Illinois governor signs law capping insulin costs at $100 per month • Hacker News Board

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

#301

Post by throwaway_tech » Wed, Jan 29, 2020, 7:13 PM UTC

ars wrote: post #277

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…

If the Dr. wants to see the patient in 30 days then they setup an appointment for that. I don't understand why you think the length of a prescription controls the appointments. It doesn't, it has nothing whatsoever to do with that.

>It doesn't, it has nothing whatsoever to do with that

Yes, the patient could pick up the phone and schedule another appointment, or the doctor could call to try to schedule another appointment in the meantime. You are missing the point...in practice those appointments don't get rescheduled.

The Doctors and insurers know this, which is why the Doctor tries to do 30 day scripts for at risk patients so they can be closely monitored, and its why the insurer attempts to change 30 day therapies to 90 day because they know the patient won't schedule an appointment in the meantime and that saves the insurer money.

Anyway its clear you see nothing wrong with an insurer interfering with a doctor's practice of medicine...or the other part you keep glossing over that is the insurer dropping doctors from their networks (i.e. patients losing their doctor) when the doctors don't follow the insurers requests for changes to therapies.

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

#302

Post by toomuchtodo » Wed, Jan 29, 2020, 7:17 PM UTC

TallGuyShort wrote: post #271

toomuchtodo wrote: post #159

Earlier quoted context omitted.

Google for your local, state, and federal law. Your continued presence in the jurisdiction indicates your acceptance of the implicit contract defined by these laws. If it doesn’t vibe with your beliefs (which is fair!), there are other jurisdictions available for consideration, a visa and plane ticket away.

The laws are not the contract. I already moved where I did because I liked the laws. But the damned things keep changing because of this social contract. If the laws were the social contract, your parent comment wouldn't make sense either. Not liking the laws is one thing. Justifying new ones because of this pretend contract is another.

I’m not sure what to say if you’re not happy that democracy isn’t static. The only thing in the world that is constant is change.

You call it “pretend”, but the results you take issue with appear to be very real.

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

#303

Post by idoh » Wed, Jan 29, 2020, 7:17 PM UTC

Consultant32452 wrote: post #298

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 r…

The market for food is not at all like the market for medicine. The main difference is that food is far more fungible than drugs are. If a patient is suffering an illness, there may be only one drug that will help, whereas if one needs calories, or vegetables, there are many more options.

Having said that, there is a reasonable argument to be made that the FDA and the patent situation stifles innovation and that most definitely should be looked at.

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

#304

Post by throwaway_tech » Wed, Jan 29, 2020, 7:17 PM UTC

chimeracoder wrote: post #279

throwaway_tech wrote: post #272

Earlier quoted context omitted.

>The purpose of these laws is to protect patients Its not the patients that lobbies for these laws...it is the insurers, and its to lower their costs. Its also why the insurers pay the pharmacists a bonus for these changes, if it was about costs to the patient, the bonuses (money back) would go to the patient.

> Its not the patients that lobbies for these laws...it is the insurers, and its to lower their costs. I mean, no, patients don't lobby for them because patients don't really lobby en masse for healthcare policy in general, but patients definitely are the ones who benefit from them. There are some cases where the relationship between insurers and patients is adversarial. This is not one of them.

>There are some cases where the relationship between insurers and patients is adversarial.

Well imagine your doctor gives you a Rx, you go to fill and the insurer tells the pharmacist to ask doctor to change it. If the doctor disagrees (for whatever reason) the insurer may drop your doctor from their network, then you will be stuck going to a doctor who does whatever the insurer asks.

If you feel there is no conflict there or that isn't adversarial that is fine...in my experience both patients who lose their doctor and the doctors themselves disagree.

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

#305

Post by malandrew » Wed, Jan 29, 2020, 7:19 PM UTC

throwaway55554 wrote: post #24

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…

The problem is convincing Americans. There is a significant population of people who would never vote for this because it would benefit those who don't work and pay taxes. They are so stubborn about this that they are willing even to let pharma prices exceed their own grasp.

One of the reasons I don't vote for it is because the current system benefits billions of people that don't pay any US taxes. Most of the rest of the world greatly benefits from positive externalities from US medical R&D.

Billions of people elsewhere in the world plus Americans in 20+ years when patents expire if far greater than ~40 million people in the US in the present

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

#306

Post by patmcc » Wed, Jan 29, 2020, 7:19 PM UTC

jotm wrote: post #94

ollie87 wrote: post #76

Earlier quoted context omitted.

It is where I live, so weird visiting the US and seeing "ask your doctor for" adverts. If I asked my GP for a specific medication they'd look at me like an alien.

> If I asked my GP for a specific medication they'd look at me like an alien. He shouldn't. They're not all knowing super genius specialists who keep up with all the drugs and research.

Sure, but neither is the guy who asks for a new drug based on the 30 second ad he just saw.

If I go to my doctor and say "hey, for my condition XYZ I hear there's a new drug ABC, would that offer any benefits over what I'm on now?" that's one thing, but if I go in and say "hey give me that ABC" they'll correctly roll their eyes at me.

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

#307

Post by EForEndeavour » Wed, Jan 29, 2020, 7:21 PM UTC

malandrew wrote: post #287

vkou wrote: post #275

Earlier quoted context omitted.

> It seems like there is a perception by these companies that there is a discoverability problem. The rest of the world manages to 'discover' that these drugs exist on the market just fine, yet pharma advertising is banned in most of it.

FWIW, a medicine I have been taking since 2003 is still not available in all other countries except the US and Canada (and it's only recently become available in Canada). It's still the only effective treatment for my condition.

I'm genuinely curious: what is your condition, if you don't mind disclosing it?

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

#308

Post by vasilipupkin » Wed, Jan 29, 2020, 7:21 PM UTC

vmchale wrote: post #291

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.

why? this is better. Every state can do whatever it wants. What's wrong with that? why have one size fits all solutions?

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

#309

Post by ikeboy » Wed, Jan 29, 2020, 7:21 PM UTC

dreae wrote: post #300

ikeboy wrote: post #266

Earlier quoted context omitted.

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...

" 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..."

This is exactly how doctors determine what works, with or without the government. See the off-label discussion in the link above.

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

#310

Post by InvisibleCities » Wed, Jan 29, 2020, 7:21 PM UTC

Consultant32452 wrote: post #298

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 r…

This is a very disingenuous comparison. For any given food, there are a large number of both perfect and imperfect substitutes, which is very much not the cases for patented medicines. It is also much easier for individuals to grow their own food than it is to manufacture their own pharmaceuticals. But beyond that, food is one of the most regulated markets in modern society. Farm subsidies, food assistance programs like SNAP, strategic food reserves, and any number of other programs function as "soft" price controls. I don't think that "changing pharmaceutical regulations to match the food industry" means what you think it does.