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All those stories about patients being billed for tens of thousands of dollars for coronavirus-related care elicited promises from the White House that "everything will be covered". Still, as thousands of Americans complain about charges related to COVID-19 testing and care being passed on by their insurance companies, Gilead, the pharmaceutical company that has pushed remdesivir down the world's throat despite the fact that the cheap steroid dexamethasone has proven - in at least one high quality study - more effective at lowering mortality rates, has just published its expected pricetag for a five-dose course of the drug.
On Monday, Gilead disclosed its pricing plan for Gilead as it prepares to begin charging for the drug at the beginning of next month (several international governments have already placed orders).  Given the high demand, thanks in part due to the breathless media coverage despite the drug's still-questionable study data, Gilead apparently feels justified in charging $3,120 for a patient getting the shorter, more common, treatment course, and $5,720 for the longer course for more seriously ill patients. These are the prices for patients with commercial insurance in the US, according to Gilead's official pricing plan.
As per usual, the price charged to those on government plans will be lower, and hospitals will also receive a slight discount. Additionally, the US is the only developed country where Gilead will charge two prices, according to Gilead CEO Daniel O’Day. In much of Europe and Canada, governments negotiate drug prices directly with drugmakers (in the US, laws dictate that drug makers must "discount" their drugs for medicare and medicaid plans).
But according to O'Day, the drug is priced "far below the value it brings" to the health-care system.

However, we'd argue that this actually isn't true. Remdesivir was developed by Gilead to treat Ebola, but the drug was never approved by the FDA for this use, which caused Gilead to shelve the drug until COVID-19 presented another opportunity. Even before the first study had finished, the company was already pushing propaganda about the promising nature of the drug. Meanwhile, the CDC, WHO and other organizations were raising doubts about the effectiveness of steroid medications.
Months later, the only study on the steroid dexomethasone, a cheap steroid that costs less than $50 for a 100-dose regimen, has shown that dexomethasone is the only drug so far that has proven effective at lowering COVID-19 related mortality. Remdesivir, despite the fact that it has been tested in several high quality trials, has not.
So, why is the American government in partnership with Gilead still pushing this questionable, and staggeringly expensive, medication on the public?

https://timmermanreport.com/2020/07/the-remdesivir-pricing-letter-gilead-should-have-written/

Dear America,

We’ve decided to grossly underprice remdesivir.

Hundreds of thousands of COVID-19 patients in America, and even more around the world, need our drug. But the US insurance system is corrupt and heartless. It has demonstrated that it will go to great lengths to prevent patients from getting appropriate, physician-prescribed treatments. You know their tricks: high deductibles, high copays, lengthy prior authorization forms, phone calls unreturned, surprise bills for patients.

Sadly, these barriers are common practice. So we decided to underprice remdesivir to get around the barriers, and make it as fast and easy as possible for all patients to quickly get this much-needed medicine.

In normal times, we drug developers have plenty of time to devise a counterstrategy. Development of new therapies typically takes years. That long lead time enables us to make the case for the value of our innovation and its proper use, and to plan our strategy for negotiating with insurers to lower barriers to accessing treatment. Knowing they often won’t, we usually also have time to set up patient assistance programs that help patients afford the out-of-pocket costs demanded by their insurance plans.
With remdesivir, amidst the COVID-19 pandemic, we don’t have that time. So, we have opted to undercut the value of our innovation to get the therapy to as many patients as possible as soon as possible.

The price we settled on is $2,340 for a five-day course for governments in the developed world, and for the US Department of Veterans Affairs and the US government’s Indian Health Services. U.S. private insurers, in addition to Medicare and Medicaid, will pay $3,120. At this price there’s really no excuse for a private insurance plan or Medicare to put up barriers (though it somehow still won’t come as a shock if they try).

Having to combat insurers’ bureaucracy with our own counter-bureaucracy wastes society’s and our company’s resources. But our insurance system has succumbed to pathological bloat and learned to feed off the bureaucracy. It has learned to extort a profit stream from all drugs, regardless of how expensive they are, to pad their own incomes.

These insurance companies invent nothing and gaslight America into thinking they are doing favors for patients. Why do insurers require that doctors seek prior authorization to confirm that a medicine is medically necessary for a patient and then, after granting authorization, still demand high copayments that many patients cannot afford?
They will say they are trying to prevent over-utilization. They will claim that is the purpose of this “skin in the game.” But really, they are trying to prevent appropriate utilization. That is not insurance. That is disgusting.

Today, we cannot play these games. COVID-19 has filled our hospitals and ravaged our economy. So, we will eat this one. In addition to all the doses of remdesivir we have donated, we are pricing remdesivir at a fraction of what we know America tacitly recognizes it is worth.

Think about how much the US has already sacrificed to save millions of lives from COVID-19. The country has spent <a href="https://www.washingtonpost.com/business/2020/04/15/coronavirus-economy-6-trillion/">$6 trillion dollars</a> to save what would likely have been about two to three million lives lost if the virus had been allowed to run rampant. That comes to about ~$2M-$3M per life. Remdesivir trials have <a href="https://www.niaid.nih.gov/news-events/nih-clinical-trial-shows-remdesivir-accelerates-recovery-advanced-covid-19">demonstrated</a> that the drug plausibly cuts mortality by ~30% and saves the life of one person for every ~30 who are treated.

The US has demonstrated that it values each life saved from COVID-19 at $2 million or more, so should be willing to spend more than $60,000 on a course of remdesivir. At $20,000, remdesivir would be an extraordinary bargain, leaving plenty of margin for error if it turns out that the drug is less effective than so far shown in trials.
Political organizations like ICER will ignore this logic. But ICER is backed by a billionaire who thinks that people would do a better job of curing their kids’ sickle cell disease and cystic fibrosis if only they had more skin in the game. That is a particularly insidious form of libertarianism better understood as “You’re free to die of treatable diseases I’d just as soon not pay to solve, because I’m rich and those diseases don’t affect me.”

Americans disagree, as evidenced by the tremendous sacrifices so many have made to save lives.
And yet, we’re charging only $2,340-$3,120 for remdesivir. That does not mean we agree that the benefit remdesivir offers is only worth $3,120. Far from it – our price is about 20-fold less than it is worth just based on its odds of saving lives. And remdesivir’s clinical trials also show it can probably cut the length of hospital stays for COVID-19 patients by an average of four days. In the US, that means about $12,000 in savings per patient. [<em>Clarification: 5:51 pm PT July 14. An earlier version said remdesivir clinical trials show it cuts average length of hospital stays by an average of four days. It has been amended to say “it probably can cut” the length of hospital stays by an average of four days.–LT</em>]
Given how expensive drug development is, how can we afford to underprice our innovation? Fortunately, Gilead remains profitable enough from our past successes that we can deeply discount remdesivir to ensure that all patients get access quickly.

Since Gilead is the biotech adult in the room, let me be clear to the scores of younger, unprofitable, scrappy biotechs out there fighting COVID-19: do as we say, not as we do … for everyone’s sake.

Most small biotechs are supported by investors (which include teachers’ and firefighters’ pension funds, not just billionaires). Their drugs may combine with remdesivir to save even more lives or may even displace remdesivir altogether. Most of those companies cannot afford to underprice their drugs, and they should not.
If investors thought that those companies would have to follow our example, they could very well decide to invest elsewhere. Without the promise of an adequate financial return, these companies would be entirely reliant on government funding. If that seems like a good idea, then you have not spent any time in either industry or the NIH. The government cannot keep up with the thriving, creative innovation engine that private capital has made possible. The NIH funds basic science, yet the drug industry funds the extremely expensive clinical trials and drug development required to turn ideas into products, investing well over $100 billion each year.

That’s not to take away anything from taxpayers. Nothing would be possible without taxpayers. &nbsp;Gilead is able to be the successful company it is because of US roads, the rule of law, public schools, a science-based FDA, and yes, even some taxpayer subsidies for projects like repurposing remdesivir for COVID-19 after it originally fell short as an Ebola medicine. But all of that government support, necessary as it is, isn’t sufficient to actually create remdesivir.
American taxpayers have elevated private enterprise to Mount Everest’s base camp, already a great height. And yet, taxpayers do not fund the climb to the peak. That’s achieved by the market offering incentives to those who succeed. Without taxpayer support for the foundation on which the biomedical innovation industry exists, there would be no innovation. But without adequate returns for private funding of development, there would be no products.

With profits of only 10-12% of all drug industry revenues, taxpayers would have to spend about 90% of what society spends now to preserve the drug industry as a tax-funded non-profit. Of course, those profits also incentivize talented scientists. Good luck retaining those brilliant people when other for-profit sectors offer them a piece of their profits through valuable stock. As it is, software, real estate, and finance have higher profit margins than the drug industry, so they can entice a lot of talent away.
We will all get more video games and financial instruments, but fewer medicines.

You might think that pharma could cut its sales and marketing budgets, but how will the world know about a useful new drug if nobody spends the time educating physicians and patients about it? Sure, there’s some fat here and there in our industry, and shareholders are constantly pushing companies like ours to find it and cut it. But there isn’t room for us to cut prices by as much as we have cut remdesivir’s if we want to continue to support and incentivize the level of innovation we have today.

So, treat remdesivir as a special case, please. Were all companies obliged to follow our example, the drug industry would become a high-risk/low-reward proposition. Investors would flee, academia would prove itself unequal to the task of developing drugs, and our drug armamentarium would be frozen in its current state. Our kids would have healthcare no better than ours.

The remdesivir case warns us about what is wrong with America’s insurance system. We need insurance reform so that health insurance does what it is supposed to do – pool the risk over large populations of people, so that healthy people are paying the bills for those who are sick. All of us and those we love will become patients at some point, so it’s in society’s interest to ensure fair and equal access to care.

There is no time to fix the systemic problems with US health insurance this week, or this month, so we are expediently making this pricing concession right now. But we urge all other drug companies not to follow our example.

If you invent a drug that advances our standard of care, it is imperative for the preservation of innovation that you confidently charge a price that will generate a return for you and your shareholders and incentivize others to risk their time and money to climb even higher. Congress should anticipate these breakthroughs in the coming months and be prepared to acknowledge their value. Better that America spend tens of billions on medicines that let everyone live normal lives than trillions countering economic depression as everyone hides from a viral terror.

Peter Kolchinsky, a biotechnology investor and scientist, is Managing Partner of RA Capital Management

Una visión totalmente contrapuesta a la de PPCC con respecto al crash USA:

https://inbestia.com/analisis/desde-2013-barra-libre-en-subida-bolsa-eeuu-y-estamos-solo-en-el-comienzo

Saludos. He estado una larga temporada desconectado del foro pero ahora les vuelvo a leer de vez en cuando.

Ya van por más de 2,600,000

bueno, 17.410.742 votaron irse. Repetirlo sería un cachondeo.

Saludos a la gente de bien, que hacía tiempo que no me pasaba.

¡Hola Spainfull! Me alegra verte de vuelta

hola, yo también me alegro de ver que seguís los mismo dando guerra  . Entre el curro y las vacaciones os tenía un poco abandonados, jeje. Lo malo es que el futuro no lo tendré mucho más despejado, pero de cuando en cuando seguro que al menos leeré con atención el foro.

Aunque en España la cosa está muy parada, en el resto se están produciendo eventos de calidad, tal y como se puede seguir por aquí. El baile continua para ver quién se queda con la fea cuando la música se pare. Coincido con aquellos que dicen que sí, que USA es el que impone las reglas, pero que cada vez menos. Rusia y China ya no le temen tanto. Y menos los chinos que planifican a 50 años vista, fecha en la que saben que los americanos solo pueden ir a menos. No tienen prisa, su cultura  no es la occidental, no hay que olvidarlo. Van a ganar poco a poco, a ser posible sin sobresaltos, para no dar ninguna excusa a nada y para poder desarrollar su estrategia sólidamente.

Cuando hablo de FOFOA en realidad me refiero a él y a los otros sobre los que se apoya, a la filosofía del conjunto. Como ya dije, a mí también me pareció revelador lo que contaba. No ya del oro, que aunque sí parece ser que va a tener un papel relevante, no estoy tan seguro que vaya a pasar lo que dice ni como dice (que el físico multiplique por 35 su valor), o al menos que a la gente de a pie le llegue a afectar de esa manera. Aún así, lo tomo como las meigas, haberlas haylas y no cuesta nada tener alguna onza 'just in case'.

Hacía un tiempo que no lo seguía, no me había enterado que había una parte que era de pago. Si alguien se suscribe, que avise si merece la pena sobre lo que publica en abierto. Me acordé hace poco de cuando hablamos si el GEAB merecía la pena, con las caídad de China. En un número de hace pocos meses el artículo que abrieron sobre consejos de inversión resolvía la cuestión de si en China había una burbuja diciendo que no, que además iba a seguir yendo p'arriba más que probablemente . Menos mal que me quité la mitad del fondo que llevaba antes de las caídas y la otra mitad con la primera recuperanción a base de paladas del BC Chino...

ZeroHedge mola pero son muy muy madmaxistas y alarmistas, supongo que es la táctica para que no les tomen muy en serio.

Saludos y gracias a todos por mantener el chiringuito vivo.

Hace años escuché hablar a ingenieros de telecomunicaciones sobre la dureza de su carrera en los 90, comparando con que más tarde, se había relajado. En un principio, pensaba que se vanagloriaban del filtro que habían superado y que les introducía en la élite y se quejaban del cambio. Nada más lejos de la realidad, siendo todos brillantes, pensaban que había sido inútil, cruel, un sinsentido, una absoluta pérdida de tiempo, esas asignaturas en las que apenas aprobaba nadie, incuso siendo ellos de los que menos la sufrieron. Y aplaudían el cambio.

sí, sufrí algo similar en esos años. Creo que ya conté algo en otro hilo. Te pegabas allí todo el día entre clases y prácticas y en la mayoría de exámenes te puteaban pero bien. Es cierto que seguramente sea innecesario, pero a favor tiene que los que sobreviven son ingenieros todoterreno que les puedes echar cualquier cosa y te la resuelven con eficacia. Es como en los marines...

La equivalencia de algunas superiores ya se ha hecho con el máster actual, me parece que he leído otra cosa en el hilo.

http://cincodias.com/m/cincodias/2015/04/24/economia/1429885408_168132.html

En esto de la renta fija, tan sencilla en apariencia como juzgar sobre un puente sin ser ingeniero civil

a mí me parece complicadísima.

Me ha recordado lo de los activos libres de riesgo a una entrevista más que interesante que le hicieron al presidente del Bundesbank el año pasado.

http://vozpopuli.com/economia-y-finanzas/46765-el-presidente-del-bundesbank-en-espana-hay-que-avanzar-en-la-reestructuracion-de-la-deuda-publica

Destaco algunas frases:

"Se ha progresado poco en la reestructuración de la deuda pública. El principio de la responsabilidad individual requiere que los gobiernos y ciudadanos respectivos consigan los ingresos necesarios para que se abone la deuda pública.

El riesgo de impago al final recae sobre los inversores, pues son ellos los que recogen el beneficio cuando las cosas van bien. Y si el límite fiscal se ha alcanzado realmente, entonces la deuda pública precisará ser reestructurada sin que suponga un riesgo sistémico a la estabilidad financiera.

Hay que dejar de tratar los bonos soberanos como activos libres de riesgo; los bonos soberanos deberían ser ponderados adecuadamente según el riesgo, y la exposición a la deuda pública debería ser limitada, como ya es el caso de la deuda privada"

Desde que la leí tengo la impresión de que van a hacer una jugada para que los inversores paguen una buena parte de las deudas de los Estados. Tanto los ETF como fondos están creciendo, ya que el resto no renta apenas nada y supongo que preferentes ya no compran. El típico T que se acerca al banco acaba con alguno endosado. Y como son "conservadores" y están más cerca de la jubilación que otra cosa, pues quieren ver cómo su dinero conseguido en la burbuja no se esfuma y está en algo "seguro". Así que se llevan un fondo de renta fija o un mixto conservador.

El día que pete la burbuja de bonos y no garanticen el pago (o alguna que se inventarán los bancos centrales) sabrán que se la han vuelto a hacer. Y será justicia poética ya que de esta manera aliviarán la carga que han dejado en su hijos. Seguramente se me escapan muchas cosas, pero no me extrañaría ver algo así en los próximos años en Europa.

El supuesto buen rollo de la dimisión indica escenificación para dar un golpe de efecto. ¿Ni un trapo sucio? Esto está pactado.

sí, aunque se ha ido rajando un poquito. Pablemos necesitaba algo para sacarlo de la espiral deflacionaria en la que se encontraba. De todas formas era cuestión de tiempo, o se iba o lo purgaban.

Puedo atestiguar esto, para escarnio y vergüenza colectiva de este estercolero que alguna vez fue un país. He asistido a reuniones donde se ha calibrado la salida de personas de la empresa, y el argumento de "pero fulanito está casado, tiene hipoteca e hijos" no es que haya sido considerado, es que ha inclinado la balanza para mantenerlo, en casos donde era flagrante la inutilidad del sujeto y la rémora que suponía.

para el típico empresaurio hispanita tiene todo el sentido del mundo. Un trabajador de estos va a ser un esclavo que no va a decir que no a nada y va a echar las horas que hagan falta. Su productividad será una mierda pero estará ahí, siempre dispuesto a que le caiga una bronca sin rechistar, que es lo que cuenta.