Mark Cuban's Cost Plus Drugs
costplusdrugs.com
costplusdrugs.com
This is by definition an improvement over what America has, so I welcome it. That doesn't change the fact it's an umbrella in a hurricane, so it's really not that interesting.
Socializing the whole thing is significantly better. Remember America already has socialized medicine for 40% of the population. It is long past time to up that to 100%.
Good will and brand alone isn't sufficient to build a medical system on.
I agree that competition often helps improve pricing and quality, of course.
But I wonder if at times competition leads to a net degradation such as "race to the bottom" scenarios?
Perhaps, but until then, I welcome the value he'd create for us
Here's an article on the topic - from a socialist source: https://www.sochealth.co.uk/2015/04/28/weaponizing-the-nhs-i...
'many campaigners who want to “Save” the NHS seem to want to do the opposite – to politicise the NHS so far that reform becomes a practical impossibility. They create alarm about cuts to local services, privatization, postcode lotteries and TTIP. They seem more motivated by anger, and fixated on political totems, than on trying to promote progress within the NHS.'
'The problem with Labour’s campaign to “weaponize” the NHS and turn it into a key political battleground, and its politically motivated and gimmicky manifesto pledges, is that it distracts from the real work that is needed: devolved reforms led by clinicians. We could have yet another 2 year hiatus. The NHS can ill-afford that.'
The kneejerk downvotes on HN are so depressing, especially when they are borne out of ignorance (not you btw, your comment is good).
US per capita health expenditure: $11000USD (#1).
I don't know what the 'left' is doing there but it seems very efficient.
[1] https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
'Labour has defended the way it is campaigning on the NHS – but once again refused to confirm that Ed Miliband told the BBC that he wanted to “weaponise” the NHS in the election campaign.'
'The spokesman said: “I am not going to talk about words used in private conversations. They should not be shared and we will not talk about private conversations.'
Another mention of the term: https://nhsproviders.org/news-blogs/blogs/dont-weaponise-the...
If there were no danger of the NHS being weaponised, the term would go out of common use.
Do you still consider my use of a term coined by the left themselves as 'idiotic'?
But anyway, before you attack it - I'm not the one that came up with it - that was the leader of the Labour Party Ed Milliband! It caused a political storm at the time. Clearly the media, political classes etc. did not consider it complete nonsense or they wouldn't have taken it seriously - nor would the government been able to hammer Milliband/the left with it for years.
> So here is a challenge to politicians who say they support the NHS. Be clear and straight about the numbers – for example, don’t double count what’s already been announced and don’t confuse five and one year commitments to boost a headline number. Acknowledge the scale of the funding needed to deliver services to meet our growing needs, and to rebuild our NHS, making it fit for the 21st century. That means looking beyond hospitals, important though they are, to other parts of the service which have suffered similar neglect, for which patients are today paying the price.
That "double counting" means that the amount of money being invested is less than claimed; the numbers of new staff being trained & recruited or retained is less than claimed; the numbers of new hospitals being built is less than claimed; etc.
Maybe this is me "weaponising" the NHS but you're going to have to provide a bit more evidence if you're making such a bold claim.
The way to fix the US system is for the health insurance market to be regulated like the auto insurance market, i.e., break up the state monopolies. Then for our employers to give us the money they're paying on our behalf. Then we could shop for a health insurance plan like auto insurance. Within a couple of years, the market would start sorting out the costs.
But no. We'll get socialized medicine. And it will look much like our disastrous Veterans Health Administration.
If you talk to people who immigrate to US from those countries with national health insurance, you’ll find that what you claim above is by no means a consensus.
For example, I immigrated to US from Poland, and in my opinion, US healthcare is much superior to Polish socialized healthcare, in terms of quality and availability. Cost wise, it’s more expensive, but my out of pocket costs are too small for me to care about: my employer pays for health insurance, which is a benefit on top of my wages, instead of being subtracted from my wages like in Poland. My deductible is low, and so are my copays and out of pocket maximums. This is opinion shared by most of my Polish friends in US.
Back in Poland, socialized healthcare is held in low regard, lines are long, quality is low, and a lot of people, especially in cities, pay for healthcare from private providers anyway.
There are a variety of different non-state companies providing health insurance in the US, no? What am I missing, how is this a state monopoly?
[1] https://www.healthcaredive.com/news/seniors-love-medicare-bu...
As an explicit example, my wife took our infant daughter to a doctor the other day, because she was coughing and sneezing for a week already, and she wanted him to confirm that it’s most likely nothing to worry about. The doctor agreed. Insurance was billed $200, with $10 paid by us out of pocket. If we had to pay $200 out of pocket, we’d probably wait another week (and ended up not paying anything at all, because the coughing indeed disappeared before the end of the second week).
If either of those are true, their lives do not depend on those procedures.
I really cannot understand how you can even think about doing healthcare system for profit. Posting this from a Single-pay country, Germany.
In my armchair politics I do wonder if single payer, market provider might work. You get the competition of the market, but the tax payer purse. I think technically this is how medicare works but there are a bunch of nuances that make medicare not work (such as negotiation of prices).
I got a "government insurance", which is the most expensive, but also the one with the best cover. There is "private insurances" with cheaper premiums and less cover that are attractive to young people, but it's kind of hard to later in life switch back to the government one.
Most countries in EU have kind of this mixed healthcare, with private, and public ones with the only goal to make sure the private offer competitive enough services... Same thing with hospitals, there is public hospitals, so private ones don't jack up the prices to crazy values...
A lot of people are negative about how America does things, but as far as I can tell most of the issues stem from corruption via money in politics. Capitalism and Market Economies seem to work well, but Crony Capitalism and Citizens United seem to just be friendly names for corruption.
An extreme case of this (in some places) is the internet provider. If they know they're the only ones they can basically charge much more than if you were living in an area with healthy competition. What're you gonna do, not use the net?
Healthcare privacy laws make it extremely difficult to evaluate the value proposition of care providers. You can't just, like, look up a list of their previous patients' medical histories.
Most people aren't medical doctors, and most aren't gonna gamble with their health. It's a transaction where one side has way more information, less to loose, and therefore more power. Hopefully they use that power for good.
This results in often legitimate procedures being denied. But make no mistake, the care providers billing insurance are just as likely or more likely to try to grab money in any way possible.
I was once involved in a company that would place laboratories and other diagnostic machinery in physician's offices. They would always be very interested in what the insurance reimburses and how many patients they can run it on. There would always be some gimmick like Oh, homocystine we can run on every patient for $5 and be reimbursed $30, and then you would see that ran on every single patient they could to make that money. Eventually insurers would have to shut it down. High sensitivity CRP was another one until medicare locked it to being run once in a patient's lifetime.
The shitty ones, maybe. I know many physicians who acknowledge that unnecessary tests lead to unnecessary interventions, which is proven to reduce quality of life and decrease outcomes.
I've personally found this particularly common and suspect within the Dental industry.
https://health.sunnybrook.ca/navigator/too-many-dental-x-ray...
(Maybe not the practitioner directly, the providing organization)
As a Canadian I highly disagree. And anecdotally many health care providers from Canada agree with my take. People frequently die, or get sicker, as they wait their turn in months long queues or lack of supply due to government quotas.
There is nothing stopping the government from substituting lower-quality, less effective procedures when their MBAs come in an consult about how to reduce costs.
My father fell off a ladder and had a pretty severe head injury, and had both an MRI and a CT scan within a half hour, at no cost. Yes, lower-priority conditions may have to wait, but it's also by definition because they're lower priority - and they'll have to wait in America too.
The idea that the Canadian healthcare system is somehow leaving people to wait and die in a way the American system is not, is a falsehood propagated by major American insurers and their lobbying group AHIP. Here's a Cigna executive apologizing for doing just that. [1]
[1] https://www.npr.org/2020/06/27/884307565/after-pushing-lies-...
> because of having the kind of health care system you have in making sure that everyone who needs to be treated is treated
That's completely false, Canada has a presupplied quota system set by government forecasting and limited by budgets. If you need treatment you will be treated eventually but you might die or get sicker in the interim.
Using a COVID-19 based article to discuss the merits of single payer single provider completely ignores the massive cultural mentality differences -- the US focuses on individual freedoms, Canada focuses on collective good. This makes a big difference when it comes to adherence things like social distancing and masks. They're taking a multivariate system and claiming it's a single variable that caused the outcome.
Edit: and I might add that it appears that Canada is always intentionally undersupplied such that a moderate wait is guaranteed. Whereas it seems that due to market competition the US system is inherently oversupplied (at least in many areas) such that they can provide to those who can pay essentially on demand.
Good to know you didn't read the article before replying.
> That's completely false, Canada has a presupplied quota system set by government forecasting and limited by budgets. If you need treatment you will be treated eventually but you might die or get sicker in the interim.
Every system in the entire world has a predefined quota. There's no unlimited supply of healthcare resources in any country - and America is no exception. The only difference here is whether these resources are centrally provisioned or not - and whether you ration it based on who can spend the most, or who needs it the most. I vote for central provisioning and need-based allocation.
You are ignoring that once again, there are wait times in America too. The reason I sent you this article is proof that in fact your assessment of the relative strengths of the system isn't grounded in fact. It's grounded in propaganda about the American system. The system you are imagining in America simply does not exist.
> Using a COVID-19 based article to discuss the merits of single payer single provider completely ignores the massive cultural mentality differences -- the US focuses on individual freedoms, Canada focuses on collective good.
This is irrelevant to the quality of a healthcare system and its outcomes. And you are ignoring that 40% of Americans are already covered by socialized medicine. Old people in America love Medicare and have no interest in getting rid of it. 75% of people on Medicare are either satisfied or greatly satisfied, while only 6% are dissatisfied or greatly dissatisfied. This is higher than the for-profit sector.
> Edit: and I might add that it appears that Canada is always intentionally undersupplied such that a moderate wait is guaranteed.
That's a cool, unfounded opinion.
And again, you have ignored the clearly measured equivalence of the two systems in terms of outcomes - while the Canadian system delivers it at literally half the per capita cost and covers everyone.
If you actually look at the data, it's clear. The private care available in America is more expensive and outcomes are either the same, or significantly worse. America has the worst maternal mortality rate in the developed world, for instance. This is quantifiable and you are not utilizing that data, one has to suspect, because it does not support your position. [1]
Didn't read the entire article due to quickly findable glaring issues of quality, yes.
Saying America spends more is pretty weak claim because Americans are fatter, more often shot, face worse natural disasters (hurricanes, earth quakes)... Of course they spend more. There are hundreds of variables why healthcare per capital would be cheaper in Canada from CoL to quality of doctors (the ones that remain are ones who cannot compete in the highly paid US Market), to greater public safety net or social goods in all areas resulting in fewer high cost outcomes (eg, Canadians take more PTO)...
Overall i think the main difference between what you're interested in and what I'm interested in -- that which we're calling "superior" differ.
To me a system is superior if it gives better outcomes to those who pay for the service. VS you seem to be claiming that a better outcome is something like the average across all citizens.
To me this is like saying "We all need food, therefore when we go to the grocery store you will be charged the average bill and given what you absolutely need to not die, but not necessarily what you need to thrive. This is how we keep others from starving..."
For me I want to go to the grocery store and receive the best I can get for my money. It's a just system to receive what you pay for and to not receive what you do not pay for. I do also believe in a separate, external to the government, system of charity to cover cases which are truly unfortunate, but also to keep people accountable for their contributions to their own health when able or
Anyways, it seems you're squarely set your values based opinion, and I am on mine. So there's no longer a reason to discuss further.
“Fatter“ and “more often shot” are at least in part due to choices about the focus and distribution of physical and mental health care, not independent factors (in fact, the political faction most defensive of the ways in which the US system differs from the less-expensive, comparable overall outcomes systems in the rest of the developed world also is prone to claiming that the elevated risk of being shot is primarily a product of defects in the health care delivery system, though they tend to lose focus on doing something about those deficiencies quickly after pointing to them.) If you've got evidence that the health impacts of natural disasters are greater—in a way explained by the nature of the disasters alone and not choices in the structure of the health care system—in the US than any, much less all, of the other advanced economies in the OECD, please point it out, because that would be interesting.
X could be lots or little, Y could be Covid or the death penalty. Data tells you nothing about the justice of a situation.
You pull out tired narratives like 'care quotas' as though they only exist in one system but not the other. You pull out tired narratives like 'wait times' as though they exist in one system but not the other. I linked you an interview that explains what the industry has been doing to further this narrative, and you didn't read it because again, it doesn't align with your preconceived notions.
What you're telling me is that you don't want to engage on data because the reality on the ground doesn't align with your values and you've been fed a crock.
There are often months long waits for here too, try getting a dermatology appointment, we just also have the privilege of paying for it out of pocket as preventative skin care checks are not actually classified as preventative medicine so it counts towards your deductible meaning you have to pay the first $2000.
What would be a good point is a discussion about if want a society where the people who pay for a procedure get better outcomes, or if we're willing to say to those who pay "You will get a worse outcome because we're also serving those who cannot pay. This comes down to cultural values and ethics.
Vs America where you get a worse outcome due to laborynthian beuracratic rent seeking.
Sounds terrible for Canadians to be forced to make things better for poor people if they want to improve things for themselves.
This also happens in the US. Plus, if you do happen to get care you can go bankrupt!
>when their MBAs come in an consult about how to reduce costs.
The US is far far past this point already.
> their MBAs come in an consult about how to reduce costs
You don’t think the big health insurance companies in the US do the same thing?
To the multiple peers who point out the US uses MBAs too. I'm pointing out that both systems use MBAs and come to the same conclusions such as "We can save n% by using n-1% less effective drug."
In theory, free market healthcare should improve alignment.
Insurance companies pay procedures and make money when people are less sick. Hospitals make money when they perform procedures. Insurance companies are therefore incentivised to only pay procedures from competent hospitals, the ones that won’t result in more follow-up costs.
The problem is, of course, it’s not a free market - neither on the hospital side (prices are not public) nor on the insurance side (it’s much more affordable through employment)
This is true of prisons (you can't exactly have private prisons compete for your business). Of fire departments (I'm not going to call for quotes while my house burns down). Of police departments.
If it's not a free market, it should be socialized, imo.
People always twist this into “you’d have to pay so much more for healthcare”.
No! I never had to pay anything substantial for healthcare. I pay for insurance. But I prefer private insurance (to improve competition, performance, quality, accessibility, …)
It's not as simple as that. Insurers are regulated. They can't keep any more than 20% of the money they collect. It sets up an incentive for them to collect and spend more money.
Do you think that part of the reason that America is so attractive to pharmaceutical innovation is because of the obscene profits that can be made in the prescription space that is not only allowed by our laws, but encouraged by our politicians?
If we were to socialize our pharmaceutical sector, which would involve putting caps on pricing, do you think this would make innovation into treatment which involves huge upfront costs in research a non-starter?
Would neutering the profit motive and corporate greed in our pharmaceutical sectors revert our pharma studies back to university programs and corporate tax write offs/good will programs and the occasional government budget surplus when they've decided to not funnel it towards another uneccessary war?
I think your entire premise is flawed here. Businesses make money by providing services that people want / need.
It's not a flawed premise. It just doesn't occur 100% of the time. It tends to occur in industries with poor competition (mono/oligo-polies)
This keeps showing up but it's total bullshit. Cuban wants to take 15% of the transaction for running a web site and processing payment. They're not manufacturing drugs. They're not buying drugs. They're not shipping drugs. They're not doing anything at all besides taking your order and giving it to someone to do all those things. It's not a charity. It's a profitable business and a very profitable one at that.
Oh yeah, and the prices aren't lower than what you can get using GoodRX.
You need <drug> in <area>
They search pharmacy prices in <area> for <drug> + <generic versions of drug>
You get back a list of where it is cheapest to have <drug> fulfilled by a pharmacy in <area>
Enter insurance companies. They don't want to pay $1,000 for a $50 drug so they negotiate. But there's too many insurance companies for them to have good leverage and efficiencies in negotiation.
Enter Pharmacy Benefits Managers. They get hired by insurance companies to negotiate with drug companies and pharmacies. Thus the buying power is pooled and they only have to pay people to negotiate one time.
GoodRX is like the last category. Except that instead of getting paid by insurance companies they sell user data and collect some fees from pharmacies and drug manufacturers.
That seems like the value prop though. The cases where it's not, and the alternatives are absurdly expensive. People seem to be focusing on the median case where it's marginally more expensive or cheaper
In reality I'd expect that 15% to be necessary if they want the company to survive after some years. There are tons of not so visible overheads and costs, and it (apparently) has taken a billionaire to be able to start such a company (disclaimer: I have no idea what GoodRx is).
If I could generate the amount of free advertising Cuban's getting I would.
I clicked on the medication's link (just for lookup), and it took me to a page which listed Manufacturing, 15% Markup, Pharmacy Labor and in a circled blue box: "* additional cost at checkout Shipping $5.00".
The original point is that if you include that cost, then their prices for many drugs are no longer the cheapest.
On GoodRx I see the same drug at a local grocery store for $6.84, (Costco is $8.49) and online pharmacies like geniusRx are $4.50 (s/h unknown). My health insurance through a local pharmacy would cost $14.38
I don't like all the advertising on costplus about how they're saving you like $490 out of $500 on Rx, because everyone else is doing that to. There is literally nothing new here. My local grocery store beat his price by 10%+. But as long as you know that the "pricing reduction" is total bunk and not a competitive advantage and just an explanation of the current state of the industry that EVERYONE is doing, then it's one more option that could be the lowest for you.
In my case, it didn't help me.
In other words, I don't think Cuban puts his name on all businesses he's involved in like this, but for this case specifically it seems fairly obvious that using his name furthers their message.
That said I have to assume Cuban is also getting a PR benefit here.
When you say the prices were about even with what you pay at costco is that comparison with or without healthcare insurance paying part of it?
If your insurance paid part of it and its comparable then Cubans pharmacy is a win for those without healthcare insurance.
I still think this is a great service regardless.
But are you taking into account how much a month you are paying into that insurance when comparing the two?
If CostPlus is coming close to what you are getting your prescription for with a paid into insurance plan, than I would call that a win for those without insurance.
Might be worth looking at lowering my own insurance coverage to one that might not be that great for prescription, as long as costplus and costco type places come close to after insurance priced meds.
It's an easy way to karma-farm on HN.
Sometimes? The medical industrial complex's MO is to squeeze as many people (in the USA) as they can for every penny they have. The American sheeple have been duped to vote against their own best interest (a single-payer system). We don't have the best medical care in the world and we pay at least 10x for it.
> Why are your prices so cheap?
Not native English, but that is not English right?
Edit; guess my school English told me that is wrong ;
- prices are low
- this medicine is cheap
So learned something ;) thanks
EDIT: As an American, "Why is it so cheap?", and any variant, is completely normal.
That seems different ; ‘it’ refers to the goods, not ‘price’.
Didn’t know it was common, like said, not native english.
It just sounds weird to me, because I think I was thought this is wrong a long time ago in school.
ooooh okay that is really neat
How do I get the drugs? order it from our pharmacy.
Wat?
Instead of:
Pharma co -> Distribution -> Pharmacy -> You
It's:
Pharma co -> Cost Plus -> You.
Cost plus is still a pharmacy by definition.
"We work with Truepill pharmacy, our trusted fulfillment partner to fill your prescriptions. Truepill has a team of accredited pharmacists who will ensure your medication is safe and delivered to your doorstep on time."
Oh, and guess who owns most of TruePill???
Hint - https://www.optumventures.com/portfolio
There is very little new in the PBM/Pharmacy world from what I've seen, just more layers of redirection and subterfuge :)
> Everything is an advertisement, and some of it is clearly marked as such.