3 ms·

The former, yes, but they’re far more expensive. The latter, kind-of. You have to have regular check-ins, dependent on the type of medication

by wepple 2y ago

olalonde 2y ago
It's crazy that you can't get a prescription for under 379$. Something is seriously broken with that system. I'm pretty sure I could get one for 1/10 that price where I live, without insurance.
- GuinansEyebrows 2y ago
  When I first moved to the Netherlands, I had to visit a pharmacy to purchase insulin. I was prepared to spend nearly half my paycheck on a months supply and deal with the headache of not having a prescription on file before I’d established insurance. I walked out the door with a box of Lantus pens having spent 80€. That would have cost me about $600 in the US at the time, if they’d even dispense to me without a prescription.
  - rafram 2y ago
    It only would’ve cost you $600 if you paid the list price, which no uninsured patient should ever have to do. GoodRx has a coupon that takes it down to $35 per 30-day supply - significantly cheaper than in the Netherlands - and any decent pharmacy should offer you their “store discount,” which will be about the same.
    - olalonde 2y ago
      Why is there a "list price" and an actual price? What's the point? Do pharmacies not compete with each other? Imagine if you went to a McDonald and the Big Mac was 300$ but it really was 10$ if you asked for a discount. So many questions...
      - dghlsakjg 2y ago
        In the US, pharmacies absolutely compete, but the model is complex. They are delivering service to a party that is not always the one paying (Patient vs. Insurer). They can dispense the same drug from multiple suppliers with wildly different costs in some cases (Original vs. Generic). Most of their customers have some sort of coverage, so the coupons don't apply. The drug companies really hate when their are articles about people dying because they can't afford meds, so they have coupon programs for the uninsured, but keep the list price high since that is the starting point for negotiating with the insurers. Don't forget that doctors are completely disconnected with cost. They don't even know their own rates that will be charged to the patient in many cases, let alone what the cost of drugs are, and what portion of that the patient will end up paying. So on the patient side, the pharmacy will compete for patients with convenience, while the insurer will try to steer the patient to approved generic drugs and manufacturers with negotiated deals, while the drug companies are trying to steer the patient to the most expensive name brand drugs. Oh yeah, and then there are the unlucky minority that don't have insurance or have insurance that won't cover the drug they need, and they get a coupon. It is SUPER fucked. The answer is that there are at least four parties in any pharmacy transaction (Dr., Pharmacy, patient, drug maker, and sometimes insurer) that all have different incentives. Some that overlap, and some that are opposed.
        rafram 2y ago
        Four parties? Try five! Insurance means there’s a pharmacy benefit manager in the mix as well. Sometimes those are independent companies, but often they’re owned by either your insurer or your pharmacy (or some other big chain of pharmacies, e.g. CVS). That’s one more middleman and often one more conflict of interest in the mix.
      - rafram 2y ago
        I’m not saying it’s a good system, just that there’s no reason for anyone without insurance to pay the unrealistically high list price. There are discount cards that work with insurance, too. Like a drug with a $10 copay might have a discount card that fully covers the copay. You just have to do a little research before going to the pharmacy.
    - GuinansEyebrows 2y ago
      There is zero humane justification to require any chronically ill person to present a coupon to afford a regular medication that they would otherwise die without. Zero.

The former, yes, but they’re far more expensive. The latter, kind-of. You have to have regular check-ins, dependent on the type of medication

by wepple 2y ago

The former, yes, but they’re far more expensive. The latter, kind-of. You have to have regular check-ins, dependent on the type of medication

olalonde 2y ago

It's crazy that you can't get a prescription for under 379$. Something is seriously broken with that system. I'm pretty sure I could get one for 1/10 that price where I live, without insurance.

GuinansEyebrows 2y ago
When I first moved to the Netherlands, I had to visit a pharmacy to purchase insulin. I was prepared to spend nearly half my paycheck on a months supply and deal with the headache of not having a prescription on file before I’d established insurance. I walked out the door with a box of Lantus pens having spent 80€. That would have cost me about $600 in the US at the time, if they’d even dispense to me without a prescription.
- rafram 2y ago
  It only would’ve cost you $600 if you paid the list price, which no uninsured patient should ever have to do. GoodRx has a coupon that takes it down to $35 per 30-day supply - significantly cheaper than in the Netherlands - and any decent pharmacy should offer you their “store discount,” which will be about the same.
  - olalonde 2y ago
    Why is there a "list price" and an actual price? What's the point? Do pharmacies not compete with each other? Imagine if you went to a McDonald and the Big Mac was 300$ but it really was 10$ if you asked for a discount. So many questions...
    - dghlsakjg 2y ago
      In the US, pharmacies absolutely compete, but the model is complex. They are delivering service to a party that is not always the one paying (Patient vs. Insurer). They can dispense the same drug from multiple suppliers with wildly different costs in some cases (Original vs. Generic). Most of their customers have some sort of coverage, so the coupons don't apply. The drug companies really hate when their are articles about people dying because they can't afford meds, so they have coupon programs for the uninsured, but keep the list price high since that is the starting point for negotiating with the insurers. Don't forget that doctors are completely disconnected with cost. They don't even know their own rates that will be charged to the patient in many cases, let alone what the cost of drugs are, and what portion of that the patient will end up paying. So on the patient side, the pharmacy will compete for patients with convenience, while the insurer will try to steer the patient to approved generic drugs and manufacturers with negotiated deals, while the drug companies are trying to steer the patient to the most expensive name brand drugs. Oh yeah, and then there are the unlucky minority that don't have insurance or have insurance that won't cover the drug they need, and they get a coupon. It is SUPER fucked. The answer is that there are at least four parties in any pharmacy transaction (Dr., Pharmacy, patient, drug maker, and sometimes insurer) that all have different incentives. Some that overlap, and some that are opposed.
      - rafram 2y ago
        Four parties? Try five! Insurance means there’s a pharmacy benefit manager in the mix as well. Sometimes those are independent companies, but often they’re owned by either your insurer or your pharmacy (or some other big chain of pharmacies, e.g. CVS). That’s one more middleman and often one more conflict of interest in the mix.
    - rafram 2y ago
      I’m not saying it’s a good system, just that there’s no reason for anyone without insurance to pay the unrealistically high list price. There are discount cards that work with insurance, too. Like a drug with a $10 copay might have a discount card that fully covers the copay. You just have to do a little research before going to the pharmacy.
  - GuinansEyebrows 2y ago
    There is zero humane justification to require any chronically ill person to present a coupon to afford a regular medication that they would otherwise die without. Zero.