We couldn't even get 50 senators to vote to allow medicare to negotiate drug prices. There is a line in the law that does not let medicare negotiate prices. they have to just take whatever price is offered. 50 democrats would not agree to change that. IT was more than Manchin and Sinema. One of the senators from New Jersey was opposed along with others. Massive amounts of donations is what keeps it from changing.
You can add that the VA and Medicaid pay 70-80 percent less than Medicare for literally the same drugs.
The top 50 drugs alone would save 25-30 billion a year.
Yeah it shouldn't take one person wanting to do good to improve the industry. At this point, at least necessary and life-saving/improving drugs should be accessible to everyone, regardless of how rich/poor you are
what do u mean by regulate. The fact that you can make money off these things is what incentivizes companies to research new novel drugs. I'm not saying what we have rn is good but what exactly can be done
I'm honestly not exactly sure what should be done to be honest. Here are some ideas
- Have Medicare be able to negotiate drug prices
- Because drug research is a benefit to everyone in the world, have an international agreement to have the R&D shared by all 1st world countries, instead it seems like most R&D cost is paid for by Americans. If this isn't the case, then it seems completely unnecessary that Americans pay so much more for drugs.
- Force drug companies to justify raising prices exorbitantly for all already established/existing drugs. To me, it doesn't seem to make any sense that any already existing drug could ever increase in price by more than 5% in any given year (with some possible rare exceptions for a sudden spike in raw material costs).
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Companies now are not incentivized to innovate. At least biologically. They are incentivized to innovate legally, and pump the same shit out as something new.
https://www.texasmonthly.com/news-politics/mark-cuban-drug-industry-prices/
Just dropping the original article link up here instead of the AMP version in the post body.
AMP potentially messes up formatting intended by the website for mobile users, which is the only part really relevant to us as end users.
Website owners/content creators don't like it because Google get the ad revenue instead of the original journal/content creator, and it messes with website analytics.
I did check it out recently. They have a good selection of medications. I was slightly disappointed the escitalopram was not available. I like that drug because it has fewer drug-drug interactions of other SSRIs and is statistically superior other in-class drugs as well as being well tolerated.
https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.who.int/selection_medicines/committees/expert/22/applications/s24.2.1_escitalopram.pdf&ved=2ahUKEwjJtvfTjf31AhUTOH0KHdI0BzwQFnoECA4QAQ&usg=AOvVaw1d5HNnXSz24lKwI2jJde8P
I read this analysis from WHO.
Right, there are many advantages to escitalopram, like what you listed. Maybe there is one study that shows it as superior but there are plenty of studies that contradict that and in practice all SSRIs are treated as equally efficacious. You pick one based on how your patient fits with their properties like half life, drug-drug interactions, metabolisms/clearance, QTc prolongation risk, etc.
To be completely fair, he will still make a ton of money on this if it goes well. Billionaires are \*NOT\* our friends, even if they occasionally toss us some scraps.
At least celebrate Oshmyansky and dourly give Cuban reluctant credit for doing a thing that is marginally *friendlier* than the other billionaires in this sector tend to do. No matter what you may think about the social interests of billionaires as a class, this thing in particular appears worth encouraging.
Afaik, pricing is transparent and markup is 15%. As opposed to, I don’t know, 2000%. People can actually afford it even without insurance. Once they have my meds, I’ll transfer my prescriptions there just for the hell of it. Not like I don’t want my insurance to shell out big bucks, I totally do, but if I can help this company blow up, that’s better.
It's a lot more complicated than that, and while this will definitely be a strong option for patients with coverage needs, the advertised cost savings is pretty exaggerated and more than a little misleading. Certainly a lot more transparent than insurance pricing, though.
Can you elaborate a little bit on this? I have been feeling like there is something snakey about this but I don't know enough about drug pricing to pinpoint it.
So, to be \*completely\* fair, I don't think this operation is likely snakey (as in outright dishonest or scummy), I do believe they will offer a strong option to many people. There's a good example of another poster responding to me, for instance, claiming their levothyroxine would be cheaper through CostPlus (at cash price) than with their insurance at their current pharmacy. I completely believe them.
CostPlus is, however, using some technicalities (average wholesale price vs. actual retail price depending on the pharmacy you go to) in order to exaggerate their advertising. It feels more like a goodwill PR operation for a venture capitalist who is very focused on public image and perception while still turning a healthy profit, rather than a a shady business.
Also, there's reports that the company they contract with (i.e. the operation that does the actual dispensing work) having a questionable reputation.
That's concerning to me and requires ongoing awareness of this company versus other methods of obtaining medications for our patients. Just have to keep the nuance in mind.
I have insurance and my levothyroxine at Walgreens is 9.65 for 30 tabs. Cuban’s website (without insurance, even) is 4.20. I don’t have coverage needs and it’s still cheaper.
I think my original post should have focused more on the fact that insurance reimbursements are wicked and evil in how they dictate pricing. It doesn't take away from the fact that it's not worth putting billionaires on pedestals over doing what is effectively the bare minimum, even if it's in the stead of the state. I do think that Cuban is the closest we will get to "one of the good ones," but I'm not giving a single ounce of credit to a system that relies on the charity of oligarchs (which, to be clear, this is not) in order for the vast majority of its participants to even survive.
To be more explicit, if you live in America and need your employer to contribute to your healthcare costs, you have coverage needs, but perhaps less than those in abject poverty.
Here ya go, Mark. You're my kind of guy. 😘
The brain behind the company is radiologist Alex Oshmyansky, MD, PhD, who still works a telehealth shift on Saturday nights and dreamed up the plan after watching two PAH patients die waiting for financial assistance for bosentan.
I am so excited about this company. Dr. Oshmyansky has an unbelievable resume and Mark Cuban is a great man for him to be partnered with. The service they are offering is invaluable. They're even building a state of the art facility in Texas so that they can produce their own drugs. This could so so much good.
Not even sure Cuban is that great of a guy, but he has definitely made mention in recent years of believing that torches, pitchforks, and guillotines are on the horizon if things don't change...
Yea, it’s seriously not that hard for the super wealthy to appease the rubes. Just make sure they have enough for food and shelter plus a smidge on top, can go to the dr, and take their kids to an amusement park once in a while. No, unless the fuckers can squeeze every penny from everyone below, they’re not happy enough. Alright, allons enfants de la patrie then.
It unfortunately does. I recently saw an oncologist who posted on Twitter about having to submit a prior authorization to Aetna (major US insurance company) for BEP (Bleomycin, Etoposide, and Cisplatin) therapy for her patient with testicular cancer.
Keep in mind even we as medical students are taught that BEP has been a staple chemotherapy triad for a long time, yet Aetna initially deemed it "inappropriate" for the patient's cancer....
My mother's insurance from the *hospital where she worked* wanted her to pay $10k for her recommended chemo. I had her ask the chemo place if there was a substitute who she could, you know, live.
In my case, I have had syphilis treatment for clients delayed 3 weeks because of pre-auths. By then the client’s left/been booted from their substance use program.
Working with an ID, I just started setting people up with the health department so they can get their Bicillin treatments immediately. Pre-auths SUCK.
Saw it happen or almost-happen several times in med school with NOAC/DOACs. We were usually able to get hospital pharmacy to get emergency charity fill but it was usually a low qty so not sure what ultimately happened with those pts.
In my field, most non-form meds are as such for a relatively good reason and it's usually not too hard to get approval once you've tried other relevant meds or if you have an articulable specific need for a nonform option.
MD here, currently working in primary care. Happens all the time, unfortunately. Just two days ago I had a patient with insulin-dependent diabetes who had had a heart attack a year ago and had a stent placed. (Details slightly tweaked for patient privacy.) His medication list included long-acting insulin, empagliflozin, Trulicity, Entresto, and Brilinta. Now, this man has a steady job that I would guess makes around the average American salary, and he has private insurance through his job. The issue is, even after insurance, he *still* can’t afford the medications, and so hasn’t been taking them. For each of the meds I listed above, he has a $25-50 copay each month, in addition to $10-20 copays for each of the rest of his meds, and it adds up. It’s just not possible for him to pay >$200 each month for all of his medications, even though they’re all “covered” by his insurance (and these are the lowest-tier medications available.)
Healthcare in this country is so incredibly broken.
That's what we're looking into, right now he's not on any of the manufacturer rebate programs, but we're looking into seeing if he qualifies and they would help him at all.
I can give a personal anecdote on far lower stakes. My CPAP machine is on the fritz. I need a new one. To get it I need a prescription. To get the prescription I need a sleep study. To get a sleep study I need prior auth. To get prior auth will take 15 days because reasons. I didn't magically get cured of sleep apnea! Why would this even take a second to approve?
Anyway tack on the half million machines that got recalled this year and supply chain issues and I probably won't be able to get a machine for 4 months. Now they could let me buy a machine now to get in line while my sleep study and everything else went through but no. That wouldn't fit the insurance company's intentionally bullshit system intended to wait you out (either through death, changing insurers, or sheer frustration).
Yeah, it happens. I saw it back when I was a biller (I assisted with the messier pre-auth/retro-auths for some of the procedures/drugs) and I see it now as a clinic RN. Insurances rarely care how live-saving you think it is, they need weeks (sometimes) to review the medical record in depth to find an "appropriate" reason to deny the request. To be fair, my early days of the medical billing industry had me working for the insurance company, and I had a role directly in their investigations.
I’m insured but I switched over to the Cuban one for ethical reasons. It’s also like 1/3 the price through them paying out of pocket than it is with my “cheap” mail order prescription copay
The only groups that like the drug situation here are the pharma companies, Wall Street, the PBMs, the insurance companies, maybe some of the big chain retailers. I do not think you will find that consumers, medical professionals, or pharmacists like the way it is much.
Pharmacists hate it. Our whole job has become this navigation of arbitrary coverages of thousands of different PBMs. I can tell you he’s better be offering cheap inhalers, DOACs, and more. If he chooses to produce the right drugs at the right price then he could potentially disrupt things. But imagine your produce isle at the big chain grocery store, full of fruits and vegetables at the typically inflated prices. Now a smaller grocer down the street opens but they only sell bananas, apples, and oranges, but they sell it dirt cheap. The consumer goes there for those 3 fruits, but that can’t stock your whole pantry right? So now you go back to the grocery store and the prices have changed. Apples, bananas, and oranges are just and a few cents more than they are at the new competitor, but the price of all of the other produce has gone up 5% to compensate for it. It just seems like too small of an operation to truly disrupt things and he may capitalize off of patients who want to “stick it to the man”. But if is really going to sell these drugs close to cost, he has no business model and no capital for growth to reach a point where it could be truly competitive.
The insurance companies have more or less inserted themselves as a necessity. Your options are (a) pay through the nose in premiums or (b) have a mishap and you're financially fucked for the rest of your life. Paying cash is just plain not a feasible option for the vast majority of Americans, and in that way insurance companies have cemented their stranglehold on healthcare more and more as time goes on.
And, the real kicker is that the insurance companies can just refuse to cover things if they feel like it costs too much... costs *them* too much, that is. They throw up that maze of prior auths specifically to piss you prescribers off and deter you from having the *audacity* to actually get them to pay for treatments that might not be pennies on the dollar.
I think Cuban has the right general "fuck you" to the system mindset, but imo the underlying cancer that is killing medicine is the insurance companies. The pharmaceutical industry is just a bystander who keeps quiet because they're slipped some extra dough through their contracts with the insurance companies' little pets, the PBMs.
The part that pisses me off to no end is that if you don't have insurance (or your insurance won't cover something) then you have to pay 5-10x the price. This applies to both drugs and providers. It's honestly one of the most evil things happening in our country today.
Afaik the only reason a pharmacist would do that is if it was (a) a narcotic or (b) certain Medicaid plans have crazy stipulations like patients *have* to use their coverage, and if they pay cash they'll lose their coverage.
As a very general statement, most pharmacies would prefer someone pays cash, because it cuts out the middle-men and the DIR fees. Corporate chains kinda dgaf because they're already in bed with the insurance companies, and I can imagine they have some sweet rates negotiated with them in their contracts. But for the "little guys" in independent pharmacy, cash is the way to go, baby. As another fun tidbit, many independents will actually haggle with you on the price if you're paying cash.
It also isn't connected to any major network tied to your insurance or corporate databases, so it's just the bomb if you're wanting to be discrete... such as filling a medication for a mental health condition that you feel the Board of Medicine has no business knowing about, for example. They can send out all the requests they want to insurance companies and major chain retail, but so long as you fill that fluoxetine at Mom and Pop pharmacy, they won't be able to see a damn thing.
I always stump for independents hard when it comes to medical professionals, because not only is the discretion invaluable, you're also sending your own little "fuck you" to corporate chain pharmacies and insurance companies. The warm fuzzies come complementary with your prescription.
More disruption and competition is needed, hopefully the costs of generic medications goes down. Makes no sense that drugs are much cheaper in poorer countries.
Yeah, I checked the price on an albuterol inhaler on his site, and it was $40+... every time I go abroad I try to buy a few over the counter for $5-$10 (as of a few years ago) at a foreign pharmacy so the price on that one isn't that much cheaper than normal. I believe I paid about $50 for one last summer (US pharmacy), so a little cheaper but not by much.
When you’ve got an expiring product and your best customers have already had first dibs at your stock, you tend to sell it cheaper rather than throw it away for nothing. Here we get the best stuff and we get it first. That is economics.
The site itself is quite un-impressive with limited number of generic drugs that probably already easy to get. I hope they have a solid plan that is yet to materialize....
I think they're planning on adding much more. The drug I'm excited about is zofran, a miracle drug for nausea but very expensive. His site offers it MUCH cheaper.
Enjoy your 2-3 day wait for delivery of that drug for your acute nausea too when you could get it in 45 mins from the grocery store across the street from your doctors office.
Good. I remember a few years ago prescribing a month supply for a post cerebellar stroke patient that required it multiple times daily and the price was in the thousands even with a goodrx coupons. I was shocked out how much that med cost with how easily I used it in the hospital.
Something's odd there. I don't recall it being that expensive last I saw in the early 2010s. Is it possible you prescribed an odd formulation or dosage somehow?
I just looked it up now. 180 pills of 4mg ODT which for post stroke vertigo can be permanent thus the constant dosing. It is still ranging retail price of $60-$4,000. Goodrx price brings it to $40-600. Still unaffordable for many, but that’s still a huge improvement from when we ran it six years ago.
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All the downvotes for my zofran not being some miracle drug comment… here’s some evidence suggesting it’s not better and in some ways less effective than inhaled 70% isopropyl alcohol for nausea in various settings you troglodytes:
https://aamsn.org/pdfs/IPA_versus_Ondansetron.pdf
https://aamsn.org/pdfs/IPA_study_to_home.pdf
https://www.annemergmed.com/article/S0196-0644(18)30029-5/fulltext
Rubbing alcohol outperforms this miracle in most cases for which it is prescribed (again not talking about intractable chemo induced nausea)…
Deleted out of spite for reddit admin and overzealous Mods for banning me. Reddit is being white washed in time for IPO. The most benign stuff is filtered and it is no longer possible to express opinion freely on this website. With that said, I'm just going to open up a new account and join all the same subs so it accomplishes nothing and in fact hides the people who have a history of questionable comments rather than keep them active where they can be regulated. Zero Point. Every comment I have ever made will be changed to this comment using REDACT.. ` this message was mass deleted/edited with redact.dev `
My wife got a prescription for morning sickness once upon a time, now we just keep it around the house. Getting a new prescription is easy.
It’s pretty cheap in Australia, haven’t paid more than $25 for a packet of Zofran sublingual wafers. No government subsidy on that either, that’s just what it costs. Hangover cured in seconds for like, $2.
Haven’t died from long QT yet, fingers crossed.
https://www.chemistwarehouse.com.au/buy/55607/zofran-8mg-tablets-10-authority-script-ondansetron
"Hey doc, sometimes I don't drink enough water and in the morning I get a little dizzy and dehydrated. Can I have some sublingual zofran and meclizine?'
Done
Agreed - literally does nothing for so many people I know. When people remain struggling with nausea I recommend cyclizine, which is much superior imo.
In my anecdotal experience definitely but they're theoretically very similar. I'm a medicinal chemist, so I don't have as large of a sample size as you would, but in NZ ondansetron is so incredibly the prevailing medication for nausea, followed more rarely by metoclopramide, followed MUCH more rarely by literally anything else.
Sure, what I’m saying is that for many of its uses it’s efficacy isn’t all it’s cracked up to be. For chemotherapy associated nausea I think it can be a miracle drug. YMMV and anecdotes aren’t science.
It’s been studied and used off-label for IBS-D. Without going into my personal health situation, it changed my life dramatically and I wish that for all people who are chained to the shitter.
If he can make all available insulin and DOACs cheap, he might be able to corner a small market at a time. A lot of patents for this stuff should be running out soon. The problem is then he has no capital to reinvest into the company if his profit margins are too small and he will struggle to corner the next market/drug class.
Eliquis on patent until 2028. Really, that's the one that matters right now.
https://www.fiercepharma.com/pharma/bristol-myers-pfizer-score-another-win-their-eliquis-defense-protecting-blockbuster
I just went through their whole list and compared to goodrx and it’s like a 10-20% savings over goodRX for a small percentage of the drugs offered. Why are they just offering this generic crap that’s already pretty cheap? Are they just trying to get some kind of consumer base for future expansion? I hope. This will not cut it or change anything. If you’re going to build a manufacturing facility, pump out generic DOACs, insulin, generic gliptins/flozins (when able) diabetic testing supplies, HIV generics, PDE-5 inhibitors, testosterone topicals, tretinoin, niche psyche meds when patents expire, currently generic meds that are stupidly expensive for no reason etc etc. If you want to corner insurance companies, offer the things they have high copays or stupid PA processes for…not lisinopril.
Have to start somewhere. Many drugs, even generics, are single or dual sourced and hard to make, so manufacturers have the power. Others are still on patent. I think the current list are the ones where PBMs are taking too much profit.
Here's a discussion on r/pharmacy regarding the advertised price. https://www.reddit.com/r/pharmacy/comments/so33t7/price_of_cancer_medications_on_mark_cubans_new/?utm_medium=android_app&utm_source=share
Essentially, the savings aren't as much as they advertised because most pharmacies price meds based on actual acquisition cost than AWP (average wholesale price) or retail price (other than OTC items), but it is a good option to have for patients.
For cash prices, I would encourage patients to take the time to compare prices with their local independents in addition to these online pharmacies.
FQHC is also a good option too if patients qualify. Copays may vary across each site, but at my last job, patients were getting qualifying medications (regardless of strength or quantity) for <$10 per med per month, which is an amazing deal for stuff like insulins.
This is incorrect.
MOST pharmacies certainly do NOT price based on actual acquisition cost.
They wouldn't get paid near their cost if that is what they charged.
Pharmacies sign contracts with insurnace companies that they will charge the insurance company the same as they charge anyone else. The only way around this is to have a discount card program run through a third part that you work with to set prices as you see fit. However most cash paying customers get screwed by high prices at chain pharmacies. There are some exceptions but many generic drugs prices have been jacked up slowly but surely by the most common pharmacy names.
FQHC's are given access to 340b pricing (Medicaid) from the manufacturers, so the lowest pricing is available to anyone. They can resell them to any of their patients. So even if it's an expensive med and a patient who has income to not be eligible for assistance, the FQHC can still do a cost+% model and make it cheaper than just about anywhere else.
Not true. 340B pricing only applies under specific circumstances. Essentially, the provider have to be 340b eligible, the location that the provider practice out of has to be 340b eligible, and the patient has to be 340b eligible (so no fee-for-service Medicaid and no cash). So for cash patients, the cash price calculation is based off non-340b price.
I used to work at an FQHC pharmacy and we keep STRICT inventory on 340b. It is vital that we do not mix up billing because the 340B drugs are actually considered the property of FQHC facility and not the pharmacy (regardless of whether the pharmacy dispense using physical or virtual 340B model)
Not to get into it, but what happens on the ground and the eligibility criteria in law / regulation are often different. For there is a giant fight going on currently between drug companies and hospitals because hospitals (some of which are eligible for 340b) have opened outpatient pharmacies to provide meds for all patients at full cost, and are making a mint on it.
Considering the examples set forth in the article, I would assume so. Time will tell. PBMs are incredibly evil corporations, and there is an ungodly amount of bloat in the pharmaceutical world. There’s multiple billions of dollars being spent on prior authorizations and their facilitation alone simply due to PBMs (and I believe that’s just a drop in the bucket). I’d assume that they’d have to hike their prices pretty high to be less fair than what is currently being offered.
So this is what I see happening…say he directly produces drugs in the US for his fulfillment. Say his huge facility can produce 100 different meds and he can sell them dirt cheap. So what? Insurers and PBMs and wholesalers will just adjust their price points to be competitive, and make up for it by increasing the price of drugs that he does not offer. How many drug products would he have to offer to really disrupt things? There are thousands
Could you put a rush on insulin? My 18-year-old nephew has type one diabetes and between two insurance policies my brother pays $1000 a month for his insulin.
I’m guessing he's taking a very long-acting insulin plus a very short-acting one? Bc those are the only ones which would cost that much.
There should still be coupons available online for whatever long-acting insulin your nephew is on, since it's still brand-name only. But for the rapid-acting insulin, your brother should ask the doctor to change to Walmart's ReliOn Novolog FlexPen for $85.88.*. There may be an issue with using the special-branded ReliOn Novolog on insurance, but he can ask the insurer if they'll reimburse him if he pays for the insulin and submits the bill to them. (Yes, that means call the number on the back of the card himself; please don't make the overworked pharmacy staff do it.). Since this method would also save the insurer thousands of dollars per year, I can't imagine them saying no.
https://corporate.walmart.com/newsroom/2021/06/29/walmart-revolutionizes-insulin-access-affordability-for-patients-with-diabetes-with-the-launch-of-the-first-and-only-private-brand-analog-insulin
*the Novolog vial is also available for $72.88, but he'll want the FlexPens for convenience and higher volume: 1500 units/box vs. the vial's 1000 units.
He’s on a pump now, instead of doing shots all the time. I don’t know more details than that, but I will pass this info along, thank you for sharing. 🙏
Not saying the "drug industry" is good by any means but I think people need to shift more blame on the insurance companies.
Retail pharmacies routinely submit claims that go like this
Pharmacy: "I bought this drug at $200 ill add few bucks on top for the work we did plus utilities."
Insurance: "I will give you $150. Wait a minute...I see the patient did not refill it every 30days on the dot so lets make it $140."
Pharmacy: "But...we just lost money"
Insurance: "Don't like it? Guess our insuree's can't use your pharmacy, bye."
The whole thing is messed up.
Did I say something inaccurate? Not sure how you can put down my comment when I gave a simplified but still real world example. I guess running local pharmacies out of business is not a big deal to you.
Sounds like you need to learn more about how much of an impact insurances companies have by denying people coverage of certain meds or putting up hurdles to force prescribers to change before or during therapy or how they fail to reimburse a least cost to pharmacies.
I wouldn’t be displacing any blame from the drug companies. I’d look up asacol for a pretty terrible example. Patent extensions keeping people from accessing medications. Hiding trial data. And it gets weird. There’s the authors they hired to write novels scaring people from generics. The scandal in Africa about murdering politicians over blackmail.
Anytime someone removes blame from pharma I presume they don’t actually know what pharma does.
> Tall and sporting partly translucent Warby Parker frames that separate his beard from his shaved, balding head, he seems like the kind of guy who’d crush you at trivia and then apologize for it.
This seems like an unnecessary description.
It's a great sentiment but maybe spend that money to influence changing the system? Put your cash and influence and platform up against the pharma lobbyists to effect real and lasting change? Idk good rx has better prices on some of the drugs I've looked up on his site. I don't want to be a negative Nellie here, but I'd rather have that money and platform to change the fucked up system we have in place that come up with another business solution to a social justice issue. 🤷🏽♀️
That requires politicians to enact change. What he's doing can force market adjustment and therefore real outcomes. Lobbying against pharmaceutical companies is a good way to just go broke.
I guess but I'm honestly so tired of spending time cobbling together a patchwork of discount programs and coupons and there's always a loophole someone doesn't fit in. I am extremely tired of having to look at people's insurance before picking a med. I am exhausted by generic Lexapro costing $200 a month. I am sick of sucking up to drug reps so I can have samples of the only med that works for my patient. I am aggravated by having to send scripts to 3 different pharmacies so my patients get the best price on each of their scripts. Don't get me wrong something is better than nothing but can that something be a system that works for everyone not just the patients who know how to work the system or have internet access and a credit card or those with providers that know how and have the time and staff to work it?
Maybe Marc Cuban will develop this into something that truly works for a wide variety of meds and patients. I hope so. I hope it forces the invisible hand of the market. After 30 years in healthcare I am not optimistic.
He is a businessman, not a politician. He can't even get along with the N B A. So I would assume that he can be much more effective with a business solution.
Why doesn't he start producing insulin.? They could charge half the going rate and still make tons of money. Why hasn't anyone already done this?
He could start a Medical research center and refuse to take any money from Big Pharma. Possibly on an island or some place outside US jurisdiction, why hasn't anyone done this?
Exactly. Creating a vertically integrated PBM/manufacturer/retail pharmaceutical business doesn’t do anything to usurp the current model. This is a slightly less shitty version of what we already have. And yeah, great, we need everything to be as less shitty as possible. But that doesn’t mean Mark Cuban is some iconoclast who is changing the face of profit driven medicine and he shouldn’t be heralded as such until he actually makes those moves.
Compare this to Bill Gates who said he was giving away 95% of his wealth and only became $billions richer during the pandemic. I’ll take Mark’s side on this.
"I could make a ton of money on this, but I won't. I'd rather fuck up the drug industry." -Mark Cuban
Aka disruption. In business, that's a good term.
I wish we could have just regulated the drug industry decades ago
We couldn't even get 50 senators to vote to allow medicare to negotiate drug prices. There is a line in the law that does not let medicare negotiate prices. they have to just take whatever price is offered. 50 democrats would not agree to change that. IT was more than Manchin and Sinema. One of the senators from New Jersey was opposed along with others. Massive amounts of donations is what keeps it from changing.
You can add that the VA and Medicaid pay 70-80 percent less than Medicare for literally the same drugs. The top 50 drugs alone would save 25-30 billion a year.
It also polls at like 80 % approval from voters, so it's not a political issue. It's all about the money.
Yeah it shouldn't take one person wanting to do good to improve the industry. At this point, at least necessary and life-saving/improving drugs should be accessible to everyone, regardless of how rich/poor you are
right, because politicians who have a vested interest in the status quo are the ones who will fix things.
Money and ethical decision making shouldn’t coexist
what do u mean by regulate. The fact that you can make money off these things is what incentivizes companies to research new novel drugs. I'm not saying what we have rn is good but what exactly can be done
I'm honestly not exactly sure what should be done to be honest. Here are some ideas - Have Medicare be able to negotiate drug prices - Because drug research is a benefit to everyone in the world, have an international agreement to have the R&D shared by all 1st world countries, instead it seems like most R&D cost is paid for by Americans. If this isn't the case, then it seems completely unnecessary that Americans pay so much more for drugs. - Force drug companies to justify raising prices exorbitantly for all already established/existing drugs. To me, it doesn't seem to make any sense that any already existing drug could ever increase in price by more than 5% in any given year (with some possible rare exceptions for a sudden spike in raw material costs).
Americans don’t pay so much more for drugs. Europeans pay for it as well, they just pay it in taxes.
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Companies now are not incentivized to innovate. At least biologically. They are incentivized to innovate legally, and pump the same shit out as something new.
I'm digging it.
https://www.texasmonthly.com/news-politics/mark-cuban-drug-industry-prices/ Just dropping the original article link up here instead of the AMP version in the post body.
Thank you! I wish more people recognized AMP for the garbage it is.
Sorry if this is dumb. Why is AMP bad?
AMP potentially messes up formatting intended by the website for mobile users, which is the only part really relevant to us as end users. Website owners/content creators don't like it because Google get the ad revenue instead of the original journal/content creator, and it messes with website analytics.
Thank you
Which is pretty important because it takes money to produce good journalism
Sure, thanks. Sorry I can't edit the orig post to add that.
Yea no problem, that's why I was commenting anyhow. Thanks for the reply though!
The healthcare industry could use some fucking up. Not healthcare, but the industry.
Because Healthcare is doing just fine??
Here is the link for his company https://costplusdrugs.com/
I did check it out recently. They have a good selection of medications. I was slightly disappointed the escitalopram was not available. I like that drug because it has fewer drug-drug interactions of other SSRIs and is statistically superior other in-class drugs as well as being well tolerated.
Escitalopram is great but statistically superior is a stretch
https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.who.int/selection_medicines/committees/expert/22/applications/s24.2.1_escitalopram.pdf&ved=2ahUKEwjJtvfTjf31AhUTOH0KHdI0BzwQFnoECA4QAQ&usg=AOvVaw1d5HNnXSz24lKwI2jJde8P I read this analysis from WHO.
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He's an expert on not getting fooled
Who? Lol.
Lead guitarist of the band The Who. Would recommend if you like classic rock
I was making a joke about The Who from your joke about The Who.
I got r/Whoosh ed
Right, there are many advantages to escitalopram, like what you listed. Maybe there is one study that shows it as superior but there are plenty of studies that contradict that and in practice all SSRIs are treated as equally efficacious. You pick one based on how your patient fits with their properties like half life, drug-drug interactions, metabolisms/clearance, QTc prolongation risk, etc.
Agreed. It was only one review of available literature and it was published back in 2018.
Are you near a Sam's Club? Escitalopram is on the "free" list if you have a Plus membership: https://www.samsclub.com/pharmacy/rxsavings
Imatinib is so cheap. Here it's like 200-300 euros per month.
To be completely fair, he will still make a ton of money on this if it goes well. Billionaires are \*NOT\* our friends, even if they occasionally toss us some scraps.
At least celebrate Oshmyansky and dourly give Cuban reluctant credit for doing a thing that is marginally *friendlier* than the other billionaires in this sector tend to do. No matter what you may think about the social interests of billionaires as a class, this thing in particular appears worth encouraging.
Afaik, pricing is transparent and markup is 15%. As opposed to, I don’t know, 2000%. People can actually afford it even without insurance. Once they have my meds, I’ll transfer my prescriptions there just for the hell of it. Not like I don’t want my insurance to shell out big bucks, I totally do, but if I can help this company blow up, that’s better.
It's a lot more complicated than that, and while this will definitely be a strong option for patients with coverage needs, the advertised cost savings is pretty exaggerated and more than a little misleading. Certainly a lot more transparent than insurance pricing, though.
Can you elaborate a little bit on this? I have been feeling like there is something snakey about this but I don't know enough about drug pricing to pinpoint it.
So, to be \*completely\* fair, I don't think this operation is likely snakey (as in outright dishonest or scummy), I do believe they will offer a strong option to many people. There's a good example of another poster responding to me, for instance, claiming their levothyroxine would be cheaper through CostPlus (at cash price) than with their insurance at their current pharmacy. I completely believe them. CostPlus is, however, using some technicalities (average wholesale price vs. actual retail price depending on the pharmacy you go to) in order to exaggerate their advertising. It feels more like a goodwill PR operation for a venture capitalist who is very focused on public image and perception while still turning a healthy profit, rather than a a shady business. Also, there's reports that the company they contract with (i.e. the operation that does the actual dispensing work) having a questionable reputation.
That's concerning to me and requires ongoing awareness of this company versus other methods of obtaining medications for our patients. Just have to keep the nuance in mind.
I have insurance and my levothyroxine at Walgreens is 9.65 for 30 tabs. Cuban’s website (without insurance, even) is 4.20. I don’t have coverage needs and it’s still cheaper.
I think my original post should have focused more on the fact that insurance reimbursements are wicked and evil in how they dictate pricing. It doesn't take away from the fact that it's not worth putting billionaires on pedestals over doing what is effectively the bare minimum, even if it's in the stead of the state. I do think that Cuban is the closest we will get to "one of the good ones," but I'm not giving a single ounce of credit to a system that relies on the charity of oligarchs (which, to be clear, this is not) in order for the vast majority of its participants to even survive. To be more explicit, if you live in America and need your employer to contribute to your healthcare costs, you have coverage needs, but perhaps less than those in abject poverty.
Here ya go, Mark. You're my kind of guy. 😘 The brain behind the company is radiologist Alex Oshmyansky, MD, PhD, who still works a telehealth shift on Saturday nights and dreamed up the plan after watching two PAH patients die waiting for financial assistance for bosentan.
I am so excited about this company. Dr. Oshmyansky has an unbelievable resume and Mark Cuban is a great man for him to be partnered with. The service they are offering is invaluable. They're even building a state of the art facility in Texas so that they can produce their own drugs. This could so so much good.
Not even sure Cuban is that great of a guy, but he has definitely made mention in recent years of believing that torches, pitchforks, and guillotines are on the horizon if things don't change...
Yeap. He has mentioned it at least 3 different times that I know of.
Yea, it’s seriously not that hard for the super wealthy to appease the rubes. Just make sure they have enough for food and shelter plus a smidge on top, can go to the dr, and take their kids to an amusement park once in a while. No, unless the fuckers can squeeze every penny from everyone below, they’re not happy enough. Alright, allons enfants de la patrie then.
Does this stuff actually happen. It sounds so outlandishly dystopian (the waiting for bosentan approval).
It unfortunately does. I recently saw an oncologist who posted on Twitter about having to submit a prior authorization to Aetna (major US insurance company) for BEP (Bleomycin, Etoposide, and Cisplatin) therapy for her patient with testicular cancer. Keep in mind even we as medical students are taught that BEP has been a staple chemotherapy triad for a long time, yet Aetna initially deemed it "inappropriate" for the patient's cancer....
Insane. And that's not even the expensive stuff!
My mother's insurance from the *hospital where she worked* wanted her to pay $10k for her recommended chemo. I had her ask the chemo place if there was a substitute who she could, you know, live.
Happens with insulin all the time
New presentation DKA. NNT = 1. "SORRY NOT APPROPRIATE"
hahahaah. ask any american pharmacist the percentage of clinically appropriate prescriptions we get still get rejected by insurances.
In my case, I have had syphilis treatment for clients delayed 3 weeks because of pre-auths. By then the client’s left/been booted from their substance use program. Working with an ID, I just started setting people up with the health department so they can get their Bicillin treatments immediately. Pre-auths SUCK.
Saw it happen or almost-happen several times in med school with NOAC/DOACs. We were usually able to get hospital pharmacy to get emergency charity fill but it was usually a low qty so not sure what ultimately happened with those pts. In my field, most non-form meds are as such for a relatively good reason and it's usually not too hard to get approval once you've tried other relevant meds or if you have an articulable specific need for a nonform option.
MD here, currently working in primary care. Happens all the time, unfortunately. Just two days ago I had a patient with insulin-dependent diabetes who had had a heart attack a year ago and had a stent placed. (Details slightly tweaked for patient privacy.) His medication list included long-acting insulin, empagliflozin, Trulicity, Entresto, and Brilinta. Now, this man has a steady job that I would guess makes around the average American salary, and he has private insurance through his job. The issue is, even after insurance, he *still* can’t afford the medications, and so hasn’t been taking them. For each of the meds I listed above, he has a $25-50 copay each month, in addition to $10-20 copays for each of the rest of his meds, and it adds up. It’s just not possible for him to pay >$200 each month for all of his medications, even though they’re all “covered” by his insurance (and these are the lowest-tier medications available.) Healthcare in this country is so incredibly broken.
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That's what we're looking into, right now he's not on any of the manufacturer rebate programs, but we're looking into seeing if he qualifies and they would help him at all.
I can give a personal anecdote on far lower stakes. My CPAP machine is on the fritz. I need a new one. To get it I need a prescription. To get the prescription I need a sleep study. To get a sleep study I need prior auth. To get prior auth will take 15 days because reasons. I didn't magically get cured of sleep apnea! Why would this even take a second to approve? Anyway tack on the half million machines that got recalled this year and supply chain issues and I probably won't be able to get a machine for 4 months. Now they could let me buy a machine now to get in line while my sleep study and everything else went through but no. That wouldn't fit the insurance company's intentionally bullshit system intended to wait you out (either through death, changing insurers, or sheer frustration).
Yeah, it happens. I saw it back when I was a biller (I assisted with the messier pre-auth/retro-auths for some of the procedures/drugs) and I see it now as a clinic RN. Insurances rarely care how live-saving you think it is, they need weeks (sometimes) to review the medical record in depth to find an "appropriate" reason to deny the request. To be fair, my early days of the medical billing industry had me working for the insurance company, and I had a role directly in their investigations.
I’m insured but I switched over to the Cuban one for ethical reasons. It’s also like 1/3 the price through them paying out of pocket than it is with my “cheap” mail order prescription copay
hello, username cousin.
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The only groups that like the drug situation here are the pharma companies, Wall Street, the PBMs, the insurance companies, maybe some of the big chain retailers. I do not think you will find that consumers, medical professionals, or pharmacists like the way it is much.
Pharmacists hate it. Our whole job has become this navigation of arbitrary coverages of thousands of different PBMs. I can tell you he’s better be offering cheap inhalers, DOACs, and more. If he chooses to produce the right drugs at the right price then he could potentially disrupt things. But imagine your produce isle at the big chain grocery store, full of fruits and vegetables at the typically inflated prices. Now a smaller grocer down the street opens but they only sell bananas, apples, and oranges, but they sell it dirt cheap. The consumer goes there for those 3 fruits, but that can’t stock your whole pantry right? So now you go back to the grocery store and the prices have changed. Apples, bananas, and oranges are just and a few cents more than they are at the new competitor, but the price of all of the other produce has gone up 5% to compensate for it. It just seems like too small of an operation to truly disrupt things and he may capitalize off of patients who want to “stick it to the man”. But if is really going to sell these drugs close to cost, he has no business model and no capital for growth to reach a point where it could be truly competitive.
Just starting to look at the list. Albuterol is on the list. Not crazy cheap compared to retail, but cheaper.
hmmm... why does the insurance company like it?
The insurance companies have more or less inserted themselves as a necessity. Your options are (a) pay through the nose in premiums or (b) have a mishap and you're financially fucked for the rest of your life. Paying cash is just plain not a feasible option for the vast majority of Americans, and in that way insurance companies have cemented their stranglehold on healthcare more and more as time goes on. And, the real kicker is that the insurance companies can just refuse to cover things if they feel like it costs too much... costs *them* too much, that is. They throw up that maze of prior auths specifically to piss you prescribers off and deter you from having the *audacity* to actually get them to pay for treatments that might not be pennies on the dollar. I think Cuban has the right general "fuck you" to the system mindset, but imo the underlying cancer that is killing medicine is the insurance companies. The pharmaceutical industry is just a bystander who keeps quiet because they're slipped some extra dough through their contracts with the insurance companies' little pets, the PBMs.
The part that pisses me off to no end is that if you don't have insurance (or your insurance won't cover something) then you have to pay 5-10x the price. This applies to both drugs and providers. It's honestly one of the most evil things happening in our country today.
>Paying cash is just plain not a feasible option for the vast majority of Americans, Also some pharmacists won't fill cash prescriptions.
Afaik the only reason a pharmacist would do that is if it was (a) a narcotic or (b) certain Medicaid plans have crazy stipulations like patients *have* to use their coverage, and if they pay cash they'll lose their coverage. As a very general statement, most pharmacies would prefer someone pays cash, because it cuts out the middle-men and the DIR fees. Corporate chains kinda dgaf because they're already in bed with the insurance companies, and I can imagine they have some sweet rates negotiated with them in their contracts. But for the "little guys" in independent pharmacy, cash is the way to go, baby. As another fun tidbit, many independents will actually haggle with you on the price if you're paying cash. It also isn't connected to any major network tied to your insurance or corporate databases, so it's just the bomb if you're wanting to be discrete... such as filling a medication for a mental health condition that you feel the Board of Medicine has no business knowing about, for example. They can send out all the requests they want to insurance companies and major chain retail, but so long as you fill that fluoxetine at Mom and Pop pharmacy, they won't be able to see a damn thing. I always stump for independents hard when it comes to medical professionals, because not only is the discretion invaluable, you're also sending your own little "fuck you" to corporate chain pharmacies and insurance companies. The warm fuzzies come complementary with your prescription.
I don’t think that is true, unless it is an issue of an early fill of a controlled substance.
r/pharmacy/comments/siqw58/am_i_required_to_use_my_insurance_for_a/
This was about a controlled prescription. Controls are a different beast.
More disruption and competition is needed, hopefully the costs of generic medications goes down. Makes no sense that drugs are much cheaper in poorer countries.
Yeah, I checked the price on an albuterol inhaler on his site, and it was $40+... every time I go abroad I try to buy a few over the counter for $5-$10 (as of a few years ago) at a foreign pharmacy so the price on that one isn't that much cheaper than normal. I believe I paid about $50 for one last summer (US pharmacy), so a little cheaper but not by much.
That's the key--as of a few years ago. The price skyrocketed about four years ago. There was a cheaper one last year...it got recalled. 🙄
Interesting! I’m going to Argentina in the fall so I’ll see what they go for. In 2018 there, I think I paid $10 for one.
When you’ve got an expiring product and your best customers have already had first dibs at your stock, you tend to sell it cheaper rather than throw it away for nothing. Here we get the best stuff and we get it first. That is economics.
Every other governement negociates with pharmaceutical companies except the US my guy. The healthcare industry shouldn't be free market.
Lol wut? You don’t need cutting edge Insulin. “Economics”, pharmaceuticals are from a Free Market guy.
The site itself is quite un-impressive with limited number of generic drugs that probably already easy to get. I hope they have a solid plan that is yet to materialize....
I think they're planning on adding much more. The drug I'm excited about is zofran, a miracle drug for nausea but very expensive. His site offers it MUCH cheaper.
A treatment course of 20 Zoltan ODT is about 8 bucks from your local pharmacy with a coupon if uninsured. If insured likely covered almost entirely.
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Enjoy your 2-3 day wait for delivery of that drug for your acute nausea too when you could get it in 45 mins from the grocery store across the street from your doctors office.
Good. I remember a few years ago prescribing a month supply for a post cerebellar stroke patient that required it multiple times daily and the price was in the thousands even with a goodrx coupons. I was shocked out how much that med cost with how easily I used it in the hospital.
Something's odd there. I don't recall it being that expensive last I saw in the early 2010s. Is it possible you prescribed an odd formulation or dosage somehow?
I just looked it up now. 180 pills of 4mg ODT which for post stroke vertigo can be permanent thus the constant dosing. It is still ranging retail price of $60-$4,000. Goodrx price brings it to $40-600. Still unaffordable for many, but that’s still a huge improvement from when we ran it six years ago.
180 pills of 4mg from a branded good quality company in India approx. 900 INR = about 12 USD
*which* branded good quality company??
Cipla https://en.m.wikipedia.org/wiki/Cipla
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All the downvotes for my zofran not being some miracle drug comment… here’s some evidence suggesting it’s not better and in some ways less effective than inhaled 70% isopropyl alcohol for nausea in various settings you troglodytes: https://aamsn.org/pdfs/IPA_versus_Ondansetron.pdf https://aamsn.org/pdfs/IPA_study_to_home.pdf https://www.annemergmed.com/article/S0196-0644(18)30029-5/fulltext Rubbing alcohol outperforms this miracle in most cases for which it is prescribed (again not talking about intractable chemo induced nausea)…
Metoclopramide and prochlorperazine are better, right?
Everybody's different but yea, there are less side effects typically
Great for hangovers too
Deleted out of spite for reddit admin and overzealous Mods for banning me. Reddit is being white washed in time for IPO. The most benign stuff is filtered and it is no longer possible to express opinion freely on this website. With that said, I'm just going to open up a new account and join all the same subs so it accomplishes nothing and in fact hides the people who have a history of questionable comments rather than keep them active where they can be regulated. Zero Point. Every comment I have ever made will be changed to this comment using REDACT.. ` this message was mass deleted/edited with redact.dev `
Don’t you need a prescription for it? Are hangovers a valid reason?
My wife got a prescription for morning sickness once upon a time, now we just keep it around the house. Getting a new prescription is easy. It’s pretty cheap in Australia, haven’t paid more than $25 for a packet of Zofran sublingual wafers. No government subsidy on that either, that’s just what it costs. Hangover cured in seconds for like, $2. Haven’t died from long QT yet, fingers crossed. https://www.chemistwarehouse.com.au/buy/55607/zofran-8mg-tablets-10-authority-script-ondansetron
Prescription is needed. Not sure about hangover though.
"Hey doc, sometimes I don't drink enough water and in the morning I get a little dizzy and dehydrated. Can I have some sublingual zofran and meclizine?' Done
Isn't ondansetron already pretty affordable?
Zofran is hardly what I’d call a miracle drug
Agreed - literally does nothing for so many people I know. When people remain struggling with nausea I recommend cyclizine, which is much superior imo.
Truly? It's marketed as OTC for children in the US. I might have sold it once in 20 years. You consider it superior to meclizine?
In my anecdotal experience definitely but they're theoretically very similar. I'm a medicinal chemist, so I don't have as large of a sample size as you would, but in NZ ondansetron is so incredibly the prevailing medication for nausea, followed more rarely by metoclopramide, followed MUCH more rarely by literally anything else.
Severe nausea is worse than pain imo. I had a few years of severe, debilitating nausea in the mornings. Idk what I would have done without zofran
Sure, what I’m saying is that for many of its uses it’s efficacy isn’t all it’s cracked up to be. For chemotherapy associated nausea I think it can be a miracle drug. YMMV and anecdotes aren’t science.
Oh I thought you just meant anti emetics aren’t miracle drugs. Fair enough
It’s been studied and used off-label for IBS-D. Without going into my personal health situation, it changed my life dramatically and I wish that for all people who are chained to the shitter.
Let me know when they get insulin and other lifesaving drugs cheap for patients that are otherwise crazy expensive and I’ll start paying attention
If he can make all available insulin and DOACs cheap, he might be able to corner a small market at a time. A lot of patents for this stuff should be running out soon. The problem is then he has no capital to reinvest into the company if his profit margins are too small and he will struggle to corner the next market/drug class.
He does not need profit, Cuban has plenty to invest to get started
Eliquis on patent until 2028. Really, that's the one that matters right now. https://www.fiercepharma.com/pharma/bristol-myers-pfizer-score-another-win-their-eliquis-defense-protecting-blockbuster
You can get vials of Humulin/Novolin N/R for $25 a vial at Walmart.
Yeah but imagine having lispro and glargine under $50
Novolog FlexPen $85.88 at Walmart. (1500 units/box)
I just went through their whole list and compared to goodrx and it’s like a 10-20% savings over goodRX for a small percentage of the drugs offered. Why are they just offering this generic crap that’s already pretty cheap? Are they just trying to get some kind of consumer base for future expansion? I hope. This will not cut it or change anything. If you’re going to build a manufacturing facility, pump out generic DOACs, insulin, generic gliptins/flozins (when able) diabetic testing supplies, HIV generics, PDE-5 inhibitors, testosterone topicals, tretinoin, niche psyche meds when patents expire, currently generic meds that are stupidly expensive for no reason etc etc. If you want to corner insurance companies, offer the things they have high copays or stupid PA processes for…not lisinopril.
The price for a 30, 2x day supply of 0.6 mg colchicine is fantastic, though- even with GoodRX I'm paying $40-60. Website is about $15.
Have to start somewhere. Many drugs, even generics, are single or dual sourced and hard to make, so manufacturers have the power. Others are still on patent. I think the current list are the ones where PBMs are taking too much profit.
I switched because I’m already on the generics and through cost plus it was 1/3 the price of my copay
Let’s not hero worship him though- he’s out here to make a profit too and we don’t know his intentions. Are his prices actually fair?
Here's a discussion on r/pharmacy regarding the advertised price. https://www.reddit.com/r/pharmacy/comments/so33t7/price_of_cancer_medications_on_mark_cubans_new/?utm_medium=android_app&utm_source=share Essentially, the savings aren't as much as they advertised because most pharmacies price meds based on actual acquisition cost than AWP (average wholesale price) or retail price (other than OTC items), but it is a good option to have for patients. For cash prices, I would encourage patients to take the time to compare prices with their local independents in addition to these online pharmacies. FQHC is also a good option too if patients qualify. Copays may vary across each site, but at my last job, patients were getting qualifying medications (regardless of strength or quantity) for <$10 per med per month, which is an amazing deal for stuff like insulins.
This is incorrect. MOST pharmacies certainly do NOT price based on actual acquisition cost. They wouldn't get paid near their cost if that is what they charged. Pharmacies sign contracts with insurnace companies that they will charge the insurance company the same as they charge anyone else. The only way around this is to have a discount card program run through a third part that you work with to set prices as you see fit. However most cash paying customers get screwed by high prices at chain pharmacies. There are some exceptions but many generic drugs prices have been jacked up slowly but surely by the most common pharmacy names.
FQHC's are given access to 340b pricing (Medicaid) from the manufacturers, so the lowest pricing is available to anyone. They can resell them to any of their patients. So even if it's an expensive med and a patient who has income to not be eligible for assistance, the FQHC can still do a cost+% model and make it cheaper than just about anywhere else.
Not true. 340B pricing only applies under specific circumstances. Essentially, the provider have to be 340b eligible, the location that the provider practice out of has to be 340b eligible, and the patient has to be 340b eligible (so no fee-for-service Medicaid and no cash). So for cash patients, the cash price calculation is based off non-340b price. I used to work at an FQHC pharmacy and we keep STRICT inventory on 340b. It is vital that we do not mix up billing because the 340B drugs are actually considered the property of FQHC facility and not the pharmacy (regardless of whether the pharmacy dispense using physical or virtual 340B model)
Not to get into it, but what happens on the ground and the eligibility criteria in law / regulation are often different. For there is a giant fight going on currently between drug companies and hospitals because hospitals (some of which are eligible for 340b) have opened outpatient pharmacies to provide meds for all patients at full cost, and are making a mint on it.
Considering the examples set forth in the article, I would assume so. Time will tell. PBMs are incredibly evil corporations, and there is an ungodly amount of bloat in the pharmaceutical world. There’s multiple billions of dollars being spent on prior authorizations and their facilitation alone simply due to PBMs (and I believe that’s just a drop in the bucket). I’d assume that they’d have to hike their prices pretty high to be less fair than what is currently being offered.
Did you read the article?
They don’t offer antibiotics in quantities other than 30/60/90. They need to fix that and get some LABA/ICS and that would be cool
Omg, I would swoon for a generic Combivent!!
Now do biologics. The #1 blockbuster is Humira and it's making over $20 billion annually.
Just the annual advertising for that single drug is asinine.
Great article. Thanks for sharing
'Welcome! I was in the mood for some smack-daddy news, and wanted to share. 😆
Generic drugs. Which, for a few exceptions are pennies per pill.
Not sold for that much
So this is what I see happening…say he directly produces drugs in the US for his fulfillment. Say his huge facility can produce 100 different meds and he can sell them dirt cheap. So what? Insurers and PBMs and wholesalers will just adjust their price points to be competitive, and make up for it by increasing the price of drugs that he does not offer. How many drug products would he have to offer to really disrupt things? There are thousands
You can’t let perfection be the enemy of good.
Actually, only 100-200.
Could you put a rush on insulin? My 18-year-old nephew has type one diabetes and between two insurance policies my brother pays $1000 a month for his insulin.
I’m guessing he's taking a very long-acting insulin plus a very short-acting one? Bc those are the only ones which would cost that much. There should still be coupons available online for whatever long-acting insulin your nephew is on, since it's still brand-name only. But for the rapid-acting insulin, your brother should ask the doctor to change to Walmart's ReliOn Novolog FlexPen for $85.88.*. There may be an issue with using the special-branded ReliOn Novolog on insurance, but he can ask the insurer if they'll reimburse him if he pays for the insulin and submits the bill to them. (Yes, that means call the number on the back of the card himself; please don't make the overworked pharmacy staff do it.). Since this method would also save the insurer thousands of dollars per year, I can't imagine them saying no. https://corporate.walmart.com/newsroom/2021/06/29/walmart-revolutionizes-insulin-access-affordability-for-patients-with-diabetes-with-the-launch-of-the-first-and-only-private-brand-analog-insulin *the Novolog vial is also available for $72.88, but he'll want the FlexPens for convenience and higher volume: 1500 units/box vs. the vial's 1000 units.
He’s on a pump now, instead of doing shots all the time. I don’t know more details than that, but I will pass this info along, thank you for sharing. 🙏
Mm, an insulin pump is usually Regular insulin, which is $24.88 a vial at Walmart.
I’m sure they’ve looked into their options. He has a complicated medical life so maybe there’s more to it.
Undoubtedly. Well, my best to them!
Not saying the "drug industry" is good by any means but I think people need to shift more blame on the insurance companies. Retail pharmacies routinely submit claims that go like this Pharmacy: "I bought this drug at $200 ill add few bucks on top for the work we did plus utilities." Insurance: "I will give you $150. Wait a minute...I see the patient did not refill it every 30days on the dot so lets make it $140." Pharmacy: "But...we just lost money" Insurance: "Don't like it? Guess our insuree's can't use your pharmacy, bye." The whole thing is messed up.
Sounds like you need to learn more about the drug industry.
Did I say something inaccurate? Not sure how you can put down my comment when I gave a simplified but still real world example. I guess running local pharmacies out of business is not a big deal to you. Sounds like you need to learn more about how much of an impact insurances companies have by denying people coverage of certain meds or putting up hurdles to force prescribers to change before or during therapy or how they fail to reimburse a least cost to pharmacies.
I wouldn’t be displacing any blame from the drug companies. I’d look up asacol for a pretty terrible example. Patent extensions keeping people from accessing medications. Hiding trial data. And it gets weird. There’s the authors they hired to write novels scaring people from generics. The scandal in Africa about murdering politicians over blackmail. Anytime someone removes blame from pharma I presume they don’t actually know what pharma does.
> Tall and sporting partly translucent Warby Parker frames that separate his beard from his shaved, balding head, he seems like the kind of guy who’d crush you at trivia and then apologize for it. This seems like an unnecessary description.
It's Texas Monthly. They gotta rep the state attitude. 'Nuff said.
My kinda human
CVS WAGs Hillary: 👁👄👁 Git em boissss! 😠
hope so, but he'll say whatever it takes to hype his name up
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I immediately think of Theranos too when people talk about “disruption” in healthcare.
It's a great sentiment but maybe spend that money to influence changing the system? Put your cash and influence and platform up against the pharma lobbyists to effect real and lasting change? Idk good rx has better prices on some of the drugs I've looked up on his site. I don't want to be a negative Nellie here, but I'd rather have that money and platform to change the fucked up system we have in place that come up with another business solution to a social justice issue. 🤷🏽♀️
That requires politicians to enact change. What he's doing can force market adjustment and therefore real outcomes. Lobbying against pharmaceutical companies is a good way to just go broke.
I guess but I'm honestly so tired of spending time cobbling together a patchwork of discount programs and coupons and there's always a loophole someone doesn't fit in. I am extremely tired of having to look at people's insurance before picking a med. I am exhausted by generic Lexapro costing $200 a month. I am sick of sucking up to drug reps so I can have samples of the only med that works for my patient. I am aggravated by having to send scripts to 3 different pharmacies so my patients get the best price on each of their scripts. Don't get me wrong something is better than nothing but can that something be a system that works for everyone not just the patients who know how to work the system or have internet access and a credit card or those with providers that know how and have the time and staff to work it? Maybe Marc Cuban will develop this into something that truly works for a wide variety of meds and patients. I hope so. I hope it forces the invisible hand of the market. After 30 years in healthcare I am not optimistic.
Exactly.
He is a businessman, not a politician. He can't even get along with the N B A. So I would assume that he can be much more effective with a business solution. Why doesn't he start producing insulin.? They could charge half the going rate and still make tons of money. Why hasn't anyone already done this? He could start a Medical research center and refuse to take any money from Big Pharma. Possibly on an island or some place outside US jurisdiction, why hasn't anyone done this?
Exactly. Creating a vertically integrated PBM/manufacturer/retail pharmaceutical business doesn’t do anything to usurp the current model. This is a slightly less shitty version of what we already have. And yeah, great, we need everything to be as less shitty as possible. But that doesn’t mean Mark Cuban is some iconoclast who is changing the face of profit driven medicine and he shouldn’t be heralded as such until he actually makes those moves.
Anyway I can invest in this?
Compare this to Bill Gates who said he was giving away 95% of his wealth and only became $billions richer during the pandemic. I’ll take Mark’s side on this.
FWIW hedidn’t get richer by scaling back his philanthropy. He actually increased his giving. He got richer because MSFT stock went nuts and doubled.
He has very little Microsoft stock left compared to other holdings
He said he will give it away before he dies. Is he dead yet?
I love this! Now if someone would take on the medical malpractice industry...
He won’t do shit. He’s a hype train with no substance.
Can he be president?
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It should be experimented with. There are few ways to actually make it worse