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  #291  
Old 11-03-2018, 11:28 PM
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Originally Posted by George Frankly View Post
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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  #295  
Old 01-10-2019, 04:14 PM
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Forgot to post this earlier. In my world of oncology, there is a new class of drugs that are called CAR-T cell therapy, and they are an order of magnitude more expensive than any other drugs in the space (link).

But they didn't stop at charging a fortune. From the link above:

"The drugs are hugely expensive. Kymriah and Yescarta cost $373,000 to treat adults with advanced lymphomas, while Kymriah costs $475,000 to treat acute lymphoblastic leukemia in children and young adults."

Yep, they charge more to treat sick kids than they charge adults.
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  #296  
Old 01-10-2019, 04:43 PM
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Originally Posted by George Frankly View Post
Forgot to post this earlier. In my world of oncology, there is a new class of drugs that are called CAR-T cell therapy, and they are an order of magnitude more expensive than any other drugs in the space (link).

But they didn't stop at charging a fortune. From the link above:

"The drugs are hugely expensive. Kymriah and Yescarta cost $373,000 to treat adults with advanced lymphomas, while Kymriah costs $475,000 to treat acute lymphoblastic leukemia in children and young adults."

Yep, they charge more to treat sick kids than they charge adults.
The way the calculate how much to charge is pretty ridiculous.

i.e.

Our drug will save the system $600k over a patients lifetime, so we are charging $470k. See how awesome we are? 20% discount on future medical spending.

The whole system is broken in the US.
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  #297  
Old 01-10-2019, 04:54 PM
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Originally Posted by The_Polymath View Post
The way the calculate how much to charge is pretty ridiculous.

i.e.

Our drug will save the system $600k over a patients lifetime, so we are charging $470k. See how awesome we are? 20% discount on future medical spending.

The whole system is broken in the US.
They trotted out the same math with the hep C drugs.

The system is f*cked.

We've been poking around to see where we might be able to reduce spend in oral drugs (for cancer pts), there is a class of drugs called CKD4/6 inhibitors, there are now three drugs in the space (Ibrance, Kisqali, Verzenio). There are some slight differences but they are all kind of doing the same thing. And you'd think, when the second and third drugs entered the market, you'd see prices fall. But the avg sales price for all three is nearly identical, maybe 2% difference. Anyone want to guess how this happens?
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  #298  
Old 01-14-2019, 02:54 PM
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Originally Posted by The_Polymath View Post
The way the calculate how much to charge is pretty ridiculous.

i.e.

Our drug will save the system $600k over a patients lifetime, so we are charging $470k. See how awesome we are? 20% discount on future medical spending.

The whole system is broken in the US.
It's not broken. The US voting public seems to want others to spend their money on R&D, and then complain when others set the price. They're free to elect people who will increase taxpayer funding for R&D for medicine and put it in the public domain, and then they won't have to worry about someone else setting the price. But the majority in swing stages want to elect people who will cut taxes.
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  #299  
Old Yesterday, 06:45 PM
Helena Lake Helena Lake is offline
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Quote:
Originally Posted by George Frankly View Post
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?
At least a few years ago, there were certain treatments for which Canada would send their citizens to Seattle to treat. Combination of comparable price, higher expertise, and shorter wait times. I had a friend in BC who came to Seattle for some particular sort of brain surgery.

Beyond that... I dunno. I know it's not uncommon for people in Alaska to be sent south for some treatments, but I don't know if that's driven by price or just a straight-up lack of doctors in AK.
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  #300  
Old Yesterday, 06:48 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?
I would guess that the benefit is structured pretty similarly to travel & donor benefits for transplants - limits on who gets to travel and a limit on total outlay. You can book whatever you want, but the carrier's not going to pay more than $x.
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