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The Ozempocalypse Is Nigh

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Re: The Ozempocalypse Is Nigh

#41

Post by scarab92 »

monkburger wrote: post #38
jmward01 wrote: post #34

This is actively improving health outcomes for millions of people so of course insurance won't cover it and it is being taken away from consumers. If the shortage is over, why does it cost $1k or even $500? Sounds like there is still a shortage to me. I guess vaccines are out but price gouging is still in in the US healthcare system.

Profits over patients. Pharmacies have to have crazy high prices though because PBMs reimburse at such shit rates, based on some percentage of the price given to them. Because if they buy the bottle at $30 and list the price at $60, the PBM contract will only reimburse at the adjusted wholesale price (another made up number), eg: 17% plus a $1.99 dispensing fee. This disgusting math results in getting a loss on the d…

How should this system work, in an ideal world?

Re: The Ozempocalypse Is Nigh

#42

Post by Centigonal »

scarab92 wrote: post #27
dragonwriter wrote: post #21

Earlier quoted context omitted.

> How can people pay $1000/month for the rest of their life No one actually pays that price. The $1000 misrepresented in the article as the "usual insurance price" is actually the list price, from which insurers negotiate discounts (that is, the full price -- not just the out of pocket price charged to the insured -- for insured patients is significantly less than that $1000 price), while most people who get the drug…

It seems like the entire US medical system runs on prices that no one actually pays. I don't really understand what all that extra complexity achieves?

The US healthcare system is a patchwork of policy, local incentives, and unchecked capitalism that barely works, some of the time. You can read intent into it, but it's really just a big mass of inscrutable complexity.

That said, a lot of the time, inentionally or not, the answer is "it facilitates the transfer of money to the shareholders of the big private health insurance companies"

Re: The Ozempocalypse Is Nigh

#43

Post by trilbyglens »

timewizard wrote: post #23
wewewedxfgdf wrote: post #6

I'm far from convinced that some random "compounding pharmacy" produces effectively the same thing as Ozempic.

What do you believe is different between their process and the patent holders?

They don't need to recoup their investments in discovery and regulatory approval.

Re: The Ozempocalypse Is Nigh

#44

Post by r58lf »

scarab92 wrote: post #27
dragonwriter wrote: post #21

Earlier quoted context omitted.

> How can people pay $1000/month for the rest of their life No one actually pays that price. The $1000 misrepresented in the article as the "usual insurance price" is actually the list price, from which insurers negotiate discounts (that is, the full price -- not just the out of pocket price charged to the insured -- for insured patients is significantly less than that $1000 price), while most people who get the drug…

It seems like the entire US medical system runs on prices that no one actually pays. I don't really understand what all that extra complexity achieves?

PBRs have contracts with medical insurance. They get paid based on how much money they "save" the insurance company.

"Save" is defined as list price minus contracted price that the insurance pays for the drug.

PBRs manipulate the list price to be higher so that they "save" the insurance company more money.

They also manipulate the co-pays so that patients will choose drugs that "save" the most, as opposed to the lowest price drug.

Re: The Ozempocalypse Is Nigh

#45

Post by Centigonal »

scarab92 wrote: post #41
monkburger wrote: post #38

Earlier quoted context omitted.

Profits over patients. Pharmacies have to have crazy high prices though because PBMs reimburse at such shit rates, based on some percentage of the price given to them. Because if they buy the bottle at $30 and list the price at $60, the PBM contract will only reimburse at the adjusted wholesale price (another made up number), eg: 17% plus a $1.99 dispensing fee. This disgusting math results in getting a loss on the d…

How should this system work, in an ideal world?

Short answer: Systems 1, 3, 12, or 23 in Figure 3 in this paper are pretty good options: https://eclass.ekdd.gr/esdda/modules/document/file.php/KST_B...

This is an extremely politicized question in the US, where a public health insurance option (a solution that's popular in much of the rest of the OECD) is fiercely opposed by a large swath of the population.

At the very least though, in an ideal world, payers, providers, pharmacies, and PBMs should not be allowed to be part of the same company.

Re: The Ozempocalypse Is Nigh

#46

Post by Mutjake »

noduerme wrote: post #4
deadbabe wrote: post #2

Can someone please explain the economics of GLP-1s? How can people pay $1000/month for the rest of their life, just to keep weight off? Rent and mortgages are already insane as is, and then there’s insurance, kids, etc.

Knowing a couple people who've done it, they do it for a few months to lose weight, then stop taking it and try not to gain the weight back. I don't know anyone who's chosen to go on it permanently.

Well, it’s a medication designed for diabetes (the weight loss variant has a higher dosage and different brand name, Wegowy or so), and for diabetes the usage is, by default, permanent. Unless it is replaced by other medication or if the lifestyle changes make the insulin resistance not be an issue any more.

Re: The Ozempocalypse Is Nigh

#47

Post by dave333 »

Medicare should spend 1% of its budget each year to buy pharma stocks. Slowly it will become neutral to drug prices since what it pays for expensive drugs will be returned in the stock value.

Re: The Ozempocalypse Is Nigh

#48

Post by dazzaji »

dragonwriter wrote: post #21
deadbabe wrote: post #2

Can someone please explain the economics of GLP-1s? How can people pay $1000/month for the rest of their life, just to keep weight off? Rent and mortgages are already insane as is, and then there’s insurance, kids, etc.

> How can people pay $1000/month for the rest of their life No one actually pays that price. The $1000 misrepresented in the article as the "usual insurance price" is actually the list price, from which insurers negotiate discounts (that is, the full price -- not just the out of pocket price charged to the insured -- for insured patients is significantly less than that $1000 price), while most people who get the drug…

> No one actually pays that price. The $1000 misrepresented in the article…

With respect, that is absolutely incorrect. People absolutely pay over $1000 and do so monthly. For example, Kaiser of Northern California makes it very difficult for their doctors to prescribe these, and nearly impossible to get a prescription for Monjaro (which is particularly effective). Therefore, Kaiser patients/insured for whom these drugs are of immense benefit but who must have their prescriptions from out of network physicians receive ZERO insurance coverage. This means they get neither the negotiated insurance price discount nor any co-pay on the full cost. I am directly aware of this. And it is a travesty. Yet the benefits of these drugs is so significant and uniquely available through these drugs that in a sense, if it is possible to pay, then pay one must. Because in effect they are invaluable.

Re: The Ozempocalypse Is Nigh

#49

Post by PeterHolzwarth »

scarab92 wrote: post #27
dragonwriter wrote: post #21

Earlier quoted context omitted.

> How can people pay $1000/month for the rest of their life No one actually pays that price. The $1000 misrepresented in the article as the "usual insurance price" is actually the list price, from which insurers negotiate discounts (that is, the full price -- not just the out of pocket price charged to the insured -- for insured patients is significantly less than that $1000 price), while most people who get the drug…

It seems like the entire US medical system runs on prices that no one actually pays. I don't really understand what all that extra complexity achieves?

It's confusing, but each payer (insurance companies) negotiates a series of prices for things. Each one is a unique, bespoke, business deal -- and this is why prices are never clear: the cost of something is unique to the deal hammered out by an individual insurance company and individual health care provider networks.

Different payers will come up with their own unique take on health care coverage prices, favoring some things (lower costs) over others. Some may favor prenatal care and maternity, some may favor meat-and-potatoes basic health needs over specific categories of care. Larger payers may get a percentage point or two average-over-everything lower, smaller ones may favor a particular subcategory to create what they feel is a "good enough but still competitive in some key marketable categories" package. Each one is bespoke and quite varied.

From the outside, it can look insane: you walk into a hospital and ask how much a procedure costs, and the person at the desk is honestly confused and honestly has no answer. The reason? The cost is entirely relative to the cost structure package hammered out by a specific insurance company - there isn't really a fixed "cost" per se.

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