5 ms·

FYI for anyone who isn't familiar with the wacky US insurance situation: Nobody in the US actually pays $800 for the drug. That's the "list price" for insurance

• Insanity 11mo ago
  I think that might be worse than just having the high price. Such a kafka-esque systems just to get medicine.
  • timeon 11mo ago
    Probably not just medicine. I heard that prices in US shops are different than final price at the counter.
  • averageRoyalty 11mo ago
    Absolutely. I'd prefer to go to the pharmacy and just pay my $20 and go.
    • dotancohen 11mo ago
      Do you prefer sunny (Greece) or snowy (Norway)? You can just pay your $20 and go. It is an option.
      • actionfromafar 11mo ago
        I prefer to pay thousands in tariffs and/or private companies, thank you very much. I'm not a communist.
        • Muromec 11mo ago
          Sir, your visa application is denied anyways.
          • actionfromafar 11mo ago
            Yes Sir Mr President Sir.
      • averageRoyalty 11mo ago
        I'm happy in both (Australia). But thanks!
    • rootusrootus 11mo ago
      That's usually how it works for me in the US. I go in to the pharmacy, and at least half the time they say 'no cost' and hand me my medication. Sometimes I pay a $25 copay. And if I get an expensive drug from Eli Lilly (e.g. Zepbound) then Eli Lilly pays Walgreens up to $1950/year on my behalf and I never even know about it. The only way I figured it out myself was trying to figure out why my insurance said they paid X, and I paid Y, but I had actually only paid $25. Took a trip onto a Zepbound subreddit to learn about the backdoor payment thing. "Savings card" but not actually a card.
  • xnorswap 11mo ago
    The best thing about universal healthcare isn't how much money I may or may not have to pay, it's that I literally don't once have to think about a bill or filling out a form to avoid paying too much. I wouldn't care if I ended up paying more in tax than I would in an insurance model. The benefit is being able to 100% focus on my health instead of navigating a system to try to reduce what I'm paying. When you're diagnosed with an illness, that's a huge peace of mind.
    • ChrisMarshallNY 11mo ago
      [flagged]
      • wang_li 11mo ago
        The US has a massively progressive tax system. On a net tax basis about 50% of the country pays nothing. Sure, they pay sales tax and employment taxes, but they also receive some mix of earned income tax credits, child tax credits, snap, medicaid, housing, etc. There is no real way for the US to have a single payer tax system without more people actually becoming net tax payers.
        • sgerenser 11mo ago
          Yeah this is something people in favor of single payer healthcare in the U.S. don’t want to acknowledge. In most other countries, the middle 50% of taxpayers pay a much higher percentage of their income than in the U.S. Everyone somehow thinks we can make it work just by raising taxes on “the rich” (where that is usually defined as anyone making more money than them). But if it was that easy, then why does Canada and most European countries have so much higher taxes on the middle class? Now I’m not inherently against increasing taxes (for all) if it gave us a much better healthcare system, but you have to be intellectually honest about who would have to pay those higher taxes. It’s not just Elon Musk.
          • yoyohello13 11mo ago
            I'm curious what the actual number is. I have health insurance through my work and I pay over $1,500 a month for that (and still have out of pocket costs). That's $18,000 a year. That's a substantial percentage of my income which essentially is just a tax going to the insurance company instead of the government. Now if it cost a couple thousand more a year and I didn't have to worry about getting claims denied for random reasons, I'd take that deal. If it's $5,000-10,000 more a year? Then I'd have qualms.
  • CTDOCodebases 11mo ago
    It's the efficiency of capitalism at work. It's more efficient to allocate capital to systems and processes that delay or stop you claiming on your insurance than it is to actually pay out a genuine claim.
    • chii 11mo ago
      This has nothing to do with capitalism, and everything to do with regulatory capture and archaic rules established in a bygone era for a purpose that has since been outlived.
• ThePowerOfFuet 11mo ago
  All that handwaving and apology but yet >the actual cash-pay price is $225 So still 11x the price, plus whatever the prescription costs. Unforgiveable.
  • yread 11mo ago
    Well but that $225 feeds and clothes a lot of the people who spend all day designing these cards and systems around that
    • actionfromafar 11mo ago
      Including Oracle, probably.
  • loeg 11mo ago
    The FDA bears much of the responsibility for that cost, which GP explained.
• brianherbert 11mo ago
  These "savings cards" have a maximum annual benefit applied to them so for those on insurance that do not cover those expensive medications or who are self-paying use up the benefits before year end and do in fact eventually pay full sticker price.
  • Ancapistani 11mo ago
    Then you switch to a difference card. That's pretty much the entire business model of GoodRx.
  • khannn 11mo ago
    I was on a blood thinner and the medication was very pricey. Didn't have insurance and the "savings card" covered fuck all unless you had insurance. There are three blood thinners on the US market and they all cost a lot.
    • dyauspitr 11mo ago
      If you don’t have insurance, you’re essentially fucked in the US but this thread is not referencing that situation. My CAT scan was billed for $10,000 but what I paid was about $200 with insurance. Without insurance I would owe $10k.
      • maccard 11mo ago
        > Without insurance I would owe $10k. Without insurance you would be _billed_ $10k but in reality you likely end up paying less than that. It's still scandalous, mind you.
      • hnuser123456 11mo ago
        Why stop the conversation here? And if you don't have insurance but go to an ER (can't be turned away) and end up getting some expensive procedure you can't afford, you can just tell them that you're broke and they negotiate way, way down, or even just forgive it. And it's setup like this to ensure only people who have proper full time jobs or who can write a good enough sob story can get care. Because so many of the people in charge of this mess are far more obsessed with blocking out people they can't get enough data on or who aren't working, then figuring out reasonable public prices that make some effort to strike some fair market balance. So that if you have some savings and aren't employed, you are forced to find any job with benefits so you aren't left bankrupt, which makes taking care of health struggles harder as you have to work instead of take care of yourself.
• autoexec 11mo ago
  > So a lot of people who take this drug in the US actually pay $0 because they sign up for this card. They do not pay $0 because the insurance company raises the rates for all of their customers to cover the cost of all the red tape and time spent negotiating with drug companies over their bullshit. The insurance companies aren't eating those costs, they're profiting from them and it's us who end up footing the bill. By the time you factor in the unnecessary time, staff, record keeping, etc. the actual cost for the $20 drug will be even more than the $800 sticker price. No matter how our crooked system twists things to make it look otherwise they always make you pay. One way or another.
  • jtbayly 11mo ago
    Yep. And it's worse than that. 80% of prescriptions are controlled by 3 companies. You can look up the FTC report on it. All three of them own or are owned by insurance companies. The insurance companies had their profit percentage capped, and so the only way they could increase profits was by increasing their share of the pie. So they bought medical providers and prescription companies. Now the insurance company is both the buyer and the seller, but not the one who pays. We pay. So they raise the prices of the drug, raise the cost of insurance, and make a lot more money while staying in their profit percent cap. All the way around, this is the opposite of a free market and the FTC should be breaking these companies up. And as everybody knows, all the way around, it is immoral, too.
• zuppy 11mo ago
  what about the poor people? the ones that can't really afford insurance. i've heard multiple times that epipen prices are crazy expensive and that's a really basic drug.
  • ksenzee 11mo ago
    If you’re really poor, you can get Medicaid. It’s the working poor who earn too much for Medicaid who are really shafted. The ACA tried to fix that for as many as it could, by expanding Medicaid to households making more money; the Republicans shut down the government to fight that expansion. It’s maddening.
    • sgerenser 11mo ago
      Gov shutdown wasn’t about medicaid expansion, which is done at the state level. It was about expanding ACA subsidies to those making more than 400% of the federal poverty level.
  • yunwal 11mo ago
    If you're poor you just wait until you're borderline dying and then go to the E.R. and get charged $120,000 and then never pay it and then have debt collectors calling you for the rest of your life. Or you're on Medicaid if you live in a sane state.
    • trollbridge 11mo ago
      Medicaid is available in all 50 states.
      • yunwal 11mo ago
        It is not available to all poor people in all states https://www.cbpp.org/research/health/the-medicaid-coverage-gap https://www.cbpp.org/research/health/the-medicaid-coverage-g...
        • 11mo ago
• sov 11mo ago
  > The FDA is partially to blame for this situation: ... > The cost of performing a New Drug Application starts in the mid hundreds of millions of dollars range and can extend into the billions for some drugs. > So nobody could feasibly introduce it to the market here without investing $500 million or more up front. At that price, your only viable option is to stick a big price tag on it and try to milk that money back from insurers. It's interesting that you seem so passionate about this because you're totally incorrect. The cost of a NDA for a novel prescription drug requiring clinical data (the most expensive application) is ~$4.5mil. In fact, the estimated TOTAL revenue to the FDA from ALL PD application fees in FY 2025 is ~$1.3billion (or, just under 300 novel prescription drugs). So, obviously, FDA fees can't be as much as you're claiming. What you're actually describing is the total cost of the entire drug development pipeline (research, design, lab costs, chemical costs, application costs, marketing costs, etc.) to develop a brand new, novel drug. And it's only ~$200m, increasing to $500m if you include dead ends / failures in the process, and ~$900m if you include both failures and capital costs--yep, that's right the capital costs alone are almost as much as the entire rest of the drug development pipeline. See: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820562 https://jamanetwork.com/journals/jamanetworkopen/fullarticle... And that's for novel Prescription Drugs. > They required a complete New Drug Application before they would let anyone bring it to market, even though it's over the counter in other countries. No. In that case they would pay the FDA OMUFA fees, not the FDA PDUFA fees, which are ten to fifty times cheaper than the PDUFA fees.
• ilovetux 11mo ago
  > FYI for anyone who isn't familiar with the wacky US insurance situation: Nobody in the US actually pays $800 for the drug. That's the "list price" for insurance companies to pay. Even insurance companies don't pay that price because they negotiate their own rates with the drug companies, which are lower. Sure, we do not pay $800 at the pharmacy when we go to pick up the prescription, but every cent the insurance company pays, we are paying by proxie with added admin costs.
• trashface 11mo ago
  > FYI for anyone who isn't familiar with the wacky US insurance situation: Nobody in the US actually pays $800 for the drug. That's the "list price" for insurance companies to pay. Even insurance companies don't pay that price because they negotiate their own rates with the drug companies, which are lower. This isn't really true on obamacare/ACA plans, even the high-end ones like gold PPOs. The formularies are much worse than employer-based plans. Insurers are required to cover one drug in each therapeutic category, but its usually an older generic. Most brand name drugs like this one have really bad coverage or not at all, which means the insurer won't even negotiate with the pharmacy to lower the drug. Yes you can use coupons, sometimes, but the pharmacy can't always process them and the manufacture is always change the conditions and expiring them. I got one for my glaucoma drops directly from my eye doctor, and it was expired immediately when I tried to use it. I have paid $650 (for a 3 month supply, the full retail cost) for my drops when the coupon didn't work, and I couldn't get them any other way - I can't interrupt the med or else my eyes get damaged. So that falsifies your "nobody" assertion.
  • cogman10 11mo ago
    Anyone know what's going on with the ACA marketplace? I like to take a peek at it every so often and it's just stupendously worse than employer healthcare. There is no plan in my market (Idaho) which doesn't have extreme out of network deductibles. The cost is also identical to what I and my employer pay for insurance. Is it just that the ACA is mostly used by sick people or something?
    • daveguy 11mo ago
      It's because health insurance companies need to pad their profits. Because we have a backward system in the US where profits are extracted by everyone without any competition from a not-for-profit. That's why the idea of a public option is so popular (it was originally a Republican idea until it was decided insurance company profits are more desirable). Personally, I don't think any health insurance company should be for-profit. But the for-profit companies sure as hell should have a non-profit competition with the same bargaining power they do.
• Someone1234 11mo ago
  This varies wildly by medication; and makes a ton of assumptions that all happen to benefit the drug company's position/parrots their PR. For example, my partner needs $100/pill medication, which also had a "savings card." That card only lasts for 12-months or 8-pills (whichever comes first). Then it is $100/pill. After insurance (High Deductible), we pay out of pocket $100/pill up until $3200. Insurance discount: 0%. So the cash price and the insurance price are identical, except the insurance price counts towards deductible. UK price of the same medication? £10/pill, and that isn't via the NHS, that is full-price private (NHS could be as low as FREE, depending on several factors).
• cyanydeez 11mo ago
  Not true. No one pays up front, our previous pay for those prices.
• jfghi 11mo ago
  I know people who have paid list prices for drugs because their insurance wouldn’t cover them.
• quantum_state 11mo ago
  The real question is: how much does the drug cost, independent of who pays for it?
• OptionOfT 11mo ago
  Except when for example your insurer choses to have certain exclusions. For example, my insurer does not cover weight loss medication. So starting next year, I'm on the hook for the $650 / month. I could of course stay fat, get diabetes and then get on Mounjaro, which is covered.
  • loeg 11mo ago
    What med do you plan to pay $650/mo for? Tirzepatide is $300-450/mo straight from Lilly[0] and semaglutide is similar from Novo[1]. (This is another price cut after Lilly dropped prices already in February[2].) It would not be shocking to see prices continue to fall in 2026 as semaglutide goes off-patent in Canada and maybe some of the in-pipeline drugs from other manufacturers come to market. [0]: https://www.reuters.com/business/healthcare-pharmaceuticals/eli-lilly-cuts-zepbound-price-widen-access-obesity-drug-2025-12-01/ https://www.reuters.com/business/healthcare-pharmaceuticals/... [1]: https://www.reuters.com/business/healthcare-pharmaceuticals/novo-nordisk-rolls-out-349-wegovy-cash-price-ahead-plan-2025-11-17/ https://www.reuters.com/business/healthcare-pharmaceuticals/... [2]: https://investor.lilly.com/news-releases/news-release-details/lilly-launches-additional-zepbound-vial-doses-and-offers-new https://investor.lilly.com/news-releases/news-release-detail...
    • OptionOfT 11mo ago
      Their autoinjectors are $650. But I did not know we could now get vials for my dose. This is great. I appreciate your comment. I really do. This medication has been a godsend.
• bobro 11mo ago
  >So a lot of people who take this drug in the US actually pay $0 because they sign up for this card. You do typically pay for insurance or otherwise have a reduced salary because your employer provides insurance, so saying you pay $0 isn’t really fair.
• WarOnPrivacy 11mo ago
  > Nobody in the US actually pays $800 for the drug. The lowest I can buy this drug for is $819.26. Period. > That's the "list price" for insurance companies to pay. $819.26 - $893.72 is the actual price (range) I must pay if I want to purchase this med. Period. The tales to the contrary fell apart the moment they were scrutinized. > Then the drug companies come in and offer a "savings card" which you apply at the pharmacy like another layer of insurance. No. They don't. They pretend to. It is a lie, as delivered. The manufacturer (Miebo) has a discount program. Miebo promises my cost for the eye drops will be ... ..."as low as $0" But below that we are told this deal only for Eligible Commercially Insured Patients. The ones with insurance that pays for the med. This American, on the other hand, will pay $819.26 - $893.72. Despite endless hints that there are pharma industry cards all over the place for the millions of millions of us who pay 100% out-of-pocket, there aren't. What there are: Tightly bounded programs, primarily for newly released and evergreened drugs. Generally the discounted cost is still more than the nearly identical drug they're trying to replace. > The FDA is partially to blame for this situation: Not in a meaningful way. Even Dodge vs Ford is a greater factor. Even the stinking DEA does more harm to out of pocket drug consumers (because it does that harm ceaselessly). > The cost of [ ... parrots pharma's trivially debunked talking points about why US Drug Consumers Must Get Gouged... ] back from insurers. No. ref: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796669 https://jamanetwork.com/journals/jamanetworkopen/fullarticle... Analysis of ref: https://www.csrxp.org/dose-of-reality-new-study-debunks-big-pharma-claims-that-high-prescription-drug-prices-are-tied-to-rd-investments/ https://www.csrxp.org/dose-of-reality-new-study-debunks-big-...
• reformd 11mo ago
  job creation and Arbeitsbeschaffungsmaßnahmen. berry cool
• drcongo 11mo ago
  Every time drug prices come up on here someone posts this explainer without mentioning the eye watering cost of the insurance.
• mooktakim 11mo ago
  You pay by paying the premium. Your employer pays, but that money comes from your potential salary.