The government created this problem in the first place by granting monopolies on drugs. If it allowed others to manufacture it, the price would drop.
EpiPen Maker Quietly Steers Effort That Could Protect Its Price
131–140 of 172 posts
Re: EpiPen Maker Quietly Steers Effort That Could Protect Its Price
#132Earlier quoted context omitted.
That's a very specific thing. The co-pay is a part of the price of the product that your insurer doesn't cover, so technically it's not theirs to begin with. Which is also why it's not a refund of the deductible paid, because that -is- considered part of the insurance contribution, i.e: (deductible paid by customer + insurance payment) = your insurance contribution co-pay = your personal contribution to the cost of t…
It's obviously fraud. If your windshield breaks and your deductible (co-pay) is $500, I can't quote you $500 above market rate to fix it and give it back to you in cash to stick it to your insurance company.
Your deductible is not your co-pay.
Deductibles, co-pays, and co-insurance are all separate things with specific definitions:
A deductible is a portion of covered medical expenses that the insured must pay. It is specifically defined as the amount of covered benefit that must be incurred and paid by the insured before benefits become payable by the insurer.
Key in the above is "a portion of covered medical expenses".
A copayment is a flat dollar amount that the insured pays each time a certain kind of service is received. The copayment is not a percentage of the total cost, as it is in coinsurance, but rather is always the same dollar amount even though the cost of the service may vary (a pharma co-pay of $x, regardless of the variable drug price).
It may seem like nit picking, but there are specific reasons for the difference.
Source: myself, who writes and maintains health insurance claims management and adjudication software.
This is all separate to your claim: of course, if your doctor agreed to charge you $x+200 (leaving aside the reality of negotiated and contracted fee schedules) and refund you that $200, then absolutely yes - this is insurance fraud.
However, the co-pay does not form part of the insurance coverage.
Re: EpiPen Maker Quietly Steers Effort That Could Protect Its Price
#133Earlier quoted context omitted.
It's obviously fraud. If your windshield breaks and your deductible (co-pay) is $500, I can't quote you $500 above market rate to fix it and give it back to you in cash to stick it to your insurance company.
Somehow there is a mechanic shop near me with a sign out front advertising that they will pay your deductible. It's not exactly hidden either -- it's located on one of the busiest streets in Chicago. Here's a street view image: https://goo.gl/maps/hUAUUEJwiQT2
If the real cost to fix a windshield is $300 but your shop advertises $800 to everyone along with an offer to 'pay the deductible' then it's not illegal. You can claim your shop is more expensive because it offers better service or better parts or whatever. It would only be illegal to quote $300 for those who are uninsured but quote $800 for those who do have a deductible.
It's still clearly a scam against the insurance companies, whether actual fraud charges would stick in court or not.
Re: EpiPen Maker Quietly Steers Effort That Could Protect Its Price
#134Earlier quoted context omitted.
It's obviously fraud. If your windshield breaks and your deductible (co-pay) is $500, I can't quote you $500 above market rate to fix it and give it back to you in cash to stick it to your insurance company.
Your deductible is not your co-pay. Deductibles, co-pays, and co-insurance are all separate things with specific definitions: A deductible is a portion of covered medical expenses that the insured must pay. It is specifically defined as the amount of covered benefit that must be incurred and paid by the insured before benefits become payable by the insurer. Key in the above is "a portion of covered medical expenses".…
> This is all separate to your claim: of course, if your doctor agreed to charge you $x+200 (leaving aside the reality of negotiated and contracted fee schedules) and refund you that $200, then absolutely yes - this is insurance fraud.
If you charge $X more for an Epipen vs. the market rate for a generic epinephrine autoinjector but offer a $X discount for uninsured persons (or a smaller $Y discount for those with copays or deductibles), it is the same scam.
Maybe not legally, but effectively.
Re: EpiPen Maker Quietly Steers Effort That Could Protect Its Price
#135Earlier quoted context omitted.
Adding to this, if you have insurance most of the hospitals will jack up the prices. One of my friend did not have the insurance card, so the hospital billed X$ and told him that if he later gives the insurance id they will charge them. He later called the hospital and gave the insurance details and he is charged (X+Y)$. Being the first time he got sick this year, he had to pay his entire deductible meaning he paid m…
IMHO providers should be required to charge the same price to all patients. That's not to say hospital X should pay the same as hospital Y, just that X needs to charge the same to all it's patients for a given service/procedure and Y needs to charge their own price for the same to all their patients. If you have insurance, then they need to be charged the same too. This would go a long way to promoting competition an…
and maybe make those prices public?
Re: EpiPen Maker Quietly Steers Effort That Could Protect Its Price
#136Earlier quoted context omitted.
> They can't "extend patent protection" for the drug Yes they can. The Hatch-Waxman Act was written specifically for this. Also see: http://www.citizen.org/congress/article_redirect.cfm?ID=6435 You never said whether or not Martin Shkreli makes you angry. Should investors be encouraged to find undervalued drugs, buy the IP, then raise the price through the roof? That would be good for society? Part of the reason the…
You're confusing different things. Hatch Waxman does not extend the patent term for orphan drugs. It allows the patent term at the time of FDA approval to be extended to account for unusual approval delays, but only up to the point there is 14 years left post-approval. That has nothing to do with extending the patent term for modifications to the drug, as you state above. As to orphan drugs, Hatch Waxman does not ext…
> As for Shkreli--he's an asshole, but it makes no sense to focus narrowly on isolated abuses.
I take it nobody in your family was affected by the price of a Daraprim tablet going from around $10 to $700 per pill?
> The big problem here is that manufacturers of generics have almost zero ability to invest in even minimal R&D.
Because that's not what they do. That's like complaining that Belkin makes lightning cables and they aren't even investing in developing new computers.
Re: EpiPen Maker Quietly Steers Effort That Could Protect Its Price
#137Earlier quoted context omitted.
Ask yourself, why is the United States the only country in the world where advertising prescription medicine to consumers is allowed? Why is it even needed? I know some people say "education", but that's backward. You have a problem. You go to your physician. He works out a treatment plan for you. For drugs advertised for specific conditions? To enlighten you to alternatives? You can oftentimes assume that alternativ…
>Why is it even needed? Because, contrary to popular belief, doctors aren't gods, and have about the same fraction of slackers as any other occupation. Unless we're ready to have a really aggressive program for revoking licenses of doctors who don't keep up with modern advances, they can and do miss available treatments. "Hm, I could eagerly search all the latest treatments that might be relevant to my patents, or I…
Doctors / nurses / pharmacists are required to submit dozens of hours of continuing medical education every year to maintain their licenses. There is an approximately 0% chance that a patient with no background in medicine will learn something useful from a TV Commercial that everyone in the treatment plan doesn't already know.
Re: EpiPen Maker Quietly Steers Effort That Could Protect Its Price
#138Earlier quoted context omitted.
If no one is making a generic, or more to the point doctors are prescribing "EpiPen" rather than "epinephrine autoinjector" being out of patent won't help. In the UK doctors had to switch to prescribing generics I think as far back as the 80s. Brands are now only prescribed, with a few exceptions, when it's something new enough to not have a generic yet. Before that lots of things were often prescribed by brand witho…
My experience in the US is that doctors prescribe drugs with generic alternatives anytime they can. I'm not sure if I've ever even taken a branded prescription pill.
Doctors in the US are reimbursed by Medicare/Medicaid and private insurances based on the rates of generics they prescribe. They look at each type of doc (Oncologists obviously use more Brand Name drugs than pediatricians) and make sure that every doctor falls in a tight band with incentives to 'beat' the number.
Most hospitals have specific formularies tilted toward generics as well, if a doctor writes "Tylenol" for a patient, they're given generic acetaminophen. More interesting is that if a doctor writes a script for something like a Brand Name statin, the formulary will auto-substitute for the hospital's drug of choice, now typically generic Lipitor.
Re: EpiPen Maker Quietly Steers Effort That Could Protect Its Price
#139Love or hate the guy, but Martin Shkreli has a good point here on the EpiPen: https://www.youtube.com/watch?v=RoMlxVimwiU Basically: That $600 is a value to save your life - much cheaper than an ambulance / hospital stay That insurance companies should cover 100% of it
That's a terrible point and could be used to justify $10,000/dose EpiPens.
Re: EpiPen Maker Quietly Steers Effort That Could Protect Its Price
#140Earlier quoted context omitted.
Her. We expect her to be out of a job when healthcare becomes socialized, then she can move into the financial sector and rip people off there.
And if the healthcare becomes socialized who will make EpiPens ?
The same company that currently makes them? Single-payer doesn't mean the government is going to try and run pharma manufacturing.