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UnitedHealth overcharged cancer patients for drugs by over 1,000%

fortune.com

251–260 of 323 posts

Re: UnitedHealth overcharged cancer patients for drugs by over 1,000%

#251

Earlier quoted context omitted.

I don't want you to give them the benefit of the doubt. I certainly don't think they deserve it. I do think, however, that a conversation about "overcharging" goes nowhere until people talk about exactly where charging ends and overcharging begins.

I'd be fine with a 20-50% markup on MSRP to cover billing and administration costs but when the insurer owns the pharmacy they can "negotiate" whatever rate they want and you have to pay it. I don't see it directly in the article, but I suspect they do the same thing with cancer drugs as with IVF drugs and require you to go through their pharmacy for insurance coverage. Insurance plans often have lifetime maximums, a…

IMO a functioning government would have trust busted an insurer with such strong collusion with a pharmacy.

Re: UnitedHealth overcharged cancer patients for drugs by over 1,000%

#252

Earlier quoted context omitted.

UnitedHealth is not an insurance company. They own an insurance company as well as OptumRx, a pharmacy benefit manager, which is described at the very top of this article.

Can you explain how discount cards (like GoodRx) work?

Basically the drug manufacturer charges the insurer high prices then kicks back some of that to cover your out of pocket costs so you are individually better off but the system is worse off. Most countries solve this by the government negotiating with the drug manufacturer for everyone and refusing to cover it until they get a reasonable price.

https://kffhealthnews.org/news/article/drug-companies-copay-...

Re: UnitedHealth overcharged cancer patients for drugs by over 1,000%

#253

Earlier quoted context omitted.

> I take issue with the claim that in order to say something is too expensive that you must be able to precisely propose an alternative price. If you want to be quantitative of course you do. How hard is it? Margin of error is allowed. If you want to be qualitative, vague and wishy washy, that has its place too, but at some point someone is going to ask for a quantitative assertion, otherwise you get nowhere.

To use a software development analogy, the average person is a user of health care, not a health care project manager or designer. Just as the user of an App doesn't need to provide an alternative design when they say "this App sucks", the average user of healthcare likewise has no obligation to redesign the healthcare system when they say "this healthcare system sucks."

Really apples and oranges comparison. But even so, if a certain App user is motivated to have the hostile App developer make a change that doesn't server their interest, they'll need to do better than cry "this app sucks".

Re: UnitedHealth overcharged cancer patients for drugs by over 1,000%

#254

Earlier quoted context omitted.

Does anybody defend them? I’ve been on the selection side as an employer and several others will probably echo what I’m about to say. Virtually every insurance provider is going up 15-20% / year to the point that it’s completely unsustainable. United was quoted to me as almost 20% lower than current rate for our provider (before they are about to go up 20%). On premium alone they will save some people close to $500 /…

I haven't seen any defenses of insurance companies lately. In fact, it seems like insurance companies are the only safe target for criticism of US healthcare problems right now. > Virtually every insurance provider is going up 15-20% / year to the point that it’s completely unsustainable. The elephant in the room is that healthcare costs are going up. Even if we waved a magic wand and eliminated health insurance over…

The medical costs are skyrocketing because insurance companies inflate the price of medicine. The slice of the pie that goes to the insurance company is small compared to the pie, so they make the pie bigger to make their slice bigger. The other parts of the pie, many of whom are owned by the same insurance company, aren't complaining. They are horribly inefficient. The cost of hospitals processing payments to insurance companies alone (and note this is typically one company sending itself a bill) is nearly $400 Billion per year. That's about 8% of all US healthcare spending, and it generates no value.

What isn't happening is increasing cost because of either more or improved care. As time goes on it should be easier to make drugs, meaning that prices should go down. Instead the cost per gram of even very simple drugs like epinephrine and insulin are going through the roof. Doctors are paid well, but they've always been paid well, and in fact while physician pay over the past 70 years has kept pace with inflation, it has been far outstripped by the price of education needed to achieve that salary, meaning doctors today are generally worse off financially than they used to be. other medical professionals like nurses are seeing increasing workloads without commensurate increase in pay. American life expectancy is decreasing, as are numerous other measures of healthcare efficacy. While we are paying more, we are getting less than we used to.

Then there is the common argument - our high drug prices subsidize new drug development. Only issue is that new drug development has been steadily slowing down. Most drug development is in the form of minor changes to existing drugs that serve little purpose beyond resetting the clock so cheap generics don't come on the market. Where new drugs are developed, they tend to be focused on profits, for example new pills to help people maintain erections rather than treat rare diseases. When the stars align and a new drug is developed that genuinely helps people, it tends to be insanely expensive, such as the cancer drugs TFA is talking about. This is not to say that nothing at all gets done, but it's less than it used to be.

Is insurance the only problem in America? No, obviously not. But at the same time, healthcare prices dramatically higher than anywhere else in the world that are also rapidly increasing is not an inescapable fact of life. Our healthcare can be both substantially cheaper and higher quality than it currently is by eliminating purposefully inefficient systems that use anticompetitive practices to jack up prices. When the dust settles US healthcare might remain a bit pricy per capita - part of having a country with very high wealth per capita is that everything is expensive per capita - but our money will be going towards paying skilled people to do useful work for our benefit.

Re: UnitedHealth overcharged cancer patients for drugs by over 1,000%

#255

Earlier quoted context omitted.

They've chosen 90% margin (cost + 1000%). Semicon tool builders (my industry) have margins around 50% (cost + 100%). This is considered high margin manufacturing work. To match United Health's margins we'd need to raise prices by 5x.

I agree, but we can't talk about "over" without talking about where the line is.

This is semantic nitting and wastes time when for all practical intents and purposes humans understand the assertion being made and find it agreeable.

Re: UnitedHealth overcharged cancer patients for drugs by over 1,000%

#256

Earlier quoted context omitted.

Australia, New Zealand, etc…

Admittedly not a ground war, but that's not entirely true: > In total, there were 97 air attacks on northern Australia, though air reconnaissance was carried out over the region by Axis Powers through much of 1944. https://en.wikipedia.org/wiki/Japanese_air_raids_on_Australi... and > German and Japanese surface raiders and submarines operated in New Zealand waters on several occasions in 1940, 1941, 1942, 1943 and 19…

If we're counting air attacks

https://en.wikipedia.org/wiki/Attack_on_Pearl_Harbor

Re: UnitedHealth overcharged cancer patients for drugs by over 1,000%

#257

Earlier quoted context omitted.

The problem is that it is different. What other industry sells a product that you might need in order to survive or to not be disabled which requires the dedicated efforts of multiple professionals with a decade of post-secondary education? What other industry sells a product that you might suddenly need at a moment’s notice that is the only way you’ll survive the day, that requires sophisticated equipment, dedicated…

> Few will answer “yes.” And everything else flows from the "no." Everything else has flowed from the "no", but I do not think it needs to have. Imagine the government being a definitive payer of last resort, instead of this unfunded mandate where hospitals have to provide emergency service for free but then receive a bunch of regulatory capture to make up for it. That still leaves an avenue for hospitals to defraud…

I think there are two paths. Having the government be a payer of last resort for emergency services starts you down the road of paying for more and more things. You’ll start asking questions like, why are we paying massive amounts to stabilize a poor, terminal cancer patient who collapsed when we could have paid 10x less on screening and early treatment? Why aren’t we paying for procedures that allow people to work and bring in more taxes than the procedure costs? Why are we ok with paying to save someone’s life when they’re hours away from death but not when it’s weeks away?

Eventually you’ll get something like the systems you see in most wealthy countries.

Or you can go the way we did, which is enact universal care in the dumbest way and pretend we didn’t.

Re: UnitedHealth overcharged cancer patients for drugs by over 1,000%

#258
post #20

Earlier quoted context omitted.

All I'm going to say is that Optum Specialty Pharmacy is the sole source that UHC will accept for a lot of special drugs. For example UHC offers insurance for IVF including a separate cap for medications, but if you use their insurance you have to order through their subsidiary Optum Specialty Pharmacy and the prices triple or quadruple over MSRP if you buy from OSP using insurance versus if you pay cash. They also w…

UHC double-dips because they own Optum even though Optum is "independent". It's fucking disgusting. How they were allowed to buy Optum and didn't have every regulator in the country on the case is beyond me. I $truggle to think how $omething like thi$ wa$ allowed to happen. Bastards.

You have that a little mixed up. Both UnitedHealthcare (UHC) and Optum are subsidiaries of UnitedHealth Group (UHG). UHC never bought Optum. Some parts of Optum were spun out of UHC's IT department so that they could commercialize software they had developed for internal use and sell it to other customers (including some of UHC's competitors in the commercial payer space). Other parts of Optum were acquired or created internally. What is now OptumRx (the PBM) was originally PacifiCare Health Systems. UHG acquired that business way back in 2005 before the Optum brand even existed.

I agree that more reform and enforcement is needed in the healthcare industry but let's at least get the facts and history right.

Re: UnitedHealth overcharged cancer patients for drugs by over 1,000%

#259

Earlier quoted context omitted.

To use a software development analogy, the average person is a user of health care, not a health care project manager or designer. Just as the user of an App doesn't need to provide an alternative design when they say "this App sucks", the average user of healthcare likewise has no obligation to redesign the healthcare system when they say "this healthcare system sucks."

Really apples and oranges comparison. But even so, if a certain App user is motivated to have the hostile App developer make a change that doesn't server their interest, they'll need to do better than cry "this app sucks".

It's even worse than you're saying actually, because health care has no price transparency, very little consumer choice, no negotiating power on the part of the user and even the services provided are extremely opaque.

To be honest, I'm quite surprised you're siding with the provider here. Are you personally satisfied with healthcare pricing in the United States? Do you not share my intuition that in general, healthcare is too expensive and inefficient?

Re: UnitedHealth overcharged cancer patients for drugs by over 1,000%

#260

Earlier quoted context omitted.

You just answered my question: Is it the case that UnitedHealth and Cigna each own (or control) one of the "big three" PBMs? If so, that is a just crazy - the control insurance premium pricing, benefit decisions, AND the pricing of covered medications? yadaebo wrote below "Medical Loss Ratio (MLR) is capped at 85% in the US which means 85% of revenue must go to patients". Does controlling a big PBM allow an insurance…

It gets even better (quoting from ceejayoz down-thread): >UHC is the largest single employer of doctors in the US. https://www.statnews.com/2024/07/25/united-health-group-medi ... > It’s no secret that UnitedHealth is a colossus: It’s the country’s largest health insurer and the fourth-largest company of any type by revenue, just behind Apple. And thanks to a series of stealthy deals, almost 1 in 10 U.S. doctors — so…

For better or worse, the incentives created by federal legislation since the 1940s make this healthcare industry consolidation and vertical integration inevitable. Payers (insurers) have been merging to gain more negotiating power over provider rates and hold down medical costs. So provider organizations have reacted by consolidating themselves to maintain their negotiating power and keep rates high. Increased costs to comply with federal and state rules around security and interoperability also drive provider consolidation to achieve economy of scale. Many areas are now dominated by only one or two large health systems. So, the logical next step is for payers to vertically integrate and bring more care in house where they can better control cost and quality.

UnitedHealth Group is hardly unique in this regard. They're the largest but all the major commercial payers (including the non-profit ones) are pursuing similar strategies. Essentially they're copying the existing Kaiser-Permanente model of having a payer and provider organization under one roof.

I'm not defending this system, just explaining why the current structure exists. Any major improvements will require an Act of Congress to better align the incentives with the interests of patients / consumers / taxpayers.

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