Colorado Governor Polis Signs Insulin Price Cap Bill

[LC]

https://denver.cbslocal.com/2019/05/23/insulin-price-cap-bill-gouging-colorado-governor-polis/

 

Quite proud of my State. So tragic that some people were paying 900-1000/month just in co-pays for a necessary medicine that has been around for decades.

[ragnarisapirate]

Well intended, but it would seem that this would do 1 of 3 things (or a combination):

 

1) create an insulin shortage

2) raise insurance prices, as the insurance companies make their margins elsewhere

3) insurance companies/insulin makers reduce profit margins, and the businesses are worth less, hurting their investors (which could take the form of retirement account holdings), and they can’t fund other medicine initiatives.

 

I like the idea of everyone getting all the medicine they need, for free nonetheless! But there are always unintended consequences that don’t seem to be looked at, past the nice headline of the article. What else could there be?

 

I’ve never bought insulin, so I don’t know much about it, but it seems as if there should be a way for an online retailer to take virtually all the profit out of insulin (I’m assuming it has no patent protection and is more or less a commodity at this point). Heck- there could be a vertically integrated manufacturer that sells the stuff. Seems like there would be a huge market for insulin, so that type of specialization would also go with volume pricing and all that.

 

https://www.healthwarehouse.com/diabetic-supplies/insulin

 

I’m curious how this site would compare to what people are paying in their local pharmacies, where the gouging is happening. On the face of things, it seems a lot cheaper.

[Cigarbutt]

^Good point about unintended consequences.

In the early 70's, President Nixon tried to use price and wage controls (it worked some for a while) in order to control inflationary forces that resulted from, among others, poor fiscal and monetary policy. What broke the back of inflation were new Federal Reserve policies adopted on October 6, 1979. That made a lot of people unhappy and Mr. Volcker's effigy was publicly burned but addressing root causes tends to work.

 

You are making a lot of assumptions that do not correspond to my understanding.

 

There are now many insulin variants that are not considered generics and manufacturers keep on tweaking the magic formula in order to delay transparent competition.

 

Out-of-pocket expenses have gone up for various subgroups. An online solution may help to some degree in some selected circumstances but patients may be limited about where to go (online or not) to get the insulin products and the available online products may not be correspond to the actual prescription.

 

Also, the online pharmacy still needs to fit in the global (complex and non-transparent) insulin supply chain with various embedded rebates and various intricacies related to insurance contracts.

http://care.diabetesjournals.org/content/41/6/1299

 

Opinion: the price-cap bill may seem to work for a while and may score political points but unfortunately does not address the underlying root causes. So it's still omerta. I would bet that somebody will eventually figure it out though.

[Spekulatius]

I said this before, but when nothing helps, set up a state financed entity to produce this stuff. It’s not this hard, insulin was first marketed in the 1930’s, human insulin was marketed in the early 1980’s, the pen mid 1980’s. Bring cheap generics on the market and it will also bring the prices of the news meds down as well, Imo.

[ragnarisapirate]

^Good point about unintended consequences.

In the early 70's, President Nixon tried to use price and wage controls (it worked some for a while) in order to control inflationary forces that resulted from, among others, poor fiscal and monetary policy. What broke the back of inflation were new Federal Reserve policies adopted on October 6, 1979. That made a lot of people unhappy and Mr. Volcker's effigy was publicly burned but addressing root causes tends to work.

 

You are making a lot of assumptions that do not correspond to my understanding.

 

There are now many insulin variants that are not considered generics and manufacturers keep on tweaking the magic formula in order to delay transparent competition.

 

Out-of-pocket expenses have gone up for various subgroups. An online solution may help to some degree in some selected circumstances but patients may be limited about where to go (online or not) to get the insulin products and the available online products may not be correspond to the actual prescription.

 

Also, the online pharmacy still needs to fit in the global (complex and non-transparent) insulin supply chain with various embedded rebates and various intricacies related to insurance contracts.

http://care.diabetesjournals.org/content/41/6/1299

 

Opinion: the price-cap bill may seem to work for a while and may score political points but unfortunately does not address the underlying root causes. So it's still omerta. I would bet that somebody will eventually figure it out though.

 

“Tweaking the formula” Ok- so that helps ME UNDERSTAND. To me, insulin is insulin. I guess a better analogy is that “Blood isn’t just blood” there are different types, like O, O+, A, B, etc. I was assuming it was more like “Tylenol is Tylenol” where it is literally acetomenaphin (sp) and its just about the amount you give someone.

 

Makes there be more issues, but, as you point out “someone will eventually figure it out” For me, it just seems like this should have already happened! We have access to all the information in the world!

 

I’m just to the point where I am pretty negative on the general healthcare system. Every interaction I have with it, or hear of, there seem to be tons of things that don’t make sense, so, probably an antidotal bias on my part. Or, stupidity. :)

 

It does seem that costs should come into play with what doctors prescribe- take our insulin analogy- if one works at, say 95% effectiveness (for lack of a better term) and costs $100, whereas another works at 97% for a person, but costs $1,000, it doesn’t seem like the doctor should prescribe the latter, unless the patient is willing to pay for that extra 2%. This is an extreme example, but, seems like it is the sort of thinking that we should apply.

 

I wonder how much of medical expenses is spent in ways similar to this?

 

A personal example: I once had a mild concussion, and they wanted to to an MRI on my head. I’m assuming that would be several grand- regardless, it ain’t free. I pressed the doctor and asked if I really needed it. After we talked for a bit, realized that we knew some of the same people, and he realized I wasn't going to sue him, he said “look, it’s my job to give you the best care possible, regardless of the cost... generally, we do an MRI. Let’s say that you have a lot of swelling in your brain- we would prolly send you home, monitor it for a few days, and tell you to rest. If you got worse,  to the extent that you were slurring your words and whatnot, we would scan you again, and then if it was REALLY bad, we MIGHT operate. In the 20 years I have done this, I have only seen that happen once. With someone with your symptoms, generally, they go home, and don’t come back to us for anything. I don’t like the idea of exposing you to the extra radiation, but, this is the standard practice...”

 

I thanked him for the candor, and went home to sleep for a day, and ran chainsaws at a rent house the next.

 

It seems like there is a lot of this type of care given that is totally not needed, that is just is CYA. Looping back to the insulin article, I do wonder how much of the “tweaking” of the product is actually “good” for consumers and costs, etc. I assume the results are better, but at what cost do they come to the system, and what is the weighted benefit?

[Cigarbutt]

...

1-Makes there be more issues, but, as you point out “someone will eventually figure it out” For me, it just seems like this should have already happened! We have access to all the information in the world!

...

2-... Looping back to the insulin article, I do wonder how much of the “tweaking” of the product is actually “good” for consumers and costs, etc. I assume the results are better, but at what cost do they come to the system, and what is the weighted benefit?

1-This business, in all countries, is based on some kind of partnership between private interests and public institutions. The best solution for the private industry (and IMO for all) is self-regulation that is reasonable with some kind of regulated profits. From an outside perspective, in the US, with a growing public input related to secular forces, private actors have a shown a progressive inability to self-monitor and are risking nationalization (think of what Spekulatius mentioned). The main thrust of present efforts come with the aim of maximizing opaqueness and unnecessary complexity. For instance, if you follow what happened when PBM executives met recently with regulators, the last thing they want is providing access to all the information in the world.

2-This is VERY hard to objectively assess as many studies are sponsored. A balanced, objective and common-sense evaluation suggests that the newer insulins only bring marginal improvements in selected subsets of diabetic patients. The reason why newer products are widely adopted is not evidence-based but more subjective in nature. In my e-mail box last week, received an invitation to learn about "Insulin intensification for patients with diabetes" and it seems that the real idea behind the promotion was to intensify the profit along the supply chain, leaving the end-consumer mostly empty-handed and with a lighter wallet.

[ragnarisapirate]

https://apple.news/AWLE1jLu1S7Srj7l5-Qnx7Q

 

Article on how a guy swapped insulin and got in pretty bad shape.

[Cigarbutt]

https://apple.news/AWLE1jLu1S7Srj7l5-Qnx7Q

 

Article on how a guy swapped insulin and got in pretty bad shape.

Dying secondary to drug rationing or to drug switching without advice due to price constitutes a preventable tragedy.

The article though (IMO) oversimplifies the issue and seems to conclude that switching to cheaper versions means less efficacy and more complications.

The person had type-1 diabetes. The reported blood sugar level a 17x normal suggests a major problem with dosage.

 

It is still unclear how analog insulins bring significant benefits in type-1 diabetes.

For type-2 diabetes (majority of diabetic cases), more and more evidence shows the absence of benefits with the more expensive drugs.

https://www.ajmc.com/newsroom/medicare-patients-with-type-2-diabetes-safely-switched-from-analog-to-human-insulin-ijamai-study-finds

[meiroy]

 

 

 

When considering medication costs it's good to remember the core reason for the costs:  systemic corruption, lack of competition and transparency, etc.

 

Same reason why infrastructure costs are so high when they shouldn't be.

 

At this point, as the GOP enables the continued system corruption, it can only be temporarily fixed by brute force.

 

Control the prices and enable the increase of quantity by allowing/encouraging imports, revoking patents, etc.