That’s a bold strategy, Cotton
Amazon pays $40 million for rights to a documentary about Melania. Should be pretty good at that price!
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The grifting thats in the open is shoocking enogh. Imagine what we arent seeing
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Drug prices.
Perhaps we should let the California Department of Insurance be repurposed to approve pharmaceutical prices rather than insurance rates.
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that sort of idea does come up at CGT conference discussion. they spend time talking about the R&D, the benefit, the tech, etc. then we wait a beat before start yelling about how the hell is anyone going to pay for it all? I think this category of treatments could be a big push towards the death of employer-sourced healthcare. (self funded employers could find a lot of people in their plan uncovered by the excess coverage owing to the tell tale diagnoses and the belief that insurance is for the things you don’t know about.)
the chargemaster system providers use doesn’t help. the system reflexively take something, multiplies the cost by 5 for the billed amount, and accepts negotiating down to 3x (vague example). not problematic on its face for a bandaid that cost $0.10, but when the wholesale cost is $1M…it begs for someone to say maybe there should be a dollar cap on the markup?
If you’re actively moving to be that close to a whale you’re violating federal law (if the whale moves towards you, you’re ok).
2M is probably highway robbery, but this article has a slant, it doesn’t seem to explain that the reason they are charging this much is because the previous treatments cost more than that over a person’s life, and this is a cure instead of just a treatment, which is obviously preferable.
I don’t think it also addresses that people aren’t being bad in trying to cure babies only with this, it’s just that the treatment only works with babies so far. It’s probably because some degeneration can be prevented instead of trying to fix something that’s already taken place which would be harder.
It is hard for the charity that funded it that the cure they funded wasn’t good for older kids but I don’t think anyone was being a terrible person by working on the cure for babies once they saw that this was all it was good for. As long as no one stated false pretenses up front.
But yeah, there’s obvious greed in pricing this.
It would be better to reasonably calculate so much for R&D cost, including all the drugs that go nowhere, so much for how rare the disease is (rarer diseases need to make more per cure to make sense), so much for profit, so much for production, so much for the cost of treatments it is replacing (so-called value based pricing). I think the CA DOI would be a great candidate for this.
I also think charities, when funding research for cures for diseases, should start buying shares in their profits, to be dedicated to future funding of more cures or the comfort of current patients, instead of just handing out money. This is a good story to share just to teach current charities what can go wrong when you don’t do this.
Hey, maybe the federal government should have a similar deal where if you use federal funding you give a share of profits to them which then would be funneled to kids needing the treatment.
Additional note: I once contributed when someone had a kid that needed this treatment
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“Morbidly speaking, the best source I can think of to get good, relevant microplastics is to take an entire human brain and digest it,” says Campen.
one thing not broken out in the amount paid by the plan is the suggestion that about 1/3 of the total paid amount is procurement. the manufacturers usually insist they are “only” getting about 1/3 of the paid amount. the markup from there is the provider side system impact.
zolgensma, among the gene therapies, has the most obvious take up bc the recipient is younger than 2 years old. there is urgency to get it and all the existing alternatives show less promise for success.
Are you saying that of the 2.1M, the manufacturer is only getting .7M? Who exactly is the provider here and how do they deserve 1.4M… is that the one administering the treatment because I doubt anyone could argue they need 1.4M to cover their costs and profit, unless they were part of the original R&D. Couldn’t the insurance company just switch providers to get the price down, or is the provider giving a kickback to the manufacturer to make sure they stay the provider? In which case, the manufacturer would be getting more than 1/3
Edit: if this means the PBM, then nowadays it seems the PBM is usually the insurer. So the real price the manufacturer is getting is 700K and the rest is just a made up amount to trade between the insurer and the PBM because no one’s deductible is that high.
But then, this means the manufacturer should be willing to provide self pay patients this medication at something close to 700K (add a little for extra admin). They could hopefully defeat most favored clauses by doing it as some kind of coupon based on income to self pays
These are treatments procured from the manufacturer. Singular manufacturer per drug. There is one source for zolgensma.
The treatment has to be performed/delivefed by a qualified provider (doc and/or hospital) than can handle the therapy.
Example used at a conference:
Manufactuer charges $1M for the treatment. (These are specific to the genes of theindividual recieving them - so made case by case. Yes it takes time to make it and stockpiling isnt possible they say.)
Hosp system bills insurance like $4M. Insurance negotiates it to like $3M.
Payer (insco) pays provider (hosp) $3M.
I find the softest portion of the total public cost ($3M) to be the markup from the provider system.
Such a multiple is not noticed on aspirin but damn it gets to real money here.
Yeah, I don’t get why someone who’s desperate to keep costs down (insurer or uninsured patient) doesn’t get a chance to go to (or incentivize people to go to) a different hospital who will only administer the treatment for 500K instead of 1.4M. There’s got to be some hospital out there who needs a little money and is willing. I find it hard to believe that 1.4M is hospital/doctor markup on this particular treatment. It seems more likely that the markup is smaller in this case, but what do I know?
OTOH administration of an aspirin probably does merit a markup of 200% for admin if not more. Aspirin’s so cheap. Fixed costs vs variable. Etc.
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Frequently people are not in a position to shop when they need a hospital’s services (especially if they’re in a location where there is only one viable option).
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The public has traditionally reacted very negatively when “their” doctor/hospital/whatever are not included in their health insurer’s network, and some regulators and legislators react to their constituents’ negative reactions.
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Where I grew up, there was only 1 hospital in town . . . the next closest one was at least a 45 minute drive (longer if the weather’s bad). After that, we’re talking 3 hours drive or a 45-60 minute flight-for-life (again, longer if weather isn’t ideal; or not an option if the weather is bad).
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It’s not unheard of for an insurer to designate Centers of Excellence for expensive treatments, and if it makes the difference between 1.2M vs 2.1M, I’m sure the insurer could adequately incentivize the insured to go a little further… eg waive the yearly deductible and OOP if you go to the place that costs about 1M less. Maybe also provide a food and lodging allowance to be nearby? That should do it in many cases, especially if you give multiple options to go to, as these families would naturally need to pay their entire OOP for that year, and OOP these days are at least 10K usually, which is lots of money to most people. And it won’t generate the bad publicity because the more expensive place is still covered. And if the insurer gives multiple options, that prevents people from turning it down because the only place the insurer is incentivizing is the hospital that’s known for bad outcomes.
An average human brain may contain 7 grams of plastic, about the same weight as a plastic spoon
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45 minutes is doable depending on how long the hospital stay. If the insurer provides lodging, and there is only one working spouse, 3 hours might also be doable.
I have a relative who went across the country for a recommended hospital, instead of the second best, still really good one that was 1 hr away, instead of the local one (known for bad outcomes), less than 30 mins away. But that was a family where one spouse could afford to take off a month from their part time work and could keep their job.
the national COE idea is the one I think that could get it done. would have to provide for travel and lodging for others for a couple of weeks. (Some of the gene therapies require an IP stay leading in and out of the treatment and those are not reflected in the prior price I mentioned. Some require a bone marrow transplant even.)
that said, forced travel when there are more local options is a challenge.
Sharks everywhere should unite behind this movement.
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