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Comment by nemomarx | Hacker News Reader

Is 12 miles a long drive for a pharmacy? It's certainly more out of the way, less convenient, but I think you could still drive there for your monthly refills or etc?

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I used to work in Houston. In Houston, almost everything (maybe not pharmacies, but the average destination) is at least 10-12 miles away and people are used to it. And Houston is highly populated.

Kernville (pop. 1549, just outside Bakersfield) seems very remote, and if one elects to live in such a remote place, one is implicitly signing up to be far away from civilization, and traveling 10-12 miles ("going into town") every now and then is part of the deal. Having a car is also part of the deal. That is one's free choice.

I grew up with friends who lived in rural Canada and this is normal for them, and they would gladly make this choice even now. In fact, this is idyllic for some.

Most of the older folks I know get their meds in the mail these days, even from the pharmacy that’s closer than that. The pharmacist is happy to talk to them over the phone.

> They also determine which pharmacies are in network for insurance plans, and which of those are “preferred,” offering patients lower co-pays.

[…]

> Dr. Qato argues that Part D plans should not select preferred pharmacies at all. “Allow patients to choose which pharmacy to go to, with the co-pay the same, regardless,” she said. “So the pharmacy is reimbursed fairly, whether it’s preferred or not.”

I must be missing something, but what is unfair about passing along cost savings to consumers (in the form of lower copays) when they patronize pharmacies efficient enough that they can accept lower reimbursement rates?

There are lots of meds that can’t be delivered by mail. Any controlled substances for example.

This seems more like an issue with how controlled substances are regulated. Maybe healthcare should be optimized for patients.

I see it as an example of stopping a crime before it happens by removing the ability of everyday people to even make the choice to commit the crime.

This seems necessary when the penalty for being caught after the fact is insufficient to stop people from doing it. Either because penalties don’t work in preventing behavior, or because current society has difficulty implementing sufficiently harsh penalties because it feels too mean.

Right but the criminal isn't the person trying to have their medicine delivered in this scenario. It's a compromise in the quality of the medical apparatus because the policing apparatus can't or won't do its job. A same medical apparatus should be independent of enforcement activities or else patients will always receive suboptimal care and services due to the now mixed goals.

Then have them delivered by the DEA.

Sorry missing something here as a non Americana person. Why should someone have to understand and negotiate co-pay, or having to chose more efficient pharmacies and reimbursement rates when they just want the pharma that like keeps them alive?

Because if you don’t do such things, you spend more than you have to.

Point being you shouldn’t have to

Ah my bad, thought you were asking why folks do it in the US.

My pharmacy is at a grocery store. They deeply discount certain common generic meds because they want you to shop there for groceries.

It’s less about negotiating a copay, but rather letting market forces work to people’s advantages

those market forces made the US have the most expensive meds

I know that is the talking point, but that is not my lived experience. I have been on 5 regular meds for chronic conditions and I currently pay less than $25/mo with my insurance plan. Twelve years ago I did a 18 month stint doing freelance work with no health insurance and paid about the same.

Those same 5 meds are probably free in most EU countries and even some south american ones. It could also be given for free in the US at a fraction of the total spending but that would impact the GDP too much.

From zero to 25usd/month is a huge difference

> From zero to 25usd/month is a huge difference

I know how much my EU colleagues make in income and how much they pay in taxes to save that huge difference of $0 to $25.

I’d much rather have my salary, insurance bill, and $25 Rx co-pay all day long.

Making some assumptions here about mobility, access/ability to drive, and of course financial circumstances. All of which effect older people.

Another comment mentions pharmaceutical deliveries, common in my country abut then I have 3/4 pharmacies in a 1-2 mile radius and they are either cheap or free. Not sure of the availability or costs in the US

Kernville seems pretty remote from a quick map check. I imagine it’s a rougher 12 miles than many folks deal with.

There are people that can’t drive due to physical disabilities or don’t own/operate a car for financial reasons.

In some areas 12 miles by public transit might as well be on the moon. Impossible to reach.

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