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  #311  
Old 01-16-2019, 03:50 PM
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Is there a "not" missing from the bolded
Crap. Will fix. At least I know one person made it to the second paragraph, that’s a win.
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  #312  
Old 01-16-2019, 04:15 PM
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Crap. Will fix. At least I know one person made it to the second paragraph, that’s a win.


Well I was just really confused about your position and then I realized it would all make sense with that one edit.

Payees reimbursing co-pays should not be allowed on any type of insurance. (Other place where I see it is with auto-glass repair.) That completely negates the purpose of the co-pay.

But then you hit gray areas like coupons & stuff. I used a coupon for a scar medication where the negotiated price was something like $500 and with my high deductible plan, I was on the hook for the whole $500. But there was a coupon for $150 off. Now it certainly didn't screw with insurance trend since I was paying the whole price anyway. But if someone else had a $75 co-pay on the Rx, then the very expensive medication would be free. And if that person was willing to spend $0 but not $75 for the expensive medicine, then that would absolutely mess with trend.

But that wasn't reimbursing the co-pay... it was a coupon. Should *that* be allowed? Probably not, but it can get murky quickly. I assume the manufacturer wanted to be able to get $425 from the guy with the $75 co-pay but was OK with only getting $350 from me. Why should the insurer be on the hook for the extra $75 though?

Generally agree with everything else you said.
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Old 01-16-2019, 04:22 PM
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What should the right number be? 17% of revenue is much higher than I expected. Most companies outside pharma don't even whiff that.
Depends on the size of the company really. A small one could conceivably plough 50% into R&D due to only being able to pipeline one drug.

On a sliding scale, I would day 25 (big company) to 50 (small company as discussed) is a good metric to use.
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Old 01-16-2019, 04:37 PM
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You are being horribly naive if you truly think a big chunk of those monopoly-level profits go to R&D spending. Even the big pharma players spend only about 17% of revenue (range of 12 - 23%). They sold the public on the lie it all gets ploughed into R&D, but that is simply not true. It mostly goes to pad their bottom line.
I didn’t say those profits go to R&D spending. I’m saying if voters wanted, they could ask their politicians to support R&D from taxpayer funds so that medicines can be part of the public domain and 1 owner can’t set the price, or vote for having IP laws changed, but sitting there voting for politicians to cut costs, cut science research, cut taxes (or spend it on things that doesn’t benefit the public), and then complain when a private entity charges them “too much” is trying to eat their cake and have it too.
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Old 01-16-2019, 04:41 PM
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Well I was just really confused about your position and then I realized it would all make sense with that one edit.

Payees reimbursing co-pays should not be allowed on any type of insurance. (Other place where I see it is with auto-glass repair.) That completely negates the purpose of the co-pay.

But then you hit gray areas like coupons & stuff. I used a coupon for a scar medication where the negotiated price was something like $500 and with my high deductible plan, I was on the hook for the whole $500. But there was a coupon for $150 off. Now it certainly didn't screw with insurance trend since I was paying the whole price anyway. But if someone else had a $75 co-pay on the Rx, then the very expensive medication would be free. And if that person was willing to spend $0 but not $75 for the expensive medicine, then that would absolutely mess with trend.

But that wasn't reimbursing the co-pay... it was a coupon. Should *that* be allowed? Probably not, but it can get murky quickly. I assume the manufacturer wanted to be able to get $425 from the guy with the $75 co-pay but was OK with only getting $350 from me. Why should the insurer be on the hook for the extra $75 though?

Generally agree with everything else you said.
Certainly a lot of gray areas. For my cancer patients, I'd rather have them get a coupon and get expensive medication rather than go without. For high-deductible plans coupons make a lot of sense, or self-pay customers.

I dislike rebates to GPOs and physicians, in general. But we are starting to re-frame how we handle these, and as that happens I'm coming around on the idea. I can't say much more than that.

There has been the notion floated of rebating payers, in order to get put on the formulary. I don't have specifics but I think it's been done a few times. That is toeing the line of payers practicing medicine, of course. But in the world we live in, I think it's going to be a big part of the new reality. Payers are absolutely going to keep tightening down with prior auth, clinical pathways, value-based metrics, etc.
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Old 01-16-2019, 04:47 PM
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I didnít say those profits go to R&D spending. Iím saying if voters wanted, they could ask their politicians to support R&D from taxpayer funds so that medicines can be part of the public domain and 1 owner canít set the price, or vote for having IP laws changed, but sitting there voting for politicians to cut costs, cut science research, cut taxes (or spend it on things that doesnít benefit the public), and then complain when a private entity charges them ďtoo muchĒ is trying to eat their cake and have it too.
I think I misread your earlier post as well. When you say the system isn't broken, you mean it's working exactly as it should... because it's been designed to make money for pharma? And we keep voting in people who maintain that status quo? Because free markets, wooooooo!!!!!

If so, then I'm with ya.
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