Luke said a lot of stuff today and exploded my brain.
My BG is low now, but there’s no time to waste. I need math who can look at details and policy people.
Here’s the best of my low BG summary of what he said. I’ll work on getting better, more detailed info.
I believe he is pulling the math from these guys - 46brooklyn Research
I guess my thoughts on the actuarial math are that the math doesn’t matter because its always been garbage math. Its like trying to investigate insert analogy here____. I don’t care what the numbers say. There is fundamentally not a lot of sophistication involved in inflating a cost to 1,000% of what it cost to manufacture, right? It doesn’t matter how much complexity they stack on top of that.
He was saying that the way that the pricing structure was written into law was so nutty that the insurers actually had to start paying to distribute medication to Medicaid patients. Where Medicaid might have originally paid 0, now it would suddenly started getting paid. They had to change everything to avoid that.
Therefore, his argument was that price drops in insulin were purely a financial decision. It had nothing to do with States suing them, or legislative changes, or anything.
Now, I’m not saying that people don’t insert little tricks into the law because they do. But, I also don’t believe that was the straw that broke the camels back.
Who is Luke?
In all likely hood the legislation didn’t have a lot to do with the lowering of prices. That was to allow them to negotiate for certain drug prices, about 10 drugs? not all of them. And a bill to lower the cost of insulin had been sitting for a couple of years. It didn’t do as much as the last thing passed, but politics became a motivating factor in it finally going through.
So I honestly can believe that lowering prices had more to do with calculating costs and generating sales/profit than anything else. An example, Calif at one time gave extra benefits for something which raised the income of a percentage of people and dropped them off of qualifying for another program that ended up saving Calif money.
So lower the cost, more/less rebate because you don’t meet or you do meet a certain threshold and actually get more money back. Things like that are done all the time.
Disclaimer lol…I did not read the articles so maybe I am off track, I just know games are played all the time with stuff like this.
Agreed…My Medicare part D plan had a zero co pay for Lyumjev and Humalog. As soon as the $35 co pay was legislated the co pay went to $35. In the grand scheme of things not a big deal but still seems like game playing.
I think this was a direct result of legislation because this bill existed and I think it passed.
The insulin pricing might be more up for debate.
Luke is a local guy who lobbies for small pharmacies. His family run pharmacy got put out of business because they were loosing money selling drugs. I first saw him speaking at a community meeting between pharmacists and the FTC during covid. It was a meeting about antitrust stuff. Amazon was there. In hindsight, FTC was preparing their antitrust cases by talking to public and taking public testimony.
This $35 copy was lobbied for by diabetic orgs and put into legislation some years ago. They push stuff through Medicare first when they are preparing to hit private insurance policies because it sets precedent.
