Is the author actually right to live and work in the US, and only fly back to Britain for getting medication subsidised by British taxpayers? And is the fact that he can do this just an indication of US healthcare being screwed?
The post doesn't tell too much about facts and I don't know the British rules for eligibility to NHS, but I think it's possible he could be committing fraud. If he were doing the same with my country's national system, it certainly would be fraud (though it would probably not be possible in the first place, because we have a Big Brother that knows more than the British one).
The rules aren't written in a particularly clear way, but in general the idea is that NHS eligibility is residence-based, and people who aren't ordinarily resident are entitled to urgent treatment only. Flying back just to pick up prescriptions is definitely against the spirit of the rules.
Enforcement -- or even understanding -- of the rules on a local level seems spotty. I've helped overseas visitors find their way through the NHS. Some GPs and out of hours services have treated them like a local patient and when asked about payment had no idea, whilst one GP pulled their wallet out in the consulting room and demanded cash there and then. Hospitals are supposed to be more consistent, but I haven't any experience there.
Well the fact that drugs are twice as expensive (or more) in the US* and the fact that the US accounts for a huge chunk of government funding into the relevant sciences are part of the reason why drugs are so cheap overseas. British taxpayers buying drugs in Britain are effectively getting a subsidy from US taxpayers even though they don't pay into the pot, so this all seems like a stroke of cosmic justice where I'm standing. Of course, I doubt the British tax authorities care much about what I think.
* Why? Remember how bargaining works: the biggest customer gets the best deal. First imagine Kaiser, Wellpoint, and Aetna sitting down at the bargaining table. Now imagine Canada sitting down at the table. Now imagine the European Union sitting down at the table. But at least our insurance companies are more efficient due to competition, right? Spoiler: not even close, and that's before you take into account the costs they offload onto the rest of the system in the form of incompatible claims policies, paperwork, and exploitation of information asymmetry against consumers.
The European Union is not bargaining as a single buyer.
There are considerable differences between the health insurance systems of EU member countries, and each of them buys their medication differently. In fact, it looks to me that the US is closer to being a one buyer than the European Union, which would first need to do a lot of harmonizing and more or less set up a United States of Europe.
Kaiser, Wellpoint and Aetna each have as many health plan members as a medium-sized European country. That's not the problem.
As far as I understand, the problem is the unavailability of generic replacement medicines in the US, clearly for IPR reasons.
> Well the fact that drugs are twice as expensive (or more) in the US
You have to compare like for like though - looking at the cost to the end user is not relevant, you'd have to look at the cost to the NHS versus the cost to US health insurance companies.
For the NHS, this is publicly available data[1] and we can see that a course of once-daily apiprazole (the drug described in the article) costs the equivalent of $150-300 per patient per month, depending on formulation. Is such data (of actual cost) available for the US?
Also, regarding biomedical research - the British taxpayer funds this as well. Anyway, apiprazole was developed in Japan. It's not all US-centric.
I don't know figures, but I imagine Kaiser represents more than 35 million people (the approx population of Canada). Shouldn't they be able to negotiate the same price?
Bingo! The largest US private insurer (United) cover 40M lives in the US. They pay higher prices than nearly all European countries (even the ones with smaller populations).
Drugs aren't cheaper in places like the UK because the gov't negotiates lower prices. Drugs are cheaper because the gov't mandates lower prices. People shouldn't confuse the two.
Drug companies spend more on marketing drugs to doctors and consumers than they do on R&D.
In the UK, marketing drugs is illegal and therefore they don't need to go to that expense. All they have to do is convince an NHS board and then it's on the list of approved prescribed drugs.
Some similar claims I have looked at have used the "Selling, General, Administrative" off of an income statement as the marketing expense, but that category includes salaries and buildings and lots of other things, not just marketing expenses.
Reading the BBC article reminded me of all the fines also. People are paying extra because drug companies push off-label uses on consumers and then get fined for it. It's not like the company really pays, they just up their prices a bit and push it onto the consumer. That sort of off-label usage doesn't happen in the UK so much, because doctors don't have any incentive to prescribe anything other than the NHS approved drug for a condition.
Costs associated with advertising are expensed in the year incurred and are included in selling, marketing and
administrative expenses. Advertising expenses worldwide, which comprised television, radio, print media and Internet
advertising, were $2.5 billion, $2.3 billion and $2.6 billion in 2013, 2012 and 2011, respectively.
That advertising number most likely does not include money they spend directly marketing to doctors and so on. So the Global Data report referenced by the BBC implies they are spending $15 billion directly marketing to doctors and other medical people/organizations.
The next step would be to figure out what they are spending paying employees (with 120,000 of them, quite a lot), but I can't find good numbers on that.
"Marketing drugs to doctors" is not exactly the same as "total sales and marketing budget". I don't even know if "cost of sales" includes the cost of regulatory approvals in various countries.
Also note that there is not necessarily anything bad about off-label use of medicines.
Medicines could be off-label simply for the reason that the regulator - out of pressure from the public health insurer, or more bluntly just the Department of Treasury in the country - does not approve using a medicine for some purpose, even though it is known to be efficient and without bad side effects.
In fact, in some cases patients are complaining bitterly because they cannot get the medicine that their doctor knows would help them, because their regulators do not approve off-label use.
A medicine can also be off-label simply because of its price - there is evidence base, but the regulator says that the health care system shouldn't pay this much for ailing this medical condition.
Of course that keeps the prices lower. That's the purpose. It also keeps some medication unavailable for some patients. I don't think it's a huge problem, but it's there.
Whoa there. Says who? The largest part of marketing drugs is paying sales reps to visit doctors. Are you saying that's banned in the UK? From what I've seen that's not true.
If you're saying DTC (direct to consumer) marketing is banned, then I agree (for prescription drugs). DTC is not all there is to drug marketing.
Also, you're fooling yourself if you think doctors have the time to research new drugs. That's why there are reps. They provide educational information, data from new trials, etc, etc.
Individual doctors do not make purchasing decisions. They don't have pharma reps turn up at GP clinics handing out free lunches in exchange for prescriptions. The NHS decides what drugs are allowed to be prescribed and doctors are limited to that list. It puts a huge crimp in any marketing.
Individual doctors don't make purchasing decisions, but they do make prescribing decisions which drive sales. They are the key stakeholder when it comes to pharmaceutical marketing. They may not be buying lunches in the UK, but sale reps are getting time with doctors and talking up their products.
BTW, is there a law in UK (or US) about using generic products? Over here, a doctor prescribes something, but pharmacies have the responsibility to offer cheapest product, typically a generic replacement when available, unless the doctor justifies a specific brand with specific medical reasons (which are rather hard to come by).
From a moral standpoint, I'd say this person is in the right - they've paid in to the NHS at some point earlier, or their parents had - to cover this sort of thing. Legally, I don't know enough about the NHS to say for sure.
From a moral standpoint in the USA the international megacorp will say "Oh, your health is worth anything to you? Hmm. Howabout everything you got minus $1" Like a semi-kind mugger. Its not a free market. Pay up or die, sucka!
In the UK the .gov will fight for you instead of the corporation so you pay a fair price. The UK gov is under no life and death pressure to pay up or die, and they have regulators who are educated and understand the market. It is a much free-er market than the USA market.
Arguably what he's coughing up in hotel fees and surcharges and taxes and hotel prop tax is Exactly how a visitor should be paying for medical care, so on an individual level he's moral and ethical.
Not getting screwed over when someone else gets screwed over does not imply some kind of survivors guilt is ethical.
That's an interchangeable commodity service and the discussion was about commodity medication. A free market requires a meeting of equals and we have a journalism grad vs the combined minds of PHD chemists and MBAs... sounds fair and free. It also requires participants in the negotiations to not be under duress, like, say, death without medication. Obviously the UK market is free-er than the US market by a considerable amount.
This is false. The UK has a national health service and private provision running side by side. Any doctor is free to work outside the NHS to provide private practice.
I'm talking about the UK, that's why I put "nearly all healthcare delivered".
My argument is that calling the UK system more "free" when a very large percentage of all healthcare delivered is purchased by a single payer is inaccurate.
>> "they've paid in to the NHS at some point earlier, or their parents had"
Yeh, to cover them for the time they were paying. If you're no longer paying your taxes or seeking employment or unable to work due disability the money you paid in the past should't cover you morally.
Edit: There's no doubt the price the writer has to pay in the US is a disgrace and if they couldn't afford it then I think using the NHS is a good temporary solution but the fact that he could afford it but uses that money for a holiday instead is very immoral imo.
Huh? I didn't say that at all. This person CAN afford their medicine. Instead they spend that money on a trip to the UK to see family but also gets their medicine. Medicine they didn't contribute taxes to pay for.
> Yeh, to cover them for the time they were paying
So... what if someone is no longer paying anything in, living there, but is a huge net drain? Should people only be covered while they're able to pay premiums/taxes?
Not to mention that most young ex-pats do eventually come back to the country and contribute. I'd rather they came back alive and well, even if it is me footing the bill for them in the meantime.
That's one of the big missing parts of the US healthcare debate. It's not just about immediate cost, it's about potential future tax revenue and economic value that you're losing when you let people die before their time.
But the rules are a bit complicated so maybe it's fine.
It's weird that he gets a six month drop of medications each time -- that is very unusual behaviour from the prescribing doctor and the prescription-filling pharmacist.
It's not fraud. Such charges for overseas visitors only apply for hospital treatment - prescriptions are explicitly excluded, and are subject to the statutory price that everyone pays (unless they are exempt and get their medicine for free), see: https://www.gov.uk/government/uploads/system/uploads/attachm...
Thank you for finding that - a surprisingly readable source. Para 23+24 spell it out quite clearly, as does "Powers to charge those not ‘ordinarily resident’ were introduced through the NHS (Amendment) Act 1949, but were not enacted through regulations until 1982. These charges were and remain only applicable to hospital treatment."
The post doesn't tell too much about facts and I don't know the British rules for eligibility to NHS, but I think it's possible he could be committing fraud. If he were doing the same with my country's national system, it certainly would be fraud (though it would probably not be possible in the first place, because we have a Big Brother that knows more than the British one).