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Illinois governor signs law capping insulin costs at $100 per month

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Re: Illinois governor signs law capping insulin costs at $100 per month

#291

Post by vmchale »

vasilipupkin wrote: post #222

everyone tearing their hair out over this: the effect of the law is just that insurance overall will be somewhat more expensive in Illinois. There won't be any effect on research or innovation or anything else. Everyone will have to chip in a bit to make sure people with diabetes don't go without insulin. I don't see this is as a big disaster. Illinois has much bigger problems than this. If people foregoing insulin b…

> Everyone will have to chip in a bit to make sure people with diabetes don't go without insulin.

Would be nice if there were actual price controls at the federal level.

Re: Illinois governor signs law capping insulin costs at $100 per month

#292

Post by vmchale »

justinzollars wrote: post #247

I think this is a naive approach. We could price cap anything. Homes in San Francisco for example. The result will be rationing and shortages. It won't solve the fundamental problem. They key to bringing prices down is to remove barriers of entry. We need to flood the market with more insulin, or with my SF housing example flood the market with many more houses.

> They key to bringing prices down is to remove barriers of entry. [sic]

Or just set price controls

Re: Illinois governor signs law capping insulin costs at $100 per month

#293

Post by vmchale »

jwbwater wrote: post #238
andrewla wrote: post #102

Unfortunately, this does not act as a price control. This just mandates that insurance companies cap the out-of-pocket expense; it does nothing to affect the retail or wholesale price of insulin except insofar as insurance companies can push back on drug manufacturers. Net effect of this is yet to be seen, since it doesn't go into effect until 2021, but one possibility is that insurance companies will only cover vari…

The politicians solution: create another law. The economists solution: create more competition, probably by getting rid of some laws. I guess JB Pritzker knows more about politics than about economics.

> The economists solution: create more competition, probably by getting rid of some laws.

Or just set price controls (in the case of insulin)

Re: Illinois governor signs law capping insulin costs at $100 per month

#294

Post by claudeganon »

Mirioron wrote: post #213
Someone1234 wrote: post #165

Earlier quoted context omitted.

And if you're not rich, and get cancer, which country do you go to? I bet in aggregate it is never the US.

Well, it depends on what citizenship you have. The point is that if it's expensive in the US now then perhaps in the future it will be cheaper and available elsewhere.

The purchasing and marking up of expired drugs/patents and blocking of transition to generic status seem the obvious counterexamples here...

https://hbr.org/2017/04/how-pharma-companies-game-the-system...

Re: Illinois governor signs law capping insulin costs at $100 per month

#295

Post by throwaway_tech »

fr0sty wrote: post #288
throwaway_tech wrote: post #258

Earlier quoted context omitted.

>And there's nothing wrong with switching from brand name to generic, and most patients don't need to see their doctor every 30 days, and if they do, they can still make an appointment. For patients with chronic conditions if the doctor determines the patient should be seen to evaluate their condition in 30 days before a new script is written, insurers having pharmacists effect a change to 90, is a direct interferenc…

> For patients with chronic conditions if the doctor determines the patient should be seen to evaluate their condition in 30 days before a new script is written I'm reasonably cynical about lots of things, but I would be absolutely shocked if a pharmacist can give you 90days of pills when handed a 30day (no refills) prescription.

The don't unilaterally change the Rx and hand it to you...they fax the Dr. a request for change to the therapy (and earn a bonus from the insurer for sending the request for change). If the Doctor authorizes the change, the pharmacy gets a 2nd bonus payment from the insurer.

If the Doctor(s) refuse to make the requested change that data is tracked and eventually the insurer will drop the doctors from their network.

Re: Illinois governor signs law capping insulin costs at $100 per month

#296

Post by pdeuchler »

rayiner wrote: post #167
learc83 wrote: post #77

Earlier quoted context omitted.

>Instead of “scrapping” the industry, wouldn’t it make more sense to, as a first step, get rid of regulatory roadblocks that prevent competitors from producing out of patent drugs? What's your solution for drugs that aren't out of patent?

> What's your solution for drugs that aren't out of patent? Wait for them to get out of patent? The average remaining patent term for newly approved drugs is 10-12 years. So drugs approved in 2008 will mostly be coming out of patent this year. All this stuff you here about “evergreening” is entirely the result of gaming the FDA approval practices. Patent law is categorical: once you make a thing publicly available, t…

> All this stuff you here about “evergreening” is entirely the result of gaming the FDA approval practices

Evergreening has absolutely nothing to do with the FDA and everything to do with the USPTO and the specific chemical makeup of insulin, which has unique characteristics that make it very easy to engage in effective "evergreening". This also allows drug companies to manipulate pricing lists in deceptive ways that fool both doctors and distributors into placing higher cost (but chemically identical) products onto "preferred" prescription lists of insurance companies. There are also current court cases where there are accusations of fraud and illegal kickbacks around those practices.

Re: Illinois governor signs law capping insulin costs at $100 per month

#297

Post by rjmunro »

nybble41 wrote: post #154
mdasen wrote: post #74

Earlier quoted context omitted.

Let's say that you write a bill "you can't sell insulin for over $100". If insulin sellers refuse to sell for less than $100, there's no insulin available. However, the bill might also say that insurance companies must keep the out-of-pocket costs under $100 or that the state will make up any amount over $100. In reality, it seems unlikely to harm insulin availability since most jurisdictions have cheap insulin and t…

The actual bill[1] says (more or less) that insurance policies that include prescription drug coverage must cover insulin with a maximum of $100 out-of-pocket expense to the insured for a 30-day supply (page 12 lines 12-18). That $100 limit is indexed to the medical component of the Consumer Price Index (page 13 lines 1-6). It doesn't directly affect the amount suppliers receive, and the state isn't offering to reimb…

Do we have any idea how much higher the premiums are likely to be?

Google says there are 1.5-3 million insulin users in the USA - lets call it 1% of the population. Let's say that their drugs cost $300 / month, but they pay $100. The extra $200 will be shared between 100 people's premiums, so $2 extra per month.

Re: Illinois governor signs law capping insulin costs at $100 per month

#298

Post by Consultant32452 »

Someone1234 wrote: post #8

I'm really past the whole "pharma need to charge high prices to fund research" line of argument. Aside from being factually untrue (research funding is dwarfed by marketing for example[0]), it is also arguing for a continued unhealthy relationship with pharmaceutical care. A large amount of research is currently publicly funded. Either via public academic research or directly. When that research bears fruit it is oft…

Food is far more important for human survival than medicine. Somehow we're able to allow a free market with for profit food producers and distributors. Lots of research is done to make better/heartier foods. Prices are quite reasonable for food with stable inflation. Almost no one thinks it'd be a good idea to nationalize food research, production and distribution. The solution seems clear to me: take a look at the relatively less important drug industry and change the regulations such that it operates more like the incredibly important food industry.

Re: Illinois governor signs law capping insulin costs at $100 per month

#299

Post by rjmunro »

jerf wrote: post #14
save_ferris wrote: post #5

Earlier quoted context omitted.

How will people lose their insulin over this?

If you can only charge $100, but it costs $110, what happens isn't that it gets sold at $100 anyhow. What happens is that it doesn't get sold. Nobody has an obligation to manufacture insulin. I'm not saying the costs are $110. I don't know. I'm just explaining why this can result in lost insulin.

Under this law, what happens is the insurance provider picks up the extra $10 and shares it with everyone else's premiums.

Re: Illinois governor signs law capping insulin costs at $100 per month

#300

Post by dreae »

ikeboy wrote: post #266
RcouF1uZ4gsC wrote: post #260

Earlier quoted context omitted.

For many medicines, you really can't separate efficacy from safety. As an extreme case, take for example cancer drugs. They typically have high side effects and every year, a certain proportion of the people taking them, die from the side effects. That is an acceptable risk because there is evidence that they are efficacious in treating cancer. If they are not efficacious, that is a completely unacceptable risk. Less…

Should a doctor be making that decision, or should the government? Or should the government make that decision for on-label uses and doctors make that decision for off-label uses? That's the status quo. Whatever argument you have for one half of that is an argument against the other half.

Are you suggesting when a new drug hits the market doctors should just try it out on a few patients to see if actually does what it says it does? If only there was some way this sort of trial and error could be performed before a drug was widely available, in a controlled environment...
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