Thread by @VincentRK

1/ Cost of Myeloma Drugs—

Lenalidomide & pomalidomide are 150 times more expensive in USA than India; Why? A big reason is true free market competition: 12-18 companies make them

Bortezomib is 25 times cheaper; 25 companies make it.

@DavidP4AD @mtmdphd @myelomaMD @Mohty_EBMT

2/ Usually one generic doesn’t help. A wide open generic market (once patents end) is what really drives cost down. At least 4 plus generics are needed. @US_FDA @tmprowell

So FDA has to be more liberal. Emphasis on safety standards is good. But need to balance it with access

3/ The prices of myeloma drugs in India are driven lower and lower by a desire to compete on the lowest price when bidding for formulary contracts. No middlemen.

We have the opposite: higher list price is more desirable for PBMs coz it means more rebates to pocket. @DavidP4AD

4/ I’m all for respecting patents. But I’m against overpatenting to prolong monopoly protection, 180 day generic exclusivity laws, REMS patenting, questionable lawsuits to prolong patent life, etc. We need a big scale patent reform. @pritikrishtel @IMAKglobal @realtahiramin

5/ Finally, a free market sans middlemen can help even if there is only one generic competitor; & an innovator company that’s willing to compete on strength of its brand name. Eg.,
Generic carfilzomib: $140/vial
Brand name Kyprolis: $ 500/vial
Both 3-10 times cheaper than the US

6/ My talk was well received at the Indian Myeloma Congress. I am deeply appreciative. Look forward to the next one at COMY where @Mohty_EBMT has given me an opportunity. And Lugano. @DrAnasYounes

7/ Lest people think that the generics in India are substandard: No. Many are reputed companies are already making many of the drugs approved and sold in the US. Odds are u have taken meds made by them already. From antibiotics to painkillers