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Exhibit A: Vimovo. One pill, consisting of two drugs that have been around for decades, and are available over the counter at any pharmacy. If bought separately
by benmaraschino 7y ago
Exhibit A: Vimovo. One pill, consisting of two drugs that have been around for decades, and are available over the counter at any pharmacy. If bought separately, a month’s supply of these drugs would run you maybe $40, at most.
Vimovo, on the other hand, is routinely charged to insurers by pharmacies at prices ranging to over $3,000 for a month’s supply. And somehow insurers are willing to pay for it, to the tune of nearly $500 million a year. More details here from ProPublica: https://www.propublica.org/article/horizon-pharma-vimovo-common-medication-455-million-specialty-pill https://www.propublica.org/article/horizon-pharma-vimovo-com...
- ChrisLomont 7y agoDoesn't the same argument apply to the elements making any drug? Carbon, oxygen, etc.. are all pretty cheap. But there is significant value in mixing things properly and getting that mixture tested and through the FDA. If it's trivial to take these cheap drugs and mix them, then why don't people simply do that?
- pxeboot 7y agoBecause people just accept what is prescribed, and neither the customer or doctor is aware of the actual cost?
- deleted 7y ago[deleted]
- sooheon 7y agoCheck out the propublica piece. Their analogy is more akin to putting pb&j in one jar. As to why it happens? People are likely to do what their doctors say and what their insurance will cover. Pharma has ways to influence both.
- refurb 7y agoThat’s a great example of how stupid insurers are. That drug have had zero sales, but they sneaked in the back when no one was looking.
- PopeDotNinja 7y agoInsurers just pass the costs through to consumers. Health insurance premiums have been going up a stupid amount, too.
- bduerst 7y agoWhich is why legislation like the affordable care act that limits premiums helps keep stupid behavior from insurance companies in check.
- PopeDotNinja 7y agoRegarding the ACA, as I understand it, there's the 80/20 rule that states insurers must spend 80% of what they make from premiums on providing & improving healthcare. [1] The problem with that is there's no cap on what premiums should be. So if you charge 10K in premiums, and keep 2K, there's nothing in the ACA that is preventing you from raising your rates to 15K to keep 3K. Please correct me if I misunderstand how this works. [1] https://www.healthcare.gov/health-care-law-protections/rate-review/ https://www.healthcare.gov/health-care-law-protections/rate-...
- ddingus 7y agoExactly right. And if you happen to have some preexisting condition, and who doesn't, individual policy prices are insane.
- bduerst 7y agoExcept that the ACA also instututes marketplaces and enforces insurance standards, so that consumers can shop and switch between substitute services if one insurer tries to hike premiums.
- tracker1 7y agoExcept they're ALL hiking premiums... What it comes down to is adding fiduciary responsibility to act on behalf of their clients' interest in negotiating rates, which they don't do and stopped doing.
- zaroth 7y agoI suspect that something very fishy is going on between when the money is “paid” by the insurance company to the money that actually makes it to the pharmaceutical company. I suspect most of this money gets rebated back to the insurer in some form or another. Reading your link it’s actually an interesting story of an absolute fraud designed to thread a perfect path through all the existing regulations and checks & balances.
- refurb 7y agoThere have been a lot of fishy dealings with the drugs that came from Valeant. They would charge outrageous prices for drugs that were just a combination of generics. They funneled the scripts to a pharmacy they partnered with. Most insurers would not cover the drug, but the pharmacy knew all the tricks. 80% of claims might get rejected, but they made a ton of money off the 20%.