
Blue Cross Blue Shield plans sue CVS for overcharging them for generic drugs - 80mph
https://medcitynews.com/2020/05/blues-plans-sue-cvs-saying-it-overcharged-them-for-generic-drugs/?rf=1
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mattlondon
Whenever I visit the states and pop into CVS I am frequently amazed at the
sticker prices on some of the dugs there. Things that literally cost pennies
per tablet in the UK (generic hayfever tablets, pain killers etc) were absurd
prices. 20USD for 7 hayfever tablets? 15 USD for 12 ibuprofen tablets? WTF?!
_Do not_ forget to get 12 hayfever tablets for £1.80 (~2USD) from a
supermarket before your flight otherwise you'll need to spend 45USD (+tax) at
the CVS a block from your hotel.

Do you guys actually pay these prices for this stuff, or is it only forgetful
travellers who fall for it and end up paying through the nose because they
have no other choice?

Surely you won't be claiming for pain killers for a headache etc on your
health insurance? (...although at those prices maybe you should??!)

It feels to me that is pretty criminal to charge those prices at retail - to
inflate even more to insurers just seems pretty outrageous.

~~~
jedberg
> Do you guys actually pay these prices for this stuff, or is it only
> forgetful travellers who fall for it and end up paying through the nose
> because they have no other choice?

Usually you can get those cheaper in bulk, like at Costco, or at a pharmacy
that your doctor works with, or you can get a discount by showing your
insurance card.

But yes, sometimes when desperate, we pay that much too.

We also have these health savings plans where we get a debit card and can buy
that stuff with pre-tax money, which is sort of like saving 10-40% depending
on your tax bracket.

But yes, it sucks. When I go to other countries I try to stock up. You have
better prices and stuff that we can't get here.

~~~
triceratops
> health savings plans where we get a debit card and can buy that stuff with
> pre-tax money,

These are stupid, and I wish they'd die, for multiple reasons.

First, the list of things that are allowed and not allowed is completely
arbitrary and random. Feminine hygiene products are allowed, but baby formula
isn't. Wtf why? And now someone's gotta maintain this list of items and
enforce it (Wageworks et al), and process claims made manually. So now we've
just added another actor in the whole system that can add their own profit
margin on top. All so we can save a few bucks in paying taxes.

Second, these aren't available to everyone (just like 401k plans, the other
symbol of taxation inequality). It's a benefit that has to be offered by your
employer, and there are plenty of shitty employers out there. The people who
could most use a tax break on a $10 bottle of aspirin are the least likely to
get it.

Third, the use-it-or-lose-it nature of FSA money. And if you lose it, the
money goes back to the employer. Again, wtf why? You're basically placing a
wager against your expected healthcare expenses every year at open enrollment
time. For really no clear benefit. Why can't the "debit card" work like a
"credit card" instead, with payments made directly from your paycheck? There's
no guessing involved, and no one ever over- or under-contributes.

~~~
FireBeyond
> feminine hygiene products are allowed, but baby formula isn't

One is a healthcare product, the other is a food (nutritional supplement at
best).

~~~
mattlondon
Formula is literally the only thing some babies can eat particularly less than
6 months old. You cant just give them cow milk, or chocolate or bread or
whatever. Has to be formula if it cant be breast milk.

Not all parents breast feed their babies for myriad reasons - some by choice,
some not by choice.

Formula is quite expensive in the UK - no idea how expensive it is in the
states, but a 800g tin of powder might cost about £12/15USD. That makes about
4 litres of milk which might last a 100% formula-fed baby 2-7 days depending
on how old/hungry they are. By comparison 4.54L (i.e. 8 imperial pints ... we
still seem to sell milk in imperial sized bottles for unknown reasons) of cow
milk is £2.18, so formula is roughly 5x or 6x as expensive.

Is £12 for 2-7 days worth of food for your kid expensive? For people on HN
probably not, but I do know that the formula in the supermarkets often have
security tags on them (along with razors etc) so I am guessing a lot of people
cannot easily afford the formula/can't afford to feed their kid literally the
only thing they can eat. Sad stuff really - this is why I would expect it to
be on these sort of discount schemes.

~~~
Spivak
> Formula is literally the only thing some babies can eat particularly less
> than 6 months old. You cant just give them cow milk, or chocolate or bread
> or whatever. Has to be formula if it cant be breast milk.

I think the ideal compromise for this situation is that if this describes your
situation you get a doc to sign off on it and then your FSA/Insurance should
cover it as medical expense. Like it wont and it makes little sense for it to
be excluded in the first place but I think we could find a compromise that
satisfies everyone.

~~~
jedberg
I think the point was more that whomever makes the list of acceptable items
for the HSA is clearly out of touch and missing important things, and there
shouldn't be a person in that role anyway.

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jedberg
Hah. When we did IVF, they had me sign up for that CVS plan. It was sold to me
as an "insurance program" offered via CVS, and only good at CVS.

It saved me many thousands of dollars, which I assume was charged to people
who had insurance that covered IVF drugs (mine did not).

I thought it was a pretty clever workaround on CVS's part.

~~~
wronglebowski
Do you have any details on this? My wife and I are currently looking into IVF
and the cost of the drugs alone is staggering.

~~~
jedberg
I believe it was this:

[https://www.singlecare.com/prescription-discount-
card/cvs](https://www.singlecare.com/prescription-discount-card/cvs)

But it was literally the CVS pharmacist who had me sign up when I went in the
first time.

And yes, the cost of drugs are staggering. :( I was super jealous of my
Canadian friends, who get one free baby with their national insurance.

I was also jealous of my friend who works at Merck. They make a lot of the
drugs, and provide them to their employees for free.

~~~
vulcan01
> who get one free baby with their national insurance.

I read that the wrong way the first time... ;)

------
coronadisaster
They also charge me more at the doctor when I have insurance... is it ok to
say that you don't have insurance and make a claim later?

~~~
labster
Many doctors discount their care when providing it to people who don't have
insurance to help them afford medical care. It's probably legal to make a
claim later, but you're effectively lying to the doctor so you can receive a
charitable contribution. It's ok to do it if you don't mind feeling like a
welfare fraudster.

~~~
thebooktocome
It's not a charitable contribution; the doctor in this situation is
unethically applying differential pricing.

~~~
kinkrtyavimoodh
So it's unethical to charge less to a person who might not be able to afford
the higher price?

I think we have different definitions of the word ethical.

~~~
colejohnson66
It’s viewed as unethical to some because when you flip the script, it’s:
“charge rich people more simply cause they’re rich”. Which isn’t a good
argument, but it’s what I’ve heard.

~~~
kinkrtyavimoodh
But rich people are not charged because they are rich. They are charged
because they have insurance. And it is insurance that has led to this bizarre
situation where the free market is completely broken and you can't confidently
put a price number to a medical product or service.

If almost everyone was paying for their medical care out of their own pocket
we would not be in this situation. And there are plenty of other countries
where this is the case. In India for example, individual doctors literally
have a board with a list of what they charge for various services, and if you
visit a hospital, someone at the reception would be happy to help you with
these.

You want a general ward? Here's the price. You want a private air-conditioned
room with five-star catered meals, here is the price.

------
tosser0001
When I was between jobs I had about a 2 week period where I was technically
without coverage, but the new company reimbursed me once I was on their plan.
I went to fill a prescription for a very common generic drug that has been
around for decades at the chain pharmacy I always use.

I was expecting to pay the same price I generally did, about $3.00. I was
shocked when they charged me $150.00. I can understand the pharmacy needing to
charge a bit more to cover costs, but this seemed like highway robbery.

~~~
Wowfunhappy
The real question here isn't how much you generally pay, but how much
_insurance_ generally pays. It was almost certainly less than $150, but it
isn't at all unusual for even generic drugs to cost insurance hundreds of
dollars, even when you have only a small copay.

------
Animats
As the number of pharmacy companies has declined, there's been a huge creep
upwards in the price of generic drugs. Even for non-prescription drugs. Price
is no longer even vaguely related to production cost. Look at the price of
antacid tablets (which are chalk, calcium carbonate) and cranberry pills (a
very cheap product.)

~~~
creaghpatr
Devil's advocate on antacids, I knowingly and willingly pay a premium for Tums
Extra Strength Smoothie Flavor.

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mattmcknight
Price discrimination in healthcare is out of control. Simple addition to
Medicare regulation that requires any provider (including Pharma resellers) to
have a public price and not charge anyone more than they charge Medicare
solves a lot of problems.

~~~
Ididntdothis
Price transparency and making extreme price discrimination illegal should be
the first steps so people can discuss solutions based on hard data.

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interestica
I thought that the grammar in this headline was all messed up. But it turns
out "Blues plans" is a thing.

~~~
woofyman
3rd person present: plans

------
VMisTheWay
I've done price comparisons and CVS is hands down the worst price for
anything.

The only reason you go to CVS, is if you have 0 other options.

While I blame the various medical cartels for making healthcare unaffordable
by bribing (Lobbying) hundreds of millions of dollars to politicians- can the
customer be blamed for negligence?

------
chrisjc
Just switched from CVS to Walgreens for this exact reason. They were charging
the insurance (and us for the uncovered amount) full prices for generic
versions.

And let me just clarify, the prescription bottle had the generic version on
the label, our receipt was for the non-generic!

We complained to the CVS pharmacist about this and their response was brazen
and they wouldn't budge even when we said we will escalate this to our
insurance company. We did escalate it to our insurance company (not Blue Cross
Blue Shield), but never heard anything more about it... perhaps more will sue
in the weeks to come.

Edit: This was in SoCal, not one of the states mentioned. Also, we weren't
part of this plan that they talk about in the article.

------
SupriseAnxiety
I had to fail 4 medications WITH insurance and I had BCBS, to get my
medication for free, thay was already free through the insurance, that just
fucked me up even more mentally than I started.

------
specialist
Repeating myself: I thought charging different customers different prices for
the exact same thing was wrong. Somehow.

~~~
cjhopman
Why? Would it be wrong for a restaurant to provide meals for free to those in
need?

~~~
specialist
What? Who's giving out free pills?

Anyhoo, is it fair to charge me $10 and you $200 for the exact same burger? I
thought there were rules against this. Why don't the laws prohibiting price
discrimination apply to pills?

[https://definitions.uslegal.com/p/price-
discrimination/](https://definitions.uslegal.com/p/price-discrimination/)

I really want to know.

Further, upthread someone said something about prices doctors charge.

I have no problem with that. Of course different doctors have different
prices. Rent, servicing debt, skill/merit.

But I have a problem with that doctor (or more likely her hospital or managed
healthcare org) charging different prices to different patients.

I know there's some history here (in the USA), and path dependence. But it is
conceptually so simple to make the system transparent, fair, accountable.

~~~
aidenn0
From the article you link:

> Merely charging different prices to different customers is not illegal, when
> there is no intent to harm competitors.

So if CVS uses price discrimination to screw-over Walgreens, it's illegal, but
if they use it to screw over their customers, it's not (with the expectation
that if they screw over their customers, the customers will go to Walgreens).

~~~
specialist
Thanks. That's an embarrassing oversight on my part.

Pharma definitely has done anti-competitive stuff. But I'm not seeing a
connection to the customer pricing we're talking about.

Even so, I vaguely remember something about price discrimination, so care has
to be taken when doing market segmentation. Or I could just be making it all
up.

Thanks again for correcting me.

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SeanDav
Seems like an obvious business model. Sell OTC drugs at fractions of current
prices and still make a large profit...

What is the catch?

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tyingq
As a former BCBS employer plan admin...the irony is thick.

