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The cost of pharmaceuticals


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Just trying to pass along a little knowledge on the FDA and patents and whatnot. Patents get blamed, often unfairly, and the FDA gets a free pass and that aint right.

 

And for cost centers in health care, hospitals tend to get a free pass also, and that aint right either, because it's the biggest black hole in the system.

Edited by TwiceHorn
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nevermind. 

 

And for cost centers in health care, hospitals tend to get a free pass also, and that aint right either, because it's the biggest black hole in the system.

 

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Edited by Anastasis
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1 hour ago, TwiceHorn said:

Just trying to pass along a little knowledge on the FDA and patents and whatnot. Patents get blamed, often unfairly, and the FDA gets a free pass and that aint right.

 

And for cost centers in health care, hospitals tend to get a free pass also, and that aint right either, because it's the biggest black hole in the system.

Yeah can’t see shit.  Which is the whole problem  

 

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3 hours ago, XYZ said:

The healthcare racket has to be the most fucked up thing about America. Pharma bribes congress to pass a law that makes it illegal to bring in cheaper medicines from other countries. Doctors and hospitals charge different people vastly different amounts for the same service. And they generally refuse to post their prices. That’s fucking illegal.

Not only is it legal, it's directly because of the government, namely Medicare.  Any clinic, hospital, etc. that contracts with Medicare must "charge" the same rate to everyone. Insurers and the government have their own rates they will reimburse based on regional and negotiated contracts with providers under that "charge" rate.  There are literally hundreds of plans to negotiate these rates individually. 

Now, all providers know they won't get this exorbitant initial fee. Their contracts are usually a percentage of this fee and the fee cannot be too high because every insurer sets a limit on what is customary in charges.

For example, Blue Cross reimburses Mercy Hospital $800 for a CT scan, Cigna - $735 and Medicare - $414.25.  Most likely there are about 300 different prices due to contracts and subcontracts with insurers. Mercy Hospital sets their charge fee at $900 because that number captures all the contracts.  If Mercy charged $700 then Blue Cross will only pay $700 and not the $800 negotiated rate.

The one patient (customer) that gets screwed in all of this is the cash pay patient because, by Medicare law, they must be charged the highest set fee that the provider had to set to capture all the negotiated rates across all their contracts.  For example, if Mercy Hospital states Mr. No Insurance can have a CT scan for $414.25 (the same as Medicare), then Mercy can be charged with fraud because although they charged the same as Medicare, they now have charged a different rate to different patients even though it is the same damn amount that Medicare pays.  So, by law, Mercy has to charge Mr. No Insurance $900.  He might get a discount if he pays cash at the time of service.

That is one example of how Medicare FUBAR'd our billing and reimbursement system while adding multiple layers to healthcare administration, opening avenues for fraud and killed price transparency.

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29 minutes ago, XYZ said:

Yes, except that in many instances, the rate for Mr no insurance is not “somewhat higher”, it’s fucking several times higher.

Who are you quoting on “somewhat higher”?

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Don't a lot of our esteemed congressmen get a fuckton of money from the insurance and pharma lobbies?

And don't a lot of those same esteemed congressmen transition to "consulting" or "lobbying" jobs for the insurance and big pharma, where they continue to get a fuckton of money?

Yeah, I'm not optimistic anything significant is going to happen with healthcare and big pharma.

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Pretty good (but long) article in advance of tonight's 60 Minutes story.

https://www.nytimes.com/2018/05/06/us/politics/trump-drug-prices-lobbying.html?rref=collection%2Fbyline%2Frobert-pear&action=click&contentCollection=undefined&region=stream&module=stream_unit&version=latest&contentPlacement=2&pgtype=collection

As Trump Prepares Plan to Lower Drug Prices, Big Pharma Girds for a Fight 

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On 5/5/2018 at 9:04 AM, ndawg said:

I pay $300 a month for a drug that was essentially developed at a publicly funded university. The pharma company added an immaterial variation, patented everything, and now has a monopoly.

The people running some of these companies are psychopaths.

This. The public funds research for drugs on university campus. Then the drug company buys drug and jacks up the price. 

Wtf 

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A lot of Trumps plan sounds like big government "solutions" that will not affect pricing.

I like the pricing where I am. A doctor's visit with a weeks worth of antibiotics is $14 with no insurance, for example.

Cialis is $18 otc, while in the states that was the co-pay. When it goes generic in September it will probably be $1. Note that I am a recreational user like many guys here.

There are lots of models around the world that the USA could follow. We dont need to reinvent the wheel here.

 

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