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Hospitals and universities repurposing drugs at lower cost

kcl.ac.uk

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Re: Hospitals and universities repurposing drugs at lower cost

#161

Post by munk-a »

epmaybe wrote: post #145
atourgates wrote: post #95

I have a little insight here from working with ophthalmologists. When the article mentions "using a cancer drug to treat a leading cause of blindness" it's talking about using Bevacizumab (brand name Avastin) to treat macular degeneration. Avastin and Lucentis are molecularly the same drug. The difference is that Avastin isn't packaged to be injected into eyeballs, and Lucentis is. Also, Avastin costs about $50/dose,…

The reason people get endophthalmitis is rarely due to a contaminated batch, but it certainly happens. But frankly it’s unsustainable to have all patients on branded drug, it would be too costly for patients and payers. Not to mention it is slightly unethical in the US due to drug rebates incentivizing branded drug use. Endophthalmitis is bad, but we can treat it if caught promptly. Patient education, informed consen…

> But frankly it’s unsustainable to have all patients on branded drug, it would be too costly for patients and payers.

This is incorrect, the Canadian healthcare system negotiates drug costing at a per province rather than per patient manner and has managed to negotiate down drugs pretty significantly especially in Ontario. A national drug plan doesn't currently exist but it's likely that drug and dental coverage is going to be a goal in the near term.

In the US there is also a complex drug reimbursement program run by most manufacturers to offer rebates to patients in the form of trial cards or direct refunds that does help widen accessibility but those programs are generally limited to patients on private insurance due to the nature of incentives and, well, greed.

I think it's very fair to say "Within this current system brand name drugs are a ridiculous ask for most patients due to the availability of generic alternatives" but the system itself is deeply broken. Generics are sometimes whitelabeled versions of the same product but often what are considered inactive ingredients may be modified significantly from brand name versions leading to issues, especially when it comes to neurological drugs, of drastically different effects to patients. The brand name vs. generic problem is a lot more complex than most people give it credit for and while patients should always prefer generics when they're similarly functional there are very notable scenarios where they are not equivalent for treatment. This comment shouldn't be read in direct opposition to the full comment above as this drug is outside my wheelhouse but rather as a comment on generics in general.

Source: I work in a company that analyzes drug pricing and, more generally, comparative insurance reimbursement for a living.

Re: Hospitals and universities repurposing drugs at lower cost

#162

Post by themafia »

Terr_ wrote: post #156
themafia wrote: post #129

Earlier quoted context omitted.

We baked the snake charmer problem into the law? Good lord.

> snake charmer problem Perhaps you mean the "cobra effect" [0]? I think that's an apocryphal story about killing snakes, rather than using them in a performance. [0] https://en.wikipedia.org/wiki/Perverse_incentive#Historicity...

So the meaning of what I said was slightly obscured but actually easy to apprehend?

oookay.

Re: Hospitals and universities repurposing drugs at lower cost

#163

Post by doctorpangloss »

bonsai_spool wrote: post #159
doctorpangloss wrote: post #98

Earlier quoted context omitted.

UNH is so big because its customer Apple has its own pool. Apple deducts $24k/y for your healthcare. Healthy 29 year old male doesn't use anything. UNH denies the claims anyway. It gives that money back to Apple, which doesn't give it to you. The 80% rule has a lot of loopholes. It doesn't apply to employer funded plans. There's a reason UNH is so big!

Employer funded plans are not all the same. Large entities with a lot of money (like universities, big firms) self-insure. Thus the insurance company in those cases is simply managing all the administrative sides of insurance while the plan owner is the actual insurer of risk. There’s an article about how a Wall St employee’s expensive care came up in C-suite meetings, as a real world consequence of this

> simply managing all the administrative sides of insurance

if you punch into a chatbot questions about the employer pool insurance product, your comment is exactly how the chatbot characterizes it.

of course, "administrative sides of [health] insurance" includes requiring pre-auths and approving/rejecting claims, which is, haha, all the fucking evil parts of what they do! it's not "simply" anything. they need a huge, comprehensive, defensible model of what regulations and customers will accept as valid healthcare. apple does not need to have an opinion on ten thousand treatments and the standard of care across all these things. the insurance company does.

this is a line of investigation that the chatbots are absolutely terrible at informing people about. "administrative" is ALL the work, that is why UNH is big! you are starting from the wrong premise. you must always ask yourself, why are health insurance companies so big?

Re: Hospitals and universities repurposing drugs at lower cost

#164

Post by lesuorac »

doctorpangloss wrote: post #163
bonsai_spool wrote: post #159

Earlier quoted context omitted.

Employer funded plans are not all the same. Large entities with a lot of money (like universities, big firms) self-insure. Thus the insurance company in those cases is simply managing all the administrative sides of insurance while the plan owner is the actual insurer of risk. There’s an article about how a Wall St employee’s expensive care came up in C-suite meetings, as a real world consequence of this

> simply managing all the administrative sides of insurance if you punch into a chatbot questions about the employer pool insurance product, your comment is exactly how the chatbot characterizes it. of course, "administrative sides of [health] insurance" includes requiring pre-auths and approving/rejecting claims, which is, haha, all the fucking evil parts of what they do! it's not "simply" anything. they need a huge…

Why do we need to ask why UNH is so big?

This comment chain was started to question why limiting profits to 80% of claims has to result in insurance companies denying cheaper options.

I have yet to see an argument as to why a company isn't incentived to drop a health insurer if they're forcing employees _not_ to do a $50/month option and instead pick a $1k/month option.

Re: Hospitals and universities repurposing drugs at lower cost

#165

Post by bonsai_spool »

doctorpangloss wrote: post #163
bonsai_spool wrote: post #159

Earlier quoted context omitted.

Employer funded plans are not all the same. Large entities with a lot of money (like universities, big firms) self-insure. Thus the insurance company in those cases is simply managing all the administrative sides of insurance while the plan owner is the actual insurer of risk. There’s an article about how a Wall St employee’s expensive care came up in C-suite meetings, as a real world consequence of this

> simply managing all the administrative sides of insurance if you punch into a chatbot questions about the employer pool insurance product, your comment is exactly how the chatbot characterizes it. of course, "administrative sides of [health] insurance" includes requiring pre-auths and approving/rejecting claims, which is, haha, all the fucking evil parts of what they do! it's not "simply" anything. they need a huge…

> if you punch into a chatbot questions about the employer pool insurance product, your comment is exactly how the chatbot characterizes it.

That's because it's the truth? I've taken graduate health policy classes from people like Don Berwick - I assure you that I did not and do not need to ask chatgpt to explain self-insurance to me.

> f course, "administrative sides of [health] insurance" includes...

How does this have anything to do with the fact that the self-insuring entity bears the risk for its insureds? The problem with the GP comment about 'giving money back to Apple' is that the money always belonged to Apple and its co-insurance / copays only exist to steer employee behavior.

Re: Hospitals and universities repurposing drugs at lower cost

#166

Post by bonsai_spool »

lesuorac wrote: post #164
doctorpangloss wrote: post #163

Earlier quoted context omitted.

> simply managing all the administrative sides of insurance if you punch into a chatbot questions about the employer pool insurance product, your comment is exactly how the chatbot characterizes it. of course, "administrative sides of [health] insurance" includes requiring pre-auths and approving/rejecting claims, which is, haha, all the fucking evil parts of what they do! it's not "simply" anything. they need a huge…

Why do we need to ask why UNH is so big? This comment chain was started to question why limiting profits to 80% of claims has to result in insurance companies denying cheaper options. I have yet to see an argument as to why a company isn't incentived to drop a health insurer if they're forcing employees _not_ to do a $50/month option and instead pick a $1k/month option.

> I have yet to see an argument as to why a company isn't incentived to drop a health insurer if they're forcing employees _not_ to do a $50/month option and instead pick a $1k/month option.

That definitely does happen, but companies have a lot of levers to pull around how employees select health insurance. When I bought health insurance for a small firm (~60 people), I provided a set number of dollars and workers could use these for any plan they wished (an ICHRA plan).

Re: Hospitals and universities repurposing drugs at lower cost

#167

Post by QuantumGood »

sapphicsnail wrote: post #120
atourgates wrote: post #95

I have a little insight here from working with ophthalmologists. When the article mentions "using a cancer drug to treat a leading cause of blindness" it's talking about using Bevacizumab (brand name Avastin) to treat macular degeneration. Avastin and Lucentis are molecularly the same drug. The difference is that Avastin isn't packaged to be injected into eyeballs, and Lucentis is. Also, Avastin costs about $50/dose,…

> And what level of risk is worth saving $1,450 per dose on an injection? 1/100? 1/1000? I've have plenty of friends that would struggle to afford that. I have friends that buy black market drugs because they can't get/afford a prescription. I don't know if I would make the same choice but I can I can understand why some people do.

You can get some branded prescription pharmaceuticals in the U.S. from outside the U.S. via workarounds (1), and find heavily tested peptides via (2), in both cases avoiding the worst of the black or gray markets. If peptides, it's worth passing the hurdles and tests to access resources at https://pep-pedia.org/

(1) Start by filtering for Brand (not generic) and then going though lowest-cost results for reliable branded manufacturing locations (e.g. Germany, New Zealand, Singapore, NOT India) at https://www.pharmacychecker.com/ . Some sources are less picky about accurately checking prescriptions (e.g. https://www.inhousepharmacy.vu/ ). US Gov't allows buying outside U.S. for personal use, but reserves right to block incoming packages, but practically speaking does not.

(2) Filter for vendors with the best results at https://www.finnrick.com/about/testing-methodology

Re: Hospitals and universities repurposing drugs at lower cost

#168

Post by tehjoker »

doublepg23 wrote: post #133
tehjoker wrote: post #105

Earlier quoted context omitted.

This is completely backwards read Marx. Superstructure (culture, politics) flows from the economic base (there are some important exceptions, but that’s the dominant arrow).

> read Marx read Popper

Popper talks about sociology as though it were physics. Unfortunately, competitive games and the subjective belief of people can influence the course of history if the right material conditions are in place. Sometimes you try different things and get different results in different contexts.

Re: Hospitals and universities repurposing drugs at lower cost

#169

Post by atourgates »

epmaybe wrote: post #145
atourgates wrote: post #95

I have a little insight here from working with ophthalmologists. When the article mentions "using a cancer drug to treat a leading cause of blindness" it's talking about using Bevacizumab (brand name Avastin) to treat macular degeneration. Avastin and Lucentis are molecularly the same drug. The difference is that Avastin isn't packaged to be injected into eyeballs, and Lucentis is. Also, Avastin costs about $50/dose,…

The reason people get endophthalmitis is rarely due to a contaminated batch, but it certainly happens. But frankly it’s unsustainable to have all patients on branded drug, it would be too costly for patients and payers. Not to mention it is slightly unethical in the US due to drug rebates incentivizing branded drug use. Endophthalmitis is bad, but we can treat it if caught promptly. Patient education, informed consen…

> Not to mention it is slightly unethical in the US due to drug rebates incentivizing branded drug use.

This is an area I'm only perephrially aware of, but the way I understand it is:

* Manufacturer sells very expensive injectible eye drug, in the range of $2k/injection.

* It's typically covered by insurance, but patients (in this demogrpahic who are often on medicare) can still have high deductibles and copayments/coinsurance costs.

* To get around this, the manufacturer funds a nonprofit organization that patients can apply to for financial help paying for their deductibles.

* The manufacturer gets a write-off for donating to a nonprofit, and while they might cover, say, $2k or $5k of a patient's deductible over the course of a year, they still get $22k in revenue covered by Medicare for a year's worth of injections for that patient.

* There was some issue recently where maybe someone realized that "a charity funded by a drug manufacturer exclusively for the purpose of reimbursing purchases of that manufacturer's drugs" might not be a wholly above board charity, but I'm not sure if that was resolved.

All this is hearsay from my perspective, but am I in the ballpark of what you were talking about?

Re: Hospitals and universities repurposing drugs at lower cost

#170

Post by Terr_ »

themafia wrote: post #162
Terr_ wrote: post #156

Earlier quoted context omitted.

> snake charmer problem Perhaps you mean the "cobra effect" [0]? I think that's an apocryphal story about killing snakes, rather than using them in a performance. [0] https://en.wikipedia.org/wiki/Perverse_incentive#Historicity...

So the meaning of what I said was slightly obscured but actually easy to apprehend? oookay.

If I guessed right, then there are probably readers who haven't heard the term/story before [0], or won't make the same jump to recall it.

If I guessed wrong, then I wanted to hear about the new thing that resisted a casual web-search.

[0] https://xkcd.com/1053/

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