46 Comments

Novo - like every other drug company - is playing a game. They know they can make more in the US so they charge more. People find a work-around using compounded meds and the drug companies and their hired FDA thugs start crying foul and threatening jail. Canada refuses to pay such a ridiculous price, so they sell it to them at a 70% discount.

The price of medicines is so far separated from the incurred costs that the old “it takes a lot of money to make a new drug” argument literally makes me nauseated now.

I am a huge believer in free market capitalism, but healthcare hasn’t been a free market for over 109 years, at least in the US.

People are starting to get wise to these folks. Their days of government-protected monopoly are going to come to an end one of these days. We can hope so, anyway.

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How could you write this article and give no mention of the massive incentive that exists by these drugs receiving permanent and lifetime approvals for Medicare and Medicaid… they’re trying to get Ozempic approved for kids as young as 6 years old … so I don’t buy they’re doing this for the sob story of the founder’s wife. Not to mention the standard of care for overweight and obesity should be diet and exercise not GLP-1.

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Clearly, obtaining Medicare/Medicaid approval for as many indications as possible must be a major goal. Unfortunately, I am not an expert on that system. The Danish Health Authority specify that Wegovy is not first line treatment for obesity, and even those who take it should of course eat healthy and exercise as well. It is no silver bullit, but for some, this drug is a major, life-saving advance.

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Look, I’m no expert either, but in an article largely about the critique that Sanders is offering, which hinges on costs to the American health care system (and thus American taxpayers) it seems to be a massive hole in the analysis. The fact still remains that the costs are exponentially higher in the US because of the failure of the US govt and certain rules under the Affordable Care Act that preclude essentially having “price matching”. So, to pharma companies, Medicare and Medicaid is a giant money printer.

As for the standard of care, I think I’d take most developed countries over the US! So I’m not surprised Netherlands is better on the subject and I’m very glad to hear it. That should also tell you something if the country the product is manufactured in has a different standard of care for when the product is used …

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As I write in the analysis, I will make no effort to defend the American health care system. You are most likely correct that Medicare/Medicaid should be given better possibility to negotiate prices. Indeed, better regulation of prices during the patent protected period is exactly what I call for. Regulation to ensure these drugs are used for the medically correct purposes and are not indiscriminately prescribed based on patient demand and wishes is also desirable in my opinion

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If you think the price of Wegovy is excessive check out this price breakdown:

Retail price of one Kg of Amoxicillin in U.S.: $400

Retail price of one Kg of Gold in U.S.: $ 83,000

Retail price of one Kg of Cocaine (Black Market): $100,000

Cost to build the aircraft carrier George Bush: $6,000,000,000

Retail price of one kg of Novonordisk drug Novoeight in U.S.: $10,000,000,000

see Processes 2019, 7(8), 476; https://doi.org/10.3390/pr7080476

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Essentially the US buyers (medicare, medicaid, private insurance) did not/would not negotiate the best deal aka price for the public (despite it being US tax payor money). Novo Nordisk is playing by the rules in that circus. Bernie and Joe could fix it to the tax payor's advantage but the miasma of lobbyists and PBMs have won out otherwise to the exorbitant profit driven price of GLP-1 derivatives in the US.

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Actually, I have another perspective, Novo Nordisk is/has stopped producing a long acting form of insulin that many in the T1 community uses to control their lack of an insulin producing pancreas in a manner that can be described as less fluctuant, flatter and similar to a natural process. Many have been on this insulin for decades. Novo Nordisk is repurposing their Levimir factory to produce a more profit making Ozempic in its place. Changing a basal insulin is no small, insignificant issue. No other insulin producers will be manufacturing this form of basal insulin. That should demonstrate their greed. There are users presenting to governments, and trying to fight this particular issue, but it’s a small coalition compared to the vast number of people that are using this GLP-1 receptor agonist. So in my mind greed drives them absolutely.

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The unique nature of Novo’s corporate structure notwithstanding, the expensive question here is trying to find the balance between incentivizing research and innovation among for-profit companies (where the relatively rare blockbuster successes backstop the many other failures in their development pipeline), and preventing predatory market practices and price-gouging that detracts from the greater societal good. It seems to me that patent protection (which by definition “allows” a monopoly) for a limited time is a reasonable trade off for such intellectual property.

I’m curious here that the author bemoans the “medicalization” of obesity on the one hand, then refers to Sema as life-saving in the other. Can both those things be simultaneously true?

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I think they can both be true - these drugs are right for some people and may save their life. But if we accept Novo's simplified definition of obesity (BMI >30), they will also be given to lots of people who don't need them and thus overdiagnosis, with associated harms.

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Pharmaceutical patents last for at least 20 years in the US, and can be extended by using various gimmicks. That is a very long time.

Our government enforces patent rights (IP) of companies throughput the world. That has enormous costs to Americans. To do that it includes those rights in trade deals with other countries. We Americans have to give up something valuable in return, such as jobs here in America, to get other countries such as China to respect those patent rights.

As you imply, patent rights are a right granted by the government to a monopoly. There is no natural right to a monopoly. When companies charge Americans far more than they charge other people for the same drug, it is time to stop protecting that patent, and all patents by that company.

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It could be life-saving for the treatment of Type 2 Diabetes. The risk of T2 Diabetes is of course elevated by obesity (root cause largely being metabolic dysfunction/insulin resistance, caused primarily by poor diet).

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Sema was not found to reduce CV mortality among diabetics (in Sustain-6) nor among obese non-diabetics (in Select). The composite primary endpoints in those studies were positive, but those benefits were not driven by all-cause or CV mortality reductions.

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That may be because the studies were not long enough to see any impact on mortality (which one would think would result from reduction in MACE events). I imagine long term follow ups are likely.

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Most big Pharma companies are publicly traded, and the equity market ensures that they are unable to earn an unreasonable reward (profit) to risk ratio. If any one of them did, investors would quickly bid up the price of the stock to bring the reward/risk ratio back to market equilibrium. After all, if there were a publicly available investment offering exorbitant returns in proportion to the risk why would anyone invest in anything else?

Novo Nordisk is an exception, and that it is owned by a charitable foundation rather than being a public company. This means that the general public shares in the profit through the charitable efforts of the foundation rather than directly by purchasing the stock.

As for pharmaceutical prices, being higher in the United States than in Europe, does it really surprise us that the European countries that are willing to under invest in their own defense as long as the United States picks up the cost are also willing to let us subsidize their pharmaceutical research and drug development needs?

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Novo Nordisk A/s is publicly traded. However, the Novo Nordisk Foundation owns the decisive majority.

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All that is fine, but we have to work out a way to stop having Americans subsidize the rest of the world. It is another one of those things that is bleeding us dry, if you haven't noticed.

And with charitable foundations, it is not usually true that the general public shares in the profit. Charitable foundations usually get captured by an ideology that puts a priority on helping some people at the expense of others. If they see some people doing worse than others they say the people doing worse off are "disadvantaged". In reality, it is more likely because those people have dysfunctional behavior that stymies their progress.

The charitable foundations quickly figure out they can get more bang for their "charitable giving" if they get the taxpayer to pay for their programs . This is usually to the detriment of everyone as they interfere with the political and legal processes that are necessary for a free and prosperous society.

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Thank you for taking the time to write this piece for Sensible Medicine. The pricing definitely creates the frenzy. These drugs aren’t that great for weight loss but the frenzy makes everyone think that we’re missing out on something wonderful. And still, the disease of addiction is not cured with a pill or a potion but there is a solution. Thanks again. Friend of Bill W.

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Let me get this straight. Pharmaceutical companies charge US consumers far more than they do people in other countries.

Yet the US taxpayer pays for global enforcement of drug patents. In order to enforce the patents the US government negotiates away American jobs in other US sectors in trade deals. The drug companies employ as few Americans as they can. When they do employ people in America, they bring in as many immigrants workers as possible. They pay very little in American taxes. Corporations are supposed to pay a nominal tax rate of 21%. But in recent years, the biggest pharmaceutical companies had an average effective tax rate of less than 12%, according to an analysis by the Senate Finance Committee.

All systems tend toward corruption. The US patent system has evolved into a monstrous criminal enterprise that is killing America. People have always had the right to copy what other people have done. There is no natural right to a monopoly on an idea. Patent rights only exist to the extent this serves the interests of Americans.

If patent rights do not serve the interest of Americans we need to abolish those patents. Our patent office should not enforce a patent if the company charges Americans more than they do people in other countries and do not pay their fair share in taxes..

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In 2008 when gas and diesel prices were going through the roof, I was dismayed and baffled by the fact that diesel cost $1 per gallon more than gas since diesel used to be less than gas and I had always heard that diesel was less expensive to produce. Part of the answer I found was that the US govt had decided to tax diesel at a higher rate, but the main reason turned out to explain the pricing much better.

I spoke with a friend who is an executive at an oil company and posed my question to him:

"Why do you charge significantly more for diesel when it costs less to produce it?"

His answer made perfect sense to me:

"Because we can."

Things are worth what people are willing to pay for them. In the same way, taxes tend to be as high as whatever the people are willing to pay. Prices tend to be as high as whatever the market allows, "the market" includes not just consumer preferences, but also government policy and the government regulatory environment. Given the mutually beneficial incestuous revolving door relationship between the government in general and the specific government regulatory agencies with the companies who produce and sell products, all of them have a mutual interest in high profits, an interest that is a conflict of interest with the people purchasing the products.

The current situation in the pharma industry will continue until the people start voting out politicians who are not looking out for their best interests, but the people are kept bamboozled by and focused on other more juicy drama and circuses issues by the politicians and the media. Meanwhile, the gravy train keeps on chugging and the cash keeps on flowing.

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PBMs are a serious problem, contribute little except for driving up prescription drug prices.

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The European love of central planning. It shows up over and over, never actually working or producing anything. Why is the idea that taking big risks and making millions of lives better results in expansive gains so offensive? Why does the reward of significant wealth for those who do great things for humanity offend you?

One other point: you say, "That is not possible for Ozempic and Wegovy, which can be a life-necessity." How can something that didn't exist 10 years ago now be a human right and life-necessity? If Novo wouldn't have created these drugs, would they be 'killing people'?

If your prescription for central planning is followed, that will be the result. Expensive and complex endeavors with government limited upside will simply be forgone and we will all be poorer and worse off. If you need evidence, please see all other forms of central planning in the 20th century for reference.

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I took an American History class when I was an exchange student in Michigan in 1992/3. We had the most wonderful teacher and it was a great class. One thing I learned was how antitrust regulation was first introduced in America the 1800's to break up railroad cartels that took advantage of their dominant market position to exploit society. I think this is a great example example of how America was ahead of the rest and that such 'central planning' ensure that the privileged do not take unhindered advantage of the less well positioned. It is a mark of a civilized society that it ensures the fundamental rights of the common man. My worry is that the state-guaranteed monopoly granted to pharma by our societies, in the US and elsewhere, threatens this originally American regulation of the free market.

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Yes, this is the key point, but I would also add that it's outrageous that America bears the burden... why Novo charges more in the US should be the focus of these inquiries

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its an easy answer, because the market will bear it. This is (yet another) way the US subsidizes the rest of the world. If they couldn't charge what they do in the US, they wouldn't take the same amount of risk.

While some erudite regulator is sitting in a danish (or most European) academic hall, congratulating themselves on holding down the price of drugs, an actuary working for Novo or any other company is figuring out what the market value of a drug is based on what they can make in the US and world combined. Artificially limit the price of drugs in the US and the entire world will have fewer options.

This (and many other reasons) is why freedom in the US makes the entire world better. If it is lost, there's no where else to replace it and the entire world will be poorer, less free, and more unhealthy.

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You think you have freedom in the USA?

Yet you have the highest prison population in the world, and a murder rate ten times higher than that in Europe.

Your people are the fattest in the world, due to the worst eating habits.

Hmmmm - a curious delusion!

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That, folks, is a good example of word salad. Free people are allowed to be fat. They're allowed to make decisions about owning firearms or knives and even riding motorcycles and hunting, all things that are inherently dangerous.

They also suffer many of the consequences of taking these risks. It is not your role, nor that of anyone in government to decide what food your neighbor eats nor what risks you are allowed to take. That's what freedom is all about.

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We have many states which have lower murder rates than in Europe. It all has to do with demographics.

And we don't put people into prison in America for thought crimes like they do in (once-great) Britain..

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That is total nonsense, That sounds like the argument of a paid shill. .

Look at our federal and trade debts. We Americans can't afford to subsidize people in other countries. This is an argument for American isolationism. We should be more like Switzerland. We don't have allies, we just have people who want to use us.

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Please point out the non-sense. I'm not sure what you are referring to with our federal and trade debts. If you are saying that our country is in debt due to government overspending, you're correct.

You're also correct that we can't afford to subsidize people in other countries.

But this is absolutely not an argument for isolationism. Isolationism would tax or prevent the importation of foreign made drugs and I'm absolutely for that. We should have as little regulation as humanly possible because we are the last beacon of freedom, free enterprise, and innovation. If its killed here, there's no where left for it to run.

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You comment suggested that it was a good thing that Americans paid more for drugs because it benefitted the rest of the world - "...Artificially limit the price of drugs in the US and the entire world will have fewer options..."

Believe me, I am all for expansion of individual freedom and less government in America. However it is the government which is the problem when it enforces patents that allow companies to charge Americans higher prices than they do people in other countries.

The solution is to get government out of the way, stop enforcing those particular patents, and allow other companies to produce that product. There is no natural right to a monopoly.

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1. "You comment suggested that it was a good thing that Americans paid more for drugs". It's not a good thing Americans pay more for drugs anymore than it is a good thing that criminals are locked up. I'd rather that neither was the case. Yet, here in the real world, both must be true or worse outcomes will ensue.

2. "However it is the government which is the problem when it enforces patents that allow companies to charge Americans higher prices than they do people in other countries." Again, compared to what. Would you prefer a world which offered no patent protection and drug prices were regulated by bureaucrats? It's a world that has much fewer options for pharmaceutical health care.

3. While there is no natural right to a monopoly, existence of property rights and their enforcement are valid roles for government. If you don't have property rights, you will have much less investment in the creation of intellectual property and many sick people will have FAR fewer options.

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Evil is as evil does—stop the lobbying for use in kids under the guise of “racism” if not approved

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Typo in this sentence: Of course, there should be a ‘carrot’ that make companies willing to take on the considerable risk of developing new drugs.

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The Biden had no problem in pumping billions into big Pharma during COVID knowing the money will come back to the Dem party in donations

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What is the cost difference for getting a drug approved in the U.S. compared to other countries?

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Good point. Is it possible for the US and the EU to harmonize their drug approval processes so that approval in one jurisdiction means approval in another ?

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Not a good idea. Japan used to do that or similar with bad results. Just look at the average person from the countries and it is easy to see that dosing alone is problematic. Then there is dietary differences and genetics plays a part too.

On the admin side, that too is difficult as each has different idea on what is the appropriate amount of bureaucracy for such things and their costs. I am an American living in Japan. I have private health insurance that covered me where ever I go in the world except the US. If I want coverage for the US, I must pay a lot more. Lots of people make tons of money in the healthcare bureaucracy in the US..

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In the US prescribers receive very generous payments from the companies making the drugs.

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Not true. Only those prescribers who are accepting money or other gifts from pharmacologic companies and any of those are listed on the following website per federal law.

https://www.cms.gov/priorities/key-initiatives/open-payments

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I encourage all US citizens to use that official database to check out their own physician prescribers or those they follow on social media.

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How about outside the U.S.?

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Very few countries publish the amount given by Big Pharma to individual prescribers.

Here is the US database

https://openpaymentsdata.cms.gov/physician/335114

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Makes it hard to compare then, doesn’t it?

I do not know if payments were given in Japan but hospitals and clinics in Japan used to be awash with promotional goods from drug and med device makers. One companies calendars were high prized by many in the health care industry. Pens, note pads, file folders (clear file), coffee mugs and small thermoses are some others. Suddenly a few years ago, this stopped. They passed a law against passing out free promotional items to doctors.

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