Comment by azalemeth | Hacker News Reader

Comment by azalemeth | Hacker News Reader

I think something else that would be of interest would be doing this for drug prescriptions: compare the cost that my employer, the NHS, pay for a compound and those that Americans pay for the exact same compound. This is easy on my end at least -- prices and prescription guidance are released in the BNF / British National Formulary annually and are all made available in public. I have never understood the US system of "co-pays" and found the whole thing very confusing.

For a few "popular" random examples that I think HN might have heard of: one branded Epi-Pen is £26.45; Naproxen (the NSAID painkiller) is £4.29 / 56 pack; and omeprazole (PPI used to treat gastric reflux) is £0.84 / 28 pack.

A more expensive example might be the cystic fibrosis "designer drugs" lumacaftor with ivacaftor -- 112 tablets are £8000 (to be prescribed by a specialist, if the patient has the genotype to respond to it -- a total annual cost of about £26k). The US equivalent is $379,780 [1].

(NB: The price you pay as a British patient is usually £0, unless you are a working-aged and working English person -- at which point it is £9.15 per item [independent of its cost] or a fixed "all you can eat" prepayment certificate that works out at about £8.83/month -- which is what I have. Oh, and plus the taxes, of course...).

[1] https://www.jmcp.org/doi/pdf/10.18553/jmcp.2018.24.10.987

> I have never understood the US system of "co-pays" and found the whole thing very confusing.

I think you're mixing up a few things here. The co-pays are meant to make the patient directly pay some of the cost to decrease abuse of the system. There are many different structures for co-pays so saying anything general is kind of difficult, but there are reasonable arguments supporting such a system. In Sweden for example you do have to pay certain costs (which are capped) for essentially the same reason.

But that has nothing to do with the fact that prices vary so widely for the same products and services. Personally I think that the US system should at a minimum require that

1. All medical products' and services' costs to published publically;

2. All costs to be non-discriminatory (meaning everyone regardless of any insurance plan or none must pay the same);

3. All costs be available prior to any services provided.

In other words, there are no negotiated plans with different prices, there are no surprise bills, patients actually are able to understand costs, and real competition is actually theoretically possible. None of this would necessarily preclude an insurance plan from having co-pays, it would just make the only point of the insurance plan purely financial and open as it should be.

Of course the US could just move to a single-payer government-run system, but that's a different discussion. If the goal truly is to have a market-based system, then I think my points above should be implemented.

Not allowing an insurance company to negotiate for the price of a drug or service is precisely why medicare and medicaid have ballooned up to 39% of US federal spending while not even approaching "universal" coverage.

I'm possibly misunderstanding you, but you seem to be implying there would be no negotiation in the system I described. I never said that. You as a patient would in fact be much more empowered to negotiate with those who provide you services, since you would actually know the actual costs available in the market.

However, if your point is that the current system would also be improved by the tiny change of allowing medicare to negotiate prices without any of my other ideal changes, then yes I agree that would be a change for the better.

One of the things that EU countries do is negotiate with the the drug manufacturers. So UK in this case of Lumacaftor, didn't cover the drug until they got a reasonable price. This meant a 4 year delay in access to the drug vs the US.

> It was approved for medical use in the United States in 2015, and in Canada in 2016.[3][5] In the United States it costs more than $US 22,000 a month as of 2018.[6][7] While its use was not recommended in the United Kingdom as of 2018,[4] pricing was agreed upon in 2019 and it is expected to be covered by November of that year.[8]

https://en.wikipedia.org/wiki/Lumacaftor/ivacaftor

I don't think you can really say that the US has "access" to a drug when it costs $22,000/month, which, given the median household income of $68,700/yr, is nearly 4x more than the average American makes in a month.

Many Americans who use expensive specialty drugs have prescription drug coverage and don’t pay the entire price of the drug. And/or they get a discount through manufacturers programs. That said, my insurance does not cover the above drug.

So practically speaking, many Americans have to wait even longer than those in the UK? Even if they have insurance? And perhaps even a well paying job with good benefits (an assumption of mine based on the setting).

I don't know about that particular drug, but I was on a super spendy drug- the manufacturer had a program that would cover the difference down to $5 / month or $25 if your insurance didn't cover it or you don't have any.

My insurance wouldn't cover it until I tried cheaper alternatives first, but I didn't want to try those given their fair more serious side effect / risk profile. Because of the manufacturer program, I was still able to get it for $25. I dont know if that would be possible in the UK if the programs arent offered there.

Also, no waiting period other than the medicine had to be shipped from a specialty pharmacy that could deal with the temperature storage and handling requirements. There is a bit of a wait to see a specialist to actually prescribe it, but that varies by geographic region and specialty.

I don’t follow. What would they be waiting for?

Money to pay the bill.

To some degree, the EU (and Canada's similar practice) forces US consumers to underwrite the cost of R & D that creates many of these drugs in the first place.

Instead of that, perhaps the US consumers are simply being overcharged?

> NB: The price you pay as a British patient is usually £0, unless you are a working-aged and working English person -- at which point it is £9.15 per item [independent of its cost]

For comparison of terminology, this is what we would call a co-pay in the US.

You pay 9.15, your health coverage pays the rest. Thus you are “co”paying.

The Health Care Cost Institute has something like what you want - see Figure 2 about halfway down this page:

https://healthcostinstitute.org/hcci-research/international-...

£9.15 per item [independent of its cost]

That's basically what a copay is.

Aren't a lot of copay's percentage based?

That form is more precisely called coinsurance, with the precise definition of copay being the case where you pay a fixed amount of money per occurrence.

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