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Medicine

Amazon Pharmacy Automates Discounts To Help Insulin Patients Get Pledged Prices (reuters.com) 41

Amazon said on Tuesday its online pharmacy will automatically apply manufacturer-sponsored coupons to more than 15 insulin and diabetes medicines to help patients access discounts pledged by the drug industry. From a report: With the new program, patients using Amazon Pharmacy will no longer have to search for and manually enter coupons from the three largest insulin makers, Novo Nordisk, Eli Lilly, and Sanofi, to lower the cost of their insulin to as little as $35 for a month's supply, the company said.

Novo, Lilly and Sanofi announced in March that they would slash their insulin prices by at least 70% by or in 2024, but a report from Senator Elizabeth Warren released last month said some patients were finding it difficult to get already discounted generic insulin from pharmacies at the promised lower price. Despite Lilly lowering the list price of its Insulin Lispro to $25 per vial in May, patients were still being quoted as much as $330 for the medicine, were not being told about cheaper options when they went to pharmacies, and were finding it difficult to use Lilly's savings program, Warren's report found. Vin Gupta, Amazon Pharmacy's Chief Medical Officer, said the report highlighted the need to make it easier for patients to get their insulin at the lowest possible prices.

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Amazon Pharmacy Automates Discounts To Help Insulin Patients Get Pledged Prices

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  • This is just an opportunity for Amazon to engage in predatory pricing without looking like the bad guy.

    Watch as it buys up pharmacies, or drive them out of business, and then suddenly, whoops, your "discount" goes to pay for price hikes.
    • And an opportunity to suffocate out new competition for the industry that has risen the price of insulin 600% over the last 20 years.
      • Government licensing always exists to snuff out the competition.

        We have fraud laws to prosecute commercial liars, and that's how human society got by for thousands of years without creating industry monopolies.

        Dumb people can't think "is a better or worse than b?" - they can only think "if a has any problems it must be banned".

      • This is all government enabled. Lantus launched in 1999 at $38 a vial cash. It has 3 other competitors in the long acting insulin market and it's now several hundred dollars a vial. How? George W. Bush and Barack Obama's signature health care laws stated that the government wouldn't negotiate drug prices and, unsurprising to anyone who understands economics, the corporations who paid heavily to get that wording into law raised their prices, hurting Americans.

        And every last fscker in Washington knows thi

    • "Predatory pricing" is the term that monopolists use to describe real capitalism, which includes competition in setting prices. It's one of the best red-flag terms in economics.

      • Ah yes!

        See, my home town's water supply was suddenly non-potable at one point. Praise Capitalism though for seeing us through! Sure prices everywhere went through the roof and limits weren't enforced, but capitalism! Sure folks quickly stockpiled a substance we literally cannot live without and then sold it for batshit high prices but hey, demand went up so good Papa Capitalism stepped up to.../ checks notes/ not do a fucking thing until there was a massive outcry from the populace about what?
        Oooh shit, wha

        • Kicker I forgot to include!

          Why was our water undrinkable?
          Ah yes, big profitable factory farms dumping so much nitrogen fixing waste into the lake that it caused an algae bloom capable of burning your skin if you bathed in it.
          But hey, people made money so I guess it's all okay!

  • Insulin scam (Score:5, Interesting)

    by backslashdot ( 95548 ) on Tuesday August 15, 2023 @10:00AM (#63769148)

    Insulin is one of the biggest scams around. Insulin is a medication that would be cheaper than a can of soda if it wasn't for the FDA bending over to the monopolies. The only reason it costs what it does is then existing companies have made it nearly impossible for competing insulin manufacturers to enter the market.

    How does insulin cost $10 in Italy and $100 in the US? Quote from https://aspe.hhs.gov/reports/c... [hhs.gov] "The average gross manufacturer price for a standard unit of insulin in 2018 was more than ten times the price in a sample of 32 foreign countries:$98.70 in the U.S., compared with $8.81 in the 32 non-U.S. OECD countries for which we have prescription drug data. The U.S. prices for the mix of insulin used in the U.S. were 8.1 times prices paid in all non-U.S. OECD countries combined."

    And btw, we know it can be even cheaper than the $10 in costs in italy. There's no gold, tantalum, or other rare Earth mineral in insulin, it doesn't require a lot of energy to manufacture, nor does it require manual assembly. So we should ask why does it cost $100, and ALSO why the fuck is it even $10? It should be less. Three companies have patents on most insulin and I believe they have colluded not only among themselves but with governments to raise barriers of entry and subsequently the price of insulin.

    • To clarify, what I mean by barriers of entry (quoted from https://www.ncbi.nlm.nih.gov/p... [nih.gov] ) :

      "This regulatory inconsistency served as a practical barrier for introducing competition into the insulin market, particularly biosimilar competition. Biosimilars are drugs that are ‘highly similar to the [biologic] reference product notwithstanding minor differences in clinically inactive components’ and has ‘no clinically meaningful differencesin terms of the safety, purity, and potency of the

    • Re:Insulin scam (Score:5, Interesting)

      by jacks smirking reven ( 909048 ) on Tuesday August 15, 2023 @10:10AM (#63769198)

      The answer is obvious, what is the common thread among those 32 countries and how they structure their healthcare systems versus how the US structures its healthcare and what about that makes it such an outlier?

      It's not just insulin, every piece of healthcare costs more in the US, out spending on healthcare-per-capita is approaching $13k versus almost all those other countries have it well under $10k, most with similar GDP/capita around $6-8K

      https://www.healthsystemtracke... [healthsystemtracker.org]

      This is not an insulin problem, this is a system USA problem. Healthcare is not and cannot be a profit center or operate in a "free market", the incentives and economic forces just make no sense and we are the proof of that.

      • This is not an insulin problem, this is a system USA problem. Healthcare is not and cannot be a profit center or operate in a "free market", the incentives and economic forces just make no sense and we are the proof of that.

        Thinking that the US Healthcare system is a free market is beyond delusional.

        FDA licenses drug manufacturers and allows them to pay all the generics companies to not produce drugs so they can jack monopoly prices.

        Let a qualified organic chemist start making drugs in your hometown and the

        • Probably why they put the phrase in quotation marks

        • I didn't say it *was* a free market (thus the quotes) but it tried to act like one, far, far more than other developed nations. The mere fact we have private, employee provided insurance is a huge "market" outlier amongst those countries. At the end of the day if you are not on Medicare/Medicaid you are partaking in a healthcare system that operates with companies that are looking to turn a profit off their services, end of story.

          FDA licenses drug manufacturers and allows them to pay all the generics companies to not produce drugs so they can jack monopoly prices.

          That is a bit of a mischaracterization of how patent systems work. We allow

        • by sjames ( 1099 )

          Well, when we tried a FREE market for healthcare, we ended up with children being dosed with antifreeze and dying.

    • Re:Insulin scam (Score:5, Informative)

      by HBI ( 10338492 ) on Tuesday August 15, 2023 @10:33AM (#63769300)

      The scam about insulin really is that providers are incentivized to prescribe the most expensive, patent encumbered forms of insulin.

      There are essentially two types: a short acting analogue of human insulin (Humalog, Novolog, etc), which are fundamentally similiar but slightly faster acting (30 min onset vs ~1hr) than the regular insulin that's been on the market since the 1990s. The various human analogue insulins are also very much more expensive than the R insulin discussed in the article, though the advantages are not all that great.

      The innovation in the 90s was making the stuff using genetically modified E. coli, which is the method used today. Before that, it was made by pressing cow and pig pancreases to get the insulin out, starting in the 1920s.

      A long-acting form of insulin is one that is modified through biochemical pathways into the human analogue. An early form of this long-acting insulin was something called NPH, which didn't work all that well and you can actually detect that someone took it at some time in the past by looking for antibodies for it (!). Modern versions of this are Lantus/Levemir/Tresiba/Toujeo etc, all with slightly different profiles. None are available generically (except the poorly performing NPH) and all are expensive as hell.

      Most people end up taking a long acting and a short acting in combination with each other. Unless you have a pump.

      The upshot of all of this is that the doctors are incentivized by drug reps to prescribe the expensive kinds of insulin as opposed to the cheaper generic stuff, and the rolling change to the long-acting to make sure the patients are always on the patent-encumbered newest insulin, thereby extracting maximal $$ from the patient and their insurance.

      It's a really shitty game.

      • Modern versions of this are Lantus/Levemir/Tresiba/Toujeo etc, all with slightly different profiles. None are available generically (except the poorly performing NPH) and all are expensive as hell.

        I find your claim a tad hard to believe, as I'm sitting here looking at a vial of generic glargine-ygfn that's enough for a full month. As far as expensive, I wouldn't know; my diabetes is Service Connected (indirect exposure to Agent Orange in Tonkin Gulf back in '72) and the VA provides it, along with my ot
        • by HBI ( 10338492 )

          Glargine-yfgn is the first 'biosimilar' product. [fda.gov] It's not precisely Sanofi glargine (Lantus). Sanofi's primary patent on Lantus expired in 2015, but something like 70 secondary patent filings ensued after the first one, extending their protection to at least 2031. Apparently, allowing Semglee (the brand name of what you take) to get approved was considered less problematic than fighting it using their secondary patents.

          It is possible for what I said to be true and the above to also be true. Sanofi's job

          • My point wasn't that you were completely wrong, but that there are exceptions, meaning that getting generic insulin isn't as difficult as you made out. Also, I also take a fast-acting insulin at mealtime (insulin aspart) and the VA wanted me to take that with vial and syringe also. I objected, as I often eat out and don't like using a syringe in public as I can understand who other customers would be bothered. I take the mealtime doses from a pen, as it's much more inconspicuous.
            • by HBI ( 10338492 )

              Semglee isn't a generic, really. You still can't take Sanofi's recipe for glargine and put it in a generic vial/pen and sell it. Not yet. The approval process wasn't as onerous as the initial ones that Sanofi/Lilly/Novo Nordisk had to go through with their products, but it was there.

              I hate pens personally. They leak at both ends to keep bubbles out of the pen injection mechanism. I'd happily trade all the pen insulin I have for vials. Much cleaner, insulin and all hormones have a characteristic smell

              • You take much more than I do. As the mealtime is on a sliding scale, it varies from day to day but even at the worst, it's under 100u/day. Back in the early 80s, I was caring for a diabetic friend who'd gone blind from it. He took 90u of "regular" and 8u of pork every morning, and I thought that was a big dose.
                • by HBI ( 10338492 )

                  I'm aggressive with the treatment - 33 years and really high insulin resistance. My only secondary symptom is foot neuropathy before I got it under tight control. My A1C hovers in the 6.0-6.3 range with all that insulin.

                  • Do be careful with that foot! That friend of mine developed an ulcer on one foot and ended up having it amputated. This was after his kidneys went out and he was on dialysis twice a week.
                    • My grandfather had a similar case to mine back in the dark ages before we had modern insulins. He was also a fifth a day boozer, scotch. Anywho, he had his right leg amputated when I was about 5, so I have a very poignant object lesson.

                      I had an ulcer in my left foot from a blister that got infected. It healed after some extensive debridement. My podiatrist is a good friend now. Your point is noted...but already started facing this one.

                    • Do you use a Dexcom/Tandem artificial pancreas system?

                    • by HBI ( 10338492 )

                      No, the volume of insulin is too high for any available pump according to my endocrinologist. I do use a Libre for CGM, I had a Dexcom before also. The Dexcom I got more fight out of the insurance company about.

    • Canadians don't have it quite as good as Italians, but we pay a capped price of $25US per vial. Not great, but not US-terrible. Look at an EpiPen. $100 or so in Canada, $650 in the States. Spin it all you like - it's just plan harder to have human illnesses in the US. If that's socialism, I'll take some of that, please.

      I know the public discourse is often reduced to one word exchanges... "Socialism!" "Bad!"... but people should aspire to better.

    • The only reason you can really call insulin "one of the biggest scams around" is because it's so prevalent. As far as the core problem goes of vastly overcharging for it? That's happening across the board with our drugs in America. And a big part of the reason is the way we essentially subsidize the drug development for the entire world. We grant our companies government monopoly protection to R&D this stuff and then get back insane profit margins on the end results. Meanwhile, the rest of the world ge

  • by Alain Williams ( 2972 ) <addw@phcomp.co.uk> on Tuesday August 15, 2023 @10:26AM (#63769276) Homepage

    Luckily I live in England where the charge for a prescription is £9.65 (US $12.30). I could pay £111.60 and get unlimited prescriptions for a year. Even better as I am over 60 I get prescriptions for free - helpful as I have diabetes and need insulin.

    • Congratulations for being born in a country where people haven't allowed their government to just let poor people die of easily treatable conditions.

    • Even better as I am over 60 I get prescriptions for free - helpful as I have diabetes and need insulin.

      If you have just aged yourself to avoid the charges, there is good news. Diabetics get free prescriptions in the UK.

      • This.

        Diabetes (type doesn't matter)is one of the (few) chronic conditions that qualifies anybody of any age who has it to get a free prescription for it in any format, along with any other prescribed medication, upon production of a medical exemption certificate.

  • by WolphFang ( 1077109 ) <m.conrad.202@nOsPam.gmail.com> on Tuesday August 15, 2023 @10:30AM (#63769294)

    What does this say about the FDA and associated drug manufacturers that AMAZON is coming to the rescue?

    Amazon is not exactly a paragon of virtue here. But being able to dress themselves up as such should be a chilling warning about what the future may hold if nothing is done to correct the systemic issues we currently have in healthcare where sick patients are profit centers unless they get too sick and get soylent greened.

    • What does this say about the FDA and associated drug manufacturers that AMAZON is coming to the rescue?

      Amazon is not exactly a paragon of virtue here. But being able to dress themselves up as such should be a chilling warning about what the future may hold if nothing is done to correct the systemic issues we currently have in healthcare where sick patients are profit centers unless they get too sick and get soylent greened.

      If we require giant retail corporations to save us from the insurance and pharma industries, god help us all.

      Maybe, at some point, we can value something a tiny bit more than money in the United States? Maybe we can think about life and health as something other than profit centers. And may be we can weigh life by some measure other than, "Does the insurance company think they can cover that, or have you just dipped into the red on the balance sheet? Yes? See ya! Have a nice afterlife!"

      This is no way to run

  • Blah blah blah Amazon blah coupons blah. How noble of them, doing what our local pharmacy has quietly done for years (on all medicines).

    Must be another PR push to address their repeated struggled to gain traction in the pharmacy business [duckduckgo.com].

  • Went through the song-n-dance routine earlier this year after I developed diabets post COVID. Had to track down a slightly differenct formulation of insulin and get my health care provider to request it specifically from one pharmacy to get it through the insurance/pharmacy maze.

    Savings? $25 / mo vs $585 / mo.

  • One major inefficiency in buying prescription drugs in general is that pharmacies are not required to find or charge you the lowest available price for your prescribed drug. This goes beyond the question of brand-name vs generic drugs. If you have commercial health insurance, they'll generally fill through your insurer, even if the cash price is lower. You have to specifically ask your pharmacist to obtain the cash price. Alternatively, you may find 3rd party contract non-insurance providers, such as GoodRX

  • I presume that any insulin bought from Amazon would be manufactured in China, like nearly everything else. That might make it cheaper, but is it SAFE?

    If you need a medicine to stay alive, and domestic supplies are short (and too expensive) I suppose you turn to imported stuff of unknown origin out of desperation.

    There was a time when nearly every state in the US had an insulin production facility - it was considered a bit of a miracle and was known to be vital for a portion of the population to stay alive.

  • Aah Yeah, let the High-Fructose Corn Syrup flow freely. It saves you money on your diabetes in the long run!

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