
Gujarati: 
હુ અહી સ્તન્ફોર્દ મેદિકલ સ્ચૂલ ના પ્રોફેસર લોરેન્સ બેકર સાથે છુ. અને અાષા રાખુ છુ કે તેઅો વધુ નહી તો માત્ર
કાઇક સમજ ની સરુવાત કરિ અાપે, જે કાયમને માટે મારા વીચારો મા હાય છે અને મારી જરાક ચિન્તાનુ કારણ પણ છે. ચાલો અેમ માનિ લઇઅે કે
હુ કાઇ દવા ની કમ્પની અે ધરાઉ છુ. હવે ધારી લઇઅે કે હુ ૧૦ વર્ષ મા ૧૦૦ મીલીયન નુ રોકાણ કાઇ નવિ દવા પર કરુ છુ.
હુ તે દવા ને ક્લિનિકલ ત્રિઅલ માથી ઉતીર્ણ કરાવી અને FDA ની મન્જુરી પ્રાપ્ત કરી લઉ છુ. અને તે
રોગ X ના ઇલાજ માટે બનાવી છે, હવે અા પરીસ્તિતી માં હુ બહુ મારા મનમ મારી દવા ની કંપની માટે બહુ ખુશી નો અનુભવ કરીષ.
પછી શુ થષે ? મારે હવે ઇન્શ્યોર્સ કંપનીઅો, મેદીકેડ, મેદીકેર, પાસે જઇને તે જાણવાનુ કે
તેઅો મને કેટલી કીંમત અાપવા માંગે છે. તે વર્તાલાપ અાવી રીતે થષે.

Arabic: 
أنا هنا مع البروفيسور لورانس بيكر من كلية الطب جامعة ستانفورد وأنا على أمل أنه سيتمكن على الأقل
من أن يبدأ يجعلني أفهم شئ كان دائما يثير تساؤلاتي و يقلقني قليلاً، دعنا نقول
أنا من شركات الأدوية - شركة فارما A - دعونا نقول أني استثمرت 10 سنوات و100 مليون دولار في بعض الأدوية
لقد حصلت عليه من خلال جميع التجارب الطبية وحصلت على الموافقة عليه من قبل ادارة الاغذية والعقاقير ويقال من أجل
ببساطة انه يداوي من المرض x، الآن فور وصولي الى هذه النقطة. اشعر كشركة فارما برضا عن نفسي .
ماذا يحدث بعد ذلك؟ أنا افترض انه ربما علي ّ الذهاب لتكلفة التأمين، الرعاية الطبية والصحية وأحسب كم
سيدفعون لها. كيف ستحدث هذه المحادثة.

English: 
SALMAN KHAN: I'm here
with Professor Laurence
Baker from Stanford
Medical School,
and I'm hoping he
can at least start
to get me to understand
something that I've always
wondered about and worried
about a little bit.
Let's say that I'm
some drug company.
So let me write this down.
So I'm some pharma
company, pharma company
A right over here,
and let's say that I
invest 10 years and $100
million in some drug.
I get it through all
of the clinical trials,
and it gets approved by the FDA.
And let's say, just for sake of
simplicity, it cures disease x.
Now once I get to
that point, I'm
feeling pretty good about
myself as a pharma company.
What happens next?
I'm assuming that I'm going
to have to go to the insurance
companies and maybe
Medicaid and Medicare
and figure out how much
they're going to pay for it,
but how does that
conversation even happen?
PROFESSOR LAURENCE BAKER: Yeah.
So you're going to
have a conversation

Gujarati: 
ડોક્‌ટર : હા તમારે બહુ બધા જુદા જુદા લોકો જાડે વાત કરવિ પદસે , અને અમેરિકા મા અાપણે બહુ
જુદા જુદા નિજિ ઇન્શ્યોર્સ પ્લાનો અને સરકારી પ્લાનો છે. હવે ખરેખર તે વાતચિત
યુરોય અને વીષ્વભરમા વ્યાપક અારોગ્ય પ્રણાલીઅો વષે ની છે, દરેક પ્રણાલીમા કઇક સમાનતા છે અને કઇક અસમાનતાઅો છે જે નાવિષે તેઅો વાત કરે છે.
સલમાન: શુ તેઅો અે પ્રણાલી ના અાગ્રાણી બનવા માગે છે? શુ તે યુરોપીયન પ્રણાલી ને અનુસરે છે , કે તેઅો નીજી
પ્રણાલી ની અમેરીકામા સ્થાપના કરવા માગે છે, કે તેઅ સમગ્ર સમસ્યા ને અક જોડે ઉકેલવાનો પ્રયાષ કરે છે, અને તેમા કેટલા નાણા દાવ પર મુકવાનિ વાત છે?
ડોક્‌ટર : કોઇક પ્રકાર ની રણનીત અવ્સ્ય હસે નહીતો તે બહુ અગરુ કામ છે
બધા પ્રસ્નો નો ઉકેલ અેક સાથે કરવો તે . તમે અમેરીકા જોડે વાત કરો, તમે યુરોપ ની વાત સામ્ભળો
અેવા જુજ બનાવો છે કે લોકો ને સરકારી સન્ચાલન પ્રક્રિયામ યુરોપ ની જરાક સેલી લાગે છે,
તેથી તેની સરુઅાત યુરોપમા કરાય છે.
પણ બીજા બાજુ જોઇઅેતો દવા માટે ઘણી રાષ્ટિય પ્રણાલીઅો અોછુ
મુલ્ય અાપસે જ્યારે અમેરીકામા થોડી છુટછાટ વધુ મલે છે.
સલમાન: પણ સામાન્ય નીયમ અનુસાર શુ યુરોપ અને અમેરીકા પાસે હાલ પુરતુ ધન છે ?
ડોક્‌ટર : ઘણુ ખરુ છે, ઘણી બધી અેષીયા મા અારોગ્ય પ્રણાલીઅો છે, કોઇ કોઇ તો બહુ ઉચ્ચકોટીની છે અને તેઅો

Arabic: 
الدكتور: نعم أنت ذاهب لإجراء محادثة مع مجموعة مختلفة من الناس، في الولايات المتحدة لدينا الكثير
من خطط تأمين خاصة مختلفة، لدينا خطط حكومية ونحن في الواقع سنجري محادثات
مع اوروبا و مع بعض الأنظمة الأخرى في جميع أنحاء العالم، وذلك لأن كل نظام له طريقة مختلفة أو متشابهة لفعل ذلك يريدون التحدث معك حولها
سال: هل هناك ميل أن تكون نظام قيادي ؟ هل هناك ميل أن تكون أوروبية أو هل هناك ميول أن تكون
شركات تأمين خاصة في الولايات المتحدة أو هل تبدأ جميع تلك المحادثات في آن واحد، كما أن هناك الكثير من المال على الطاولة؟
الدكتور: ستكون هناك استراتيجية أو ستأتيكم أعمال كما سيكون من الصعب تلقي
جميع المحادثات تماما و في وقت واحد. سوف نتحدث الى الولايات المتحدة وسوف تتحدث إلى أوروبا
هناك بعض الحالات التي قد ينظر الناس فيها الى العمليات التنظيمية في أوروبا أسهل قليلا في بعض الأشياء ، حتى أنها قد ترغب البدء في أوروبا
ولكن في حالات أخرى أنت تبحث عن أدوية التي في بعض النظم الوطنية في أوروبا اقل عرضة
لتدفع ربما عليك أن تبدأ مع الولايات المتحدة حيث هناك مرونة أكثر من ذلك بقليل.
سال: ولكن القاعدة العامة للقبول تقضي بجعل المال بالدرجة الأولى في أوروبا والولايات المتحدة في الوقت الراهن؟
الدكتور: وهناك الكثير منه وهناك أنظمة آسيوية أخرى، بعضها متطور جدا

English: 
with a bunch of different folks.
In the US, we have lots of
different private insurance
plans.
We've got government plans.
And you're actually going
to have conversations
with Europe and with some of the
other systems around the world,
because each system is going
to make its own decision.
SALMAN KHAN: And they have
a different way of doing it.
PROFESSOR LAURENCE
BAKER: They may some
have similarities in the
way that they probably
want to talk to you about.
SALMAN KHAN: Does there
tend to be a lead system?
Does it tend to be
either the Europeans,
or does it tend to be the
private insurers in the US?
Or do you just start all of
those conversations at once
because there's so much
money on the table?
PROFESSOR LAURENCE
BAKER: So there
will be some strategy
your business is going
to come to because it's
very hard to have all
of these conversations
exactly simultaneously.
So you'll talk to the US.
You'll talk to Europe.
And there are some
cases in which people
have viewed the regulatory
processes in Europe
as a little easier
for some things,
so they may want
to start in Europe.
But in other cases, if
you're looking at a drug
that maybe some of the
national systems in Europe
are less likely to
want to pay for,
you might want to start
with the US, where
there's a little
more flexibility.
SALMAN KHAN: But the
general rule of thumb
is all the money is in Europe
and the US mainly right now.
PROFESSOR LAURENCE
BAKER: A lot of it.
The Asian systems, some of
them are pretty sophisticated

Arabic: 
ويستخدم الكثير من الأدوية المتقدمة جدا ولكن أعتقد أن الأغلبية منهم في الولايات المتحدة.
سال: صحيح، وبين أوروبا والولايات المتحدة، أعتقد، تخيلت دائما أن أمريكا الشمالية كانت مكان الجزء الأكبر من المال ، ولكن هل هذه هي القضية؟
الدكتور: الولايات المتحدة، أنا آسف أن نظم الرعاية الصحية لدينا تنفق أكثر من أي بلد آخر في العالم، وهذا ينطبق على الأدوية أيضاً
نحن ننفق على الأدوية هنا أكثر من أي مكان آخر
SAL: نعم، وبالتالي إذا أنا شركة فارما A، أريد أن أتأكد من أني حصلت عليها بشكل صحيح في الولايات المتحدة.
الدكتور: نعم، في نهاية المطاف ربما يهتمون كثيرا.
سال: ويستند جزء من الاستثمار الخاص بي الذي كنت قد طرحته على بعض التفاهمات أنه إذا حصلت على جميع الطرق التي
أود أن أحصل من خاللها على نموذج من العوائد داخل الولايات المتحدة، لذا، هل بالضرورة، احصل على االرعاية الطبية فوراً في حين انها واحدة
من أكبر اللاعبين أو سوف أذهب كمثل من تحدث عن الصليب الأزرق، بلو شيلد
أو كايسر أو بعض اللاعبين الآخرين؟
الدكتور: الرعاية الطبية هي نوع مثير للإهتمام لأسعار الأدوية بسبب أن الرعاية الطبية تاريخياً
لم تكن و لاتزال ليست غطاء كبير في كثير من الأدوية التي تسمع عنها - وبالتالي ،لاتسدد الرعاية الطبية بنفسها على أدوية مرضى العيادات الخارجية، يمكنك أخذها في المنزل.

English: 
and using a lot of the
advanced drugs, too,
but I think the
majority of the money
is in the US and
Europe, North America.
SALMAN KHAN: And between
Europe and the US,
I guess I've always imagined
North America was maybe
where the bulk of the money was.
But is that the case?
PROFESSOR LAURENCE BAKER:
The US, well, our health care
system spends more than
everybody in the world,
and it's true for drugs, too.
We spend more on drugs here
than most other places.
SALMAN KHAN: OK.
So definitely if I'm
here, pharma company A,
I want to make sure I
get this right in the US.
PROFESSOR LAURENCE BAKER: Yeah.
Eventually you probably
care a lot about the US.
SALMAN KHAN: Part
of my investment
that I made is based on
some understanding that,
if I got all the
way through, that I
would get some type of
return within the US.
Will I necessarily
immediately go to Medicare
because they're one of
the largest players,
or will I go to, like we
talked about, Blue Cross Blue
Shield or Kaiser or some
of these other players?
PROFESSOR LAURENCE
BAKER: So Medicare
is actually an interesting
one for drug prices
because, historically, Medicare
has not been a big coverer
and still isn't of a lot of
the drugs that you hear about.
So Medicare does
not pay by itself
for outpatient drugs, drugs
that you might take at home.
SALMAN KHAN: Really?

Gujarati: 
ઘણી બધી અાધુનીક દવાઅો નો ઉપયોગ કરે છે,પણ અમેરીકામા અાધુનક દવાઅોનો ઉપયોગ વધુ પ્રમાણ મા થાય છે.
સલમાન: ખરુ અનને યુરોપ અને ઉતરિય અમેરીકા વચે હુ માનુ છુ કે ઉતરિય અમેરીકા જોડે વધુ નાણા છે, તમારા પ્રમાણે શુ તે સાચુ છે?
ડોક્‌ટર : અમેરીક ની અારોગ્ય પ્રણાલી મા બજા દેશો કરતા અાપણે વધુ નાણા નોવપરાસ કરીઅે છીઅે તે દવાઅો માટે પણ અેટલુ સાચુ છે.
અાપણે દવાઅો પાછળ બીજા બધા કરતા વધારે ખરચો કરીઅ છીઅે.
સલમાન: સારુ તો જો હુ દવા કંપની A હોઉ તો મારે નવી દવા અમેરીકા મા પહેલા દાખલ કરવી જોઇઅે.
ડોક્‌ટર : હા તે લાંબાગાળે સારુ રહેસે.
સલમાન: મારા રોકાણ નો અાધાર અે ગણત્રી મા લઇને કરવામા અાવેલો હસે કે બધુ ધારવા મૂજબ થસે તો
હુ કઇક વળતર ની અાષા અમેરીક પાસે થી રખીસ,તો તો તે ને માટે મારે તાતકાલીક મેડિકેર જે કે બહુ
મોટા પાયે છે અથવા તો બ્લુ ક્રોસ્સ, બ્લુ શિલ્ડ જેવા મોટા ખેલાડી જાડે વાત કરવી પડે
અથવા કાઇસર કે કાઇ બીજા ખેલાડી ને પકડવા પડે.
ડોક્‌ટર : ઇેતીહાસીક રીતે મેડિકેર દવાઅો ના ભાવ ને
અાવરીલેવા મા સહાય બનતુ નથી, અને હજુ પણ ઘણી બધી દવાઅો ના મુલ્ય ની ભરપાઇ કરતુ નથી. તે દવાના મુલ્ય ને દરદી અે પોતે ચુકવા પડે છે.

Arabic: 
سال: حقا، أنا افترض دائما - لم يفعلوا ذلك؟
الدكتور: لم يفعلوا ذلك، الرعاية الطبية في الجزء الرئيسي - سوف تغطي الجزء A ،B، الجزءc - لذلك اسمحوا لنا الذهاب والبدء هناك، الجزء A و B
هم توجهو الى عدم التغطية إلا أنها سوف تغطي الأدوية للمرضى الخارجيين إذا حصلت على الدواء في المستشفى في اثناء وجودك في المستشفى، ستدفع الرعاية الصحية لهؤلاء وبذلك سوف تحصل على دواء
يستخدم في المقام الأول في هذا الوضع - ستذهب لتتحدث للرعاية الصحية عن ذلك، والذي سيكون جزء مهم
من المحادثة - ولكن إذا كنت تتحدث عن دواء للمرضى الخارجيين سوف تتحدث للكثيرين.
سال: أنت تقول المرضى الخارجيين، المرضى المنومين هو عندما تكون في المستشفى، كنت مريضا، و تقول أحتاج المورفين الآن، وهذا الدواء للمرضى الداخليين المنومين. العيادات الخارجية هو أن تعود إلى المنزل، وتأخذ هذا 3 مرات يوميا
الدكتور: نعم يرسلك شخص إلى الصيدلية لصرف وصفة طبية، ستأخذها معك للمنزل- التي من شأنها أن تكون أدوية في العيادات الخارجية. لذلك، لا تغطي الرعاية الطبية القسم الرئيسي من الجزء A و B ، هناك قسم الرعاية الطبية الجزء دال الذي هو خطة الأدوية في الرعاية الطبية وهي التي سوف تغطي

Gujarati: 
સલમાન: ખરેખર ! મારા ધારવા મુજબ તો મેડિકેર દવાના મુલ્ય ને ચુકવતુ હસે.
ડોક્‌ટર : ના, મેડિકેર બધી દવાના મુલ્ય ને ચુકવતુ નથી. મેડિકેર મુખ્ય ભાગ A, ભાગ B, ભાગ C મા વીભાજીત છે. ચાલા અાપણે ભાગ A અને ભાગ B વષે વાત કરીઅે
મેડિકેર બહારી દરદીની દવા ને ચુકવતુ નથી, તે માત્ર દવાખામા દાખલ કરેલા દરદી ની જીવન જરુરી દવા નીજ ભરપાઇ કરવમા અાવે છે.
અે તેમની પ્રથમીક રીત છે. જોતમે મેડિકેર ને તેવી દવા વિષે વાત કરવા ના હો
તોતે મહત્વની વાતચીત સાબીત થસે, પણ જો તમે બહારીય દરદીની દવા માટે વાત કરષો તો તે મહત્વ બહુ ધરાવસે નહી.
સલમાન: તો તમે અેમ કહો છો કે જે દરદી દવાખા ના મા દાખલ છે તેને દવાખાના મા જરુર પ્રમાણે મોર્ફીન ઉપલબ્ધ કરવામા અાવષે અને તેમને રજા અાપ્યાબાદ તે બહારીય દરદી તરીકે જણાષે અને દવા નો ખરચો દરદી અે અાપવાનો હાય છે.
ડોક્‌ટર : હા , કોઇ તમને દવા લેવા બહાર માકલે તો તેને બહારીય દરદી ની દવા ગણાય અને મેડિકેર ભાગ A અને ભાગ B તેની ભરપાઇ કરતુ નથી. ભાગ D છે કે તે દવાના મુલ્ય ને ચુકવે છે.

English: 
I always assumed
that-- they don't.
PROFESSOR LAURENCE
BAKER: So Medicare,
in its main pieces-- Medicare,
we call Part A, Part B,
Part C-- so Part A and
Part B, let's start there.
They tend not to cover, or they
don't cover, outpatient drugs.
If you get a drug
in the hospital
while you're hospitalized,
Medicare will pay for those.
And so if you've
got a drug that's
going to be primarily
used in that setting,
you're going to talk
to Medicare about it,
and that's going to
be an important piece
of the conversation.
But if you're talking
about an outpatient drug,
you're talking to
many [INAUDIBLE].
SALMAN KHAN: Now, when
we're saying outpatient,
inpatient is you're
in the hospital.
You're sick.
You need, I don't know,
morphine right now.
That's inpatient drug.
PROFESSOR LAURENCE BAKER: Yeah.
SALMAN KHAN: Outpatient is,
hey, you're going back home.
Take this three times a day.
PROFESSOR LAURENCE BAKER: Yeah.
Somebody sends you
to the pharmacy
to pick up the prescription,
and you take it home with you.
That's going to be an
outpatient kind of drug.
So Medicare doesn't cover that
in its main Part A and Part B.
There's Medicare Part D, which
is a drug plan in Medicare,
and that will cover a lot
of the outpatient drugs.
And so there you'd have
conversations with them.
But most of the
Medicare Part D plans

English: 
are essentially
private companies
that Medicare contracts with.
So you're not really talking to
the government at that point.
You're talking to these
private plans that
have contracted with Medicare
to provide Part D care.
SALMAN KHAN: So once
again going back
to the crux of the question
of how are these drugs going
to get paid for,
how are we going
to determine the price at
which these drugs get paid for,
it goes straight back
to the private plans
again because they're
going to contract.
Part D is going to say,
oh, you're Medicare Part
D. We're going to
go to go to Aetna.
We're going to go to some other
plan or whoever it might be.
I don't know who it might be.
PROFESSOR LAURENCE
BAKER: Whoever
is offering those Part D plans.
SALMAN KHAN: Whoever is
offering those Part D plans--
and so it will ride off of
whatever that private party has
already negotiated with
the pharma company.
PROFESSOR LAURENCE BAKER: It
would be related, probably,
to that.
SALMAN KHAN: OK.
So let's say that we have
some type of insurance.
I'm running out of letters now.
Let's call this insurance
company Y right over here.
And I go have a conversation
with insurance company Y,
and I'm like, hey,
this is a big deal.
Disease x, you know it's
been killing people.
I want $1 million per pill.
PROFESSOR LAURENCE
BAKER: Yeah, and so those

English: 
have been really interesting
conversations in the US.
So there's some
bargaining back and forth
between the insurance
company and the drugmaker.
The drugmaker is going to
have spent a lot of money.
You've got $100
million up there.
SALMAN KHAN: Yes.
I deserve to make at least $10
billion off-- I'm only kidding.
PROFESSOR LAURENCE BAKER:
So there's a certain amount,
to a certain extent [INAUDIBLE].
SALMAN KHAN: It's called
anchoring in a negotiation.
PROFESSOR LAURENCE BAKER: Right.
You start with what
you think you can get.
SALMAN KHAN: Yes.
Absolutely, yeah.
[?
PROFESSOR LAURENCE BAKER:
Push ?] that number to get
everybody's mind around, yeah.
So in reality, it costs
well over $100 million
to take a drug
through the trials,
to do the development work.
So they're going to be sitting
there with a number, at least
internally, saying, we want
to get our $800 million,
our $1.5 billion back from this.
And so we're going to try
and price it accordingly.
SALMAN KHAN: Because
it's not just
the cost of that one
drug-- so what is the cost?
Do you know that off the top
of your head, the average drug?
PROFESSOR LAURENCE BAKER:
It's hundreds of millions.
So there's the
development costs that
go in that the pharma
companies aren't typically
willing to talk a lot about.
And then there's
the cost of getting
through the trials and the FDA
approvals, which people say
$500 million and up.
They'll say higher
numbers sometimes.
SALMAN KHAN: For one given drug?
PROFESSOR LAURENCE BAKER: Yeah.
SALMAN KHAN: $500 million.
So it can be as high
as $500 million.

English: 
PROFESSOR LAURENCE
BAKER: It can be higher.
SALMAN KHAN: Can be
greater than $500 million.
And so that doesn't even take
into the probability-weighted
risk, that there's a
10% chance that it fails
or a 10% chance that it works.
So it's really, if you're
spending $100 million per drug
and only 1 out of
10 of those drugs
are going to get
to the end zone--
PROFESSOR LAURENCE BAKER: Yeah.
You'll see along the way.
You won't spend a whole
wad and then find out.
You'll find out in steps.
So you'll have to spend
something to get there.
SALMAN KHAN: I see.
You'll stop.
So even though on one drug, it
might be $100 million or $500
million, they might have spent
another $300 million or $400
million on drugs that
didn't go anywhere.
PROFESSOR LAURENCE BAKER:
Plus their own development
costs in the background.
SALMAN KHAN: Plus their
own development costs.
So if you try to fully load
the cost, it's a large number.
PROFESSOR LAURENCE
BAKER: It's large, yeah.
Right.
Exactly.
They're running
an operation where
they've got to put in a
lot of money in up front.
When they get a
success, they have
to get enough out
of that one success
to pay for the operation,
to keep things going
for the next development round.
So they're looking at
those kinds of numbers,
and they're trying to figure
out in this negotiation what

English: 
they can sell this for.
And that's a back
and forth discussion.
The insurance companies
have some ability
to say what they're
willing to pay,
but a lot of these
drugs, if they're
doing the curing a disease that
people care about, the pharma
companies have a lot of
ability to come and say, this
is what we need to get for
this and set that price
and be able to get
it for a while.
SALMAN KHAN: So obviously,
the pharma company
is coming here with
all of this investment.
They definitely want
it to get covered.
But the insurance company,
their incentive is they
don't want to look
like, all of the sudden,
this company that doesn't
provide the cure for disease x.
Do insurance companies
ever walk away
and say, well,
that's just too much.
I understand you invested
all of this money,
but we just can't do that.
That's just crazy.
PROFESSOR LAURENCE
BAKER: So it's
a little bit of a mixed bag.
The US doesn't
have a lot of cases
where insurance companies have
really put their foot down
and said, no, they're
not going to do anything.
They're not going
to have anything
to do with some new
drug that comes out.
And some of that's
due to the existence
of lots of different companies.
So if five of the companies
say no but the next guy in line

English: 
says yes, then the dynamic of
that in a competitive market
is often that everybody else
will eventually come around
and say, OK, we're
going to [INAUDIBLE].
SALMAN KHAN: Someone is
going to do something.
They might not pay
for it outright.
The whole reason why we're
having this conversation
is because there are some drugs
that seem reasonably priced
to me, but there
are some that are
like $30,000 a
pill or something.
I made up that number.
PROFESSOR LAURENCE BAKER: Yeah.
So the cases, the
really expensive ones,
are drugs that are
unique-- tend to be unique,
at least to some extent--
cure disease that
gets some high profile, so
people are worried that they're
going to die if they
don't get this drug.
And of course, they're
still on patent.
That's another
feature of all this,
where you get the high price
for a certain period of time
until your patents run out.
SALMAN KHAN: And
then the generic--
PROFESSOR LAURENCE
BAKER: And then generic
comes in and the price--
SALMAN KHAN: Can make them
for the cost of the pill,
which is--
PROFESSOR LAURENCE BAKER:
It drops dramatically.
SALMAN KHAN: Pennies or dollars.
PROFESSOR LAURENCE
BAKER: So how you
get these things set
in a competitive market
is an interesting question.
One of things that
gets the brand name
drugs to be a little cheaper is
competition within the class.
So if there is two or three
drug manufacturers who
have something that will
basically do the same thing,
that will tend to take the edge
off the $30,000 a pill kind

English: 
of situation and get you down
to more reasonable prices.
It won't get you all the
way to generic pricing, but
[INAUDIBLE].
SALMAN KHAN: It
just seems to me--
you just mentioned that very
few insurance companies have
ever walked away from this.
If you ever have a negotiation--
buying a used car--
where one of the two
parties is not walking away,
then it doesn't seem
like there's actually
a hard, serious negotiation.
Am I getting that wrong?
PROFESSOR LAURENCE
BAKER: Yeah, I
don't know all the ins and
outs of all these negotiations.
There's lots that goes
on in these things.
But I think that one of the
things that people would
say about the US is that when
a drug manufacturer comes up
with fairly unique,
on-patent drug
that does some tangible good,
that they more or less can
set the price that they
want to get for it.
And they're going to make some
calculation, because they could
set a high enough price that
everybody would say forget it.
So they're going to try
and figure out something.
But they're trying to
get as much as they can,
and they get some leeway for
at least a period of time
to name that price.
SALMAN KHAN: So
they'll get leeway,
and I guess there's some
range of reasonableness
where it's like, OK.
Yes, you've done something
amazing for humanity.

English: 
You're going to get a 35%
return on your investment,
but that shouldn't be a 300%
return on your investment.
PROFESSOR LAURENCE BAKER: Yeah.
I don't know at what point
the US would ever walk
or the private insurers
will ever walk from this.
I haven't seen it
really happen, and I
think drug companies are pretty
sophisticated about trying
to figure out what
price they think
they can make work and get that
as high as they can get that.
SALMAN KHAN: So
I guess I'm still
unclear to see who's making
out here really well.
PROFESSOR LAURENCE
BAKER: This has
been a really
interesting debate.
Pharma companies put
huge amounts of money
into these drugs.
And once in a while, they do
some really useful things,
and they get high premiums.
There are other people
who argue that some
of the things that they're
getting high premiums for
aren't really valuable
enough or somehow we've
been told we need a
drug that, if we had it
to our own devices, we
would never have come up
with the fact that we need it.
And so what's the real
value at the end of the day?
And I think that's one
of the debates we're
going to have in this
country for a little while.
The industry has been
coming up with new things,
and they're going to
keep trying to do that.
We want to, from a social
standpoint, from a policy
standpoint, try to make
sure that things we're doing

English: 
are really valuable to society
and not copies of other drugs
or not inventing a disease
that didn't need a solution
and then solving the problem.
And sometimes we
worry that maybe we're
getting some of that.
And I think that's the challenge
for the US health insurance
system, for the
regulatory processes
to try to guide the
innovation and guide
the purchasing of these
things to really create
the most value for society.
It's been a challenge.
It's going to be a challenge.
We have the challenge, because
we have tremendous opportunity
with new drugs created.
SALMAN KHAN: So your gut
sense is there probably
are some drugs out there that
they're doing really well,
well above and beyond
the investment cost,
but it's hard to say.
It's really on a
case by case basis.
PROFESSOR LAURENCE
BAKER: Yeah, I
don't think you'd want to make
a generic statement about all
the drugs that have
been discovered.
Some of the things that
we've put out there
in the last couple
of decades are really
important drugs that are
going to do a lot of good.
And I think there are debates
about some other ones where
maybe somebody's been able
to be clever about marketing
and sell it, and we're less
sure that it's [INAUDIBLE].
SALMAN KHAN: And that,
actually, marketing-- I
don't want to make this
conversation too long--
but some people bring up that
the drug companies, they say,

English: 
look, there's a lot
of investment right
over here on this.
And so they have to get some
reasonable return on it,
and that seems to make sense,
especially when you probability
weight it and all of that.
But they spend a significant
amount of marketing
as well, on actual marketing.
You watch the nightly
news, most of the ads,
you're going to
see a drug company.
They do the physician dinners,
and they do all of their things
like that.
That seems to undermine that
argument that all of the money
is going for R&D.
PROFESSOR LAURENCE BAKER: Right.
If you just totalled
up the dollars,
I'm not sure what the
numbers would come out like,
and honestly, the
pharma companies
aren't really excited
about telling everybody
all of the details of their
businesses for good reason.
So absolutely,
there's a huge amount
of marketing [INAUDIBLE].
SALMAN KHAN: You spend a ton
of money on the marketing.
And then you get
the consumer here
to put the pressure
on the insurance
companies and the doctors to
say, hey, you better cover
that, or I'm asking for that.
PROFESSOR LAURENCE BAKER: Yeah.
There was a time
within my memory
where we weren't allowed
to do direct to consumer
marketing, where the
laws prohibited that.
And the change came around,
and now we're allowed to do it.
And it's really changed the
way that drugs are marketed.

English: 
SALMAN KHAN: And I
have found that weird
because, if these are
drugs that are meant
to be by prescription, which
means that it should be
a doctor's judgment
on whether or not
you should get the drugs,
why is it being advertised
on the nightly news
to a general audience?
PROFESSOR LAURENCE
BAKER: Right-- a general
audience who doesn't
understand all the ins and outs
of the drug and whose
doctor may or may not
want to take the time to
explain it all to them.
SALMAN KHAN: Exactly.
But then they'll go to
the doctor and say, please
give me this drug.
And then the doctor, it's easier
for them to say, well, sure.
Why not?
PROFESSOR LAURENCE BAKER: Yeah.
No, I think a lot
of doctors would
express a certain amount
of frustration about that.
Their patients come in.
It's hard to have the
conversation in a short period
of time, so it's easier
just to give them the drug.
SALMAN KHAN: Fascinating.

Gujarati: 
જેમા ઘણી બધી બહારિય દરદી ની દવાઅોનો સમાવેષ થાય છે. તેની વધુ માહીતી અાપ મેણવી સકો છો, પણ મોટા ભાગ ના મેડિકેર ભાગ D
નો કરાર નીજી કંપનીઅો સાથે નો હોય છે. તેમ સરકાર ને મોટો નિષ્બત હોતો નથી.
ત્યારબાદ નીજી કંપનીઅો નો સંપર્ક કરવો પડે છે.
સલમાન: તો ચાલો અપણે મુળ મુદ્દદા પર પાછ વળીઅે, તો તે દવા નુ મુલ્ય કેવી રતે
ચુકવાષે ? કેવી રીતે ખબર પડે કે દવા નુ મુલ્ય કેટલુ ચુકવાય છે, જો તે ફરી ને નીજી
કંપની જોડે વાત જાયતો?
ડોક્‌ટર : જે કંપની ભાગ D ના વેચાણ ની સેવા પુરી પાડે, તે મુલ્ય ચુકવે.
સલમાન: તો તે નીજી કંપની ભાગ D ના વેચાણ ની સેવા પુરી પાડે, અેમના અને દવા બનાવતી કંપની ના સોદા પર નીરભર છે?
ડોક્‌ટર : કઇક અેવજ હોય છે.
સલમાન: ચાલો માની લઇઅે કે અક વીમા કંપની છે Y, હુ તેની પાસે જઇ ને
કોઇ ભયરૂપ બીમારી X ,જે બહુ લોકો ની મૃત્યુ નુ કારણ છે, તેના ઇલાજ ની દવા
માટે મારી કંપની ૧૦ લાખ ડોલર ની મંગણી અેક બીલ પર કરે તો?
ડોક્‌ટર : હા તે બહુ મજા નો પ્રશ્ર્ન છે. તેવા સોદો કરવા માટે ઘણી વાતચીત ની અાપલે દવાની કંપની અને વીમા કંપની વચ્ચે થતી હોય છે.
દવાની કંપની અે તે દવા ની સોધ માટે બહુ બધા અન્દાજે ૧૦૦ મલીયન ડોલરનુ રોકાણ કર્ય હોય છે.

Arabic: 
الكثير من الأدوية للمرضى الخارجيين. سيكون لديك محادثات معهم، ولكن معظم خطط قسم الرعاية الطبية
هي أساسا شركات خاصة التي تعاقدت معها الرعاية الطبية لذلك أنت حقا لا تتحدث إلى الحكومة
في تلك المرحلة، كنت تتحدث إلى الخطط الخاصة التي تعاقدت مع الرعاية الطبية.
سال: أرى، لذلك مرة أخرى العودة إلى جوهر المسألة، وكيف لهذه الأدوية أن تدفع
لهم ؟ كيف سنحدد السعر الذي سيغطي هذه الأدوية، إنه يعود إلى الخطط الخاصة
مرة أخرى؟ لأنها تسير على العقد، الجزء D وهو الذهاب الى القول اننا في سبيلنا للذهاب إلى أي خطة أخرى أو أي من كان
الدكتور: كل من تقدم بتلك الخطط. سال: كل من فاوض خطة الجزء D- لذلك هي ستستحوذ على ما فاوض عليه الطرف الخاص مع شركة فارم. الدكتور: أو يمكن أن يتعلق به.
سال: دعونا نقول اني دهبت إلى، لدينا نوع من التأمين - دعونا نسمي هذا شركة تأمينY و أنا اجري
محادثات مع شركة التأمين y - انا ذاهب الآن هناك صفقة كبيرة مع المرض 'X' فقد قتل الناس. أريد مليون
دولار بكل فاتورة، الدكتور: دكتور: نعم، تلك كانت محادثات مثيرة للاهتمام حقاً في الولايات المتحدة حتى لا يكون هناك مساومة صعوداً وهبوطاً بين شركات التأمين وشركات تصنيع الأدوية.
وقد أنفق صانعي الدواءالكثير من المال - كنت قد حصلت على مائة مليون هناك.
