No. But all these “we should provide this and that” posters had better stare at that number a while.
Medicare negotiated drug prices...some observations
- Thread starter Aardvark86
- Start date
Since Biden took office: $7,426,137,876,823.30
During Trump's term (Jan 20, 2017 to Jan 20, 2021) debt increased: $7,804,591,681,202.30
During Obama's two terms: $7,619,923,750,515.60
Biden has about five months to go.
I think he’s going to seize the debt crown from Trump.
It's not simply pr, it's that their total sales (to my read, including their non-government sales) become subject to a 2200% tax.
So a child is born to a poor family. That infant will die for lack of a life saving procedure. A procedure that has a 100% likelihood of curing the disease. You’re saying the society you want to live in will sacrifice that child for the want of higher taxes?
I do not want to live there and if you believe that, you’re an awful awful person.
I’ll agree with this. But federal spending should be reserved for national issues that can only be solved nationally. Healthcare cannot be fixed state by state.
...which of course is why we regulate insurance on a state by state basis...
I'm going to interrupt this circle jerk with some facts...
Walgreens and CVS are two companies having to realign their business model.
Both companies have seen their profit margins under stress amid declining reimbursement from Medicare/Medicaid/insurance because of the Biden/Harris efforts to lower drug costs.
Both companies have seen the price of their stock decline significantly YTD.
What's one solution?
Lower retail prices to increase unit sales!
That's a win for consumers.
Walgreens and CVS are two companies having to realign their business model.
Both companies have seen their profit margins under stress amid declining reimbursement from Medicare/Medicaid/insurance because of the Biden/Harris efforts to lower drug costs.
Both companies have seen the price of their stock decline significantly YTD.
What's one solution?
Lower retail prices to increase unit sales!
That's a win for consumers.
actually, one of the biggest hits to their bottom lines has been manufacturers clamping down on their participation in the 340 program.
And guess what, the ira negotiated prices aren’t going to help on that front because the price is a pass through. Worse yet, four of the ten neg prices are lower than the 340b prices they can access. Having to pass thru discounts is most assuredly not going to help their bottom lines.
CVS is another story as the poor stepsister to its cousins cmrx and zinc, which payors have had just about enough of in terms of their revenue skimming.
Lost in your analysis regarding my mention of Walgreens and CVS is that they will close some locations resulting in additional savings as overhead is reduced and savings passed to consumers.
There will be some inconvenience with less locations, but still a plus for the general public.
All this stuff is trickle down from the WH efforts to lower drug costs.
How is retail pharmacy not a dying business model? Pharmacy by mail is the future.
It happens a ton. That's part of the reason for the medical tourism industry.
Pharmacy Tourism
Pharmacy tourism, the reimportation of prescription drugs from offshore countries at lower prices, is growing. Learn more about pharmacy tourism with HUB!
www.hubinternational.com
I moved my prescriptions from Walgreens to Costco about a year and a half ago after noticing that the prices they charged were consistently and significantly higher. They need to heed the old market adage of "Pigs get fat and hogs get slaughtered. "
I believe you. They expanded way too fast and they usually have those "corner lot" locations that probably didn't come cheap.
The society I want to live in doesn’t see taxes as the only solution to any given situation.
Taxes and bureaucracy are extremely crude, expensive and inefficient methods to solve problems, and should be exercised as sparingly as possible.
Exactly how would you fund public services like fire protection, road maintenance, snow removal, and the like?
I appreciate OPs post enough to not go down that path in this thread, but I’ll answer you in another if you want to start the conversation.
My initial post was to point out this whole system is a mess because consumers are largely cut out of it.
In the end, there are only a few ways to do things.
You pay for what you get, in which case you care about cost and quality/quantity in the proportion each matter to you for the thing in question.
Maybe you buy expensive tires, but cheap towels.
You pay for what someone else gets, which leans you toward greater interest in cost than quality/quantity. Especially when you’re operating a budget that has to last until date X, with unknown between then and now still to come. That’s not even getting into the perverse incentives of expending budgets to ensure they’re never cut. Efficiency is incidentally, but generally, punished in this regard.
Someone else pays for what you get, in which case you don’t have to care about cost, so your focus is on quality/quantity (at Someone’s unrewarded expense). When cost quits regulating consumption shelves empty in a manner similar to price controls. The cost becomes standing in line in order to be among the first when the shelves restock.
The Someone else pays category can really get bad for society when the Someone else is being forced to pay with government debt. It seems for a while as if no is having to pay at all.
Just an fyi, a pretty interesting piece yesterday from UCSD economists in Health Affairs sought to better quantify the net savings associated with the negotiated price program. It's too long to post here, notwithstanding my aspirations of an homage to @cigaretteman, but the gist of it is that the savings are likely to be fairly dramatically less than the $6B claimed by CMS. Aside from list price comparison issues noted previously in this thread, this is because (i) that figure did not take into account "other" new mandatory part D rebates (10-30%) that manufacturers would have had to pay to the G but for the fact that selected drugs for negotiation are exempt from those other rebates, and (ii) given the late stage of many products' life cycle, it's likely that voluntary rebates into the system would have actually increased but for their selection. A colleague's back-of-the envelope math suggested that one manufacturer might even come out more favorably in the net under negotiated pricing than otherwise for its product. While that is speculative, and while overall the program is likely to generate 'some' savings, I think my colleague's bigger picture observation is spot on: the "real" accomplishment of the negotiated pricing model is to effectuate the pass through of pre-existing price concessions offered by manufacturers to patients and pharmacies at the point of sale, rather than having them be gobbled up by PBMs and payors (or, more charitably, having them be used by pbms/payors to subsidize premium costs rather than point of sale savings). Time will tell, of course, what premium costs will do (though even that is a little artificial since theyre subject to YTY increase caps now. So I guess time may tell whether any part D plans exit the market, or whether formulary restrictions get materially tighter.
I have an “in” on the issues with insurers covering drugs like Wegovy. Many insurers don’t cover the is medication. I asked a physician friend of mine, who is also an insurance contractor, why they don’t cover it since weight loss would lead to fewer claims. His answer is that the savings from weight loss happen later in life. Often after the patient is on Medicare. The cost to the insurer is up front.
No idea of the validity but he is sort of an insurance insider on this.
my guess is that's oversimplifying things a bit. most policies will provide a relatively broad statement of coverage, particularly post ACA defined benefit packages -- now that doesn't mean that the insurers can't throw up road blocks like prior authorization or step therapy, but usually they'll be 'covered' at least from a technical perspective.
that said, the sooner/later dynamic you describe absolutely exists.
I’m sure my information from him is slanted. This physician is a dyed in the wool 💯 universal coverage advocate. Bernie sanders supporting liberal socialist. I have no doubt his views are slanted. In fact, I’ve asked him why he contracts with one and it’s all about the cash.
So a few recent tidbits.
First, on Friday, the Fifth Circuit actually allowed a case on drug price negotiations to go forward. https://thedailyrecord.com/2024/09/...-biden-medicare-drug-price-reduction-program/ As is typical of the fifth circuit, the majority opinion had a fair bit of bending over backwards, on standing and 405 preclusion issues. First win for industry, but not on the merits at this point. If I were a betting man, i'd guess they don't appeal, and just proceed to summary judgment motions, where the G is something-and-oh. It certainly wouldn't be surprising if industry wins on the merits at the fifth circuit (given the fifth circuit), but no need to accelerate that process.
Second, also on Friday, the ftc announced an administrative claim against the big 3 pbms in connection with insulin prices. (Essentially, the allegation is that they promote high list prices so that they can earn bigger rebates (which are based on the list prices) while not necessarily passing those rebates through in a way that benefits patients. )
First, on Friday, the Fifth Circuit actually allowed a case on drug price negotiations to go forward. https://thedailyrecord.com/2024/09/...-biden-medicare-drug-price-reduction-program/ As is typical of the fifth circuit, the majority opinion had a fair bit of bending over backwards, on standing and 405 preclusion issues. First win for industry, but not on the merits at this point. If I were a betting man, i'd guess they don't appeal, and just proceed to summary judgment motions, where the G is something-and-oh. It certainly wouldn't be surprising if industry wins on the merits at the fifth circuit (given the fifth circuit), but no need to accelerate that process.
Second, also on Friday, the ftc announced an administrative claim against the big 3 pbms in connection with insulin prices. (Essentially, the allegation is that they promote high list prices so that they can earn bigger rebates (which are based on the list prices) while not necessarily passing those rebates through in a way that benefits patients. )
