Medical Cost

[Eagle1]

This is true, but the US funds the R&D for the world.

For example, Humira cost the US consumer around 7K per injection, even during the patent phase. That same injection in Europe was around $200.

Big pharma has deals with Pharmacy Benefit Managers to soak the US consumer with the brunt of the costs. The US has money and good insurance companies, they know where to make back the R&D costs.

I have heard PBM's want to use AI to set pricing for Rx drugs. They will use AI to understand what a person can afford. If you are wealthy, it will cost more and vice versa. hoo boy...

So what about the Trump/Kenedy plan to mandate the same prices as the lowest offered worldwide. Spread the cost of R&D across the globe.
Fact Sheet: President Donald J. Trump Announces Actions to Put American Patients First by Lowering Drug Prices and Stopping Foreign Free-riding on American Pharmaceutical Innovation

 

[Snobdds]

So what about the Trump/Kenedy plan to mandate the same prices as the lowest offered worldwide. Spread the cost of R&D across the globe.
Fact Sheet: President Donald J. Trump Announces Actions to Put American Patients First by Lowering Drug Prices and Stopping Foreign Free-riding on American Pharmaceutical Innovation

We know there is an entire body of people that will resist this just because of who it's from. They will be rejected even though it makes great sense.

I want to see who big pharma aligns itself with on this issue. That will be the tell...

 

[Eagle1]

We know there is an entire body of people that will resist this just because of who it's from. They will be rejected even though it makes great sense.

I want to see who big pharma aligns itself with on this issue. That will be the tell...

I know and you see it like I do.

 

[ponytug]

This is true, but the US funds the R&D for the world.

For example, Humira cost the US consumer around 7K per injection, even during the patent phase. That same injection in Europe was around $200.

Big pharma has deals with Pharmacy Benefit Managers to soak the US consumer with the brunt of the costs. The US has money and good insurance companies, they know where to make back the R&D costs.

I have heard PBM's want to use AI to set pricing for Rx drugs. They will use AI to understand what a person can afford. If you are wealthy, it will cost more and vice versa. hoo boy...

No question. Most of the foreign countries with lower prices have national agencies for government approval and purchase for distribution (on formulary) in their national health systems. Some countries do approve drugs, but only for private use, as they aren't subsequently approved for use in the national healthcare system. The drug pricing in those countries gets closer to US pricing.

The flip side within drug companies is running the expected cost/benefit call of whether to introduce a drug in a given country if the desired price might be too high for adoption. Many countries fail that test, and the drugs aren't available there. For political reasons, I have seen drugs introduced even the drug wasn't approved for use in the national healthcare system system, and was sufficiently expensive that nobody in the company ever expected it to be put on the formulary, but that politically it might help other drugs get approved for the formulary.

Personally, I'd love to see the pharmacy benefit managers taken out of the equation in favor of national buying / pricing scheme, but I can see how many folks see that as government expansion / intrusion / socialism.

Our healthcare system is definitely an imperfect system. For those with health insurance, I think that it functions, albeit not without costs and friction. When I speak with folks in overseas healthcare systems, I think that those systems are clearly imperfect to my eye in other ways. For the systems that I have seen, I would not trade ours for theirs.

None of this addresses your earlier point about the extent to which issues being dealt with in the US healthcare system are preventable, and lifestyle issues. I think that many folks have trouble connecting decisions that they make today and their future well being, or lack thereof. I think that it is complicated, as not many folks are 100% rational, myself included.

All the best,

Peter

 

[bigtiller]

Why do we need a pharmacy benefit manager (PBM) to buy medication.

Why can't we by drugs like we by tractors?
From the factory to the dealer to us, seams to be working okay.

 

[Snobdds]

Why do we need a pharmacy benefit manager (PBM) to buy medication.

Why can't we by drugs like we by tractors?
From the factory to the dealer to us, seams to be working okay.

Because drug companies only sell to PBM's. They don't want to have inhouse sales people selling to 15K individual pharmacies. It would be a conflict of interest for insurance companies or Medicare to sell them too...

 

[brkdrvr]

People wonder why insurance is so costly...it's because the procedures are so costly.

Obamacare addressed access to healthcare, without addressing the cost of healthcare. Costs have gone parabolic since 2010.

In order to address healthcare and insurance costs patients have to have skin in the game ( before they are terminal). Feeding I have a DR. ( oncological & General Surgeon) friend on the local Hospitals board ('Non-profit"). I am a member of a medical Heathshare and see all my bills and what they are negotiated to. I was talking to my friend about the bills I had from a stroke 3-4 years ago and was amazed at what the providers accepted usually half or less than they originally billed and in some cases less than a third. My Healthshare uses a company that analyzes medical bill for insurance companies and the price Medicare pays as a guide, the Healh share always pays more than Medicare. My friend said the hospital was happy to get even half what they billed and I started to argue, he looked at me and pointed out I'm on the board. These non-profits are a scam the local Hospitals CEO makes @ 2 million a year, (far more than most of the DRs. and has never actually practiced medicine) they are able to use unpaid bills as losses to be non profit no matter how much over market they bill. I have seen two emergency room bills for 2-3 stitches go from just under $2,000. each to paid at under $500 while another 2 stitch incident be paid at the local critical care for @ $350.00. Obama crap is a complete scam and definitely has death panels as does Great Britain, Canada and many European systems if people took the time to research and as questions, they do have better "palliative care" while you die programs and are also moving to Euthanasia and assisted suicide to save costs. At least 8 countries in europe allow assisted suicide and Netherlands lets families request it for terminally ill 12yo +. Sorry for the rant medical billing and insurance is a govt sanctioned scam. Why are not all non elective/cosmetic type medical and related expenses 100% deductible???? The federal politicians get it for free they are even transition military at our expense.

 

[JTKub]

I was just chatting on the phone with a good friend and former co-worker of mine who retired a few years ago at 59.5 and we were talking about health care costs.

For him and his wife to stay on a company sponsored health care plan, it was $1600/mo for him. He did that for the first year and has been shopping the market place yearly, ever since (he's 62-63 now). He's currently paying $1300 for the two of them w/ your typical high deductible plan.

If you have very little money, or are able to make it look like you have no money, you pay very little for health care. If you worked hard all your life to provide for your family and have savings/retirement, you pay a lot. It sucks. I'm glad I still like my job. 28+ years in, I guess I do!

 

[part-time-Farmer-NC]

Im 4 weeks post hip replacement surgery.. Got the bill a couple days ago.. Total for that day in the hospital was 48K.. Did not include previous appointments and previous x rays etc before D day. also does not include the PT appointments for the next month. My co pay was 4800.00... My insurance for my wife and myself is 2300.00 per month.... Roughly 1150.00 ea per month.

If you don't mind me asking is that medicare obama care or what plan?

I ask as I am about to have to get insure for me and the wife with me it'd be for 14mos for her 43 mos.

 

[Dftodd]

No question. Most of the foreign countries with lower prices have national agencies for government approval and purchase for distribution (on formulary) in their national health systems. Some countries do approve drugs, but only for private use, as they aren't subsequently approved for use in the national healthcare system. The drug pricing in those countries gets closer to US pricing.

The flip side within drug companies is running the expected cost/benefit call of whether to introduce a drug in a given country if the desired price might be too high for adoption. Many countries fail that test, and the drugs aren't available there. For political reasons, I have seen drugs introduced even the drug wasn't approved for use in the national healthcare system system, and was sufficiently expensive that nobody in the company ever expected it to be put on the formulary, but that politically it might help other drugs get approved for the formulary.

Personally, I'd love to see the pharmacy benefit managers taken out of the equation in favor of national buying / pricing scheme, but I can see how many folks see that as government expansion / intrusion / socialism.

Our healthcare system is definitely an imperfect system. For those with health insurance, I think that it functions, albeit not without costs and friction. When I speak with folks in overseas healthcare systems, I think that those systems are clearly imperfect to my eye in other ways. For the systems that I have seen, I would not trade ours for theirs.

None of this addresses your earlier point about the extent to which issues being dealt with in the US healthcare system are preventable, and lifestyle issues. I think that many folks have trouble connecting decisions that they make today and their future well being, or lack thereof. I think that it is complicated, as not many folks are 100% rational, myself included.

All the best,

Peter

Arkansas just passed a law that PBM's can't own or operate pharmacies in the state.

I'm waiting to see how this plays out in the court system since i'm stuck using one of those PBM managed pharmacies.