Comment by Someone1234 2 months ago
It is worth noting that Compounded Semaglutide sold in the US is still more expensive than branded Semaglutide sold in other markets, where national price negotiations occur. For example, it can be under $100/month in several European nations.
The US just has no mechanism to control prices. There isn't really competition for specific drugs.
Although you're right, it's a little misleading.
The point is that governments won't pay any price, they usually negotiate a (good) price given their buying power. As you say they may not buy it, but countries that dictate a price (generally) cannot force a company to supply it.
Ultimately it comes down to market forces, even if the market looks very strange, with essentially one buyer and one seller.
> Ultimately it comes down to market forces, even if the market looks very strange, with essentially one buyer and one seller.
That isn't really a market.
Suppose you have a government that requires everyone to pay for public health insurance, effectively eliminating the market for private insurance because hardly anybody buys private insurance when they both already have public insurance and have paid the money they'd have used to buy it in taxes. Then the government insurance declares the maximum price they'll pay. Is there any meaningful way to distinguish this from price controls? The vast majority of customers can't afford the drug without insurance and the government is the insurance company and is setting the price through regulation.
In particular, notice that this has all of the problems of price controls. There is no real market to enable price discovery, no effective way for customers to switch insurers and thereby punish insurers who pay too much and have high premiums or pay too little and have poor coverage, it's just regulators making up a number and saying take it or leave it.
And even at that, you shouldn't have a problem for generic drugs because then the insurance can just put it out for bids and still have price discovery (i.e. a lowest bidder). But here we're talking about brand new drugs that are still under patent, which have one supplier because they're supposed to be expensive because that's the incentive for the drug companies to fund the R&D and cause them to exist to begin with.
> There is no real market to enable price discovery
Note also that this is a feature, not a bug. You don’t want drug companies figuring out what price makes them the most money, because the market for patented drugs is not a competitive market (or a transparent one for the consumer). The price that makes the company the most money is not the same as the one that maximizes welfare.
Romania has state mandated public health insurance (if you're employed or if you make over minimum wage from non employement sources, you have to pay for public health insurance), but the private health insurance market is also thriving.
But, in Romania, Ozempic was negotiated/price controlled by the government to be for around ~100$/month. First year or two supply was enough, so we got it, this year demand in places with more cash is high, so Romanians don't get any more Ozempic (but we still have Rybelsus)
Why is it worth noting in this context? It seems like an unrelated observation. The original commenter is clearly in the U.S., so you're telling them something that doesn't help them at all.
The research peptide sites are about the only reasonable places to buy this stuff
Nonsetrile compounding, like you'd do from the peptide sites is only safe for immediate use, and semaglutide is not that way. You mix up a vial and use it for a month or so.
Can you do it? Sure. Are you going to get an infection from it? Probably not. Is it riskier than having a compounding pharmacy doing it the right way? Absolutely, and in a meaningful amount of risk. The type of infections you get from contaminated injections are not something you want to deal with
It comes as lyophilized powder. You reconstitute the drug yourself and follow WHO sterility guidelines (reconstitute with bacteriostatic water, alcohol wipe ampoule top before accessing, keep it in the fridge, and throw it out if you havent finished it within 30 days). I know a dozen people doing this for the last year and none of them have had any sign of even superficial infection.
Those are wise safety procedures, not that's not sterile compounding. EVERYTHING needs to be sterile. The needles used for mixing, the air in the room, the hood you're mixing it in, everything. The room or hood has to be in positive pressure, and the ampule needs to be at a partial vacuum.
What you're describing is a adequate for immediate use. Not use and storage.
Wiping the bottle before use is just standard practice to prevent contamination after compounding.
I think the way it works when you get bacteria into your blood is either you have no noticeable symptoms, or you get a high fever and almost die from sepsis.
Haven't done it myself but there is a robust DIY community for GLP-1 drugs. No idea if anyone's gotten hurt yet or if it's been pretty okay so far.
I found a pack of 10 5mg bottles in a Discord group for $90 For me that would be a year's worth. Comes with 3rd party testing. Haven't pulled the trigger on that deal yet but I do have some I got for $50 for a 5mg bottle and that's still a hell of a deal. So far so good.
Except you have to figure out who is actually selling legit stuff at the real dosage.
From a quick look earlier this week that's not easy, and I've dealt with research peptide sites before. I was hoping to try one of the ones that's newer than Semaglutide for my IBS - that worked really well the later half of the week but not the first few days where it made things worse. I don't need to lose weight but I'd love to get that under control better.
Check out local weight-loss and hormone clinics, which often have connections to reliable compounding pharmacies.
I’ve seen these comparisons a lot, but how is it determined that the actual quality of a name brand medicine is the same in the two different markets…?
i.e. The price difference could be reflecting a real qualitative difference such as being produced in different facilities, slightly less pure ingredients, less stringent QC, etc…
Drugs cost what they cost because of R&D, not manufacturing.
Look at how cheap generics are, that's what it costs to actually make and distribute a drug.
The pharma business model is that you spend incredible amounts of money on doing research, identifying promising drugs, doing trials, and overcoming all the regulatory hurdles you need to overcome to get the drugs to market. You then get a 20-year[1] exclusivity deal on your newly-introduced drug through patents, which you use to recoup your costs.
You don't just recoup the costs of inventing this particular drug, but also all the other drugs that seemed promising, had all that money spend on trials, but ended up just a bit too ineffective to ever be sold.
We could abolish the patent system and genericize everything, and that would instantly bring drug prices down massively, but then we wouldn't ever see any new drugs being researched.
It feels very conspiratorial to suggest multinational pharmaceutical companies are creating low quality versions of their own branded drugs in Europe.
We know that these drugs cost roughly $10/dose to produce, and most of that is the auto-injector pens. Hardly seems worth ruining their reputation and getting punished be regulators to save a few dollars on something with a 600-6000% markup.
> We know that these drugs cost roughly $10/dose to produce…
Can you link the source?
If it really is a 600% to 6000% markup then it does seem unlikely they would try to save a few dollars.
yes, most of the costs are A) development and B) relatively fixed costs of maintaining the manufacturing staff and infrastructure.
The marginal cost of an additional batch is relatively small in comparison.
Wait until I tell you about the bootleg version I get get from China for $9 for 5mg bottle of Semaglutide. It lasts a month for me and works great. You have to mix it with Bac water yourself so there's a little prep and there isn't a plastic infector. Have to inject yourself with a syringe. These are 3rd party tested so there is some level of safety involved.
I think it is critical to differentiate price controls and purchasing controls.
Most other markets with state insurance have purchasing controls. That is to say, if the price is too high, the government doesn't buy it.
Very few places have price controls e.g. "products cant be sold for more than X".
The US government is the outlier in that it situationally states it will pay the price no matter the cost.
Reasonable government policy needs to start with putting a price on human life (QALY), and purchasing goods and services that come in under that price. This is how it works in other state insurance systems.