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

fortune.com

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

#281

Post by idhegeu »

BugsJustFindMe wrote: post #4

https://archive.ph/cg4we I do not like UnitedHealth, I do not like our existing crop of health insurance executives, and I might even be viscerally glad at some level that the UnitedHealth CEO was killed in a world where justice clearly takes a back seat to greed, but I wish the headline didn't say "overcharged", because there's no established amount of markup that is the correct amount of markup other than what peop…

Health insurance profit margins are regulated, so UHC earning higher margins does seem like overcharging.

Perhaps we need antitrust action in healthcare.

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

#282

Post by criddell »

pkaye wrote: post #252
criddell wrote: post #34

Earlier quoted context omitted.

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-...

That’s the coupon scheme which is a bit different. The discount programs I’m talking about make deals with pharmacy benefits managers which are middlemen between pharmacies and drug companies. Part of the agreement between the pharmacy and PBMs is that the pharmacy must honor discounts with companies like GoodRx even though it means they could be losing money on the sale.

I’d like to learn more about these PBMs and how they have so much power and what their purpose is.

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

#283

Post by kenjackson »

legitster wrote: post #187
kenjackson wrote: post #184

Why is insurance charging anyone for drugs? Shouldn't the pharmacy/doctor/hospital charge the patient and the insurance company pay some percentage of the cost (maybe negotiating the price of the drugs downward)? It seems we've overcomplicated a system that should be much simpler.

The report is misleading. What is being alleged here is that PBMs overpriced over the generics. So it's like if Coca-Cola set the price of their can at $50, and NoName at $0.50. So you be are being "overcharged" at the grocery store when you buy the Coke and not the NoName. It's not actually clear from the report that the PBMs actually profited from overcharging. Furthermore, if the doctor prescribes a name brand dru…

Thank you. That makes sense. Why are you being downvoted? I'd love if someone could say why they're downvoting you, because it seems like you addressed my question -- unless you just fabricated an answer -- but it would be nice if they said that.

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

#284

Post by hnburnsy »

Companies who signup for these plans on behalf of their employees are finally getting on onboard that PBMs are hiding these markups and making backdoor deals with the drug companies. The best thing you can do is put pressure on your employer if you run into this.

https://www.fiercehealthcare.com/payers/industry-voices-why-...

>This past year saw a wave of mid-sized employers, unions, and health plans exploring alternatives to the Big Three, a trend that will only continue to gain momentum in 2025. In fact, a recent report found that 52% of employers are considering changing their PBM in the next 1-3 years. While 72% of employers still primarily contract with a Big Three PBM, 12% have already embraced a transparent PBM.

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

#285

Post by franktankbank »

nradov wrote: post #260
bugglebeetle wrote: post #221

Earlier quoted context omitted.

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…

Why does it need an act of congress?

Isn't this clearly in need of trust bust?

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

#286

Post by franktankbank »

nradov wrote: post #267
mattgreenrocks wrote: post #147

Earlier quoted context omitted.

I never understood why health care had to be so tightly coupled to employment. All it does is tie people down, obfuscate costs, and give insurance companies more leverage over everyone, companies and employees alike.

This is an example of what economists call path dependence. In principle there's no good reason for access to health care to be coupled to employment and we wouldn't design the system that way if we were starting from scratch. Originally it started during WW2 when the federal government imposed wage controls to hold down inflation, so employers took advantage of a legal loophole to offer free employee benefits such a…

Why mandate it at all?

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

#288

Post by nradov »

hn_throwaway_99 wrote: post #100

I think one of the things that deserves discussion here is the whole concept of pharmacy benefit managers in the first place. To start, can anyone give some good resources that really explain clearly what the role is that PBMs actually serve, and how the whole system even functions? I've tried to understand in the past but have always thought "Why do you exist???". Like the whole way companies like GoodRX can have a…

The PBM industry originally started with noble intentions, even if some of them have now morphed into something closer to parasites. They helped to hold down drug costs for consumers and employers by negotiating with pharmaceutical companies and retail pharmacies on behalf of multiple buyers. And they created formularies and clinical guidelines to encourage use of most cost effective drugs (generics and step therapy). A lot of doctors tend to write prescriptions for certain drugs out of habit without carefully considering what's best for and individual patient, both clinically and financially. And before federal laws were tightened up, it was common for drug companies to essentially bribe doctors to prescribe their expensive branded products through loopholes like paying them "speaking fees" to show up at company meetings held at 5-star resorts. So PBMs were a way to counteract that. But then some of the PBMs started taking kickbacks themselves and making money on pharmacy price spreads so it has all become a big mess.

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

#289

Post by baggy_trough »

LPisGood wrote: post #207
baggy_trough wrote: post #35

Earlier quoted context omitted.

Setting aside human health and agreeing that it should be outside capitalist endeavor would be incredibly damaging to human health. I can hardly imagine any policy that would reduce life years more than that.

Why then do countries with socialized healthcare have linger life expectancy than countries with capitalist-only healthcare system?

Do those countries use any practices or innovations developed by non-socialist entities, or are they entirely socialist-based?

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

#290

Post by nradov »

kstrauser wrote: post #106
wlesieutre wrote: post #86

Earlier quoted context omitted.

And shouting about "death panels" in public healthcare systems, as if the private insurance companies don't have people whose whole job is denying as many claims as possible

Yeah. The biggest difference is you can elect the public healthcare death panels, or call your senator or representative to lean on them. There's not a thing you can do about the private insurers' death panels. Medicare may turn you down for an organ transplant because there are only so many to go around and you're not the best candidate. Private insurance may turn you down because "shareholder value".

Payers don't really play any role in allocating the limited supply of transplant organs.

https://optn.transplant.hrsa.gov/patients/about-transplantat...

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