Viewpoint from a pharma employee

This doesn't work with The Epipen, sorry. All they did was make a design adjustment, raise the price and increase their salary.

Thank you for addressing this. Everyone seems to think that "Big Pharma" should just take HUGE financial and legal risk without any profit. I work in healthcare and have seen many instances of companies giving expensive meds to people in need via special programs.

It seems like people think all these meds should be free or on the $4 menu at Walmart. Yes, there are people who have special medical needs hat cannot afford medications that they need. There should absolutely be assistance for them.

The media villianized based martin shkreli the same way they did the don

Bernie Sanders released a statement warning companies, including the one I work for, that their insulin prices were far too high and are in collusion with one another. While I agree to an extent that medicine can be expensive, there is a good rationale for it.

This is a red herring.

What exactly is to be R&D-ed on insulin? It was crystallized back in the 1950s, has been made recombinantly for more than 3 decades, and as far as I am aware, human physiology has not changed in that time.

If anything, it should be getting cheaper and cheaper because we are getting better and better at making it. Shouldn't it?

Then why is the price going up (if it truly is; knock on wood, I haven't had to check what exactly it is)

Also, there is a lot of mythology surrounding pharma R&D.

Yes, it costs a lot and the outcomes are highly uncertain. I am well aware how it works, I work in that field too, but on the academic side.

How is that an argument for for-profit drug manufacturing? The people in academia, who do the bulk of the fundamental science, do not do that for the money. The rank-and-file people in big pharma work for a salary. The profits go to the shareholders and the executives. The government is paying for the fundamental science on the academic side, give me one reason why it could not be paying for the compound screening, drug trials, etc. (if anything, there are significant economies of scale to be realized if there weren't so many different companies duplicating the same tasks and crucial information being kept secret from competitors). The scientific creativity comes from the academic researchers and the rank-and-file scientists in BioTech/Big Pharma, all of whom work for salaries. Yes, some strike it rich off patents and start-ups, but the bulk of the work on any product that makes it to the market is not done by those people.

There are also some really perverse incentives in the private BioTech/Big Pharma model -- the focus on chronic disease at the expense of infectious disease, for example. And yes, I am well aware of the scientific difficulties with the latter, those are all the more a reason for heavier investment into it and much stricter regulation of things such as the abuse of antibiotics, not for less regulation and Big Pharma pulling out of the field.

First off, the FDA does not even do a well enough job of keeping drugs that don't work off the market.

Second the patent extension process for Pharma specifically is absurd. They have way too much protection.

Third there are drug prices climbing as more generics enter the market. Why is this?

Fourth, companies commit research fraud by keeping their data locked up and no publishing unfavorable trials. Tgn1412 horrible phase 1 anyone? How about SSRI?

Fifth, Pharma companies aren't doing real research to extent most think. The money spent on "me too" drugs is absurd. Check out the lawsuit fights currently happening in the biosimilar market. Company A suing company B to not release generic of As drug and vice versa! The money spent coercing doctors to write their scripts undermining evidence based medicine is greater than that devoted to research. Mostly clinical anyway.

total that is $1,491,840,000,000 in excess spending and given the poor performance of US health care that $1.5 trillion dollars can only be seen as waste. To put that number in perspective, the United States 2014 defense budget was $526.6 billion, $615.1 billion including the Overseas Contingency Operations “slush fund.” Looked at from another perspective, it would cost the government a mere $62.6 billion to provide free public university education. That is to say, if we spent the OECD per capita average, we could double the defense budget, provide free public university education to all, and have the combined GDPs of Florida and Minnesota left over https://www.sciencebasedmedicine.org/rd-and-the-high-cost-of-drugs/

Arguments in defense of maintaining high drug prices to protect the strength of the drug industry misstate its vulnerability. The biotechnology and pharmaceutical sectors have for years been among the very best-performing sectors in the US economy. The proportion of revenue of large pharmaceutical companies that is invested in research and development is just 10% to 20% (Table 4); if only innovative product development is considered, that proportion is considerably lower. The contention that high prescription drug spending in the United States is required to spur domestic innovation has not been borne out in several analyses. A more relevant policy opportunity would be to address the stringency of congressional funding for the National Institutes of Health, such that its budget has barely kept up with inflation for most of the last decade. Given the evidence of the central role played by publicly funded research in generating discoveries that lead to new therapeutic approaches, this is one obvious area of potential intervention to address concerns about threats to innovation in drug discovery.

The point here is that pharmaceutical companies are increasingly in the business of running clinical trials and marketing drugs rather than plowing the hard ground for new discoveries. In this sense the basic research costs are socialized while the profits, increasingly breathtaking profits, are privatized.

An unintended consequence of the patent extension system is that less innovative,me-too drugs like the cholesterol lowering statin, Crestor, and proton pump inhibitor, Nexium, have received longer extensions than the more innovative first member of those classes of drugs. Granting extensions for less innovative drugs serves no public interest and adds tens of billions of dollars to annual drug costs because of heavy advertising that stimulates demand for those low-value products.

Companies scams that they "help" people by getting them the very expensive medication seems altruistic at first glance but be suspicious here. Why? Companies donated hundreds of millions of dollars to charities that help patients afford the co-pays for its high-priced drugs for multiple myeloma and other cancers “as part of a core business scheme to gain billions” from Medicaid, which pays the largest portion of the bill. Basically if a medication is too expensive to afford even after the Medicare or insurance picks up nearly all of the tab, the drug company will donate to a charity which can pay that copay for the patient, granting the company big dough. The directing of money from the charity to the specific drug the company makes is something which is not supposed to happen(wink wink).

u/gkm64 has a good handle as well