Remdesivir priced at $3,120 for 5 day course (10 day also in EUA and twice as much). $GILD says will discount to $2,340 for ‘government programs (incl Medicare)’ in the US (and other countries). I have thoughts: 1/n https://www.wsj.com/articles/covid-19-drug-remdesivir-to-cost-3-120-for-typical-patient-on-private-insurance-11593428402

Diff price for Medicare?? Rem is for inpatients, hospitals buy drugs in bulk, not based on which insurance a future patient will have. So $GILD cannot price discriminate at purchase, and rebate to hosp after fact is a kickback. $GILD how are you doing this? @joewalkerWSJ 2/n

The cynic in me (I know. redundant) expects $GILD will now request Medicare makes separate Rem pmt to hospitals to enable the discount. Medicare rarely makes these 'add-on’ pmts (the NTAP), they are not at full price, the hosp eats the diff, still don't know how this works! 3/n

No surprise $GILD picked price in the sweet-spot – high enough to somewhat satisfy investors, low enough that they can claim they showed some restraint compared to some analyst estimates. The ‘anchoring’ strategy I described here wrt $NVS Zolgensma 4/n: https://www.statnews.com/2019/06/04/anchoring-price-zolgensma/

Savings on reduced length of stay are being exaggerated as hospitalized patients trend younger, as younger pts who can be discharged after night or two, will be kept for 5 day treatment, driving up costs a lot (medicare doesn't even count one night as an inpatient event) 5/n

Big picture pt #1: The release I wanted this morning from $GILD but didn't see. That they would run the trial to define Rem's utility in this widening pandemic – an RCT of dex +/- Rem with mortality as an endpoint, we don't know if Rem is needed in more severe pts at all 6/n

Drug cos do not run these kinds of trials. $GILD would risk showing no benefit of their now multi-billion $ drug. Only data we have on ? is underpowered Wuhan RCT of Rem, in which most patients got steroids, Rem did not have any effect on mortality 7/n https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31022-9/fulltext7/n

Big picture pt #2: "Savings" from shortened hospital stay bake in excessively high US hospital prices. Next up Covid vaccine maker will claim they save money b/c they prevent people from needing Rem. Sensible pricing needs to start somewhere 8/n. https://www.nejm.org/doi/full/10.1056/NEJMp1512750

Big picture pt #3: We need to run more trials, we need to do stratification of treatments and long term follow-up. Doing so will mean some drug companies will have franchises weakened by data. But what is impt is those data will help patients - where the priorities should be 9/9