Treat Medicines Like Netflix Treats Shows • Hacker News Board

Re: Treat Medicines Like Netflix Treats Shows

#101

Post by Anon84 » Thu, Mar 07, 2019, 8:23 PM UTC

fwip wrote: post #51

Anon84 wrote: post #30

Earlier quoted context omitted.

> No one's pumping Hep C drugs into people who don't have Hep C However, that is what is being done with HIV drugs under the guise of PrEP https://en.wikipedia.org/wiki/Pre-exposure_prophylaxis So I wouldn't be so quick to rule it out, specially if Pharma companies see a way to profit out of it.

> Under the guise of I thought y'all were all about prevention? Now you're acting like preventing acquisition of a lifetime disease is a bad thing.

Prevention is great, and I'm certainly a big fan of it...

but by overexposing people to the drugs that are actually effective against HIV we're both helping the virus evolve around them and having to deal with whatever adverse side effects the drugs have on healthy patients.

Re: Treat Medicines Like Netflix Treats Shows

#102

Post by Pyxl101 » Thu, Mar 07, 2019, 8:26 PM UTC

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. >…

Some states allow pharmacists to substitute generic drugs for name brand prescriptions. To my knowledge they don't need the doctor's permission, and can make the change on their own unless the doctor specifically requests the name brand medicine for some reason.

Re: Treat Medicines Like Netflix Treats Shows

#103

Post by jazoom » Thu, Mar 07, 2019, 8:40 PM UTC

will_brown wrote: post #46

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…

>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…

In Australia pharmacists can automatically switch to the generics unless a doctor says they can't on the prescription. I am totally okay with that for almost all scripts I write because it's the same drug and it saves the patient money.

Re: Treat Medicines Like Netflix Treats Shows

#104

Post by 3into10power5 » Thu, Mar 07, 2019, 9:14 PM UTC

okmokmz wrote: post #91

3into10power5 wrote: post #85

I went to PAMF in Palo Alto, california yesterday for a "group diagnosis session" with the dermatologist. It seems dermatologist appointments are hard to get, so they came up with this method. You sit in a circle with other patients and doctor comes to each of you and quickly checks what happened to you and prescribes medicines. If she thinks it requires deeper consultation, she will scheduler private visits. I thoug…

I would not be comfortable with that method, and would definitely find a new doctor if I was presented with that situation

Well big ailments I would mind too. But small ones like fever or flu, I am ok particularly because its much less time consuming and much cheaper.

Re: Treat Medicines Like Netflix Treats Shows

#105

Post by keiferski » Thu, Mar 07, 2019, 9:21 PM UTC

hjk05 wrote: post #72

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…

You didn’t read the entire second half of my comment.

Re: Treat Medicines Like Netflix Treats Shows

#106

Post by will_brown » Thu, Mar 07, 2019, 10:01 PM UTC

jazoom wrote: post #103

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…

In Australia pharmacists can automatically switch to the generics unless a doctor says they can't on the prescription. I am totally okay with that for almost all scripts I write because it's the same drug and it saves the patient money.

well you may not mind if a pharmacist changes your Rx from name brand to generic to save the patient a little money.

But this is more of the pharmacist interfering with your relationship with the patient...

So imagine you write a therapy, and the patient gets a call from the pharmacists to the extent:

1. Your Doc Wrote the expensive drug, but if you agree we can save you $x by contacting your doc and encouraging them to change it;

2. Your Doc only wrote a 30 day fill, do you want us to ask for 90 days? (Consider these are your sickest patients, only your patients with chronic diseases, so you probably give them 30 days on purpose to get them back into the office to check their blood).

It may sound reasonable on its face but: 1. Your patient loses faith you are acting in their best interest; 2. It’s framed in a way that the pharmacist knows more than you; 3. It’s not disclosed to the patient or to you as the doc, that the pharmacy getting paid bonuses by the insurance company to do it; and 4. If you disagree with the request for change (it doesn’t matter why, it will harm your rating with the insurer and you will potentially be dropped from the insurance network and lose your patients with that plan/insurer).

Re: Treat Medicines Like Netflix Treats Shows

#107

Post by simonebrunozzi » Thu, Mar 07, 2019, 10:21 PM UTC

tathougies wrote: post #77

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…

Do you mind sharing some details, without naming names? I'm curious to know more about the specific issue.

Re: Treat Medicines Like Netflix Treats Shows

#108

Post by jazoom » Thu, Mar 07, 2019, 10:22 PM UTC

will_brown wrote: post #106

jazoom wrote: post #103

Earlier quoted context omitted.

In Australia pharmacists can automatically switch to the generics unless a doctor says they can't on the prescription. I am totally okay with that for almost all scripts I write because it's the same drug and it saves the patient money.

well you may not mind if a pharmacist changes your Rx from name brand to generic to save the patient a little money. But this is more of the pharmacist interfering with your relationship with the patient... So imagine you write a therapy, and the patient gets a call from the pharmacists to the extent: 1. Your Doc Wrote the expensive drug, but if you agree we can save you $x by contacting your doc and encouraging them…

I wasn't at all saying the way it's done in USA is good. I was suggesting that making it allowed unless explicitly disallowed might be a better way to go.

Re: Treat Medicines Like Netflix Treats Shows

#109

Post by cryptonector » Thu, Mar 07, 2019, 10:35 PM UTC

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…

So many things are wrong with healthcare in the U.S.

Where to start?

Low- or no-deductible insurance makes it difficult for consumers to be price conscious.

Networks and co-pays make it difficult for anyone to ascertain the price of any good or service until after it has been provided and consumed. Doctors don't know list prices or any prices. Insured consumers don't have incentives to ask, let alone shop.

Too little or no price signalling -> disfunctional market -> over-consumption -> inflation.

The Trump administration's push for hospitals to publish prices is a surprisingly good idea, provided no way around it is found by the industry. This needs to be pushed all the way down to clinics -- don't stop at hospitals.

Other things that are wrong include:

  protectionism -- wanna build a hospital?? first you'll
                   have to get a "certificate of need",
                   and that's a very political thing
  
  protectionism -- it's too hard to become a doctor
  
  protectionism -- the FDA helps pharmaceuticals
                   defend their profit margins even
                   when drug patents expire

All of this needs fixing.

A single-payer system would simply fix pricing, but would not be sufficiently dynamic (only markets can be decently efficient at discovering pricing), and it would impose rationing. I would prefer to fix the market's price signaling issues first and then also reduce the protectionism, then a healthy market can emerge and can increase supply to reduce prices (or reduce prices if supply were already high enough).

Re: Treat Medicines Like Netflix Treats Shows

#110

Post by phonon » Thu, Mar 07, 2019, 10:38 PM UTC

Pyxl101 wrote: post #102

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. >…

Some states allow pharmacists to substitute generic drugs for name brand prescriptions. To my knowledge they don't need the doctor's permission, and can make the change on their own unless the doctor specifically requests the name brand medicine for some reason.

Yes, those are "Dispense as Written" (DAW) Laws.

http://beta.aan.com/globals/axon/assets/4698.pdf

In most states, just using the trademark name instead of the generic is not sufficient (which makes sense, since the generic names are usually quite wordy and hard to remember) the doctor needs to specifically write "DAW" if a generic cannot be used.