Posted on 06/17/2017 4:53:46 AM PDT by Kaslin
When it comes to the nation’s healthcare system, most citizens recognize the need to counter rising healthcare costs and control fixed costs such as spending on insurance premiums and prescription drugs. By reducing these burdens on consumers and taxpayers, the U.S. can lower costs for entitlement programs and reinvest or return money to taxpayers where it’s needed most.
In an effort to identify areas for additional cost savings across the healthcare delivery network, the Senate Health, Education, Labor and Pensions Committee recently held a hearing on how drug delivery systems affect consumer prices.
Though only covering one aspect of the larger healthcare system, this is an important step in understanding the numerous players that operate in the opaque ecosystem between drug manufacturers and consumers. Organizations that influence pricing for pharmacies hold enormous sway over the healthcare market and face very little scrutiny or regulation.
The largest of these players are Pharmacy Benefit Managers (PBMs), companies which function as third party administrators of prescription drug programs. PBMs develop a list of approved medications they will cover, negotiate with manufacturers for list prices and accompanying rebates on behalf of pharmacies, and then contract these lists and prices to pharmacies.
The size and power of these companies means that manufacturers must negotiate with them to distribute their products, while pharmacies must contract to them to fill prescriptions for patients.
In fact, just three PBMs (Express Scripts, CVS Caremark, and OptumRX) control 75-85 percent of the market and have more than $250 billion in estimated revenues. It should be of no surprise that many of these companies are some of the largest in the U.S. – CVS Health, which owns CVS Caremark, is the seventh largest company in the country and Express Scripts is the 22nd largest.
This has led to numerous instances of abuse and outright criminal behavior as PBMs pocket savings intended for consumers and operate a business model that privileges profits over patients. Recently, Anthem decided to part ways with its PBM, Express Scripts, over an ongoing suit the insurer filed claiming Express Scripts withheld billions in savings. These are savings that ultimately are not being passed onto the taxpayer.
From rebates from manufacturers to processing fees for pharmacies, PBMs pocket profits at every step and, due to their market power and size, can even increase costs to consumers while reducing choice and competition.
PBMs author and update formulary lists, a master list of prescriptions that are approved by the PBM for issuance. Exclusion from these lists can result in non-coverage for patients or higher prices for comparable technologies. All while the company profits.
Without a full understanding of the players in this space, it remains unclear how much of the savings PBMs negotiate from drug manufacturers are passed onto U.S. taxpayers in the form of lower out of pocket costs, lower premiums or lower copays.
It is vital to the health of our nation that we identify inefficiencies that are driving up health care prices and resulting in more out of pocket costs for American taxpayers.
By taking a holistic view of the market and scrutinizing all players equally, we can make real progress towards improving our nation’s health and saving American families money.
They don't offer a small vial of calibration standard??? Heck, the kit I bought for my DOG has that. And I can easily buy more when the expiration date runs out.
Okay list to start.
However, you fail to mention a Big reason why medical care prices are So Out of control:
Hospitals and Pharma are Absolute indecent Gouging Bass turds!
Name one other essential service where you are refused an accurate price estimate before service delivery?
Hospital billing Dept secret “Charge book” gins up procedure treatment actual costs by 500 - 100%!
Investigations determined that actual cost of non-paying ER patients was far lower impact to justify outrageous charge book markup.
Your Hospital Could Be Marking Up Costs 1,000 Percent - Forbes
www.forbes.com/sites/kateashford/2015/06/29/hospital-markups/ Proxy Highlight
Personal Finance Jun 29, 2015 @ 02:27 PM ... Some markup on costs is probably expected. Nationally, the average hospital charges about 3.4 times the cost of a procedure. ... hospitals charging the most for their services are marking up prices a full 10 times, or 1,000 percent over ...
Why Hospitals Mark Up Prices by 1,000 Percent - Newsweek
www.newsweek.com/why-hospitals-mark-prices-1000-percent-343006 Proxy Highlight
Jun 15, 2015 ... Of the 50 U.S. hospitals that mark up prices the most, 49 of them are part ... almost three times the average markup at the other 4,433 hospitals.
50 hospitals charge uninsured more than 10 times cost of care ...
https://www.washingtonpost.com/national/health-scienc... Proxy Highlight
Jun 8, 2015 ... Researchers said the hospitals with the highest markups are not in ... Wellness · Magazine · Home and Garden · Inspired Life · Fashion ... Uninsured patients are charged 12.6 times the actual cost of patient ... This means when it costs the hospital $100, they are going to charge you, on average, $1,000.”.
The Hospitals That Overcharge Patients by 1000 Percent - The Atlantic
https://www.theatlantic.com/health/archive/2015/06/ho... Proxy Highlight
Jun 8, 2015 ... Magazine ... The ratio of hospital charges to costs has only increased over time: In ... Overall, three-quarters of the hospitals on the highest-markup list are .... Amazon announced on Friday morning that it’s buying Whole Foods ...
Many U.S. hospitals mark up prices 1,000 percent: study | Reuters
www.reuters.com/article/us-usa-hospitals-prices-idUSKBN0OO2C920150608 Proxy Highlight
Jun 8, 2015 ... Many U.S. hospitals mark up prices 1,000 percent: study ... some U.S. hospitals: The price for procedures is often 10 times the cost, according to ...
Two biggest cost drivers:
1. As the share of out individual out of pocket costs goes down, costs go up. IOW, if people had to pay for most of their health care, it would be a lot cheaper. Just look at high quality private hospitals in places like Mexico, Thailand, India. People also spend their own money more wisely than other people spending money for others.
2. Government regulation. Hospitals and medical facilities have to spend billions on compliance officers and lawyers to keep up with all the regulatory changes and audits. If fact, government regulation probably incurs more overhead costs than personal litigation.
In that order.
My first point:
1. Government price fixing and regulations
Yes, prices are jacked up to self-pay and private insurance to compensate for MEDICARE and MEDICAID price fixing.
Thanks for playing.
...and you should suspect the lefty sources you cite. They have an agenda.
>
However, you fail to mention a Big reason why medical care prices are So Out of control:
Hospitals and Pharma are Absolute indecent Gouging Bass turds!
Name one other essential service where you are refused an accurate price estimate before service delivery?
Hospital billing Dept secret “Charge book” gins up procedure treatment actual costs by 500 - 100%!
>
Root cause: GOVT.
Please define ‘essential’ as it relates to services. Grocery? Electric?
When the govt can FORCE an entity to work for the benefit of another w/o compensation\choice (we used to call that slavery)....yet you expect the same entity to NOT attempt to make up the difference elsewhere??
IMO, remove the 3rd party pay from the mix. People start to think ‘competition’ when they’re the ones writing the check.
Is this satire?
Definitely part of The Swamp. Which lawmakers are receiving big donations and benefits from these unnecessary companies anyway?
>>>I will do my part. If I get cancer I have already decided I would not take chemo because it didn’t work for my wife or anyone I know....just gave them a year of pain and misery at great expense to Medicare.<<<
My Friend, if that is what you really believe at least allow me to educate you based on my personal experience.
I was diagnosed with Leukemia about eleven Years ago at age 52. If not for Chemotherapy, I wouldn’t be here telling you this.
For what it’s worth. modern day Chemotherapy is not the miserable experience you imagine it to be. Of course there are exceptions since we all a little different, but speaking for myself I have not experienced anything near what I dreaded when I was told of my Prognosis and Treatment.
I spent hours sitting in a room full of other Cancer Patients receiving Chemotherapy. Every type of Cancer you can imagine. For the most part they were comfortable, as was I and the Nurses made a priority of insuring receiving Treatment was a positive experience. Some people experience Nausea, but you are given intravenous Drugs to combat that while you are receiving your Treatment.
The variety of so called Chemo Drugs available today is nothing like it was years ago. In my case, I was treated with a mixture of specific Drugs, a Cocktail as they say, which would not necessarily be described as what people think of Chemotherapy. In my case, one of the Drugs was Antibodies to attack the specific Cancer Cells that had taken over half my Body’s Bone Marrow.
Treatment is much more specific to attack different types of Cancer, it isn’t Drano that attacks everything on your Body like People always used to say.
A dear Friend felt as you did based on her Mother’s experience with Cancer Treatment decades ago. Because of that she chose “alternate” treatments that were useless. Her “treatable” Breast Cancer turned into Untreatable Painful Bone Cancer. Her last six Months on this Earth were dismal to say the least.
It’s you Life and you do what you think is best, but I implore you to look at ALL viable Treatments should the day come when your Oncologist tells you that you have Cancer.
As for me, been there, done that.
Take good care of yourself.
Thank you for your thoughtful words. I guess it all depends on what stage of cancer and what type of cancer. No one in my family ever survived cancer - 7 cousins, aunts, siblings, etc. and they all took chemo. My father was diagnosed late with leukemia and he went swiftly. My mom lasted 6 months with brain cancer. My wife with Stage 4 esophageal/lung cancer and died four years ago. She did live for 2 years (one year longer than predicted) but her life was hell. It was very difficult for them and my family to deal with it. I realize there are some types that are highly treatable like colon cancer and such if caught early enough.
I am counting on the hydrogen peroxide to resist any type but if a diagnosis calls for one year or so with or without treatment, I know what I must do and that is certainly not to be a burden upon myself, my family or the taxpayers since I pay nothing for my medical (being retired military) Medicare plus disabled veteran status, AND knowing how much my wife’s treatment cost taxpayers.
Also I guess I took to heart several “House” TV episodes where the oncologist, Dr. Wilson, himself caught cancer and vehemently refused chemo. I totally agreed with him in view of my experience.
Be well yourself!
Not the ones Medicare/Tricare Life are given. My big question is if Kroger’s and Wal-Mart can sell 100 strips for $22 why do the ones Medicare/Tricare Life supply cost $85 for 100? And they are in the bottle UPSIDE DOWN with the bar code up, you touch it and it errors. I keep the old bottle and dump the new in it, blood up take side up. I test 1-2 times a day. Now my eldest son is a true Type 2. He test 4-5 times a day. Gets his from Wal-Mart. All the test meters I’ve seen are ‘FIXED’ just shove the strip in and hope it doesn’t say error.
I’m not a diabetic, but blood sugar is erratic due to Gastropresis painful SLOW DIGESTION. And you tend to eat more carbs as they digest easier, as they can be chewed to mush, than fiber foods like fruits and veggies. You’d have to turn those into baby food. Food high in sugars like bananas, grapes, raisins, cranberries are not in diet due to high sugar content. And I watch mine like a hawk; was 88 this morning and will drop quick if I don’t eat something in about an hour.
I wonder if you can ask your doctor for a source for a standard solution. That the meter is "fixed" is just an inconvenience...it is simple enough to add or subtract an offset.
A quick Google search using this search term:
-Calibration Standard for Glucose Meter-
Turns up a lot of possibilities, the most expensive of which is less $20.00. Most less than $10.00. Walmart has one for $4.40.
As an analytical chemist, I've spent my entire work career coaxing better performance out of measurement instrumentation. "Not" having a check standard seems to be not very bright on the part of meter manufacturers.
Have to agree with you, not only is it stupid, it’s dangerous. And putting the test strips in the bottle upside down is too. It is simple to tell a machine to load the bottle the correct what with the blood up take right side up, instead of the bar code side. But then again we have to figure the Congress into this mess, they award those contracts to family and friends after all with no regard to them being accurate or factual, or at the best cost ratio.
My other issue is why generic drugs can be 30% less than name brand? My Synthyroid med is a critical hormone and can’t be off by that much, my ENDO only uses the Name Brand as he is aware the generic has more side effects and is not accurate in hormone levels.
A senator found Medicare blowing hundreds of millions on a drug private insurers wouldn’t touch — and nothing happened
http://www.businessinsider.com/tim-scott-letter-on-acthar-and-medicare-waste-2017-4
H.P. Acthar Gel - Questcor/Mallinckrodt
In less than 15 years, its price has been jacked up more than 1,000 times, even as questions about whether it is very effective have also mounted.
http://www.fiercepharma.com/special-report/h-p-acthar-gel-questcor-mallinckrodt
Questcor Reveals Adverse Events Data for Acthar for First Time
https://www.nytimes.com/2014/07/11/business/questcor-reveals-adverse-events-data-for-acthar-for-first-time.html
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