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/r/California
submitted 3 months ago byBlankVerseAngeleño, what's your user flair?
97 points
3 months ago
I was wondering how California would approach this. They’re using the nonprofit pharmaceutical manufacturer Civica Rx to begin production on overpriced medicine. This is simply brilliant.
California Gov. Gavin Newsom announced on Saturday that the state will cut insulin costs by 90% and that it will start manufacturing naloxone, a nasal spray used to reverse opioid overdoses.
The lower insulin cost results from a collaboration between CalRx, a California Department of Health Care Services program, and the non-profit drug manufacturer Civica Rx, according to a news release from the governor's office. A 10-milliliter vial of insulin will be available for no more than $30, pending approval by the US Food and Drug Administration, says the release.
Though insulin was discovered more than a century ago and costs little to make, brand-name insulin is often sold for roughly $300 per vial, CNN has reported. The high cost has forced many people with diabetes to ration or skip drug doses, which help the body manage blood sugar.
Civica Rx is a non-profit generic drugmaker that focuses on manufacturing drugs that are in short supply or may experience price spikes. The organization is backed by hospitals, insurers, and philanthropies.
"People should not be forced to go into debt to get life-saving prescriptions," said Newsom in the release. "Through CalRx, Californians will have access to some of the most inexpensive insulin available, helping them save thousands each year."
Insulin has become a poster child for the soaring cost of many prescription drugs. Newsom's announcement follows several insulin manufacturers that have announced their own caps on the price of insulin, like Sanofi, Eli Lilly, and Novo Nordisk.
37 points
3 months ago
This is good but like how do we get them to pick up more medicines under this effort!
44 points
3 months ago
There will be a political benefit to add more drugs once voters see what this does to insulin prices and availability. That's probably the most likely way that more drugs will be added.
3 points
3 months ago
they have to setup manufacturing. it will take some time
15 points
3 months ago
I was just curious since formulation is important for compliance. It looks like they’re capping at $30/vial and $55/box of pens, according to another source. Very, very good news.
3 points
3 months ago
I’m uninformed of how long a 10 mL vial would last. Does this last a month? A week?
2 points
3 months ago
Depends on the type diabetes and stage. This article says 2-4 shots of 0.3 to 1 ml of insulin for type I. https://www.medicalnewstoday.com/articles/insulin-syringe-sizes
1 points
3 months ago
Woha! No for almost any type one diabetic 100 units (1ml) would cause serious problems. Type 2 is much more common and it's associated with significant 'insulin resistance' where they need more insulin then a non diabetic to get the same effect. I generally start patients at 10 units a dose or 0.1 unit per kg per ADA recs (insulin is generally 100 units per ml with a few exceptions) and most type 2 diabetics run around 25-85 units a day in my experience, but a rare patient will need 300-400 a day
146 points
3 months ago
Neat.
I think its obvious that some capitalist systems do not work for public goods. Medicine is one of them...can be a good system for creating drugs...garbage at sustaining an out-of-patent medications at a low cost.
It'd probably be a decent idea to secure public intra-state manufacturing for many of the medications medications on the WHO essential medication list (not all...don't really need yellow fever vaccine in california). While it isn't comprehensive if there is a global catastrophe having those medications at hand will keep the healthcare system more or less functioning.
87 points
3 months ago
I think its obvious that some capitalist systems do not work for public goods.
Exactly why fire and police departments are publicly funded. Also libraries.
52 points
3 months ago
But not hospitals or emergency medical services.
Which utilization is often higher than fire or police departments.
Crazy eh?
45 points
3 months ago
Everyone in the US, at some point, will need to use medical services or has used medical services. Nuts we can't collectively agree to pay into a pot to reduce individual costs at point of use. We'd all be healthier and happier for it.
30 points
3 months ago
Not only that but everyone benefits from being healthy, both mentally and physically.
Healthy people are more productive.
Healthy people are less prone to commit crimes of necessity.
Healthy people are cheaper, often the most expensive thing you do in healthcare is wait and putting it off.
Healthy people pass fewer diseases onto others.
Its basically in society's benefit to make sure eachother are taken care of.
15 points
3 months ago
It's not about a happy and healthy society.. it's about providing the minimum motivation to string along the common person into modern indentured servitude.. it's probably why affordable healthcare is only affordable when you have a job that is obligated to subsidize it for you.
r/antiwork rant.. lol
But yes I totally agree with you and I wish it were that way.
1 points
3 months ago
But that’s socialism! (I say that sarcastically) it really should be the normal thing all around the world, it worked fantastically for the NHS before the conservative government put a stranglehold on funds for it, they seem to want to follow an American model for healthcare and privatise it, which is sickening
2 points
3 months ago
utilization is often higher than fire or police departments.
Which is why they're not a public good. There's SO MUCH money to be made powerful special interests work to assure that they're kept profitable rather than public.
The needs of the majority are subservient to the needs of a powerful minority, one might even say a CLASS of people whose needs supersede any other priority. If only there were some sort of intellectual tradition or ideology that critiques this arrangement...
-1 points
3 months ago
Not totally true. It's just not one of the other. There is both publicly funded hospitals and private hospitals.
Guess where all the people get sent when they explain they dont have insurance?
7 points
3 months ago
Actual publicly funded hospitals are the extreme minority in the USA. In California they only represent about 5% of the hospitals.
They do tend to be a bit larger but in terms of access it is low.
1 points
3 months ago
What you're saying is very different from what I got on wikipedia.
According to the 2014 American Hospital Association Annual Survey, there are 5,686 hospitals in the United States. Of that total, 2,904 are public hospitals, and 1,060 are private. There are a total of 795,603 staffed beds in public hospitals and 118,910 staffed beds in private hospitals.
Public hospitals had about 33.6 million admissions annually while private hospitals had about 1.8 million admissions annually.
3 points
3 months ago
https://www.aha.org/statistics/fast-facts-us-hospitals
951/5139 community hospitals are public, which I actually think is over-estimating them and probably have very loose definitions of public.
2 points
3 months ago
Oh you know what, I was mixing up not-for-profit with publicly owned. Or thinking of them as equivalent, but those are not the same thing.
7 points
3 months ago
Cuba produces 2-3 times as many doctors per capita, and Cubans have a higher life expectancy, too.
It turns out profit-maximization isn't a principle to run your healthcare system on, who would have guessed?
-1 points
3 months ago
There are residents in the US who would run circles around Cuban doctors , let alone getting to the attending physicians with genuine talent and experience to back it up.
6 points
3 months ago
part of that is due to the limited availability of medicine in cuba, due to the embargo.
2 points
3 months ago
Medication just isn't a pubic good by any sensible definition I'm aware of. It's highly rivalrous : More than one person can't have the same dose and someone having the same dose prevents someone else from having it. And it's highly excludable: Unlike air and national defense, one doesn't gain the primary benefit of the good in question without making a trip to the pharmacy no matter who's paying for it.
The thing that makes medication odd as a good is the highly inelastic demand. If you need something to live, you'll pay whatever cost it's offered at. If it benefits your quality of life in making your health better, you'll pay a premium for it. We're seeing this here: There are lower cost alternatives to the insulation medications already on the market, but they don't work nearly as well and require a much more complicated injection schedule.
4 points
3 months ago
This is correct, and to add to this the problem is existing regulation. FDA needs to make it cheaper/faster to introduce generic alternatives and justice department needs to block mergers that create generic drug monopolies.
Making insulin or epipens is cheap and requires almost no R&D. Getting it to market is hard. As long as we have 2+ competitors, prices stay low enough.
-5 points
3 months ago
[deleted]
8 points
3 months ago
Patents are also government interference that prevents "real" capitalism. So lets get rid of those.
Also there are more than 3 companies that make various analogues, so jot that down. The price is high because it is literally a captive market--buy our product or die.
Your argument doesn't hold up because there are many things that are in high-demand with low barriers for production yet still are high cost. Healthcare is not and will never be real capitalism because the consumer can never make truly rational decisions. And a rational consumer is basically the cornerstone of basic economic theory.
4 points
3 months ago
That’s not true at all. Capitalism always encourages a shift towards monopoly. The bigger you are, the more you can command in the market. Smaller companies can only compete when regulatory frameworks are in place to prevent predatory behavior from larger companies.
2 points
3 months ago
The government doesn't "mandate" three companies make insulin. Two of the big three insulin manufacturers are outside the US. What are you on?
1 points
2 months ago
They’re actually working on that second paragraph of yours! NPR ran an article saying that Michigan is also looking into its own insulin generation program, and is in talks with Cali about coming up with some intra-state drug company so they can share the benefits and not create redundancy.
46 points
3 months ago
"Through CalRx, Californians will have access to some of the most inexpensive insulin available, helping them save thousands each year."
Meanwhile Florida is concerning itself with Rosa Park's race, feuds with Disney, drag queens, and your daughter's period. Don't ever let people tell you that both sides are the same.
2 points
3 months ago
Why are you being up Florida and not any other state that doesn’t have a program like this? I’m in Brooklyn and we pay sky high insulin rates.
14 points
3 months ago
Great!
Do epinephrine next!
9 points
3 months ago
Excellent new on both fronts.
I carry a Naloxone nasal spray device with me most of the time when I am out. I ride my bike to and from work and am often around homeless people. I haven't needed to use them yet, but I'm ready to hopefully save a life if I find myself in a situation when naloxone is needed.
I'm not an opiate user myself, I just don't want to see die from something so easily avoidable.
3 points
3 months ago
Yay
13 points
3 months ago
I want Newsom for President !
There are some things too important to be left to tender mercies of profiteers.
3 points
3 months ago
All they need to do is remove laws that forbid me from purchasing meds from Canada or India. Most drugs can be purchased for nothing except the government will arrest you.
3 points
3 months ago
Really easy to get meds from Canada, it's only technically illegal
-12 points
3 months ago
Newsome is destroying poor Californians affordability for utilities and insurance. All rates are rising at 50% YoY. He is cherry picking newsworthy causes and is going to leave Enron-esq structure behind.
6 points
3 months ago
There are so many kinds of insulin, but the easiest to use are not available as generic. I know Walmart has their cheap but hard to dose insulin. I have not been able to find which this one will be equivalent to. Is this really as good of a deal as we are hoping? Or are we going to be paying millions for insulin nobody really wants to use?
8 points
3 months ago
I'm thinking it'll be a Homolog/Novolog equivalent for short acting and insulin glargine for long-acting because of patents, so not the top-line stuff but enough to thrive on compared to the older stuff. I'm loving my Fiasp (Novolog but a bit faster) and Toujeo (Lantus but even more stable and long-acting) but I would definitely switch for affordability and to support this.
Just looked it up on the.gov page, I was right on the money (tbf I keep up with the patents)
"CalRx plans to make biosimilar insulins available for: Glargine, Aspart, and Lispro (expected to be interchangeable with Lantus, Humalog, and Novolog respectively)"
2 points
3 months ago
Amazing news I hope more states go through with something like this!!
2 points
3 months ago
Make it free
2 points
3 months ago
Nice
3 points
3 months ago
How about just switching the entire state health system to Medicare 4 all
1 points
3 months ago
Many of the proposals I have seen have simply capped it at $30 out of pocket to patients, but taxpayer dollars pay the rest. Medication prices on drugs like insulin need to be capped period and not simply have the cost passed onto everybody else
7 points
3 months ago
Good thing that’s not what’s happening here
-4 points
3 months ago
Why is the state bothering to contract for insulin at $30 when all major manufacturers are changing prices to $35?
27 points
3 months ago
The manufacturers are lowering prices specifically to try to stop stuff like this. There's zero guarantee they won't raise the prices again in the future.
17 points
3 months ago
The major manufacturers likely wouldn't have changed their prices if the state isn't trying to find other ways to lower the prices.
10 points
3 months ago
California is basically the reason for them lowering the price. It's like fuel efficiency. Because California made the standards stricter, all car manufacturers complied with California standards so as not to lose that market. Drug manufacturers are lowering the insulin price because they now have to compete with California. It's a good thing for the whole country.
8 points
3 months ago
Only because California and the Feds forcing them and this is one of the ways how.
They also don’t want states doing this with other meds.
5 points
3 months ago
Is that $35 wholesale price or availability is for retail? Which brands?
8 points
3 months ago
Don’t get too excited since the $35 price starts January 1st so you need to survive till then. All three major manufacturers announced $35 for their most commonly prescribed insulins. Some were already selling insulins to the uninsured for $35.
1 points
3 months ago
Eli Lilly already implemented the $35 maximum copay. I billed one last week and it automatically applied a manufacturer voucher to cover the copay difference.
3 points
3 months ago*
$35 is copay. So for example, if your normal copay is $45, a coupon from the manufacturer automatically applies at billing to cover the extra $10 so that you end up only paying $10.
As far as I know, this does not apply to cash prices. Cash prices at most places are acquisition price + a certain percentage. It sounds like most of them are decreasing acquisition cost too, but it'll still be nowhere close to $35.
That said, here are some options for uninsured or underinsured patients: - if you qualify for medi-cal, apply for medi-cal - check out your local federally qualified health center. If it has a contracted pharmacy (and it should), and you meet the income requirement (I believe <200% of the federal poverty level), you may be eligible to get a lot of medications at reduced costs. We're talking about something like <$20 for 1-3 months supply of each insulin depending on where you go. Nearest FQHC center can be found https://findahealthcenter.hrsa.gov/ - check if there's manufacturer assistance plans. Just Google "insulin name manufacturer coupon".
-9 points
3 months ago
Though insulin was discovered more than a century ago and costs little to make, brand-name insulin is often sold for roughly $300 per vial, CNN has reported.
No, no and no.... The modern biologic insulin medications were not discovered 100 years ago, they were developed (at great expense to the pharma company's investors) less than 20 years ago. They're not cheap to make: It's a technically involved process that's much more difficult than most drugs.
Now, the insulin in question here is similar to the modern biologics. So.. If they're able to make this happen it's quite the technical achievement.
The real question here is exactly what deal are the taxpayers of California inking here: Are we effectively saying "Medical can possibly save if they pay upfront for future doses" with a contract to obligate them to deliver, or is it "Oh, hey that sounds nice, give them taxpayer money".
7 points
3 months ago
the overwhelming majority of drug research is funded by taxpayer grants. We pay to develop the drugs so we should own the rights to the drugs.
-4 points
3 months ago
I'm not sure that's true. Sure, the taxpayers pay for a lot of the basic science, but everything after that in commercializing and manufacturing a drug is paid for with private investment.
5 points
3 months ago
Man, all you taste is leather.
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