I wonder if it’s useful to consider the $40,000 price tag as the price that’s only practically relevant on an actuarial kind of level, as “0.35% of our pool of insureds who will be very expensive to us whether treated or untreated” rather than “hey sick person, here’s a $40K bill.”
As I understand it Gilead in particular seem to be pretty good about using those cold-hearted, “lifetime cost-effectiveness-ratio” sticker prices to effectively subsidize enormous quantities of affordable or free, high-quality drug in those poorer parts of the world that are bearing the brunt of the HIV epidemic. If the premise of insurance is pooling risk, is it inconsistent for the drug manufacturer to coldly calculate the “fair” price of the drug in proportion to its economic value—that is, the savings it brings over a given patient’s lifetime—then do their humanitarian discounting from that starting point?
They license their HIV patents to the UN Patent Pool so that generic manufacturers can produce them freely for low- and middle-income regions [0], they cover people’s insurance copays if their rich-world insurance bills for access to the drugs [1], and they provide access to the HIV drugs for free to uninsured people in the US [2].
As distasteful as the sticker prices are, I’ve always gotten the sense that you kind of have to play that twisted game if you’re going to get anything shipped at scale and stay in the pharma business. And that Gilead in particular have bent over backward both to focus their research on serious disease that primarily affects marginal and disadvantaged populations, and to make sure that their therapies actually make it out into the lives of the greatest possible number of patients.
The patient assistance program [1] sounds good but it typically runs out at 12 months. At that point the regular copay kicks back in. In a bizarre way it mirrors the pusher giving away some stash to get someone hooked.
I was under the impression that it’s 12 months at a time, you just reapply the next year. Which isn’t to take away from the precariousness of a program that could change on the manufacturer’s whim.
That said, in the US, 12 months also buys you enough time to sort out appropriate insurance if you don’t have it, for example by hitting the Affordable Care Act’s open enrollment window.
I can say with rather higher confidence that the copay coupon program renews annually.
Indeed. It sucks, but developing the quasi-vaccine thing and proving it works seems pretty cool, regardless of what comes next. Sure beats chasing pills for boners and hair loss.
Now things look good for this drug (after decades of false starts on long-acting HIV vaccines and prophylactics). And MSF and the usual (tireless, wonderful, humane) vocal advocates seem to be calling for affected countries to license production compulsively should Gilead attempt to license it on bad-faith terms. Seems like a good sign, though I’m not in a position to understand how serious those kinds of threats might be.
Wish I could access the session about this $40/pppy cost estimate, but the abstract seems to be here:
The way the abstract is phrased, it sounds to me to be in the spirit of “we’re doing this cost analysis because we bet this stuff will soon become available to the worst-affected regions at close to that price, with or without Gilead doing the right thing. So we figure we should see how that fits into our public health planning.”
Could be a total misreading, but a person can hope :)
As I understand it Gilead in particular seem to be pretty good about using those cold-hearted, “lifetime cost-effectiveness-ratio” sticker prices to effectively subsidize enormous quantities of affordable or free, high-quality drug in those poorer parts of the world that are bearing the brunt of the HIV epidemic. If the premise of insurance is pooling risk, is it inconsistent for the drug manufacturer to coldly calculate the “fair” price of the drug in proportion to its economic value—that is, the savings it brings over a given patient’s lifetime—then do their humanitarian discounting from that starting point?
They license their HIV patents to the UN Patent Pool so that generic manufacturers can produce them freely for low- and middle-income regions [0], they cover people’s insurance copays if their rich-world insurance bills for access to the drugs [1], and they provide access to the HIV drugs for free to uninsured people in the US [2].
As distasteful as the sticker prices are, I’ve always gotten the sense that you kind of have to play that twisted game if you’re going to get anything shipped at scale and stay in the pharma business. And that Gilead in particular have bent over backward both to focus their research on serious disease that primarily affects marginal and disadvantaged populations, and to make sure that their therapies actually make it out into the lives of the greatest possible number of patients.
[0] https://medicinespatentpool.org/
[1] https://www.gileadadvancingaccess.com/patient
[2] https://www.gilead.com/hiv-facts/expanding-access