Example: Imatinib is listed anywhere between $3k and $19k retail depending on the store you buy it (source: GoodRX). With insurance, you would never pay this amount. Without insurance you can use a coupon provider like GoodRX to reduce the retail price to as low as $120. I am told, but have no proof, that if you have no insurance and no coupon, the store will provide a “cash purchase value” that matches or is very close to the coupon price.
In: 7
It’s quite simple. Insurance typically pays only a small % of the list price. Because hospitals, drug manufacturers and medical device manufacturers know this, they create a artificially high price.
Want to get paid $300 for your product? List it at $3,000, because the insurance company will only pay 10%.
This is why over the counter Tylenol costs $2, and by prescription it’s $20.
Want to be an honest drug company and list your price at what you actually want to get paid for? The insurance company will take that as a starting point and negotiate down from there.
This is all fine if you have good insurance. But if you have a bad policy, your out of pocket expenses will skyrocket, as providers will have to collect from you what they are not getting paid by insurance.
And this is all under the guise of letting the free market decide! Welcome to US healthcare.
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