In reply to aircooled:
Lowest market price... And if you are the holder of the patent and therefore the only one selling said drug on the market?
Then yes, whatever price you ask is by default the lowest market price.
Im sure it's that kind of language trick that allowed the lobbyist to pass the law.
http://www.economist.com/blogs/economist-explains/2016/09/economist-explains-2
Read in the middle of the third paragraph.
Klayfish wrote: 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'....
True dat.
Dealing with insurance companies is an arcane science, not by mistake either.
Appleseed wrote: 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.
Have you looked into the EpiPencil? Something like this might work for you if you can get insulin cheaper in bottles.
(I just recommended a DIY medical device as an alternative to a hyper-expensive commercial product first thing in the morning, how cyberpunk is that?)
RX Reven' wrote: 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$$ed away on playing games with who pays and how much…fire all of the non value added people in billing roles and redirect their salaries to the value added functions…nurses, doctors, beds, diagnostics, consumables, meds, and devices. $12,300 Period!
On the surface, this makes complete sense. Hospitals should be able to give a standard price for a given medical need. It seems like a hospital could benefit substantially by implementing a policy like this, so what's keeping it from happening? What are some hurdles that would need to be overcome?
STM317 wrote:RX Reven' wrote: Second only to tort reform in Professor Reven’s strategy for fixing our health care system is absolute visibility and consistency of pricing across the board. 32 year old carpenter presents at hospital XYZ with a compound fracture to his right femur and is allergic to penicillin. That’ll be $12,300…what if he has no insurance…$12,300…what if he’s a Vet…$12,300….what if he’s got the ACA Bronze plan…$12,300. I estimate that about 3% of our nation’s entire health care delivery cost is currently getting pi$$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!On the surface, this makes complete sense. Hospitals should be able to give a standard price for a given medical need. It seems like a hospital could benefit substantially by implementing a policy like this, so what's keeping it from happening? What are some hurdles that would need to be overcome?
What's keeping that from happening is the general public thinking that you should be able to show up at the ER and get treated no matter what. That, and the convoluted mess of lobbyists and cronies that have perviosuly been mentioned.
Part of the problem of "standard pricing" is that there is no "standard patient." You ain't a 97 Camry. A broken femur on you is not a broken timing belt on a 97 Camry. Sure, basic costs could be better standardized, and I've seen some examples of pricing that was several times different for the same thing, but there are too many variables.
Oh, and if you will recall, back when doctors owned the hospitals instead of corporations, medical care was much cheaper. But the lawyers got involved and said "Ohh, conflict of interest. We need to strip the hospitals from doctors and give them to corporations. That will fix it fer sure."
Dr. Hess wrote: Part of the problem of "standard pricing" is that there is no "standard patient."
My understanding is that all hospitals already have a price book containing procedure codes along with what is essentially their MSRP for nearly everything they do. The MSRP’s are set at a level much higher than cost + target profit margin to offset all the people that pay nothing (present at the ER with no insurance or money) or provide unsustainably low reimbursements because they’re on Medicaid or something like that.
I realize it isn’t possible to construct a price book that identifies every conceivable eventuality but they probably already include well over 90% of services provided and the few that aren’t can be itemized manually to arrive at an honest number.
My recommendation is to transition from asking for ridiculous sums of money up front resulting in an inordinate waste of time and money on everyone’s part negotiating down to simply publicizing a price book that’s based on real cost + target profit margin. This would result in bills being identical regardless of the patients’ circumstances and any unpaid balances would be charged to various accounts.
I’ll stop short of specifically naming the accounts to avoid floundering this thread.
Robbie wrote: In reply to aircooled: Lowest market price... And if you are the holder of the patent and therefore the only one selling said drug on the market? Then yes, whatever price you ask is by default the lowest market price. Im sure it's that kind of language trick that allowed the lobbyist to pass the law. http://www.economist.com/blogs/economist-explains/2016/09/economist-explains-2 Read in the middle of the third paragraph.
Yes, but those prices are still negotiated by non-government buyers, so the government is only being screwed as much as the least screwed of the non-government entities. If there is a monopoly situation, the government is not in a unique situation.
The 6 categories they mention: They don't offer any links but I could not find anything that says "pay what they ask". Those are categories that they "must cover", which means they must pay lowest market price again.
https://www.ncoa.org/wp-content/uploads/part-d-drug-coverage-rules.pdf
(what I could find):
This is more to your point, but is in reference to offered rebates. I think this gets us into the weeds of pricing strategies and such, but I am not sure how the government is in a different situation than a large insurer. If an insurer doesn't get a certain rebate, will they honestly not offer ANY treatments for HIV/AIDs etc.? Which seems to be the implication since what other leverage do they have?
Can you canoe?
Should probably just lock this one for good.
Zombie canoe i know but drug prices are ridiculous. My Mom when she went in for a heart bypass, looking at the billing noticed the asprin they gave her was.....$80
This topic is locked. No further posts are being accepted.
