18 votes

The opaque industry secretly inflating prices for prescription drugs

7 comments

  1. [4]
    Spydrchick
    Link
    They mention Mark Cuban's Cost Plus Drugs a few times. I recently retired and was without insurance. I was able to get my scripts for common meds for about $11ea on average with $7 shipping. This...

    They mention Mark Cuban's Cost Plus Drugs a few times. I recently retired and was without insurance. I was able to get my scripts for common meds for about $11ea on average with $7 shipping. This is close to what I was paying while insured. They list out the cost to them for each medication, which I found to be useful .

    A lot of the examples in the article mention generics. Cost Plus Drugs only handles generics, so if you were considering looking at them as an option, it might not fit your needs if a generic is not available for you meds.

    This article really highlights how complicated costing pharmaceuticals has become. Its become a bunch of middlemen looking to profit for no benefit to the end users. We need more healthcare reform in the US, and this would be a great start.

    15 votes
    1. [2]
      imperator
      Link Parent
      I work in Generic pharma, I'm on the finance side and help my team within the charge back and rebate area. The agreements you have to do to get your products sellable is crazy. Getting your...

      I work in Generic pharma, I'm on the finance side and help my team within the charge back and rebate area. The agreements you have to do to get your products sellable is crazy. Getting your product to the end customer requires agreements and fees. It's so convoluted and requires so much administrative work it's insane.

      10 votes
      1. Spydrchick
        Link Parent
        Soumds about right. Why make it simple when you can complicate things and profit. <hard eye roll>

        Soumds about right. Why make it simple when you can complicate things and profit. <hard eye roll>

        5 votes
    2. elight
      Link Parent
      Middlemen once served a purpose, I imagine. As technology has improved, there is less need. However, destroying industries is something we abhor in the US. And so we accrete redundant industries...

      Middlemen once served a purpose, I imagine. As technology has improved, there is less need. However, destroying industries is something we abhor in the US. And so we accrete redundant industries that all must collect their cut, increasing costs for everyone. Sure, this keeps people employed but in useless jobs.

      See also: Intuit.

      10 votes
  2. [3]
    krellor
    Link
    I highly recommend reading the full article which gives an in depth look at one way prescription costs have dramatically risen since 2018 through the creation of corporate structures designed to...

    I highly recommend reading the full article which gives an in depth look at one way prescription costs have dramatically risen since 2018 through the creation of corporate structures designed to skim off the healthcare industry.

    Summary below, but the graphics are also worth looking at.

    Over the decades, P.B.M.s have had different owners, including drug makers and large chains of pharmacies. They were often credited with saving money for patients and employers, including in the early 2010s when they embraced a new wave of generic drugs. They kept a slice of the savings for themselves.

    The modern P.B.M. emerged in 2018. The giant health insurers Aetna and Cigna were trying to achieve the growth demanded by Wall Street. They sought to merge with the P.B.M.s, whose profits were soaring. Aetna and CVS combined. Cigna bought Express Scripts. (UnitedHealth had built its own P.B.M.)

    When you hear about a $16,000-a-year obesity drug or a $275 vial of insulin, that’s not the final price of the medication. This sticker price is just the starting point for negotiations between P.B.M.s and drug companies.

    The drug companies generally agree to reduce prices on brand-name medications by giving rebates and other payments to the P.B.M.s. The P.B.M.s then share most of that with employers. But they also pocket a portion — sometimes about 10 percent — for themselves. Because of the huge national volume of drug spending, that adds up to billions of dollars.

    Greater discounts do not necessarily benefit patients. While lower costs for employers can translate into lower insurance premiums for workers, some out-of-pocket costs are set as a percentage of the original sticker price. So when sticker prices are higher, patients pay more.

    The P.B.M.s’ demands for greater discounts often lead drug companies to increase sticker prices so that they can maintain their profit margins.

    As a result, it is common for a drug’s final price after discounts to plateau even as patients’ out-of-pocket costs for that drug go up.

    7 votes
    1. vord
      Link Parent
      I recall that both Republicans and Pharma companies were both quick to villify PBMs during the congressional hearing about drug prices with the pharma CEOs. While PBMs almost certainly cause more...

      I recall that both Republicans and Pharma companies were both quick to villify PBMs during the congressional hearing about drug prices with the pharma CEOs.

      While PBMs almost certainly cause more harm than good, the fact that they were used as a scapegoat to deflect direct questions about expenses and such tells me that they're a relatively tiny part of why drug prices are so fucked in the USA.

      5 votes
    2. imperator
      Link Parent
      Rebates on some products can be upwards of 85% of list price

      Rebates on some products can be upwards of 85% of list price

      4 votes