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Mark Cuban's pharmacy started with a cold email

beckershospitalreview.com

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Re: Mark Cuban's pharmacy started with a cold email

#211

Post by claudiulodro »

robbedpeter wrote: post #148
danachow wrote: post #120

Earlier quoted context omitted.

I’m not saying freer markets in some aspects of medicine would be better - but the libertarian dream in medicine is probably very naive and fails to learn from history to boot (medicine, especially pharm was much freer 120 years ago - it didn’t work out too well). And of the big problems in medicine - a prescription for glasses (which isn’t really a medical service in the US - optometry is not a medical profession) j…

Where's the "didn't work out too well" come from? Prohibition never works, whether it's restricting coffee or cocaine. Combine education and free access to everything with reasonable daily unit limits and per-substance licensing. You want meth, you go through meth safety training and get a yearlong endorsement allowing you to buy up to the daily limit at a pharmacy, no prescription involved. Set up due process that l…

> Where's the "didn't work out too well" come from?

I believe they were referring to the snake oil craze of the 19th century, not prohibition:

> The term comes from the "snake oil" that used to be sold as a cure-all elixir for many kinds of physiological problems. Many 19th-century United States and 18th-century European entrepreneurs advertised and sold mineral oil (often mixed with various active and inactive household herbs, spices, drugs, and compounds, but containing no snake-derived substances whatsoever) as "snake oil liniment", making claims about its efficacy as a panacea. Patent medicines that claimed to be a panacea were extremely common from the 18th century until the 20th, particularly among vendors masking addictive drugs such as cocaine, amphetamine, alcohol and opium-based concoctions or elixirs, to be sold at medicine shows as medication or products promoting health.

> https://en.wikipedia.org/wiki/Snake_oil

Re: Mark Cuban's pharmacy started with a cold email

#212

Post by s1artibartfast »

Scoundreller wrote: post #209
s1artibartfast wrote: post #204

Earlier quoted context omitted.

Yes for PBM because that is where the pharmacy buys the drug, not the manufacturer. Manufacturers usually can't sell direct to pharmacies. You can usually pay cash at a pharmacy, skipping insurance

The pharmacy will buy the drug from a distributor, not the PBM. The PBM manages the insurance. These may all be standalone operations, or one corp with its hands in each pocket: PBM, pharmacy, insurer and distributor.

That is correct. My point was to highlight that there is a lot more to the supply chain than manufacturer to pharmacy, with intense negotiations and fake pricing at each step

Re: Mark Cuban's pharmacy started with a cold email

#213

Post by Auracle »

bobthepanda wrote: post #139
adam_arthur wrote: post #95

Earlier quoted context omitted.

Should cut out the doctors for most of these too... Or at least allow people to continue to renew their medications after prescribed one time, rather than requiring further doctor's visits. Most things in medicine are expensive due to legal monopolies/improper regulations. e.g. no reason you shouldn't be able to buy prescription glasses for $10-20 dollars off the shelf. The main problem with medical costs is that it'…

Some medications are not renewed like this for good reason. Some medications require regular monitoring to ensure that bad side effects aren't happening; PrEP requires checkups every 90 days to make sure kidney function is not getting impacted.

I’m prescribed 3 controlled substance medications. I need to go online and send a message to my doctor every time I need them refilled, and I go through them all at different rates. I can’t get them especially early and if the doctor isn’t in I might need to wait, though I think he sometimes does it remotely. It’s insane.

My clinic’s backend used to have a slightly easier ‘refill prescription’ form but they changed it to only work with their integrated pharmacies. The closest one is an hour away.

Re: Mark Cuban's pharmacy started with a cold email

#214

Post by amluto »

thaumasiotes wrote: post #124
amluto wrote: post #109

Earlier quoted context omitted.

I don’t know anything about the legality, but UMRP is very common.

UMRP has no legal effect. It's just a declaration by the manufacturer that "if we catch you pricing below this point, we will stop selling to you". Once you have the item, you can price it however you want.

But that’s the point: UMRP is not illegal. It gives the manufacturers de facto control of retail pricing.

Re: Mark Cuban's pharmacy started with a cold email

#216

Post by coolso »

thematrixturtle wrote: post #205
coolso wrote: post #201

Earlier quoted context omitted.

I used to be okay with generics, until I realized that I wouldn't buy food that I knew was made in India or China. Imagine buying Cinnamon Toast Crunch if it were made in India. So why would I eat a prescription / OTC drug that's made there?

Bought any cheap pickles lately? (Plain old cucumber dill pickles, that is, not achar etc.) If yes, odds are fairly high they come from India. https://www.india.com/business/india-becomes-pickle-king-of-...

Thanks, now I know to check the back of my pickle jars before I buy them!

Re: Mark Cuban's pharmacy started with a cold email

#217

Post by samstave »

ipaddr wrote: post #132
samstave wrote: post #53

Earlier quoted context omitted.

But what rate is my insurance "billing" for the total price of the transaction with my insurance? So - while you may be able to get nearish the same price (before the shipping) So, if Mark Cuban the Billionaire can start a pharmacy model such as this, not dealing with insurance, then what precludes market competition with his pharmacy? Franchise license with supply chain to open ones own brick and mortar etc... Serio…

Drug companies selling directly? Brick and Mortor stores selling without dealer discounts? Or others copying and marking up only 10% or 5%? I guess nothing but greed stopped this before.

The most F'd up thing about our medical institution in the US, is that while "you must have insurance" is regulated - depending on the size of the Hospital Group - they all can (Could - may have changed since I last built a hospital) negotiate their individual rate with each insurance company based on the size/volume of patients.

This is wrong.

The coding for a given procedure should be standardized and priced as such.

This simple change could do great things for leveling the playing field for the nation of healthcare ;

If regardless of your volume of encounters on a particular code, the price should be set.

This may do several things:

Make rural hospitals/clinics more competitive with a major hospitals.

In my experience though - the big spending in non-medical areas that hospitals have are around "comfort aesthetics" (Art, pretty buildings etc)

Hospitals which cost $400MM -- to $1B facility (2009) spent a LOT on art. They seek donors constantly...

Maybe they should have the rich donors, as a requirement for their contribution, also require they provide a loaner art install.

This way - lets say you donate $1MM to a hospital, 100% of that donation should go to actual clinical build etc.. and the hospital should be precluded from your financial donation from being used to pay a digital arts company from being paid their ~250K fee through your donation...

I've built quite a few big facilities and art is a HUGE aspect in the health aesthetics of an environment ; but the cost is always exorbitant. Personally, having managed the install of such - I think that this should be outside of what the hospital should spend money on - unless the donation is specifically for art/aesthetics...

This lightens the build cost for large hospitals.

Source designer/TPM/etc on:

- El Camino CA (I just got this today: https://i.imgur.com/KFCX4N0.jpg)

- UCSF CA

- NOME AK

- Sequoia CA

- Methodist CA

- Others I cant even recall now...

---

All of these costs get baked into the overall cost of the facility - and guess who pays for that? (not only in monetary costs)

My brother was the head of the VA for AK - commander of 10th medical wing for the USAF and is currently the CMO for the largest hospital group in AK.

Familiar with both sides of the table on price-fixing...

I don't have pharma exp WRT drug costs... just sunk costs in the facilities I build - but I get info from my brother on certain things...

but pharma prices need to be heavily reg'd

Re: Mark Cuban's pharmacy started with a cold email

#218

Post by refurb »

Dylan16807 wrote: post #206
refurb wrote: post #191

Earlier quoted context omitted.

Huh? If a company gives you a $5 rebate for buying 5 bottles of shampoo, then it gets extra sales. So if a $5 grocery rebate a kick-back?

Increased sales, when paid by the same entity that gets the rebate, are not a kickback. If a doctor took money to steer you to a specific hospital, that would be a kickback. If a hospital gives you a rebate and you're paying, that's not a kickback. But if a hospital gives you a rebate and your insurance is paying based on the non-rebated price, that's probably a kickback.

Precisely. PBM rebates are based on sales as well. Drug company gets more sales by making their drug “preferred” and PBM gets a rebate. It’s not a kickback.

Re: Mark Cuban's pharmacy started with a cold email

#219

Post by Dylan16807 »

refurb wrote: post #218
Dylan16807 wrote: post #206

Earlier quoted context omitted.

Increased sales, when paid by the same entity that gets the rebate, are not a kickback. If a doctor took money to steer you to a specific hospital, that would be a kickback. If a hospital gives you a rebate and you're paying, that's not a kickback. But if a hospital gives you a rebate and your insurance is paying based on the non-rebated price, that's probably a kickback.

Precisely. PBM rebates are based on sales as well. Drug company gets more sales by making their drug “preferred” and PBM gets a rebate. It’s not a kickback.

Precisely what? If the PBM gets money then that's not the customer. Being paid for marking something as preferred is a kickback.

If the PBM buys something themselves and gets money back, that wouldn't be a kickback.

Just like a customer buying something and getting money back.

But when you have a buyer on one side, and a separate entity getting the money back, that's probably a kickback.

Re: Mark Cuban's pharmacy started with a cold email

#220

Post by gm »

s1artibartfast wrote: post #165
thaumasiotes wrote: post #154

Earlier quoted context omitted.

The difference would appear to be whether you buy a name-brand drug or a generic equivalent.

I don't think that has any impact whatsoever. If people think they are buying a drug from a manufacturer they are wrong. Typically they are paying insurance who pays the pharmacy, who pays the PBM who pays the Manufacturer. This is true for generics and brand-name. Each step has price negotiations and a bunch of mixed incentives.

>If people think they are buying a drug from a manufacturer they are wrong.

No one is saying that (at least on this thread).

All I'm saying laypeople assume the mfg is the bad guy when it comes to high drug prices. Time and time again on the news we are told that X drug costs $$$$$ in the US and the exact same drug costs orders of magnitude less in some other country. Everyone points the finger at the drug mfgs.

What I'm saying is that it's good that the secret is getting out that the mfgs are not necessarily the bad guys, and there's all these other companies involved in the drug price crisis.

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