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DBL%20Hendrix%20small.png College chemistry, 1983

Derek Lowe The 2002 Model

Dbl%20new%20portrait%20B%26W.png After 10 years of blogging. . .

Derek Lowe, an Arkansan by birth, got his BA from Hendrix College and his PhD in organic chemistry from Duke before spending time in Germany on a Humboldt Fellowship on his post-doc. He's worked for several major pharmaceutical companies since 1989 on drug discovery projects against schizophrenia, Alzheimer's, diabetes, osteoporosis and other diseases. To contact Derek email him directly: derekb.lowe@gmail.com Twitter: Dereklowe

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April 2, 2013

Tecfidera's Price

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Posted by Derek

Let us take up the case of Tecfidera, the new Biogen/Idec drug for multiple sclerosis, known to us chemists as dimethyl fumarate. It joins the (not very long) list of industrial chemicals (the kind that can be purchased in railroad-car sizes) that are also approved pharmaceuticals for human use. The MS area has seen this before, interestingly.

A year's supply of Tecfidera will set you (or your insurance company) back $54,900. That's a bit higher than many analysts were anticipating, but that means "a bit higher over $50,000". The ceiling is about $60,000, which is what Novartis's Gilenya (fingolomod) goes for, and Biogen wanted to undercut them a bit. So, 55 long ones for a year's worth of dimethyl fumarate pills - what should one think about that?

Several thoughts come to mind, the first one being (probably) "Fifty thousand dollars for a bunch of dimethyl fumarate? Who's going to stand for that?" But we have an estimate for the second part of that question - Biogen thinks that quite a few people are going to stand for it, rather than stand for fingolomod. I'm sure they've devoted quite a bit of time and effort into thinking about that price, and that it's their best estimate of maximum profit. How, exactly, do they get away with that? Simple. They get away with it because they were willing to take the compound through clinical trials in MS patients, find out if it's tolerated and if it's efficacious, figure out the dosing regimen, and get it approved for this use by the FDA. If you or I had been willing to do that, and had been able to round up the money and resources, then we would also have the ability to charge fifty grand a year for it (or whatever we thought fit, actually).

What, exactly, gave them the idea that dimethyl fumarate might be good for multiple sclerosis? As it turns out, a German physician described its topical use for psoriasis back in 1959, and a formation of the compound as a cream (along with some monoesters) was eventually studied clinically by a small company in Switzerland called Fumapharm. This went on the market in Germany in the early 1990s, but the company did not have either the willingness or desire to extend their idea outside that region. But since dimethyl fumarate appears to work on psoriasis by modulating the immune system somehow, it did occur to someone that it might also be worth looking at in multiple sclerosis. Biogen began developing dimethyl fumarate for that purpose with Fumapharm, and eventually bought them outright in 2006 as things began to look more promising.

In other words, the connection of dimethyl fumarate as a possible therapy for MS had been out there, waiting to be made, since before many of us were born. Generations of drug developers had their chances to see it. Every company in the business had a chance to get interested in Fumapharm back in the late 80s and early 90s. But Biogen did, and in 2013 that move has paid off.

Now we come to two more questions, the first of which is "Should that move be paying off quite so lucratively?" But who gets to decide? Watching people pay fifty grand for a year's supply of dimethyl fumarate is not, on the face of it, a very appealing sight. At least, I don't find it so. But on the other hand, cost-of-goods is (for small molecules) generally not a very large part of the expense of a given pill - a rule of thumb is that such expenses should certainly be below 5% of a drug's selling price, and preferably less than 2%. It's just that it's even less in this case, and Biogen also has fewer worries about their supply chain, presumably. The fact this this drug is dimethyl fumarate is a curiosity (and perhaps an irritating one), but that lowers Biogen's costs by a couple of thousand a year per patient compared to some other small molecule. The rest of the cost of Tecfidera has nothing to do with what the ingredients are - it's all about what Biogen had to pay to get it on the market, and (most importantly) what the market will bear. If insurance companies believe that paying fifty thousand a year for the drug is a worthwhile expense, the Biogen will agree with them, too.

The second question is divorced from words like "should", and moves to the practical question of "can". The topical fumarate drug in Europe apparently had fairly wide "homebrew" use among psoriasis patients in other countries, and one has to wonder just a bit about that happening with Tacfidera. Biogen Idec certainly has method-of-use patents, but not composition-of-matter, so it's going to be up to them to try to police this. I found the Makena situation more irritating than this one (and the colchicine one, too), because in those cases, the exact drugs for the exact indications had already been on the market. (Dimethyl fumarate was not a drug for MS until Biogen proved it so, by contrast). But KV Pharmaceuticals had to go after people who were compounding the drug, anyway, and I have to wonder if a secondary market in dimethyl fumarate might develop. I don't know the details of its formulation (and I'm sure that Biogen will make much of it being something that can't be replicated in a basement), but there will surely be people who try it.

Comments (58) + TrackBacks (0) | Category: Drug Development | Drug Prices | The Central Nervous System


COMMENTS

1. David Borhani on April 2, 2013 9:09 AM writes...

Surely a significant proportion of MS patients who want to give dimethyl fumarate a try will seek other sources (Sigma-Aldrich, etc.)? The maintenance dose is 240 mg bid (time-released capsules). 182 g/year. A 3-year supply from Aldrich costs $104. Even cheaper from ChemReagents.

Sure, we all know it's not about the cost of goods. Rather, as Derek writes, it's the cost of buying FumaPharm, conducting the clinical trials, facing the regulatory hurdles and the inevitable lawsuits.

But given all that --- is $54,000/year reasonable? Ethical? Is this the best, or a proper, use of a society's wealth? I don't think so.

Permalink to Comment

2. Janne on April 2, 2013 9:11 AM writes...

This reminds me of something I've been wondering about: patents are all about protecting the _commercializing_ of an idea. If I understand it right (and from the lab seminars from the patent office, I should) anybody, whether company or private individual, is free to make use of a patented idea for themselves.

So a company can for instance produce this compound in the lab (or buy a tankful I guess) and study its effects on MS as long as they don't actually sell it or something. In the same way, I could implement a patented algorithm in a program I write for my own use. It's only if I try to sell or offer the code to others that I get in trouble.

And the patent application does at least nominally contain the information needed to apply the compound for MS — dosage, form and so on. Nobody could claim that information is secret or protected, as disclosing it is a requirement for getting the patent.

So, let's say somebody figured out and published a workable protocol using, say, the topical cream as a base, and people _did_ start to self-medicate with it, there would, as far as I can see not be a lot the maker could do about it. Am I missing something here?

What makes this interesting is a hypothetical future where many people would have the resources to perhaps duplicate real medical compounds; an amateur can already do a lot more today than they could just twenty years ago, so who knows what could be feasible in another twenty or fifty years.

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3. Matthew Herper on April 2, 2013 9:19 AM writes...

David Borhani -- why? This is why the pharmaceutical industry works so hard to make sure patients don't have to pay for their medicines.

Say you were a patient prescribed this drug, allowing you not to get interferon. Your insurer is willing to cover the bulk of the cost. There is a huge copayment, but Biogen Idec is willing to cover that. In the alternative, you have the option of trying Gilenya, which requires some blood monitoring.

Why are you going to go out and try to compound the drug? Why is a doctor going to prescribe it?

Sure, there might be some people who can't get access to the patient assistance program who would want the compounded version. But Biogen has a huge interest in making sure there aren't, and in preventing a market in compounded fumarate from existing.

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4. Anonymous on April 2, 2013 9:21 AM writes...

I should also have noted Biogen Idec's $10/month co-pay program.

With the Tecfidera $10 Co-pay Program,* you pay just $10 a month for your treatment. This program includes:

No income requirements — regardless of your income, you can enroll in the $10 Co-pay Program
No time limit — you can re-enroll every year for as long as you take Tecfidera
No waiting — your specialty pharmacy can enroll you immediately into the program so that you can get Tecfidera right away

*Co-pay details and eligibility include:

Please note that for the $10 Co-pay Program, cost per month assumes one box of Tecfidera, containing 30 days of doses. You are eligible to enroll in the $10 Co-pay Program for as long as you are treated with Tecfidera.
Federal and state laws may prevent eligibility. People covered by Medicare, Medicaid, the VA/DoD, or any other federal plans are not eligible to enroll. If any of these apply to you, please call MS ActiveSource for information about charitable programs that may be able to help you with the cost.

Let's say I have MS: I'm not on Medicare, etc. But I do have medical insurance through my employer. Yet, these terms would suggest that I am eligible for the $10/month program. Really?

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5. NMH on April 2, 2013 9:26 AM writes...

If somehow the insurance could negotiate the price down to a fraction of that, then it might be a reasonable expense for the combined payers-of-the-insurance. If there are going to be ridiculously high drug prices (no matter what the drug companies justification, reasonable or not) then we need a single payer system that can negotiate it down to a societally sustainable level.

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6. David Borhani on April 2, 2013 9:42 AM writes...

(#4 was me.)

Matthew --- Hyperbole to make a point. Of course few patients are willing or able to do this, but I wouldn't be surprised if a grey market crops up. I agree that pharmaceutical financial assistance programs are a good thing, but let's remember that profits have always been (quite) high. These programs help remove the sting of high costs, and also help divert attention, a bit, away from the profit margins.

The terms of this DMF co-pay program seem odd, in particular that there is no income requirement. Let's look at the numbers: The average age of MS diagnosis is 37. So the vast majority of patients are not covered by Medicare (at least not for several decades). About 20% of the population is covered by Medicaid, ~3% as federal employees, and perhaps another ~5 %VA/DoD. Call it one-third of MS patients excluded from the co-pay program. The remaining two-thirds really pay $120/year? Seems too good to be true...

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7. MDA Student on April 2, 2013 9:43 AM writes...

As a non-MS researcher, what does this mean screening wise? Did a lot of screen never pick this up? Did people just never throw it in?

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8. NUchemist on April 2, 2013 9:54 AM writes...

NMH - a single-payer system will make everything more expensive. Do you realize how much overhead you're adding when you involve the federal government?

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9. Bell4 on April 2, 2013 10:18 AM writes...

Just to elaborate a bit on the pricing justification - Biogen has to pay not just for the trials to get this drug approved, but more importantly, for all of the R&D spend for the much larger cohort of failed drug candidates.

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10. NMH on April 2, 2013 10:23 AM writes...

Nuchemist: Someone correct me if Im wrong, but as I understand it hospitals often time refuse medicare patients because they cannot get a high amount of re-imbursement for the care, compared to patients on private insurance. In other words, medicare, compared to private insurance, does a great job of negotiating prices. So it appears that even though there may be a great deal of overhead, that is made up in negotiating power for lower prices, at least for hospital care (sections A and B of medicare).

In theory, a single payer system in the US could do the same for drug prices, like Canada, which pays much less for drugs then medicare does (because of section D of medicare, medicare cannot negotiate prices)

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11. Chrispy on April 2, 2013 10:36 AM writes...

@#7 There is no single target for this drug. If it was to turn up in a screen someone would probably wonder what moron left this highly reactive compound in the screening deck, right before they cast it aside.

Kudos to Biogen for taking this forward and getting real proof of efficacy in MS, a patient population badly in need of more choices. It takes courage to move forward (these days) with a dirty drug with no clear mechanism. (And, it should be added, a history of allergic reactions.)

As Derek points out, the price is for the trial, not the chemical complexity of the underlying compound.

Those who find ourselves stuck in target-based drug discovery should see this as a wakeup call. Many in this industry continue to believe (erroneously) that only highly selective molecules that hit a known target have a chance at the FDA. What matters is safety and efficacy, period.

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12. Competition? on April 2, 2013 10:37 AM writes...

What confuses me is that as more MS drugs become availabe (a good thing for patients), the cost of each of them is going up. Contrary to normal effect of having to lower the price of your product when alternatives come to market, the makers of all MS drugs have been raising their prices 10% - 20% per year! The manufactures say "to make up for lost revenue from patients going to alternative products, we are having to raise our prices". Copaxone, a drug for MS that has been around since 1996 or so, has quadrupled in price since 2005 or so! Because there are more choices, us MS patients have to pay more for each one!! Silly.

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13. milkshake on April 2, 2013 10:40 AM writes...

another nasty irritant immunomodulatory compound like this is dibutyl squarate, used for treatment of alopecia and warts.

I would be quite concerned about patients taking di-Me-fumarate out of Aldrich bottle rather than formulated as a pill. You probably do not want blisters forming in your stomach. Plus the drug clearance is very fast - My understanding is that Biogen developed an extended release form.

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14. Another Derek on April 2, 2013 10:57 AM writes...

Well, a quick look at the "Orange Book" (FDA's listing of approved drugs) a minute ago doesn't show Tecfidera yet. But in a day or two - FDA says the on-line "Orange Book" is updated daily - we should be able to see what patent and exclusivity protection exists for Tecfidera. My bet, for what it's worth, is that there are both basic method claims on treatment of MS with dimethyl fumarate, and some sort of claims to an extended-release formulation, whether in method or product form I couldn't say.

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15. anon2 on April 2, 2013 11:22 AM writes...

Let's see, my insurance negotiates a price of about $1200 for a CT-PET scan which is billed at about $15,000, of which my co-pay is $120 under my total out-of-pocket for the year when it would them be of no charge to me.

For any 90 day's supply of drug for any maintenance drug, I currently pay $15.

So for this new drug, what will my insurance negotiate for their cost of this? $5000 / year? And for a year's supply, my cost would be $60. Of course, I appreciate that I have great insurance which is fantastic in terms of any family health casualty, of which we have had a few in the past several years.

Then, as ususal, who actually pays the full advertised price? Those who are the uninsured or under-insured, as so much of today's health care system in America.

If you are working in the Pharma industry, acting indignant or surprised is simply ignorance. It's the way it continues to work, and certainly not in the best interest toward the public's view of the industry as a whole.

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16. Thomas McEntee on April 2, 2013 11:23 AM writes...

Fascinating topic...what goes into establishing "The Price." The low cost of materials is straight-forward but I would like to have the been the proverbial fly-on-the-wall at Biogen when all other costs, including Tecfidera R&D and clinical trials and any non-Tecfidera costs were discussed and oh by the way, how many doses per year do we expect to sell...without a composition of matter patent position can a market for plain old dimethyl fumarate kill us...and what's the break-even analysis look like... Whatever the answers are to these types of questions, Biogen DID take the risk to move forward and will probably be rewarded for doing so.


Permalink to Comment

17. barry on April 2, 2013 11:32 AM writes...

more power to 'em for shouldering the risk and expense of Clinical Trials. But the USPTO still stands on the three-fold test:
utility AND non-obviousness AND novelty. I grant the first two freely. But is dimethylfumarate as an immunomodulator novel? The extension from psoriasis to MS is utile and non-obvious. But does that constitute novelty?

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18. barry on April 2, 2013 11:32 AM writes...

more power to 'em for shouldering the risk and expense of Clinical Trials. But the USPTO still stands on the three-fold test:
utility AND non-obviousness AND novelty. I grant the first two freely. But is dimethylfumarate as an immunomodulator novel? The extension from psoriasis to MS is utile and non-obvious. But does that constitute novelty?

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19. anchor on April 2, 2013 11:46 AM writes...

#13- di-Me-fumarate, is it more like a pro-drug? If that is the case, the active ingredient is Fumaric acid (trans?). Still a lot of mystery!

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20. anchor on April 2, 2013 11:47 AM writes...

#13- di-Me-fumarate, is it more like a pro-drug? If that is the case, the active ingredient is Fumaric acid (trans?). Still a lot of mystery!

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21. D-Not on April 2, 2013 11:51 AM writes...

Gilenya (Novartis' MS drug) is set to go off patent by Sept 21st 2015 or earlier (comp of matter expires Jul 20th 2014). I suspect that the price for Gilenya would drop significantly from its current $ 60,000/- pa to $ 500- pa.

I am sure this would impact Tacfidera's sales starting 2015.

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22. D-Not on April 2, 2013 12:01 PM writes...

@anon2 - "Then, as ususal, who actually pays the full advertised price? Those who are the uninsured or under-insured, as so much of today's health care system in America".

If you dont have fantastic insurance coverage -- then "medical tourism" is the answer. Most of these drugs (all of expensive anti-cancer drugs and soon BG-12 as well) are availabe for a "fraction of a fraction" price for a years supply in countries like India or China. Canada is an option too -- but not quiet as cheap as in India or China.

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23. HTA on April 2, 2013 12:15 PM writes...

One of the issues in drug pricing is that other relatively wealthy countries (i.e. Germany, France, UK,Canada etc.) have very rigorous Health Technology Assessments of new drugs whereby they slice and dice the data from registrational trials and then either refuse to pay for the drug altogether (NICE in the UK is notorious for this)or negotiate a much lower price for certain subgroups of patients. Of course this is becoming an even more rigorous process given the state of the world economy and austerity measures in the EU. The problem is that because these countries inevitably end up not paying their fair share, the US insurance companies and patients shoulder the bulk of the burden of paying for the R&D. Regardless of this point, however, a small molecule drug should not cost $55,000 a year no matter what country you live in!

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24. cynical1 on April 2, 2013 12:28 PM writes...

Couple of points: First it's priced like that due to the lack of a generic drug with similar efficacy in the disease indication. That's pretty obvious. Second, was it Biogen who took the risk and should be congratulated or was it Fumapharm? Based on what I read it was Fumapharm that did the first Phase II study. Biogen just looked at the data behind closed doors and had a *holy crap* moment. Biogen's entire viability relies on the MS market. They couldn't risk not taking the risk with the drug. Avonex (and all the interferons) aren't that well tolerated with the flu like systems from every injection and Tysabri has the PML risk. And, of course, since no one really knows how this drug works, they're going to be looking at combination trials with the two others for improved efficacy when used together. But if they don't show that, I'm guessing that this drug will actually eat into sales of the other two pretty quickly. Kudos to Fumapharm but I see this as Biogen covering their ass with good reason. That's why Biogen isn't circling the drain and a lot of big pharma is.

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25. Steve on April 2, 2013 1:30 PM writes...

I wonder how quickly an Indian generic company will make and sell dimethyl fumarate...

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26. David Borhani on April 2, 2013 1:42 PM writes...

@24, cynical1: I believe FumaPharm had done Phase II trials only in psoriasis, before Biogen signed up in Oct. 2003 (press release). Biogen and FumaPharm together moved the compound into trials for MS, with Biogen buying out their partner in 2006 (press release).

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27. anon2 on April 2, 2013 2:12 PM writes...

#22, D-Not:. Well, that might be nice if you can afford to get there, but many without health insurance in the great US of A don't have enough to eat, let alone to get the cost of a flight to the far east. Get real here, bud.

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28. anon on April 2, 2013 3:10 PM writes...

@#7"Do you realize how much overhead you're adding when you involve the federal government?"

you do realize medicaid and medicare have the lowest overhead of any medical insurance right? its actually the exact opposite of what your suggesting

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29. bad wolf on April 2, 2013 3:12 PM writes...

@26--how can 20% of the US population be on food stamps and still not have enough to eat?

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30. Samuel71 on April 2, 2013 5:48 PM writes...

Any patient who does a Google search on the compound will find that they can acquire a year's supply, legally, for pennies a day, as #1 stated. I really hope no pour soul ends up paying for Tecfidera out of their own pocket.

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31. watcher on April 2, 2013 5:54 PM writes...

Free Market in all it's glory.

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32. watcher on April 2, 2013 5:55 PM writes...

(But with lack of competition).

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33. gippgig on April 3, 2013 12:23 AM writes...

Are related compounds like diethylfumarate active? How about diPEGylated fumarate for something that's inherently extended release?
#2 - I believe a patent technically does prohibit personal use by an individual. Also, there is some sort of exemption in patent law for use in research. Incidentally, I recall a patent case many years ago involving the unpatentable maleic acid (yes, the isomer of fumaric acid) hydrazide which was patented as an herbicide (or something similar). The courts ruled that a company that was selling it was infringing the patent even tho the compound itself wasn't patented. In that case, I believe there was no other known use for the compound and the seller put the instructions for use as an herbicide on the container.

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34. Sean on April 3, 2013 8:33 AM writes...

The pricing of chemicals in general is horrible. We see 100x differences all the time, which I'm sure most chemists have come across at one time or another.

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35. Dennis on April 3, 2013 11:15 AM writes...

Maybe the patent system isn't the best way to fund drug development.

It would almost make sense for health insurers to do it. They get better treatments cheaper, at some upfront cost, but they come out ahead overall since there's no money going to pharmaceutical profits. The problem is, if the drugs aren't patented, freeloading companies can get the full benefit. Therefore nobody does it.

To solve this, Bernie Sanders proposed a tax on insurance companies, the money going to development of patent-free medicines. That way there are no freeloaders, and everybody saves money.

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36. cynical1 on April 3, 2013 11:25 AM writes...

@ David Borhani: No Fumapharm did the first small study in 10 patients for 48 weeks and they did see statistical significance in lesion number and volume. I didn't realize it was that small a study though.

Schimrigk et al European Journal of Neurology 2006, 13: 604-610.

But it does point towards Biogen assuming more of the risk than I suggested. You can't get overwhelming confidence out of a 10 patient study regardless of the P values. Point taken.

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37. Cynical2 on April 3, 2013 11:37 AM writes...

We should be very happy that MS patients have one more treatment option. Profits from this new drug will help research other drugs for other diseases.

Derek it sems that your pharma experielnce was not good and your article lacks the cost and high failure of developing new drugs. What is the reward for taking such high risks (1 billion investment and less than 5 percent chance to get a drug apporoved?) if you cannot charge as much as the market is willing to pay?

If you didn't want to pay this much then you should reform the healthcare system in your country and move to a socialist one where goverment can negotiate better prices as in Europe.


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38. Thomas on April 3, 2013 4:19 PM writes...

The cost problem is real. If one sees insurance as zero-sum savings, does it make sense to pay a year's wage in advance for a 3 month life extension with poor quality of life?

People are discovering that it does not make sense. Which probably points to the need to make development cheaper.

It becomes different if the result is better quality of life over a longer period and the chance of having the problem is low. But it is setting a maximum for treatment costs for common illnesses.

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39. Yancey Ward on April 3, 2013 9:01 PM writes...

Nothing is stopping MS patients from buying dimethyl fumerate.

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40. steve on April 6, 2013 7:56 PM writes...

I've followed the DMF story for quite a while, even tried to get my company to purchase the rights before Biogen did. What I think everyone is missing is the formulation work Biogen did. DMF itself had a lot of GI problems and Biogen spent a considerable amount of effort to make it a tolerable oral drug. Kudos to them.

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41. Nitric Acid on April 11, 2013 4:07 PM writes...

I'll remember to quote this next time I hear someone talk about how dichloroacetate cures cancer, but Big Pharma won't use it because it's too simple a molecule to be patented.

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42. mikeW on April 14, 2013 2:48 PM writes...

@anon2:
"Let's see, my insurance negotiates a price of about $1200 for a CT-PET scan which is billed at about $15,000, of which my co-pay is $120 under my total out-of-pocket for the year when it would them be of no charge to me."

WHAT!?
CT scan takes around 30 minutes machine-time on average, most places that run it operate 12/day (and there is no reason why they shoun't be 18h/d or full tiem for emergencies).
Equipment costs vary greatly (from 300k) to 2M for latest and greatest.
At the retarded base price you quoted, even most expensive machine would pay for itself in less than 6 days!

This is the problem you US fuckers cause for health insurance - absurdly balooned prices that everyone thinks are okay.

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43. experienced chemist on April 22, 2013 12:42 AM writes...

This cost is really ridiculous. How did Biogen Idec decide the price of this drug? Why do they think this drug is worth that much money? Why the did federal agency which controls the price approve this? There is no doubt that many multiple scelrosis patients will benefit this medicine. It doesnot sound like a breakthrough medicine. As mentioned in this assay, this medicine has been used for psoriasis for a while. This is another sort of autoimmune disease. Now Biogen Idec is just the 1st company to test this drug for MS patients. If not Biogen Idec, some other companies will also make this discovery sooner or later? So it is not a medicine hard to find or hard to manufacture or hard to discover. Well, all these factors may not matter that much. In the end the price is determined by how much benefits will be brought to the patients. It will be a great drug for the MS community. But what on earth does this drug cost so much? I am pretty the company has been thinking for this for a long time? Are we too greedy? Insurance will pay? Consumers will object? All these questions have been hanging in the company's managers' minds for a long time. As a experienced research, I would suggest a few things to the whole society: 1st, let's boycut the medicine. If no one buys it or no doctor prescribes it, the price will fall from the sky. 2nd seeking goverment help. These legislaturers are elected by their constituent, they will do whatever it takes to stop this. 3rd, let us ask the biogen idec ceo: if you or your family member has this devastating disease, would you be willing to pay this money. 4th as a scientist with consciousness and responsibility, I definitely don't think this is the right price. Remember, we are discover good medicines to benefit the whole society. We are not vampires to suck everydody's blood. The reason we are working on this subject is we want to bring a affordable medicine to the whole patient. Of course there will be a cost because there is no free lunch. But this doesnot mean the price will be skyrocketing. Ridiculous price. Last we could resort to India: they could sell this medicine with the cost of just a few dollars.

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44. Kelley Burton on May 8, 2013 11:24 AM writes...

After 11 years of injections, I have very few places wtih no scar tissue to inject into. I was thrilled with the release of Tecfidera. My neurologist likes the way this drug works chemically and it has a great efficacy rate.

However, I have two insurance policies. Neither cover Tecfidera. I called MS Active Source and the $10 copay program is great...if your insurance covers the