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Treat Medicines Like Netflix Treats Shows

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Re: Treat Medicines Like Netflix Treats Shows

#71

Post by ratling »

vonmoltke wrote: post #65
will_brown wrote: post #46

Earlier quoted context omitted.

>The problem with a "netflix" model, is that doctors can currently prescribe anything, regardless of cost or efficacy Unknown to almost everyone in the US is that if you are a Medicare patient, when you go to fill a Rx before the pharmacist fills the therapy, insurance software suggests cheaper generics to the pharmacist and requires the pharmacist to do the leg work of asking the doctor to change the Rx based on wha…

> insurance software suggests cheaper generics to the pharmacist 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. >…

NexGen will suggest generics when you have a script for a name brand. It’s not coming from the insurance company.

Source: worked for RiteAid for half a decade.

Re: Treat Medicines Like Netflix Treats Shows

#72

Post by hjk05 »

keiferski wrote: post #4

Maybe I’m missing something, but discussions on the cost of medicine never seem to question whether using prescription drugs is the right choice to begin with. IMO, it would be far preferable to treat pharmaceuticals as a last resort, focusing instead on preventative medicine and addressing the underlying social issues that cause the medicine to be prescribed in the first place. From the article: Hep C kills more peo…

> Surely the solution to this epidemic is to address the underlying drug problems first?

Try this scenario out for size: Tomorrow you go shopping, while leaving the shop, a teenager enters with a gun demanding money, he gets nervous and shoots the cashier and while running out the store shoots you in the leg. Luckily authorities are quickly at the scene, arrest the criminal, and medical personal take the clerks body away. A cop comes by you and says: Geesh, that sure looks bad, but don’t worry, we are hard at work trying to solve the youth criminal behavior at the root of your current condition. And don’t worry after you bleed to death the medics will be able to fit you in the same van as the clerk, so you won’t be that big of a bother for them. Sad though to think, before we started focusing solely on root cause issues, they could have just stopped your bleeding and taken you to the hospital. But I hope you understand, it’s about efficient allocation of resources.

Re: Treat Medicines Like Netflix Treats Shows

#73

Post by rexpop »

VikingCoder wrote: post #58
kakaorka wrote: post #53

Earlier quoted context omitted.

Maybe because that’s just you, a unique individual. For a different unique case, such as someone who has Hep C, the utility value for the medicine could literally be everything for the person. So, if we average the utility value for a whole population, the utility value would actually be pretty high, especially if a lot of people have Hep C.

I'm sorry, can you explain how we "average" the utility? For me, it has zero value. For another person, it saves their life, and they would pay literally anything they could. How do we average that? My hot take: We can't. Buy medicine in bulk, give it to people for free, progressive taxes to pay for it.

I like your take, but how are we going to enforce progressive taxation? The wealthiest firms escape taxation, at the moment.

Re: Treat Medicines Like Netflix Treats Shows

#74

Post by VikingCoder »

rexpop wrote: post #73
VikingCoder wrote: post #58

Earlier quoted context omitted.

I'm sorry, can you explain how we "average" the utility? For me, it has zero value. For another person, it saves their life, and they would pay literally anything they could. How do we average that? My hot take: We can't. Buy medicine in bulk, give it to people for free, progressive taxes to pay for it.

I like your take, but how are we going to enforce progressive taxation? The wealthiest firms escape taxation, at the moment.

I can't pretend the answer is easy, but...

Starting with personal income tax, capital gains, and estate taxes would go a long way.

I think we really need to come up with an International version of the Uniform Commercial Code. And get money out of politics.

Re: Treat Medicines Like Netflix Treats Shows

#75

Post by will_brown »

vonmoltke wrote: post #65
will_brown wrote: post #46

Earlier quoted context omitted.

>The problem with a "netflix" model, is that doctors can currently prescribe anything, regardless of cost or efficacy Unknown to almost everyone in the US is that if you are a Medicare patient, when you go to fill a Rx before the pharmacist fills the therapy, insurance software suggests cheaper generics to the pharmacist and requires the pharmacist to do the leg work of asking the doctor to change the Rx based on wha…

> insurance software suggests cheaper generics to the pharmacist 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. >…

From the Center for Medicare and Medicaid Services. But like I said nearly no one knows any of this.

Go into any pharmacy and ask the pharmacist about “MTM” and gauge their reaction.

Look at outcomesMTM they are 1 of the 2 dominate insurance software vendors. Again you can ask nearly any pharmacist and they have an outcomesMTM portal that feeds them automated recommendations on behalf of the insurance carrier. Some of the bigger pharmacies, like Wal-Mart, have even removed the MTM portals from the individual stores already and created nationwide MTM centers. I even know of one company who uses pharmacy students (for free) to do this work for the insurers. Here is another tidbit for every recommendation the portal gives the pharmacist the pharmacy gets a “tip” (ie monetary bonus) to forward that to the doctor and if the doctor makes the change the pharmacy gets another tip. The only reason the insurers link up with the pharmacists to do their dirty work instead of the doctors directly is the insurers can’t pay the doctors the way they pay pharmacists to do their work bc of anti kickback laws.

>Pharmacists cannot just ask doctors for prescription modifications.

Again try asking any practicing family physician, ask them how many faxes they get a day from pharmacies requesting they change the patient Rx.

Re: Treat Medicines Like Netflix Treats Shows

#76

Post by Jwarder »

vonmoltke wrote: post #49
anjc wrote: post #39

Am I missing something: >A study just published in The New England Journal of Medicine found that on average, Australia pays $7,352 (U.S.) per course of treatment. It has been able to treat seven times as many patients as it would without the agreements. I guess the reason we don't treat medicine like Netflix is because most people don't want to spend $7352 for a course of penicillin....?

What does penicillin have to do with this?

I don't want to put words in their mouth, but I think it might be a bundle vs a la carte argument. For issues that tend towards short term treatments (eg a handful of antibiotic pills to mitigate the risk of wound infection) then you don't want to pay the same total price as someone who is treating some chronic condition.

I can't find statistics on comparing one-off and routine prescription drug use. CDC data from 2014 shows that when asking about a 30 day period 47% of the population used >1 prescription drugs, 21% used >3 drugs, and 11% used >5 drugs. That suggests to me that there is a large population of people who could be bundled together, but for the context of the article this would all depend on the specific treatments.

https://www.cdc.gov/nchs/data/hus/2017/079.pdf

Re: Treat Medicines Like Netflix Treats Shows

#77

Post by tathougies »

KaiserPro wrote: post #37

This is insurance. Literally insurance. You pay a monthly fee in return for a good, service or cash payment should something happen. however in the USA, something odd has happened. For what ever reason, be it legal, cultural or other, copay, crippling buerocracy and down right greed has stopped the health system working properly. The problem with a "netflix" model, is that doctors can currently prescribe anything, re…

> US doctors must follow national guidelines laid out by a scientific body

No thanks. My daughter is alive today thanks to a therapy that would not be sanctioned by 'standards bodies'. I'm good.

Thank goodness her doctor was a professional that was able to make professional judgements. If you want to reduce doctoring to looking up values in a dictionary, I suggest you try that with you and yours first, before forcing it on everyone else.

Re: Treat Medicines Like Netflix Treats Shows

#78

Post by refurb »

fastball wrote: post #62
refurb wrote: post #41

Earlier quoted context omitted.

What a terrible analysis. Pretty sure that number is just the "Selling, marketing and administrative expenses" line from the 10-K, which lumps all expenses outside of COGs, R&D and a few others. That's not just marketing as people know it. It's all the other costs of running a company too.

Except drugs are different from other products. If a drug is actually a good idea for patients, with no profit motive behind it, it will sell itself. Doctors should be aware of the drugs the big drug manufacturers are producing, and prescribe accordingly based on need. If you need to hawk your drug by plastering TV ads all over the place, or by having salespeople push it to hospitals / etc., it's arguably not a neces…

If a drug is actually a good idea for patients, with no profit motive behind it, it will sell itself.

This is entirely untrue.

The one thing I learned in the biotech space is that doctors range from those doing research and know all about the cutting edge drugs all the way to doctors who are surprised to learn about a new drug that was approved a year ago. And there are way more of the 2nd kind.

Changes to how conditions are treated actually happens really slowly. What often hinders adoptation of new drugs is information and that’s a key goal of marketing - actually letting doctors know something new is available.

Re: Treat Medicines Like Netflix Treats Shows

#79

Post by lostapathy »

vonmoltke wrote: post #65
will_brown wrote: post #46

Earlier quoted context omitted.

>The problem with a "netflix" model, is that doctors can currently prescribe anything, regardless of cost or efficacy Unknown to almost everyone in the US is that if you are a Medicare patient, when you go to fill a Rx before the pharmacist fills the therapy, insurance software suggests cheaper generics to the pharmacist and requires the pharmacist to do the leg work of asking the doctor to change the Rx based on wha…

> insurance software suggests cheaper generics to the pharmacist 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. >…

>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?

This is not strictly true, at least in the US. I have had to wait while pharmacists contact the doctor to modify a prescription to sub something in due to availability issues.

The mail order service through my insurer will also do this to have doctors to order a 90 day supply rather than the usual shorter supply.

Re: Treat Medicines Like Netflix Treats Shows

#80

Post by vonmoltke »

will_brown wrote: post #75
vonmoltke wrote: post #65

Earlier quoted context omitted.

> insurance software suggests cheaper generics to the pharmacist 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. >…

From the Center for Medicare and Medicaid Services. But like I said nearly no one knows any of this. Go into any pharmacy and ask the pharmacist about “MTM” and gauge their reaction. Look at outcomesMTM they are 1 of the 2 dominate insurance software vendors. Again you can ask nearly any pharmacist and they have an outcomesMTM portal that feeds them automated recommendations on behalf of the insurance carrier. Some o…

> From the Center for Medicare and Medicaid Services.

Please direct me to citations, not "try asking any X".

> Go into any pharmacy and ask the pharmacist about “MTM” and gauge their reaction.

MTM has nothing to do with insurance.

> Look at outcomesMTM they are 1 of the 2 dominate insurance software vendors.

outcomesMTM is not insurance software, it's pharmacy patient management software.

> Here is another tidbit for every recommendation the portal gives the pharmacist they pharmacy gets a “tip” (ie monetary bonus) to forward that to the doctor and if the doctor makes the change the pharmacy gets another tip.

That you need to substantiate with more than just "go talk to pharmacists", particularly in light of the above.

> Again try asking any practicing family physician, ask them how many faxes they get a day from pharmacies requesting they change the patient Rx.

I've had my pharmacy request changes on my behalf, if it was something simple (like getting the wrong dosage), and they have done so as a convenience, not because they were required to. I have never had them request a change without my consent or knowledge, and I would stop using such a pharmacy if it ever happened.

You have also completely ignored what I said about prescription changes not being necessary for generic substitution.

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