Comment by BugsJustFindMe
3 days ago
I don't want you to give them the benefit of the doubt. I certainly don't think they deserve it. I do think, however, that a conversation about "overcharging" goes nowhere until people talk about exactly where charging ends and overcharging begins.
I'd be fine with a 20-50% markup on MSRP to cover billing and administration costs but when the insurer owns the pharmacy they can "negotiate" whatever rate they want and you have to pay it. I don't see it directly in the article, but I suspect they do the same thing with cancer drugs as with IVF drugs and require you to go through their pharmacy for insurance coverage. Insurance plans often have lifetime maximums, and when they set their own prices and collect money from themselves for the medication they sell you they can basically dictate how much actual coverage you get versus someone paying cash. And because you chose "bill insurance" when you ordered the medication, you're now on the hook for whatever additional cost there was versus the cash price. And also they won't tell you what the cost is until after the medication has already shipped.
So it's at least plausible that they're abusing their position as the company that owns the pharmacy and the insurance plan to charge you a lot of money and provide very little coverage and also to gouge you at the very end of your coverage, because that's exactly what they did to my partner and I.
IMO a functioning government would have trust busted an insurer with such strong collusion with a pharmacy.
Yeah, we need to be careful with using something like MSRP because of what that S means. I would rather we find a different baseline more fundamental to the cost of production than something that essentially amounts to "the price is the price". But I'm right there with you, and I think it's a good start.
Anything above what Medicaid pays for drugs/procedures (and maybe a few % over to account for health insurance salaries) is overcharging.
Is that clear enough for you?
The trouble with this cascades as follows:
1) I don't know what Medicaid pays.
2) I don't know that what Medicaid pays is a just price until we define what a just price is on its own merits. Maybe Medicaid pays more than they should.
3) What Medicaid pays could change at any time for any reason unless what Medicaid pays is based itself on some metrics that define otherwise, in which case let's just look at those metrics directly, yes?
4) If Medicaid decides to pay more, is that the new line?
1. Unlike private insurance, this is publicly available.
2. If anything, it's a bit stingy. The negotiating power of government (and the predictability of it) helps keep reimbursements down here.
3. I mean, that's how they're set. They analyze how long and how much a particular procedure should take/cost.
4. Sure.
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