6 ms·

Just chiming in here to help bring attention to the Express Scripts near-monopoly. Their market position and it's implications are surprisingly under-reported.

by lbhnact 10y ago

Just chiming in here to help bring attention to the Express Scripts near-monopoly. Their market position and it's implications are surprisingly under-reported. Surprised the HN crowd doesn't get more riled up about this, given the implications for science, opiate abuse, and other opportunities missed for improving the health system.

nerdponx 10y ago
Yep, I never even heard of this company before. This is why I read HN.
- cylinder 10y ago
  I've known about it for a long time, and several times I've tried to read about them and figure out what exactly they do. "pharmaceutical benefits management." Okay, not sure what that actually means. I figure it's just another business / industry that exists solely because of the disastrous healthcare system in America, and would not otherwise be needed if the government managed pharmaceutical access so everyone has access to them.
  - refurb 10y ago
    Express Scripts does a few things. They are a pharmacy benefits manager (PBM). PBMs sell pharmacy plans to other insurance companies and employers. They basically say "Pay us $X and we'll handle all of the pharmacy insurance work for you". They are also a specialty pharmacy and a mail-order pharmacy. I'm sure there are a few other services they offer as well.
ck2 10y ago
Isn't the lack of ability to negotiate better prices under obamacare a much much bigger abuse of health care? The lack of ability to (legally) import from Canada too? And the fact all prices are becoming geared only for people with insurance to milk the system. I don't have insurance and my script went from $4 to $80 when Target cancelled support for people without insurance. Walmart is the last place now and how long will that last when they figure out there is no competition.
- lbhnact 10y ago
  I agree the non-negotiation was a major compromise. However it was, as I am told, basically required to get the ACA passed at all. The drug companies were represented by Billy Tauzin [1] who, as I am told by insiders that worked directly with him, was able to get the Pharmacos to not fight the ACA. Their support was not just critical, but a necessary factor in getting anything done. It was a trade-off, whether or not is was worth it is hard to know. As for your own care, I am sorry to hear about the lack of insurance. Some states (for often historical market reasons) make it hard for providers to sell or even give medications to their patients, which is also part of this problem. If you look around, there are occasionally 'Direct Primary Care' providers or community clinics that stock generics for their own patients and will provide them at no or low-cost. Many organizations and states have processes for the uninsured to obtain medications at low cost as well. If you find a clinic with PCPs who are mission-driven, and they are out there, they perhaps can help you enroll. [1] https://en.wikipedia.org/wiki/Billy_Tauzin https://en.wikipedia.org/wiki/Billy_Tauzin
  - hga 10y ago
    It was a trade-off, whether or not is was worth it is hard to know. It depends on whether you care about there being any new drugs developed in the future or not. ck2 is having trouble paying his current drug costs and would seem to be in one camp. I can pay mine---granted, they've all gone generic---but with a barely, maybe, kinda treatable genetic in my case but generally common condition for which nobody has come up with a cure including an effective drug, I'm in another camp (heck, if new drug discovery had been shut down before the mid-90s or so, I might well be dead, or suffering enough you wouldn't be blessed with my contributions to HN). And as more and more people die due to antibiotic resistance infections I suspect more people will shift into mine. Ditto importing from Canada, with their small market the easiest thing for drug companies to do is simply cease exporting brand name drugs to them so they don't suffer from re-importation and still have something of a new drug development budget.
    - Retric 10y ago
      New drug development is mostly paid for by other party's. The major drug company's spend money on acquisitions, advertising, and minor tweaks to get around patents. ex: Viagra> Uprima and Cialis Sure, Pfizer for example does spend billions on R&D. But, far more of this is Development than Research. They also call a lot of dubious spending R&D.
hga 10y ago
Errr, I wouldn't say they're that close to having a "near-monopoly". Or at least, back in 2011 I chose a Medicare Part D plan that used them, and they were so horrible I've made a point to never use a plan that uses them again, and that hasn't been difficult. For example, they didn't succeed in buying Caremark, bought by CVS, and that's whom I'm using this year, although I was not pleased when they bought Medco recently.
- lbhnact 10y ago
  Apologies, it was an early morning... I meant to point out the Express Scripts-Surescripts connection (and CVS, other pharmacy stakeholders...), which is part of why I think they may have dropped PillPack. PillPack, and some of the other startups and smaller actors in the space, are potetial threats to the established players, like Express Scripts, that essentially collude through Surescripts to protect their access to the patient-provider origination channel. It's the Surescripts network that has the near-monopoly on prescription EDI, and it acts to protect it's members interests. The tech is ancient and entrenched in a way that I imagine would greatly upset the HN crowd if they looked at it more closely. Regulatory actors have not been paying enough attention here IMHO, and the nature of the market has led to an opaque situation that's prevented opportunities to advance research on important questions for social issues and patient care. [1] http://surescripts.com/support/faqs/general/detail/who-owns-surescripts http://surescripts.com/support/faqs/general/detail/who-owns-...
  - Gratsby 10y ago
    The amount of overprotective entrenched businesses in the medical industry is insane. But that's also one of the reasons the industry is attractive to new ventures and businesses -- it's just plain lucrative. Opportunity abounds for people who have the wherewithall and resources to fight the long battle it takes to earn a stable spot in the crowd.
  - maxerickson 10y ago
    Is there even a regulator that would have jurisdiction to do something meaningful? Or is it more of a legislative issue?

by lbhnact 10y ago

nerdponx 10y ago

Yep, I never even heard of this company before. This is why I read HN.

cylinder 10y ago
I've known about it for a long time, and several times I've tried to read about them and figure out what exactly they do. "pharmaceutical benefits management." Okay, not sure what that actually means. I figure it's just another business / industry that exists solely because of the disastrous healthcare system in America, and would not otherwise be needed if the government managed pharmaceutical access so everyone has access to them.
- refurb 10y ago
  Express Scripts does a few things. They are a pharmacy benefits manager (PBM). PBMs sell pharmacy plans to other insurance companies and employers. They basically say "Pay us $X and we'll handle all of the pharmacy insurance work for you". They are also a specialty pharmacy and a mail-order pharmacy. I'm sure there are a few other services they offer as well.

ck2 10y ago

Isn't the lack of ability to negotiate better prices under obamacare a much much bigger abuse of health care? The lack of ability to (legally) import from Canada too? And the fact all prices are becoming geared only for people with insurance to milk the system. I don't have insurance and my script went from $4 to $80 when Target cancelled support for people without insurance. Walmart is the last place now and how long will that last when they figure out there is no competition.

lbhnact 10y ago
I agree the non-negotiation was a major compromise. However it was, as I am told, basically required to get the ACA passed at all. The drug companies were represented by Billy Tauzin [1] who, as I am told by insiders that worked directly with him, was able to get the Pharmacos to not fight the ACA. Their support was not just critical, but a necessary factor in getting anything done. It was a trade-off, whether or not is was worth it is hard to know. As for your own care, I am sorry to hear about the lack of insurance. Some states (for often historical market reasons) make it hard for providers to sell or even give medications to their patients, which is also part of this problem. If you look around, there are occasionally 'Direct Primary Care' providers or community clinics that stock generics for their own patients and will provide them at no or low-cost. Many organizations and states have processes for the uninsured to obtain medications at low cost as well. If you find a clinic with PCPs who are mission-driven, and they are out there, they perhaps can help you enroll. [1] https://en.wikipedia.org/wiki/Billy_Tauzin https://en.wikipedia.org/wiki/Billy_Tauzin
- hga 10y ago
  It was a trade-off, whether or not is was worth it is hard to know. It depends on whether you care about there being any new drugs developed in the future or not. ck2 is having trouble paying his current drug costs and would seem to be in one camp. I can pay mine---granted, they've all gone generic---but with a barely, maybe, kinda treatable genetic in my case but generally common condition for which nobody has come up with a cure including an effective drug, I'm in another camp (heck, if new drug discovery had been shut down before the mid-90s or so, I might well be dead, or suffering enough you wouldn't be blessed with my contributions to HN). And as more and more people die due to antibiotic resistance infections I suspect more people will shift into mine. Ditto importing from Canada, with their small market the easiest thing for drug companies to do is simply cease exporting brand name drugs to them so they don't suffer from re-importation and still have something of a new drug development budget.
  - Retric 10y ago
    New drug development is mostly paid for by other party's. The major drug company's spend money on acquisitions, advertising, and minor tweaks to get around patents. ex: Viagra> Uprima and Cialis Sure, Pfizer for example does spend billions on R&D. But, far more of this is Development than Research. They also call a lot of dubious spending R&D.

hga 10y ago

Errr, I wouldn't say they're that close to having a "near-monopoly". Or at least, back in 2011 I chose a Medicare Part D plan that used them, and they were so horrible I've made a point to never use a plan that uses them again, and that hasn't been difficult. For example, they didn't succeed in buying Caremark, bought by CVS, and that's whom I'm using this year, although I was not pleased when they bought Medco recently.

lbhnact 10y ago
Apologies, it was an early morning... I meant to point out the Express Scripts-Surescripts connection (and CVS, other pharmacy stakeholders...), which is part of why I think they may have dropped PillPack. PillPack, and some of the other startups and smaller actors in the space, are potetial threats to the established players, like Express Scripts, that essentially collude through Surescripts to protect their access to the patient-provider origination channel. It's the Surescripts network that has the near-monopoly on prescription EDI, and it acts to protect it's members interests. The tech is ancient and entrenched in a way that I imagine would greatly upset the HN crowd if they looked at it more closely. Regulatory actors have not been paying enough attention here IMHO, and the nature of the market has led to an opaque situation that's prevented opportunities to advance research on important questions for social issues and patient care. [1] http://surescripts.com/support/faqs/general/detail/who-owns-surescripts http://surescripts.com/support/faqs/general/detail/who-owns-...
- Gratsby 10y ago
  The amount of overprotective entrenched businesses in the medical industry is insane. But that's also one of the reasons the industry is attractive to new ventures and businesses -- it's just plain lucrative. Opportunity abounds for people who have the wherewithall and resources to fight the long battle it takes to earn a stable spot in the crowd.
- maxerickson 10y ago
  Is there even a regulator that would have jurisdiction to do something meaningful? Or is it more of a legislative issue?