The Windfall

Here’s a snippet from Matt Taibbi’s lengthy, rambling piece at Rolling Stone on the profits that “Big Pharma” is likely to reap from COVID-19:

Take the example of remdesivir, which he describes as having been “pulled off the scrap heap” to become a major revenue-driver. Having failed to be approved as a treatment for hepatitis and Ebola, it is now one of the most in-demand products in the world, and its price isn’t quite so low as Gilead claims.

For one thing, ICER reported it costs just $10 of raw materials to make each dose of remdesivir. Generic-drug producers in Bangladesh and India were already making a version of it, and their price per course of treatment was $600. Meanwhile, Gilead’s own price for governments around the world — the price it settled on for everyone except American private insurers — was $2,340 per treatment.

Moreover, ICER’s assessment of remdesivir’s price relied significantly on the idea that it would actually help save the lives of Covid-19 sufferers. “If the drug doesn’t impact mortality, and only shortens recovery time,” says Dave Whitrap of ICER, “we figure a course of treatment is worth about $310.”

To recap: Gilead, a company with a market capitalization of more than $90 billion, making it bigger than Goldman Sachs, develops an antiviral drug with the help of $99 million in American government grant money. Though the drug may cost as little as $10 per dose to make, and is being produced generically in Bangladesh at about a fifth of the list price, and costs about a third less in Europe than it does in the U.S., Gilead ended up selling hundreds of thousands of doses at the maximum conceivable level, i.e., the American private-insurance price — which, incidentally, might be about 10 times what it’s worth, given its actual medical impact.

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The business model for Big Pharma is brilliant. A substantial portion of research and development for new drugs is funded by the state, which then punts its intellectual work to private companies, who are then allowed to extract maximum profits back from the same government, which has over decades formalized an elaborate process of negotiating against itself in these matters.

How big are these giveaways? Since the 1930s, the NIH has spent about $930 billion in research. Between 2010 and 2016, every single drug that won approval from the FDA — 210 different pharmaceuticals — grew at least in part out of research funded by the NIH. A common pattern involves R&D conducted by a small or midsize company, which sells out to a behemoth like Gilead the instant its drug makes it through trials, and obscene prices are set.

There is no scandal in Gilead’s or Pfizer’s making money. They are, after all, for-profit companies. That’s what they’re supposed to do. The scandal is that we’re subsidizing for-profit companies, not just through research dollars and purchases but in thousands of other ways. These are political problems and the failure of either political party to do much more than posture about the matter is a scandal and an outrage.