Treat Medicines Like Netflix Treats Shows

Netflix & Spotify are aggregators, they own the consumer and distribution. Acquisition of movies costs either royalties to a studio or cost to produce the movie (actor salaries, etc.) Royalties are probably negotiated and the aggregator has leverage in negotiations because they own the consumer and distribution to them.

Insurance owns the patient, but the patient doesn't necessarily get to choose the medication. Their condition plus the doctor's prescription dictates what medication they can use. You're also not allowed to shop around for doctors who will prescribe what you ask for. Pharmacies own the distribution of medication. Drug companies need to recoup the massive R&D costs of developing drugs and thus are granted 20 year patents. This is somewhat similar to studios producing content and the copyrights afforded to those studios.

Not sure how to put all of this together but I think a big difference is that the consumer doesn't have discretion like they do in the Netflix/Spotify space. Maybe a good parallel would be Friends/Garth Brooks. If I want to watch Friends, I have to use Netflix or if I want to listen to Garth, I have to use Amazon Music. But despite the fact that I enjoy Garth's music, I can live without it or I can get it through other means (youtube, buying an album direct from a studio-owned distribution channel, etc.) People literally cannot live without some of these medications so consumer discretion is removed there.

Also, consumers don't have the ability to self-diagnose and self-prescribe. There are also no other distribution channels for medication. All of it must come through a pharmacy. There is no distribution done by the owner of the consumer(insurance companies), although PBMs may be a similar model?

Maybe somebody else could help me fill in the gaps with how the aggregator model is different from the pharmaceutical model or identify mistakes in my assumptions.

I have never heard of pharmacists using "insurance software". The pharmacy system requests coverage from the patient's insurance, and it is either accepted or rejected.

Additionally, if there is a generic they just fill it, assuming the patient consents. In fact, pharmacists in many states are required to point out generic alternatives if they exist.

> requires the pharmacist to do the leg work of asking the doctor to change the Rx based on what the insurance company wants (ie the cheaper medication)

If a prescription requires modification, the patient is required to go back to their doctor. Pharmacists cannot just ask doctors for prescription modifications.

Where are you getting these ideas from?

There are many reasons generics, especially in the case of Medicare patients with chronic conditions, are worse for a patient.

Generally if you have a Medicare patientwith chronic conditions such as diabeties and/or high blood pressure, and their physician has successfully been managing their conditions using a name brand therapy, it’s not good practice to switch their therapy to a generic because it helps the insurance company. More importantly, it’s only the active ingredients in name brand drugs and generics that are the same. coloring agents, binders, etc... are different and those can have significant negative side effects. There is no shortage of examples of generics having worse outcomes in the case of chronic conditions.

Also it’s not just the therapy the insurance is changing, they also change the quantity. So again say you are a Medicare patient with type 2 diabetes and your doc prescribed 30 day Rx so you come back for the doc to check your blood work between fills, insurance is demanding the doctor change the Rx from 30 days to 90 days, because they don’t want to pay for the additional doctor appointment/blood work. They are watering down care and interfering with doctor/patient treatments.