The EU: In, out, shake it all about.... (25 Viewers)

[SkyblueBazza]

The fear is that rather than have a list of allowed drugs and the doctors etc can prescribe those which they feel are best for the patient.

Under a trade deal a company could be given exclusive rights to produce certain drugs and effectively give them a monopoly, allowing them to charge what they like. This on top of other potential changes common in the US like lobbying and paying doctors to prescribe their specific brand even if it isn't the most cost-effective. It could effectively remove competition from the sector.

Think of it like in a football stadium. When it used to be different companies there was an element of price compeition. Now they're largely entirely filled with catering contracts by one company for the entire stadium (with a few different signs above the kiosks to give an impression of competition) prices can be astronomic.

Mate, for any of what you describe and seem to fear to happen - the UK would have to make changes akin to what Screaming Lord Sutch might have suggested.

It is a scare story - I will give it that, but that is all it is.

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[SBAndy]

Mate, for any of what you describe and seem to fear to happen - the UK would have to make changes akin to what Screaming Lord Sutch might have suggested.

It is a scare story - I will give it that, but that is all it is.

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I hope you are correct in your judgement but I really don’t think you are.

 

[clint van damme]

Mate, for any of what you describe and seem to fear to happen - the UK would have to make changes akin to what Screaming Lord Sutch might have suggested.

It is a scare story - I will give it that, but that is all it is.

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We are going to have to make all sorts of huge wholesale changes in all sorts of industries if we want free trade with the countries high on the list of our free trade deal hit list.
States- NHS
Brazil- Agriculture
India- immigration

To name a few.

They aren't going to give us free trade for nothing.

 

[Sky_Blue_Dreamer]

Which is rather ironic considering the US pharma companies’ arguments centre around having market-driven pricing.

But it depends on how they define 'market driven'. They can argue 'market driven' for tendering a contract. If you win the contract then you've got it made - you have the market to yourself by law and how many of those contracts don't end up costing more than the tender price? Market driven is all the different options available to you and you choose the best depending on your needs and means.

It'd be like saying you want to buy a sofa but then agreeing your only going to buy from DFS.

Why do you think companies spend so much time when tendering for contracts lobbying politicians and wining and dining them? If it was just price based they're just wasting their own time and money.

 

[CCFCSteve]

We are going to have to make all sorts of huge wholesale changes in all sorts of industries if we want free trade with the countries high on the list of our free trade deal hit list.
States- NHS
Brazil- Agriculture
India- immigration

To name a few.

They aren't going to give us free trade for nothing.

Depends what the trade surplus/deficit is (also if the trade partner is a major competitor in certain industries)...amongst various other considerations

If a country is keen to export more to us, why wouldn’t they agree a free trade deal

Addressed the US - NHS on other thread. Might be bullshit but it’s not on the table

 

[chiefdave]

Johnson has done a cracking job of getting Brexit delayed. Having got a positive vote on his WA it could have been full steam ahead but now we're going to be in election mode until 12th December.

Then, at best, a week before the Christmas recess. If they come back on the 6th that gives 4 weeks before the extended deadline.

Anyone confident of everything being sorted by then?

 

[clint van damme]

Depends what the trade surplus/deficit is (also if the trade partner is a major competitor in certain industries)

If a country is keen to export more to us, why wouldn’t they agree a free trade deal

Addressed the US - NHS on other thread. Might be bullshit but it’s not on the table

I didn't say they wouldn't sign them but they come at a cost.
The scenario Baz called out isn't as far fetched as he thinks in my opinion.

 

[Sky_Blue_Dreamer]

Depends what the trade surplus/deficit is (also if the trade partner is a major competitor in certain industries)...amongst various other considerations

If a country is keen to export more to us, why wouldn’t they agree a free trade deal

Addressed the US - NHS on other thread. Might be bullshit but it’s not on the table

Or it is on the table but not willing to admit it. Trump said it was and the look he got from May was 'shut the fuck up'. He then backtracked. My take on it was Trump once again couldn't help shoot his mouth off when he shouldn't.

It may be packaged as non-privatisation to make it more palatable, but the companies seem to be pushing for it with both the US govt and our own.

 

[CCFCSteve]

Or it is on the table but not willing to admit it. Trump said it was and the look he got from May was 'shut the fuck up'. He then backtracked. My take on it was Trump once again couldn't help shoot his mouth off when he shouldn't.

It may be packaged as non-privatisation to make it more palatable, but the companies seem to be pushing for it with both the US govt and our own.

Johnson’s said NHS is not on the table (link on other thread)

If it’s a case of US companies having the ability to supply the NHS, I’ve got not issue, as long as it’s competitive tendering/procurement process. If it’s a move towards their insurance based system I’d be totally against (but can’t see it ever being accepted in this country)

 

[chiefdave]

Johnson’s said NHS is not on the table

Well that's convinced me, not like he's ever been caught lying.

 

[skybluetony176]

Johnson’s said NHS is not on the table (link on other thread)

If it’s a case of US companies having the ability to supply the NHS, I’ve got not issue, as long as it’s competitive tendering/procurement process. If it’s a move towards their insurance based system I’d be totally against (but can’t see it ever being accepted in this country)

The problem is a lot of drugs are under the grip of the American pharmaceutical industry and if Trump pushes for the rest of the world paying the same as the US rather than the US paying the same as the rest of the world (already his confirmed stance) then it’s difficult to see how the supply of drug’s aren’t going to be on the table as part of agreeing a trade arrangement.

 

[fernandopartridge]

Johnson’s said NHS is not on the table (link on other thread)

If it’s a case of US companies having the ability to supply the NHS, I’ve got not issue, as long as it’s competitive tendering/procurement process. If it’s a move towards their insurance based system I’d be totally against (but can’t see it ever being accepted in this country)

US companies have the opportunity to supply the NHS already. Nothing is stopping them at all.

I'd imagine they'd want mandatory inclusion of US firms in competition + limits on the extent to which weighting could be applied to price criteria and Britain to be outside the scope of the Falsified Medicines Directive.

I've just awarded an NHS IT contract and some months ago had a conversation with a large American company who showed interest in bidding. They didn't like the idea that
1. We set a load of technical standards they'd have to meet before we'd award a contract to them, and;
2. We set an affordability cap on their pricing to limit what they could charge a service recipient


.

 

[skybluetony176]

US companies have the opportunity to supply the NHS already. Nothing is stopping them at all.

I'd imagine they'd want mandatory inclusion of US firms in competition + limits on the extent to which weighting could be applied to price criteria and Britain to be outside the scope of the Falsified Medicines Directive.

I've just awarded an NHS IT contract and some months ago had a conversation with a large American company who showed interest in bidding. They didn't like the idea that
1. We set a load of technical standards they'd have to meet before we'd award a contract to them, and;
2. We set an affordability cap on their pricing to limit what they could charge a service recipient


.

Did you see Despatches last night FP? If you did I’d love to hear your take on it with you being our NHS expert.

 

[CCFCSteve]

US companies have the opportunity to supply the NHS already. Nothing is stopping them at all.

I'd imagine they'd want mandatory inclusion of US firms in competition + limits on the extent to which weighting could be applied to price criteria and Britain to be outside the scope of the Falsified Medicines Directive.

I've just awarded an NHS IT contract and some months ago had a conversation with a large American company who showed interest in bidding. They didn't like the idea that
1. We set a load of technical standards they'd have to meet before we'd award a contract to them, and;
2. We set an affordability cap on their pricing to limit what they could charge a service recipient


.

Interesting stuff Fernando, I hope you never have to soften those type of criteria ! (they’re essential I’d say !) Price criteria is rather important when we/government is paying though so a government giving this control away would be bizarre. Stand to be corrected in future though

 

[skybluetony176]

Drug costs should be a 'prominent issue' in Trump trade talks: Mount Sinai Health CEO

 

[SkyblueBazza]

I hope you are correct in your judgement but I really don’t think you are.

There are mostly alternatives to the US Pharma's drugs...from UK or EU companies. So if the US companies want to price themselves out of the market that is up to them. If you are thinking our Prescribers will be swayed by bribery of some sort, by US Pharma, as a whole I am confident that won't get to the start line let alone off the blocks. There are Medicines Optimisation programs in place that need to be binned - how that would be justified I cannot imagine. Prescribers almost to a man have patient best interests at heart.

Plus there are already British & European Pharma making shedloads from selling drugs to the NHS...& US Pharma already here doing business. Maybe the deal would open doors for more British Pharma innovations?

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[SkyblueBazza]

But it depends on how they define 'market driven'. They can argue 'market driven' for tendering a contract. If you win the contract then you've got it made

Quite...& the model in the US is patients being advertised to directly so once the Doctor prescribes, the patient can buy their drug anywhere. Here they can buy illegally on the internet or other unauthorised sources...but generally - it is from a reputable source at the NHS price

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[SkyblueBazza]

Johnson has done a cracking job of getting Brexit delayed. Having got a positive vote on his WA it could have been full steam ahead but now we're going to be in election mode until 12th December.

Then, at best, a week before the Christmas recess. If they come back on the 6th that gives 4 weeks before the extended deadline.

Anyone confident of everything being sorted by then?

Yes. The near the death deal that Boris offers will be accepted by parliament.

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[SkyblueBazza]

I didn't say they wouldn't sign them but they come at a cost.
The scenario Baz called out isn't as far fetched as he thinks in my opinion.

What I call out is the cost of changes necessary to bring about the scenario suggested would be so massive & so disruptive - I doubt they will be possible within 20yrs

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[SkyblueBazza]

The problem is a lot of drugs are under the grip of the American pharmaceutical industry and if Trump pushes for the rest of the world paying the same as the US rather than the US paying the same as the rest of the world (already his confirmed stance) then it’s difficult to see how the supply of drug’s aren’t going to be on the table as part of agreeing a trade arrangement.

What drugs Tony??? Give us some examples

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[chiefdave]

Yes. The near the death deal that Boris offers will be accepted by parliament.

Certainly hope so. The other option would be stalling for a few more weeks and falling out by default with no deal if the EU refuse to extend further.

Get the feeling they are getting pissed off with extensions being requested and then wasted on leadership elections and general elections and might not be open to any further extension.

 

[skybluetony176]

What drugs Tony??? Give us some examples

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I gave you a link to a paper that explained it all but although you replied to it you clearly didn’t read it. You can take a horse to water and all that. It’s basically every drug. Some are double the price, some are as high a six times what the British government currently pays for the exact same thing.

 

[SkyblueBazza]

Drug costs should be a 'prominent issue' in Trump trade talks: Mount Sinai Health CEO

This link?

If a different one then please let me know where it is & I promise I shall read it.

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[skybluetony176]

This link?

If a different one then please let me know where it is & I promise I shall read it.

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No. The link in the post you originally replied to of mine on this subject.

 

[SkyblueBazza]

No. The link in the post you originally replied to of mine on this subject.

Ah, ever the child I see?!

Well having tracked back the only drugs referred to in that link are generically available. That means anyone & everyone can produce them if the so wish & get regulatory approval to do so.

In fact if you research the top 100 most prescribed drugs in the UK they are virtually all available generically. That means that if the US manufacturers want to charge the earth for the brands they produce, the NHS will simply go buy the cheapest available alternative...then the next cheapest...etc until all generic supplies are exhausted before buying the perceived expensive US brands.

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[Brighton Sky Blue]

Ah, ever the child I see?!

Well having tracked back the only drugs referred to in that link are generically available. That means anyone & everyone can produce them if the so wish & get regulatory approval to do so.

In fact if you research the top 100 most prescribed drugs in the UK they are virtually all available generically. That means that if the US manufacturers want to charge the earth for the brands they produce, the NHS will simply go buy the cheapest available alternative...then the next cheapest...etc until all generic supplies are exhausted before buying the perceived expensive US brands.

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The 'big pharma' company I made medicines for had a contract with the NHS. We and a generic manufacturer were the only ones who produced the compound in question but we were chosen despite being more expensive since the quality was more reliable and trustworthy. This was a while ago but the risk always exists with generics that you get what you pay for.

 

[SkyblueBazza]

The 'big pharma' company I made medicines for had a contract with the NHS. We and a generic manufacturer were the only ones who produced the compound in question but we were chosen despite being more expensive since the quality was more reliable and trustworthy. This was a while ago but the risk always exists with generics that you get what you pay for.

The active ingredient is the active ingredient. That is what produces the medicinal effect.

Most generics fall short via adverse effects caused by the various 'inactive' ingredients. A bit like some people don't eat garlic because it upsets their stomach only sometimes the effect is enough for them to want to stop taking the drug despite the beneficial effect.

The NHS is already in a culture of prescribing cheaply for well-established generically available drugs. Indeed all the fears people have about big-Pharma influence are countered by Precriber bans on Pharma interactions either by individuals, or whole GP Practices, Hospital Departments, CCGs etc. Medicines Optimisation teams make frequent wholesale changes from brands to generics to save money.

That is fine, but it stifles profit which stifles investment in new drug development. 20yrs ago, that was definitely needed as Pharma spent loads developing drugs with a miniscule tweak on the 1st to market to then charge the same or sometimes more for it. Things are much tighter now. It is much more hit & miss for the Pharma companies. One or two win with their brands, most make relatively little...so struggle to get money to invest in developing a future pipeline

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[fernandopartridge]

Interesting stuff Fernando, I hope you never have to soften those type of criteria ! (they’re essential I’d say !) Price criteria is rather important when we/government is paying though so a government giving this control away would be bizarre. Stand to be corrected in future though

When you hear about removal of LPF obligations in Boris Johnsons deal, this is the sort of thing that is implied (to a lesser extent though)

 

[Brighton Sky Blue]

The active ingredient is the active ingredient. That is what produces the medicinal effect.

Most generics fall short via adverse effects caused by the various 'inactive' ingredients. A bit like some people don't eat garlic because it upsets their stomach only sometimes the effect is enough for them to want to stop taking the drug despite the beneficial effect.

The NHS is already in a culture of prescribing cheaply for well-established generically available drugs. Indeed all the fears people have about big-Pharma influence are countered by Precriber bans on Pharma interactions either by individuals, or whole GP Practices, Hospital Departments, CCGs etc. Medicines Optimisation teams make frequent wholesale changes from brands to generics to save money.

That is fine, but it stifles profit which stifles investment in new drug development. 20yrs ago, that was definitely needed as Pharma spent loads developing drugs with a miniscule tweak on the 1st to market to then charge the same or sometimes more for it. Things are much tighter now. It is much more hit & miss for the Pharma companies. One or two win with their brands, most make relatively little...so struggle to get money to invest in developing a future pipeline

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It is no secret that the biggest pharmaceutical successes have not laid in infectious diseases but in cancer, anti-asthmatics, statins etc...the protein target won't change every 6 months. The further into clinical research a drug candidate goes the more invested in its success you become. Thankfully because we aren't quite at the stage of the American system we don't have pharmaceutical sales reps pushing dodgy products onto individual doctors. The government is also still yet to catch up with the fact that a complex compound can be given a miniscule tweak to circumnavigate existing regulations. But these are conversations for another day.

Working on the other side of this, it would be nice if people recognised the years and years of work we do as scientists to get these things right.

 

[fernandopartridge]

Ah, ever the child I see?!

Well having tracked back the only drugs referred to in that link are generically available. That means anyone & everyone can produce them if the so wish & get regulatory approval to do so.

In fact if you research the top 100 most prescribed drugs in the UK they are virtually all available generically. That means that if the US manufacturers want to charge the earth for the brands they produce, the NHS will simply go buy the cheapest available alternative...then the next cheapest...etc until all generic supplies are exhausted before buying the perceived expensive US brands.

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That's what happens today but the direction of travel big US pharma wants is in the opposite direction, with unrestricted or even preferential access to the NHS.

There are generally no tariffs for imports of finished drugs under WTO rules, but the list of products in scope has not been updated for years, it is being held up by the USA for reasons unknown.

 

[Sky Blue Pete]

70bn lost

Brexit deal means ‘£70bn hit to UK by 2029'

love that experts aren’t listened to now

 

[clint van damme]

70bn lost

Brexit deal means ‘£70bn hit to UK by 2029'

love that experts aren’t listened to now

They must be communists!

 

[Mcbean]

16 year olds would offer nothing except the opportunity for McDonnell to offer them the sweet shop for free - most when out of school are more interested in shagging than voting

 

[clint van damme]

In theory no

just watched an interview with Laura Piddock who said Corbyn had agreed to the GE now no deal is off the table.
When the interviewer said it's not she said they classed the extension as no deal of the table because it meant we couldn't crash out on the 31st.

I don't think many people would class that as no deal off the table. Chance of no deal delayed but not off the table.

 

[skybluetony176]

Ah, ever the child I see?!

Well having tracked back the only drugs referred to in that link are generically available. That means anyone & everyone can produce them if the so wish & get regulatory approval to do so.

In fact if you research the top 100 most prescribed drugs in the UK they are virtually all available generically. That means that if the US manufacturers want to charge the earth for the brands they produce, the NHS will simply go buy the cheapest available alternative...then the next cheapest...etc until all generic supplies are exhausted before buying the perceived expensive US brands.

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This link Drug pricing trends in the EU versus in the US - Results Healthcare