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Comment by alwa | Hacker News Reader

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?

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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.

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.

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