Went to my new cardiologist yesterday for a check up. All went well. Got two scripts. Wife called the pharmacy to check if ready, yup. Asked what the cost was. 400.00 for the Plavix. She explained that I had Medicare Part B, price came down to 3.00. Can anybody explain this? I am certainly not complaining, but how does anybody afford this kind of pricing?
I believe that's what they "charge" medicare or insurance companies. The reality of the matter is that medicare or insurance doesn't pay that however as they have a lower negotiated price.
I watched that happen after the birth of my first child. The hospital bills for the emergency C-Section and the stay came out to something like 70 thousand dollars. Of that, the insurance company paid 13 thousand and we paid $2600 (20% copayment.)
I feel like it's similar to marketing sometimes. Just keep chucking E36 M3 at the wall and see what sticks. Except there's no critical price point for a variety of reasons.
This new plan is way more complicated. If I go to a hospital sponsored lab its 180 dollars for the bloodwork I need to have drawn four times a year. If I go to Quest or Labcorp it doesn't cost me anything. This has had the effect of making me gun shy when having procedures performed as I could be stuck with a huge bill for heading to where my doctor told me rather than going through the hassle of calling the insurance company first ever single time. Yes, call. Capital Blue Cross's website is useless for procedure pricing.
http://worthly.com/most-expensive/15-expensive-prescription-drugs-world/16/
Yeah, these don't seem gougy at all. I'm all for free enterprise and all but $400,000 a year for one drug? Ouch.
Medicare is subsidized AND prices are regulated. It's also why others have to pay the larger price, because the drug companies need to compensate for profit loss on Medicare and VA pricing.
It's currently being debated by the legislative and executive branches. I'm not very optimistic about the outcome though.
My medicines are roughly $4000/month. Obviously, I don't pay anything remotely close to that, thankfully I have insurance. I'm not sure how much my insurance pays the drug companies, but I'm sure it's not anything near that amount.
I see both sides of the argument. There clearly are cases of gouging, no doubt. But I also fully believe that the drug companies invest millions upon millions to research and develop these medicines. I'm incredibly grateful that they do, it gives me a quality of life I wouldn't have without it.
Friend's wife's meds are around $15K/month. High deductible and a HSA, so first month cleans that out plus. He dug around some and the same drugs in India are a few hundred dollars (US). He could fly her to India once a month and come out way ahead.
Why is this? Crony Capitalism, AKA, Socialism, AKA Fascism. The merging of corporations with government. Company A makes a drug. There is a patent. That give them x years protection. IP lawyers, jump in (but WE'RE NOT PAYING YOU). Company A buys ("captures") regulatory agency. Regulatory agency makes sure that Company B can not come out with a competing identical drug, even after the patent expires. Otherwise company B could charge less and there might be competition. Company A ups price on the drug to whatever the insurance companies will bear. Note this really works on drugs that people need to stay alive, like my friend's wife's, or the epinephrine pen thing. But even other drugs way out of patent and produced everywhere, like ibuprofen, get raised in blowback, or near by type effect. Hey, all drugs went up X%, we need to raise the price of ibuprofen.... There is a chart of insulin costs. 2 companies make it. Their prices rise in a 1:1 slope over years in lockstep. Collusion, maybe? Ha. That's 2 companies where more are kept out.
Oh, you mean LEGAL drug prices. 
My favorite pay was the "hidden" fees. My dad had a rare kidney disease, he was diagnosed in 1990. Went into a federal drug research program from 91 to 99 for an anti rejection drug that has become fairly common place, named FK1000.
At about the 8 year Mark of the testing program, over a third of all participants had developed cancer. This was also the time we had to start paying COBRA for health insurance. The drug itself was covered, but the testing involved, followed by radiation treatments and getting pulled off of the transplant list was a small fortune. Followed by 15 years of dialysis, 3 times a week, 10k a visit. Even with Medicare and Medicaid, the bills piled up quick. Add in uncovered surgeries for new fistula, and a doctor who broke the rules because of his anti gun stance, taking away my dad's favorite past time of shooting(they usually put the fistula in your non dominant arm so you can still do things) and the $100+k annual medical bills don't even seem like much.
Funny, you're not allowed to kill people for money, but if you can save your insurance company money by refusing to treat or preventing payment for life saving drugs, you get a bonus at the end of the year. But I'm not bitter or anything.
A woman I work with was getting prescription naproxen. They asked why she was using her insurance. She was confused. They said it's $60 with insurance, $15 without insurance. Perhaps they markup when insurance companies are involved as a negotiation tool. You know, ask for 75, take 50, would have done 35. Really though, I have no other answer. Greed too. 
Dr. Hess wrote: Why is this? Crony Capitalism, AKA, Socialism, AKA Fascism.
Those are three completely different things. I'd say the first is to blame here.
It's really a case of "how much you got?" playing out at a national level - the pharma companies set different prices for different countries based on what they think they can get for them.
The whole system is really messed up. My friends wife needed a prescription for some anti-inflammatories for a procedure. When she went to pick them up the pharmacy told her the co-pay was $12, but they didn't know if the insurance company would cover it. She asked how much if she just paid, $1.98. How does that make any sense?
No, GB, they are all the same in practice. Socialism and Fascism are the same thing. Oh, they each say they are different, but they are identical. Crony Capitalism is not capitalism at all, but Fascism or Socialism.
Part of the problem in the US is the barriers to entry. That's why "Canadian drugs" can be cheaper than "US drugs." Yes, what will the market bear?
See, most of what is taught in Economics is total bullE36 M3. Like supply and demand curves. It is all like arguing over how many angels can dance on the head of a pin. That was a serious argument in the past. Today, we have economics to replace that. About the only thing in economics that is not bullE36 M3 is Game Theory.
You do realize that most of the drug makers with the high cost drugs offer assistance programs where you can pay little to nothing for the medicine if you don't have insurance and/or can't afford the high deductible/copay. Just sayin'....
If we're going to absolutely crush companies for trying to make money (and by the way, I do agree there's some component of greed by the drug companies, just not to the extent that others here seem to), we need to crush some car companies. Porsche comes to mind. They charge something like $500 if you want a key fob that matches the color of your car. Somehow I bet that colored fob costs them $50. We should call Porsche evil. Yeah, I realize we're talking about life saving drugs vs. premium sports cars, but the concept of making money hand over fist still applies.
With Porsche, you don't have to buy a Porsche. You could buy an F car, or a Maser, or a Lotus or one of the really out there ones. With human insulin, if you're a type I diabetic, you're screwed. There's 2 makers. This chart has two lines, one from each company:
Show me where the competition is.
Second only to tort reform in Professor Reven’s strategy for fixing our health care system is absolute visibility and consistency of pricing across the board. 32 year old carpenter presents at hospital XYZ with a compound fracture to his right femur and is allergic to penicillin.
That’ll be $12,300…what if he has no insurance…$12,300…what if he’s a Vet…$12,300….what if he’s got the ACA Bronze plan…$12,300.
I estimate that about 3% of our nation’s entire health care delivery cost is currently getting pi$$ed away on playing games with who pays and how much…fire all of the non value added people in billing roles and redirect their salaries to the value added functions…nurses, doctors, beds, diagnostics, consumables, meds, and devices.
$12,300 Period!
D2W wrote: The whole system is really messed up. My friends wife needed a prescription for some anti-inflammatories for a procedure. When she went to pick them up the pharmacy told her the co-pay was $12, but they didn't know if the insurance company would cover it. She asked how much if she just paid, $1.98. How does that make any sense?
In a similar vein, why do doctors write prescriptions for over the counter meds instead of telling the person to take tylenol or tylenol generics? They are probably getting kick backs or have quotas on prescriptions written per day.
Plavix is the blood thinner, no? It shouldn't be on patent anymore--what does the generic cost?
Drugs on patent cost a lot because there is a very small time when the pharma company can make significant money off of it. Once it is off patent, every company can make it and they don't have the competitive advantage anymore. And remember, for every drug you see on the market, there were 50 that were developed with full R&D that never made it through. Guess what? The doctors/chemists/everyone else for those 50 drugs that will never see the light of day still need to get paid. (50 is a total guess. Maybe its 10 for every one we see. Maybe it is 500. No clue)
Then as the drug has been off patent for a long time, there is no longer any profit in it since there is so much competition. Eventually company after company will pull out, and we'll get left with Hess's insulin chart. Even worse when there are zero competitors. If the company is smart, they'll hold the price at a point where they're making money, but if they raise it higher another company comes in and starts to make it too, driving the price back down. See Epi Pens as an example (Auvi-Q coming back to market).
1kris06 wrote:D2W wrote: The whole system is really messed up. My friends wife needed a prescription for some anti-inflammatories for a procedure. When she went to pick them up the pharmacy told her the co-pay was $12, but they didn't know if the insurance company would cover it. She asked how much if she just paid, $1.98. How does that make any sense?In a similar vein, why do doctors write prescriptions for over the counter meds instead of telling the person to take tylenol or tylenol generics? They are probably getting kick backs or have quotas on prescriptions written per day.
Umm... No.
Doctors write prescriptions for drugs that are also available OTC for several reasons. One is that prescription strength is not necessarily the same as OTC strength. There are instances where OTC strength is not even theraputic. But, if you don't know what you are doing, you can kill yourself trying to second guess the pharmco's and physicians. Another reason is that SOMETIMES a patient's insurance company will pay for an OTC drug if there is a prescription. Or if you have a prescription, you can use a HSA and the IRS will allow you to claim that as a legitimate medical expense. If you just buy it OTC, you can not deduct it or have it as a legitimate expense on your HSA card.
I'm not sure why Medicare Part B would affect a prescription price. Part D is the Medicare prescription insurance, plus any supplemental prescription program you might have. My Vytorin went from $60 per month co-pay when I was working, to $300 per month on Medicare. Meh, it's only money, and it's the only drug that seems to keep my cholesterol in check. I've tried many.
NEALSMO wrote: Medicare is subsidized AND prices are regulated. It's also why others have to pay the larger price, because the drug companies need to compensate for profit loss on Medicare and VA pricing. It's currently being debated by the legislative and executive branches. I'm not very optimistic about the outcome though.
No, Medicare is actually legally not allowed to bargain with drug companies on price. Medicare has to pay whatever they say. That's why prices of drugs are so high. The manufacturers are HAPPY to sell the same drugs in Canada at 1/10 to 1/50th the cost, but they charge more in us because we have to pay.
Has got to be the biggest profit from a single lobbyist law in the history of America.
Medicare does bargain HARD on all other medical prices though. They are one of the biggest drivers of keeping costs down.
When a box of 5 insulin pens, 15ml total, cost $1,200 uninsured, out of pocket, there's a reason I roll the dice buying it off of Craigslist. It might kill me, but I'll be dead and not care.
In reply to Appleseed:
I hear India is a good option for cheap prescription drugs (buy online), probably a bit more reliable than CL.
Robbie wrote: No, Medicare is actually legally not allowed to bargain with drug companies on price. Medicare has to pay whatever they say....
You are sort of half right.
Medicare does not negotiate price because companies are required to sell any drug to the government at the lowest market price (in the US of course).
One of the prime reasons prices are lower in other countries (for the same drug sold here) because pretty much every other country negotiates their prices for the entire country, not the hundreds of different insurers, hospitals etc we have in the US. In fact, many countries simply say "give to me at what you are selling it to country X for"
I know my wife takes an injectable once a month that the ins. Co pays 5 grand for bu in Mexico it costs 300$
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