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Biohackers take aim at big pharma’s stranglehold on insulin

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Re: Biohackers take aim at big pharma’s stranglehold on insulin

#361

Post by eganp »

lotsofpulp wrote: post #98
nceqs3 wrote: post #83

Earlier quoted context omitted.

This is not true and just an industry talking point from the PBMs. They use revenue tricks to hide their profit margin. See https://www.fiercehealthcare.com/payer/facing-criticism-pbms...

My information is from 10-K filings with SEC, and my statement is referring to net profit margins, which are what they are. Unless there is massive fraud going on, managed care organizations are not earning massive profits. If their PBM divisions are, then they are simply subsidizing the insurance division, but it would make no difference to people. The total expense for premium plus out of pocket expenses would not…

Some insurers (looking at you United Health Care) have wholly owned PBMs. Thus, the PBM is an asset in its insurance trust. Any profit the PBM makes will appear as in increase in asset valuation for their insurance trust, or balance sheet in some cases.

However, insurance margins remain unaffected as the money did, in some sense, go out the door and is no longer in control by the insurer directly. It's not fraud. It's just anti-competivie self-dealing. So, no, it's not profits per se, but rather increased valuation via clever financial engineering.

Re: Biohackers take aim at big pharma’s stranglehold on insulin

#362

Post by rrrrrrrrrrrryan »

api wrote: post #282
rrrrrrrrrrrryan wrote: post #164

Earlier quoted context omitted.

Obamacare was widely derided by many Democrats as a worst-of-both-worlds plan when the public option was scraped.

I've heard that Obama was reluctant to push harder for a public option because the health bureaucracy is such a massive employer. If true then we're basically dragging along a counter-productive boat anchor that eats a ton of our health care spending as a back-door jobs program.

They dropped it to woo one moderate Democratic senator (Lieberman), who was basically the Manchin of his day. Without his vote, it would've gotten filibustered to death.

https://www.google.com/search?q=lieberman+public+option&oq=l...

Re: Biohackers take aim at big pharma’s stranglehold on insulin

#363

Post by [deleted] »

ravitation wrote: post #138
HPsquared wrote: post #119

Earlier quoted context omitted.

I guess the question is, do countries with socialized healthcare provide the cheap version or the expensive one?

Not actually the question since countries with modern healthcare systems provide all types of insulin at an average cost per unit that is roughly 1/10th to 1/20th the cost in the United States (cheap vs. expensive is an over simplification).

[deleted]

Re: Biohackers take aim at big pharma’s stranglehold on insulin

#364

Post by [deleted] »

chefkoch wrote: post #270
clarkrinker wrote: post #38

Every time this stuff comes up it feels like we focus on the politics and not the people with diabetes. If you or your kid or your friends have Type 1 and are struggling to make your insulin out of pockets please, please, please call the Eli Lily hotline and get the copay card. They've dropped the monthly cost for Humalog to $35. Don't ration. Work the system. https://www.humalog.com/savings-support

Wich is around the list price you pay for two weeks of insulin in germany.

[deleted]

Re: Biohackers take aim at big pharma’s stranglehold on insulin

#365

Post by api »

dv_dt wrote: post #189
adventured wrote: post #185

Earlier quoted context omitted.

> There are no free market health systems in leading economic nations That also does not exist in the US and hasn't in more than half a century. The US could hardly be any further away from a free market in healthcare. It's hyper regulated, and hyper dominated by government programs (Medicare, Medicaid, and dozens of other programs and agencies). The US healthcare system is controlled top to bottom by rigid, strict g…

My point is that it's seems a little optimistic to think that a free market for healthcare is an adequate solution, given that no free market healthcare system exists anywhere at scale. I think some markets are simply inappropriate for free markets - particularly one where services are by definition specialized and market feedback involves failures in critical life risking situations.

The parent was fairly pointing out that healthcare in the US is not a free market. For one there is zero price transparency let alone competition. For another there is the insurance industry which is both heavily regulated and state backed. Health insurer market is similar to the wired ISP market.

We don’t really know what a true free market would do with modern healthcare because as you say there is no such thing. Personally I think it could work for middle class and above but would leave a big coverage cliff down below because it’s not profitable to insure or treat the really poor.

The question is whether real transparency with price competition and efficiency gains would make it cheaper to then add a safely net for the poor.

Re: Biohackers take aim at big pharma’s stranglehold on insulin

#366

Post by emodendroket »

dragonwriter wrote: post #356
emodendroket wrote: post #337

Earlier quoted context omitted.

I mean in many cases the product is still profitable for them at the reduced rate, but why settle?

> I mean in many cases the product is still profitable for them at the reduced rate, but why settle? Because for a customer who would pay nothing if their only choice was to get the drug at full price, settling for a reduced price (especially when you also get a tax deduction, and some PR benefit from advertising the discount for the needy) is more profitable than not settling.

You're not really getting what I'm saying. That's what the program allows them to do, while still charging an exorbitant rate to others.

Re: Biohackers take aim at big pharma’s stranglehold on insulin

#367

Post by tashi »

eganp wrote: post #360
tashi wrote: post #273

Earlier quoted context omitted.

Their claim is that if the pharma companies lowered the cost of insulin but then refused to give rebates to insurance companies for it, the insurance companies would stop covering insulin for diabetic patients? And they're using a diagram created by a pharmaceutical trade group to explain this? I'll be honest: I'm skeptical.

Unfortunately this is pretty accurate. Pharmacy Benefit Managers (PBMs) are contracted by insurers to set the formulary, in effect the list of drugs the insurer will pay for. They negotiate to lower drug costs, usually via manufacturer rebates. Where this is perverted, is that the PBMs have complex compensation schedules wherein they receive a percentage of drug rebates . Their goal is to secure the largest rebate po…

All these complicated incentives make it hard to figure out who's responsible, so let me ask a question:

What if a manufacturer lowered the price of insulin to $10 a month and gave no rebates at all? Would insurance companies refuse to cover it and pharmacies refuse to carry it?

Re: Biohackers take aim at big pharma’s stranglehold on insulin

#368

Post by mikeproctor »

mgarfias wrote: post #253
RHSeeger wrote: post #193

Earlier quoted context omitted.

On a related note... if you can afford a CGM (continuous glucode monitor), especially one with alerts (like the Dexcom G6), I wholeheartedly recommend one. They are life altering for a type 1 diabetic. Being able to check your blood sugar by just looking at your phone (or separate receiver) is very convenient. I check my blood sugar 100 times a day, instead of poking a hole in myself 10 times a day. And I can (mostly…

I keep on trying to get one, but being well controlled, the ins cos won't approve it. And its pretty spendy out of pocket. My biggest use case would be an alert that my glucose levels are tanking while exercising so I can do something about it before I drop out. I find myself not doing things like long bike rides that I'd really like to do because of it.

You should be able to get the Libre 14 day sensors for about $120/per month (2 sensors) without insurance. I've been using it for about a year and it has been a huge game changer for me. I've been on insulin for about 23 years. The Libre doesn't have alerts but being able to tap your phone to your arm to test your glucose makes a big difference in how you test/monitor even without alerts.

Re: Biohackers take aim at big pharma’s stranglehold on insulin

#369

Post by GrinningFool »

ramraj07 wrote: post #323
GrinningFool wrote: post #301

Earlier quoted context omitted.

> please, please, please call the Eli Lily hotline and get the copay card. While this is a great thing, it's also necessary that you be prepared to fork over personal data - especially proof of income - and otherwise do whatever is required to prove that you are (un?)worthy enough as with any similar medical financial aid program. https://www.lillycares.com/assets/pdf/lilly_cares_applicatio...

Wow nitpicking much?

Not at all.

I believe that regardless of whether someone is at a financial disadvantage, neither business nor government should have the ability force them to surrender both dignity and personal financial information in order to receive aid.

It's hard enough to ask for help without having to lay your life bare to strangers in order to receive it.

Re: Biohackers take aim at big pharma’s stranglehold on insulin

#370

Post by lotsofpulp »

eganp wrote: post #361
lotsofpulp wrote: post #98

Earlier quoted context omitted.

My information is from 10-K filings with SEC, and my statement is referring to net profit margins, which are what they are. Unless there is massive fraud going on, managed care organizations are not earning massive profits. If their PBM divisions are, then they are simply subsidizing the insurance division, but it would make no difference to people. The total expense for premium plus out of pocket expenses would not…

Some insurers (looking at you United Health Care) have wholly owned PBMs. Thus, the PBM is an asset in its insurance trust. Any profit the PBM makes will appear as in increase in asset valuation for their insurance trust, or balance sheet in some cases. However, insurance margins remain unaffected as the money did, in some sense, go out the door and is no longer in control by the insurer directly. It's not fraud. It'…

All the big managed care organizations (better word than insurer) have their own PBM. I would need to read more about how an MCO accounts for assets set aside for insurance, but I would be surprised if insurance regulators are allowing it, considering how strict insurance regulators are.

A quick search shows me that on page 73 of Cigna’s 10-K, it clearly does not have its Express Scripts division accounted for in the “Investment Assets” section, based on how low those numbers are.

It just does not pass the smell test to me. The simpler answer, based on all the numbers, is that managed care organizations are squeezing other entities in the healthcare chain, but due to competitive pressure and upper profit margin limits due to ACA, they are not raking in big bucks.

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