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Comment by refurb | Hacker News Reader

The funny thing is that Epipens have been really expensive for a while. Sure they took a 15% price increase over the past year. The price has been over $400 for a two pack for a while.

The reason why this has come to a head is high deductible health plans. This is where you pay the first $1000-$6000 in medical costs before insurance kicks in. When all it was was a $30 copay, consumers didn't give a shit.

So maybe, just maybe, pushing more medical costs to patients will actually create the pressure needed to reduce medical costs? Interesting thought.

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Well, right, that would remove the Moral Hazard.

And instead of insurance companies, it appears Social Media mobs are being effective at collective bargaining, which in other countries outside of the US has shown to be effective at keeping prices lower. Unfortunately it's a very selective outrage.

The problem is that most doctors don't take treatment costs into account when writing prescriptions. They may not even know the cost themselves. And patients can't really be expected to keep up with the prescription drug industry enough to request cheaper alternatives.

There are competitors to the Epipen but they don't get prescribed as much. I would surmise that has something to do with marketing budgets. Maybe we should join the rest of the world and ban drug advertisements? Oh, and allow Medicare to negotiate a bulk rate for drugs rather than pay MSRP[1].

[1] https://en.wikipedia.org/wiki/Medicare_Part_D#Criticisms

> They may not even know the cost themselves. And patients can't really be expected to keep up with the prescription drug industry enough to request cheaper alternatives.

In Australia we solved this by requiring pharmacies to offer generic alternatives.

And in Norway, and I think the UK, and probably lots of other places.

Including the US. Unless your doctor names a specific brand and includes the phrase "dispense as written" on the prescription slip, you'll almost certainly get a generic.

That's already the law in the US. Pharmacists have to fill with a generic unless otherwise specified.

>And patients can't really be expected to keep up with the prescription drug industry enough to request cheaper alternatives.

You don't have to keep up with the Rx industry to research different treatments and pricing for your individual condition. When I went to the dermatologist for skin cancer screening, she prescribed me Picato for my actinic keratosis. When I called the pharmacy and found out it would cost $200 after insurance, I called BCBS and spoke with their pharmacist about alternatives. She gave me a short list of brand names and generics, from $10 up, and at the end I decided to go with the doctor's Rx because it had the shortest treatment and recovery time. I did find an online coupon, however, which my doctor didn't tell me about.

Why should that burden land on patients? Many patients will have trouble understanding the pros and cons of different meds; especially if there is any polypharmacy going on.

Because it's the patient's health and their money? It's not like they have to make the decision on their own. The grandparent mentioned he called his insurance company's pharmacist and got advice.

Another problem is that the software doctors use sometimes presents a drop down list of medication, and the expensive version is at the top of the list.

https://twitter.com/drmarkporter/status/765569736423927813

> Q for SystmOne GPs: is there a simple way to ensure default drugs offered when prescribing are cheapest versions most commonly prescribed?

https://twitter.com/drmarkporter/status/765570038048911360

> For context: our default omeprazole version (20mg) is currently 5 times price of one 4 down. Easily repeated costly error when busy.

I have a friend who recently became a pharma shill. Job pays far better than running the biomed lab, and comes with fantastic perks (and expense accounts) for simply educating doctors about drug options.

There's no way a GP can keep up with everything that's out there. Less expensive remedies have no one to fight for them either.

Until we see a measurable, provable change from one of these "social media" campaigns, they don't mean shit.

The Internet's attention span is 45 seconds on a good day, and that's not enough time to affect real change. Until this changes companies realize that all they have to do is weather the (brief) shitstorm until people move on to the next buzzworthy thing and then they can just go back to business as usual.

How many people know that the drug Martin Shkreli jacked the price on is still that same price long after he left the company? They never even did a show of putting it back briefly, the price was jacked up, Martin took the hate off the drug company that did it, and they kept collecting the money.

I don't think social media can affect real societal change because it's like trying to get an unmedicated ADD kid to do his homework, you can't hold his attention long enough to make meaningful progress.

> pushing more medical costs to patients will actually create the pressure needed to reduce medical costs?

The laws of supply and demand get regularly rediscovered <g>. A discouragingly large amount of government policy ignores supply&demand.

It's hard to follow supply and demand when we (US) subsidize the rest of the world's R&D because they limit legal drug prices.

Isnt this the free market being discussed rather than government? And isn't this a great example of "supply and demand" being an over simplification of the factors that can influence price?

As discussed elsewhere in this thread, FDA regulations make it very difficult for competitors in this space.

> over simplification

I suppose it's like "gravity" being an oversimplification of the bending of light around stars.

Yes this is exactly it. High deductible health plans are succeeding in making prices more transparent and letting the markets work as a check on healthcare costs.

What Mylan is trying to do is a bit sneaky -- mollifying the high deductible complainers by giving them a coupon they can use but I believe in the long run it will backfire since it will drive more people to high deductible plans.

low deductible health insurance plans dont make much sense b/c no one has an incentive to save money. by having people share in more of the costs (up to a certain level) I think you get market forces to help keep prices in check

Market forces either didn't work or were suddenly introduced (otherwise how did the price get so high?) in this case. But people buying epipens don't have a lot of options, and unlike the price of coffee or something you're dealing with anaphylactic shock...

> The reason why this has come to a head is high deductible health plans

That was one of purposes of high deductible plans -- to expose people to the prices.

In an ideal situation they would go search for more reasonable alternatives so create a market, but other, unintended perhaps consequence is it creates an outrage. So far, though, it is more of an impotent outrage. The stock went down from $50 to $45. That's not huge, it will recover soon.

The results of such an outrage is often the opposite -- other companies see and say "Ah, well, everyone else doing it without repercussions, we should raise our prices by 200% as well".

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