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  #291  
Old 11-03-2018, 11:28 PM
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Seems like the best thread for this. Utah hatches a new plan for about a dozen drugs. They will allow employees to get the drugs in Mexico. If an employee decides to do it, they will be reimbursed for travel and given $500 cash.

https://www.sltrib.com/news/2018/10/...h-drug-prices/
I wonder how much work had to go into the regulations and 'guidance' surrounding this legislation. I'm thinking of things like:

-first-class allowed?
-which Mexican cities are eligible?
-round-trip?
-how many layovers allowed/required?
-cheapest available required?
-do they contract with certain airlines?
-do they contract with certain Mexican pharmacies?
-do they contract with certain manufacturers WRT the suppliers in Mexico?
-require travel via rented automobile? rented limo? rented RV? bus? train?
-what kind of documentation of itinerary is required for reimbursement?
-if I have a family member, friend, or other party that can travel and make the purchase (a straw purchase, sort of) for me, at a cheaper cost, can they do that? if they do, do I get reimbursed the actual cost or the cost it would have been if I did it as though I did it myself? or some savings split amount in between?
-if another country, for example Honduras or Panama or Benin, is actually cheaper, can that be used instead of Mexico with the same reimbursement plan?
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Last edited by FormLetter; 11-03-2018 at 11:29 PM.. Reason: added the word 'Mexican'
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  #292  
Old 11-03-2018, 11:34 PM
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True. But this is interesting because it's not a patient gaming the system. An employer has actually structured a benefit to pay for this, which is fascinating.

And my question was really around health services, like a joint replacement or what-have-you. Medical tourism is obviously a thing, but has a payer, or an employer, ever offered a deal like this for something besides drugs?
I thought that some surgeries had this take place in India and some East Asian counties. Not sure if my brain's wires are simply crossing WRT medical tourism. I know it takes place for elective things like plastic surgeries, and that people do cross the border to Mexico for [non-trivial] dental care regularly.

I saw signs to that effect on some dentist offices while traveling in Mexico.
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  #293  
Old 11-06-2018, 05:26 PM
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Originally Posted by FormLetter View Post
I wonder how much work had to go into the regulations and 'guidance' surrounding this legislation. I'm thinking of things like:

-first-class allowed?
-which Mexican cities are eligible?
-round-trip?
-how many layovers allowed/required?
-cheapest available required?
-do they contract with certain airlines?
-do they contract with certain Mexican pharmacies?
-do they contract with certain manufacturers WRT the suppliers in Mexico?
-require travel via rented automobile? rented limo? rented RV? bus? train?
-what kind of documentation of itinerary is required for reimbursement?
-if I have a family member, friend, or other party that can travel and make the purchase (a straw purchase, sort of) for me, at a cheaper cost, can they do that? if they do, do I get reimbursed the actual cost or the cost it would have been if I did it as though I did it myself? or some savings split amount in between?
-if another country, for example Honduras or Panama or Benin, is actually cheaper, can that be used instead of Mexico with the same reimbursement plan?
As I read it, this isn't legislation. This is benefit plan design. That said, I'd be curious to know more of how the sausage was made. I assume there was a lot of investigating. They probably would want the Mexican pharmacy to provide drug provenance, to ensure they weren't giving their members counterfeit drugs.
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  #294  
Old 11-06-2018, 05:48 PM
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Oh, the Trump administration recently rolled out the International Price Index, a mechanism to tie the drug price in the US to drug prices in other countries. And there are other provisions being contemplated as well (this is a proposal, it's not final).

Currently, Medicare reimburses physicians 4.3% above the average sales price, for drugs administered in a physician office. It effectively gives physicians who administer drugs a 4.3% margin on drugs, which encourages physicians to use more expensive drugs. They aim to make a (revenue-neutral) switch to paying physicians a flat amount per drug administration, more or less. So a physician would make the same giving a generic as they would with a branded drug.

They also talk about having physicians participating in this model purchase their drugs from a third-party vendor. Ostensibly those vendors would compete against one another, lowering prices. I'm still digesting how this might or might not substantially differ from how distributors compete today.

Linky
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