"Rome said the companies seem to be maximizing prices while negotiating discounts behind the scenes with health and drug insurers and then setting yet another price for direct-to-consumer cash-pay sales."
This describes the biggest problem in US healthcare. No clear and consistent pricing. If we had a real market, you would get a prescription and then go to the seller with the lowest price. And everybody would get the same price. This whole business with PBMs that are owned by the insurance companies, discount cards and other shenanigans just invites corruption.
I just had some bloodwork done, myself. My provider accidentally billed insurance, which had lapsed due to being laid off. I got my "Explanation of benefits" and it was $1000 billed to them, but I was given a $500 "discount." So I only owed $500... Cash cost was $50. Makes no goddamn sense.
Also I went in for a colonoscopy and an endoscopy. Insurance was billed for $14000. I got statements from 4 different doctors, and the facility where it was performed. None of the statements matched the explanation of benefits from the insurance company. And when I called each doctor, to pay them, they all told me that I didn't actually have to pay them what it said I owed. So I just ended up paying $2500 to the insurance company. It again, makes zero sense.
In practice, the whole system is set up in a way that discourages asking questions. Waste of time. It's truly the opposite of the transparent ideal market.
"And everybody would get the same price. This whole business with PBMs that are owned by the insurance companies, discount cards and other shenanigans just invites corruption."
It's hard to say that it isn't racketeering at this point.
"Specifically, a racket was defined by this coinage as being a service that calls forth its own demand, and would not have been needed otherwise."
There's demand for the meds, but the demand for discount cards, forcing people to use specific services/companies, and related programs is all invented by the companies themselves.
> "Rome said the companies seem to be maximizing prices while negotiating discounts behind the scenes with health and drug insurers and then setting yet another price for direct-to-consumer cash-pay sales."
This sounds like typical negotiating 101. You know you are going to be forced to lower from your starting position, so increase your starting position so when you do negotiate down you are closer to where you wanted to be.
Here in Brazil, we have something called 'Genéricos.' These are essentially the same medications as the brand-name versions, produced with the same chemical ingredients, but they often cost half the price, sometimes even cheaper than that.
Interestingly, while on-patent medications in the US tend to be significantly more expensive than elsewhere, generics in the US tend to be less expensive than generics available elsewhere.
Health insurance in general is the problem; PBMs/discount cards are just a cherry on top. Insurance is fundamentally incompatible with clear and consistent pricing.
Insurance companies do not force the sellers to use complex billing practices, they would benefit from more transparent pricing (since they are seeking to pay less).
The root cause is healthcare is inherently complicated and complex, it has a problem of supply being nowhere near demand, and since prices for things are so high (including liability), there is a lot of cover your ass and fraud prevention going on.
As a european living in the US, the idea there is a market at all is laughable. I tried to get price quotes for treatments several time just to get a "well, it's hard to say" or "it's very complicated".
But of a paywall there, can't tell if raw materials and precursors are costing more, or R&D spend is up, or employee wages and salaries have risen. Those are usually the "pressures" on prices. I can't understand what or who might be applying "pressure" to lower prices on oligopolistic pharmaceutical makers.
Rueters doesn't show a paywall for me. The source of the pressure described is in the headline though. I'm not sure why OP editorialized it (as it is against hn guidelines): Exclusive: Drugmakers raise US prices on 350 medicines despite pressure from Trump.
The article is about drug pricing, which is the part I found interesting (and by extension thought we’d find interesting). I thought taking it out both saved space and made the comments less likely to veer into flamebait.
There's a character limit on the titles you can submit, probably wasn't intentionally editorializing. I assumed from the HN title that the pressure was from the Trump admin just based on the current state of US politics.
I think its obvious: theres a LOT of love for Trump here in VC circles. So anything speaking ill of his laughable policies, EO's, and other garbage is -1'ed or flagged to oblivion.
big Pharma has properties unlike many other business. The R&D is very, very expensive and, income is not directly related to expenses each year. The natural "moat" is such that only a relatively few, giant and wealthy, companies exist over time.
Why does the US consumer of said medications subsidize many other countries who have access to the same medications for a fraction of the US sticker price?
> Drugmakers plan to raise U.S. prices on at least 350 branded medications including vaccines against COVID, RSV and shingles and blockbuster cancer treatment Ibrance, even as the Trump administration pressures them for cuts
Few days ago, Donald Trump pressured Emmanuel Macron to raise the prices of all medicines. The pressure was made with unspoken threats [1].
It's possible that Americans are all about free markets (I have severe doubts on this point, but let's accept it), but Trump and his MAGAts are far more concerned about fucking with people weaker than them.
If given two options, they will take the one that will hurt more people, every day of the week.
Why is the supreme-court slow-walking the tariff decision which is crystal clear as lower courts clearly demonstrate only Congress can set taxes/tariffs?
It would end inflation within 90 days
Even their silly 15% tariff fallback law abuse would be more sane than the 50-150% currently
It slowed down Americans because we aren't recently used to it. The rich did adapt relatively quickly by buying up all the housing they could at negative real interest, stocks, gold, and to a lesser extent crypto.
The lesson has been learned by this point though, even a day laborer is holding silver and crypto nowadays because we have in recent memory the COVID shenanigans of mass QE.
People in China and Russia have basically taken for granted so long that their currency is completely manipulated, they all already knew to not be hoodwinked.
Mate, this Supreme Court ruled that the President is immune to prosecution and de facto outside and above the law. I’m honestly not sure what to tell you if you’re still hoping for rule-of-law decisions to come out of it.
"Rome said the companies seem to be maximizing prices while negotiating discounts behind the scenes with health and drug insurers and then setting yet another price for direct-to-consumer cash-pay sales."
This describes the biggest problem in US healthcare. No clear and consistent pricing. If we had a real market, you would get a prescription and then go to the seller with the lowest price. And everybody would get the same price. This whole business with PBMs that are owned by the insurance companies, discount cards and other shenanigans just invites corruption.
Last year I needed to get blood work done, some of which may or may not be covered.
It took me two weeks, dozens of phone calls, and multiple "escalations" to learn what would be covered and what the price would be if it wasn't
Totally insane. The kicker is that after all that, the price I was billed wasn't even the price I was given (thankfully it was less though).
I just had some bloodwork done, myself. My provider accidentally billed insurance, which had lapsed due to being laid off. I got my "Explanation of benefits" and it was $1000 billed to them, but I was given a $500 "discount." So I only owed $500... Cash cost was $50. Makes no goddamn sense.
Also I went in for a colonoscopy and an endoscopy. Insurance was billed for $14000. I got statements from 4 different doctors, and the facility where it was performed. None of the statements matched the explanation of benefits from the insurance company. And when I called each doctor, to pay them, they all told me that I didn't actually have to pay them what it said I owed. So I just ended up paying $2500 to the insurance company. It again, makes zero sense.
6 replies →
In practice, the whole system is set up in a way that discourages asking questions. Waste of time. It's truly the opposite of the transparent ideal market.
"And everybody would get the same price. This whole business with PBMs that are owned by the insurance companies, discount cards and other shenanigans just invites corruption."
It's hard to say that it isn't racketeering at this point.
"Specifically, a racket was defined by this coinage as being a service that calls forth its own demand, and would not have been needed otherwise."
There's demand for the meds, but the demand for discount cards, forcing people to use specific services/companies, and related programs is all invented by the companies themselves.
> "Rome said the companies seem to be maximizing prices while negotiating discounts behind the scenes with health and drug insurers and then setting yet another price for direct-to-consumer cash-pay sales."
This sounds like typical negotiating 101. You know you are going to be forced to lower from your starting position, so increase your starting position so when you do negotiate down you are closer to where you wanted to be.
Here in Brazil, we have something called 'Genéricos.' These are essentially the same medications as the brand-name versions, produced with the same chemical ingredients, but they often cost half the price, sometimes even cheaper than that.
Insanely comical.
Interestingly, while on-patent medications in the US tend to be significantly more expensive than elsewhere, generics in the US tend to be less expensive than generics available elsewhere.
in the US, we call these 'generics'
Now look into the places that manufacture these generic versions. Not all factories are equal, and some are not of the best of reputations.
Those are available in America too
7 replies →
Health insurance in general is the problem; PBMs/discount cards are just a cherry on top. Insurance is fundamentally incompatible with clear and consistent pricing.
Pharmaceutical companies, hospitals, and doctors are free to charge by the medicine, by the night, and by the minute.
For example, this place does it:
https://surgerycenterok.com/surgery-prices/
Insurance companies do not force the sellers to use complex billing practices, they would benefit from more transparent pricing (since they are seeking to pay less).
The root cause is healthcare is inherently complicated and complex, it has a problem of supply being nowhere near demand, and since prices for things are so high (including liability), there is a lot of cover your ass and fraud prevention going on.
11 replies →
As a european living in the US, the idea there is a market at all is laughable. I tried to get price quotes for treatments several time just to get a "well, it's hard to say" or "it's very complicated".
Hmm, I heard they’re down 1500%.
But of a paywall there, can't tell if raw materials and precursors are costing more, or R&D spend is up, or employee wages and salaries have risen. Those are usually the "pressures" on prices. I can't understand what or who might be applying "pressure" to lower prices on oligopolistic pharmaceutical makers.
Rueters doesn't show a paywall for me. The source of the pressure described is in the headline though. I'm not sure why OP editorialized it (as it is against hn guidelines): Exclusive: Drugmakers raise US prices on 350 medicines despite pressure from Trump.
> not sure why OP editorialized it
The article is about drug pricing, which is the part I found interesting (and by extension thought we’d find interesting). I thought taking it out both saved space and made the comments less likely to veer into flamebait.
1 reply →
There's a character limit on the titles you can submit, probably wasn't intentionally editorializing. I assumed from the HN title that the pressure was from the Trump admin just based on the current state of US politics.
1 reply →
I think its obvious: theres a LOT of love for Trump here in VC circles. So anything speaking ill of his laughable policies, EO's, and other garbage is -1'ed or flagged to oblivion.
3 replies →
big Pharma has properties unlike many other business. The R&D is very, very expensive and, income is not directly related to expenses each year. The natural "moat" is such that only a relatively few, giant and wealthy, companies exist over time.
ref- The Billion Dollar Molecule
> big Pharma has properties unlike many other business. The R&D is very, very expensive and, income is not directly related to expenses each year
Isn’t this any capital-intensive business with variable demand?
Why does the US consumer of said medications subsidize many other countries who have access to the same medications for a fraction of the US sticker price?
24 replies →
Except many (most?) pharmas spend more on marketing and sales than R&D. Lobbying is another big expense for most of them.
> Drugmakers plan to raise U.S. prices on at least 350 branded medications including vaccines against COVID, RSV and shingles and blockbuster cancer treatment Ibrance, even as the Trump administration pressures them for cuts
Few days ago, Donald Trump pressured Emmanuel Macron to raise the prices of all medicines. The pressure was made with unspoken threats [1].
[1]: https://www.tf1info.fr/international/trump-se-vante-d-avoir-...
That's like pressuring a politician to commit seppuku. French would be rioting in the streets if he would even try that.
Furthermore how Macron can increase prices of drugs? I was thinking that Americans are all about free market.
It's possible that Americans are all about free markets (I have severe doubts on this point, but let's accept it), but Trump and his MAGAts are far more concerned about fucking with people weaker than them.
If given two options, they will take the one that will hurt more people, every day of the week.
Why is the supreme-court slow-walking the tariff decision which is crystal clear as lower courts clearly demonstrate only Congress can set taxes/tariffs?
It would end inflation within 90 days
Even their silly 15% tariff fallback law abuse would be more sane than the 50-150% currently
Next few years is going to be insanity
There was a lot of inflation before tariffs, and it didn't even have the effect of slowing China down economically or Russia militarily.
It slowed down Americans because we aren't recently used to it. The rich did adapt relatively quickly by buying up all the housing they could at negative real interest, stocks, gold, and to a lesser extent crypto.
The lesson has been learned by this point though, even a day laborer is holding silver and crypto nowadays because we have in recent memory the COVID shenanigans of mass QE.
People in China and Russia have basically taken for granted so long that their currency is completely manipulated, they all already knew to not be hoodwinked.
Inflation is low (relative to the last few years) and so far tariff related inflation hasn't manifested.
Mate, this Supreme Court ruled that the President is immune to prosecution and de facto outside and above the law. I’m honestly not sure what to tell you if you’re still hoping for rule-of-law decisions to come out of it.