Comment by mngnt | Hacker News Reader

Comment by mngnt | Hacker News Reader

Parent Full thread

Do you have any source I could read to see how it works in Italy? I live in central Europe (Slovakia) and insulin is also "free" here (if you are diabetic and have a prescription), but it´s not "paid by the government", it´s paid by the compulsory insurance everyone is paying (for me, it´s about 5% off of my net salary).

I 100% agree to your second point. I found some data to compare: Humalog from Eli Lilly Netherlands costs 19,42 € per 10 ml vial in Slovakia [1] and $296.29 in the US [2]. Yep, that´s ~13 times as much (I ignore exchange rates, but it´s in the same ballpark). This is not saying much though, due to salary difference. Average monthly salary in Slovakia is 1133 € , while in the US it is $4692.5.

Thus, an average Slovak can pay for 580 ml of insulin monthly (I´ll note here, they doesn´t have to pay, it´s covered by insurance), while an American can only get 158 ml of the same brand, same product insulin.

On top of that is the manufacture price is up to $6.16 per vial. [5]

[1] https://translate.google.com/translate?sl=auto&tl=en&u=https... [2] https://www.drugs.com/price-guide/humalog# [3]https://translate.google.com/translate?hl=&sl=sk&tl=en&u=htt... [4]https://www.bls.gov/oes/current/oes_nat.htm#00-0000 [5]https://www.singlecare.com/blog/insulin-prices/

The "cash" price in the US is $142:

https://www.goodrx.com/humalog?dosage=10ml-of-100-units-ml&f...

(GoodRx doesn't have any direct user fees, they make money by understanding the stupid prescription drug system in the US)

There's a generic that is $50 at several pharmacies.

Thanks for pointing that out. GoodRx is not available from EU (Either due to GDPR or due to not being applicable to non-US readers, I guess). That invalidates my numbers a bit.

However, it´s also pointing to another facet of this issue: the opaqueness of the pricing. In here, price of medication (including insulin) is regulated and it´s the same everywhere, for everyone and no seller-specific discount can be applied.

Yeah, they make money by working the convoluted US system.

It isn't good that the prices vary, but it's been long enough that people with substantial drug costs should be doing some basic checks, discussing the highest quoted US prices doesn't reflect what people are paying.

The "cash" price is $342. The $142 is from a $200 which has eligibility requirements, which don't allow you to get that discount in many cases.

What requirements are attached to using the PBM replacements? My understanding is that you go to a pharmacy that accepts them and give them a number to put into the computer.

Or does using them disqualify people from other programs?

I may have slightly overstated the case above (and have now edited my language to be softer) because frankly, a lot of stuff said in this thread is extremely upsetting to me. (Not you, you are one of the more reasonable people here.) I don't actually know what the numbers are, strictly speaking. In my experience, a lot of things around this sound reasonable until you actually have to come into contact with the bureaucracy surrounding them, and they end up being much more onerous in practice.

But yes, if you click on the green button, you'll see a list of restrictions. One of those is that if you're participating in any other state or federally funded programs, yes.

The "I have been prescribed this drug" bit is also pernicious; you don't get a prescription for "insulin," you get one for Humalog or Novolog or Levemir. You are at the whim of your doctor. Used one kind for years, but suddenly lose your job, which means a change in health insurance and a change of doctor, who decides that you need to change your brand for whatever reason? You can't use this discount to help keep continuity. (Additionally I am not sure what the "or am a caregiver" requirement is legally, but should really look that one up so that I know exactly what those requirements are, so thank you for giving me something to do today...)

In addition you are comparing somebody who has insurance (slovenia) to somebody who theoretically doesn't 'US'. Most people in the US get their health insurance through their employer and would pay nothing out of pocket, and if you are uninsuranced the drug companies will often times just give the drug away to you for free.

Even if you have really good health insurance, you often pay out of pocket.

> if you are uninsuranced the drug companies will often times just give the drug away to you for free.

This is horribly incorrect. People die for lack of insulin in the US all the time, and it's not because they just didn't bother to ask for their free insulin.

No, I´m not. The price for an insured patient (which is everyone, by law) is zero. 19.96 is just the sticker price.

But they have 'insurance' through their taxes.

> but it´s not "paid by the government", it´s paid by the compulsory insurance everyone is paying

Is there really all that much of a difference; isn't that insurance pretty much just another name for the state?

If taking exchange rate into account it's 13.05 times as expensive.

LIST PRICE DOESN'T MATTER IN THE US

Try to buy prescriptions from a pharmacy without insurance and you'll see how much list prices matter in the US. If you don't have the money for the retail price, you're shit out of luck and won't be able to buy them.

Reply on news.ycombinator.com