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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%

#301

Post by BugsJustFindMe »

johnnyanmac wrote: post #299
BugsJustFindMe wrote: post #143

Earlier quoted context omitted.

> I have no idea what the correct margin for essential cancer drugs is. So let's talk about it and think about it and form an idea. There's no universally right or wrong answer, but you should at least be able to decide what answer is right to you. > I don’t think it should be a 10x markup. What about 1x markup? > Intuitively, it seems that there’s something wrong with price gouging There is, but you're relying on th…

So, important question: What problem are we trying to solve here? Is there any benefit to the overall populace for us in HN to debate what we feel is "overcharged"? ---- But to go along with your exercise, I take a look at current market dynamics and compare it from there. Apparently, the typical wholesale markup is 20-40%, and stores will typically markup another 20-50% on top of that. So we're talking roughly a 125…

> Is there any benefit

I perceive that one of the reasons that people who want change in the devastatingly perverted system are repeatedly plowed over, cheated, and ignored when it comes to making actual policy is that as a group those with the most reason to be upset are easily swindled into engaging only vague moans about some miniscule ignorable example being bad but not being ready to articulate what should be done instead as a set of categorical rules. And it happens over and over again until the voting public are bred into helplessness, and the way out is to talk about things in actionable ways instead of in vague handwavy ways. And the path to collective dialogue shift has to start somewhere, so it can start with us. Was it painful?

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

#302

Post by johnnyanmac »

BugsJustFindMe wrote: post #301
johnnyanmac wrote: post #299

Earlier quoted context omitted.

So, important question: What problem are we trying to solve here? Is there any benefit to the overall populace for us in HN to debate what we feel is "overcharged"? ---- But to go along with your exercise, I take a look at current market dynamics and compare it from there. Apparently, the typical wholesale markup is 20-40%, and stores will typically markup another 20-50% on top of that. So we're talking roughly a 125…

> Is there any benefit I perceive that one of the reasons that people who want change in the devastatingly perverted system are repeatedly plowed over, cheated, and ignored when it comes to making actual policy is that as a group those with the most reason to be upset are easily swindled into engaging only vague moans about some miniscule ignorable example being bad but not being ready to articulate what should be do…

>And the path to collective dialogue shift has to start somewhere, so it can start with us.

I suppose so. But I have no insight of these concepts outside of the 30 minutes I spent studying various markup strategies. And I have no interest in trying to personally influence policy (especially in something I studied for 30 minutes ". I don't know how many qualified people in this community can influence such stuff (or any that will read HN specifically) , so I simply question the tactic's effectiveness.

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

#303

Post by anthuswilliams »

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…

Theoretically the role they serve is that they can negotiate with pharmacies and develop a formulary which insurers package into their various offerings. PBMs can negotiate with pharmacies by sending them lots of customers in exchange for negotiating for a discount (or, more likely, a rebate) on their "usual and customary" price. (Pharmacies know they do this, and thus they charge very prices to the uninsured, to ensure their U&C is high enough that they can still make a profit after applying the PBM discounts). Insurers are not experts in the local pharmacy markets of particular geographies, so in essence they outsource this negotiation and craft plans with formularies prepared by PBMs.

GoodRX and other discount providers generally work in one of two ways:

1) They have relationships with multiple PBMs, allowing you to choose the one who has negotiated the cheapest rate with the pharmacy for the drug in question. This is why it might be cheaper than your insurance: another PBM has negotiated a better deal.

2) The discounts come from patient assistance programs run by the manufacturers intended to reduce patient co-pays. Lately insurance companies have started to add clauses to their plans (called copay accumulators or copay maximizers) so that these discounts don't count as part of your copay or your deductible. So these types of discounts are going to be harder to get.

This all stems from a time when pharmacies were much less consolidated and vertically integrated than they are today.

One of the frustrations of the current system is that incentivizes sky-high drug prices. PBMs like high drug prices because they negotiate rebates (some of which they keep, but most they pay back to the insurer) and because the fees they charge to insurers are a percentage of the claims that go through. Pharmacies like high drug prices because they get more money paid them in reimbursements, and because the PBMs send them most of their customers. Manufacturers like high drug prices because they net more revenue, even if they later have to pay it back in the form of rebates, and in any case being on the formulary of major insurers is an existential issue for them. And insurers like high drug prices because they can max out patient co-pays, as the money returned to them in the form of rebates gets kicked into the general fund, thus allowing them to lower premiums, which is their primary axis of competition with other insurers.

The net effect is that you have sick people maxing out their deductibles in order to lower the premiums paid by healthy people--the exact opposite of how insurance is supposed to work. If I could wave a magic wand in Congress and make only a single surgical change to healthcare markets, the change I would make is banning rebates. They were anti-customer when John D Rockefeller used them to obtain a monopoly on oil, and they are anti-customer today.

A good place to read about these dynamics in American healthcare is drugchannels.net. The author is super well informed on how these plans are implemented.

Source: ran a startup targeting pharmacies (which failed) and currently work in a starup focused on discovering and developing new drugs.

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

#304

Post by BugsJustFindMe »

johnnyanmac wrote: post #302
BugsJustFindMe wrote: post #301

Earlier quoted context omitted.

> Is there any benefit I perceive that one of the reasons that people who want change in the devastatingly perverted system are repeatedly plowed over, cheated, and ignored when it comes to making actual policy is that as a group those with the most reason to be upset are easily swindled into engaging only vague moans about some miniscule ignorable example being bad but not being ready to articulate what should be do…

>And the path to collective dialogue shift has to start somewhere, so it can start with us. I suppose so. But I have no insight of these concepts outside of the 30 minutes I spent studying various markup strategies. And I have no interest in trying to personally influence policy (especially in something I studied for 30 minutes ". I don't know how many qualified people in this community can influence such stuff (or a…

Every journey, etc.

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

#305

Post by cluckindan »

gruez wrote: post #203
cluckindan wrote: post #140

Earlier quoted context omitted.

”Survey of 1,000 registered voters conducted Dec. 11-13, 2024”

Again, not sure what you're trying to say but given how it's overwhelmingly against "killing was acceptable or somewhat acceptable", it's unlikely that polling error would significantly change the conclusion.

Unless the 1,000 were not a representative sample of the 8 billion people on the planet.

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

#306

Post by cluckindan »

Jimmc414 wrote: post #224
cluckindan wrote: post #132

Earlier quoted context omitted.

And which countries would those be?

Iceland New Zealand Australia Sweden Norway Switzerland Finland (winter war might count)

I don’t know if your history books are correct… in WWII, Norway was invaded by Nazi Germany and Finland was even allied with them against the Soviet Union before the Soviets forced Finland to drive the Nazis out of the country.

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

#307

Post by pkaye »

criddell wrote: post #282
pkaye wrote: post #252

Earlier quoted context omitted.

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 h…

Thanks for the clarification. From this link looks like another middleman that negotiates discounts with drug makers for insurers then marks it up. I'm curious who makes more profit. The PBM or the drug manufacturer.

https://www.investopedia.com/articles/markets/070215/what-ph...

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

#308

Post by ceejayoz »

NegativeLatency wrote: post #269
jjk166 wrote: post #256

Earlier quoted context omitted.

If we're counting air attacks https://en.wikipedia.org/wiki/Attack_on_Pearl_Harbor

> on the continent

We had that too. https://en.wikipedia.org/wiki/Bombardment_of_Ellwood?wprov=s...

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

#309

Post by ceejayoz »

nradov wrote: post #264
landryraccoon wrote: post #259

Earlier quoted context omitted.

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, healthc…

Health care now has significant price transparency, although there are still some major gaps and it can be challenging to shop for the best option. Many consumers are still unaware of the tools available. https://www.cms.gov/priorities/key-initiatives/healthplan-pr... https://www.cms.gov/priorities/key-initiatives/hospital-pric...

Good luck trying to make sense of it.

https://www.dolthub.com/blog/2023-03-23-illusion-of-transpar...

> Humana published their MRFs across 11,000,000 different files, then rate-limited how fast you could download them

HN discussion: https://news.ycombinator.com/item?id=35347647

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

#310

Post by ceejayoz »

Jimmc414 wrote: post #224
cluckindan wrote: post #132

Earlier quoted context omitted.

And which countries would those be?

Iceland New Zealand Australia Sweden Norway Switzerland Finland (winter war might count)

Iceland was invaded by a foreign power (the UK) during WWII.

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

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

(Very politely, but still...)

> Uncomfortable with the crowd, Consul Shepherd turned to the Icelandic police. "Would you mind ... getting the crowd to stand back a bit, so that the soldiers can get off the destroyer?" he asked. "Certainly," came the reply.

> One Icelander snatched a rifle from a marine and stuffed a cigarette in it. He then threw it back to the marine and told him to be careful with it. An officer arrived to scold the marine.

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