America's FTC Sues Insulin Middlemen Who 'Artificially Inflated' Drug Price (npr.org) 124
Friday America's Federal Trade Commission brought action against three companies for "anticompetitive and unfair" practices "that have artificially inflated the list price of insulin."
For years, many of the millions of Americans who need insulin to survive "have been forced to pay exorbitant prices for a product that's inexpensive to make," writes NPR. "Now, the federal government is targeting one part of the system behind high insulin prices." While out-of-pocket costs have gone down for many people to $35 a month, questions remain on how the drug became so expensive in the first place. In a new lawsuit filed Friday, the Federal Trade Commission said it's going after one link in the chain: pharmacy benefit managers. The FTC brought action against the top pharmacy benefit managers (PBMs) — CVS Health's Caremark Rx, Cigna's Express Scripts, and United Health Group's OptumRx — saying the companies created a "perverse drug rebate system" that artificially inflates the cost of insulin. If the suit is successful, it could further drive down costs for patients at the pharmacy counter.
PBMs are essentially the middlemen between drug manufacturers and insurance providers. Their job is to reduce drug prices. But the process is complex and opaque, and critics say they're actually driving prices up for patients. The FTC said a big issue is that PBMs' revenue is tied to rebates and fees — which are based on a percentage of a drug's list price. Essentially, in the case of insulin, when the drug costed more, it generated higher rebates and fees for PBMs. "Even when lower list price insulins became available that could have been more affordable for vulnerable patients, the PBMs systemically excluded them in favor of high list price, highly rebated insulin products," the FTC said in a press release on Friday.
The three PBMs named in the FTC lawsuit make up about 80% of the market. According to the suit, the PBMs collected billions of dollars in rebates and fees while insulin became increasingly unaffordable. Over the last two decades, the cost of the lifesaving drug shot up 600% — forcing many Americans with diabetes to ration their medication and jeopardize their health. In 2019, one 1 of 4 insulin patients was unable to afford their medication, according to the FTC. Some people have died.
The FTC's statement says the companies "have abused their economic power by rigging pharmaceutical supply chain competition in their favor, forcing patients to pay more for life-saving medication... While PBM respondents collected billions in rebates and associated fees according to the complaint, by 2019 one out of every four insulin patients was unable to afford their medication..."
"[A]ll drug manufacturers should be on notice that their participation in the type of conduct challenged here raises serious concerns, and that the Bureau of Competition may recommend suing drug manufacturers in any future enforcement actions."
For years, many of the millions of Americans who need insulin to survive "have been forced to pay exorbitant prices for a product that's inexpensive to make," writes NPR. "Now, the federal government is targeting one part of the system behind high insulin prices." While out-of-pocket costs have gone down for many people to $35 a month, questions remain on how the drug became so expensive in the first place. In a new lawsuit filed Friday, the Federal Trade Commission said it's going after one link in the chain: pharmacy benefit managers. The FTC brought action against the top pharmacy benefit managers (PBMs) — CVS Health's Caremark Rx, Cigna's Express Scripts, and United Health Group's OptumRx — saying the companies created a "perverse drug rebate system" that artificially inflates the cost of insulin. If the suit is successful, it could further drive down costs for patients at the pharmacy counter.
PBMs are essentially the middlemen between drug manufacturers and insurance providers. Their job is to reduce drug prices. But the process is complex and opaque, and critics say they're actually driving prices up for patients. The FTC said a big issue is that PBMs' revenue is tied to rebates and fees — which are based on a percentage of a drug's list price. Essentially, in the case of insulin, when the drug costed more, it generated higher rebates and fees for PBMs. "Even when lower list price insulins became available that could have been more affordable for vulnerable patients, the PBMs systemically excluded them in favor of high list price, highly rebated insulin products," the FTC said in a press release on Friday.
The three PBMs named in the FTC lawsuit make up about 80% of the market. According to the suit, the PBMs collected billions of dollars in rebates and fees while insulin became increasingly unaffordable. Over the last two decades, the cost of the lifesaving drug shot up 600% — forcing many Americans with diabetes to ration their medication and jeopardize their health. In 2019, one 1 of 4 insulin patients was unable to afford their medication, according to the FTC. Some people have died.
The FTC's statement says the companies "have abused their economic power by rigging pharmaceutical supply chain competition in their favor, forcing patients to pay more for life-saving medication... While PBM respondents collected billions in rebates and associated fees according to the complaint, by 2019 one out of every four insulin patients was unable to afford their medication..."
"[A]ll drug manufacturers should be on notice that their participation in the type of conduct challenged here raises serious concerns, and that the Bureau of Competition may recommend suing drug manufacturers in any future enforcement actions."
For reference (Score:5, Informative)
On how bad US citizens are getting ripped off.
https://www.visualcapitalist.c... [visualcapitalist.com]
Re: (Score:3)
Re: (Score:3, Interesting)
Rather, it is a result of the incestuous relationship between pols and these guys. Payola in return for contributions. But I agree it is not inherently a capialist issue, would get the same with socialism and communism, for instance.
Re:For reference (Score:4, Informative)
In pure, socialism we've seen what happens .. the government will produce insulin of low and cheap quality and their own regulatory agency will certify it as safe. As it won't really benefit politicians to spend money for long term, there will be no money spent on research to develop artificial pancreas or elimination of insulin dependency. Socialism is capitalism wherein one entity controls both the regulation and the production, and often the media too .. so you wouldn't even know that people are getting shitty insulin.
What we need is a transparent regulatory body and competition. Right now what's happened is the FDA has accumulated layers and layers of regulation, encouraged by the established players, that ensure that no new competitor can manufacture insulin (barrier of entry is high, you won't be able to find investors because of the high capital cost and risk tolerance required to prove manufacturing process and purity and go through an expensive clinical trial). We saw this with the Epi-pen too, where something you can (illegally) 3D print for $2 was being sold for $800.
Re: (Score:3, Informative)
Except there already are companies that manufacture insulin and epi-pens at low cost and passed clinical trials in several countries decades ago. Some even have a major presence in US
Interlarding throughout (Score:5, Informative)
Insulin is only one facet of the middle middle middleman in healthcare, each taking their cut of the revenue stream.
Hedge / private equity funds taking over
- dental practices - https://corient.com/insights/a... [corient.com]
- dialysis practices - https://www.scientificamerican... [scientificamerican.com]
- hospitals - https://hms.harvard.edu/news/w... [harvard.edu]
and a lot more of the medical industry.
What's the common factor?
The actual customers usually do not pay their own bills. The government low income health subsidy programs do, or insurance companies do.
This is a larger part of the economy and increases medical costs.
And if you are adventurous, you can dig into how private equity are now running large parts of the government functions which involve children: foster care, detention facilities, remedial schools, foster care.
https://www.fox4news.com/news/... [fox4news.com]
All of these also have one thing in common, the payer is the state or federal government. And, in some cases, the juvenile courts get a cut of the profits from 'saving' a child from a 'neglect at home' and 'saving the child' by placing the child into a 'for profit foster home' which helps fund the county budget.
Essentially, the rise of third party payers leads to escalating costs, lower standards, worse outecomes, higher taxes and harm to the citizens.
Re:Interlarding throughout (Score:4, Interesting)
Essentially, the rise of third party payers leads to escalating costs, lower standards, worse outecomes, higher taxes and harm to the citizens.
Indeed. When a political candidate tells you that the government always is bad, they are literally bragging that they will do a bad job. This is one of the few instances when you should absolutely take a politician at their word. Believe them, then vote for someone who will at least attempt to do an OK job.
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Except that's bullshit and we all know it. When a candidate complains that "government can't do anything right", they're trying to justify more privatization, which is the real problem. As we've seen time and time again, once elected, these same people don't work to improve things, they work to undermine them. See, there is an unspoken part of that phrase "The government can't do anything right ... I'll make sure of that!"
Virtually all of the so-called government waste and inefficiency comes from public-
Re:Interlarding throughout (Score:4, Insightful)
Whether privatization is the correct approach or not is not a simple question. Sometime it is.
HOWEVER, whether a system is private or governmental, independent auditing is necessary. INDEPENDENT, And those regulating it should NEVER be allowed to be paid by those they have ever regulated, whether while in power or after they depart.
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The government does no such thing. We saw how the govt handles high costs w/ Obamacare: do nothing about the high costs and just pay "whatever the price tag is" to cover "more people". They don't do efficiency, they do volume. The only thing that could lower costs is a competitive market with transparent pricing and consumer choice, and you'll never get that the more you cram government into the picture. Because
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How can a government run company get oversight? The government has a vested interest in ensuring the oversight of the public agency doesn't increase its own running costs while keeping itself elected or in power.
We can't have a separate election for who runs oversight, then a separate election for those running public companies, and then a separate election for media (who reports on malfeasance) as all three would be competing for the same tax revenue pot.
The best solution is elect people to run public over
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You're a special kind of stupid, aren't you? A quick look at the post office shows just how full of shit you are.
Public-private partnerships, as I've already explained, are where you'll find virtually 100% of so-called "government waste".
You mention "Obamacare", but you obviously don't have a clue what it is or what it does. That's fine, because it's a good example. Do you know why private insurance fought hard against a public option for the individual mandate? Because the government would easily out-
Re:Interlarding throughout (Score:4, Insightful)
What's the common factor?
The actual customers usually do not pay their own bills. The government low income health subsidy programs do, or insurance companies do.
Funny, that part. It's almost as if those wascally conservatives who warned y'all about all that were right ...
Re:Interlarding throughout (Score:5, Insightful)
Re:Interlarding throughout (Score:4, Insightful)
Bullshit. So-called "conservatives" are the ones who created this system and they're the ones who are fighting to preserve it. They are the ones who want healthcare shacked to employment. They are the ones who fight against reforms that we know will lower costs and improve outcomes.
So-called "conservatives" have one and only one goal: to most efficiently use the power of government to funnel money into the hands of corporations and the wealthy. They fought against a 'public option' because they know that such a thing would easily out compete private health insurance companies. They're actively fighting against the ability of Medicare to negotiate drug prices. They were also the ones who prevented Medicate from negotiating drug prices in the first place!
So-called "conservatives" didn't "warn" anyone about the problem -- they fought for decades to create the problem!
Missed the point (Score:3)
Point: Third party payers - government, subsidized insurance, insurance, etc. are being charged and overcharged for medical treatment, unnecessary medical treatment and fraud by large-scale private corporations to enrich those corporations.
There's been systemic overcharging and doing unneeded dental procedures and only because the paying party was the government and not the patients.
https://www.pbs.org/wgbh/front... [pbs.org]
Left, right or center politically, there's not a great solution here, when there is a vast po
Re: For reference (Score:2)
There is no economic justification for developing an articulated pancreas. No one knows what the cause of insulin dependent diabetes is, and thatâ(TM)s the first step towards curing it. There is too much money to be made by businesses and the taxes those businesses/employees pay to governments.
Re: For reference (Score:5, Interesting)
We do know the enough of the cause of insulin dependent diabetes to know that an artificial pancreas that is protected from immune attack will likely be curative. How? Because it's been done already. Here's a link to one example (of many): https://www.cgtlive.com/view/p... [cgtlive.com]
However patients will have to be followed for a decade before others are allowed this treatment.
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These people are not spending it research and development they are screwing people who need it to live out of every penny they can. They are middle men. As drug companies keep telling us medical research is expensive, and risky, it is much more profitable to milk an existing product and use patient to prevent others developing new drugs with patent than do your own. No system should be "pure", pure capitalism fails, we need to work as a team. Pure socialism fails, there needs to be an incentive to achieve.
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The problem is unregulated capitalism in the US.
Recent study shows that the US spends twice the amount of money on healthcare of the 10 most developed countries and has the the worst health status of the 25 most developed countries.
Capitalists are ripping us off.
Re:For reference (Score:5, Insightful)
Speaking of tax, in civilised countries tax is used to provide medicine for chronic illnesses at zero cost to the unfortunate user. Some of these medicines cost a hell of a lot more than insulin to manufacture.
Re:For reference (Score:5, Insightful)
Capitalism exists as a bit player in this scenario but it's really more about socialized or mandated medial insurance making the costs of products opaque while the institutions regulating this have been captured. Corporatism run amok would be a far better description IMO.
Re:For reference (Score:4, Informative)
There are seriously broken parts of US patent system as well. The FDA actually approved generic insulin, which should theoretically drive prices down, as it did with asthma inhalers. Unfortunately, with asthma inhalers, George W Bush banned CFC propellant 2 years before HFA was supposed to be out of patent, promising that inhaler prices would drop after a couple of years of pain... well yeah, that never happened. The manufacturers reformulate the HFA propellant every 10 years, get it approved within 7 and it is now under perpetual patent and inhalers have mostly been stuck at $99 since then (right around the cost of insulin). I brought back inhalers from Mexico and Canada (where they are $5-8) and when the US government tried to confiscate them, I told TSA they were over the counter medications even in the US and only the propellant was under patent. TSA looked it up and let me go. What infuriates me is W. did it to appease a Canadian environmental push to control greenhouse gasses and it was literally his only environmental change (and CFCs in inhalers were less than 1% - a whopping 70% is ammonium perchlorate, but no, you can't ban solid rocket fuel, right?).
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The manufacturers reformulate the HFA propellant every 10 years, get it approved within 7 and it is now under perpetual patent
I mean I get why they do that, but why isn't someone using the older, approved, unpatented formulation? There's something else broken in the system, surely.
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it is not "capitalism"
It isn't Libertarianism, but it is Capitalism indeed. People tend to confuse both.
Capitalism is about maximizing control over the means of production (aka capital) seeking absolute maximum profits for the controller. Anything that helps in that is fair game, including buying laws, from law sellers, in an open market of law negotiations, including for laws to enable monopoly behavior and to protect huge incumbents from new competitors and even, in the extreme, buying laws to enable indentured servitude and c
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Left libertarians explicitly reject capitalism, but the label "left libertarian" has mostly been abandoned since right libertarianism grew so much.
Right libertarianism is a spectrum. Right libertarians want capitalism, and they want the "non-aggression principle" as the underlying maxim determining what impositions on capitalism are allowable. The NAP is not terribly coherent, so right libertarians vary considerably, but they generally want to increase the power of capital and decrease the power of governme
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right libertarians vary considerably, but they generally want to increase the power of capital and decrease the power of government
Indeed. The core problem is they don't notice this exchanges one form of centralized societal rule for another form of centralized societal rule. In both cases, there's a small group of very powerful people making decisions and a very large group of mostly powerless people living with the decisions the small group took, some of whom want to ascend to rule-making positions via the means suitable to each specific scenario.
Anarcho-capitalists do want unfettered capitalism.
Even those don't want it. The most radical accept and argue in defense of things like "c
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What are you blabbering about? Of course Capitalism "has been tried". I described what it has historically done over and over and over again unless forcibly prevented from.
Learn to read what the other person actually wrote, rather than projecting upon it what you "feel" they "meant".
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This is incorrect. Barrier to entry and excess govt regulation has led to these high prices. If we could go on ebay and buy cheap imported insulin powder, the price would be much lower.
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Thank you. You may be interested in Bozo's Cheap and Totally Effective insulin powder. Just a dab in your syringe and fill the rest with water, give it shake, and you free to inject it in the site of your choice.
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5$ certification costs in independent lab so people know it's safe
LOL!
$3 certification from an independent lab that will certify anything you want as anything you want
$2 certification, with important-looking hologram, "from" whatever independent lab you want printed on the label
Under-regulated capitalism is pure evil. You really, really, want "big government" looking out for your interests here.
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Oh, you poor illiterate moron. Was my post too complicated for you? Apparently, it was.
Try this: It is trivial to fake certifications.
Still too much? Find a trusted adult to help you.
About time (Score:3, Interesting)
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This has been a hidden, complex arrangement that is so opaque and difficult to unravel, that these PBMs have been able to rip off consumers for decades. Before anyone objects, this is not capitalism.
I don't know how this came about, but wouldn't be surprised if it was someone telling an insurance company they could save money by outsourcing work (to them of course) to coordinate dealing with the various pharmaceutical companies instead of having employees for that ...
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The people the insurance companies outsourced the negotiations with the drug companies with started out helpful. After corporate mergers and Venture Capital buyouts, there were only three firms left. And they realized they could use their positions as middlemen to make a lot of money.
For example, Advair Diskus is a "name brand" asthma inhaler. Available through my insurance company at $400 per month, because of PBM markups. GoodRx does a better job negotiating (which tells you something about the PBM ro
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Thanks for the background.
BTW, I looked up Advair Diskus (Fluticasone/Salmeterol) on Mark Cuban's Cost Plus Drugs [costplusdrugs.com] site (mfg cost + 15% markup, + $5 pharmacy labor) and both it and a generic are available available in several dosages: 100-50mcg, 250-50mcg, 500-50mcg
- Brand [costplusdrugs.com]: 60 doses, 100-50 mcg, $94.70 ($78.00+$11.70+$5)
- Generic [costplusdrugs.com]: 60 doses, 100-50 mcg, $63.40 ($50.78+$7.62+$5.00)
Plus $5 shipping.
Re: About time (Score:2)
Perhaps it goes toward the "free" pharmaceuticals that the people who hit their out-of-pocket maximum get. I would think that if you were so aware of deductibles and pricing, you would have considered that.
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You'd have to explain which tenets in capitalism strictly forbid this, especially given several cheerleading capitalism uber alles actively indirectly advocate for several aspects of this (lack of regulation, let the market decide, etc.).
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You'd have to explain which tenets in capitalism strictly forbid this, especially given several cheerleading capitalism uber alles actively indirectly advocate for several aspects of this (lack of regulation, let the market decide, etc.).
Use of the coercive power of government to create artificial barriers of entry to the market.
One of the feedback mechanisms in capitalism is that high profits entice other firms to enter the market for the high-profit good or service (or a similar good or service that's a reasonable substitute), increasing supply and reducing prices
Next question, please.
Re:About time (Score:5, Interesting)
In countries that don't subject their citizens & healthcare services to so called "free market" capitalism, medicines are typically a fraction of the cost.
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Exactly what coercive power of the government forces the use of PBMs and exactly how is it an artificial barrier to entry anymore than any contract agreement between businesses?
Another aspect of capitalism is to maintain monopoly and noting specifically forbids business from lobbying the government to do so (money is speech).
Further, capitalism isn't a direct substitution for markets.
Not impressed.
Re: About time (Score:2)
Why not? They wouldn't interfere with your "perfect information" hypothetical at all. The copyright or patent would be an asset like any other, and with perfect information would be eminently able to be valued. Licenses, purchases, and even outright dedication to the public would all be available at the correct price.
Amateurs.
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Patents and copyrights and such create artificial scarcity. You can't compete around them basically, so they are detrimental. Basically in a patent-encumbered world, you could have a manufacturing process 50% less expensive than the patent owner, but the general public can't realize the full benefit because the patent-holder extracts some rent.
With the infamous "all else equal", patents and such are a detriment to free trade. The analysis is more difficult if you consider the argument that "without patent
Re: About time (Score:2)
One of the reasons you can't presume that reallocating is unfair or wrong (or even inefficient) is that you can't assume that a definitionally-patentable advancement or literally-creative work would just "happen on its own." Besides, where would the "rent" come from on a pro
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The issue with patents is that they are artificial scarcity, which can easily be abused to manipulate prices. In any other type of industry, all you have to do to address scarcity is increase production, and you don't have to get the resources from the current producer. If someone holds a patent, you cannot legally just increase production even if you can independently get the necessary resources. This makes society fragile.
It's unclear patents are worth the downsides in modern society. If we made it exp
Re: About time (Score:2)
More to the point, it's unintelligible to assert that there's something wrong with how suppliers and their potential competitors assign value to patents- I might as well claim that consumers misunderstand their own marginal utility and therefore your concerns about "rent" are illusory by definition.
Re:About time (Score:5, Interesting)
In order for there to be a free market, there must be price transparency, freedom to enter and exit the market, and equal information. The pharmaceutical market scores 0 out of 3.
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Not at all.
Auctions are an in kind market, and I have yet to hear railing against blind bidding as somehow being anti-capitalist.
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Re:About time (Score:5, Insightful)
To me believing in capitalism is just as much as knowing where it doesn't work and healthcare is one of those areas. It's just too inelastic and I think there is an obvious moral hazard in keeping it behind access to wealth effectively. You can still be a card-carrying capitalist and hold that opinion, we do it for lots of things already.
When you have something with effectively infinite demand (how much would you pay not to die) a market can't rally operate, or you end up with so much regulation just to play kayfabe that there is some sort of free market that you may as well implement the universal system like the US is about 80 years late on.
Another solution (Score:3)
To me believing in capitalism is just as much as knowing where it doesn't work and healthcare is one of those areas. It's just too inelastic and I think there is an obvious moral hazard in keeping it behind access to wealth effectively. You can still be a card-carrying capitalist and hold that opinion, we do it for lots of things already.
When you have something with effectively infinite demand (how much would you pay not to die) a market can't rally operate, or you end up with so much regulation just to play kayfabe that there is some sort of free market that you may as well implement the universal system like the US is about 80 years late on.
One problem is that the system is set up with the wrong goals. Insurance companies see premiums as revenue and care as expense, while people see premiums as expense and care as benefits. Those two are at odds with each other, and leads to all sorts of tug-of-war problems.
A different system might identify the average age of death in the US, then penalize insurance companies for subscribers who die before that age, and reward them for subscribers who live longer.
Perhaps the US could open a term life insurance
Re: Another solution (Score:2)
This is simplistic. Healthcare is not only about longevity. Quality of life also matters greatly. My HIV drugs will likely keep me alive a long time, judging by the last 2 decades. But the other chronic conditions still lower my quality or life x and it would be much worse if they went untreated.
Insurance companies are middlemen, just like PBMs. They sit between patients and providers, such as doctors, hospitals and so on.
I can never see the best providers on the market, as some providers are exclusive to
Re: Another solution (Score:2)
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These are probably all decent ideas to look into but it definitely feel like it falls into my "so much regulation just to play kayfabe that there is some sort of free market" and goes back to how do you have a "market" for something where the demand curve is always higher than the supply curve. How can you have competition for products the consumer is unable to walk away from a purchase? These to me are the fundamental issues everything else flows downstream of.
We already have dozens and dozens of examples
Re: About time (Score:2)
You appear not to know who the PBM's consumers are: the corporations whose employee pharmacy benefits they manage. Those corporations haven't been ripped off at all.
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They've been ripping off both sides. The corporations are paying PBMs to get a discount out of drug manufacturer's through volume sales. If the drug manufacturers have been incentivized to either have two lines (expensive but discounted to insurance and a cheaper not insurance) or to just drive up prices so that they can be discounted.
So then PBMs are getting a cut of the discount, but it's not the true discount. So either the PBMs are stealing the discount of the corps with drives up copays on consumers. O
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This actually is capitalism. It is not a free market though, but the usual greedy capitalists do not want a free market.
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It *IS* the result of a poorly regulated market combined with patents.
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Before anyone objects, this is not capitalism.
There hasn't been Capitalism in America for at least the past 30 years. It is all "private funds" gathering up every last portion of "profit". They buy out entire industries. We are close to the end game where the mask of Democracy and Capitalism is ripped off and what we see is Fascism and Despotism.
Incoherent (Score:2)
Something fishy with Paxlovid pricing too (Score:3)
Last week I came down with whatever strain of Covid is going around and got an RX for Paxlovid. That's gone up in price to something like $1,700. Weird thing is, almost nobody actually has to pay that price, since it's either covered by insurance or there's presently a patient assistance program if you're uninsured.
Still, it reminds me of that Star Trek Voyager episode [fandom.com], where The Doctor is kidnapped and forced to work on an alien planet that essentially had a carbon-copy of the US healthcare system.
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Yeah, it's so they can utterly overcharge the government, like with medicare.
I remember when the mandate came down to have a epipen in with the AED (Automatic External Defibrillator). It's also about the time that epipens started being ridiculously priced.
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That's one example, but the broken feedback is generic in the system (and not limited to health care, either).
There needs to be truly independent oversight..and truly independent means that those overseeing it are forbidden to ever accept payment of any kind from those they were overseeing.
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Last week I came down with whatever strain of Covid is going around and got an RX for Paxlovid. That's gone up in price to something like $1,700. Weird thing is, almost nobody actually has to pay that price, since it's either covered by insurance or there's presently a patient assistance program if you're uninsured.
Still, it reminds me of that Star Trek Voyager episode [fandom.com], where The Doctor is kidnapped and forced to work on an alien planet that essentially had a carbon-copy of the US healthcare system.
I also came down with that strain, the XEC variant. Been a rough week but meh, working from home so I cant even claim a full 2 weeks off. My employers been pretty supportive though as last week I was completely out of it.
Paxlovid you can get on prescription here, it's about £400 for a course, which if you're prescribed by a doctor, the NHS will pick up. I didn't even bother with a doctor (just did the home lateral flow test) as I'm fully vaccinated and get mandatory paid sick leave. This strain isn
All the above comments are right on! (Score:3)
I gotta say, that as I write this with maybe 8 comments so far, I like the discussion. We've got too many complexities that are neither red or blue, Marx nor Adam Smith, or any shade between. We can be aware of green or gold or whatever the color of money, which hides behind many veils, domestic and foreign . The above approach is way more constructive, because we can all follow the money, no matter where it goes. Scrutiny is needed to correct the failure of election cycles in government to focus on metrics that matter; efforts on interests outside re-election. Too often, we the people get sold out by lobbyists who pay to be ignored as much as they do to be noticed, Those that buy a lot of advertising and K street are definitely the problem.
"Rebate"? (Score:2)
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You're right. "Rebates" are just "kickbacks" and should be banned
Single Payer (Score:4, Insightful)
The only way this garbage gets solved is with a single-payer system. When you have a profit motive everything gets gamed.
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This is like programmers saying that the "only" way to fix the buggy software they are working on, is a complete rewrite. Usually, when they get their way, the result is disaster, and certainly not better than the original buggy code. This happens because the "rewrite" advocates forget about all the problems that *have* been solved in the current system, and have to re-fix them in the new version.
Our system is terrible, I agree. But it's not an indication that single payer is the only solution. How about so
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You're lying again. Stop it.
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You're lying again. Stop it.
This.
Most cutting edge medical developments, technological, pharmaceutical or procedural tend to come out of learning and research institutes like universities or research hospitals, most of which, even in the US are wholly or in large part funded by public money. I don't think it matters if it's a single payer, private or hybrid system in place for the general public, rather having the institutions that perform the research and development and they're mostly publicly funded.
The private sector tends t
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Neither of these things are true. Not even remotely close to true. They're both lies - propaganda pushed by the private health & insurance industry to discourage you dumb fucking yanks from guillotining the fucking lot of them and replacing your shit health system with something that actually fucking works: a universal public health care system.
Public health systems
Re: (Score:2)
You fail to understand the difference between:
1. doctors deciding whether you need a specific treatment or medication for whatever condition you have, and
2. a business deciding whether they want to spend the money on a treatment you actually need.
The former is medicine being practiced. The latter is a death panel.
"How it works" in civilised countries is: if you need treatment and it's effective for the condition you have, you get it.
In crazy countries without universal public health care, you get treatment
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This is not a thing in the real world.
This is grotesque manufactured "watch out for the evil socialist boogie-man" propaganda.
You're just repeating nightmarish propaganda spread by the corporations who want you to keep paying for private health. The same people who told you that "public health = death panels"
Re: (Score:2)
If there's any shred of truth in this then it'll be some lunatic speaking shit, or they just tricked someone into carelessly saying something stupid that could be twisted into this bullshit.
and your media did their job and spammed it for a few days until it became "fact" that everybody knows. i.e. an alternative fact AKA bullshit.
woo! scary socialist boogie-men with their death panels and euthanasia!!!
This propaganda also serves as a good distraction from the American practice of just sending the poor home
Re: (Score:2)
Shit like that is only happening because the Tories want to destroy the NHS and implement a "business-friendly" American-style private for-profit health system - and disguise all the under-funding and private outsourcing and general fucking with the health system as "necessary compromises" because they know they'll be fucking lynched if they openly admit what they're trying to do.
You do know that, right? You are capable of seeing the obvious?
PS: and ditto for the right-wing parties in Australia who do the s
Re: (Score:2)
Here's the problem with your argument.
You're basically saying "If we just followed *my* political party's vision, everything would work fine. But the *other* party is ruining it for everyone."
This is exactly the kind of tribalism that is destroying American politics today. Each party thinks they are right and the other party is wrong. If we want to be successful, we have to instead acknowledge that the other side might have some valid points, and find ways to compromise. Otherwise, you just get whiplash whe
Re: (Score:2)
No. You have no fucking idea what you are talking about. Stop looking at world politics through your fucked up American political lens - there's more to the world than just your false dichotomy of right-wing liberals and ultra-right-wing christo-fascists.
The Tories in the UK hate the NHS, and the Libs in Australia hate Medicare and the PBS. They hate any form of welfare or public services, because they're either members of or servants of the 1%. Every fucking time they get elected they do whatever they
Re: (Score:2)
This is very interesting. You start by saying that it's not about politics, and then you proceed to discuss how the political sides differ. And then you threw in some swear words because apparently you don't know how to emphasize a point without them. I think you made my point nicely.
Regardless of nation, there are some who think it's the job of the government to take care of people, and advocate for giving the government more and more power in order to do so. And there are others who think the government i
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This is very interesting. You start by saying that it's not about politics, and then you proceed to discuss how the political sides differ. And then you threw in some swear words because apparently you don't know how to emphasize a point without them. I think you made my point nicely.
What the fuck is so difficult to understand about "It is an observable fact that one side of politics does its utmost to destroy the public health system whenever it gets elected"?
They may have ideological reasons for doing so
Re: (Score:2)
Well, I can see that you've mastered at least one swear word, and all its forms. Good job. Maybe you could get a little more creative and try a different swear word now and then.
It's funny that you use an analogy of compromising over someone stealing your land. That's a conservative argument. Conservatives say that they don't want the government taking their stuff and giving it to other people. Ironic that you think the government _should_ take your money and use it to pay for other people's healthcare.
What
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I deliberately used that example because I knew it would be one of the few you'd have a chance of understanding. I even fucking said that to preface the example.
but yeah, that's a real gotcha - you're so smart to have spotted it. there's no fooling you, is there?
No, it is NOT an extreme politi
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I'm really confused now, I can't figure out whether I'm dumb, or smart!
Anybody who insists that "universal" is the only acceptable option, is extreme. Clearly, you aren't as opposed to the 1% as much as you say you are.
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Dumb. And you're obviously American, because sarcasm is an incomprehensible concept to you. So, just another dumb american.
A public health system has to be for everyone. That's the fucking point you fucking cretin.
And, no, that is NOT an extreme position. It's an entirely sensible and completely rational position, boringly mainstream and not in the least bit controversial anywhere but in the the land of the brainwashed slaves.
And, yes, i realise that you're just a moronic arsehole who thinks that twisting w
Re: (Score:2)
Thanks for clearing that up about my dumbness. I wasn't clear on that. You got a little soft though with some of your name-calling, I think you're losing your edige.
What's sensible to YOU is not necessarily sensible to others. Yes, "universal" means everyone, but that in itself is no argument that "universal" *should be* the goal. What that really means is that you think there should be only one way that healthcare is delivered to people, that they should have no choice but to get it from the government. Th
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Nobody, and I mean NOBODY in the world except for Americans thinks that it's not only normal to be raped by private health insurance (and private hospitals and big pharma and all the middle-men parasites and the rest of your fucked up system) but actually thinks it's good.
You poor brainwashed dumbfucks are the only ones who think that.
Of course
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You clearly don't understand people from the US as much as you think you do.
We don't love our healthcare system, and we certainly don't love the cost. But that doesn't mean that the only solution is the hand it all over to the government. The government *is the problem* because they have stupid rules like:
- You can't buy insurance across state lines.
- You can't form insurance groups except through your employer.
- Medicare isn't allowed to negotiate drug prices, by law they must pay whatever the drug manufac
Re: (Score:2)
You understand those stupid rules only exist because of corporate lobbying and corruption, right?
Don't you already have laws prohibiting restraint of interstate trade? or does this somehow qualify as "regulating" under your Commerce Clause?
I know the CC was a huge manufactroversy around 2011 that went all the way to the Supreme Court because of the "individual mandate", but has anyone eve
Re: (Score:2)
Every country in the world has corporate lobbying and corruption, whether they have universal healthcare or not.
As for buying insurance across state lines, it's true that states cannot prohibit interstate trade, but our constitution specifies that trade between states is regulated by Congress. In 1945, Congress passed the McCarran-Ferguson Act, which designated states as the primary regulators of health insurance. Since states can only regulate what happens within their borders, the law effectively makes it
Serial killers (Score:2)
These people make serial killers and mass shooters look like novices. They'll get to keep almost all their blood money, too.
The new FTC (Score:3, Insightful)
Say what you will about inefficiencies of our govt., but this new FTC has been kicking ass.
Re: The new FTC (Score:2)
Put it on the insurance companies, not the PBMs. (Score:3)
Better idea: hold the insurance companies themselves responsible for only offering the higher-priced options when lower-priced equivalent ones are available. Using a PBM is the insurance company's choice, no law requires them to do so, so let them be responsible for how their chosen PBM operates. That gives you a much clearer argument against them in court, because what legitimate reason could the insurance company have for paying more for insulin than they have to? And if they try to point the finger at the PBM, point out that they don't have to use the PBM if the PBM's costing them that much money so why haven't they fired the PBM over this? And go digging into transactions between the PBM and the officers of the insurance companies looking for indications it's because the PBMs are paying those officers to keep using the PBM. Even if you don't find anything, it'll leave the jury wondering.
And frankly I'd bet you will find something going on under the table, seeing as the PBMs are all subsidiaries of either insurance companies or pharmacy chains. This has many of the hallmarks of Hollywood accounting.
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Except these PBMs basically are part of the insurance companies - it's not like it's even an independent company doing this.
Caremark is part of the CVS Caremark portfolio - along with Aetna
Express Scripts is a subsidiary of Cigna
OptumRX is a subsidiary of UnitedHealth
They even limit which pharmacies you can use - e.g. my UnitedHealth plan won't let us me CVS Pharmacy (which I can walk to) for example.
The insurance companies are not really going to care unless there is enough push-back from regulators and co
In India (Score:3)
Re:In India (Score:4, Informative)
There are differences between US and India on drug prices. But the bigger piece here is in what insulin is being talked about. Old school NPH insulin [wikipedia.org] in a vial injected with a needle is cheap everywhere, here in the US it can be around $25 a vial without insurance. But there's a big downside to NPH, it's an "intermediate" acting insulin with about a 1.5 hour lead time until it starts working, an 8 hour peak, and a 24 hours until it wears off. This makes it very difficult to use, it means that someone needs to know what they are going to eat long before they are going to eat it and have to plan very carefully around their day and night to not go low.
Enter in the expensive insulins that come in two classes, rapid acting and long acting. Being able to have one that is very steady for a baseline, then someone can look at what they are going to eat and calculate the right amount of rapid acting insulin that works in under 30 minutes. This then enters the second expensive part, using an "insulin pen" is way easier to calculate, administer, and carry than needles and vials.
So these factors add up to a very muddled conversation on insulin, because there's not just one insulin to compare costs on. Outside of countries having different regulations, intellectual property rights, and different bargains with corporations.
I confused (Score:2)
IANAL, but doesn’t that mean this is completely for PR purposes?
Poetic justice (Score:2)
Political PR stunt (Score:2)