drug Plan: Buy Canadian

[Zoupa]

These stories are always about insulin because you don't need a prescription to buy it in Canada.

[Malthus]

I had a few medical tourists over the years. What americans fail to realize is that in 99% of cases, the drugs they need require a prescription, and the prescription needs to be from a canadian doctor.

"Just call my CVS in Milwaukee!". Yeah, it doesn't work like that. Dumbass.

Do you ever get docs in your province who specialize in co-signing US prescriptions to get around that?

No. I don't think the market is there for that kinda thing. Plus the local doctors would expose themselves to all sorts of disciplinary reviews/punishment from their professional order. Not worth it.

It sometimes happens here, for Internet pharmacy orders, but is highly frowned upon. In every province it's considered unethical and subject to discipline, but some physicians do it, in large volumes, for Internet pharmacies.

The CMPA announced it won't defend physicians accused of doing that.

https://www.cmpa-acpm.ca/en/membership/protection-for-members/principles-of-assistance/internet-and-cross-border-prescribing-to-non-patients

[crazy canuck]

It was a thriving business in the past.  But as Malthus and Zoupa suggest, it became more heavily regulated/enforced especially when it started to create shortages in the Canadian market.   But as someone already noted, this is not really about making prescription drugs more affordable for Americans.  If trump wanted to do that there are a lot of other ways of achieving that goal.  This is a sound bit that makes no sense that Fox will spin into a meaningful policy initiative that shows Trump wants to reduce the cost.

[derspiess]

AARP has been running radio commercials encouraging us to agree with Trump on some of his statements about prescription drug prices being too high.  Funny, I thought AARP was solidly anti-Trump.

Automatically rejecting everything a political opponent says and taking the exact opposite position out of spite, even when you would otherwise agree with them - well, not everyone does that. It's more of a Trumpian Republican thing. 

Just thought it was odd for an organization like that to sort of masquerade as pro-Trump.

[The Minsky Moment]

There's a really easy way to get Canadian level drug prices in the US - impose a Canadian-style price regime in the US.

Declaring as official policy the encouragement of parallel imports to achieve the same end point is just an indirect way of imposing a national price control regime.

[OttoVonBismarck]

Something worth noting about insulin, is the stuff sold at (admittedly too-high) prices to American patients today isn't the stuff Banting and Best were injecting back in 1922. Reformulations of it occur regularly, insulin sold at large scale in the 1980s for example isn't the same formulation as sold today. You can actually still buy older formulations, Wal-Mart has a program where their pharmacies sell some of the older formulations of insulin for quite cheap. But it is not as good in terms of outcomes for insulin dependent diabetics. Wal-Mart sells a formulation called NPH that was first formulated in 1950, another that was formulated in 1982, and another that was formulated in 1989. They sell them by the vial for like $24 and they have prescription subscription plans that make them available very cheaply.

Lots of diabetes advocates point out that these aren't great options for insulin dependent diabetics and there are reasons newer formulations are more desired.

Maybe neither here nor there, just pointing out that high insulin prices in America aren't a consequence of companies just jacking up the price of ancient medication due to quasi-monopoly power, the insulin sold decades ago is still made, and sold cheaply because it is not patent protected, it's also relatively "simple" to produce compared to newer formulations.

[crazy canuck]

Except the same insulin formulations are priced differently in our two countries.

[OttoVonBismarck]

Except the same insulin formulations are priced differently in our two countries.

For sure, there's price controls in Canada. I'm just saying it's frequently claimed here in the United States that companies like Novartis and et al. are just jacking up the price of an "ancient drug" because few other companies manufacture it. That's not really true, these newer insulin formulations are newer, patented formulations. The patents mean it is essentially not legal to compete with them in the United States. The actual "ancient" insulins still exist and are widely manufactured by lower cost producers (many of them are used for diabetic animals where the negative side effects of the older formulations are less concerning.)

[crazy canuck]

Except the same insulin formulations are priced differently in our two countries.

For sure, there's price controls in Canada. I'm just saying it's frequently claimed here in the United States that companies like Novartis and et al. are just jacking up the price of an "ancient drug" because few other companies manufacture it. That's not really true, these newer insulin formulations are newer, patented formulations. The patents mean it is essentially not legal to compete with them in the United States. The actual "ancient" insulins still exist and are widely manufactured by lower cost producers (many of them are used for diabetic animals where the negative side effects of the older formulations are less concerning.)

"Novo Nordisk's NovoLog, which is known in Canada as NovoRapid, for roughly $30 a pop. The same drug retails for $289.36 in the U.S."

I understand you saying this is not an 'ancient' drug - but the price disparity is considerable.

[OttoVonBismarck]

I mean there's no price controls in the U.S. A simple understanding of economics would predict a company with a monopoly patent to sell an insulin formulation will sell it for much more in a non-price regulated market. Not sure why you're even quoting my stuff about this, has nothing to do with anything I said.

[Zoupa]

The newer insulins offer marginal benefits at most.

It's part of a widespread pattern of "R&D" in pharmaceutical companies. Basically they tweak an existing molecule, test and market it as a new drug and get around patent expiration.

There's very little innovation going on. No search for a cure kinda thing. It's mostly "let's add a hydrogen there, test it and see if it works". Out of the hundred different variations they'll find one where they can make the statistics say it's 1% better than the old drug. That's good enough to market it to doctors at their yearly conference in Honolulu and there ya go.

"R&D"

It's why I gave up on research and went to work at a community pharmacy.

[crazy canuck]

I mean there's no price controls in the U.S. A simple understanding of economics would predict a company with a monopoly patent to sell an insulin formulation will sell it for much more in a non-price regulated market. Not sure why you're even quoting my stuff about this, has nothing to do with anything I said.

Ok, you seemed to be suggesting that people who thought the price was being jacked up were not properly analyzing the situation.  But so long as you acknowledge that the price is being jacked up because the regulatory environment, or lack thereof, in the US permits such a practice then there is no disagreement between us.

[merithyn]

The newer insulins offer marginal benefits at most.

It's part of a widespread pattern of "R&D" in pharmaceutical companies. Basically they tweak an existing molecule, test and market it as a new drug and get around patent expiration.

There's very little innovation going on. No search for a cure kinda thing. It's mostly "let's add a hydrogen there, test it and see if it works". Out of the hundred different variations they'll find one where they can make the statistics say it's 1% better than the old drug. That's good enough to market it to doctors at their yearly conference in Honolulu and there ya go.

"R&D"

It's why I gave up on research and went to work at a community pharmacy.

And when insurance companies call this out and ask doctors to prescribe the older drugs, they're vilified for not covering "the good stuff".

[mongers]

The newer insulins offer marginal benefits at most.

It's part of a widespread pattern of "R&D" in pharmaceutical companies. Basically they tweak an existing molecule, test and market it as a new drug and get around patent expiration.

There's very little innovation going on. No search for a cure kinda thing. It's mostly "let's add a hydrogen there, test it and see if it works". Out of the hundred different variations they'll find one where they can make the statistics say it's 1% better than the old drug. That's good enough to market it to doctors at their yearly conference in Honolulu and there ya go.

"R&D"

It's why I gave up on research and went to work at a community pharmacy.

Very interesting, thanks Zoupa for the insight.

[Syt]

There's very little innovation going on. No search for a cure kinda thing. It's mostly "let's add a hydrogen there, test it and see if it works". Out of the hundred different variations they'll find one where they can make the statistics say it's 1% better than the old drug. That's good enough to market it to doctors at their yearly conference in Honolulu and there ya go.

Sounds about right for a lot of studies we did when I was with a Contract Research Organization. Another big thing was off label uses - application of medication to conditions they weren't originally designed for, to increase market/customer base.