$12,544,000.00 per pound. ........

[Manifestor_of_Light]

Spiriva is an inhalant prescription drug for asthma, and other respiratory problems.

It is manufactured by Pfizer and Boehringer Ingelheim.

I was prescribed this medication. Each capsule (to be used in an inhaler) has 18 mcg (that is micrograms, NOT milligrams) of active ingredient, tiotropium bromide powder.

There are 30 capsules in a month's supply, which is 540 micrograms of active ingredient. This cost me $153.00 at the pharmacy without insurance.


540 mcg at $153.00 comes out to:


$28,000.00 per gram.


$784,000.00 per ounce (28 grams to the English ounce)


$12,544,000.00 per pound (454 grams to the pound)


and $28,000,000.00 per kilo. A kilogram is 2.2 pounds.



Is this not completely insane?????????

:wtf:

[Hydra]

1. Welcome to Wonderland

I see more insane things every day. Thanks for showing me this one.

[Hissyspit]

2. I went to drugstore.com last week

and was checking out some prices. Prices changed depending on what amount you bought and how many miligrams were in the pill, but the price changes were erratic and seemed to follow no logic at all.

[sammythecat]

24. I've noticed that too.

You really have to pay attention.

[Turbineguy]

3. And people take the risks

associated with selling crack!

[Manifestor_of_Light]

4. I find this mind-boggling, personally.

I got the resident math genius to figure this stuff out, since I have trouble with micrograms (millionths of a gram). That's ten to the minus 6th.

[alcibiades_mystery]

5. As I heard once: The first pill costs $50,000,000...each additional, 15 cents

That's the reasoning, anyway. It doesn't cost $12,000,000 a pound. It costs $140,000,000 for the FIRST capsule.

[lumberjack_jeff]

6. What happens to prices when patents expire.

In about 1990, I began taking a prescription antihistamine called Zyrtec.

At that time, the price was about $100 for a 30-day supply. About $3.25 a pill. My copay was $15. Over time, the price increased and so did my copay. By 2003 the price was about $150 for a 30 day supply ($5 per pill) and my copay was $25.

About this time, I changed insurance so I looked around for a cheaper substitute. It turns out that in Canada, patents are limited to seven years, so there was a generic available. This generic Zyrtec was $70 for 100 tablets (or $1.42 ea). How can they sell the stuff so cheap? Such a bargain!

By early this year the price for the generic stuff had risen to about $90 for 100 pills. Still much cheaper than the real deal. Last I checked, the US price was $200 for 30. ($6.66 ea)

Last month, I got a Costco circular. Apparently Zyrtec was going over the counter. Great! Their coupon price for real Zyrtec was only $35 for 75 tablets ($0.46 ea). So I went to Costco, coupon in hand. What I found when I got there was that apparently Zyrtec had become OTC because the US patent had expired. Costco offers a bottle of 300 generic zyrtec for $18. That's $0.16 ea.

Last year, McNeil made $1.3billion selling this drug.
http://www.drugpatentwatch.com/premium/p...chstring=Zyrtec

It is obvious that this drug had been approved for OTC some time previously.

So, in summary: McNiel sold for $6.66 that which can be profitably marketed at 17¢

This is a primary reason that healthcare is expensive.

It's also funny how a drug becomes OTC on the same day that the patent expires.

[hunter]

11. Generic OTC "Equate" Zyrtec at Walmart is even less.

I think we used to pay $90 for Zyrtec before it was OTC.

[TheFriendlyAnarchist]

14. Yea, it's pretty messed up.

I took Zyrtec for a while when I was younger, but the last time I took it, it seemed to exacerbate some anxiety issues I had, so I switched to Allegra/Claritin.

[ChairmanAgnostic]

19. I'm in a high stress field, and self employed.

I self-prescribe and self-dose with scotch.

[Horse with no Name]

15. Oh but look now

Since the patent expired and they put it OTC...they have tinkered with the formula a little bit and made a BETTER pill (probably the same one...but what the hell! Gotta fleece those consumers somewhere)...:eyes: www.xyzal.com
I quit taking Zyrtec mid-nineties when my insurance wouldn't cover it. I was going to one of the BEST allergists in the country (Dr. Gary Gross in Dallas, he was NOT the one who had prescribed it for me)and he told me that the ACTIVE ingredient in Zyrtec (vistaril or Atarax or Hydroxizine--all the same drug) would be just as effective and a heck of a lot cheaper. The only thing I MIGHT notice was a little more drowsiness at first and he suggested I take it at night. Now, the insurance company WOULD have paid for it if he had written a letter, but he said there was really no need.
Sometimes it's these little conversations that give you pause about the newer and more improved "purple pills" on the market. Many times there is a forgotten older one that is cheaper and comparable...however, drug companies don't make money on THOSE.

[lumberjack_jeff]

21. Amazing.

There's no money to be made by curing things, the only money to be made is by selling maintenance meds.

I'm sure that this new and improved cetirizine will cost $7/pill too.

[Horse with no Name]

22. I just called CVS. $90 for a 30 day supply. $3 a pill.

I found this on a pharmacy message board...not hard to figure out their strategy.
http://www.cafepharma.com/boards/showthread.php?p=1971157
>>>>SNIP
Xyzal is going to have a hard time getting all of the Zyrtec business. It would seem like a no-brainer to ask docs to just switch all of their Zyrtec right over to Xyzal at the end of the year, but there's probably going to be a lag time.

The first mistake was launching Xyzal when Zyrtec was still in its last quarter. Sure, you wanted to get the word out, but you may have lost a good punch with Zyrtec still lingering around. Wouldn't it have been nice to be able to see an empty bin or shelf where Zyrtec used to be and fill it up with Xyzal. If you do that now, then you're into the sample room shenanigans again.

Second, with no good access message and coming in at or above the Zyrtec price, Xyzal is going to have a slow take-off. Why would you sell a drug with an apology about price that goes along with it?

You'd better hope that generic Zyrtec takes a total dump in its effectiveness like generic Claritin did, and then, you'll definitely have the docs calling you for more starters. It's not going to be in this quarter, though.

Good luck!

[dixiegrrrrl]

39. Visteril is something like 90.00 for a 30 day supply at the vet.

Visteril/hydroxine has been around for years and years.
The vet prescribed for it my dog. Thunderstorms drive him crazy.
I bought direct from the vet. It was hugely expensive at a regular drug store.
first few months last year it was 23.00 for a 30 day supply.
Then it went up to 40.00.
Then it went to 90.00 and I did not buy it.
We switched to Valium, very cheap. 10.00 for 30 day supply, and of course the dog does not use it every day.
( Interestingly, 20 mgs. does not hit him as hard as it would if I took it.}

what happens is patents become "extinct", so drug companies have to keep inventing expensive "new" shit to keep their profit up.
And I have found most docs don't keep up with the details, but the pharmacists are usually very reliable for information.
I always ask for a generic, every time, from the doc/vet, whatever.

The truth is most otc stuff works just fine, sometimes you have to take 1/3 more and a lot of vet meds work just fine for people.
My son is an aquarium expert, fisheries degree and all that, he buys antibiotics for himself thru pet stores, 1/3 the price, same strength, works fine.

[knitter4democracy]

58. That happens all the time.

Hubby gets so upset about this. He always starts his patients on the generic or the older, cheaper drug first. If they have problems with side effects or whatever, then he'll start trying different ones to see which one fits that patient best. He always starts with the older ones, though, unless he has a patient like me who gets every side effect under the sun.

The only reason I take Prevacid is because we tried all the other ones first, and nothing has worked like the Prevacid. Same with the kids' and my asthma inhalers, too. I was allergic to the cheaper one, so we had to switch to a more expensive one. I'm not the norm, though, so Hubby and my doctor both usually start with older, cheaper drugs.

[Ghost in the Machine]

25. Ummm...

About this time, I changed insurance so I looked around for a cheaper substitute. It turns out that in Canada, patents are limited to seven years, so there was a generic available. This generic Zyrtec was $70 for 100 tablets (or $1.42 ea). How can they sell the stuff so cheap? Such a bargain!

Actually, it would have been .70 cents per tablet. .70 x 10= $7.00
.70 x 100 = $70.00 ...

Just nitpicking, don't mind me ....

:hi:

[lumberjack_jeff]

28. Sheesh! What's up with that?

Calculator fart, I guess.

PEBCAK, probably.

[Ghost in the Machine]

29. reversed equations...

you did 100 divided by 70 instead of 70 divided by 100...

No biggie... no one died or anything, right?

[panAmerican]

7. How utterly disheartening.

[tabasco]

8. God Bless The Rich People!

They are so damn good to us!

[Manifestor_of_Light]

9. And they try to stop people from importing their medications!

Nutty as hell.

[cloudbase]

10. It costs so much more these days

to buy a senator or congressman, and they don't stay bought, either.

[Deja Q]

12. Marijuana is cheaper.

:silly:

[Manifestor_of_Light]

13. One more rec, please!

Can't do it myself. I've never before had a thread make the Greatest Page.

Thanx!

[bobbolink]

17. I gave it #7, cuz this is something we need to be talking about.

Mine is related, so maybe you can give it a rec, too:

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=3232671&mesg_id=3232671

Put some brakes on this runaway train!!

:thumbsup:

[gateley]

16. Buy stock in Pfizer and Boehringer Ingelheim.

None of the candidates' heal care plans will go far in reducing costs of prescriptions. Might as well try to make a little money off of YOUR money.

[indepat]

18. How else can big pharma pay for their constant barrage of TV commercial for ED et al?

A national disgrace which disgraces the Congress even more than big pharma. :mad:

[slutticus]

20. Drugs are priced per dose, not per weight.

$28,000,000 per Kilo sounds like a lot, but one kilo is enough for 55 million doses (if i did my math correctly).

This pricing disparity (between weight and dose) is even more pronounced in the bio-therapeutic industry.

[leftofthedial]

23. are you implying that the american medical industry is a fraud?

[Dukkha]

26. what's the street price of China White these days

who's the real drug lords now? Pfizer and Boehringer Ingelheim probably have huge manors in the hills of Cambodia guarded by pit bulls, cameras, and Uzis

[Jed Dilligan]

27. The Rich, God Bless Them, Should Have ALL The Opportunities. nt

[crimsonblue]

30. I'm sure you all expect drugs to appear out of nowhere...

but that is utterly unrealistic. Millions, even billions, goes into the research, development, and testing of new drugs. Not to mention salaries and benefits to the researchers, CEOS, and dividends to the stock holders. I'm not defending their pricing, which many times is absurdedly gouging, but you have to keep in mind that these companies are for-profit, and expect returns on the huge financial risks they take. Developing a drug for the wrong metabolic pathway, for instance, can doom a drug and cost the company billions in assumed risk. One shadier side of big Pharm are the freebies and other goodies given to doctors by drug reps and the like. When I was a kid, my dad and I had to have attended atleast 4 or 5 Chiefs games and about 5 KU basketball games thanks to the drug companies. The drug rep (many times it was big busload of people) would give their talk about the drug and its uses for about 30 minutes or so, and then we would get our free tickets. That sort of thing is illegal now, but they don't need to do it anymore-- not with the FCC allowing pharm ads (bc the patient should know about flomax and all that... sigh) and with the ubiquitousness of online web "doctors" (think WebMd) that diagnose people. Big pharm is just like any other industry-- trying to maximize profits.

[HummanaHummana]

31. How much does it cost to develop a new prescription medicine?

It costs about $800 million to research and develop a single new medicine. But did you know that only one out of a million potential new medicines screened by scientists at such high cost will ever make it to the pharmacist's shelf? Along the way, many questions must be answered, such as:

Is the potential medicine safe for patients?
Can it be created in a form patients can use—such as a pill, inhaler, or injection?
What is the proper dosage for different patients?
Is it effective for patients with the condition it would treat?
Even after FDA approval for your doctor to prescribe, not all new medicines are profitable. In fact, only three out of ten medicines that reach the marketplace ever make enough profit to cover average research and development costs.

These companies are not in business to lose money. When something is finally approved, they have to recoup their investment, pay their employees, and also pay the shareholders.

[Horse with no Name]

33. How much does it take to tweak an existing formula

yet not change the main compound...slap a new name on it and market it?

[Juche]

37. How about the fact that 80% of medicines are knockoffs of old medicines?

http://www.motherjones.com/news/qa/2004/09/09_401.html


"MA: The industry arrives at that $802 million figure by looking at a tiny handful of the most costly drugs. Those are drugs that were developed entirely in-house, and that are new molecular entities. That’s a very tiny handful of the drugs that come to market each year. They’re the most expensive drugs. Second, even for those drugs, they come up with a figure of $403 million per highly selected drug. They then double that to $802 million simply by adding in what they call the “opportunity costs” — what they could have made if they’d spent the same money on investments. Third, the figure is inflated by not including the tax deductions and tax credits. They get very large tax deductions and credits. So the figure is highly inflated. That gets buried in the reporting of it. When you hear the figure, you hear it given with the implication that for any random new drug, that’s what it costs to develop it. And that’s just simply not so"

"In 2002, the top 10 American companies in the Fortune 500 made 17 percent of their sales in profits, whereas they spent only 14 percent on R&D."


80-90% of medicines that come out are knockoffs of old medicines or work no better than old medicines.

40-50% of medical research is done with public funds, not private funds. So expecting the public to pay for the science to create a drug, then expecting them to pay $150/month for it is stupid.

The real figure for a new drug is closer to $200 million.

[caraher]

38. Yes, R&D is expensive...

but apparently marketing is a bigger priority according to NYU researchers:

"The researchers’ estimate is based on the systematic collection of data directly from the industry and doctors during 2004, which shows the U.S. pharmaceutical industry spent 24.4% of the sales dollar on promotion, versus 13.4% for research and development, as a percentage of US domestic sales of US$235.4 billion."

[slutticus]

67. Not all companies do this...

...but the ones that do are suffering from shitty pipelines and too many "me-too" competition from competitors as a result of trying to desperately hold on to old blockbusters instead of re-investing into R&D.

Unfortunatly, most (if not all) big Pharma companies do this and are now paying the price.

[Hannah Bell]

54. Gov't funds plenty of research. Pharmas spend as much on ads &

marketing as they do on research.

They're vampires, & half of what they produce is useless or worse.

[slutticus]

66. Yip.

It's usually about 10 years from discovery to BLA licensure for a drug. If you consider that only 20% of drugs make it past Phase I, 30% make it past Phase II and 60% make it past Phase III....that's a lot of investment to recoup.

Besides the R&D costs...you have to also consider the costs of GMP manufacturing regulations (process validation, facilities validation, raw materials validation...etc). The costs can add up fast.

The costs associated with proving to the FDA that you can safely (and consistently) manufacture a safe product is astounding compared to any other manufacturing industry requiring strict QA and QC.

[Juche]

32. You can get it for half that in Canada

http://www.pharmacychecker.com/Pricing.asp?DrugName=Tiotropium&DrugId=65031&DrugStrengthId=122583

[HummanaHummana]

34. Than move.

[Juche]

36. You first

[Beetwasher]

63. "Than move." LOL! Hey Jeenyus, You Live In This Country

Learn how to speak the language you fucking idiot.

[Manifestor_of_Light]

42. That's $250 for 3 months, according to that.

$83.33 a month is cheaper, true.

The most expensive medications I take are the asthma inhaler drugs. I am convinced this is Social Darwinism to kill off the old and sick, not to mention the young and sick. Asthma death rates for children have skyrocketed due to poverty.

[Juche]

52. You can supposedly buy it generic from Canada too

http://www.canadageneric.com/index.cfm/fuseaction//product.display/pn/NULL/product_id/2287.htm

$40 for 90 pills in generic form.

It says it is CIPA certified (the cert agency that ensures Canadian pharmacies don't just take your money and run and sell you sugar pills). I went to the CIPA site and the pharmacy checks out as a legit CIPA certified pharmacy. So it is something to look into.

http://www.ciparx.ca/pages/index.html

[Manifestor_of_Light]

53. Wow, that is far cheaper than the other Canadian pharms.

The others were about $75.00 a month.

[superkia]

35. In the movie "Sicko" one of the people Moore took to cuba...

purchased a refill for an inhaler he uses and it cost $.05 in Cuba and $50.00 here at home for the same thing. We just have no representation here anymore, I don't even know why people use the word government, it should be mob or gang? We have a bunch of powerful wealthy people that are selling our lives to the highest bidder so they can all enjoy life as we physically run the country for them...it must be great to be born into one of those families.

I don't know if it will be in my lifetime but eventually things will be forced to a head and it will most likely not be a pretty site.

[Manifestor_of_Light]

41. People are going to cheaper countries for medical treatment.

It's called medical tourism. Now the insurance companies are sending Americans to other countries, such as Mexico and India and Thailand, to get expensive surgery such as heart bypasses, for peanuts.

We have medical outsourcing now.

[truedelphi]

40. Cocaine would clear up your asthma

And it is a whole lot cheaper - even pure pharmaceutical cocaine.

It's side effects are euphoria and a sense of happiness that is hard to come by without it. (Unfortunately it can also be addictive.)

I'm jes' sayin' - it seems totally ridiculous that they can get away with this type of outrageous pricing.

I was reading in the American Chemical Society magazine that we here in the USA pay more than anyone else because we have to pay for the cost of the drugs being researched and produced, but that is wrong for two reasons
one) our government quite often contributes research funding (ie tax payer money) to Big Pharma to help them develop drugs
two) we are not the only country in the world that researches drugs - it might be true that some third world countries don't - but many if not most countries do.

[Manifestor_of_Light]

43. no thanks.

Don't need a pounding heart. Already have high blood pressure.

Yes it is ridiculous that we pay those prices, but it's real.

[knitter4democracy]

59. And mess up my heart, no thanks.

Hubby saw many cocaine-related heart attacks and other heart problems in med school and residency, and he keeps a close track of his patients whom he suspects use it, worried about their hearts.

[truedelphi]

68. Hey I am sorry if I was being overly flippant

I was trying to show the absurdity of the current system of tremendously huge costs to people who are trying to pay overpriced amounts for legal drugs.

Cocaine is a drug that all the "experts" point to as being expensive. But it appears to be cheaper than a lot of the illegal drugs.

I didn't think anyone would get their panties in a knot.

[knitter4democracy]

69. I didn't.

I'll let you know when my panties get in a knot, okay? ;) I was just pointing out the problems it causes with heart trouble.

You're right--it's a bad day when street drugs are cheaper than prescription drugs.

[truedelphi]

70. To help with the process, I offer the following number??

1 800 999 4545 Panties in A knot dot com?? (SHould you ever need it!)

In any case, I apologize if I was too flippant.

Cocaine has been a joking matter in this household ever since the long ago days when my teenaged son Endlessly said "Mom are you still smokin' crack?" He'd ask this at any point in the time space equilibrium that my decrees did not match his take on reality.

I tend to forget that coke has had its victims.

[knitter4democracy]

71. I totally need that!

:rofl:

Yeah, Hubby's ruined me on several things (drug use as a joke, trampolines, CT scans). Darn doctors!

[hokies4ever]

44. Price is misleading

Because companies work on creating drugs that are potent. That way you have to take less of it and there will be fewer side effects because it more specifically binds to the target receptors. Also, some of these drugs are created in more complicated ways than you can imagine. For example, Merck has an AIDS drug which has multiple steps and takes many months to create.

I'm not saying that drug prices are completely fair, but looking at the price per pound is VERY misleading. Most of the time the overall yield that you get from the raw materials is VERY low. You might start off with 10,000 pounds of materials and end up with 1 pound of drug. Then you will lose a lot of that drug when you purify it, because it has other nasty chemicals mixed in with it.

[Manifestor_of_Light]

46. I have absolutely no idea how they make this particular drug.

Or what the raw materials are. I never took organic chem or biochem.

[hokies4ever]

47. Got A's in my undergrad O-Chem classes

and some industrial experience as well. Drugs are much more difficult to make than most people think. Often you'll start off with about 10,000 lbs. of raw materials and end up with 1 lb. of drug that is mixed with other dangerous chemicals. That's why the price per pound always makes it sound like oil companies are making chump change in comparison to drug companies.

I do think that drug prices are too high, though it's not as urgent of an issue as oil companies. Oil company profits go straight to their coffers. Drug company profits go disproportionately higher into their R&D, helping to develop new drugs. I wouldn't have as much of a problem with oil companies if most of their profits were going into R&D to find new ways to make oil and gas cheaper, but they aren't doing that.

[Hannah Bell]

56. The profit margins & ad budgets tell me they ain't as expensive

as all that. Plus some of the (cough) "expenses".

[proud patriot]

45. We absolutely must keep the pressure on policymakers

This issue is so important to me .

[GOPBasher]

48. That sounds pretty fair.

:sarcasm:

[femrap]

49. I want Big Pharma to

meet Karma....SOON!

[Posteritatis]

50. To be (moderately) fair

You're not just paying for the active ingredient there. Even without taking into account R&D/marketing/etc - other people have handled thos in this thread - you've got the mechanism of getting the stuff into your lungs to worry about. You've got to make sure the dose in each capsule is exact (if it's only 18mcg/dose, I'm going to assume it's powerful enough stuff that the difference between 18 and 20 - or 18 and 50 - is significant), you've got to make sure the capsules can deliver it reliably, you've got to make sure they're durable enough to survive at least some day-to-day storage in different conditions without being broken or degrading, etc.

Inhalers are fascinating things, especially if it's a multi-dose capsule you're using (like the ones I had to be on this winter for awhile); inhalants are at least a little different from pills, which you can just glomp into a pill/capsule/etc and swallow. Inhalant delivery is way more complex, and probably at least somewhat pricy to get working if you have to be really really precise with it. I needed two inhalers, one with a 100mcg dose and another with a 250mcg dose. Those are gigantic compared to 18, and I'm assuming there's a substantial margin of error, or at least a substantial one by the standards of anything measured in millionths of a gram.

You're paying $28,000,000 for a kilo of the drug and the fairly precise equipment built around delivering it, on top of the other stuff.

It's still insane, but it's a couple of baby steps down from completely insane. I'm glad I'm not on that stuff anyway. Salbutamol goes at a fairly civilized $25/200 doses in my neck of the woods, which isn't terribly painful to pay for. $153/30 is absurd, especially if it's something you have to take long term. ;P

[knitter4democracy]

60. That's true, but . . .

They used to have cheap inhalers. All the ones with CFCs as propellants went generic long ago. Then, the FDA decided to ban CFCs in inhalers, so they had to come up with new ways to get the drug into the lungs safely. The companies knew it was coming and had done the research and prepwork to be all ready, and they managed to convince the FDA to give them new patents on the same old drugs because of the new delivery system. Ta-da! No more generics, no more cheap inhalers. That's disgusting.

[Fly by night]

51. I thought you were posting about some REALLY GOOD pot.

[Hannah Bell]

55. Pharmas are among the most profitable of all corporate

categories. I read the figures at one time, I believe the margins were about 20%, but on't quote me.

[ruby slippers]

57. It is from Pfizer...that is the problem. Remember, Dubya's granddaddy, Prescott,

was involved with Pfizer (he funded part of the Holocaust through them) so it is no different that the billions wasted on the war in Iraq. It is PFIZER that is making the profit for the Bush family!!!!!!

[MilesColtrane]

61. Must be made of unicorns and sea serpents.

Why don't they just hold a gun to our heads?

[highground]

62. $12,544,000.00 per pound. ........

Ever think about getting insurance!

[Manifestor_of_Light]

65. Let us not go round and round on this issue again, please.

I, and several other people, hassled with Rosemary, who started a thread stating that she could not understand why people with good educations cannot get jobs. She herself is disabled, however. Her premise was that adults are worthless unless they have a paying job, apparently. I beg to differ. I do not get my self-worth from some humorless asshole boss who is incompetent, and threatened by my competence.

No job, no earned income. Stopped looking for a job because insanity is doing the same thing over and over again and expecting different results. Looking for a job was like beating my head against the wall.

Apparently Rosemary can't understand how bad the economy is and how nobody will hire people who are over 40 and well educated, because we might cost them money for health care costs.

I'm not getting insurance, because, as Michael Moore demonstrated in "Sicko", millions of Americans think they are insured but the insurance company turns down their claim, because they make money by denying claims, not honoring their contracts and paying medical bills.

[electropop]

64. That's the same as the cost for launching a pound into orbit.

In other words, the cost of your medication is astronautical.