The diabetes stash, market realities force us


#21

I agree with your assessment and applaud your honesty. I think we need to do these things in order to survive. The only person that is looking out for you is you.
That is why when it’s time to vote, my criteria for a good candidate all hinges are their health ins platform. A bit selfish? Maybe so but I’m looking out for me.


#22

If you want to send your congressman a diabetic valentine, they are here. Diabetic Valentines


#23

This might be a bizarre POV regarding “insurance fraud”, because I’m putting on the shoes of the insurance company.

But we all suspect and or know, that the insurance companies and their sales reps and their middlemen and their pharmacies get huge kickbacks/incentives for every bottle of insulin we get through them.

So we aren’t defrauding the insurance company. We’re making them richer.

But between the stockpile and the massive kickbacks, we are increasing all the insurance premiums and deductible amounts.


#24

Can you explain this further, @Tim12. It sorta seems like they are increasing premiums by setting the value of insulin artificially high. I dont think I get it. They are simultaneously getting richer AND increasing premiums as a byproduct, thus getting even richer? Heres the ADA petition. https://makeinsulinaffordable.org/petition/


#25

See, you are thinking that as far as personnel at the insurance company are concerned, that premiums - costs = profit. And that’s true, that’s the on the official insurance company’s ledger books profit.

But we also know there’s HUGE quantities of kickbacks and incentives flowing to the pharmacy benefit managers. This is the funny money that may sometimes be on the books but often goes directly into the pharmacy benefit manager’s pocket. Does he do what’s right for the industry as a whole and kill the cash cow, or does he do what every other pharmacy benefit manger in the USA does, and takes the cash?


#26

Who does a PBM work for? The drug manufacturers? The pharmacy? The insurer? Are they hired guns that work independent?


#27

Here’s a WIKI description of PBM.

And this from PBM point of view.


#28

ahhhhh, thats who they are. They work for the insurance company. They are, in the case of Optum, owned by the insurance company. Have you ever seen an Optum building? Its pretty clear that they are rich beyond our wildest dreams. They are building all kinds of subsidiary companies, like re-insurers that insure the insurance company (which is, after all, its fundamental parent company - United Health). It a twisted web. But, it all leads back to the fundamental players - the insurance company, the pharmacy, etc.


#29

I love this statement in the second link.

Pharmacy Benefit Managers (PBMs) reduce prescription drug costs and improve convenience and safety for consumers, employers, unions, and government programs. PCMA’s mission is to lead the effort in promoting PBMs and the proven tools they utilize, which are recognized by consumers, employers, policymakers, and others as key drivers in lowering prescription drug costs and increasing access.


#30

Sure.


#31

United States Secretary of Health and Human Services Alex Azar stated regarding PBMs, “Everybody wins when list prices rise, except for the patient. It’s rather a startling and perverse system that has- that has evolved over time.” https://www.latimes.com/business/hiltzik/la-fi-hiltzik-pbm-drugs-20170611-story.html


#32

In discussions of insurance companies, do not lose track of the fact that many times insurance companies may have no financial interest at all.

In the USA, the vast majority of large businesses, many mid-size businesses and increasingly more and more small businesses are self-insured. The “insurance company” is used for administrative and management purposes however the insurance company has no financial liability or gain based on size and number of claims.

Which is not to say that insurance companies are not ALSO still in positions where they are financially liable (loss or gain) but rather that health insurance companies as we know have two very different roles. The self-insured model is actually very large but seems to largely be ignored.

Sponsors of self-insured plans pay their plans’ covered health expenses directly, as the plans incur claims. In contrast, sponsors of fully-insured plans generally pay premiums to insurers and transfer all the responsibility of paying claims to them. Some sponsors retain this responsibility for a subset of the benefits, but transfer the risk for the remaining benefits to health insurers – that is, they finance their plans’ benefits using a mixture of self-insurance and insurance. Self-insurance is more common among larger sponsors, mainly because the health expenses of larger groups are more predictable and therefore larger sponsors face less risk.

Self-insured and fully-insured plans are governed by somewhat different rules. For example, State insurance laws generally do not apply to self-insured ERISA-covered plans. Likewise, some Affordable Care Act provisions apply to group health insurance but not to self-insured plans.


#33

This image seems to be reasonably accurate in terms of numbers of covered persons in the USA per category of Health Insurance Coverage.

Of the Employer-Based number, this can be further broken down to about 110 Million are in an Employer sponsored self-insured plan (vs fully insured plans).


#34

If you feel bad about it have someone pay back the insurance company for any unused supplies from your estate when you are dead.


#35

I think I can do a better reply then that, I know I can, let me think about this.