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Comment by bdcravens | Hacker News Reader

The pricing is more like $25-30K/month. It's taken twice a day, in pill form. (I have CF and take Trikafta)

Please tell me insurance pays for most of that?

Nobody actually pays those sky-high drug prices themselves. It’s a scheme to extract as much money as possible from insurers.

Companies often have programs that provide the drug free of charge (or at a nominal price) to people without insurance. They might also have “copay assistance” programs where they reimburse patients for their copay to bring the out of pocket costs down.

The goal is to maximize the amount billed to insurance companies. They’ll go out of their way to reduce the amount billed to the patient directly, because that results in more patients signing up and enabling them to bill more insurance companies.

It’s not a good system, but it’s how things work right now. Nobody pays that $100-300K price themselves. Well, we all do through higher insurance costs.

> Nobody actually pays those sky-high drug prices themselves. It’s a scheme to extract as much money as possible from insurers.

Alternatively, we all pay those sky high prices. It’s baked into our premiums.

while employed Premiums = $0. while unemployed, premiums = $3600/year for $0 deductibles for private insurance. would you rather pay 10% of your income in higher taxes like so-called universal healthcare providing countries maintain?

This is such a short-sighted take. Who do you think pays for your $0/year premiums? You do, through reduced wages.

The main difference between US healthcare and socialized health care is that in the US, nobody is responsible for lowering healthcare costs... and so they go up. Why do you think PE loves buying up healthcare facilities?

Yes, personally. Instead of my employer paying for my healthcare (and that being factored into base salary), I would rather receive that money as salary and pay higher taxes. The idea of employers paying for health insurance in the US only came about in the first half of the last century as a way for companies to attract employees without having to raise/compete on salary.

The premiums are nowhere near that cheap.

I have the best insurance policy my employer offers, where I have a $250 annual out of pocket max. I pay an additional $230/mo for the coverage over their base plan; I pay $900/mo to add my wife to the plan.

I'm just one datapoint, and there may be better plans out there, but you're presenting an alternative that doesn't exist for 95% of Americans.

Correction: Deductible $250, out of pocket maximum $1500

These numbers are pretty far off for me. I have:

- $4,000 deductible

- $8,000 Out of pocket max

- $1,800/year premiums while employed, $7,200/year premiums on COBRA if unemployed.

On an $80,000/year salary.

Can you give me a link or reference to this incredible $3600/year for $0 deductables insurance?

That's cheaper than I pay with my employer covering most of my healthcare. That could be literally lifesaving for friends of mine who currently have to choose between paying about $800/month for insurance with deductables or going without.

One look at the individual market for insurance shows that you will be paying many times the quoted figure if you want insurance that you can actually use, and you will have $8k deductibles and higher out-of-pocket maximums with cheaper insurance.

It's just completely BS then? Looks like it's plenty upvoted too.

Yes. As for upvotes, chalk it up to the bias against "socialized" medicine.

> It’s a scheme to extract as much money as possible from insurers. [...] The goal is to maximize the amount billed to insurance companies.

A big part of the goal is being able to bill a profit, insurers generally require significant drug rebates for coverage. So you triple the sticker price of the drug, offer a 66% drug rebate which the insurer can advertise to their client under the guise of fighting for their access, and they cover your drug at essentially the price you wanted for it in the first place (modulo nonsense like prior authorization, and insurance kickbacks).

Of course :-)

Vertex's copay assistance is also very generous, even for those with high income. I have a good developer income, and pay essentially nothing.

I personally consider copay assistance to be essentially fraudulent as a concept. The drug company is literally paying the patient to invoke an insurance benefit that kicks a bunch of money to the drug company.

I imagine that when an auto body shop pays their customers’ deductibles, it is fraud, legally and ethically.

Not having to deal with insurance & copay shenanigans for my daughter's CF meds is one of the things that keeps me at the large tech company I work at...

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