Comment by will_brown | Hacker News Reader

Comment by will_brown | Hacker News Reader

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The insurance companies are not recommending generics because it’s cheaper for the patient...they do it because it’s cheaper for them.

There are many reasons generics, especially in the case of Medicare patients with chronic conditions, are worse for a patient.

Generally if you have a Medicare patientwith chronic conditions such as diabeties and/or high blood pressure, and their physician has successfully been managing their conditions using a name brand therapy, it’s not good practice to switch their therapy to a generic because it helps the insurance company. More importantly, it’s only the active ingredients in name brand drugs and generics that are the same. coloring agents, binders, etc... are different and those can have significant negative side effects. There is no shortage of examples of generics having worse outcomes in the case of chronic conditions.

Also it’s not just the therapy the insurance is changing, they also change the quantity. So again say you are a Medicare patient with type 2 diabetes and your doc prescribed 30 day Rx so you come back for the doc to check your blood work between fills, insurance is demanding the doctor change the Rx from 30 days to 90 days, because they don’t want to pay for the additional doctor appointment/blood work. They are watering down care and interfering with doctor/patient treatments.

Do you think cost should ever be a factor in patient care? Looking it up, generics usually cost 80-85% less than brand drugs. They are tested and contain the exact same active ingredients. Is it worth the patient and/or the insurance company paying 5-7x more to keep the coloring agents etc the same? I understand that sometimes it may make a difference, probably especially for things with complicated delivery mechanisms like time-release drugs, but in those specific cases the doctor can explicitly request brand if it's important.

Usually the patient copays are substantially higher for brand drugs than generic ones. And the insurance company paying obviously isn't free money either, it's from premiums that people pay every month (and/or taxes). At least in the US, people often don't get medical care because of the expense, so anything that inflates the cost further can be expected to cause real negative health outcomes by pricing more people out.

I agree it would be better to not change even minor things if a drug is working. But I think that problem would be better solved by (as a condition of drug approval) requiring companies to disclose coloring agents, binders etc to generics makers once the patent expires, so they can make the exact same drug that was used in the initial clinical studies, rather than overpaying for drugs by 5-7x.

>Do you think cost should ever be a factor in patient care?

Should the insurers costs be a factor in patient care? No.

Should pharmacists be paid by insurers to contra to cold call patients and interfere with the doctor patient relationship? No.

Should the pharmacists be financially incentivized to get patients to consent changes to therapies on the basis those changes lower insurers costs? No.

Should pharmacists be forced to do the bidding of the insurers under threat of being dropped from the insurance network? No.

Should doctors be forced to accept the insurers recommendations for changes to patient therapies under threat of being dropped from the insurers network? No.

It’s great to lower patient costs...and that’s what insurers and pharmacists on hanging their hat on, as I said almost no one knows the reality of how and why it’s being done. It’s no secret insurance companies are dropping pharmacies and doctors who don’t play ball (it’s worse for a patient to lose their network of doctors than pay for name brand drugs if the doctor feels that’s in their best interest). It’s also no secret that insurance companies are consolidating the market (buying pharmacies, buys hospitals and buying doctor offices) and forcing thei patients to the insurance owned doctors/pharmacies.

It can’t be ignored that patients are now often seeing a doctor owned by the insurer, filling their drugs at an insurance owned pharmacy...and decisions about patient care are made by the insurance company to lower their cost, not patient costs.

>>Should the insurers costs be a factor in patient care? No.

This is a very odd view to take. I live in a single-payer system (Canada), although we don't have a similar system for prescriptions (yet). I have supplementary medical insurance through my work. Of course I want my insurer to keep costs low; that means more money to pay for important things, and lower costs for my employer (and by extension, me).

I take two regular prescriptions, and I happily accept generics, because they're cheaper and they work. If they didn't, and the name-brand would for some reason, then yes, I'd expect my insurer to pay for that. But to default to the lower-cost one is not a bad thing for patient care.

If you think the insurance companies are taking too much money from this relationship (I do) or if the whole idea of barely restrained medical capitalism is immoral (I do) or if insurance companies should have much less control over medical decisions (I do), I can understand that, but especially in the current system this is one of the few good ways to keep costs slightly lower.

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