In practice there aren't legal repercussions. If you import scheduled drugs (adderall, opioids, etc.) and get caught that's obviously going to be a big issue. But with most prescription medications, the worst case scenario is that Customs will just toss your package. And the likelihood of that is low; the majority of the time it makes it through undetected.
I've done this in the past with another drug. In the US it was $30/month but from India I got 1000 pills for $30 + $40 expedited shipping. For me the big factor wasn't cost, but rather the convenience of not needing to go through the process of getting a prescription.
https://www.flgov.com/eog/news/press/2024/florida-becomes-fi...
> "Today, the DeSantis administration received U.S. Food and Drug Administration (FDA) approval of its Canadian Prescription Drug Importation Program. The Agency for Health Care Administration (AHCA) submitted this first-of-its-kind plan to safely import cheaper drugs from Canada to the FDA nearly 37 months ago, and after filing a lawsuit against the FDA due to delays, has finally received approval. This approval will save Florida up to $180 million in the first year."
Thanks to the bargaining power of my nationalised healthcare, my government pays around 1/5th of that, and I'll pay nothing myself.
Revlamid is listed under it's generic name Lenalidomide, price is in pence: https://www.drugtariff.nhsbsa.nhs.uk/#/00791628-DD/DD0079145...
Generally I think (this is highly subjective and irrational, of course) that I'd be comfortable with a 10%-20% return-on-capital overall. Lower than that and I'd think that risky drugs couldn't get funding; higher and I'd think there's too much rent-seeking.
Perhaps some economists have studied what an optimal ROC might be for pharmaceuticals.
In any case, the gross margin per-pill doesn't really tell you anything about ROC. 99.875% is astounding, but what was invested to get to that point - including the drugs that never made it to market?
It works so well that their efficacy reports have caveats like “not enough patients that were treated have died yet” to provide meaningful statistics.
The drug was initially developed in china. They presented results at a conference in the USA but no one believed them other than a skeptical Pfizer who sent a big team to china to confirm the data. Pfizer soon invested billions into the company and drug to bring it to market.
The drug’s sales are on track to be $1 billion this year but the stock is heavily depressed because of the china connection.
That daily pill is 25mg. You can buy 5g of Revlimid's active ingredient for $352.
> https://www.sigmaaldrich.com/US/en/product/aldrich/901558
200 doses at less than $2/ea.
If you want to get adventurous, you can probably buy 1kg from China or India for $900. Find a university or commercial lab with HPLC and LC/MS and run your own QC for a few hundred bucks. Store the powder in a vacuum-sealed container in a refrigerator. You're set for life.
I've done this sort of thing before, and a lot of people are doing it for GLP agonist drugs. (To say nothing of sports doping, nootropics, etc.)
Sometimes you've gotta take matters into your own hands.
https://web.archive.org/web/20220811173542/https://ir.celgen...
> Celgene has agreed to provide Alvogen with a license to Celgene’s patents required to manufacture and sell an unlimited quantity of generic lenalidomide in the United States beginning no earlier than January 31, 2026.
planck_tonne•2d ago
How did they do that?
Why is the sale of a super expensive drug used exclusively to treat a super specific type of cancer even controlled in the first place? What is even the argument?
I couldn't think of any argument before. After reading, I can only think of "to restrict competition".
throwanem•4h ago
Look, I didn't say I buy it. But you asked for the basic argument advocates make in support of such practices, and here it is.
throwawaymaths•4h ago
smt88•4h ago
nradov•4h ago
throwanem•4h ago
It is as if VCs in the tech industry demanded the taxpayer guarantee them a healthy rate of profit, to a standard of health the VCs themselves are privileged to define. Indeed, as with Allred and the regional airlines, perhaps now we see whence Altman has cribbed his "innovation."
nradov•4h ago
One could make an argument that taxpayer subsidized health plans which include prescription drug coverage such as Medicare Part D or Medicaid should limit the prices they are willing to reimburse on a QALY basis. And Medicare has started a limited drug price negotiation program. But generally, voters have been unwilling to accept the trade-offs inherent in drug price controls.
https://www.cms.gov/newsroom/fact-sheets/medicare-drug-price...
throwanem•3h ago
(If you want to do something else, I can't tell what it would be.)
nradov•3h ago
mikeyouse•4h ago
nradov•3h ago
https://www.fiercebiotech.com/biotech/drug-development-cost-...
cogman10•3h ago
Big pharma is providing very little benefit and a lot of cost. We've seen their playbook with people like Martin Shkreli who'll buy up patents to existing drugs and jack up the price to make a quick buck. Do we really need that sort of "private investment"?
nradov•3h ago
The primary claim in support of the current system is that it encourages greater levels of innovation than would happen under a socialized central planning system where government bureaucrats allocate funding for all trials. We don't have any solid evidence about that one way or the other. But year after year, US pharma companies do consistently release more new drugs than any other countries on a per-capita basis. We don't want to wreck that just because of high prices on a few patent protected drugs. Let's take a longer view and consider possible second-order effects before making any drastic changes.
cogman10•3h ago
What innovation? All the innovation with the current system happens outside the big pharma companies. They are merely swooping in at the final steps and manufacturing to benefit from the public investment.
The actual innovation is happening because of public social investment. Not because if private investment (at least in terms of medicine). Private investment here is simply leaching off of the public investment.
nradov•1h ago
If we want to have new a lot of new drugs every year that meet the FDA standard for being safe and effective then someone has to put in enormous capital investments. In theory I suppose we could raise taxes and socialize the whole system but so far I haven't seen any evidence that would be a net improvement. More likely just another opportunity for graft and corruption.
throwanem•3h ago
> The primary claim in support of the current system is that it encourages greater levels of innovation than would happen under a socialized central planning system where government bureaucrats allocate funding for all trials.
Oh, I see. You argue against the barely reanimated corpse of Nikita Khrushchev, in the breath after you accuse someone else of playing with a strawman.
Considering that I obviously disagree with the argument you've been trying to advance, I hope I can be forgiven some surprise at having presented so much stronger a formulation to argue against than you seem prepared to present in arguing for. Whom do you imagine yourself convincing in this way?
cogman10•2h ago
But if you want to argue innovation instead, I see that as particularly worse in terms of medicine and science. Pure research is rarely profitable which is why you pretty rarely see it in an open marketplace.
It's not that it never happens. Obviously some research specifically targeted at manufacturing efficiency does happen as that will increase profits. However, outside of maybe semiconductors you'll almost never see a purely private institution invest in something like material sciences. More often than not, that research actually comes from something like the DoD contacting out to a defense agency trying to do better tank armor.
With medicine in the US, pretty much all innovation has come from public investment. The polio vaccine, for example, didn't come from a drug company, it came from a university researcher. That's the story of a large number of modern medicines.
A private company doesn't need or in some cases even want new medicines. Why would they want to make something that benefits 1/100000 of the population when something like insulin has a huge market and few competitors. Manufacturing new medicines for rare diseases isn't profitable, so why would they ever research it in the first place?
throwanem•2h ago
The argument is also not too well presented, in that it lacks grounding. For example:
> Why would [a pharma company] want to make something that benefits 1/100000 of the population when something like insulin has a huge market and few competitors?
Because insulin has a huge market and few competitors. That means they have defense in depth on pricing because their manufacturing will be highly specialized and high-throughput, else they could not continue to serve the market unless protected: someone would acquire them or shoulder them out. If you try to disrupt that incumbent, the same will happen to you; you'll be either acquihired, vivisected, or left to go bankrupt in peace for lack of anything novel enough to attract interest.
If, conversely, you can go to one person in every hundred thousand and offer them a pill that will make the difference between life and death - a pill that no one else, ideally, can possibly sell them - well, what can't you ask in return? The traditional rate I understand to have been in the order of one to ten firstborn sons and heirs.
We do things differently now, of course, or less overtly at least. But the business case when considered amorally, as any of that species must be to be understood on its own terms, is trivially clear. The discussion you really want to have is that of whether income inequality can and must be allowed to dictate even partially the dimensions of a human life, versus whether that can and must be prevented. I'm not going to pretend I could summarize the state of the field on that one, which has much older names even than "theodicy."
cogman10•2h ago
If someone is going to find that Benadryl can treat a new disease, it won't be a pharma company.
throwanem•1h ago
That's the sort of question folks like my prior interlocutor, who appears now to have abandoned the effort, really don't want to answer. And no wonder! There's no way for them to do so while maintaining the usual comfortable abstraction over the essential bloodthirstiness of their philosophy.
SAI_Peregrinus•2h ago
tough•4h ago
America, the land of the dollar
ricksunny•3h ago
Correction: America, the land of the rent-seeking.
bschne•3h ago
Roche (Pharma Division): 7533 MCHF vs. 11096 MCHF
Novartis: 12566 MUSD vs. 10022 MUSD
Pfizer: 14730 MUSD vs. 10822 MUSD
Eli Lilly: 8594 MUSD vs. 10991 MUSD
AstraZeneca: 19977 MUSD vs. 13583 MUSD
Johnson & Johnson: 22869 MUSD vs. 17232 MUSD
The left side here contains more than just marketing, and already "far far outstripping" seems like a mischaracterization.
For comparison, the average R&D spend between these firms is bigger than the 2024 NSF budget (~9bn) and bigger than 1/4 of the 2024 NIH budget (~37bn).
dgacmu•2h ago
bschne•2h ago
derektank•1h ago
tptacek•2h ago
(I don't know how much that matters in this case, where a tiny company lucked into a blockbuster and then used every lever in the system to protect their exclusivity).
throwanem•1h ago
tptacek•59m ago
(Pharmaceutical costs, all in, across the board, are a relatively small component of total health spending in the US. They're not why your health insurance is so expensive.)
This is mostly a story about anticompetitive abuses, so that question isn't super relevant to the story. I'm just answering the claim that invisible marketing/SG&A costs are why drugs cost so much. They also cost a lot because most drugs fail, sometimes after billions invested.
leereeves•4h ago
How does that work? Does it extend patent protection on the original molecule? Or if not, what stops generic copies of the original version?
throwanem•4h ago
jmward01•2h ago
photochemsyn•3h ago
> "Celgene had acquired the rights to thalidomide patents held by researchers at Rockefeller University in 1992."
Change Bayh-Dole law to non-exclusive licensing, but with some level of royalties paid to institution that originated the patent, and other corporations could have made the drug - and it would be a competitive market, so costs would drop due to lack of a monopoly on the drug.
This one simple change to Bayh-Dole - 'non-exclusive' - would upset the academic-corporate apple cart well beyond pharmaceuticals. Eg the PageRank algorithm created at Stanford could not have been exclusive licensed to Google - any American corporation or person could have applied for a license to the invention, entirely erasing the benefits of a monopolistic patent to the corporation.
One great benefit of this change is that corporations who wanted exclusive patents would have to finance their own private R & D divisions, instead of just capturing the output of taxpayer-financed researchers.