Home Forums Discussions General Discussion Drug Reps Policy/Rant

Let's get off the ladies. I don't know what drug reps you people are seeing, but mine are men with nice suits (I bet it drives up the cost) and well-dressed women in suits.

I am sure I am naive, but again, they have a right to advertise their product. You have a right to not talk to them. There must be a reason for them to advertise. It is to sell product. Just like an Audi dealer must charge more from advertising. But, in the end, they make more money.

The drug companies are not into it to help patients. They are into it to make money. And, as a by product, medications are produced that you (everyone) can prescribe. Are they supposed to just sit there and not advertise their product so that Prevacid outsells their Nexium? That's not good business. This is capitalism.

Everyone has a role. Insurance companies screw everyone over, doctors treat patients WITH DRUGS and other modalities, the drugs come from the drug companies who people perceive as evil. The same ones who somehow produced the H1N1 vaccines on two days notice. The drug companies advertise with drug reps. It is certainly much better than television ads. I now use Intuniv quite often due to information exchange and samples. I wouldn't be giving out Intuniv from my television.

Bottom line: Drug companies make drugs. They get rich. More power to them. It's America. Pfizer would go out of business if they decreased their drug costs by 20% just to be helpful to the patient. They advertise how they please. You/We decide whether to use the drug or not. I suppose we could argue all day whether their business practices are ethical, but how they advertise is something you can control. Don't see them. But, I will see them. Because they are helpful and they supply samples. Just my take on it.

What happened to the government's proposal to get rid of drug reps and instead supply their own people to educate and be unbiased. The first day they come in, they will have to head right to DD before I listen to them.

I don't think that drug companies are evil, but I also don't respect their sales and advertising practices. We all know that Merck knew the problems with Vioxx, and suppressed the cardiovascular risks. Bayer was fined for misrepresenting risks of Yaz in consumer ads. Johnson & Johnson was sanctioned for its Risperdal antipsychotic for off-label marketing. Eli Lilly employed irresponsible marketing strategies that down-played the increased risk of diabetes to physicians and promoted off-label usage of Zyprexa. All of these misrepresentations were foisted on us by the drug reps. It's amazing that they can even look us straight in the face.

The drug companies are also instilling their amoral behavior in research. The University of Illinois at Chicago?s Center for Pharmacoeconomic Research that over half retracted drug studies were attributed to scientific misconduct, including "data falsification or fabrication" and "questionable veracity" -- triple the retraction rate of other biomedical research. Merck routinely generated clinical study reports and review articles, "ghost-written" by the company?s marketing department. Spanish researchers found that only 34.5 percent of drug company-funded studies versus 65.1 percent of studies funded by other sources identified significant adverse events from inhaled steroids.

Drug companies are rewarded for significant research costs by an insanely long patent periods and often obscene prices, squeezing sick people. Almost alone within the other segments of the health care system, they are allowed to act in this predatory way, capitalists among the sheep.

Hey, did I forget to say that I don't think drug companies are evil?

Bert,

Is this capitalism?

If a car company wants to sell me their car, I decide if the money spent is worth it. I will decide if the value of the product is worth the money. I will decide how much that car is worth to me. I will realize that the money I spend on the car is not there to spend on something else. I would look to see if a competitors car is cheaper.

If a drug company wants me to rx the latest and most expensive ARB, I have no financial stake in the transaction. None of the above considerations apply. The patient, who puts out a small share of the cost, really has little input. The insurance companies or state, who put out most of the money, have no input (except denial or prior auth.)

This, to me, is far, far, far from capitalism.

The current system shields the drug companies of most aspects of capitalism.

Gene

Never said the drug companies didn't do unethical things or even criminal things. I highly doubt if they were covering up Vioxx problems they would tell their drug reps.

And, I always thought it was the insurance companies driving up health care. I don't see where they do anything good for patients.

But, I give up. This is kind of hijacked. I like drug reps.

"The current system shields the drug companies of most aspects of capitalism.
Gene"


Definition of capitalism is.....

An economic and political system in which a country's trade and industry are controlled by private owners for profit.

So, how do you figure it aint capitalism? Perhaps you meant free enterprise? To previous poster re insurance companies somehow driving up medical costs I would ask do you prefer competition or a single payer controlled by bureaucrats and pols?

(Hint: My patients or I can "fire" an insurance company)

I too like drug reps. Samples are invaluable for determining if something works or isn't tolerated. A bunch of samples can be a Godsend for patients who are down on their luck financially. If someone actually prescribes a medication only because the drug rep bought them lunch then I suspect that physician hasn't a clue about the area of treatment to begin with or a very big girth.

Generics are a double-edged sword. No more samples so need to take a flyer and write script. Hunt down "coupons" for indigent etc. Bummer.

Thanks Ches. I COMPLETELY would prefer a single payer system. It may be horrible, but it has to be better than what we have now. I pay around $700 per month, so the insurance company can tell me they won't cover my $1200 worth of labs. At least if I walk into a drug store and pay $500 out of pocket for a med, the pharmacist gives it to me.

I am sure I will get shellacked on these statements, lol. I just have NO sympathy for insurance companies.

Ches,

You are right. I should have said "Free market capitalism."

However, I question how a patient can fire an insurance company?

Thanks. Gene

Bert, in the days when I did see drug reps, I liked them, too. They were attractive, pleasant and totally appropriate young men and women, who believed fiercely in the value of their product and their companies. I was treated with respect. As human beings, they were great and as salespeople, highly effective.

Again, the problem is, the information they gave was highly distorted. Not their fault. But it was. And every time I looked at that shelf of samples, I could only wonder how they could leave me with 50 tablets of something that they then sold for $20.00 a pill. Samples that then as likely as not ended up in the hands of those who needed it least.

I think the system is wrong. And, even though I liked it, and them, I bailed.

Been there done it. United Healthcare reimbursed less than Medicare. I dropped them and told their patients sorry, please talk to your employer(s) about offering a different insurer next time around. I called the CEO of a medium sized manufacturing company who I knew socially and clued him in re "unhappy docs and employees". Emerald Health Network came in with ridiculous rules and payments. Same scenario. Ultimately UHC dropped by local businesses and then shaped up (okay, a lawsuit in southern Ohio helped) and I opted to see their patients again. Emerald was dropped the next year by the three major local employers (including my own hospital!) and happy patients returned to the fold.

For the life of me I don't see how any physician can think they are going to have any influence whatsoever over government and it's sea of bureaucrats, pols, lobbyists, grifters etc. Maybe it's simpler to have one entity to bitch about? Simplicity has it's virtue ;-)

See my experience re "firing" insurance companies. Try it, it will make you feel "free at last". Understand your out of pocket expenses are high (I pay my employees med insurance, copays etc) but how expensive do you think it will be when it's "free"? I suspect your out of pocket $1,200 added to your $700 would be about right for the government's monthly monopolistic fee for your future free care.

Two points that perhaps you haven't considered.

1. Around the world single payer (aka socialized) systems are straining the budgets and racking up unsustainable future debts. All this and yet we are subsidizing their pharmaceutical costs! If they paid their fair share (and our pharma prices benefited) a truer, scarier picture would emerge.

2. Do you notice every few months there's a headline "Medicare Bilked for 30 Million Dollars" by doctors, medical device shams etc? Most recent one last week in Miami. The month before 20-30 million for mail order penis pumps etc. Exactly when was the last time you saw headlines "Local Medical Group Bilks Aetna (or name your private insurer) for 30 Million Dollars"? That alone ought to tell you how you will pine for the good old days when you only paid $1,200 out of pocket now and then.

Just food for thought.

(Frankly, I've been in practice for sooo long I'm just in it for fun but most of you will have to deal with the options on the table)

Thanks Bob,

My $1200 was due to the fact that it was the wrong CPT codes. If lipids had been screening, then paid. But, if for hyperlipidemia (any code to correlate) it isn't.

Antitrust. Personally, I am sick of the antitrust stuff. Lawyers would never put up with this stuff. Bill me for $185.00, get $90 back. Or maybe the attorney insurance wouldn't cover it.

I know I can't say this, but if all of the PCPs in Maine decided to not see one group of "insured" the system would fall apart, and they would have to sit down and negotiate. That would be if we were willing to loses our licenses I guess.

The other problem as I see it is the public don't know anything about. The public is a powerful entity. They think we are overpaid. Katrina hits and the entire U.S. knows in a day and is all over the government. We and our patients put up with insurance companies day in and day out, and I doubt a Congress person would know what Medicaid pays.

Andrew, I don't think this was your intent, lol. Still a good discussion with just a hint of hijack.

Antitrust. Personally, I am sick of the antitrust stuff. Lawyers would never put up with this stuff.

Bert

Of course most patients think, those that care to think, that the AMA is a union. Only physicians know how restricted we are by antitrust. Socialized law has always made more sense than socialized medicine. After all we ARE all equal under the law supposedly but some poor shlub does time in the slammer for stealing a six pack while another guy kills his wife and a waiter then walks free cause he's rich.

After having my bone marrow sucked dry by my first onslaught of patients this a.m. I met with three drug reps, 2 women and their boss, a man, over lunch and I have to say got my battery recharged after a quick but nice lunch and a conversation that addressed the issue on this thread.
I suggested the formation of a "red easy button", like the staples button, any time my nurse gets a denial fax or phone call for a branded drug. She hits the button and magically the branded drug is approved without any hassle. I do not think it is appropriate or fair to have my nurse spend a half hour on the phone to get the branded drug approved, and there has to be an alternative to fight the bullying of the insurance companies imposing their will over our decision making.
After more thought and introspection-- I really like having actual live human beings to discuss my concerns with as it pertains to their particular drug. I like having samples available so I can delegate it to those I choose, and for now will continue to meet with drug reps, even for all the arguments that can be made against doing so, it is nice to be catered to and listened to, and maybe overtime some of the power in medical decision making can be reestablished (probably wishful thinking).
I think for all the shortcomings of big pharma, that excluding the drug reps in the office will have more negative effects than positive at this time, for my style of practice.
But that is what makes America the best place to live and practice.

Thanks jimmie. Today, I saw two kids who were exposed to strep a week ago. The symptoms the kids with strep had were sore throat and abdominal pain. Classic. Supposedly, none of their RSAs came back positive the first day, but they did the second day. So, the mother (very reasonable) was convinced that even though are RSAs were negative with a NPV of about 97%, she knew that tomorrow they would be possible. I wasn't going to argue with her, so I compromised. I sent the culture, which I rarely do, and wrote a prescription for $50 mLs of amoxicillin. I don't like using amox when I am not certain of the diagnosis given the mono/red disease, but I didn't want to write for anything else given penicillin tastes awful. This way they could take the 40 mLs while I waited on the culture.

Flash back 10 years ago. Message to MA. Please give two samples of Cefzil to these patients. Done. No going to the pharmacy. No calculating dosages and explaining what I was doing. Did it drive costs up? Maybe. Did it improve patient care and satisfaction? Yes.

4 year old boy in waiting room for 45 minutes. Crazy day. I can relate jimmie. CC: Conjunctivitis. While my MA put a patient back, I asked them to come back to triage. Eyes red. Vigamox sample given. Patient does not have to go to pharmacy. Patient did not have to wait to be triaged. Now, they are happy, and I have gained ten minutes. Was my care great? Not particularly. H flu runs with conjunctivitis. Didn't look at the ears. But, no ear pain.

Just some positives.

OK, I can't stand it!!

Today I got a copy of the American Journal of Medicine, a journal I do not subscribe to and rarely glance at. But there was a little doohickey included in the package. it turned out to be a USB thumb drive pre-loaded with advertising of a Viagra clone.

Now, I know USB drives are fairly cheap. But am I the only one that is offended that a company is going to send an advertising blurb that overall must cost over $10.00 a pop to every doctor on the mailing list of an unsolicited journal? Is there any way possible to see that and NOT believe that salespeople and gimmicks significantly increase the cost of medication?

No and no.
So they can't give you a pen or a pad but they can send a thumb drive? David, that must have been educational material and not advertising. That's what made it ok.

And how do we know that thumbdrive isn't preloaded with something you DO NOT WANT?

JamesNT

I know this is off topic, but is there a way to "scrub" the thumb drive and clean it up?

http://technet.microsoft.com/en-us/sysinternals/bb897443

JamesNT

By definition we don't want them.

JBS,

True. Of course, I'm speaking from a technical standpoint in that how do we know the drives don't have malware.

Apologies for the ambiguity.

JamesNT

I'll take them. First, if they come from a drug company, they likely won't contain a virus.

Two drug companies can advertise any way they please. It's their money, and it must be effective or they wouldn't do it.

When I listen to Rush Limbaugh, I always think when he bashes EVERYTHING the democrats do, that it would seem it would be more effective if he at least agreed with one thing they said a month. It would seem like it would give him more credibility.

But, the producers and those who run his show and want Republican voters must run the numbers and have found that by bashing EVERYTHING they say, the results are better than another.

I wouldn't have a problem if they gave cars to every single physician. I just see it as capatalism and figure they can choose journals, TV commercials, pens and paper, USB drives or whole computers.

Just my thoughts.

Bert, on some days I'd agree. But, just yesterday, I had to deal with a patient who manages a fast food franchise, low income (but not low enough), no insurance, who could not afford insulin because it was going to cost him more than $1,000 a month. Rabid reactionary capitalist that I am, that level of care really should be possible for anyone.

I have a bit of scotch blood circulating so find the idea of scrubbing the "free" thumbdrives appealing, and have thought of handing out to patients thumbdrives for those that travel or just want to have their records available on person--i think there is a guy from Findley Ohio that has been handing out thumbdrives but I can't remember his name.

Also for what it is worth, I hate TV advertising the pharmaceutical companies do, but I miss the "free" trips to Chicago, Seattle X 2, San Antonio, Cour de Lene that were my vacations when I first started practice many moons ago.

OK, and I don't want anyone to think I am cold-hearted, I just can't get past this way of thinking. First, I should say that what you describe would not take place in Maine.

Let's take another situation. A family of four, dad is out of work and mother does her best with cleaning jobs (please don't find that sexist). The father goes to the local supermarket every week and purchases some Top Ramen, milk, Wonder Bread and Jif Peanutbutter. This is what they live on until he gets a job or they receive TANF and food stamps.

Now here are two ads for Jif and Wonder bread.

Now based on your post where I am assuming that your message is that if drug companies didn't hand out $10.00 thumb drives, then insulin would be cheaper. I would contend that without their advertising, they would not be able to sell enough Viagra (unfortunately that is the medication we are dealing with, although I do use it for pulmonary hypertension). If you look at most industries, advertising is essential to continue with a product line. Certainly, a Toyota Camry would be less expensive if Toyota didn't have to pay for advertising, but without advertising Toyota would be forced to discontinue that product line. In fact, we don't have the numbers, but it is possible that the Camry is cheaper, BECAUSE Toyota is selling more of them due to advertising. My guess is they have people in their company that do just that. Determine where the price point of advertising vs. cost of car and sales.

I simply do not understand how we as doctors or anyone expect the drug companies to be able to sell their product without letting doctors know it is out there. I would not be prescribing Intuniv, the only long-acting selective alpha2A-adrenergic receptor agonist. That is the whole idea of advertising. Without it, the product doesn't exist. Now, that brings us to how do you advertise. Radio? Television, drug reps, etc. I don't watch much TV, and I doubt I would have looked into it that way. Radio isn't used that often. Whether I like drug reps or not, and the Intuniv rep is a good one, being introduced to Intuniv by a live person had my interest. Same as with the new ADHD suspension. At first, it was not covered by Mainecare, but since I used it more than any other physician due to how well it worked, we received samples, which I gave out. And, like in the old days with many drugs, they were the perfect starter kit.

As you may have already seen, I inserted two links to bread and peanut butter. One could make the argument that the ads (especially the Superbowl ad) raised the price of the two products making it less affordable to the family above? Does that mean, Jif and Wonderbread don't have the right to advertise? In fact, again, if they didn't, Jif and Wonderbread would cease to exist. But, given the ads are on TV, it isn't so transparent. What if the two companies had Jif reps and Wonderbread reps that stood outside giving "free" sandwiches to shoppers? Would there be an article in the newspaper stating, "Local family can't afford peanut butter sandwiches due to food reps giving away their product. This surely must increase the prices of the two products inside." And, Jif's actions were even more costly as they gave out brochures of studies showing that kids preferred Jif over Skippy and Peterpan 3 to 1 and that it had lower cholesterol. And, Wonderbread hands out brochures touting their new Wonderbread + with white bread and whole grain combination.

I don't know. I will listen to the rebuttals, and I am not that smart about this stuff, so I will get reamed over this, but at least I will learn.

Disclaimer: The author is not affiliated or associated with either Jif or Wonderbread. In fact, he prefers Skippy brand peanut butter.

"free" for me--as I realize it costs the pharmaceutical companies to market and that is their choice so they can move the "merchandise". I just can't stand the multitude of tv ads for pharmaceuticals, and for that matter lawyers or docs. I guess I am a bit old school when docs never advertised for business when I grew up, just word of mouth. This carries over to the distaste for the pharmaceutical tv ads--I know it is not logical, but that is how I "feel".

Not too long ago, drug companies weren't allowed to advertise on TV. But, now it seems, everyone prefers that over drug reps. It's funny, because when a group of people don't like the way Exxon/Mobil do business, they boycott the product, but I know of a certain doctor around here who depises drug reps, treats them with disdain and generally will not see them. But, I do not see that doctor boycotting Enfamil Newborn or Nutramigen or Concerta. If you think that Janssen Pharmaceuticals, Inc. has increased prices for Concerta, then don't use the product.

OK, Bert... suppose you are correct. Then what DO I do the next time I see this guy? Just say "Awfully sorry, but if they don't get to charge $1,000 a month for insulin, they won't want to develop their trade name mood elevator with no advantages over an already developed drug " ?

I am all for the profit motive. But there is a line someplace that distinguishes successful from greedy. Like pornography, I may not be able to define it, but I know it when I see it.

I do have to agree with Bert, Skippy is much better tha Jif

No, you blame the government for setting up such a system. To not have health care for everyone even though it has been around for decades. You blame the FDA, because the mood drug had to pass its tests not only for the four phases, etc., but it has to show why it is different.

There could be things we don't know. One of the drugs I take is over $800 a year, but I get it for $20. I am sure the insurance company doesn't pay $780.00. Maybe that company makes a profit off Viagra so they can pay for the other. All of the big chains like Wal-Mart, etc. have loss leaders for many products.

I just don't understand why drug companies who can make that $800 to a self pay person, needs to sell it for $400. It just isn't the drug companies' responsibility to treat the needy or fix the medical system. It is their job to 1. Make good and safe drugs, if possible, and 2) make money. It's simply capitalism.

Why should the drug company subsidize the patient. Personally, I have paid for quite a few things for patients, but why don't I pay that $1,000 a month for that patient? I would still turn a profit. But, for the most part, it's not my place, I don't have to, and I'm not going to.

This isn't going to be solved by one of the big three, (providers, insurers or drug companies) making a big change to rescue healthcare. Instead of Congress and the President who, for the most part, know nothing of medicine or the business of medicine, a huge commission should have been devised with nurses, doctors, attorneys, economists, businessmen and women, insurance executives, pharmaceutical representatives and sat down for a year and come up with a doable system. The Lee Iacocas and Ross Perots of the world should be heading this commission along with economists. Of course others as well. But, how does a congress person who has no idea what the reimbursement of Medicaid, Medicare and private insurance is and has to read a 10,000 page document in a matter of a few days going to make a good decision?

My final thought (for now) is that I am a compassionate person, and I think someone needs to help your patient, but it isn't the drug company's responsibility at all to lower what it charges for a drug so people can afford it. The drug company's responsibility is to make money for its stockholders and charge what the market will bear.

BMW can charge $55,000 for its 335xi. Why should it sell it for less? The difference is that no one feels sorry for someone because they can't afford a BMW.

Don't get me wrong. We see self-pay patients for $25.00 and some patients at no charge. We have, at times, had someone walk in off the street and treat them at no charge and even did follow-ups.

I am sure that some people think that samples cause drug prices to go up, etc. I think that there is way less chance that the "trickle down theory" of drug companies helping by decreasing the cost of insulin from $1,000 to $800, than for hundreds of samples being right where the patients are.

Bert, deliberately picked this example because Insulin has been in use for about 100 years, and I suspect the patent has run out. Costs like this can only be explained by assuming a company charges what the traffic will bear, to a totally captive customer base, with no relationship to what it costs to develop or make. I do believe a company, doctor, or other vital service has some humanitarian responsibility in addition to profit. Someone in their system should say "Wow, we can make this drug for $0.14 per dose. Maybe a 10000% profit is a little excessive, since our customers have no choice?"

I have the same issue on a local level. A vial of Remicade costs less that $700 at Drugstore.com. If the hospital gives the infusion, they charge about $8,000.00. And, it is not like my crohns patient can walk down the block and get it cheaper. They have no choice. Now, I know they use a precious IV bag and needle, and 15 minutes of nurse time, and need to make money, but that is just greed.

You make some good points.

Yes, but the hospital at least has overhead and cost shifting it has to make up.



In a purely capitalistic system, there would be no insurance, no government programs and no restrictions of access to either the medical or pharmaceutical systems. Over 50% of the health care in this country is provided by the federal government and another 20% are not insured. But we want to pretend that the private insurance system is the dominant system in the US.

We have, as a society decided that health care (at some basic level) KIND OF is not a right. I say kind of, because:
1) Hospital ERs are not allowed to turn away patients, nor ask their their ability to pay. Then they must admit them and cannot dump them on another hospital. This would suggest that some level of care IS a right.
2) Somehow local governments have become responsible for health care of the uninsured. Why would this be necessary if health care were not a right.

If some level of health care is mandatory and government is assuming the burden of the cost of providing the care, then fully laissez faire pricing for necessary drugs is not in the interest of the larger society and some type of price control might be warranted.

OK, now that I sound to the left of Teddy Kennedy in proposing A) health care as a right and B) price controls on "essential" drugs, I think that it is not only how we have been operating as a country (we put price controls directly or indirectly on quite a number of products, and have already demonstrated that the government provides the bulk (when you include state and local government) of health care in this country.)

While there are those who feel that we should have more of a laissez faire government and less regulation, we are already the only large economy country in the world who does not completely operate as if health care is a right and provide the service to our populace. ("so if everyone else was jumping off the bridge, you would too???") I suspect the majority of persons in this country feel that some form of health care should be mandated, this would only go to suggest that indeed every other country has the right idea.

We have rampant inflation in the health care industry and spend exorbitant sums of money on health care. One way to curb the cost is some type of price control.

WE PHYSICIANS HAVE ACCEPTED IT FOR YEARS WITHOUT ISSUE. Medicare sets the rate and most insurance companies base their rates off of their rates. We must, by law, charge all insurance companies the same rate, and yet they will pay what they wish, not what we want. That, my friends, is PRICE CONTROL. If you don't like it don't accept insurance. Sure, there are a few docs who don't but they are a tiny minority.

So I will argue that I am not to the left of Teddy Kennedy (although he was OK in my opinion) but rather closer to where America has and probably should be operating. Now, let the debate ensue.

That was extremely well put. I think your point about cost shifting is exactly what I was referring to. And, while I agree with David, I still don't think it is the drug companies' duty to fix the system or sell their drugs at a certain price. Although I do agree with his main point, which is they have a captive audience.

Exxon sells gas way over the price they need to. But, like us physicians who continue to agree to take $42.00 plus for Medicaid, people continue to buy gas from them. I would think that three months of EVERYONE buying gas from Citgo would start a price war. But, I REALLY digress.

I had a mother and a 22 year old patient come in whose sister has mitochondrial disease. He just finished college and is going into law school. He has an IQ in the 160s, can play chess blindfolded and talks faster than anyone I have ever heard. He is extremely liberal. He has nothing to do with healthcare, but BLEW me out of the water in the debate. His mother continued to point out the experience vs his looking at it intellectually.

But that is why we need to look at healthcare from a pragmatic point of view with a large group of very intelligent, objective people.

And, just like the story above, I couldn't begin to argue with Wendell as he is much smarter than I on these topics. Yes, I can out debate him, MAYBE, on some motherboard issues. But, this is why I have such high regard for him.

I will say that the drug companies operate in a capitalistic fashion in as much as they can.

And, I realize this post adds nothing to the overall topic other than to acknowledge that I would never engage in a debate with Wendell.

Not really a debate with you, more a point of view. I have long learned that everyone has a point of view and there is something to be learned by investigating all of them. I doubt I am smarter than you but have in varies points in life focused more on group level health care.

Of course the drug companies are capitalistic! They are trying to make as much money as possible. I understand that Gardasil vaccine was priced after looking at what savings it would achieve and retroverting it to a per dose basis. While this may have just been justification for their price I have little doubt it is many times the manufacturing cost, even when the cost of researching, testing and FDA approval are factored in.

My point is that while we control costs in many areas, we let the drug companies charge what they will, or at least for 17 years.... then the generics come into play and the price (within a couple of years) plummets precipitously.

And unless there is intervention, drug companies will remain as profit oriented as they can. It's the American Way!