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I'm on a similar deal for my Psoriasis medication, Cosentyx. The Insurance company is billed some ungodly amount, and my copay is small or $0. There has to be
by jasonjayr 2y ago
I'm on a similar deal for my Psoriasis medication, Cosentyx.
The Insurance company is billed some ungodly amount, and my copay is small or $0.
There has to be some financial shenanigans going on: someone is marking up the price, and writing it off to some reasonable level for some benefit. It's not sustainable to the insurer or the insured to be paying these kinds of prices for what amounts to a 'forever' medication.
The stress of maintaining the discount programs, induces quite a bit of anxiety.
- s1artibartfast 2y agoNovartis revenue from Cosentyx is 3 billion for the first 6 months of 2024, and up 20% YoY. There is absolutely some shenanigans going on, but most of that goes on with the Pharmacy benefits manager.
- jasonjayr 2y agoRight, so, My insurer is United, the Pharmacy is OptumRX, the PBM is OptumRX, and the discount program is from Novartis. All these parties (ultimately 2?) are doing something to their balance sheets.
- ceejayoz 2y agoYes. For example: https://www.propublica.org/article/when-buying-prescription-drugs-some-pay-more-with-insurance-than-without-it https://www.propublica.org/article/when-buying-prescription-... https://www.propublica.org/article/take-the-generic-drug-patients-are-told-unless-insurers-say-no https://www.propublica.org/article/take-the-generic-drug-pat... https://www.nytimes.com/2024/04/07/us/health-insurance-medical-bills-takeaways.html https://www.nytimes.com/2024/04/07/us/health-insurance-medic...
- s1artibartfast 2y agoRight. PBMs and insurance make large profits, and that is additive to that of the manufacturers. I wonder what the total cost to patients of the drug is.
- gusgus01 2y agoI'm not sure if it was the point, but both United Healthcare Insurance and OptumRx are both owned by United Health Group. Also I think it's about 1 in 10 doctors in the US work for them in one form or another. They've been in the news a bunch this year.