8 ms·

A former travelling companion (on a long distance train trip) moved from Head of R&D for an advertising agency into working in the medical technology industry.

A former travelling companion (on a long distance train trip) moved from Head of R&D for an advertising agency into working in the medical technology industry. After six months or so, he returned to his former job of head of R&D at the advertising agency. When quizzed by the staff at the advertising agency as to why he came back to such a corrupt industry. His comment was that advertising were little children in terms of corruption compared to the medical technology industry. I had a long discussion with him about what he had seen. He made the statement that every company that he saw would increase their prices for any product that was being sold into health care by at least a factor of 10 over what they would sell the same product for to non-health care areas. I, myself, have had other conversations with various people (in both drug companies and medical institutions) and it has been common for comments to be made as to the vast difference between drug production costs and the final retail sale prices (even taking into consideration all the development costs, I have seen some of these figures and they are, well ....). Health care is as exorbitantly priced as legal consultations and representation and the value received is in many ways far less than what you would receive by going to Macca's.

kingkawn 9y ago
Straight up exploitation of people during their most vulnerable moments.
- fredley 9y ago
  The free market is a poor model for providing healthcare. In an ideal free market, market forces work to find the optimum price for a product, depending on how much it costs to create the product, and how much people are willing to pay for it. In healthcare, though, how much people are willing to pay for a product is anything, if it's the one thing they need to stay alive, or to reduce chronic pain, etc.
  - patrickg_zill 9y ago
    We don't have a free market in healthcare. Easily proved by looking at the artificial barriers to entry, both for products and people.
  - pfranz 9y ago
    It sounds like he's talking about a different problem. This is a problem with certification and regulation. What you're talking about is, "I'm bleeding and don't have time to drive to the next city over because it's cheaper." When that hospital purchased its gauze, sutures, and other equipment it wasn't under duress and theoretically could switch suppliers at any time. Being intended for use on or inside a human body, we have higher expectations in quality and consistency. Unfortunately, these certifications can make the barrier to entry too high for good competition. Or they're locked into a supplier for whatever reason.
  - deleted 9y ago
    [deleted]
  - bluecalm 9y ago
    People are willing to pay anything for food or clothes as well. Still, free (well, at least way more free than in case of healthcare) market works decently, at least when it comes to providing cheap and decent food options. The problem with healthcare is the opposite: there is no free market and it's impossible to compete without huge investment and even then it's sometimes still impossible (patents, long approval periods etc.). The problem is for sure not simple but a lot of basic healthcare services could be a lot cheaper if it was easier to get in.
    - timthelion 9y ago
      When I'm hungry, I'm still able to visit multiple restaurants/ stores to compare prices. But when I'm having a heart attack, do I really have the option to shop around?
      - fennecfoxen 9y ago
        1. What percentage of your health issues are "emergency, heart attack RIGHT NOW"-class issues? What percentage of health care spending overall are these issues? 2. Have you or someone you know in the United States ever "shopped around" or otherwise prepared in advance for an emergency through the provision of, say, catastrophic health care insurance, which promises to pay for emergency room visits? (Employer coverage can count here.) To the extent that (1) is a small number, this question is a non sequitor. To the extent that (2) is large, even that small number is further mitigated. There are lots of arguments about why it might be better to structure health care as a centrally-planned activity instead of a market-based activity. This isn't one of the good ones.
        dagw 9y ago
        1. What percentage of your health issues are "emergency, heart attack RIGHT NOW"-class issues? If just you're counting all issues it's obviously quite few. If you're weighting by potential costs then it's very high. Basically the more expensive and necessary a procedure is the less chance you have to shop around. If I was to break down the costs of all medical procedures I've had over the past 30 years I'd say that almost all of it would be taken up by a single series of emergency surgeries.
  - duncan_bayne 9y ago
    > The free market is a poor model for providing healthcare. No; a free market has been _proved_ to be good at providing healthcare in the US. What you folks have now is an utterly corrupt cartel.
    - kalleboo 9y ago
      I feel like I'm walking into a trap now, but when was that proven?
      - duncan_bayne 9y ago
        "Friendly societies", back in the day. My understanding is the AMA was formed more or less as a counter to the negotiating power of those societies around pay and conditions.
      - com2kid 9y ago
        > I feel like I'm walking into a trap now, but when was that proven? Any elective procedure. If I want to get laser eye surgery done, the price has dropped to 1/10th of what it was when the procedure first debuted. Likewise for common plastic surgeries. Dental care is also interesting, there is actual competition for many cosmetic procedures, although there is of course a price floor, Dentists compete based on reputation and presentations of previous quality work to justify higher prices. Same thing for eye glasses. Eye glasses range from $50 to $500, insurance distorts this a little bit, but the market is generally quite competitive. If you want hand made frames from a local artists, they are as available as $50 mass produced frames. Likewise many lens materials exist, from $20 plastic lens all the way up to $300+ fancy coated materials with some really cool properties (oleophobic lens coatings!). There is also an interesting market for customer requested lab work. If I want to get basic blood work done, I can walk into clinics that specialize in it and request blood work for a fraction of the price my doctor can order it at! Finally DNA testing is another example where an incredibly complex technological process can now be, quite literally, ordered off of Amazon, and mailed off to a processing center. Meanwhile if I break a toe, I get a giant rubber flat sandal from the doctor that is billed at $200, that same boot can be ordered online for under $30!
  - lr4444lr 9y ago
    Health care is a free market? Where?
  - tertius 9y ago
    Life threatening ailments are very rare. It is not only those that are off the charts expensive. Negotiation is easier when you have some time to negotiate. Most do.
  - duckingtest 9y ago
    There's no free market in healthcare. Healthcare in the US is a guild with state-enforced monopoly. Reasonable prices would defeat the whole point of this. Naturally, it's sold to the public as 'safety' or other BS.
- brightball 9y ago
  It's not. People don't see the prices. It's whatever the insurance company can be convinced to pay. People don't get to pick their insurance plan either because it's locked into corporate contracts for the employees (for most people). This model happens because the government allows companies to tax deduct the cost of health insurance as a benefit but not individuals...which happened from union demands. When people are totally removed from the cost, people aren't being exploited. Removing people from the cost increases the cost.
  - kingkawn 9y ago
    Yes I also believe it is possible to spin a web of the intellect to make this seem like something else than what it is, but all you get from this is the satisfaction of a web well spun, and the exploitation continues.
    - brightball 9y ago
      It's what happens when you hide the price in a supply/demand chart.
    - cookiecaper 9y ago
      It gets tiresome to see accusations of things like "mental gymnastics" and "web of intellect" every time someone attempts to discuss a non-trivial political issue. If we could just snap our fingers and fix all of our problems, we'd have done so by now. Law, politics, and economics are hard, and they sometimes involve considering multiple factors. We shouldn't allow ourselves to be goaded into an unprincipled anti-intellectual stance by people trying to expedite their own solution. Everyone agrees that the economics of health care in the US are bad. I don't know anyone who is happy with this state of affairs. Everyone feels like the other parties are out to screw them. Docs feel that they get fleeced by facilities and insurers, insurers feel that they get fleeced by beneficiaries and providers, etc. I had a medical device manufacturer as a client for a while and they too felt that the industry was unfair to them and that they had to set high prices to try to survive. With so many people in the U.S. receiving their care on differing bases, it's hard to really get a single, strongly-motivated group to coalesce and push some real change through. Every employer negotiates their own contracts; some are good and some are bad, depending on how much your employer cares about benefits and such. Some people have state-provided care through Medicare or Medicaid. Others have to pay private (which is where things get really bad). With everyone's experiences on such a deeply personal issue differing so widely, unification is difficult. Mix in a little political brou-ha-ha and it becomes nearly impossible. I'm sure that fracturing is part of the game by the insidious elements that lie underneath the covers, but it is a reality we must recognize and address legitimately. On top of that, medicine is one of the largest industries in the U.S., and changes to that structure threaten to disrupt the employment of many people. There is no surer way to get a political position dismantled (and its elected purveyors destroyed in the next election cycle) than to threaten the livelihoods of a meaningful portion of the constituency. Changes to the regulatory structures impacting all of this should be carefully considered, and I would hope that we at least run them through the "intellectual paces", as it were. Let's not jump on each other's backs with silly accusations for not acquiescing quickly enough.
douche 9y ago
There's also a lot of stupid shit that you need to have a prescription for that you ought to just be able to go out and buy. Case in point, my dad has a CPAP machine for sleep apnea, and it stopped working a few months ago. You'd think something that is conceptually similar to a vacuum cleaner operating in reverse with a mask on the end would be something that you could just go find on Amazon and have shipped to you in two days, but no, you have to do the dance of the different doctors first, then wait more weeks for it to be shipped, then wait even longer for them to schedule an appointment to pick up the damned thing. It's completely absurd.
- tertius 9y ago
  Self-diagnosis may be the reason for something like that? I agree that it's silly in general though.
- tim333 9y ago
  You can get them on Amazon.co.uk. Different regs I guess. https://www.amazon.co.uk/Carejoy-Quality-Screen-Portable-Machine/dp/B017B7WD54/ref=sr_1_1_a_it?ie=UTF8&qid=1498055333&sr=8-1&keywords=cpap https://www.amazon.co.uk/Carejoy-Quality-Screen-Portable-Mac...
crusso 9y ago
factor of 10 over what they would sell the same product for to non-health care areas That's a key statement. So these same people charge less for the same product in other fields. Why? The reason has to do with the construction of the healthcare industry. Lots of regulations. Lots of middlemen. Laws designed to destroy innovation. Very little transparency for costs and outcomes.
- fao_ 9y ago
  > The reason has to do with the construction of the healthcare industry. Lots of regulations. Lots of middlemen. Laws designed to destroy innovation. Very little transparency for costs and outcomes. Or the reason has to do with the fact that the people that need these treatments are willing to pay any price for it because their life literally depends on it. I don't see why regulations, and laws "designed to destroy innovation" (i.e. keep people safe from bogus drugs) are a bad thing. (Of course lack of transparency and middlemen are bad). Almost all of the regulations in the medical industry are for ensuring people are safe, and do not succumb to drugs that are no more effective than a placebo. I think one of the main reasons why the price is artificially inflated is because of the patent laws in this area. Capitalism itself has various safeguards to ensure that the cost does not get too high for people to buy it, and to ensure that monopolies do not grow, but it seems that we have actually created laws (patent laws, mainly) that circumvent these safeguards.
  - tertius 9y ago
    > Or the reason has to do with the fact that the people that need these treatments are willing to pay any price for it because their life literally depends on it. Largely the end user does not pay full price and relies on negotiation by an insurance company. Have you seen what doctors charge these days? Those are all fake numbers.
    - deleted 9y ago
      [deleted]
  - crusso 9y ago
afpx 9y ago
For all the big talk that US republicans do on 'regulations' I'll only take them seriously if and only if they deregulate the health care market. The regulations only enable a demand-heavy, supply limited market which jacks prices to crazy levels (ever try to buy CPAP equipment?). On the flip side, without some sort of oversight, reporting, and rational tort-enforcement, I'm sure the slimiest of vendors would overtake the market.
- maxerickson 9y ago
  The focus on discussing regulations in terms of "more" and "less" is a big problem. Things like whether a regulation is well targeted, whether the costs it imposes are reasonably related to the benefit it provides and so on are much more interesting.
AdmiralAsshat 9y ago
It doesn't surprise me. I did several weeks of physical therapy for back pain. The PT suggested that I get a TENS Unit for pain. She said, "It costs about $800, but don't worry, your insurance will cover it with no copay to you." Additionally, the pad refills were free and paid by insurance (they stop being adhesive after so many uses). And so for several months I had sales rep calling me once every few weeks, asking if I needed more pads. Again, it cost me nothing, so I'm sure this is a useful service for senior citizens who otherwise might run out--but I'm also positive that this guy was massively upselling the stuff to insurance, or he would not have been so persistent. I spoke later to my parents, who also had one, and asked them where they got theirs. They said they paid about $50 at Wal-Mart. A cursory look on Amazon reveals similar pricing.[0] I don't care how much more effective the professional-grade one is, I doubt it could be 20x more effective, and yet it is 20x the price. [0]https://www.amazon.com/s/ref=nb_sb_noss_2?url=search-alias%3Daps&field-keywords=tens+unit https://www.amazon.com/s/ref=nb_sb_noss_2?url=search-alias%3...
- tzs 9y ago
  Prescription drugs are often similar. I don't know how much the pharmacy charges the insurance company for these drugs, but on my insurance I had to pay a $20 copay for metformin, simvastatin, and carvedilol. Then I found that if I went to Walmart I could buy metformin and carvedilol for $4 each, and I could get simvastatin for $8.50 if I used a GoodRx coupon. I was also paying a $20 copay for a 120x50mcg bottle of fluticasone propionate nasal spray. I have since found out that I can buy a 5 bottle pack for $35 from Amazon, with no involvement from insurance.
  - ghaff 9y ago
    I don't know about your pharmacy but at my (major chain) pharmacy, if a drug price is less than the co-pay, I just pay the price. (Which is I assume the same situation as with Walmart.)
    - cookiecaper 9y ago
      Without an external mandate to keep the price low, this should only happen rarely, because the chain will realize that they're underpricing the drug. If your copay is $10 and they sell it retail for $5, they'll make some kind of differentiation in the labeling to effect price segmentation and maximize the profit from each group of potential shoppers. That way, they'll be able to bill your insurance co $30, you'll pay your $10 copay, and they won't legally be allowed to sell you the cheaper $5 version since it will no longer fit the doctor's Rx. They may keep a few things underpriced so that they can have pharmacists offer the cheaper version and create the impulse/illusion that the chain is looking out for their best interest.

kingkawn 9y ago

Straight up exploitation of people during their most vulnerable moments.

fredley 9y ago
The free market is a poor model for providing healthcare. In an ideal free market, market forces work to find the optimum price for a product, depending on how much it costs to create the product, and how much people are willing to pay for it. In healthcare, though, how much people are willing to pay for a product is anything, if it's the one thing they need to stay alive, or to reduce chronic pain, etc.
- patrickg_zill 9y ago
  We don't have a free market in healthcare. Easily proved by looking at the artificial barriers to entry, both for products and people.
- pfranz 9y ago
  It sounds like he's talking about a different problem. This is a problem with certification and regulation. What you're talking about is, "I'm bleeding and don't have time to drive to the next city over because it's cheaper." When that hospital purchased its gauze, sutures, and other equipment it wasn't under duress and theoretically could switch suppliers at any time. Being intended for use on or inside a human body, we have higher expectations in quality and consistency. Unfortunately, these certifications can make the barrier to entry too high for good competition. Or they're locked into a supplier for whatever reason.
- deleted 9y ago
  [deleted]
- bluecalm 9y ago
  People are willing to pay anything for food or clothes as well. Still, free (well, at least way more free than in case of healthcare) market works decently, at least when it comes to providing cheap and decent food options. The problem with healthcare is the opposite: there is no free market and it's impossible to compete without huge investment and even then it's sometimes still impossible (patents, long approval periods etc.). The problem is for sure not simple but a lot of basic healthcare services could be a lot cheaper if it was easier to get in.
  - timthelion 9y ago
    When I'm hungry, I'm still able to visit multiple restaurants/ stores to compare prices. But when I'm having a heart attack, do I really have the option to shop around?
    - fennecfoxen 9y ago
      1. What percentage of your health issues are "emergency, heart attack RIGHT NOW"-class issues? What percentage of health care spending overall are these issues? 2. Have you or someone you know in the United States ever "shopped around" or otherwise prepared in advance for an emergency through the provision of, say, catastrophic health care insurance, which promises to pay for emergency room visits? (Employer coverage can count here.) To the extent that (1) is a small number, this question is a non sequitor. To the extent that (2) is large, even that small number is further mitigated. There are lots of arguments about why it might be better to structure health care as a centrally-planned activity instead of a market-based activity. This isn't one of the good ones.
      - dagw 9y ago
        1. What percentage of your health issues are "emergency, heart attack RIGHT NOW"-class issues? If just you're counting all issues it's obviously quite few. If you're weighting by potential costs then it's very high. Basically the more expensive and necessary a procedure is the less chance you have to shop around. If I was to break down the costs of all medical procedures I've had over the past 30 years I'd say that almost all of it would be taken up by a single series of emergency surgeries.
- duncan_bayne 9y ago
  > The free market is a poor model for providing healthcare. No; a free market has been _proved_ to be good at providing healthcare in the US. What you folks have now is an utterly corrupt cartel.
  - kalleboo 9y ago
    I feel like I'm walking into a trap now, but when was that proven?
    - duncan_bayne 9y ago
      "Friendly societies", back in the day. My understanding is the AMA was formed more or less as a counter to the negotiating power of those societies around pay and conditions.
    - com2kid 9y ago
      > I feel like I'm walking into a trap now, but when was that proven? Any elective procedure. If I want to get laser eye surgery done, the price has dropped to 1/10th of what it was when the procedure first debuted. Likewise for common plastic surgeries. Dental care is also interesting, there is actual competition for many cosmetic procedures, although there is of course a price floor, Dentists compete based on reputation and presentations of previous quality work to justify higher prices. Same thing for eye glasses. Eye glasses range from $50 to $500, insurance distorts this a little bit, but the market is generally quite competitive. If you want hand made frames from a local artists, they are as available as $50 mass produced frames. Likewise many lens materials exist, from $20 plastic lens all the way up to $300+ fancy coated materials with some really cool properties (oleophobic lens coatings!). There is also an interesting market for customer requested lab work. If I want to get basic blood work done, I can walk into clinics that specialize in it and request blood work for a fraction of the price my doctor can order it at! Finally DNA testing is another example where an incredibly complex technological process can now be, quite literally, ordered off of Amazon, and mailed off to a processing center. Meanwhile if I break a toe, I get a giant rubber flat sandal from the doctor that is billed at $200, that same boot can be ordered online for under $30!
- lr4444lr 9y ago
  Health care is a free market? Where?
- tertius 9y ago
  Life threatening ailments are very rare. It is not only those that are off the charts expensive. Negotiation is easier when you have some time to negotiate. Most do.
- duckingtest 9y ago
  There's no free market in healthcare. Healthcare in the US is a guild with state-enforced monopoly. Reasonable prices would defeat the whole point of this. Naturally, it's sold to the public as 'safety' or other BS.
brightball 9y ago
It's not. People don't see the prices. It's whatever the insurance company can be convinced to pay. People don't get to pick their insurance plan either because it's locked into corporate contracts for the employees (for most people). This model happens because the government allows companies to tax deduct the cost of health insurance as a benefit but not individuals...which happened from union demands. When people are totally removed from the cost, people aren't being exploited. Removing people from the cost increases the cost.
- kingkawn 9y ago
  Yes I also believe it is possible to spin a web of the intellect to make this seem like something else than what it is, but all you get from this is the satisfaction of a web well spun, and the exploitation continues.
  - brightball 9y ago
    It's what happens when you hide the price in a supply/demand chart.
  - cookiecaper 9y ago
    It gets tiresome to see accusations of things like "mental gymnastics" and "web of intellect" every time someone attempts to discuss a non-trivial political issue. If we could just snap our fingers and fix all of our problems, we'd have done so by now. Law, politics, and economics are hard, and they sometimes involve considering multiple factors. We shouldn't allow ourselves to be goaded into an unprincipled anti-intellectual stance by people trying to expedite their own solution. Everyone agrees that the economics of health care in the US are bad. I don't know anyone who is happy with this state of affairs. Everyone feels like the other parties are out to screw them. Docs feel that they get fleeced by facilities and insurers, insurers feel that they get fleeced by beneficiaries and providers, etc. I had a medical device manufacturer as a client for a while and they too felt that the industry was unfair to them and that they had to set high prices to try to survive. With so many people in the U.S. receiving their care on differing bases, it's hard to really get a single, strongly-motivated group to coalesce and push some real change through. Every employer negotiates their own contracts; some are good and some are bad, depending on how much your employer cares about benefits and such. Some people have state-provided care through Medicare or Medicaid. Others have to pay private (which is where things get really bad). With everyone's experiences on such a deeply personal issue differing so widely, unification is difficult. Mix in a little political brou-ha-ha and it becomes nearly impossible. I'm sure that fracturing is part of the game by the insidious elements that lie underneath the covers, but it is a reality we must recognize and address legitimately. On top of that, medicine is one of the largest industries in the U.S., and changes to that structure threaten to disrupt the employment of many people. There is no surer way to get a political position dismantled (and its elected purveyors destroyed in the next election cycle) than to threaten the livelihoods of a meaningful portion of the constituency. Changes to the regulatory structures impacting all of this should be carefully considered, and I would hope that we at least run them through the "intellectual paces", as it were. Let's not jump on each other's backs with silly accusations for not acquiescing quickly enough.

douche 9y ago

There's also a lot of stupid shit that you need to have a prescription for that you ought to just be able to go out and buy. Case in point, my dad has a CPAP machine for sleep apnea, and it stopped working a few months ago. You'd think something that is conceptually similar to a vacuum cleaner operating in reverse with a mask on the end would be something that you could just go find on Amazon and have shipped to you in two days, but no, you have to do the dance of the different doctors first, then wait more weeks for it to be shipped, then wait even longer for them to schedule an appointment to pick up the damned thing. It's completely absurd.

tertius 9y ago
Self-diagnosis may be the reason for something like that? I agree that it's silly in general though.
tim333 9y ago
You can get them on Amazon.co.uk. Different regs I guess. https://www.amazon.co.uk/Carejoy-Quality-Screen-Portable-Machine/dp/B017B7WD54/ref=sr_1_1_a_it?ie=UTF8&qid=1498055333&sr=8-1&keywords=cpap https://www.amazon.co.uk/Carejoy-Quality-Screen-Portable-Mac...

crusso 9y ago

factor of 10 over what they would sell the same product for to non-health care areas That's a key statement. So these same people charge less for the same product in other fields. Why? The reason has to do with the construction of the healthcare industry. Lots of regulations. Lots of middlemen. Laws designed to destroy innovation. Very little transparency for costs and outcomes.

fao_ 9y ago
> The reason has to do with the construction of the healthcare industry. Lots of regulations. Lots of middlemen. Laws designed to destroy innovation. Very little transparency for costs and outcomes. Or the reason has to do with the fact that the people that need these treatments are willing to pay any price for it because their life literally depends on it. I don't see why regulations, and laws "designed to destroy innovation" (i.e. keep people safe from bogus drugs) are a bad thing. (Of course lack of transparency and middlemen are bad). Almost all of the regulations in the medical industry are for ensuring people are safe, and do not succumb to drugs that are no more effective than a placebo. I think one of the main reasons why the price is artificially inflated is because of the patent laws in this area. Capitalism itself has various safeguards to ensure that the cost does not get too high for people to buy it, and to ensure that monopolies do not grow, but it seems that we have actually created laws (patent laws, mainly) that circumvent these safeguards.
- tertius 9y ago
  > Or the reason has to do with the fact that the people that need these treatments are willing to pay any price for it because their life literally depends on it. Largely the end user does not pay full price and relies on negotiation by an insurance company. Have you seen what doctors charge these days? Those are all fake numbers.
  - deleted 9y ago
    [deleted]
- crusso 9y ago

afpx 9y ago

For all the big talk that US republicans do on 'regulations' I'll only take them seriously if and only if they deregulate the health care market. The regulations only enable a demand-heavy, supply limited market which jacks prices to crazy levels (ever try to buy CPAP equipment?). On the flip side, without some sort of oversight, reporting, and rational tort-enforcement, I'm sure the slimiest of vendors would overtake the market.

maxerickson 9y ago
The focus on discussing regulations in terms of "more" and "less" is a big problem. Things like whether a regulation is well targeted, whether the costs it imposes are reasonably related to the benefit it provides and so on are much more interesting.

AdmiralAsshat 9y ago

It doesn't surprise me. I did several weeks of physical therapy for back pain. The PT suggested that I get a TENS Unit for pain. She said, "It costs about $800, but don't worry, your insurance will cover it with no copay to you." Additionally, the pad refills were free and paid by insurance (they stop being adhesive after so many uses). And so for several months I had sales rep calling me once every few weeks, asking if I needed more pads. Again, it cost me nothing, so I'm sure this is a useful service for senior citizens who otherwise might run out--but I'm also positive that this guy was massively upselling the stuff to insurance, or he would not have been so persistent. I spoke later to my parents, who also had one, and asked them where they got theirs. They said they paid about $50 at Wal-Mart. A cursory look on Amazon reveals similar pricing.[0] I don't care how much more effective the professional-grade one is, I doubt it could be 20x more effective, and yet it is 20x the price. [0]https://www.amazon.com/s/ref=nb_sb_noss_2?url=search-alias%3Daps&field-keywords=tens+unit https://www.amazon.com/s/ref=nb_sb_noss_2?url=search-alias%3...

tzs 9y ago
Prescription drugs are often similar. I don't know how much the pharmacy charges the insurance company for these drugs, but on my insurance I had to pay a $20 copay for metformin, simvastatin, and carvedilol. Then I found that if I went to Walmart I could buy metformin and carvedilol for $4 each, and I could get simvastatin for $8.50 if I used a GoodRx coupon. I was also paying a $20 copay for a 120x50mcg bottle of fluticasone propionate nasal spray. I have since found out that I can buy a 5 bottle pack for $35 from Amazon, with no involvement from insurance.
- ghaff 9y ago
  I don't know about your pharmacy but at my (major chain) pharmacy, if a drug price is less than the co-pay, I just pay the price. (Which is I assume the same situation as with Walmart.)
  - cookiecaper 9y ago
    Without an external mandate to keep the price low, this should only happen rarely, because the chain will realize that they're underpricing the drug. If your copay is $10 and they sell it retail for $5, they'll make some kind of differentiation in the labeling to effect price segmentation and maximize the profit from each group of potential shoppers. That way, they'll be able to bill your insurance co $30, you'll pay your $10 copay, and they won't legally be allowed to sell you the cheaper $5 version since it will no longer fit the doctor's Rx. They may keep a few things underpriced so that they can have pharmacists offer the cheaper version and create the impulse/illusion that the chain is looking out for their best interest.