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Many times they still charge more for the prescription med still. Great example I just saw. We all know ibuprofen has been available as an OTC for a long time.

Many times they still charge more for the prescription med still. Great example I just saw. We all know ibuprofen has been available as an OTC for a long time. Cheap to buy too, < $10 gets you a 100 cnt of 200mg pills at most pharmacies OTC in the US. But a physician can and will still prescribe 800mg Ibuprofen tablets to a patient. That prescription for say 40 tablets may cost the consumer $5-10 co-pay, but insurance has paid $35 or more. So the price per pill is drastically different, you can take 4 of the OTC pills and get the same affect. The one difference in this example, the one 800mg pill is less harsh on the stomach than taking 4 of the 200mg pills. Which is the reasoning usually for this type of prescription, that and convenience for the patient.

ars 8y ago
> but insurance has paid $35 or more Insurance does not actually pay that much. Because of drug rebates (paid by the drug manufacturer), clawbacks, and Co-Pays, in total the drug manufacturer gets about the same as they would for the OTC drug. See here: https://money.cnn.com/2018/05/07/news/economy/drug-prices-rebates/index.html https://money.cnn.com/2018/05/07/news/economy/drug-prices-re... (and that article barely scratches the surface). Destroying that entire money-network would be probably the #1 thing that could help US medical spending. And as much as people hate Trump, he's probably the only one with the actual ability, and desire to do something about it. Other presidents have cared, but they were too risk adverse, Trump would be like "hmm, looks good - do it and let's see what happens". That kind of risk taking gets him in a lot of trouble, but it's why he was elected, and why he still has support despite the INCREDIBLY stupid things he says.
- davismwfl 8y ago
  Rebates and incentives are very common when a drug is on patent, but not once it is available as a generic. Insurers have to pay the generics generally and have no rebate for those, though I am sure there are exceptions. Even the article you linked points that out, and a drug like ibuprofen that is generic at this point, has no rebates or incentives, only a negotiated fee on the class of medication generally. When I worked on doing data analytics for one of the large speciality pharmacies a while back, some of their medications had rebates in the low 5 figure range, the medications were typically a low 6 figure prescription. But for the generic meds they carried, there was no rebate and insurance paid the full fair at whatever was negotiated for the class of medications. That was a fun/educational project but also a bit depressing seeing how the system works. The pharmacies are also in this weird middle position where they have to process a lot of the data (and business rules), but can easily get squeezed out of the profit if they aren't savvy. I am with you, destroying the supply chain money antics would be a huge benefit in the US to cutting down the waste and useless spending.
- jrochkind1 8y ago
  > he's probably the only one with the actual ability, and desire to do something about it. I'll believe he has either the ability or the desire when I see it.

ars 8y ago

> but insurance has paid $35 or more Insurance does not actually pay that much. Because of drug rebates (paid by the drug manufacturer), clawbacks, and Co-Pays, in total the drug manufacturer gets about the same as they would for the OTC drug. See here: https://money.cnn.com/2018/05/07/news/economy/drug-prices-rebates/index.html https://money.cnn.com/2018/05/07/news/economy/drug-prices-re... (and that article barely scratches the surface). Destroying that entire money-network would be probably the #1 thing that could help US medical spending. And as much as people hate Trump, he's probably the only one with the actual ability, and desire to do something about it. Other presidents have cared, but they were too risk adverse, Trump would be like "hmm, looks good - do it and let's see what happens". That kind of risk taking gets him in a lot of trouble, but it's why he was elected, and why he still has support despite the INCREDIBLY stupid things he says.

davismwfl 8y ago
Rebates and incentives are very common when a drug is on patent, but not once it is available as a generic. Insurers have to pay the generics generally and have no rebate for those, though I am sure there are exceptions. Even the article you linked points that out, and a drug like ibuprofen that is generic at this point, has no rebates or incentives, only a negotiated fee on the class of medication generally. When I worked on doing data analytics for one of the large speciality pharmacies a while back, some of their medications had rebates in the low 5 figure range, the medications were typically a low 6 figure prescription. But for the generic meds they carried, there was no rebate and insurance paid the full fair at whatever was negotiated for the class of medications. That was a fun/educational project but also a bit depressing seeing how the system works. The pharmacies are also in this weird middle position where they have to process a lot of the data (and business rules), but can easily get squeezed out of the profit if they aren't savvy. I am with you, destroying the supply chain money antics would be a huge benefit in the US to cutting down the waste and useless spending.
jrochkind1 8y ago
> he's probably the only one with the actual ability, and desire to do something about it. I'll believe he has either the ability or the desire when I see it.