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> Amazon claims Prime members will be able to save “up to 80 percent off generic and 40 percent off brand name medications when paying without insurance. This

by bhupy 6y ago

> Amazon claims Prime members will be able to save “up to 80 percent off generic and 40 percent off brand name medications when paying without insurance. This was buried in the article, but is IMO a bigger deal. In the long run, this could really drive down drug prices.

Shivetya 6y ago
It will be very interesting to see their insulin prices and which types of insulin they sell.
- friedegg 6y ago
  I took a look, and didn't see any huge price breaks.
NikolaeVarius 6y ago
Instead of the Govt being the price negotiator, we got giant corporations instead. yay
- lbacaj 6y ago
  You really believe the government will do a better job?
  - smeyer 6y ago
    Don't they do a better job in lots of other countries? I'm not an expert, but my understanding is that a lot of the countries with socialized medicine such that their government is the one negotiating with drug manufacturers pay substantially less for drugs than customers in the US.
    - bhupy 6y ago
      In other countries, government “negotiation” is just a euphemism for price controls. An example of this is Canada’s Patented Medicine Prices Review Board, which regulates drug prices. This isn’t “negotiation”, this is just centralized policy-driven price control. The US could very well institute their own price controls on drugs, but it wouldn’t invalidate the value in services like Amazon’s, especially if the price controls in question do not create a lower bound on prices, but instead focus on setting upper bounds.
      - toomuchtodo 6y ago
        I support price controls in the US, and the government manufacturing generics if necessary (stepping in if the private sector won't due to it not being profitable enough). EDIT: I removed an unrelated paragraph about Planned Parenthood and drug supply chain I thought was out of scope.
        bhupy 6y ago
        > stepping in if the private sector won’t due to it not being profitable enough That’s effectively what government-enforced drug patents are for. I think it’s debatable whether that’s the best implementation of what you’re describing. Government sponsored “Prizes” are another approach that sounds promising -> https://marginalrevolution.com/marginalrevolution/2020/03/prizes-now.html https://marginalrevolution.com/marginalrevolution/2020/03/pr... I donate to Planned Parenthood as well, and decoupling drug purchasing from insurance is a reliable way to make sure that everyone can get access to birth control or contraceptive, even if their employer feels strongly opposed to it (eg Hobby Lobby).
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        deleted 6y ago
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        mikeyouse 6y ago
        The US Pharma market is full of "found $20 bills" that just shouldn't exist if markets were as efficient as people wishcast they would be. I'd love for someone to rationalize PBMs in the same manner they rationalize every other horrible inefficiency in US health care.
        bhupy 6y ago
        > The US Pharma market is full of "found $20 bills" that just shouldn't exist if markets were as efficient as people wishcast they would be This presupposes that the US pharma market (and healthcare writ large) constitute an actual market. It's really not, by just about any measure. The only thing remotely resembling a "market" is the fact that insurance is predominately provided by the private sector for profit. Outside of that, the industry is ridden with the worst combination of distortionary incentives and regulations. The fact that healthcare is tied to employment didn't happen by accident, it's the net result of WW2-era wage ceilings, followed by 1970's tax deductibility for employer group plans, followed by the ACA employer mandate. I'd describe the US as combining the worst of public healthcare systems with the worst of privatized systems. PBMs and every other horrible inefficiency of US healthcare aren't some accident of a functioning market.
    - mfer 6y ago
      I've been reading some books on the medical industry and one of the things pointed out is that the price controls will often not provide enough profit to R&D new drugs. That the US ends up subsidizing a lot of R&D cost that everyone benefits from. If this is the case, I wonder what would happen to drug development if that goes away. Note, I'm not saying there's not too much profit from drugs. These statements don't have anything to do with that.
      - pkaye 6y ago
        If this is true, what is the point of US consumers subsidizing the R&D is they themselves cannot benefit from it.
        lazyasciiart 6y ago
        The rich ones can benefit from it, and then it gets added to the claims that the US has the world's best healthcare system that helps convince the rest that the system should be kept.
      - SuoDuanDao 6y ago
        I've heard that argument, not sure how much I buy it. Seems the drugs that get developed tend towards niche applications, while common diseases that affect mostly uninsured people are addressed by places like the Gates foundation.
      - AuryGlenz 6y ago
        That’s why we should tie our drug prices to the prices other countries pay. I believe Trump did that (or talked about doing it?) for Medicare, but it’s absolutely insane we haven’t done it across the board. Republicans would be hesitant due to “regulations bad,” and Democrats don’t want to improve our current system because they’d rather throw it out. And of course both sides get donations from pharma.
      - lostcolony 6y ago
        So that assertion is only sorta true. Initial discovery research is pretty much entirely tax payer funded. There's then a second phase, moving from that discovery to POC, that is extremely underfunded, and which a lot of charity and such funding goes toward. It's only the last phase, taking POCs -> product, that companies really invest in. https://www.ncbi.nlm.nih.gov/books/NBK50972/ https://www.ncbi.nlm.nih.gov/books/NBK50972/ Now, that capital investment is not a trivial amount of money (about 80 billion in 2018 - https://www.statista.com/statistics/265085/research-and-development-expenditure-us-pharmaceutical-industry/ https://www.statista.com/statistics/265085/research-and-deve... ), but it still is only 17% of drug company revenues - https://www.investopedia.com/ask/answers/060115/how-much-drug-companys-spending-allocated-research-and-development-average.asp https://www.investopedia.com/ask/answers/060115/how-much-dru... Note, too, that private companies tend to fund research toward common first world diseases, since they're profit driven, and far less to niche and/or common third world diseases. So not only do they not fund early discovery (government does that), nor generally moving those discoveries to POCs ('valley of death', and charitable foundations and the like do that), they also leave plenty of potential meds untouched, since the likely profitability is low.
  - EliRivers 6y ago
    Governments certainly can do, although the US government seems to be permanently hobbled by about half of its leaders having built their identity on the idea that government is incompetent and a bad idea; I'm not surprised it's dysfunctional when the people inside it have their sense of self wrapped up in being shit at their own jobs.
    - LanceH 6y ago
      > the idea that government is incompetent and a bad idea To be fair, the other side frequently tries to prove them right.
  - jvanderbot 6y ago
    IMHO, this is the massive problem in the USA. We have one side dug in against corporations, and the other side dug in against the government.
  - alex_anglin 6y ago
    As a Canadian, I believe that the Patented Medicine Prices Review Board [1] does quite a good job, judging from the cost of medication up here (broadly speaking). [1]https://www.canada.ca/en/patented-medicine-prices-review.html https://www.canada.ca/en/patented-medicine-prices-review.htm...
    - jacques_chester 6y ago
      Australia has a similar mechanism in the Pharmaceutical Benefits Scheme. Drugs are selected based on cost-effectiveness analysis and subsidised price is negotiated with pharmaceutical companies. If anything, Australia is quite generous to pharmaceutical companies. New Zealand's Pharmaceutical Management Agency has much less negotiating power but still manages to obtain substantially lower prices. For myself I can't help but wonder if lump-sum licensing might not be more effective. Pharmaceuticals are a bit like software: very high R&D cost, but the marginal cost to manufacture is very small. A one-time payment to sink a large chunk of R&D for a drug might be quicker and easier than guessing at a price. On the other hand, I have no experience in health economics, so it's possible this is a terrible idea.
      - bhupy 6y ago
        > For myself I can't help but wonder if lump-sum licensing might not be more effective. Pharmaceuticals are a bit like software: very high R&D cost, but the marginal cost to manufacture is very small. A one-time payment to sink a large chunk of R&D for a drug might be quicker and easier than guessing at a price. You're describing "Prizes", and that's a legit point of view -> https://www.mercatus.org/publications/covid-19-crisis-response/grand-innovation-prizes-address-pandemics-primer https://www.mercatus.org/publications/covid-19-crisis-respon...
        jacques_chester 6y ago
        I think they're similar but not quite the same. A prize is offered in advance of a solution, a lump-sum license is after the solution is developed. On reflection I like prizes better, especially if there are multiple tiers (first to reach the target gets the most prize money, second gets less, etc). You want to ensure that multiple pharmaceuticals are developed independently, in case one of them needs to be pulled from the market.
  - Frost1x 6y ago
    Better than the farce that is "competitive market forces." I have more faith in government than corporate structures delivering optimal cost pricing to consumers as opposed to optimizing their profit margins. Competive forces only work while there's competition, the second competition declines, rest assured consumer pricing is the first to take a hit.
    - efitz 6y ago
      Competitive forces in the health care market in the US don't function (pretty much at all) because of government induced market distortions and regulatory capture. FDA certification enormously drives up the cost of medicines and medical devices; government bureaucrats have no incentive to balance safety with time to market, price, availability, supply, or diversity of sources; most of these represent risk to the people making the decisions. Most US consumers don't pay for their own medical care, they pay for insurance that pays for their medical care. Often their employer pays some of the costs of insurance. Insurance usually fixes the cost that the consumer has to pay, e.g. a $10 copay. So there's little incentive for consumers to shop around for medical care, meaning that consumers can't drive prices down with normal market decisions. States and the federal government put enormous restrictions on insurance, driving up the cost of insurance. Health insurance doesn't function as in other sectors, where payouts are rare- most insurance is a bet - I'll bet you $3000 a year my house burns down - I'll bet you $400000 it doesn't. Health insurance is more like a discount plan, kind of like a CostCo membership. AMA and insurance companies lobby for limiting supply of doctors and hospitals, respectively, which drives costs up. They do this under state licensure laws purporting to improve quality or safety. Bottom line is that almost every single aspect of the US health care market has had government intervention effectively disable any market based control. The situation would fix itself quickly if we deregulated EVERYTHING regarding healthcare, and restricted insurance to catastrophic event coverage. Businesses would quickly come up with ways to serve the market in a market-friendly fashion. Worried about pre-existing conditions? We'd see businesses like "diabetes maintenance organzations" where you pay a monthly fee and you get all the treatment you need related to that condition. Accidents would still be covered by insurance. You'd pay privately for things like doctor visits for the flu, etc., but supply and consumer choice would drive those costs down, e.g. if I have a sprained ankle I could just use an app on my phone to summon a military vet who was a battlefield medic to treat it, rather than pay for 15-30min of time of someone with 24 years and half a million dollars worth of education. What about quacks/frauds? We know how to deal with them - reputation (AngiesList, Consumer Reports, Google Reviews) on the front-end, courts on the back-end.
  - redisman 6y ago
    Seems to work in every other country with a modern medical industry.
  - xtracto 6y ago
    I think the USA Military branch of the government does a very good job managing their resources. Why would it be different in other branch?
    - CWuestefeld 6y ago
      Why would it be different in other branch? Lack of choice; the government has captured the "market", and "consumers" can't choose to go anywhere else. Compare to the service (and especially customer service) offered by your cable/internet provider where you have not choice. The cable companies vie for literally worst customer service of all businesses year in and year out. And we know that the government is doing an awful job in regulation of healthcare. I've got kind of a front-row seat to this and see things that most might not, since my wife's whole career has been in healthcare finance, and in particular around how Medicare reimburses hospitals for services. She's currently working with one client hospital for whom their Medicare cost report still hasn't been resolved for some years back even before 2010. How can a business operate efficiently when they don't know what their expenses are going to be - not just in the future, but even historically, more than 10 years into the past? Worse, the way the government forces hospitals to report this stuff is extremely specific, and optimized for how Medicare wants to run things - which is why Medicare can claim to spend less on administration: they just force hospitals to do all the administration for them. And hospitals can't say "no", with Medicare (together with Medicaid, which generally rides on Medicare's regulatory coattails) comprising a plurality of the market, if not an outright majority. The result of this is that hospitals have a choice of either running two separate accounting systems (one for what Medicare demands, and another to do rational cost accounting), or more likely, to just do the one for Medicare and muddle along as best they can. And that's a major reason why hospitals can't operate more efficiently. And my wife's currently involved in a battle with them over some detailed rules they posted early in the summer. She's been working all summer for her client hospitals based on what the government posted on their website. Last week they changed the rules posted (you can even see the "last changed" date). But the change was in a way that contradicts their previous statements, and invalidates much of what she did all summer - and worse, they're lying about it, not admitting to what the previous version of the page said. Unfortunately the wayback machine didn't track that site, and while she's got her own records quoting the page, the gov't won't acknowledge it. So there's a clear explanation for why it can get bad, and tons of evidence that it really is bad.
  - davidwparker 6y ago
    Check out the book "The Long Fix". It goes into detail on this quite a bit, and yes, the government does a better job by a longshot.
  - PaulRobinson 6y ago
    Yes. Governments do a better job everywhere from Cuba to Britain. Americans do not have the highest life expectancy but do have the highest healthcare costs. Private firms might have a part to play, in the same way contractors can fix roads, but free markets are not efficient when people’s lives are on the line.
- mhh__ 6y ago
  > price negotiator Would you prefer the government to negotiate the price of your car for you? Markets are a powerful tool
  - dave5104 6y ago
    If the difference between affording a car and not being able to afford a car would kill me, then maybe I would like the government to step in to negotiate on behalf of all of its citizens.
    - mhh__ 6y ago
      You can guarantee universal healthcare (and medication) without top-down control of pricing, or at least not total control. Most drugs aren't making headlines, so you can control the x% that matter while still getting cheaper prices for most consumers by letting the outlets compete. Your website suggests you are American, so I recommend taking a look at the various healthcare systems on display in Europe, they're not all made equally (i.e. Some do more on behalf of their citizens than most). In my experience of watching American discussing healthcare in the EU, the subtleties are often lost, sadly.
    - bhupy 6y ago
      Not being able to afford food can also kill you (you would starve to death). Is that a sufficient justification for the government to step in to negotiate food prices on behalf of its citizens? There are merits to government price controls and there are certainly countries that have employed them successfully. That said, it isn’t the only solution to bending the cost curve, and there are also downsides to price controls. It’s complicated.
      - claudeganon 6y ago
        > Is that a sufficient justification for the government to step in to negotiate food prices on behalf of its citizens? Yes? We already do this? For many years directly in the postwar period and now indirectly through agriculture subsidies and programs like SNAP. Making sure everyone has enough to eat is step one of having any kind of functioning society and why it’s always been a source of massive government intervention in the economy.
- peoplenotbots 6y ago
  Next up Renaissance style guild wars between rival companies Amazon endorsed candidate vs Walmart endorsed candidates
  - joncp 6y ago
    Snow Crash is coming true.
eli 6y ago
Doesn't Walmart already do this?
hourislate 6y ago
You can probably save more at Walmart https://www.walmart.com/cp/4-prescriptions/1078664 https://www.walmart.com/cp/4-prescriptions/1078664 Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages.
- bhupy 6y ago
  This is very similar (and really interesting) though I’m not sure if Walmart has a special condition on use of insurance. Amazon appears to be incentivizing customers to not use insurance to pay for their drugs. I’m not sure if Walmart does the same. If so, that’s also noteworthy.
  - dragonwriter 6y ago
    Discount programs everywhere focus on the uninsured (the insured have the insurance company also paying discounted rates, generally, but those are individually negotiated; the sticker price is just to have a starting point for negotiations with deep pocket public and private insurers.) In many cases, the discounts in the discount programs are subsidized by the drug companies for uninsured patients.
    - bhupy 6y ago
      Yep, for full disclosure, I work in healthcare pricing and payments and adjust claims myself. While discount programs focus on the uninsured, this is the first time I’m seeing the discount being framed in such a way that it effectively incentivizes paying out of pocket. It’s an important incentive if your goal is to decouple routine drugs from the third-party-payer model of insurance. Health insurance in the US is actually 3 different services bundled into one: (1) risk sharing for catastrophic care, (2) access to low prices (called "fee schedules"), and (3) tax advantaged pre-payment for non-catastrophic care. 40-80% discount on drug prices essentially competes with insurance company fee schedules, i.e. service (2). By offering what amounts to insurance rates without charging insurance premiums, Amazon is essentially decoupling the fee schedules from risk sharing. That's a really underrated side effect of this product offering, and can have long run impacts on the industry (IMO for the better).
caturopath 6y ago
Time will tell how this compares to other pharmacies. Big savings off MSRP are common.
dudus 6y ago
I'm not surprised, there's some serious shenanigans on medicine pricing and insurances. Medicine prices are clearly inflated when you can buy at a huge discount using insurance, but then you can get apps like GoodRX, which is free and give you coupons that far exceed my insurance discount on every single time I had to fill a prescription. To the point that I don't even bother going through insurance anymore. I saved thousands on medicine by just checking on GoodRx before buying it.
- ev1 6y ago
  I'm curious who or what the end goal of GoodRx is. They pay for expensive ($$$$$$) cloud anti-bot/anti-scraping, captcha you after a few requests if you run adblock, they pay for extensive browser/device (attempting to reidentify a user across multiple devices/multiple browsers) fingerprinting services and Fastly. The site loads a dozen trackers, googletagmanager, branch, segment, what are they doing with this data? How much money are they spending handing out coupons? The coupons aren't unique or require a login, why go through all of this? All the services they use are "request demo / contact us for enterprise pricing", not free-to-sign-up SaaS either. Just who is paying for all this and with what?
  - canada_dry 6y ago
    > what are they doing with this data? As a company selling via the internet it would be handy to know what drugs/prescriptions a prospective client (via fingerprinting) is taking... it would certainly change what/if I marketed to them. Of course the concept of retail companies having even the slightest access to a customer's medical/health/drug information for marketing purposes is a compelling plot for Black Mirror.
    - ev1 6y ago
      Amusingly, right as I read this reply, I get a chain of heavily-obfuscated JS loading with the text Please verify you are a human Access to this page has been denied because we believe you are using automation tools to browse the website. Please make sure that Javascript and cookies are enabled on your browser and that you are not blocking them from loading.
burnte 6y ago
So I signed up to see. As far as I can tell I can't get a quote on my scripts without transferring them. I'm not doing that. Every other pharmacy I can enter my dosages or call someone and get a quote.
sithlord 6y ago
They say that, but then I looked up Insulin price, and it was astronautical. Even compared to normal drug stores.
jedberg 6y ago
Walgreens has an insurance plan too. It was cheaper for me to buy Walgreen's insurance and then my drugs than it was to just use my own insurance, and I had Platinum+ insurance at the time.
macjohnmcc 6y ago
When I signed up it estimated that I would be paying whatever my co-pay is for each of my prescriptions which is a great deal more than what I pay just going through Walmart. Like more than double more.
satya71 6y ago
So savings are similar to GoodRx, RxSaver, and WellRx?
- notsureaboutpg 6y ago
  Yep, this is just GoodRx. GoodRx adverts are in most pharmacies. I've had a pharmacist apply a GoodRx discount code for me without my asking before. Pharmacies already run on such discounts.
DominikPeters 6y ago
This is just a shallow wrapper around https://insiderx.com/ https://insiderx.com/ which appears to be a GoodRx clone. See https://www.amazon.com/primerx https://www.amazon.com/primerx.
- atombender 6y ago
  Are you sure? The article says this is a rebanding of PillPack, which Amazon acquires a few years ago.

by bhupy 6y ago

Shivetya 6y ago

It will be very interesting to see their insulin prices and which types of insulin they sell.

friedegg 6y ago
I took a look, and didn't see any huge price breaks.

NikolaeVarius 6y ago

Instead of the Govt being the price negotiator, we got giant corporations instead. yay

lbacaj 6y ago
You really believe the government will do a better job?
- smeyer 6y ago
  Don't they do a better job in lots of other countries? I'm not an expert, but my understanding is that a lot of the countries with socialized medicine such that their government is the one negotiating with drug manufacturers pay substantially less for drugs than customers in the US.
  - bhupy 6y ago
    In other countries, government “negotiation” is just a euphemism for price controls. An example of this is Canada’s Patented Medicine Prices Review Board, which regulates drug prices. This isn’t “negotiation”, this is just centralized policy-driven price control. The US could very well institute their own price controls on drugs, but it wouldn’t invalidate the value in services like Amazon’s, especially if the price controls in question do not create a lower bound on prices, but instead focus on setting upper bounds.
    - toomuchtodo 6y ago
      I support price controls in the US, and the government manufacturing generics if necessary (stepping in if the private sector won't due to it not being profitable enough). EDIT: I removed an unrelated paragraph about Planned Parenthood and drug supply chain I thought was out of scope.
      - bhupy 6y ago
        > stepping in if the private sector won’t due to it not being profitable enough That’s effectively what government-enforced drug patents are for. I think it’s debatable whether that’s the best implementation of what you’re describing. Government sponsored “Prizes” are another approach that sounds promising -> https://marginalrevolution.com/marginalrevolution/2020/03/prizes-now.html https://marginalrevolution.com/marginalrevolution/2020/03/pr... I donate to Planned Parenthood as well, and decoupling drug purchasing from insurance is a reliable way to make sure that everyone can get access to birth control or contraceptive, even if their employer feels strongly opposed to it (eg Hobby Lobby).
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      - mikeyouse 6y ago
        The US Pharma market is full of "found $20 bills" that just shouldn't exist if markets were as efficient as people wishcast they would be. I'd love for someone to rationalize PBMs in the same manner they rationalize every other horrible inefficiency in US health care.
        bhupy 6y ago
        > The US Pharma market is full of "found $20 bills" that just shouldn't exist if markets were as efficient as people wishcast they would be This presupposes that the US pharma market (and healthcare writ large) constitute an actual market. It's really not, by just about any measure. The only thing remotely resembling a "market" is the fact that insurance is predominately provided by the private sector for profit. Outside of that, the industry is ridden with the worst combination of distortionary incentives and regulations. The fact that healthcare is tied to employment didn't happen by accident, it's the net result of WW2-era wage ceilings, followed by 1970's tax deductibility for employer group plans, followed by the ACA employer mandate. I'd describe the US as combining the worst of public healthcare systems with the worst of privatized systems. PBMs and every other horrible inefficiency of US healthcare aren't some accident of a functioning market.
  - mfer 6y ago
    I've been reading some books on the medical industry and one of the things pointed out is that the price controls will often not provide enough profit to R&D new drugs. That the US ends up subsidizing a lot of R&D cost that everyone benefits from. If this is the case, I wonder what would happen to drug development if that goes away. Note, I'm not saying there's not too much profit from drugs. These statements don't have anything to do with that.
    - pkaye 6y ago
      If this is true, what is the point of US consumers subsidizing the R&D is they themselves cannot benefit from it.
      - lazyasciiart 6y ago
        The rich ones can benefit from it, and then it gets added to the claims that the US has the world's best healthcare system that helps convince the rest that the system should be kept.
    - SuoDuanDao 6y ago
      I've heard that argument, not sure how much I buy it. Seems the drugs that get developed tend towards niche applications, while common diseases that affect mostly uninsured people are addressed by places like the Gates foundation.
    - AuryGlenz 6y ago
      That’s why we should tie our drug prices to the prices other countries pay. I believe Trump did that (or talked about doing it?) for Medicare, but it’s absolutely insane we haven’t done it across the board. Republicans would be hesitant due to “regulations bad,” and Democrats don’t want to improve our current system because they’d rather throw it out. And of course both sides get donations from pharma.
    - lostcolony 6y ago
      So that assertion is only sorta true. Initial discovery research is pretty much entirely tax payer funded. There's then a second phase, moving from that discovery to POC, that is extremely underfunded, and which a lot of charity and such funding goes toward. It's only the last phase, taking POCs -> product, that companies really invest in. https://www.ncbi.nlm.nih.gov/books/NBK50972/ https://www.ncbi.nlm.nih.gov/books/NBK50972/ Now, that capital investment is not a trivial amount of money (about 80 billion in 2018 - https://www.statista.com/statistics/265085/research-and-development-expenditure-us-pharmaceutical-industry/ https://www.statista.com/statistics/265085/research-and-deve... ), but it still is only 17% of drug company revenues - https://www.investopedia.com/ask/answers/060115/how-much-drug-companys-spending-allocated-research-and-development-average.asp https://www.investopedia.com/ask/answers/060115/how-much-dru... Note, too, that private companies tend to fund research toward common first world diseases, since they're profit driven, and far less to niche and/or common third world diseases. So not only do they not fund early discovery (government does that), nor generally moving those discoveries to POCs ('valley of death', and charitable foundations and the like do that), they also leave plenty of potential meds untouched, since the likely profitability is low.
- EliRivers 6y ago
  Governments certainly can do, although the US government seems to be permanently hobbled by about half of its leaders having built their identity on the idea that government is incompetent and a bad idea; I'm not surprised it's dysfunctional when the people inside it have their sense of self wrapped up in being shit at their own jobs.
  - LanceH 6y ago
    > the idea that government is incompetent and a bad idea To be fair, the other side frequently tries to prove them right.
- jvanderbot 6y ago
  IMHO, this is the massive problem in the USA. We have one side dug in against corporations, and the other side dug in against the government.
- alex_anglin 6y ago
  As a Canadian, I believe that the Patented Medicine Prices Review Board [1] does quite a good job, judging from the cost of medication up here (broadly speaking). [1]https://www.canada.ca/en/patented-medicine-prices-review.html https://www.canada.ca/en/patented-medicine-prices-review.htm...
  - jacques_chester 6y ago
    Australia has a similar mechanism in the Pharmaceutical Benefits Scheme. Drugs are selected based on cost-effectiveness analysis and subsidised price is negotiated with pharmaceutical companies. If anything, Australia is quite generous to pharmaceutical companies. New Zealand's Pharmaceutical Management Agency has much less negotiating power but still manages to obtain substantially lower prices. For myself I can't help but wonder if lump-sum licensing might not be more effective. Pharmaceuticals are a bit like software: very high R&D cost, but the marginal cost to manufacture is very small. A one-time payment to sink a large chunk of R&D for a drug might be quicker and easier than guessing at a price. On the other hand, I have no experience in health economics, so it's possible this is a terrible idea.
    - bhupy 6y ago
      > For myself I can't help but wonder if lump-sum licensing might not be more effective. Pharmaceuticals are a bit like software: very high R&D cost, but the marginal cost to manufacture is very small. A one-time payment to sink a large chunk of R&D for a drug might be quicker and easier than guessing at a price. You're describing "Prizes", and that's a legit point of view -> https://www.mercatus.org/publications/covid-19-crisis-response/grand-innovation-prizes-address-pandemics-primer https://www.mercatus.org/publications/covid-19-crisis-respon...
      - jacques_chester 6y ago
        I think they're similar but not quite the same. A prize is offered in advance of a solution, a lump-sum license is after the solution is developed. On reflection I like prizes better, especially if there are multiple tiers (first to reach the target gets the most prize money, second gets less, etc). You want to ensure that multiple pharmaceuticals are developed independently, in case one of them needs to be pulled from the market.
- Frost1x 6y ago
  Better than the farce that is "competitive market forces." I have more faith in government than corporate structures delivering optimal cost pricing to consumers as opposed to optimizing their profit margins. Competive forces only work while there's competition, the second competition declines, rest assured consumer pricing is the first to take a hit.
  - efitz 6y ago
    Competitive forces in the health care market in the US don't function (pretty much at all) because of government induced market distortions and regulatory capture. FDA certification enormously drives up the cost of medicines and medical devices; government bureaucrats have no incentive to balance safety with time to market, price, availability, supply, or diversity of sources; most of these represent risk to the people making the decisions. Most US consumers don't pay for their own medical care, they pay for insurance that pays for their medical care. Often their employer pays some of the costs of insurance. Insurance usually fixes the cost that the consumer has to pay, e.g. a $10 copay. So there's little incentive for consumers to shop around for medical care, meaning that consumers can't drive prices down with normal market decisions. States and the federal government put enormous restrictions on insurance, driving up the cost of insurance. Health insurance doesn't function as in other sectors, where payouts are rare- most insurance is a bet - I'll bet you $3000 a year my house burns down - I'll bet you $400000 it doesn't. Health insurance is more like a discount plan, kind of like a CostCo membership. AMA and insurance companies lobby for limiting supply of doctors and hospitals, respectively, which drives costs up. They do this under state licensure laws purporting to improve quality or safety. Bottom line is that almost every single aspect of the US health care market has had government intervention effectively disable any market based control. The situation would fix itself quickly if we deregulated EVERYTHING regarding healthcare, and restricted insurance to catastrophic event coverage. Businesses would quickly come up with ways to serve the market in a market-friendly fashion. Worried about pre-existing conditions? We'd see businesses like "diabetes maintenance organzations" where you pay a monthly fee and you get all the treatment you need related to that condition. Accidents would still be covered by insurance. You'd pay privately for things like doctor visits for the flu, etc., but supply and consumer choice would drive those costs down, e.g. if I have a sprained ankle I could just use an app on my phone to summon a military vet who was a battlefield medic to treat it, rather than pay for 15-30min of time of someone with 24 years and half a million dollars worth of education. What about quacks/frauds? We know how to deal with them - reputation (AngiesList, Consumer Reports, Google Reviews) on the front-end, courts on the back-end.
- redisman 6y ago
  Seems to work in every other country with a modern medical industry.
- xtracto 6y ago
  I think the USA Military branch of the government does a very good job managing their resources. Why would it be different in other branch?
  - CWuestefeld 6y ago
    Why would it be different in other branch? Lack of choice; the government has captured the "market", and "consumers" can't choose to go anywhere else. Compare to the service (and especially customer service) offered by your cable/internet provider where you have not choice. The cable companies vie for literally worst customer service of all businesses year in and year out. And we know that the government is doing an awful job in regulation of healthcare. I've got kind of a front-row seat to this and see things that most might not, since my wife's whole career has been in healthcare finance, and in particular around how Medicare reimburses hospitals for services. She's currently working with one client hospital for whom their Medicare cost report still hasn't been resolved for some years back even before 2010. How can a business operate efficiently when they don't know what their expenses are going to be - not just in the future, but even historically, more than 10 years into the past? Worse, the way the government forces hospitals to report this stuff is extremely specific, and optimized for how Medicare wants to run things - which is why Medicare can claim to spend less on administration: they just force hospitals to do all the administration for them. And hospitals can't say "no", with Medicare (together with Medicaid, which generally rides on Medicare's regulatory coattails) comprising a plurality of the market, if not an outright majority. The result of this is that hospitals have a choice of either running two separate accounting systems (one for what Medicare demands, and another to do rational cost accounting), or more likely, to just do the one for Medicare and muddle along as best they can. And that's a major reason why hospitals can't operate more efficiently. And my wife's currently involved in a battle with them over some detailed rules they posted early in the summer. She's been working all summer for her client hospitals based on what the government posted on their website. Last week they changed the rules posted (you can even see the "last changed" date). But the change was in a way that contradicts their previous statements, and invalidates much of what she did all summer - and worse, they're lying about it, not admitting to what the previous version of the page said. Unfortunately the wayback machine didn't track that site, and while she's got her own records quoting the page, the gov't won't acknowledge it. So there's a clear explanation for why it can get bad, and tons of evidence that it really is bad.
- davidwparker 6y ago
  Check out the book "The Long Fix". It goes into detail on this quite a bit, and yes, the government does a better job by a longshot.
- PaulRobinson 6y ago
  Yes. Governments do a better job everywhere from Cuba to Britain. Americans do not have the highest life expectancy but do have the highest healthcare costs. Private firms might have a part to play, in the same way contractors can fix roads, but free markets are not efficient when people’s lives are on the line.
mhh__ 6y ago
> price negotiator Would you prefer the government to negotiate the price of your car for you? Markets are a powerful tool
- dave5104 6y ago
  If the difference between affording a car and not being able to afford a car would kill me, then maybe I would like the government to step in to negotiate on behalf of all of its citizens.
  - mhh__ 6y ago
    You can guarantee universal healthcare (and medication) without top-down control of pricing, or at least not total control. Most drugs aren't making headlines, so you can control the x% that matter while still getting cheaper prices for most consumers by letting the outlets compete. Your website suggests you are American, so I recommend taking a look at the various healthcare systems on display in Europe, they're not all made equally (i.e. Some do more on behalf of their citizens than most). In my experience of watching American discussing healthcare in the EU, the subtleties are often lost, sadly.
  - bhupy 6y ago
    Not being able to afford food can also kill you (you would starve to death). Is that a sufficient justification for the government to step in to negotiate food prices on behalf of its citizens? There are merits to government price controls and there are certainly countries that have employed them successfully. That said, it isn’t the only solution to bending the cost curve, and there are also downsides to price controls. It’s complicated.
    - claudeganon 6y ago
      > Is that a sufficient justification for the government to step in to negotiate food prices on behalf of its citizens? Yes? We already do this? For many years directly in the postwar period and now indirectly through agriculture subsidies and programs like SNAP. Making sure everyone has enough to eat is step one of having any kind of functioning society and why it’s always been a source of massive government intervention in the economy.
peoplenotbots 6y ago
Next up Renaissance style guild wars between rival companies Amazon endorsed candidate vs Walmart endorsed candidates
- joncp 6y ago
  Snow Crash is coming true.

eli 6y ago

Doesn't Walmart already do this?

hourislate 6y ago

You can probably save more at Walmart https://www.walmart.com/cp/4-prescriptions/1078664 https://www.walmart.com/cp/4-prescriptions/1078664 Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages.

bhupy 6y ago
This is very similar (and really interesting) though I’m not sure if Walmart has a special condition on use of insurance. Amazon appears to be incentivizing customers to not use insurance to pay for their drugs. I’m not sure if Walmart does the same. If so, that’s also noteworthy.
- dragonwriter 6y ago
  Discount programs everywhere focus on the uninsured (the insured have the insurance company also paying discounted rates, generally, but those are individually negotiated; the sticker price is just to have a starting point for negotiations with deep pocket public and private insurers.) In many cases, the discounts in the discount programs are subsidized by the drug companies for uninsured patients.
  - bhupy 6y ago
    Yep, for full disclosure, I work in healthcare pricing and payments and adjust claims myself. While discount programs focus on the uninsured, this is the first time I’m seeing the discount being framed in such a way that it effectively incentivizes paying out of pocket. It’s an important incentive if your goal is to decouple routine drugs from the third-party-payer model of insurance. Health insurance in the US is actually 3 different services bundled into one: (1) risk sharing for catastrophic care, (2) access to low prices (called "fee schedules"), and (3) tax advantaged pre-payment for non-catastrophic care. 40-80% discount on drug prices essentially competes with insurance company fee schedules, i.e. service (2). By offering what amounts to insurance rates without charging insurance premiums, Amazon is essentially decoupling the fee schedules from risk sharing. That's a really underrated side effect of this product offering, and can have long run impacts on the industry (IMO for the better).

caturopath 6y ago

Time will tell how this compares to other pharmacies. Big savings off MSRP are common.

dudus 6y ago

I'm not surprised, there's some serious shenanigans on medicine pricing and insurances. Medicine prices are clearly inflated when you can buy at a huge discount using insurance, but then you can get apps like GoodRX, which is free and give you coupons that far exceed my insurance discount on every single time I had to fill a prescription. To the point that I don't even bother going through insurance anymore. I saved thousands on medicine by just checking on GoodRx before buying it.

ev1 6y ago
I'm curious who or what the end goal of GoodRx is. They pay for expensive ($$$$$$) cloud anti-bot/anti-scraping, captcha you after a few requests if you run adblock, they pay for extensive browser/device (attempting to reidentify a user across multiple devices/multiple browsers) fingerprinting services and Fastly. The site loads a dozen trackers, googletagmanager, branch, segment, what are they doing with this data? How much money are they spending handing out coupons? The coupons aren't unique or require a login, why go through all of this? All the services they use are "request demo / contact us for enterprise pricing", not free-to-sign-up SaaS either. Just who is paying for all this and with what?
- canada_dry 6y ago
  > what are they doing with this data? As a company selling via the internet it would be handy to know what drugs/prescriptions a prospective client (via fingerprinting) is taking... it would certainly change what/if I marketed to them. Of course the concept of retail companies having even the slightest access to a customer's medical/health/drug information for marketing purposes is a compelling plot for Black Mirror.
  - ev1 6y ago
    Amusingly, right as I read this reply, I get a chain of heavily-obfuscated JS loading with the text Please verify you are a human Access to this page has been denied because we believe you are using automation tools to browse the website. Please make sure that Javascript and cookies are enabled on your browser and that you are not blocking them from loading.

burnte 6y ago

So I signed up to see. As far as I can tell I can't get a quote on my scripts without transferring them. I'm not doing that. Every other pharmacy I can enter my dosages or call someone and get a quote.

sithlord 6y ago

They say that, but then I looked up Insulin price, and it was astronautical. Even compared to normal drug stores.

jedberg 6y ago

Walgreens has an insurance plan too. It was cheaper for me to buy Walgreen's insurance and then my drugs than it was to just use my own insurance, and I had Platinum+ insurance at the time.

macjohnmcc 6y ago

When I signed up it estimated that I would be paying whatever my co-pay is for each of my prescriptions which is a great deal more than what I pay just going through Walmart. Like more than double more.

satya71 6y ago

So savings are similar to GoodRx, RxSaver, and WellRx?

notsureaboutpg 6y ago
Yep, this is just GoodRx. GoodRx adverts are in most pharmacies. I've had a pharmacist apply a GoodRx discount code for me without my asking before. Pharmacies already run on such discounts.

DominikPeters 6y ago

This is just a shallow wrapper around https://insiderx.com/ https://insiderx.com/ which appears to be a GoodRx clone. See https://www.amazon.com/primerx https://www.amazon.com/primerx.

atombender 6y ago
Are you sure? The article says this is a rebanding of PillPack, which Amazon acquires a few years ago.