back to article Who's to blame for the NHS drug prices ripoff?

The NHS has been hit by a new scandal – overpaying for generic drugs. It’s a cracking story, and all credit to The Times for breaking it. The Thunderer reports how the NHS buyers continued to acquire drugs at eye-gouging prices, using prices set by the marketing middleman, when much cheaper alternatives could have been …

  1. Bronek Kozicki Silver badge
    Megaphone

    I've read the original article

    ... and my impression was that there was no choice in suppliers of these generic drugs, because they are just not popular enough. The drugs even though generic, are apparently exclusive to the suppliers. So it is more failure of the competition (or, perhaps, failure of regulation) rather than the buyer. At least that was my impression from reading of the article.

    But perhaps I've read a different article today morning in The Times, or missed some important point.

    1. teebie

      Re: I've read the original article

      If that's the case then apparently a few companies have seen the coverage of Martin Shkreli on the news and thought "what an excellent idea".

      1. Yet Another Anonymous coward Silver badge

        Re: I've read the original article

        There have also been a few cases over this side of the pond where the drug makers have agreed among themselves who will be the sole maker of which generic.

        1. Alan Brown Silver badge

          Re: I've read the original article

          "the drug makers have agreed among themselves who will be the sole maker"

          The very essence of cartel behaviour....

      2. MonkeyCee Silver badge

        Re: I've read the original article

        It's the other way around, companies have been doing that, then people like Shkreli start buying companies on the basis that they can do that, perhaps at a higher level than others are.

    2. chrspy

      Re: I've read the original article

      Mr Orlowski is following his usual (rampant) capitalism/greed is Ok agenda, as usual ....... (why does this article merit a place on an IT website if it is not for that purpose??)

      1. John Tserkezis

        Re: I've read the original article

        "(why does this article merit a place on an IT website if it is not for that purpose??)"

        Because for me, buying Polo Mints at the cheapest price is of upmost importance.

        1. Anonymous Coward
          Anonymous Coward

          Re: I've read the original article

          Hmm, interesting that patent length for drugs is generally 20 years but for music copyright it's much, much longer.

          Personally, I think 10 years would be better for drugs and five should be enough for music.

          1. Robert Carnegie Silver badge

            Drugs patent length

            The argument that I referred to is the claim that too much of the term of a patent for medicine has to be spent expensively testing it for safety and for how good it actually is, before they can sell it and make their money back.

            I think the system isn't failing yet (although medical science ought to be led by government and above commercial limitations), but cutting from 20 years to 10 probably would cripple drug research as private business.

            As for music and words... they are protected for a very long time, but mostly that doesn't matter, you can write your own. Whereas the patent law is designed to give the man who invents the square paperclip his just reward, and then share his invention with the world.

    3. tony72

      Re: I've read the original article

      Nope, I think you have it exactly right. I don't read The Times, but the non-paywalled article in The Independent gives the same impression, that the NHS buyers have no other options with these drugs, and the companies selling them are exploiting that fact.

    4. jonathanb Silver badge

      Re: I've read the original article

      If you want to make a generic copy of a drug, you need to get approval for it which means demonstrating to can make it correctly, and part of that process means holding a batch of them until the expiry date so you can show that they are still effective and safe at that time.

    5. This post has been deleted by its author

      1. Robert Carnegie Silver badge

        Re: I've read the original article

        As far as I can tell, this isn't "cheap medicine for the Third World" generics of patented drugs as you are apparently reading it, it is drugs whose patent term has ended and anyone can legally make them, for a rather restricted set of "anyone".

        There is a claim that patents should be longer, but they are not.

  2. graeme leggett

    Pricing

    Having access to an old copy of the BNF or two. I find that in 2015 the 'NHS price' was listed as £12.10 for 30 tabs, the same as in 2009.

    1. graeme leggett

      Re: Pricing

      And that in Feb this year, there were about 750 packs prescribed at GP level in England.

      Average number of packs per prescription - about 3, and at about £130 per pack actual cost to NHS.

      Data from Health and Social Care Information Centre after a bit of wrangling in Excel and <cough>Access</cough>.

      1. Scott 53

        Re: Pricing

        " a bit of wrangling in Excel and <cough>Access</cough>"

        Do you feel dirty?

        1. graeme leggett

          Re: Pricing

          I'm just aware that anyone admitting to using Access to manage a dataset can pick up some disparaging comments in The Register comment section.

          Though the HSCIC assumes you are going to load a 4-million row CSV file into Wordpad or use Excel pivot table "Once PowerPivot has been installed, to load the large files, please follow the instructions below. Note that it may take at least 20 to 30 minutes to load one monthly file" .

          1. Vic

            Re: Pricing

            Though the HSCIC assumes you are going to load a 4-million row CSV file into Wordpad or use Excel pivot table

            Who needs Excel when you've got Perl-DBI?

            :-)

            Vic.

      2. Adrian Midgley 1

        Packs of?

        Prices of?

  3. Andy 97

    We could just do it ourselves...

    No, wait, that would be too simple...

    1. James 51

      Re: We could just do it ourselves...

      Yes it would be. Imagine trying to design your own chemo regime, buy the drugs and get them safely to the ward you were being treated on. Or buying antibiotics when you have a fever. Having a direct to patient marketing effort like there is in the states would turn it into a major nightmare.

  4. James 51

    There has to be something more to than than just the NHS is a public sector body that's wasting money. If each trust is buying it's own supply of medicines then their bargaining power is a lot less that the article implies.

  5. Anonymous Coward
    Anonymous Coward

    Generic AIDS drugs

    If Western drug companies were willing to sentence 10s of million to death in African in the late 90s then this is almost a non-story in comparison.

    http://fireintheblood.com/

  6. jason 7 Silver badge

    The problem often is...

    ...that Public Sector workers just don't give a shit about costs. As long as the work gets done, orders filled and the boss isn't having a go at them, who cares? Cutting costs and negotiating decent contracts takes time and effort.

    After all...it's only tax payers money!*

    *A phrase that my other half heard many many times in her 6 weeks working in the Public Sector as a Projects co-ordinator. She quit as she couldn't live with the wasteful and lazy mentality.

    1. Triggerfish

      Re: The problem often is...

      Seen that through a lot of council expenditure, used to watch people go out and repair boilers two three times a night through a week, never a thought maybe just replace the boiler, keep doing it. (I estimated you could buy a new boiler from the savings of a night or two of no callouts on it). The guys fixing the boiler don't care they are on a callout, in fact I suspect some of those fixes were very temporary. Never saw one person think maybe lets buy a boiler.

      1. Loud Speaker

        Re: The problem often is...

        As a victim of this, I can explain: the council will not approve replacement of life expired boilers with newer models, because it could lead to the engineers being corruptly induced to replace boilers unnecessarily.

        In other words, the public sector is totally committed to the idea that the whole concept of a public sector is unmanageable (except at union meetings).

        You never hear anyone on the streets saying "Save our NHS by stopping the appalling waste and mismanagement".

        And it is not normally the public sector that says "OK, I will buy IF YOU HAVE A SECOND SOURCE" and then buying from multiple sources in inverse proportion to their prices (used to be standard practice in industry for high volume procurement).

        1. Triggerfish

          Re: The problem often is... @Loud speaker

          But if you do not replace the boilers then you get a council gas engineer, who gets paid a call out fee for everycall out he goes to for the boiler, plus his hourly fee, all at night time rates, and it's not much difference in cost from paying for a private plumber yourself. So not replacing the boilers is a false economy, I was not kidding when I said you could probably buy a new one with a couple of nights call outs, and that system gets gamed more than any boiler replecment one.

          1. John Brown (no body) Silver badge

            Re: The problem often is... @Loud speaker

            "I was not kidding when I said you could probably buy a new one with a couple of nights call outs, and that system gets gamed more than any boiler replecment one."

            That's how it works in real life. In the fantasy land of public spending, new kit comes from a different budget to maintenance. Fine, you say, so lets use the other budget. Answer: You can't. It's another department who are fighting to preserve their budget and authority, just as the maintenance department are fighting to preserve their budget and authority.

    2. Anonymous Coward
      Anonymous Coward

      Re: The problem often is......that Public Sector workers just don't give a shit about costs.

      It may be often but a lot of the (older?) public sector workers do care about costs and understand long term planning.

      Their bean counter managers who don't understand the business, however? Perhaps not so much.

      1. Triggerfish

        Re: The problem often is.. @Voyna i Mor

        Yes to be fair there were some that did, unfortunately people like that seemed to rarely play the politics game, and either end up giving up or just leaving.

        Also never ever tell someone high up in a council that after seeing how money is spent there, it makes you resent paying your council tax.... good job it was just a temp job.

    3. Anonymous Coward
      Anonymous Coward

      Re: The problem often is...

      A slight digression...

      @jason 7

      I'm going to leap in here and (possibly controversially) point out that in my long years experience of NHS employment, the NHS is not just "Public Sector".

      @Voyna i Mor has it right. I am a professional scientist in the NHS. We have validated the reagents and diagnostic test kits that we use in our daily work so that we can be confident of purchasing the most fit-for-purpose that we can.

      While we were our own bosses, that was OK. But when the structure changed, and the purse strings were transferred to managers who had never worked in diagnostics, sometimes even never worked in the NHS, things changed. There is an NHS spirit (yes, possibly among older employees) that these new-breed managers have never been a part of.

      We find ourselves having test kits foisted on us because it is conveniently part of a larger contract, and when protests are made we are told that the new kits are "adequate".

      I didn't choose to make the NHS my career to be adequate

      1. jason 7 Silver badge

        Re: The problem often is...

        The NHS...is public sector as much as anyone cares.

        1. Anonymous Coward
          Anonymous Coward

          Re: The problem often is...

          @jason 7

          "The NHS...is public sector as much as anyone cares."

          Well you see, there's your problem. That's how you see it, but that's not how NHS staff see it. Most NHS staff of my acquaintance (and I know many) see themselves as Public Service.

          And they hope that the public see and respect that. They hope it's not just "as anyone cares"

          1. jason 7 Silver badge

            Re: The problem often is...

            At the end of the day chap, whether Public Sector or 'Public Service' some of you (not necessarily you) need to start being a bit more careful with the 'Public Money'.

            It isn't in endless supply.

            1. Anonymous Coward
              Anonymous Coward

              Re: The problem often is...

              Of course the point of the article isn't that we (the NHS) are being careless with money, it's that they (money-grabbing capitalists) are charging exorbitant prices just because they can. Now I know that's supposed to be how economics works, but we're talking public health here FFS. (Hey capitalists, if your market dies you won't have any more market)

              1. jason 7 Silver badge

                Re: The problem often is...

                So you are saying the NHS has limited bargaining power? One of the largest buyers of drugs in the world.

                Yeah...(rubs chin).

      2. ecofeco Silver badge

        Re: The problem often is...

        ...the purse strings were transferred to managers who had never worked in diagnostics, sometimes even never worked in the NHS, things changed

        Why am I not surprised? In this modern time, there is NO excuse for a manager NOT knowing the process and business of what is being managed and no excuse for the the senior managers assigning such a person.

        In medicine, this is absolutely criminal on its own.

        Thanks for your story AC. Keep up the good work as long as you can.

  7. This post has been deleted by its author

    1. Anonymous Coward
      Anonymous Coward

      Re: "Cheap" generics are not always the answer!

      Then again we know people tend to think the more expensive drug is better. Are you sure you haven't fallen in that trap.

      1. James 51

        Re: "Cheap" generics are not always the answer!

        It could be the coating or stabling agents which are responsible for the different reactions.

      2. Anonymous Coward
        Anonymous Coward

        Re: "Cheap" generics are not always the answer!

        Non-active ingrediants often differ and I find it easy to believe a slow release drug doesn't release as it should for the generic version.

        But the effect you describe is real and so begs the question, why aren't generic drugs given packaging that looks more like a brand? It would cost virtually nothing to do but if it contributes to the patient well being, thinking they are getting a better quality product, then why not do it?

        My personal experience is that I prefer the branded product, it's always prescribed as generic for me but some pharamacies dispense a version that has a brand name on it. The ingredients are the same but the branded tablets are smaller and easier to swallow and the blister packs are higher quality. Often the generic blister packs the foil breaks away from more than 2 tables at once, or the tablets break in half (+dust) when trying to push them through. Plus the branded packaging is a lot smaller, the generics come in huge wasteful packs.

        1. Alan Brown Silver badge

          Re: "Cheap" generics are not always the answer!

          "Often the generic blister packs the foil breaks away from more than 2 tables at once, or the tablets break in half (+dust) when trying to push them through"

          FWIW, cracking the foil with a fingernail first before pushing the pill through stops that happening.

          I agree on the variabliity of generics though, Even between them there are major differences between effectiveness or side effects.

          For a drug with only 750 prescriptions/year, paying 130 pounds a shot may be cheaper overall than going through the entire tendering process to get a 12 pound rate, but it does encourage general gouging on low-rate items and there's no reason that sourcing has to be within the UK (single EU market, etc)

      3. This post has been deleted by its author

    2. Anonymous Coward
      Anonymous Coward

      Re: "Cheap" generics are not always the answer!

      generics can differ between manufacturers but all should have the same release characteristics as the thing they are supposed to be generic of.

      should being the operative word.

    3. ecofeco Silver badge

      Re: "Cheap" generics are not always the answer!

      I do not know who downvoted you, but they are arse headed.

      While generics are supposed to follow rigid processes and quality control, it is sometimes not the case and these things DO happen.

      Glad you were not injured or outright killed.

      1. Anonymous Coward
        Anonymous Coward

        Re: "Cheap" generics are not always the answer!

        Does this explain what happened with Voltarol (diclofenac sodium) tablets. I'd occasionally used it as a very effective anti-inflammatory (POM). It was made available OTC (but low dose). The OTC was withdrawn so I asked a pharmacist why. She said they'd found an unwanted side effect: death. As a consequence she said I'd now struggle to get a prescription too. Is it possible that this side effect is related to a different formulation in the generic and the original version was OK?

        1. DocJames
          Coat

          Re: "Cheap" generics are not always the answer!

          Is it possible that this side effect is related to a different formulation in the generic and the original version was OK?

          No.

          It's actually a class effect - initially found in the COX-2 inhibitors (celecoxib, etirocoxib ?sp) which were supposed to replace NSAIDs like diclofenac as they have less GI side effects. Vioxx was the name of the disaster drug that the company hid the info on (can't remember what drug is properly called, can't remember what company, can't be bothered to google as irrelevant). Unfortunately it was then looked into a bit more and found that nonselective NSAIDs have similar problems...

          There are differences between NSAIDs, although not in efficacy: all work. Indomethacin has magical extra properties for some unusual headaches. Other than that I consider them the same. The choice between them therefore depends on side effects: ibuprofen is cheap and therefore my go-to. Diclofenac is also cheap but (probably) worse in terms of GI side effects (gastritis, ulcers) and coronary artery disease (that's heart attacks and deaths, which although rare are generally considered worth avoiding if possible). Longer acting NSAIDs (meloxicam, tenoxicam) are good as they require taking less pills but bad as risk of heart failure (separate risk from CAD) increases with the increasing half life of the drug.

          In summary, drugs are bad, m'kay? Don't take them unless you need to.

          It's the white one with the prescription pad in the pocket.

          Edit: forgot to say naproxen probably has the lowest cardiovascular risk, and therefore if needed long term or in a high risk patient that's the one to choose.

  8. Jason Bloomberg Silver badge

    That £10 pack of polos

    Sounds expensive; but only if you know what price you can get them at. And what if you don't have the time or the money to investigate the cost and alternatives, are too busy to do that before you need to buy polos again?

    Probably the best thing to do would be to get a middleman who can get you the best deal.

    Of course, you might not have the time or money to check the middleman has got you the best deal, are too busy to do that before you need to buy again.

    Regulation which sets the price of polos would mean buyers would instantly know what they should be paying and don't have to waste time and money on ensuring they have got the best deal they could get and sellers not being able to exploit the lack of either.

    1. Shady

      Re: That £10 pack of polos

      If making a few phone calls instead of arseing around on Facebook can save a few million quid, then it is both time and money well spent.

    2. Jon 37

      Re: That £10 pack of polos

      > Regulation which sets the price of polos would mean buyers would instantly know what they should be paying and don't have to waste time and money on ensuring they have got the best deal they could get and sellers not being able to exploit the lack of either.

      But... how does the author of the regulations choose the price?

      If the answer is "they go out and figure out the fair market price", then why don't the NHS purchasing people go out and figure out the fair market price right now and then refuse to pay more than that? And if they *can* do that, then why do we need the regulations?

      Adding another layer of indirection doesn't solve the actual problem!

    3. Triggerfish

      Re: That £10 pack of polos @Jason Bloomberg

      Surely if your job is procurement officer for Polos supply of, then investigating the cost and alternatives are part of the bleeding job.

  9. Anonymous Coward
    Anonymous Coward

    Thank goodness for El Reg

    Without Andrew having apparently free rein to write here about any of his pet hates I might have to read a general (non-paywalled - gasp!) news site to find out about NHS drug procurement practices. This permissive editorial policy will be particularly useful over the next few weeks, since with Euro 2016 imminent I feel certain that some in-depth comment on England's team selection and the wisdom of playing a 4-4-2 formation will be essential, particularly when linked to paywalled and geoblocked Sky Sports coverage.

    1. ecofeco Silver badge

      Re: Thank goodness for El Reg

      So news in the interest of public health and safety is not a noble or worthy public service?

      I see...

      NHS or vendor?

  10. Toltec

    NHS are at it too

    Every eight weeks I pay £8.40 for a prescription containing a couple of quids worth of tablets. I cannot buy them without a prescription, a private one costs £25 and an NHS one cannot be used for a private purchase.

    Given I have a yearly blood test why does the prescription only supply eight weeks?

    1. Anonymous Coward
      Anonymous Coward

      Re: NHS are at it too

      "Given I have a yearly blood test why does the prescription only supply eight weeks?"

      Because you are sick and in need, & they know they can get away with gouging you for the extra cash.

      1. Anonymous Coward
        Anonymous Coward

        Re: NHS are at it too

        "Given I have a yearly blood test why does the prescription only supply eight weeks?

        Because you are sick and in need, & they know they can get away with gouging you for the extra cash."

        Because you are sick and in need, & they know you might need a drug that costs £1000 a dose which you probably cannot afford, so they charge you £8.40 whatever the cost of the drug. It also has the effect that the drugs budget goes further.

    2. Triggerfish

      Re: NHS are at it too

      Can you not apply for a year long prescirption or 3 month?

      http://www.nhs.uk/NHSEngland/Healthcosts/Pages/Prescriptioncosts.aspx

      1. indie

        Re: NHS are at it too

        Hi could, but he'd end up paying more if he used a Prepayment Certificate.

        If he pays the standard charge of £8.40 every 8 weeks then he's paying £50.40 over the year.

        PPCs come in at £29.10 for 3 months (£116.40 for the year) or £104 for 12 months.

        However as soon as he needs more than 1 prescription each month it's cheaper to just get a PPC!

        1. Alan Brown Silver badge

          Re: NHS are at it too

          "However as soon as he needs more than 1 prescription each month it's cheaper to just get a PPC!"

          I have 6 each month, so the PPC is the way to fly - but it's worth noting that the _actual_ NHS price of the items is still substantially lower than the cost of the PPC (it works out about 10p/day)

          1. Triggerfish

            Re: NHS are at it too

            Aah right posters thanks for the explanation. Didn't think of it that way.

    3. tfewster Silver badge
      Facepalm

      Re: NHS are at it too

      You're lucky you don't have the same GP as me. I used to get 28 days worth of tablets in a prescription, to be taken daily for a long term condition (but not one covered by the Exemptions, so I had to get a repeat prescription every 4 weeks - which was especially annoying before EPS came in, as I had to leave work early to collect a prescription from the Surgery).

      Some time ago, (we) agreed to halve the dosage, so my prescription actually lasted for 8 weeks. After a couple of months of that, the Surgery halved the quantity on the prescription so it ran out after 4 weeks again.

      I wrote to the practice manager, complaining that this had been done without consultation and that it was a waste of Surgery and Pharmacy staff time - Which is what the prescription charge is MEANT to cover, not the cost of the medicine. Didn't get a reply of course, and as I have no intention of taking time off work to go in and argue with them, I continue to subsidise wastage in the the NHS.

    4. Anonymous Coward
      Anonymous Coward

      Re: NHS are at it too

      "Given I have a yearly blood test why does the prescription only supply eight weeks?"

      Off the top of my head:

      Because you could have a reaction to the treatment and need to have your prescription changed.

      Because you might develop other symptoms or another illness (short term or long) that would require a change in prescription.

      Because something better might be in testing that your GP wants to try you on when it's available.

      Because there is a drug trial comming up that you would be suitable for.

      There are a lot of reasons why you might be on an eight week prescription rather than a full year. But you'll only find out if you talk to your GP about it.

      ** Please note: The above is a generic reply as I don't know your specific circumstances, but if you do have questions about your prescription, either talk to your GP or your pharmasist. They should be able to advise.

  11. Nixinkome

    Who's to blame for the NHS drug prices ripoff?

    Don't worry; tomorrow's ill people will pay today's ill peoples' charges.

    1. Ken Hagan Gold badge

      Re: Who's to blame for the NHS drug prices ripoff?

      Hmm ... that's an eye-watering amount of cash apparently (*) wasted on just this one issue. Perhaps the EU vote doesn't actually matter, because either way the country will still be administered by the same people. (Sigh!)

      (* On the other hand, there are already plenty of comments to suggest that this waste is more apparent than real. Let's hope so.)

      1. Nixinkome

        Re: Who's to blame for the NHS drug prices ripoff?

        Ken Hagan

        It does matter whether you get an inny or an outy on birth and, barring plastic surgery, you'll have to live with.

  12. Wolfclaw

    the question that also needs aksing, is how many politicians and civil servants who had dealings with NHS procument now work for these a$$holes ripping off the taxpayer !

    1. John 110

      "...how many politicians and civil servants who had dealings with NHS procument now work for these a$$holes ripping off the taxpayer !"

      Lots

  13. Aaiieeee

    Surely this is a good example of giving the drug procurement department a bonus that scales with how much dosh they save? This means they have a financial interest in saving money and the bonus costs will be minor compared to the savings?

    This method should *not* be applied across the board as it does not work in all areas especially where services affecting people are involved. An example would be my friend who is a social worker and deals with children in danger and a lot of the service her department provides are being cut to save costs (no doubt for a bonus to some manager).

  14. sad_loser
    Thumb Up

    This problem has been sorted in the past

    but big pharma killed the process because it was so effective.

    In Australia in the 90s they had the Pharmaceutical Benefits Scheme that priced all drugs of a certain type according to the cheapest price. If people wanted the more expensive branded version they had to pay the difference.

    It worked a treat, to such an extent that big pharma killed it off as part of a big trade agreement.

  15. Anonymous Coward
    Anonymous Coward

    I'm sure that the NHS wastes some money when buying drugs but their buyers face problems that are fairly unique to the medical world. Some of the drugs they are buying may no longer be protected by patents but that doesn't mean there will be a generic version of them. Some of the more complex drugs take a lot of fiddly chemistry to produce which costs significant amounts of money. The generic drug manufacturers may simply not be interested in setting up a facility to produce the drug.

    I'm sure as well that with some of the more exotic generics there's simply not enough money available in the market for more than one producer so they just agree to not compete. It's not great behaviour but the alternative is to have two or more companies slog it out until all but one has gone bust and then you buy from them at a huge price.

    If you want the real scandal then look at what the NHS spends on cancer drugs that have really questionable efficacy or small benefits for huge costs. There are no shortage of cancer drugs now that have treatments costs in the thousands of pounds a week which, at best, give people a few weeks of additional life. I'd rather see that money being pushed into antibiotic research, a problem that will affect us all in the near future.

    1. Richard Cranium

      What I don't understand is why the manufacturer of a patent protected drug would choose to stop making it when patent protection runs out. If no competitor appears, keep selling at the current price. If a competitor does appear then they'll face big tooling up and quality control, testing and approval costs and marketing costs.

      The original manufacturer is in a far stronger market position. While under patent protection you've recovered not only the tooling up and testing costs but also the vast cost of developing a new drug, you can afford to drop the price to wipe out the generic. If I were an investigative journalist I'd "follow the money" to understand why this is the situation. What is the financial link between the beneficial owners of big pharma and the manufacturers of over priced generics?

      1. John Brown (no body) Silver badge

        "If a competitor does appear then they'll face big tooling up and quality control, testing and approval costs and marketing costs."

        If the patent is due to expire in 5 years and it takes 5 years for a competitor to "tool up" then I don't see anything to stop them from being ready to go the day the patent expires. So long as they are not selling the patented item while the patent is valid, then the patent holder can't stop them/

  16. Rol Silver badge

    Free market, my arse!

    If only we had a government that wasn't chin deep in pharmaceutical shares and boardroom retirement plans.

    If my company couldn't buy an elbow for less than an arm and a leg, I'd be building an elbow factory, if for nothing else than to lower my costs.

    Then why, with all the expertise that the NHS has, are we not churning out our own generic drugs?

    They do it in many parts of the world, much to the chagrin of established pharma, but a little bit of chagrin is nothing compared to saving the lives of millions.

  17. pharmacyst

    Whilst we have a positive balance of trade in pharmaceuticals, the government won't do much. Why debilitate one of the few export industries that are left in the UK ?

  18. Anonymous Coward
    Anonymous Coward

    Supermarket rip-off on Aspirin too...

    There is a school of thought that suggests a small daily small dose of Aspirin is an effective preventative against heart disease and some cancers (inevitably there are those that disagree but let's put that debate to one side).

    A "normal" aspirin is 300mg. A low dose aspirin is 75mg. Compare the price of both in your local supermarket. Typically the quarter strength version costs 4 times as much (80p compared with 20p).

    Possible reasons:

    Perhaps the inert carrier ingredients they have to add to make up for the missing 225mg of aspirin cost more than the missing aspirin (!)

    Perhaps they've learned from homeopathy that less is more

    Perhaps they're screwing the customer

    I get normal aspirins and break them into 4 pieces

  19. Anonymous Coward
    Anonymous Coward

    Part of the problem is people look at unit price, not consumption.

    A cheaper 'generic' Paracetamol might look attractive to some, but if it crumbles easily then you'll get more rejects, both in pharmacy and at the bedside. You see, nurses need to know how much of a drug is administered, and a crumbled tablet isn't a known dose any more, hence the tablet has to be returned to pharmasy and a replacement issued. This can result in the 'cheap' generic tablet costing more per dose administered.

    It isn't just the tablet crumbling, either: I had a tablet brought to me pre-operation where the coating had started to melt. The nurse took it away and got a replacement because the tablet would have started to disolve too soon, meaning I would have gotten the wrong dose. As it was part of the anaesthetic...

    But some don't see it like that. They see '100 tablets for x, nearly half what we pay, so it has to be value for money!'.

    As for companies ripping off the NHS... yes... when you get to compare otherwise identical stationary catalogues, one for the NHS and one for private business, then you see how much the NHS is being ripped off. Same for workmen: We've had quotes for work which were suddenly doubled when they realised they were dealing with the NHS... so why wouldn't we see the same with drug companies?

    (Yes, I do get to speak to pharmasists, and one told of how she provided her board of directors the proof that the branded version of paracetamol was actually cheaper than the cheaper generic brand they were using simply because they had too many tablets returned due to crumbling. Fortunately the board paid attention and allowed that pharmacy to swap back to the more expensive, but also more reliable, branded tablet and saved the trust quite a bit of money.)

    1. John Brown (no body) Silver badge

      "As for companies ripping off the NHS... yes... when you get to compare otherwise identical stationary catalogues, one for the NHS and one for private business, then you see how much the NHS is being ripped off."

      Part of that is terms and condtions as well as specific or unique requirements. eg we do work for the MoD. If we go in to fix something, we can't take out the faulty parts. Anything with permanent storage must be retained by the client for disposal/destruction. That affects the cost of repair because we can't take the faulty part away for a replacement by our suppliers. And in the IT world, pretty much every replaceable part has some sort of permanent and editable storage on it somewhere these days, even sticks of RAM.

  20. ZenCoder

    Elasticity of demand matters.

    Drug A is a produced in large volume by multiple suppliers, treats a minor condition and have multiple alternatives that are "good enough" substitutes for most patients. Demand is highly elastic.

    Drug B is produced in low volume by 1-3 suppliers, treats a life threatening conditions and there are no effective alternatives. Demand is high inelastic.

    A company could easily buy every manufacturer of drug B then raise the price by 5000%. That price is paid or people suffer and die. It takes 48 months for a new manufacturer to get a generic to be approved. Human clinical trials are still required.

    Its a generic, so the high prices do not reward, encourage or fund research and development.

    Generic drugs like A don't really require any price regulation at all. Generic drugs that are more like B will cripple any nations health care system if left unregulated.

    That's the point of government, to interfere in useful ways.

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