Quote:Well I can't address everything in a short post, I'm sorry to hear about your epilepsy, I've seen how debilitating that can be. 

 

When you say that both drugs are unaffordable despite being covered on the insurance plan, are you saying that the copay on them is so high that they are unaffordable? I've seen that happen before. 

I remember hearing them promise that the ACA would close the Donut hole but you know how government promises go eh?

 

Given that the government is full of a bunch lying scam artists are crooks, I am not sure that Soviet style price controls are a solution either. You may be able to set price controls on an item in the short term, but you aren't actually lowering the cost of the item, you are only distorting the market for it and that plays out in the unintended consequences. 

 

The cost of the extended release tablets is super high only because that cost is getting paid somehow. If they weren't getting that price for the drug, they wouldn't be selling it that high. I doubt that the incredibly wealthy have far more epilepsy than the average Joe and are just shelling out massive amounts of money for this extended release drug, so someone is paying that bill--probably either the government or the insurance company. They are distorting the price and the market for that drug. Perhaps there is another insurer that would cover more of the cost of that rx? I'd bet if you weren't buying it through the insurance, the actual final cost of the drug would not be the same at all. When insurance is paying, why charge $5 when you can charge 20 and they still pay? Same deal with the government, that's why they pay $500 for a hammer or $10,000 for a toilet seat. It is all market distortion. 

 

What if we had a law that said that a pharmacy or pharma company cannot charge different rates to different customers? If you and I were both in line at the Walgreens and we're both getting the prescription XYZ-ER and they tell you it's $750 and they tell me it's $150, that's some bullpucky, but that's what they are doing. They say o ok 80% of your $750 is covered by your insurance, so you pay $150 out of pocket----you paid the same out of pocket as me, but you got ripped off cause you pay for your insurance too. They inflate the price to make it look like the insurance has saved you money when it hasn't. 

 

Actually you're wrong about pricing. It's against the law for any health care entity, pharmacy included, to price their drugs or services differently because of the insurance status of the customer. They can contract with insurance for lower reimbursement, but they cannot have a different list price, it has to be the same all the time. What's different is the amount of the contractual discounts from that price, those vary payer to payer and even contract to contract from the same payer.

 

Additionally, drug costs are reimbursed by insurance companies based on the Average Wholesale Price document produced by CMS each quarter. Most contracts are set in stone at the AWP so you don't negotiate them, you just get paid what the document says plus a small percentage. If the pharmacy is giving you a number it's the out of pocket expense which varies, not the shelf or list price because that really doesn't.

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