somewhere down the road, somebody is earning more money

August 7, 2017 6:23 PM

Consumers have grown accustomed to being told by insurers — and middlemen known as pharmacy benefit managers — that they must give up their brand-name drugs in favor of cheaper generics. But some are finding the opposite is true, as pharmaceutical companies squeeze the last profits from products that are facing cheaper generic competition. Out of public view, corporations are cutting deals that give consumers little choice but to buy brand-name drugs — and sometimes pay more at the pharmacy counter than they would for generics. - Take the Generic, Patients Are Told. Until They Are Not.
posted by beisny (18 comments total)

I'm waiting to find out that my insulin is going up again and there's no one making the effective generic. Again.

I'm so glad these people want me dead.

Wait, no, the other thing, I want to punch them all until they are a slurry.
posted by mephron at 6:27 PM on August 7, 2017 [15 favorites]

my extremely expensive insurance will not pay for generics like half of the time, there appears to be no rhyme or reason to it. they will happily cover generic imitrex but gave me a fucking nightmare runaround trying to get adderall xr.

also i just realized that the author of this article contacted me to discuss this very situation last month and i forgot to respond
posted by poffin boffin at 6:29 PM on August 7, 2017 [3 favorites]

Insulin is different. There are only 3 manufactures with giant war chests and it cost several billion to make an insulin manufacturing plant due to the genetic engineering involved. Anyone who would want to break into the market would likely be undercut and would go bankrupt. No one makes generic insulin for this reason. I think there are couple lawsuits about insulin pricing.

I actually talked to pharma rep who explained to me how this whole thing works. The drug company will usually give a popular medication/high volume at cost so the insurance company saves(makes) money on that drug and then will ask them as part of the contract to make another drug as the only other one on their formulary.
posted by roguewraith at 6:39 PM on August 7, 2017 [2 favorites]

capitalism is doing a pretty great job with pharmaceuticals, isn't it?
posted by indubitable at 6:46 PM on August 7, 2017 [10 favorites]

Isn't this the definition of collusion?
posted by Kevin Street at 7:06 PM on August 7, 2017 [2 favorites]

Isn't this the definition of collusion?

Nope. The pharmaceutical industry and the insurance industry are not in competition with each other, so it's only natural that they'd cut deals, the same way a cinema chain might cut deals with M&M and Coca-Cola to only serve their products.

Only, you know, with more destitution and death.
posted by Sys Rq at 7:17 PM on August 7, 2017 [6 favorites]

I thought it was the Pharmacist getting a kick back and was wondering how that was legal but on closer reading I see it is pharmacy benefit managers which doesn't appear to be the same thing.
posted by Mitheral at 7:25 PM on August 7, 2017 [1 favorite]

Oh, and I've definitely seen an ad on TV in the last month or so touting the virtues of only buying brand-name medications. It seemed to be trying to cast generics as bootlegging or piracy or something. And it was definitely NOT about dodgy boner pills from the internet.

I was taken aback by the gall of it.
posted by Sys Rq at 7:28 PM on August 7, 2017 [5 favorites]

I spent nearly two years on a brand of topical testosterone whose marketshare collapsed to next to nothing when Androgel was introduced because the, uh, user experience is terrible in comparison. (Brand name topical testosterone is absurdly expensive, but it's fairly uniformly absurdly expensive.) In that time, generic Androgel, which had been delayed for years because Abbott paid off the generic manufacturers* finally came out and... nothing. Six months goes by and they update the formulary. Still nothing. The prior auth expires and insurance tries to force me on to patches only to give in because my doctor literally refuses to write the prescription (patches have an even worse reputation). This was an insurance company that made you use their mail order pharmacy. The only thing I can imagine is that they bought a job lot of lousy topical testosterone products and were trying to get rid of it. I got a new job and new insurance before they started paying for the generic (if they are in fact paying for it now).

Anyway, I hope you enjoyed my testosterone rant.

*Which, by the way, resulted in a case that went to the Supreme Court, so you can read Scalia's opinion on topical testosterone--the ruling was "totally not cool, but we'll not actually do anything"
posted by hoyland at 7:55 PM on August 7, 2017 [5 favorites]

oh cool is this where I can talk about how generic wellbutrin made my throat close up and almost killed me. needed to get that out
posted by colorblock sock at 8:19 PM on August 7, 2017 [1 favorite]

Wait, there's generic Androgel??? who the hell is my endo sleeping with?
posted by AFABulous at 8:23 PM on August 7, 2017 [1 favorite]

Wait, there's generic Androgel??? who the hell is my endo sleeping with?

Only in the 1% concentration. Of course, that's exactly the same as the 1.62%, except you use more of it (duh). And the abdomen is an official application area (no one knows why that's not true for the 1.62% except that then it's clearly "different" for patent purposes).
posted by hoyland at 8:34 PM on August 7, 2017 [2 favorites]

oh cool is this where I can talk about how generic wellbutrin made my throat close up and almost killed me. needed to get that out

was it ranbaxy? i bet it was ranbaxy. their generic imitrex almost killed me too.
posted by poffin boffin at 11:51 PM on August 7, 2017

I think there are couple lawsuits about insulin pricing.

Someone referenced this one filed in January (PDF) a few months ago—sign up page. (I'm not a lawyer and know nothing about class action lawsuits, so for all I know that might be some kind of scam.)
posted by XMLicious at 2:00 AM on August 8, 2017

Gra, or you switch to a generic of my blood pressure med, which is BP med + diuretic and all is well. Then they double your copay because BP med + diuretic is no longer covered, so I have to get separate (separate payment OF COURSE) for the BP med pill AND the diuretic pill. Twice the cost, twice the pills to swallow, less than a quarter of the convenience.
posted by Samizdata at 3:30 AM on August 8, 2017 [2 favorites]

I would have no problem if my insurance company were to say "Hi, we just noticed that your doctor prescribed something that has been shown by research to be ineffective in most cases. We've requested additional information before funding this and we are following up with your doctor."

But they never do that, and instead their decisions are transparently about making money at the expense of our health rather than using their position to guide doctors and pharmacies towards better outcomes.

It's a terrible system and I resent everything about it.
posted by Dip Flash at 6:12 AM on August 8, 2017 [1 favorite]

I hadn't understood how much power pharmacy benefit managers have in the US drug market until I looked into it (self-link) a little bit. They're basically middle-man market makers between the insurance companies and the drug manufacturers. They're the ones that set the price you pay for drugs if you go through your insurance. And often they don't get the best price for you. I figured this all out when I realized I could pay $1/pill for some medicine I needed instead of $4/pill for the exact same medicine. A generic, even. Apparently they also double-deal and take deals to force customers to buy non-generics. Nice.

There's a couple of startups trying to game the PBM system for the benefit of consumers. GoodRx offers what looks like coupons for drug discounts, but are really negotiated PBM rates that anyone can use. That's how I saved $3/pill. And Blink Health works by presenting a single price direct to you as a Blink member, which you then pay at your regular pharmacy. They're both presumably getting some compensation from the drug manufacturers too, but they work more like a comparison shopping price that gets consumers a better price.

It's all an incredibly stupid way to price a product that literally saves peoples' lives. It is the opposite of free market economics.
posted by Nelson at 6:50 AM on August 8, 2017

Bad news: A person in my family takes medication for a chronic condition.

Good news: The drug is old, and apparently simple to manufacture, so there are numerous generic versions and the price is (relatively) cheap.

Weird news: For reasons that are beyond me, the insurance company must regularly renegotiate with the drug companies on very short deals because we're constantly getting told that Generic XXX is off the formulary and we have to switch to Generic YYY. Then ZZZ. Then AAAA. Then BBBB. Then back to YYY. Then back to XXX. Then BBBB again.
posted by LastOfHisKind at 7:30 AM on August 8, 2017