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Insulin Wars: How insurance companies farm out dirty work to doctors patients

nytimes.com

61–70 of 95 posts

Re: Insulin Wars: How insurance companies farm out dirty work to doctors patients

#61
post #29
post #19

Earlier quoted context omitted.

I agree 100%. The approach I like is what I call "lowest negotiated price". How it would work is that buyers (i.e. insurance companies) could still negotiate for a lower cost, but whatever that cost ends up being is the cost _everyone_ pays. This allows buyers to continue to try to get a better price if they can, while likely making sure the price that is agreed upon is fair to all.

There is evidence that this would actually increase prices across the board. How do we know? Such a system already exists. The price that Medicaid plans pay is either 23% less than the average price paid or the “best price” (if lower). When this was instituted, drug companies actually pulled back on their discounts to non-Medicaid accounts, so as to not trigger the “best price”.

Another part of this is the rise of 'rebates' for PBM's and insurance companies, that does not change the price paid for the drug.

Re: Insulin Wars: How insurance companies farm out dirty work to doctors patients

#62

I still think the approach I proposed years ago would be a big help: Turn the usual arguments on their head, prohibit all negotiation. Drug companies would be required to sell to all customers at the same price. This would end all cost-shifting, it's fair for all and forces the drug companies to actually compete on the end price. This would end this sort of preferred drug shifting, it would end the game of state Medi…

A better approach might be to prohibit insurance coverage for insulin altogether.

Part of the reason healthcare is expensive is that the entity paying for the product is not the customer of the product. When the customer pays, the customer becomes price-sensitive and markets work the way they're supposed to: Prices go down. Since insulin is inherently cheap, making everybody pay for it out of pocket would be both humanely reasonable and it would stabilize prices.

Re: Insulin Wars: How insurance companies farm out dirty work to doctors patients

#63
post #38

Why is insulin not an over the counter medicine? Would having it OTC cause problems on the scale of alcohol? What's the "value add" of having a doctor renew an insulin prescription?

First because overdosing on insulin is fatal. That's not unique to insulin; overdosing on Tylenol is fatal too, but with insulin you don't get any warning: With a slight OD you'll feel your brain get foggy and you can chew some candy to fix the problem, but with a big OD you just pass out and die.

Second because the peculiarities of insurance often mean prescription drugs are cheaper to the patient than OTC drugs. Making insulin OTC might well make it more expensive.

Re: Insulin Wars: How insurance companies farm out dirty work to doctors patients

#64
post #32
post #14

Earlier quoted context omitted.

There is a great living for someone to make a generic. No need to make bazillions. Crowd fund it. Or, regulate. Both would be just fine with me.

A generic already exists - Walmart insulin. Apparently it’s not that great.

Yes I read that. I wonder if better is still possible, but not just being done.

Re: Insulin Wars: How insurance companies farm out dirty work to doctors patients

#65
post #15
post #5

This is exactly what you get when there is no transparency, and everything is driven by non-market forces. Why not create an actual market where all medications, medical services, tests, etc, have a known price and people can make decisions based on cost, quality, and other factors?

Kenneth Arrow showed in 1963 that markets can't work for Healthcare.

Well I'll provide the citation and personally disagree with that summary. Adults who give a fig can read it, it's short.

https://www.who.int/bulletin/volumes/82/2/PHCBP.pdf

Re: Insulin Wars: How insurance companies farm out dirty work to doctors patients

#66
post #52
post #42

Earlier quoted context omitted.

Tell that to cancer patients who are living longer than ever.

The word "most" doesn't imply an absolute.

I assume OP is talking about “me too” drugs. However, there is an argument that they offer a lot of value too. Incremental improvements is why we have a single pill therapy for AIDS with minimal side effects. It took dozens of “me too” drugs to get to that point.[1]

[1]https://www.acsh.org/news/2012/05/10/me-too-drugs-are-innova...

Re: Insulin Wars: How insurance companies farm out dirty work to doctors patients

#67
post #34

Earlier quoted context omitted.

That’s list price. Interestingly, net prices have barely budged in the last decade. Up only single digit percentage.[1] As the list price rose and rebates grew, Novo ended up paying more and more rebate money into the health insurance system. Employers used these extra payments to offset costs in any area, including hospital and physician payments. Health plans used them to reduce premiums and also offset other healt…

https://www.nytimes.com/2018/07/27/health/rebates-high-drug-... > Even as insurers’ drug spending has grown slowly, critics say the rebate game has served to inflate the list price of drugs, which consumers are increasingly responsible for paying. This is especially true for expensive specialty drugs, which treat serious conditions like cancer and multiple sclerosis — and whose prices have been skyrocketing. > As the…

That is very true. If your insurance requires a copay, it’s on the list price, not net.

Sometimes the discount is so big that 20% of the list price is more than the entire net price of the drug.

Re: Insulin Wars: How insurance companies farm out dirty work to doctors patients

#68
post #31

Earlier quoted context omitted.

Yet they seem to work fine for elective surgery like vision correction and cosmetic surgery.

Possibly because there's an opt in gap between "I need larger breasts" and "If I don't find a way to pay for my chemo, I'll die"?

Sure, the stakes are much higher, but people often choose their physician based on skill. Why not throw cost into the mix as well? Right now that’s impossible.

Re: Insulin Wars: How insurance companies farm out dirty work to doctors patients

#69

I always say this, but reading that makes me think thank God for the NHS in the UK. Health and education should never be a business. The pharmaceutical companies are so strong and greedy in the US they want people on their drugs, rather than look for preventing the problems. They often lambast and send confusing scientific studies out to ensure no alternative therapies succeed over their drugs.

In the US, dental and vision care are much more business-like than healthcare in general. Prices are reasonable and care is quite advanced. If there was no protection racket, dentistry would be even cheaper.

Which isn't to say that running them as businesses is necessarily the right idea, but the regulatory morass that is broader US healthcare probably doesn't teach us everything there is to know about healthcare as a business.

(people get angry when you do things like call a $200 filling "cheap", but it lasts for 15+ years and you get to keep the tooth. It's cheap!)

Re: Insulin Wars: How insurance companies farm out dirty work to doctors patients

#70
post #20

Earlier quoted context omitted.

It's not like doctors and actuaries don't know this. For reasons poorly understood (though there are many theories) most people have a difficult time changing whatever lifestyle was hurting them in the first place. People also have a poor model of how health care works (most people seem to think it's like getting your car fixed: go to "mechanic" and have problem fixed). Finally the educational level that needs to be…

Do you mind if I ask what the underlying illness was? Or maybe some of the testing you did?

I had an underlying autoimmune disorder (diabetes can be an autoimmune disorder and isome common comorbidities are too, like Hashimoto’s).
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