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Comment by polalavik | Hacker News Reader

I had to get a medication for a stomach bacteria called C. diff. It has bad relapse rates and its best to get it in check asap. What my doctor prescibed was the newest/best antibiotic for the issue, the other have worse recovery rates and way worse side effects.

I have very good insurance. The price of the medication without insurance was about $5000, the price with very good insurance was about $1300. After redditing i found a thread where you can find a manufacturers coupon on the manufacturers website. After knowing this seemingly secret hidden trick the medicine was $50. My doctor didnt know about that, my insurance didnt either. Absolutely insane. Absolutely arbitrary.

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Well of course. In the USA, health insurance is legally required to spend at least 80% of premiums on medical care [1]. So, if they paid for only 50$ of care, they would only be able to make at most 62.50$ of revenue. The only way to keep revenue and total profits increasing is to increase costs.

[1] https://www.healthcare.gov/health-care-law-protections/rate-...

That’s a really important point. All the incentives are to increase cost.

The insurance still paid the $3700 or so, the rebate coupon is to remove the obstacle for the patient so that the larger payment gets made.

> After redditing i found a thread where you can find a manufacturers coupon on the manufacturers website. After knowing this seemingly secret hidden trick the medicine was $50. My doctor didnt know about that, my insurance didnt either. Absolutely insane.

This is GoodRx's business model in a nutshell. I used them when I didn't have insurance and saved a ton on medicine.

Some manufacturer coupons/copay programs work a little differently than GoodRx—specifically the ones that you can only use if you're insured.

Those ones work like this: HelpfulDrug costs $2000/month. Your insurance company will pay $1500/month, and wants to pass the remaining $500 onto you, but that's too expensive for you to pay.

The manufacturers of HelpfulDrug see this and would rather not lose our on a deal, so they make you an offer: as long as your insurance pays the $1500 as promised, they'll tell insurance to waive $450 worth of your portion. You only pay $50, and the HelpfulDrug manufacturer still earns $1500, most of which is pure profit anyway.

i just looked up the medication on goodrx [1]. still listed as ~$5000 when there is still a $50 coupon [2]

[1] https://www.goodrx.com/dificid

[2] https://www.merckconnect.com/dificid/coupon/

Interesting I Google'd this and it costs NHS in UK £1,350 GBP aka $1,719.22 USD for same 20 pills at same dosage (document dated 2019)

https://gmmmg.nhs.uk/wp-content/uploads/2021/08/Fidaxomicin-...

Manufacturers' discount coupons are a fairly common thing in the US. But if the patient is on any kind of government medical assistance program (Medicare & Medicaid being the two big ones), they're not eligible.

My bit of anecdata is the insured price of $1249/month for a drug whose manufacturer would sell me for $40/month - if only I weren't on Medicare. $14,988/year vs. $480/year. Sucks.

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