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The Mark Cuban Cost Plus Drug Company

• mikece 6y ago
  I've wondered for a long time how much money could be saved if the non-trivial administrative overhead of insurance companies were removed from all but truly catastrophic cases (where claims start at $10k or more) and medical, dental, and drug costs were paid out of pocket (including via an HSA account). There are numerous cases where cash-only medical clinics are able to offer up-front pricing for a fraction of what is billed to medical insurance companies. If Cuban's idea is "we don't do insurance but you're free to pay with an HSA card or seek reimbursement from your insurance company" then this could be a huge winner.
  • xcskier56 6y ago
    From some of the studies that I've seen of primary care practices moving to a cash only model, I think its in the range of 15-20% reduction in overhead costs. These were for the most part smaller independent clinics, so the number is probably lower for large health systems.
  • tlb 6y ago
    A good comparison is veterinary medicine in the US. All the functionality is fundamentally the same, but insurance isn't common. Prices are vastly lower, and it's all super-convenient. Typical for an injury requiring stitches: $150, plus $15 for some antibiotics, which they hand you as you walk out. Every time I go to the doctor I wish I could take myself to the vet instead.
    • mc32 6y ago
      Is it the same for studs or thoroughbreds? What I’m getting at is that for most animals the owner can be compensated for accidental death easily. (How much is a head of cattle at auction?) Not that this explains all the discrepancy, but it may explain a non trivial percentage.
      • olyjohn 6y ago
        Also your dog probably needs 1/10th the dose that an adult needs.
        • philwelch 6y ago
          Large dogs can be the same weight as small humans, so I'm not sure what accounts for 1/10th. Even medium-sized dogs like labs are about half the weight of a healthy, average-sized person.
          • girvo 6y ago
            Depends on the drug, but their metabolism isnt identical to ours, and humans can often require significantly higher doses compared to other animals when controlling for dosage per weight unit. But again it depends and there is no hard and fast rule as far as I’m aware.
        • mattkrause 6y ago
          It's way more complicated than that: there are differences in metabolism as well as size. It varies from drug to drug too, but as a rule of thumb dog needs about twice the human dose (in mg/kg). A 60 lb dog therefore needs about the same as a smallish adult. Here's some FDA guidance on how to translate doses from animals to humans: https://www.fda.gov/media/72309/download https://www.fda.gov/media/72309/download
          • tguvot 6y ago
            Even more than twice. My dogs, despite weighting 5th of me had similar to mine dosages of antibiotics and antihistamines
    • deleted 6y ago
      [deleted]
    • giantg2 6y ago
      Just learn aseptic technique and suture yourself. I generally agree with your sentiment - regulation and insurance overhead are big costs. I do think some people should be able to do the basics at home if they wanted. Basic sutures are a pretty good example, you could even save that $150 that you mentioned.
      • dml2135 6y ago
        While I'm usually a DIY kinda guy, giving this advice on a large scale is a perfect recipe for disaster and really encapsulates the dark-ages dystopia that the current US medical system has become.
        • giantg2 6y ago
          If someone self-studies basic things, it shouldn't be a big problem. Just look at first aid. There are many people who have no idea what to do for minor injuries because they never took the time to learn. Suturing is on the borderline of of falling into first aid. There are people today who learn the basics of it for emergencies or because they live in remote locations.
        • chihuahua 6y ago
          While looking for moldable plastic material ("Sugru" and similar) on Amazon, I was a bit taken aback by the reviews for one such substance. Multiple reviewers were stating that they were using this stuff to make their own dental crowns or some other DIY tooth repair because they couldn't afford a dentist. I found this quite shocking and I'm not sure if these people were serious. See the reviews on this product page: https://www.amazon.com/InstaMorph-Moldable-Plastic-6-oz/dp/B004MFLU4Y https://www.amazon.com/InstaMorph-Moldable-Plastic-6-oz/dp/B...
          • pseudosavant 6y ago
            The teeth reviews on that product are pretty crazy. I kept reading them thinking "they really thought they could do this themselves??"
      • 6y ago
    • tdfx 6y ago
      Very similar in developing countries, as well. I've gotten stitches in Mexico and Colombia for less than $40 USD each time which healed comparably or better to the stitches I've paid >$500 for in the US. Consultation for an eye infection along with the antibiotics in Mexico was $23 USD.
    • tcbawo 6y ago
      Veterinary care has been increasing considerably more than core inflation (quick search turned up https://www.in2013dollars.com/Veterinarian-services/price-inflation https://www.in2013dollars.com/Veterinarian-services/price-in...). I'm not sure how that compares to inflation in human healthcare.
      • missedthecue 6y ago
        I feel like the demand for veterinary services has gone up drastically. It shocks me how my millennial friends will spend $5000 without a second thought to keep a dog alive. Older generations often seem to put pets down in that situation.
        • cpwright 6y ago
          I haven't come to that yet, but when our 3 year old GSD went blind, even though it was an elective surgery it wasn't a super difficult choice to spend that much to restore his sight (cataract surgery) given that the same problem basically can't come back. He is six now, and it has really improved his quality of life (he enjoys chasing sticks in the lake again). If he was 10, we would probably not have made the same choice to spend the money; because he would get much less benefit from it. You spend more time with your dog than most people, and I certainly care about him more than any person who is not in my immediate family.
        • Jweb_Guru 6y ago
          Older generations had a lot more children.
      • mNovak 6y ago
        Vet care and pet products generally have been a target of private equity lately. Of course so has private (human) practice.
    • jsight 6y ago
      Hmm, I'm not sure how I feel about that comparison. Most vets double up as pharmacies, restrict access to prescriptions, and sell at least some prescription drugs at prices that have been marked up by at least an order of magnitude by the manufacturer. Some of the bills that I've run into have still managed to approach the cost of routine visits at some specialists when billed to my HSA.
    • majormajor 6y ago
      Whatever markups are there are not linear, interestingly. I had to get an MRI from a vet hospital in the past. It was still over a thousand bucks, and in the range of quotes I'd gotten for human MRIs before. I wonder what similar stitches in an urgent care vs a primary care office vs an ER for a human would cost.
      • rtkwe 6y ago
        Part of that is probably the lower volume, so they have to amortize the costs over fewer procedures. Most pet injuries don't need an MRI or if the injury/illness is that bad the euthanasia or palliative only option is more considered.
        • dodobirdlord 6y ago
          Human MRIs are also pretty expensive, and human MRI machines are generally booked solid. MRI machines cost a lot and also cost a lot to operate.
          • Gibbon1 6y ago
            Last time looked at the costs of imaging I got the impression that there are a monopoly and other captive market effects at work. You'll hear medical professionals claim imaging is expensive because the machines are expensive. Which just says to me that medical professionals aren't accountants. Consider a dental w-ray machine. $15-30k. That's the cost of Prius used as a Taxi. You don't pay a couple dollars for a 15 minute Taxi cab ride. An MRI machine, I forget how much those cost. But whatever, lets compare one with a modern passenger airliner. Cost is about equivalent on a 'per passenger' basis. And an airliner requires highly trained professionals to keep it running.
            • s1artibartfast 6y ago
              A new 787 is 200 million and carries up to 300 people and has a working life of 44,000 flights, for a total of 13 million people trips. A new MRI costs ~3 million, has an operational life of 10 years, performs 5000 scans per year, for a total 50,000 people trips. The people operating the MRI machine are probably payed more than anyone working on the airplane and take vastly more time per passenger.
    • mcguire 6y ago
      It would work fairly well for minimal routine care and relatively minor trauma, as long as euthanasia is on the table for major long-term care, major trauma, and for those who cannot pay.
      • ben_w 6y ago
        Well that sounds like a Black Mirror episode — “Crowdfund your schoolfriend to not be euthanised”
    • celloductor 6y ago
      It can be the opposite as well. I work in a vet clinic, but I also am in New Zealand- where there is free/subsidized public healthcare. Thus you get people who go to the vet expecting things to be free or cheap.
    • skeeter2020 6y ago
      In Canada (at least in my experience) it's the opposite. Vet clinics look a lot like US medical centres, including the state-of-the-art equipment and corresponding prices. Meanwhile the limited for-profit medical services are (mostly) affordable because they do general procedures with relatively low barriers for competitors. Generic drugs are dirt cheap when available; non-generics cost as much as the US. Dental care is all over the map from very affordable to ridiculously overpriced.
      • adventured 6y ago
        Vets vary widely in the US. Vet clinics are wildly expensive in many locations here, with veterinarians earning well-paid doctor wages and using modern vet equipment.
        • alisonkisk 6y ago
          Doctor wages and modern equipment are a small portion of human care, though.
      • mikepurvis 6y ago
        Another Canadian here with a similar experience— friends with dogs even pay for insurance because of the potential for frightfully expensive private surgeries down the road. Though I do wonder if there's a psychological thing there where dogs form stronger bonds and so people go to greater lengths for them, whereas other animals are easier to let go of if circumstances indicate that the time has come. And yes, dental care is all over the map— it feels very much like what I imagine US healthcare to be, with co-pays and mystery charges and having to log into my insurance company's online portal to do stuff. The NDP made a bunch of noise in the last election about a national dental plan, though even that effort would only have covered family incomes up to CAD$90k [1], so it wasn't anything like the universal no-questions coverage we have for core healthcare. 1: https://www.cbc.ca/news/politics/ndp-dental-plan-fact-check-1.5289005 https://www.cbc.ca/news/politics/ndp-dental-plan-fact-check-...
        • perardi 6y ago
    • SilasX 6y ago
      Not disagreeing, but one factor that complicates it is that they're allowed to take bigger risks with pets (both with regulations and potential civil liability) than with humans.
      • jksmith 6y ago
        Indeed, treating for cost of liability (insurance) vs best outcomes. Doctor's conflict of interest built into the system.
    • Spooky23 6y ago
      My PPO pays my GP about $75 for a regular visit. A zpack is $6.50 at my local grocery store, $15 at CVS. The vet always guilts me into some sort of stupid test. Usually I walk out of there $300 lighter.
      • alisonkisk 6y ago
        > For example, in 2011 in America, the average charge for an office visit for an established patient, level 3, requiring approximately 15 minutes with a doctor, was $104. The average total paid was $69. Some more examples: a cholesterol test has an average submitted charge of $72; and a glucose tolerant test (GTT) has a submitted charge of $60. Seems pretty similar to the vet. But that's just an office visit. The expensive stuff is at a hospital when the CYA care shows up.
      • throwawayboise 6y ago
        > My PPO pays my GP about $75 for a regular visit. Which is why they spend 5 minutes on you, 90 minutes after your scheduled appointment time.
    • heavyset_go 6y ago
      My experience conflicts with your assertion. Costs for veterinary care have sky rocketed over the last 15 years, and costs for procedures without pet insurance are sometimes 75% to nearly the same price as the same procedures on humans. Prices for MRIs, X-rays, surgery and drugs are all very close to human medical care costs.
      • poulsbohemian 6y ago
        FWIW: I wonder if you are in an urban area? When I compare the cost of vet services with my friends in an urban setting relative to what we pay here in rural, small-town America, I'm shocked at the difference. We have a university about a two hour drive away with a noted vet hospital - even their services were priced better than those I've heard anecdotally on the other (more urbanized) side of the state.
        • dd_roger 6y ago
          I'm guessing vets take advantage of the ever growing tendency to consider pets as family members to inflate the price. Especially since (from very anecdotal evidences) it seems to be mostly middle/upper class people who are so invested into their pets. In the countryside people tend to have a more utilitarian view of animals and would simply get a new one rather than wasting money keeping a sick animal alive.
        • heavyset_go 6y ago
          > FWIW: I wonder if you are in an urban area? I'm not.
      • alisonkisk 6y ago
        An human ACL surgery is $20-$50k, 10x the price for dogs.
    • poulsbohemian 6y ago
      Even more importantly: When you walk into the vet, they can estimate what your options will cost, so that you can make an informed decision. When it was our cat's time too, I was struck by his end of life experience versus that of a human. Whereas a human could have exhausted their life savings on futile treatment or end of life hospice care, Denver cat went quietly into that good night on his favorite blanket surrounded by his loved ones. I'm currently in need of some very common medical treatment, but the maze of providers I need to go through in order to get a referral just ain't worth it. Versus, if I were a cat or dog, I could simply go to the area university veterinary hospital and likely get my answer same day.
      • jen20 6y ago
        This experience is often available for humans too (even in countries without risk of medical bills bankrupting oneself) - it largely depends on how far the religious right has embedded itself in government. Pieter Hintjens (of ZeroMQ and AMQP fame) chose this option when diagnosed with terminal cancer, and wrote about it extensively at [1] and [2]. [1]: http://hintjens.com/blog:116 http://hintjens.com/blog:116 [2]: http://hintjens.com/blog:115 http://hintjens.com/blog:115
        • alisonkisk 6y ago
          Euthanasia is commonly banned, but palliative hospice (morphine until you die, combined with caloric reduction) is allowed.
          • Retric 6y ago
            Starvation at hospice is a slow and expensive way to go. It’s only appealing in comparison to hospital stays.
          • nicoburns 6y ago
            I'm cautiously optimistic that euthanasia will become widely available by the time I'm old. It seems to preferred over dementia by most people I've spoken to in both my generation (late twenties) and my parents.
    • LinuxBender 6y ago
      Me too. I suspect some of this is regulatory overhead and compliance. I can give pets injections (inoculations and antibiotics) without even talking to a vet. The only exception I ever ran into was antibiotics for a snake, as the feed store didn't carry that. To get those things for myself would require a prescription from a doctor.
    • vondur 6y ago
      "Every time I go to the doctor I wish I could take myself to the vet instead." Kramer thought that in a Seinfeld episode; it was a great episode. Season 8 Episode 10.
    • strken 6y ago
      The last time I needed stitches, it cost between $70 and $80 AUD (unsubsidised - this is what an international visitor would have paid), and was wholly covered by the government.
    • ecommerceguy 6y ago
      You can certainly go to Farm and Feeds and get penicillin amongst other pharmaceuticals. Plenty of farmers hours away from metro hospitals and providers commonly use these sources.
    • tguvot 6y ago
      Actually pet health insurance is very common. Everybody that I know with a pet has one and even work has discounted pet health insurance as part of employee perks
    • josefresco 6y ago
      Having just put down two pets with costly late in life medical conditions I'm kicking myself for not getting health insurance. We were able to afford most recommended procedures but not many can. In fact, there are several programs locally for people who can't pay for their vet bills which I've considered contributing to now that I've seen first-hand the anguish people have to face when considering procedures they can't afford for animals they love like children.
  • nextos 6y ago
    Lot's of private hospitals work like this in Europe and you can get really cheap care, plus the standard is quite high.
  • giantg2 6y ago
    The problem is that most people don't have $10k that they could pay directly. You might find this interesting too. https://slatestarcodex.com/2020/04/20/the-amish-health-care-system/ https://slatestarcodex.com/2020/04/20/the-amish-health-care-... Edit: why is this downvoted?
  • nickff 6y ago
    The biggest problem is that most of the money in healthcare actually goes to pay salaries, mostly those of nurses and doctors, but administrators are up there too. Pharmaceutical companies are not as profitable as one might imagine, and drugs are a relatively small fraction of total healthcare costs.
    • Darmody 6y ago
      Then why the same drugs are incredibly cheaper in other wealthy countries? They don't pay salaries there? Healthcare in the US is a scam. There's no other way to look at it.
      • paulmd 6y ago
        Salaries are certainly a part of it - medical staff are paid much lower in other countries. Because they don't have to pay for their education. Governments there recognize that having lots of doctors is a public good and don't saddle them with hundreds of thousands of dollars of debt from medical school. Doctors aren't the ones who pay that medical school bill (if they get a job). It's their patients who pay the medical school bills. The problem of medical expenses in the US is a very complex one. It's essentially at the nexus of a whole bunch of problems with our society. Higher education is too expensive. We have too many middlemen. Strong intellectual property laws make drugs and devices expensive. Patent laws make evergreening more profitable than innovation. Intense regulatory requirements for approval make competition very limited for pharmaceuticals. The government doesn't maintain control of the products resulting from the blue-sky R&D it funds. etc etc.
        • munk-a 6y ago
          This will partially ignore your attribution that the US problem is a complex multi-faceted issue (I agree with that but wanted to focus in) - you mention that higher education is too expensive and suggest that there are many other societal factors that make the US noncompetitive. This can cause an effect like we're seeing with the US healthcare market but the US does well in a lot of the more transferable industries (like software development) and I'm not seeing how the factors you're highlighting for healthcare wouldn't equally apply to all of those transferable jobs.
  • minikites 6y ago
    Why do we need a system as complex as this instead of just funding healthcare through tax dollars and giving it to everyone like many other developed nations?
    • giantg2 6y ago
      Can you show where the tax funded systems are not complex? It might remove some issues, but it can create others. I don't think a simplistic solution exists anywhere in the modern world.
      • minikites 6y ago
        You're right that the back-end of any healthcare system is complex, but a government-funded single-payer system is simpler for the end user (every citizen), that was my point.
        • giantg2 6y ago
          I must be missing something then. In the current system you walk in and hand them your card (insurance, Medicare, medicaid, etc) and they treat you. You get mailed a bill later. Tax funded systems would be similar. Walk in, give them your ID/card and get treated. Get a bill if it's a taxable condition (like Italy). Obviously there are other non-payment related differences like scheduling and what's covered.
          • minikites 6y ago
            >In the current system you walk in and hand them your card (insurance, Medicare, medicaid, etc) and they treat you. You get mailed a bill later. The thing you're missing is that the current system in the USA is in no way like this.
            • giantg2 6y ago
              That's completely false. I've had to deal with many medical bills in the US last year.
  • nathanvanfleet 6y ago
    I don't know, maybe the government should regulate the predatory behaviors or business instead of weird libertarian strategy that is already not working for people who have no insurance and their life is destroyed when they get sick?
    • giantg2 6y ago
      You really think the current situation is libertarian? There is so much regulation around anything even remotely medically related. Just look at the HIPPA mess. Edit: why are you downvoting without rebuttal? Its utterly false to claim the system is libertarian.
    • tdfx 6y ago
      There's nothing libertarian about the US healthcare system. If anything, it's a great example of regulatory capture by the AMA and insurance industry.
    • deelowe 6y ago
      What? I went to a specialist today. My doctor scheduled the appointment. I had no say in it. This doctor is at one of two offices that I am allowed to choose from based on my insurance's negotiated contracts. This is insurance that is provided by my employer that I had no choice in. When I first saw the doctor, he prescribed meds that I had no choice in. The specific meds he prescribed were chosen as these are what the insurance company would prefer from a clinical perspective although they were extremely unlikely to help. And, on top of all of this, not once was I informed of the cost prior to services being rendered and if I had asked, I would have been told this wasn't possible. How is any of this libertarian? The libertarian solution would be that only individuals would be allowed to purchase insurance, that insurance would distribute funds to the individual (not the doctor or pharmacy), all fees would be provided prior to service being rendered and individuals would purchase meds without a prescription.
      • munk-a 6y ago
        > The specific meds he prescribed were chosen as these are what the insurance company would prefer from a clinical perspective although they were extremely unlikely to help. I work close enough to healthcare that I can say that while insurers do take cost of treatment into account they are looking to minimize ongoing treatment costs - if there is a 5$ pill and a 500$ pill available for treatment the insurer may prefer to trial you initially on the 5$ pill if it's been proven effective for a good proportion of patients, but they do use calculations to minimize those ongoing costs that includes costs from condition escalation (i.e. if you have a boil you're absolutely going to get antibiotics covered since dealing with a septic boil is an emergency room visit.
  • colechristensen 6y ago
    There is always an amount “billed” to insurance companies which is strictly imaginary. There is this billed rate, the negotiated rate per insurance provider, and a cash rate.
    • aj7 6y ago
      So it winds up you pay for everything. Your “drug plan” too.
      • SeanLuke 6y ago
        It depends on the drug. Under my insurance, I get certain drugs for $0.
      • colechristensen 6y ago
        No, there’s just a base rate that nobody pays used as a negotiation tactic that’s still published on bills for whatever reason, you can see what your insurance provider actually pays as well.
        • aj7 6y ago
          I’ve seen that and I don’t always trust it.
    • jjoonathan 6y ago
      > a cash rate An equally imaginary number that gets hauled out during debates so that health care providers can pretend that insurance companies are the ones responsible for price inflation. If you actually try to obtain the cash rate, they'll give you a 2% "lol nice try" discount off the billed rate.
  • DubiousPusher 6y ago
    The problem is many people don't have cash either. https://www.federalreserve.gov/publications/2019-economic-well-being-of-us-households-in-2018-dealing-with-unexpected-expenses.htm https://www.federalreserve.gov/publications/2019-economic-we...
  • rush86999 6y ago
    I completely agree with you. That is why we started Tangerine Health (https://www.tangerinehealth.co https://www.tangerinehealth.co). We charge a flat rate of $25 per visit. With new policy changes to Telehealth, we also launched virtual primary care with the same pricing model. If you have insurance we accept Aetna and UHC. We are in the process of getting Blue Cross as well. I believe also doctor's office visits are covered by HSA (not 100% sure but here's a link found: https://www.foley.com/en/insights/publications/2020/03/covid19-law-free-telehealth-tax-benefits-hsa https://www.foley.com/en/insights/publications/2020/03/covid...).
  • flyingfences 6y ago
    That's what insurance is supposed to be: coverage for the catastrophic cases. This use of insurance for ordinary, everyday medical care is ridiculous. I have insurance on my car in case of a catastrophic collision; can you imagine if I had to deal with them for every oil change and brake job?
    • codegeek 6y ago
      I make the same argument and people don't get it. We are so brainwashed about the whole health insurance thing in America. Get rid of insurance middleman in EVERYTHING and see how prices drop.
      • pkaye 6y ago
        Until it comes to dental work and hearing aids. Then people wish the insurance middleman was there.
        • chordalkeyboard 6y ago
          Not me, I pay cash for my dental work. The only way insurance would help me is if there was a catastrophic event.
      • jfrunyon 6y ago
        Because it's not valid. Ignoring routine and preventive care makes those catastrophic cases almost inevitable.
        • deleted 6y ago
          [deleted]
        • codegeek 6y ago
          I don't understand your argument. Even on insurance, a lot of Americans routinely ignore preventive care because of the hassles, overhead and out of pocket costs even after insurance. Unless you are lucky to have great insurance by your employer. The point is that insurance should NOT be involved in preventive care. It should be a direct free market cash exchange b/w just 2 parties. Patient and doctor. That's it. NO premiums, no copays, no coinsurance, no claim paperwork, no calling insurance companies to figure out the charges etc etc and most importantly, no dependency on having a job to be able to afford going to a doctor even for preventive care.
  • aj7 6y ago
    I’ve been buying my drugs for cash for a decade. I’m lucky, I’ve got 5 prescriptions that run me ~$1000. I started when I found that open market pricing was lower than my insurance (UHC Optum) pricing.
  • noir_lord 6y ago
    Insurance companies are a symptom of the problem but the real solution is either single payer, something NHS like or something like the German model (which is probably the most similar of the major countries to what the US has now - though it’s still three quarters state funded). The NHS was to an extent a statistical fluke (right politician in the right place, just post-WWII) that the right wing has been trying to dismantle for decades, without WW2 I’d be surprised if we had anything like the NHS. Basically you need politicians to ignore the lobbyists and do their job of regulating this shit for a better society. Sadly I don’t see it happening though there are some hopeful trends.
    • cocoa19 6y ago
      I don't buy the single payer/Obamacare/more regulation speech as the single healthcare fix. NHS has a ton of problems of their own. We need a lot of doctors, more than what we are producing. It's baffling you need 100s of thousands of dollars to become a Dr in the US. Remove the undergrad requirement to apply for med school, like most of the world, and fix the college affordability problems. If the amount of money to produce doctors keeps escalating, it's not surprising medical care only goes up.
      • noir_lord 6y ago
        There is no single solution, the world isn’t that neat however the NHS problems and it does have them are a result in large part to it been a political football for decades. Even with those problems we spend about half per capita on healthcare with about equal outcomes, also the US gov in one form or another already foots about 50% of the bill itself. > Results The UK spent the least per capita on healthcare in 2017 compared with all other countries studied (UK $3825 (£2972; €3392); mean $5700), and spending was growing at slightly lower levels (0.02% of gross domestic product in the previous four years, compared with a mean of 0.07%). The UK had the lowest rates of unmet need and among the lowest numbers of doctors and nurses per capita. https://www.bmj.com/content/367/bmj.l6326 https://www.bmj.com/content/367/bmj.l6326 They do more for less with less and mostly do it well. Compare that to any other major country and it’s good, compared to the US system it’s very good. Does the US have amazing doctors, hell yeah of course but do they have a fair system when on average everyone gets what they need if not always what they want, I’d argue no.
  • codegeek 6y ago
    I would bet my life that costs would be lower. Insurance middleman in everything drives up the cost a lot due to so many overheads involved.
  • gigatexal 6y ago
    The average American can’t afford a 400 dollar expense and you are advocating a post pay insurance model? That seems very regressive.
    • adventured 6y ago
      > The average American can’t afford a 400 dollar expense The average American has $432,000 in net assets, is the second richest in the world (behind Switzerland), and can trivially afford such an expense. Did you mean that around 12-16% of the population can't afford an immediate out of pocket $400 expense? Because that's the real figure according to the Federal Reserve study that's constantly misquoted. The median American has a higher net worth than either Germany or Sweden, and among the highest disposable income of any nation.
      • ashayh 6y ago
        "Poorer" countries than the US like Portugal, France, Japan, UK have far better health outcomes including lower infant mortality, lower chronic diseases, better life expectancy than the US. The US is the only "developed" country where 10 are uninsured: https://en.wikipedia.org/wiki/List_of_countries_by_health_insurance_coverage https://en.wikipedia.org/wiki/List_of_countries_by_health_in... Another N% are under insured, or hampered by high deductibles, copays, limits etc. Whats the point of having a "high median net worth" if the basic needs of the people aren't met?
        • IG_Semmelweiss 6y ago
          As far as infant mortality and life expectancy, the picture is a lot more complicated than you portray. The US is including in their life expectancy data cases of stillbirths or nonviable fetuses at birth, which are not recorded in EU numbers, for example. " measurement problems arise in international comparisons because the data are not consistently gathered or reported. Although the World Health Organization (WHO) has a formal definition of what should be included in the infant mortality statistics, anecdotal evidence suggests that countries do not use consistent practices in measuring these data (Haub and Yanagishita, 1991; Hartford, 1992). " https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193257/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193257/ https://www.nber.org/bah/2015no1/why-infant-mortality-higher-us-europe https://www.nber.org/bah/2015no1/why-infant-mortality-higher...
  • codegeek 6y ago
    Yea and for people who cannot even afford the lower costs out of pocket, subsidize the HSA card for them. This could work better than trying the big bang Single payer approach which btw I am for if that's the only option. I am desperate to try anything other than what we have right now in the US.
  • throwawayboise 6y ago
    There's a cash-based medical practice in my town. They don't accept or file insurance claims (they will give you an invoice with billing codes so you can file your own claim if you want). Their prices: New patient visit: $400 MD or $300 PA Follow up visit: $200 MD or $150 PA Labs: $25 draw fee + laboratory cost
    • jfrunyon 6y ago
      That's significantly more than my doctor - who is part of a major hospital/healthcare network and works primarily with insured patients - charges out-of-pocket... (I know this because they screwed up billing the insurance company and got denied, and tried to switch me to cash and bill me the higher amount instead. I love our healthcare system.)
      • throwawayboise 6y ago
        Yeah it didn't strike me as especially cheap either, and I have not used this practice myself, but as I understand it he does spend a lot more time with the patient discussing their questions and concerns than most docs do. He also pretty clearly markets to an upscale clientele, not people looking for bargain price medicine.
  • jfrunyon 6y ago
    Generic manufacturers don't have anything to do with insurance companies, though, do they? Other than perhaps trying to convince insurance companies to put their drug on the formulary. It would be between the pharmacy & insurance.
  • disabled 6y ago
    The company sounds predatory. A lot of countries have much better health systems, with people fully insured (this is really designed for people who are underinsured), with significantly better outcomes, than the US. The US lifespan is also significantly trailing compared to other developed countries, and we are not a “normal” country at all. It’s going to be more appalling by 2040. Anyways, the place to study this data and information is https://www.HealthData.org https://www.HealthData.org You can spend hundreds of hours studying the data on that website, along with extreme specifics about medical care. I used it to inform my decision of where to live in Europe with rare immune mediated neurological diseases and type 1 diabetes.
  • mlthoughts2018 6y ago
    > If Cuban's idea is "we don't do insurance but you're free to pay with an HSA card or seek reimbursement from your insurance company" then this could be a huge winner. This is the way it works for a lot of therapy and mental health services and it’s horrible. Prices are absolutely insane, practitioners are not accommodating to patient schedules, and patients have absolutely zero bargaining power. In some ways doing it through insurance is kind of like a union. You all agree to accept certain inefficiencies, bureaucracy, etc., (and associated cost) in order for better collective bargaining terms. Of course people with great jobs usually don’t care about unions. They don’t need the collective bargaining power and thus figure the bureaucracy cost is just a loss they don’t need. Same thing with very healthy people and insurance. If you’re healthy you just figure, give me cheap catastrophe insurance, what do I care? But if you’re in the depths of the medical industrial complex because you need frequent treatment for chronic conditions, you quickly learn that papering everything over with lots of bureaucracy to adhere it to better collective bargaining for patients is way better, and I’d rather take the nasty, churning quagmire of price inflating insurance than deal with spartan libertarian mini-insurance that essentially just results in rich-get-richer (i.e. genetically lucky healthy people just get to save money while everyone else suffers).
    • supertrope 6y ago
      The supply and demand imbalance in clinical psychology and psychiatry is why they can choose to be out of network. Demand is not only wanting a good or service but being able to pay for it. Mentally ill people tend to have less or much less money. The long term trend is not good; why become a psychiatrist when you can earn more as almost any other specialist? (With exception of pediatry). Jails are collectively America's largest mental health service providers. If there was money in psych work you'd see even private equity pump it up like urgent care chains. Even with single payer or heavily regulated universal insurance schemes there's often a mental health services gap.
    • Analemma_ 6y ago
      I'm sure individual experiences vary widely, but I know several people getting frequent treatment for chronic conditions, and none of them talk about how happy they are that an insurance company is collectively bargaining on their behalf. Most of them curse their insurance provider with every breath, and are firmly of the opinion that it would shoot them in the head if it thought it could get away with it.
  • fallingknife 6y ago
    Do drug companies get involved with insurance companies? I thought the pharmacies purchased the drugs, and then they handled that at the point of sale.
    • refurb 6y ago
      Yes, they do but the insurers don’t touch the drugs (unless they own a pharmacy too). You know how a drug can be tier 2 ($25 copay) or tier 3 (20% coinsurance)? That often the manufacturer offering a lower price in exchange for easier and cheaper access for patients. Drug companies can also rebate on the back end. If an insurance pays for 1,000 vials of drug, they get a 10% rebate. 2,000 vials, a 20% rebate.
  • himinlomax 6y ago
    Counterpoint: this seems to not be a problem ANYWHERE but the US.
  • WalterBright 6y ago
    > I've wondered for a long time Wonder no more: https://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/307617/ https://www.theatlantic.com/magazine/archive/2009/09/how-ame...
    • masonic 6y ago
      This tragic case of a hospital-acquired infection has nothing to do with the parent comment.
      • WalterBright 6y ago
        The article has much more than that. Scroll down to "There’s No One Else to Pay the Bill" where it says: "For fun, let’s imagine confiscating all the profits of all the famously greedy health-insurance companies. That would pay for four days of health care for all Americans. Let’s add in the profits of the 10 biggest rapacious U.S. drug companies. Another 7 days. Indeed, confiscating all the profits of all American companies, in every industry, wouldn’t cover even five months of our health-care expenses."
        • deleted 6y ago
          [deleted]
  • lcall 6y ago
    I wonder if concierge medicine ( https://en.wikipedia.org/wiki/Concierge_medicine https://en.wikipedia.org/wiki/Concierge_medicine ) would fit what you describe. I don't personally know enough to discuss its pros/cons extensively though.
  • snarf21 6y ago
    We can fix a lot about with a few small changes that don't even require raising taxes. The #1 and easiest change is for the government to just pass a law mandating reference based pricing. This is not M4A, the government just says you can't charge more than Medicare plus 20% (e.g.) and cash gets your Medicare flat. This gets rid of brokers, negotiations, out of network and any of the other nonsense. Probably removes 20% of the national healthcare spend. The other changes are straightforward too and again require no new taxes and are not single payer.
    • vidarh 6y ago
      Medicare already get gouged because of restrictions on leveraging their market power to negotiate best possible prices. Medicare + Medicaid costs US taxpayers as much per capita as the NHS costs UK taxpayers per capita. Only the NHS provides universal cover for that cost. US taxpayers are in effect paying twice.
  • ur-whale 6y ago
    Say you managed to remove these costs, what would all those newly unemployed people do?
    • chordalkeyboard 6y ago
      Find useful jobs somewhere else.
  • jlamberts 6y ago
    This is actually the idea behind Direct Primary Care[1]; basically the idea is that by not taking insurance the overall cost of care goes down due to the decreased overhead around the claims process. My dad is a PCP who switched his practice over to that model several years ago. From what he's told me he prefers it a lot over the traditional model specifically because it allows him to have a subscription based model rather than charging per-visit. That means that his revenues are more consistent but also has the benefit of aligning the patients' and doctors' incentives more directly: the doctor makes more money when their patients are healthy than when they are sick so they're incentivized to do a better job. It also meshes well with telemedicine and chat-based consultations. He was offering both of those options to his patients well before covid because it tends to save both doctor and patient a lot of time, and there's no concern over "how much do I bill for telemedicine vs a normal visit, and how do I bill insurance for it." [1] https://en.wikipedia.org/wiki/Direct_primary_care https://en.wikipedia.org/wiki/Direct_primary_care
  • aledalgrande 6y ago
    I don't know if it's because of this, but as a European I was flabbergasted the first time I went to a pharmacy in US with a prescription and they told me "come back in an hour". Like what? In Europe you talk to the pharmacist, give the presciption and 5 minutes later you're out.
    • rootusrootus 6y ago
      That varies by location quite a bit. I can generally walk in my local pharmacy and have a prescription filled in a few minutes. Maybe more like 15 minutes if it's a controlled substance. But as a practical matter I just walk in, pay, and pick it up, my doctor sends the prescription over electronically. And lately, any recurring prescriptions are handled by mail anyway. Have I ever experienced that "come back in an hour" phenomenon? You bet. Then I went to a different pharmacy.
    • Jweb_Guru 6y ago
      That's not true at all. I've been told to come back in many hours multiple times in Germany.
      • aledalgrande 6y ago
        Then sub that with Italy, Spain and UK.
  • dehrmann 6y ago
    The main issue with this is people avoiding care they should get so they can save $200. It's one of the reasons I don't recommend HSAs for people.
• DevX101 6y ago
  For some context on why this cost-plus is necessary and great, several generic manufacturers have been colluding and price-fixing. There are ongoing lawsuits from the Department of Justice and 46 states, and at least one pharma co pled guilty, and was fined $200 million. https://www.biospace.com/article/states-accuse-drugmakers-of-colluding-to-keep-generic-drug-prices-artificially-high-in-lawsuit/ https://www.biospace.com/article/states-accuse-drugmakers-of...
  • snoshy 6y ago
    Quite damning, and that's only the most blatant infractions, because it's such a high bar to prove collusion and price fixing. The most disingenuous tactics to prevent competition that are harder to prove in court continue to cause harm to the average consumer nevertheless.
  • ProAm 6y ago
    > cost-plus is necessary I wish cost plus worked but its just as easily gamed. Ive seen many industries that contracted cost-plus and the costs magically went up a lot. If there is money to be made the system can always be gamed/contorted/scammed, etc...
    • neltnerb 6y ago
      While true, wouldn't the point of such a rule be to provide a framework for fighting against exactly that? Without the rule they don't even need to try to manipulate the books, so there's even less to find as evidence that might be used to either improve the rule or enforce it differently. Of course, market pressure is much simpler if one manufacturer just decides to do it according to a consistent and justifiable method and stick with it.
      • JumpCrisscross 6y ago
        > Without the rule they don't even need to try to manipulate the books Screwing with cost plus doesn't require manipulating books. If you're passing on your costs, you have no incentive to find cheaper suppliers. Need to hire a bunch of people? Meh. Guy didn't show up to work for two weeks? Not your payroll, really. Enabling new entrants where possible, and regulating where not, is a simpler and more-scalable solution. Pharmaceuticals manufacturing seems to be light on the former.
• tpmx 6y ago
  I thought this space was already cornered by companies in India? That's where most of the world gets it cheap generics from, I think.
  • mikeyouse 6y ago
    Very true - but it turns out they all collude to raise prices - some actual competition will go a long way: https://www.biospace.com/article/justice-department-charges-glenmark-pharma-with-price-fixing-for-generic-drugs/ https://www.biospace.com/article/justice-department-charges-...
    • tpmx 6y ago
      Some actual competition on generics from a US company, with a much higher salary cost? Also, from the web site: - "We are hoping to introduce over 100 additional drugs by the end of 2021." - "By 2022, building a pharmaceutical factory of our own in Dallas, TX" I can't shake the feeling it's just a shallow rebranding play using a billionaire's personal brand. Perhaps many americans don't trust non-US brands, even when it comes to generics?
      • tasty_freeze 6y ago
        I don't care if it is rebranding inexpensive Indian generics so long as they are vouching for the quality.
        • tpmx 6y ago
          Is there a quality problem with generics in the US? There doesn't seem to one in Europe (or at least Sweden). I assume you also have regulations and testing protocols etc?
          • mikeyouse 6y ago
            There were actually a number of scandals out of India on this front as well: https://www.npr.org/sections/health-shots/2019/05/12/722216512/bottle-of-lies-exposes-the-dark-side-of-the-generic-drug-boom https://www.npr.org/sections/health-shots/2019/05/12/7222165... It's extremely hard to enforce GMP and QA/QC from across the world and there's a strong incentive to cheat and lie when it comes to these costly procedures. Whether it'll be any better in a US manufacturing facility is of course up for debate.
• yboris 6y ago
  UI comment: the top banner vibrates (small-large jitter) when you scroll a few pixels down.
  • gallegojaime 6y ago
    The "Find a Pharmacy" option doesn't work for me either.
• bluedino 6y ago
  It's funny how privatizing space travel made costs plummet. Privatized healthcare, on the other hand, is a disaster.
  • lifeplusplus 6y ago
    one is a necessity and other one is not. If it's too expensive to launch stuff to space, most companies won't. If it's expensive to get a drug, well you will either pay up or suffer until you die.
    • DubiousPusher 6y ago
      Exactly. One market is elastic the other is inelastic.
      • lifeplusplus 6y ago
        I had forgotten those terms.. yea nothing mysterious going on here. This is well understood situation. Everyone should take micro-economics not matter the profession.
    • savanaly 6y ago
      But we have markets in necessities and they work just fine. What's the difference from healthcare?
      • lifeplusplus 6y ago
        such as?.. give an example.. milk - regulated water - regulated electricity - regulated education - k12 regulated most of it .
  • atonse 6y ago
    Well before space X, we did have private companies, but they were government contractors and a monopoly. So they had no incentive to reduce prices. It’s almost like SpaceX took rockets from being a consulting business to a product business.
• mindcrime 6y ago
  I know it's trendy to hate on billionaires, and by no means do I think this step makes Mark Cuban the new "Mother Teresa" or anything. But I have to say, by and large, I feel like Cuban is legitimately a "good guy" as billionaires go. Yes he's rich, and he's unabashed about it, but he seems like a normal and reasonable human being nonetheless.
  • breck 6y ago
    Ever since he joined Shark Tank that show has become one of the best things to happen to our economy in the 2000's. He's exposing millions of Americans to the long term benefits of a value creation, non-linear thinking, honesty is the best policy, builder/craftmanship mindset. When I was a kid growing up far away from Silicon Valley we had "The Apprentice" to learn from. Shark Tank (especially Cuban, but really the whole cast), is orders of magnitude better.
    • skizm 6y ago
      I believe there was a point when Shark Tank would take some amount of equity from every business that came on the show regardless of if one of the sharks invested or not. Cuban called BS and said he wouldn't be on the show if that was the case. The policy was removed as a result. Smart move too, since you will probably get better companies on the show without that sort of policy.
      • breck 6y ago
        Yes. I can confirm this is exactly what happened (roommate almost went on the show, pre-Cuban. though I'm sure theres a lot more to the story that insiders would know).
      • valarauko 6y ago
        Curious: does the show take equity IF the sharks invest? I haven't really seen the show beyond a few episodes.
        • 6y ago
• offtop5 6y ago
  I'm a bit too cynical to believe a benevolent billionaire will save us. Me thinks theirs something else at work here. I could see Mark Cuban building this company up , selling it for billions at which point we're back were we started
  • deelowe 6y ago
    I believe Mark Cuban is an altruist, but as you alluded to, the empires he builds are not inherently benevolent and could eventually end up in the same place over time as ownership changes.
  • wrsh07 6y ago
    I'm also pretty cynical about this. It will only work if it fundamentally changes the pharmaceuticals industry They could make up the loss on volume, though. Especially if selling outside the US Or as you say, they might join the incumbents and renege on the promise painted here
  • jawns 6y ago
    I agree, either there's something else going on or he's entirely genuine about the mission -- in which case it's unlikely to thrive. While this business model can work in some industries, in this particular heavily regulated industry, Cuban is either going to discover that it's harder than it looks and fold in a few years, or he's trying to sell a grand vision and offload it for a profit before the cracks in the foundation are discovered. I would be more inclined to see the mission as genuine if this were launched as a public benefit corporation or B corp (but even then, the promises such companies make of serving the public good can be overblown).
  • retrac 6y ago
    I'm not usually a "market" guy, but some good competition in generic drug production might actually save us. Presumably, he sees large potential profits by aggressively undercutting the non-competitive overpriced generics. If that takes off, it could be a good thing overall.
  • ksm1717 6y ago
    It’s easy pickings but putting your name on a generic drug company seems like an oxymoron. This and the thing in the news recently with Delonte West’s rehab that Mark Cuban sponsored - not even an attempt to get the stink of PR off of it which rubs me the wrong way
• thesausageking 6y ago
  "The Mark Cuban Cost Plus Drug Company" is a mouthful. Did he really need to put his name on it? I also don't see anyone else listed on the website. No physicians, no chemists, no engineers. It doesn't inspire confidence.
  • valarauko 6y ago
    "Cuban Drug Company" would be more fun
    • marton78 6y ago
      Cuban Drug Dealership
    • dfxm12 6y ago
      The CDC? :)
  • xiphias2 6y ago
    Actually I like it that an investor gives his name to a company. Usually problems start when he’s not the main owner anymore though....
• tthun 6y ago
  is this sort of the “free market” example of disruptions in healthcare space that could may be move healthcare in US towards a model where you pay for what it actually costs instead of the inflated and opaque pricing that private health insurance thrives on ?
  • wrsh07 6y ago
    In spite of the missing question mark, I think the answer is yes I'm not even particularly bullish about companies being able to improve transparency (it's a really complicated system, the incumbents stand to make/lose enormous sums of money, even when lower cost alternatives exist doctors might be contractually obligated not to discuss them) But I think that this is a really good step Similar to toasttab or chownow in the food ordering space
• woadwarrior01 6y ago
  Everything is relative. The first generic they're launching at $20 a tablet: Albendazole, retails for less than 50 cents a tablet in India.
  • aiven 6y ago
    compare price of labor between usa and india. Outsourcing everything to asia will be beneficial for company (and probably consumers since lower prices), but not for americans who work for cuban rn
    • markdown 6y ago
      This isn't the garment industry. Labour costs in drug manufacturing (as opposed to drug development) are negligible.
  • georgeecollins 6y ago
    People in the US can afford to pay a lot more for healthcare than in India. They just can't afford to pay twice as much as other industrialized countries.
    • retrac 6y ago
      Mebendazole (functionally equivalent to albendazole, as I understand it) is 4 USD a tablet here in Ontario. So even with this you're still paying 3x as much.
  • flowerlad 6y ago
    Close to $0.03 USD: https://www.sastimedicine.com/salt-alternatives/5785-736518/Albendazole-400mg-Price-Dosage-Side-Effects-and-Generic-Alternatives-its-cost https://www.sastimedicine.com/salt-alternatives/5785-736518/...
  • deleted 6y ago
    [deleted]
  • asdfadsfgfdda 6y ago
• Nelkins 6y ago
  I wonder what the chances are that they take on insulin.
• athenot 6y ago
  The name let me to think it was related to Cost Plus World Market, the home goods store. https://www.worldmarket.com https://www.worldmarket.com
• StreamBright 6y ago
  Can't wait until the government find ways to make this more expensive.
• ChuckMcM 6y ago
  This is great, do Insulin now.
• vedtopkar 6y ago
  This is cool, but what they're claiming is puzzling. Perhaps someone here can clarify. Making generic drugs is non-trivial. The medicinal chemistry may be decades old, but you still need to do trials to demonstrate efficacy equivalency to the non-generic version. Are they really saying they'll do 100 of these trials by the end of the year? While this is cool, I'm thinking that this type of initiative should be done by the federal government. A generic drug "mint" if you will.
  • CapriciousCptl 6y ago
    You're right. If it was just one drug, I'd think they were manufacturing it themselves. Apparently, they plan to have a single factory in 2022. Most likely, significantly all of their formulary will be copacked.
  • enchiridion 6y ago
    Why does this generic have to be retested if it's the same as the existing generic? Can't they just do composition(?) testing to very it meets manufacturing standards?
    • vedtopkar 6y ago
      I don’t have the best answer for you, but there are a number of considerations apart from the synthesis of the active molecule itself. Delivery vehicle can alter the physiological impact of the active substantially, and so the overall “package” needs to be tested even though the active is already approved. To my knowledge, generic trials aren’t as involved as their non-generic counterparts for obvious reasons. But they are still non-trivial logistical undertakings.
      • enchiridion 6y ago
        That makes sense! This is where I feel like I have a disconnect between what I think applied science is and what it looks like in practice. It seems like they should know enough about the molecule, delivery vehicle, etc, to know that it will work the same. A medical "proof" if you will. I guess we're not quite there yet? Is there work pushing in this direction?
• stakkur 6y ago
  I want affordable drugs. But not sure I want to rely on the goodwill of a single private enterprise billionaire to get them.
  • Invictus0 6y ago
    I don't understand the criticism here. A customer of this company is not reliant on Cuban at all--if Cuban's company raises prices, the customer can switch to another company or move to a country with cheaper drugs. I also don't get the "goodwill" argument. This is designed to be a profitable, sustainable business built on the classic mantra "your margin is my opportunity".
    • qqii 6y ago
      > or move to a country with cheaper drugs I think it's ridiculous that someone has to consider moving countries, which is no small task and out of reach for many, just to be able to afford their healthcare.
  • deleted 6y ago
    [deleted]
• aj7 6y ago
  Amazon, which should have led this effort long ago, seems to have a half-hearted approach. Almost like they want your data as much as your business.
• warent 6y ago
  Can we just appreciate the level of moral depravity needed to price fix medication? In my opinion something this repugnant and egregious needs personal executive accountability. I'm willing to wager that many human lives have been altered for the worse because of this, and there's nobody taking personal accountability. Imagine if Epstein wasn't personally charged, instead just his business was fined. To me, that's actually the level of crime we're approaching here. If you think this is tenuous, at least consider the fact that it is proven that poverty is correlated with human trafficking (due to desperation and vulnerability) and illegally high medical bills force people into poverty.
  • merpnderp 6y ago
    Maybe people would have less problems with "corporations are just groups of people working together" if the people of a corporation were ever held accountable.
    • usrusr 6y ago
      Sell your shares before it's getting caught and you won't even be affected by the heaviest fines. Absence of information asymmetry is a fiction.
  • tehwebguy 6y ago
    Price doesn't even have to be fixed for it to be depraved! Good time to remind everyone that Shkreli is in prison for financial crimes largely unrelated to the pharma side of his businesses, the rest of the pharma industry continued doing the same things as him as usual.
    • deleted 6y ago
      [deleted]
    • fastball 6y ago
      That was kinda the point, no? Shkreli was made into a bogeyman, but he was just doing in the open what every other pharma was smart enough to keep secret (pricing things higher than necessary). He also did it an excessively bombastic way. Don't hate the player, hate the game. Fix the root causes, not the symptoms.
• deftnerd 6y ago
  The problem with drug prices isn't because of the drug manufacturers, it's with the middle-men and private insurance companies. At least, that's what the manufacturers are saying For instance, with the manufacturers of insulin, none of them are American and they offer to sell the insulin to everyone at the same price. The problem is that the large insurance companies use just three middle-men drug buyers called Pharmacy Benefits Managers (PBM) who DEMAND growing discounts every year from drug manufacturers, so the drug manufactures have to raise the prices to the US market every year to keep making a profit. Novo Nordisk is willing to sell insulin much cheaper, but the drug buyers demand about a 75% discount off of the wholesale cost or they'll make the product not covered by the insurance companies they represent. To compensate, they raise the wholesale price in the US so after the forced discounts, they still make the same amount of money. The people who suffer are the ones who don't have insurance. The solution, at least in the case of insulin, isn't cheaper prices from the manufacturer, it's for the US to pass a law that prevents insurance companies from dropping a product based on the refusal to discount the product if it's under a certain price-per-month. This article seems to cover the finger-pointing between the manufacturers and PBM's and insurane companies very well: https://www.healthline.com/diabetesmine/pharmacy-benefit-managers-and-drug-pricing#Villains-or-Scapegoats https://www.healthline.com/diabetesmine/pharmacy-benefit-man...?
  • hn2017 6y ago
    Very informative, thank you!
  • Antipode 6y ago
    How would forcing insurance companies to pay whatever drug companies ask not just raise insurance premiums? How do you differentiate dropping a drug because they're not willing to sell underpriced from dropping a drug because it's overpriced?
    • danmaz74 6y ago
      Just compare with the international market
  • pettusftw 6y ago
• alberth 6y ago
  Does this compete with Good RX?
• pottertheotter 6y ago
  Intermountain Healthcare did something similar in 2018 and created Civica RX. See: https://www.fiercehealthcare.com/hospitals-health-systems/drug-prices-healthcare-costs-intermountain-healthcare-civica-rx-generic https://www.fiercehealthcare.com/hospitals-health-systems/dr... https://civicarx.org/ https://civicarx.org/
  • lcall 6y ago
    ...and it's a nonprofit who has been delivering results. https://en.wikipedia.org/wiki/Civica_Rx https://en.wikipedia.org/wiki/Civica_Rx
• ksec 6y ago
  Excuses my ignorance. Does Tablet, mean one, single pill? ( Just making sure ) And they sell Albendazole for $225 Per tablet in US? And quote >our cost to make and distribute the drug is approximately $13.00 per tablet It cost $13 to make one Tablet, or one pill? And this is low cost? Anyone from Europe or UK living in US could sort of explain a little bit here. I know US medication are expensive, but this is... something else. I cant comprehend what I am reading here.
  • biggestdummy 6y ago
    Yes, a tablet is a single pill. Sometimes you'll split the pill, so a tablet might be 2 doses. But 1 pill. Note that retail pricing is an unreliable indication of actual cost to consumers. They jack it up so that they various plans can claim huge discount policies. Some of these plans are free, so there's very few people who are paying this "retail" price. The pill makers get paid by the consumers and, in most cases, by the plan-owners. And such agreements are made exceedingly complicated. IMO, only to make them more opaque and more difficult to regulate. Unfortunately, such a system is highly regressive as the richest tend to have the best plans, the poorest tend to have a meager plan, and the transient have no plan other than showing up at a hospital.
    • cavisne 6y ago
      The US system works like this * hospitals run as non profits, so they dont pay federal taxes * they still pay local taxes, so they need to generate a large loss to offset these taxes * insurance companies negotiate huge "discounts" on list prices, and then go back to their customers (large corporations) and boast about these discounts, meanwhile the hospital gets its tax writeoff This entire system is rigged to also grow the number of hospitals/ the overall size of healthcare in america. Pharma companies play this game too, and anyone who doesnt have insurance can quietly get a "coupon" from them to bring down the cash price to the same as insurance. No politician will close hospitals, so at this stage any move to "single payer" will just move the boasting role to the government.
      • chordalkeyboard 6y ago
• phkahler 6y ago
  >> There are no hidden costs, no middlemen, no rebates only available to insurance companies. Everybody gets the same low price for every drug we make. I've been advocating this for a while. Any given provider should have the same price for a given drug or procedure, regardless of insurance concerns. Putting this in law would probably help a lot.
• lcall 6y ago
  There is a similarly interesting, nonprofit drug company that is trying to resolve shortages and price problems, and where the founding hospital system is also a nonprofit with a very good, long-term reputation (and good personal experience--their intake forms to get a blood sample drawn totaled 2 reasonable pages, where the next-nearest hospital came out at 11 pages of icky legalese including documents by reference), and have generally done friendly good work for a long time as far as I can tell. Wikipedia says (lightly edited here for brevity): "Civica Rx is a nonprofit generic drug manufacturer .... started by national philanthropies and leading US health systems. By [EO] 2019, over 45 health systems representing 1200 hospitals were members of Civica. Member ... pharmacists and clinicians help prioritize the medications Civica makes.... By the end of 2019 Civica had 18 medications (28 SKUs) in production, and plans to bring over 100 medications to market in five years through various manufacturing approaches such as partnerships, developing ANDAs, and building its own manufacturing capability. ... The first shipment of Civica private-label medication was vancomycin, delivered to Riverton Hospital, a part of Civica founder health system Intermountain Healthcare, in October 2019." ( https://en.wikipedia.org/wiki/Civica_Rx https://en.wikipedia.org/wiki/Civica_Rx ) (edit: somebody else here also mentions civica and has a couple of other links, in their comment.)
• chad_strategic 6y ago
  I'm not going to over analyze this good news. I'm going to accept that at least one thing in the world seems to have gone right today.
  • xiphias2 6y ago
    2 if you look at what’s happening with GameStop
• dexwiz 6y ago
  Mark Cuban must have my conversations bugged. I recently was talking to a friend about how the rich should realign how they do large charity spending. In previous decades a rich industrialist may have built a library or a university building. This made sense when education was for the rich, and knowledge was inaccessible the wider public. But now knowledge is cheap, and large gifts like this are disconnected from today's average public person. Also putting a name on a hospital that still puts people into debt isn't a good image either. Now the wider public needs cheaper pharmaceuticals. In order of the rich to stay in power for extended periods, they need to give some amount of handouts. Nuevo rich don't understand this, so they look to predecessors, and look on how they spent their money (hospitals, universities, etc), without realizing why they spent it. Expect to see more charity capitalism aligned with today's needs: generic drugs, taxi services, even phones and internet access.
• f430 6y ago
  You can shit on billionaires and capitalism all you want but you can't argue with the benefits of trickle down effect of wealth. Somebody has a big ego and wants to put his name on schools, hospitals? Let him. Somebody wants to make a profit by exploiting the inefficiencies of an industry? Let him. Wallstreetbets wants to take out a few hedgefunds by beating them at their own game? Let's go.
  • ksm1717 6y ago
    “Can’t argue with the benefits of the trickle down effect of wealth”... yes I think decades of economic doctrine have covered the benefits. Probably should keep in mind other things like the consequences
• lawwantsin17 6y ago
  Wait, who's funding this? Doesn't mention his name.
• sitkack 6y ago
  This needs to get plugged into medicare/medicaid on a national level.
• mikesabbagh 6y ago
  I dont know if manufacturing is the problem. Cant you import drugs from India or other country with cheap off label drugs? The system is built to prey on the sick, it has nothing to do with manufacturing. I like his idea, but doubt it will work
  • kube-system 6y ago
    IIRC, the drug has to be tested, and it has to be made in a facility that meets QA standards, etc.
• res0nat0r 6y ago
  I wonder how much of a shakeup between this and whatever Amazon Pharmacy is doing may have on pricing... https://pharmacy.amazon.com/ https://pharmacy.amazon.com/
• ttul 6y ago
  “ The first product we are producing is Albendazole. Albendazole is an antiparasitic drug that currently has a list price of approximately $225 per tablet (currently listed average cash price per tablet on goodrx.com).” I bought this in Canada for maybe $30 last year. And not just one pill. An entire course of it.
• jimbokun 6y ago
  Looks like Mr. Cuban is demonstrating that, sometimes, a superior business plan is the shorter path to justice than waiting for the Courts and the Legislature to catch up. Wiping out their businesses financially might be the most effective way to fight them, in the short term.
  • m463 6y ago
    robust competition cleans up a lot of problems. Also, as an employee having a company that has to actually compete can really eliminate a lot of BS. If you're in the 800-lb gorilla, there can be a lot of dysfunction. If you're in a company with an 800-lb gorilla, there's a good chance what you do may not matter (unless its really good).
    • taurath 6y ago
      Robust competition doesn’t exist without strong regulation, because the natural state of competition is monopoly even with a medium barrier to entry. Almost all of our companies nowadays are high barrier to entry.
      • satyrnein 6y ago
        In this case, isn't the barrier to entry itself regulatory? The drug approval process stops new entrants and federal law stops consumers from buying drugs from other countries. Otherwise, I imagine there would be a pretty robust market, given that these are generics and there's no R&D involved.
        • taurath 6y ago
          Capital costs are the barrier for a new generic drug maker, since the approval process is already done. Hense, Cuban starting a new one with his huge capital. But I’ll bet it will take lots of capital and well, they’ll find that there is no incentive to lower the price unless they want to gain market share. I suspect that pharma factories are quite expensive especially given the chemical reagent supply chain already being heavily owned or partnered with the incumbents.
• alexhwoods 6y ago
  THANK YOU
• sn_master 6y ago
  I like to know where those drugs are manufactured. I don't want to buy from another Ranbaxy...
• cyokada 6y ago
  Albendazole can be found for US$ 1 in drugstores in Brazil.
• weeboid 6y ago
  Nice, $GME the fuck out of big pharma
• randyrand 6y ago
  From the original title, i thought the company was called “Transparent”. That would have been a better name than this long name.
• antonzabirko 6y ago
  Yay! Glad he's doing something awesome for the world
• fireeyed 6y ago
  My friend recently got admitted to the hospital. There must be 10 people during the intake who didn’t seem to be doing anything. Some “nurses” were just observers. There were two admin people who came into to take personal information. 2 medical techs who just took temperatures and nothing else and finally a real nurse who did all the vitals and finally the doctor after 2 1/2 hours. Imagine the efficiencies that could be extracted and passed on to the patients.
  • tsjq 6y ago
    > efficiencies that could be extracted that that MBA speak for "making those many people unemployed" ?
• xmichael0 6y ago
  Not sure, but albendazole seems over priced still. I bought 6 tablets less than a year ago in Costa Rica for about $5
• whitej125 6y ago
  For those interested... I thought this was a pretty good book going over the creation and evolution of the US Healthcare system. It's equal parts fascinating and infuriating. An American Sickness: How Healthcare Became Big Business and How You Can Take It Back by Elisabeth Rosenthal ASIN : 1594206759 Publisher : Penguin Press; 1st edition (April 11, 2017) Language : English Hardcover : 416 pages ISBN-10 : 9781594206757 ISBN-13 : 978-1594206757
• codecamper 6y ago
  It's lucky we have so many rich people to see us through. /s
• marcell 6y ago
  Isn't the whole issue with drugs the fact that they have a huge upfront cost in terms of research, and then they are basically free to produce? If you just do cost plus, then the research can't get (retroactively) funded. This is similar to software, where the marginal cost is zero.
  • apendleton 6y ago
    Sure, that's what patents are for: to guarantee exclusivity to whoever bore the R&D cost so they can charge a lot for long enough to recoup their investment. This service is selling generics, though, so they'll be off-patent at this point.
• eatbitseveryday 6y ago
  Albendazole is given as an example on the page. Last time I was in China, I purchased a pack of these pills just in a grocery store pharmacy, no prescription needed. It was something under a dollar per pill. How does Albendazole still cost $13 / pill to produce?
  • newsclues 6y ago
    Made in America costs more?
• treelovinhippie 6y ago
  This is hilariously bizarre from a non-US perspective, but your country is so primitive in this area that a "Mark Cuban" branded solution is probably the most viable path out of the mess.
• HarryHirsch 6y ago
  Mark Cuban is selling Albendazole, the well-known anthelmintic that has been at market since 1975. Current sticker price of Albenzazole in US: several hundred dollars. Cost in the developing world: a few pennies, according to Wikipedia. Is this a joke? Would the government rouse itself to negotiate prices with manufacturers, like it does in the developed world? We'll have to wait four more years, with Mr Joe "Nothing will fundamentally change" Biden.
  • tomcam 6y ago
    > Would the government rouse itself to negotiate prices with manufacturers, like it does in the developed world? Well... the previous occupant of the White House tried to do exactly that and was struck down by the courts. https://www.fiercepharma.com/pharma/fierce-pharma-politics-judge-blocks-trump-s-most-favored-nations-drug-pricing-rule https://www.fiercepharma.com/pharma/fierce-pharma-politics-j...
    • HarryHirsch 6y ago
      The government isn't just the executive branch, there's also the legislative. The courts just interpret current laws. It's Congress and the Senate that need to act, but they won't. They are financed by people like Marc Cuban who buy politicians to increase their wealth even further, as seen here. The complete disregard for public health actually makes me angry. Here's more: https://www.ft.com/content/f0080fe4-c3ad-11e6-9bca-2b93a6856354 https://www.ft.com/content/f0080fe4-c3ad-11e6-9bca-2b93a6856... A common anthelmintic is somewhere north of 400 dollars in US but in Britain it's something like 5 pounds. Profits for the well-connected, pinworm for those that can't afford it. Pharma markets are funny, of course there is a monopolist, given the size and entry requirements, consequently you need a monopoly buyer. Can the government please wake up and govern?
• monadic3 6y ago
  As long as insurance will pay up for these drugs, this is good. Even if they don't there's a chance this might have a positive effect.
• stefantalpalaru 6y ago
  > Our low cost albendazole product allows physicians to affordably treat hookworm outbreaks throughout America that were previously too expensive to treat systemically before. Relevant article: https://www.theguardian.com/us-news/2017/sep/05/hookworm-lowndes-county-alabama-water-waste-treatment-poverty https://www.theguardian.com/us-news/2017/sep/05/hookworm-low...
• alexosh1 6y ago
  Hi guys, Alex Oshmyansky here, CEO of the Mark Cuban Cost Plus Drug Company. Crazy to see our little project at the top of Hacker News! We're planning to introduce a lot more drugs with transparent prices later this year, cutting out monopolistic middlemen in the supply chain and alleviating pharma drug shortages, particularly for rare and orphan disease conditions. We are looking for a few devs (fullstack, frontend, and backend). If anybody is interested, drop me a line at alex@costplusdrugs.com In the meantime, happy to answer questions if anyone is interested!
  • evo_9 6y ago
    Awesome project! What is the stack, what kind of developers are you looking for? Maybe post a link to your job listings.
    • alexosh1 6y ago
      Currently our frontend is react, backend node.js, and a MySQL database with a graphql API (edit). Would be looking for folks to help make a more robust consumer facing site as we add products and different types of customers. We've been focusing mostly on filling roles for the sterile fill-finish facility we are constructing in Dallas (QA, formulation specialists, etc.) and have put building out the dev team for the web sit kind of on the backburner with me just kind of personally managing it at the moment. While Hacker News is looking though... :-)
      • brianwawok 6y ago
        Why do you need a graph database to run a drugstore? You will save hundreds of thousands of dollars in development if you just use postgres...
        • erikpukinskis 6y ago
          GraphQL is not a database it’s just a wire protocol. You need a database behind it and Postgres is quite common. Compare it to JSON:API or GRPC. With Apollo it also solves a lot of frontend caching and state management problems so you can somewhat use it as an alternative to Redux.
• ridaj 6y ago
  > There are no hidden costs, no middlemen, no rebates only available to insurance companies. Everybody gets the same low price for every drug we make. While this sounds good in practice, will it work in reality? I remember a pharma sales guy explaining that one of the ways his company got away with being more expensive than the competition was to practically give the medicine away to hospitals, so that the hospital would be more likely to prescribe it than the cheap generics, after which point the patients would just keep refilling the same meds (with the higher price then picked up by insurance) In any case, I wish this company good luck! The US really could use more "maverick competitors" in the medical space
  • tsjq 6y ago
    wasn't a similar attempt by Amazon+Berkshire+JPMorgan recently dismantled ?
• dakial1 6y ago
  Wait, doesn't the US has generic medicine? In Brazil they have managed to keep the prices low for medicine in general.
  • deleted 6y ago
    [deleted]
  • TaylorAlexander 6y ago
    Medicine in the US is a dumpster fire.
• Sprbdg 6y ago
  This owns.
• edison112358 6y ago
  Where are/will these drugs manufactured?
  • tsjq 6y ago
    China/India,
• Triv888 6y ago
  Only 2 top level comments on the first comment page[1]... 1. https://i.imgur.com/w9zkfCM.png https://i.imgur.com/w9zkfCM.png If you are having troubles scaling up, maybe you could collapse all comments by default and load the child comments only when the user expand them?
• nojvek 6y ago
  It’s pretty insane how big of a marketshare CVS owns. They can make or break small pharmacies. Either you accept their terms or they refuse to let hospitals and doctors to work with you. I really hope this works out. We need more public corps companies like this.
• eplanit 6y ago
  I'm very happy to see that Dallas, TX will be the site of the factory.
• asdofindia 6y ago
  Indian doctor here. We give Albendazole tablets away for free. Maybe you can take a flight, buy a bunch of these tablets from the local pharmacy, and go sell them for half the price you are putting on your low-cost website.
  • tsjq 6y ago
    ha haa :) good one indeed.
• jcims 6y ago
  Seeing albendazole on the company site is cool. It and other anthelmintics seem to be showing possible benefit in a variety of cancer therapies. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404055/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404055/
• ratsforhorses 6y ago
  Just saying, in some countries you don't need to buy the whole packet (of pills) it's more ecological(less use of packaging, less unused stuff) and cheaper for the consumer...is this illegal in the US (or other countries) also what are the downsides ? (Theoretically the usage paper could be photocopied, found on the net)
• Outdoorsman 6y ago
  Old coder here...multiple environments ... I've kept up, still making enough to live comfortably ... hope to retire soon. Couple of thoughts: 1) Not a bad idea, been proposed before, drugs at a fair market value ... a little over cost ... good if true ... keeping in mind current restrictions. 2)Is this a springboard for a 2024 Cuban run at the presidency?
• geoelkh 6y ago
  This is awesome!
• anovikov 6y ago
  Albendazole - retail price in Russia is $2 per pill... How in the world it may cost $13 per pill to manufacture and sell? OK you can factor in Russia vs USA ~2.5x PPP factor, it's still $5 per pill retail then - how come it comes out 4x more expensive?
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• tsjq 6y ago
  Check out the Jan Aushadhi Pharmacies model of India.
• KrishnaAnaril 6y ago
  Is this similar to India government's Janaushadhi Pariyojana[1][2]? 1. https://www.india.gov.in/spotlight/pradhan-mantri-bhartiya-janaushadhi-pariyojana https://www.india.gov.in/spotlight/pradhan-mantri-bhartiya-j... 2. https://en.wikipedia.org/wiki/Pradhan_Mantri_Bharatiya_Janaushadhi_Pariyojana https://en.wikipedia.org/wiki/Pradhan_Mantri_Bharatiya_Janau...
• rplnt 6y ago
  Well if this is supposed to be an eye-opener, than it might work. Otherwise the prices listed are still insane, and comparing them to non-existent prices doesn't help the case to make it trustworthy.
• edeion 6y ago
  My French brain frequently struggles to parse English titles. But this one takes the cake! Before opening the link, I was expecting something about drug addictions and Cuban cigars. (It's about a company that goes under the overly complicated name of Mark Cuban Cost Plus.)
• lisa39 6y ago
  Will the company be selling stocks
• deleted 6y ago
  [deleted]