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.
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The good ol USA is always for sale to the highest bidder. Not as a whole, but as pieces. The hospital industry, now being mandatory costs, is relentless in charging exorbitant amounts for their services, that most citizens cannot afford. The pharmaceutical industry relies heavily on the hospital industry to direct monetary inflow. If an ailment can be Band-Aid with high dollar pharmaceuticals, why actually treat the issue?
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I feel like this whole thread has been set up to advertise Mark Cuban and is not a real ELI5. The example of Imatinib, which just happens to be one of the drugs on the company’s splash page example; the multiple explanations that quickly pivot to Mark Cuban; a ELI5 question with “retail list price” and “rhetorical quote” using industry words that would only be used if you understand the industry well already. As much as I am in favor of affordable medical prices, this seems awfully sketchy and probably is being used as quasi-legal way around medical advertising laws.
Edit: I have no problem if this is removed by a mod. That would mean a mod read it and perhaps considered my point.
I can confirm, I’ve went to major pharmacies with a script and no insurance, ready to pay $200 for a dose, and the tech goes “oh no, I’ll find you a coupon…..here ya go, $32”
Medicare is forbidden from negotiating prices, so the only group that pays full list price is those under Medicare.
There are some billionaires I have iffy opinions of. More and more mark cuban is not one of them. The people I work for right now have worked with him directly and often and say he’s kind and attentive and down to earth. This all adds up to me keeping an eye on this.
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.
Sadly, I’ve watched people spend 6k on prescriptions for 1 month as a pharmacy tech. Every month. Nothing they could do. Either fork it over or die
USA healthcare is inhuman. In civilized countries patients don’t take wallets to doctors/hospitals because there is no use. Paracetamol (Tylenol equivalent) if prescribed has the competitive price of £0.00 and if given in the hospital too. For kidney transplant one pays £0.00 too.
Because the same people sit on the hospital board, insurance company board, pharmaceutical company board and super PAC board that lobbies for the industry.
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