Good news everybody:
The Washington Post fact checks President Obama’s claim that 50,000 have not died in hospitals because of the Affordable Care Act and finds it largely true.
“The 50,000 number is derived from a study, released on Dec. 2, 2014, by the Agency for Healthcare Research and Quality, an arm of the Department of Health and Human Services… The numbers might seem large, but the research seems solid, according to experts we consulted…….
We know readmissions are declining, we know coverage is increasing, we know the cost curve seems to have been bent to some degree, and now we know that preventable deaths are declining. Things are working roughly as predicted or hoped when the law was signed and programs were implemented. However, the policy success is not translating into political success.
Some of that is the reactionary nature of the Tea Party where reality does not matter as they have a liberal bias. Part of the political problem is that most of the direct, obvious, non-option value benefits of Obamacare flow to marginalized groups of people with minimal actual political power. Finally success is statistical and diffuse.
The 50,000 averted deaths don’t have names on them. I don’t know if Grandma survived her hip replacement surgery because of Obamacare’s focus on preventing re-admissions and hospital deaths. I don’t know if my prom date’s daughter survived her chemotherapy because of Obamacare. I don’t know who the survivors are who in the counterfactual universe of no PPACA, would be dead. We can’t place names on the winners of this success story.
The losers aren’t anywhere near as sympathetic but they know they either objectively are losing because of Obamacare because they are paying higher taxes or their individually underwritten policy without maternity benefits was cancelled for the 23 year guy or they believe they are losers because their deductible went up again this year. It is a concentrated grievance (real or imaginary).
Baud
Black Democrat.
Cervantes
Perhaps not the best use of their fact-checking prowess.
OzarkHillbilly
@Baud: Either one by itself would be sufficient.
Steve
That’s great. In the meantime the group health insurance I provide my employees was radically changed, premiums have risen dramatically, and the fundamental personal liberty that goes with electing not to purchase insurance all to allegedly help less that 2 percent of the population stumbles on. Great.
Belafon
@Steve: Or (if what your saying is true): Your right to offer your employees substandard insurance and force the rest of society to pay for your illness has been curtailed.
OzarkHillbilly
@Steve: See? Obamacare has still failed to cure Steve of his terribly debilitating case of oral fecalitis.
Morat20
So, random medical question here:
A relative of mine got prescribed a new drug for type 2 diabetics (maybe two years old) that’s supposed to work in concert with stuff like metformin. It’s called…Invok-something. Anyways, apparently a nifty, useful little drug (as opposed to slapping some minor tweak on an old one, claiming it’s new, then charging out the rear) that tackles excess sugar in the blood stream and forces your body to excrete it.
So you can see this is an interesting drug, especially combined with one that causes your cells to start processing insulin correctly. (Given how useful it is, we all frankly expect it to make you grow a second head or something as a side effect).
However, it costs something like 400 bucks a month. My relative’s got one of those lovely high-deductible plans (as do I. We’ve commiserated at LENGTH about how much we hate them, how much we hate our companies for switching to them, and fantasizing about revenge. Prank level revenge. We’re adults with kids, not crazy). So he’s got this 400 dollars a month drug he can’t afford.
But fear not, the company that makes it gives over a nice little coupon card that makes it cost…NOTHING. Zilch. Zero. For an entire year. (It’s supposed to renew yearly, in fact. If it doesn’t, he’ll probably stop taking it. It’s nice to have, and will basically help him lose weight faster and reduce the pressures from his diabetes, but metformin alone would do that over a longer period of time. In short, as best he can tell it’ll make him healthier FASTER but isn’t even remotely indispensable for his health).
How does that even work, economically? Even if you assume (as I do, reflexively) that the drug certainly costs only a fraction of 400 dollars for a month’s dosage (including R&D costs), it certainly costs something. So how can they give it out free? Neither of us think his insurance is kicking in some hidden payment (he hasn’t hit his deductible yet and the insurance price is the cash price, so they’re not even getting much of a discount).
Literally, where is the money coming from?
Chyron HR
@Steve:
There, there. At least you can still fire people for being homosexuals (in most states).
Gian
@Steve:
the day to post that was earlier this week, Wednesday to be exact.
JPL
@Gian: good point
Yatsuno
@Steve: So…nothing really changed for you then. Because THAT’S HOW THE INSURANCE MARKET WAS FOR EVERYONE BEFORE ACA.
Omnes Omnibus
@Steve: DougJ, if this is the best you can do in the morning, please wait to troll until after you have had some coffee. I say this with the utmost respect and affection.
Mike E
Shorter Steve: Lovey, come back!!
Redshift
Hey, Richard – I saw an article recently that suggested part of the reason public opinion hasn’t tracked the success of Obamacare is that while the increase in health care spending overall has slowed dramatically, employer-sponsored plans have passed more costs on to customers (and falsely blamed it on Obamacare, which the article didn’t mention, but I know from personal experience.) Does that seem reasonable to you?
currants
@Cervantes: I just love a little understatement in the morning.
Punchy
Why the qualifier “largely”? Why cant they just say “true”? Exactly what’s not “true” enough to justify the qualifier of “largely”?
Wash Post just a shit paper with shit writers.
OzarkHillbilly
@Redshift: Well, they had to get their profits from somewhere after the ACA took away all their old sources.
Tenar Darell
@Morat20: Well, I don’t know about diabetes. But as a long time allergy sufferer, I can tell you that a drug combo that means less chronic misery in the spring is wonderful. So, 1) your relative feels better, faster. Economically 2) are you sure that the drug company isn’t including him in some kind of study on the pharmacy side? Like how fast does the drug become popular with these cards? And thus get transformed by demand or something to a class 1 drug?
Redshift
@Morat20: Huh. All the ones I’ve encountered have limits on how many times you can use them, which makes them simple loss leaders.
Since they can stop allowing it to be renewed whenever they want, maybe they’re trying to build demand by being it to be commonly prescribed, and they expect to make enough in the future that they can afford to lose quite a bit on it now. Not telling you up front that the coupon isn’t forever could be part of that.
d58826
Totally OT and it seems a bit late for an April Fool’s joke but Bibi Nutty-yahoo is demanding that any final deal with Iran include a provision that Iran will recognize the state of Israel. Pink Unicorns and flying sheep anyone:-).
raven
@Morat20: From Steve
Redshift
Oh, and the other thing I’ve been meaning to ask: do co-pays and coinsurance and deductibles figure into the medical loss ratio at all, or just premiums? Because if they don’t, it seems like a perverse incentive to just shift around how they make their profits – they charge lower premiums, as required, the approved charge amounts for doctors stay the same, but they’re paying less of it. Or is there something wrong with my math?
Redshift
@raven: Win.
Violet
@Morat20: Loss leader. Get the patient hooked on the medication then yank the subsidy coupon. It encourages doctors to prescribe it–which is one of the big stumbling blocks for new drugs–because they can say to the patient who asks about price, “There’s a coupon!”
I’d be surprised if the coupon renews after a year. Your friend may quit taking the medication but a lot of people won’t be able to find another one that works so they’ll be hooked.
Meanwhile the drug company can talk about how many users they have, how well their new product is doing, stock price goes up. Win for them.
RSA
@Steve:
Counting just the number of newly insured people since the ACA became law, you get 5%. Then we can add young adults who didn’t go off their parents’ health insurance, another 2%.
Belafon
@Morat20: While your friend may not be able to afford it, others can, who will pay for it (if through their insurance). With a few thousand users, one or two give aways won’t matter that much.
The Other Bob
@Steve:
Translation: We now are forced to buy actual insurance, not some BS plan without preventative care or a plan with lifetime caps that will bankrupt my employees.
Translation: Our previous fake plan was cheap because it wasn’t even insurance. We now have to actually provide our employees with a plan that will provide them real care.
Translation: We can no longer be deadbeats who freeload off the healthcare system when we end up in the emergency room.
Translation: math is hard.
Steve
Ah rats, another poster called Steve and a right wing idiot to boot. I guess I need a less generic handle.
boatboy_srq
@OzarkHillbilly: True, but the first term has especial power.
The Other Bob
@Steve:
I suggest “Real Steve”, “Liberal Steve” or my favorite “The Other Steve”
Central Planning
@The Other Bob: Nice job, TOB. Although I doubt we’ll see that version of Steve back here.
Belafon
@The Other Bob: “The Steve Unlike Any Other Steve that Steved”.
Major Major Major Major
@Steve: join us in the Catch-22 reference empire. You can be Milo Minderbender!
khead
@Steve:
If that’s too much to bear, I hear McDonald’s is hiring. At $1 over minimum wage even.
NonyNony
@The Other Bob:
I’d suggest “The Magnificent Steve”.
More people should pick Internet handles that make them sound like stage magicians from the 1940s.
Amir Khalid
@The Other Bob:
I’d go with “Steve the Famous and Original, Accept No Substitutes!”
CONGRATULATIONS!
@Steve: Sadly for you, we have a long-standing tradition in this fine nation of curtailing liberties when they start to seriously impinge upon the welfare of your fellow citizens, with the exception of guns, of course.
Me, I’m tired of paying five-figure hospital bills for a procedure that doesn’t even require an overnight stay, just so a bunch of folks like you and your imaginary “employees” can continue to walk around getting their “health insurance” from an emergency room.
JustRuss
@Steve: An old friend of my wife’s just killed himself because he couldn’t take his back pain any longer, and couldn’t get health insurance for the surgery he needed ( I don’t know why he couldn’t use the ACA,. My wife’s from Mormon country, maybe he thought using Obamacare was a ticket to hell. I’m not asking). Anyway, my point is, fuck the freedom to not have insurance.
cahuenga
It still sucks. Just a lot less than it used to.
Roger Moore
@Morat20:
It’s a combination of marketing and discriminatory pricing. The drug probably costs them relatively little to make once they’ve paid off the R&D, so their marginal cost per dose is well below $400. They really want to charge everyone $400/month, but they know that will make the drug unavailable to some people who could benefit from it, and that would create pressure on them to lower their price. Rather than lowering the price across the board, they give discounts- even 100% discounts- to some people who can’t afford it. That takes off the pressure to lower the price for people who can afford the $400/month and means more revenue overall. They can also use their “generosity” as a marketing gimmick to show what a great company they are and fight against more general pressure on the industry at large to stop price gouging.
JCJ
@The Other Bob:
What about “Steve (human version, not feline)”
Major Major Major Major
@JCJ: assumes facts not in evidence. On the Internet, nobody knows you’re a cat.
Mike E
@Steve: You should call yerself ‘Mike’…you’ll blend right in! :-)
Frankensteinbeck
@Steve:
‘The Great and Powerful Steve’. Anything that other Steve can do, you can do better!
Richard Mayhew
@Roger Moore: Exactly — price discrimination of a low(ish) marginal cost product and good PR is the reasoning behind the discount clubs
scav
@Major Major Major Major: There’s also the problem that a cat, even a polecat, a half-asleep, drugged, illiterate junkyard polecat walking on keyboards could exhibit better logical skills, let alone better empathy and manners than some that wander by leaving ASCII scat here.
Gin & Tonic
@Amir Khalid: That would be “Ray”, then.
Frankensteinbeck
@scav:
I have never seen a ferret display empathy of any kind. These are animals that bite their own ass in case it’s some other ferret, then bite it again because that mean ferret bit them!
scav
@Frankensteinbeck: That suddenly brings up an interesting point. If they’re both feeling it (the random bitey), maybe that is ferret empathy. Why is empathy only about the nicer emotional stuff? Are we missing a word, malempathy (we probably use projection).
eta. clearly my experience with non-religiously inspired ferrets is purely dictionary-based and in the quest for rhetorical and poetic rhythm.
japa21
@Redshift: No, co-pays, deductibles, etc. do not figure into the equation. It counts actual dollars paid out by the insurance company to pay for care.
The Golux
@Gin & Tonic:
But ya doesn’t have to call him Johnson!
Major Major Major Major
@Frankensteinbeck: ah, the domesticated steppe polecat. Used to have a pair. Strange little creatures. One of mine was blind and we didn’t know until she died since they rely on smell so much. She was a little slower, but we just figured she was more docile. Number two though she was a hellraiser. Rescued though so we just figured she was abused.
Major Major Major Major
By which I of course meant European polecat. Somebody fix the mobile edit button.
Roger Moore
@Richard Mayhew:
Do you know if they’re allowed to write off the free doses at wholesale price? That would provide another nice incentive.
scav
@Major Major Major Major: well, I somehow envisioned a pair of polecats instead of the single bitey one going after his own ass in a sort of Mustelinea Ouroborus. Somebody push my reading all the words button!
Major Major Major Major
@scav: the blind one was very nice. She liked to cuddle. They’re basically tiny cats, now that I think about it.
Or as my sister called them “snakes with für, legs, and a tail.” To each their own.
Major Major Major Major
1. Somebody fix the mobile edit button.
2. Apparently I write in german enough that ‘fur’ autocorrects to ‘für’.
RSA
Nice observation. This happens in so many areas of regulation. Pollution controls on factories, safety equipment in coal mines, wheelchair ramps for entrances to public buildings, smoking bans… A lot of conservatives and libertarians seem unhappy with the distributive nature of these arrangements, I think in part because they ignore the diffuse costs of not taking measures to prevent damage. (“I’m just dumping a small amount of toxic chemical waste into the river…”) Instead they just see the direct hit to the bank account.
gene108
@Steve:
How big is your group? Did you have any catastrophic claims? Did you have higher than anticipated usage, for example more pregnancies / deliveries than the norm the actuaries did not factor in?
Without giving specifics as to what the driver of your premium increase is the statement is meaningless.
BretH
I have secret info that Steve is indeed a Troll…but he does use his real name!
http://tinypic.com/r/2rnk12s/8
Davis X. Machina
@gene108: Cost floors probably went up because of the medical-care ratio requirements in ACA compliant plans — money has to be actually spent, or rebated, not retained.
Gotta fatten the bottom line, plan A is gone (spend less) and this is plan B (bill more).
Brachiator
Wow. Death panels make a return under Obamacare. Who knew?
stinger
@Steve: How about, “Cole, Put the Damn Razor Down, I’m Not That Steve”?
Mike J
“Only Nixon could go to China.” You know what that phrase means? Republicans would ignore what’s best for America if it meant giving credit to a Democrat. The United States means nothing to them, just winning political battles at any cost.
Frankensteinbeck
@Major Major Major Major:
Ferrets are just like that. They are spastic little bundles of curiosity and affectionate aggression. Even when they get mature and fat. To agree with your later comment, they’re permanent kittens.
Elizabelle
@Frankensteinbeck:
What’s the Matter with
KansasFerrets?fuckwit
@JustRuss: Wait… what? A Mormon who committed suicide? That does not compute. I thought they were against that… more than they’d be against Obamacare.
fuckwit
@Major Major Major Major: It’s more metal that way http://en.wikipedia.org/wiki/Heavy_metal_umlaut
Shakti
I can’t cheerlead for the ACA based on my personal history; bully for everyone else, though. I have to buy insurance on the individual market (my employer does not offer insurance) and premiums have shot up every single year even with a high deductible. I don’t really care that 25+% increase is considered low or that $2100 is low, it’s VERY unaffordable for me. I’ve kept my pre ACA plan because everything on the exchange is exponentially higher in terms of premiums and deductibles, and I am not eligible for subsidies and my state has not expanded Medicaid. As it is, if I reach the deductible on my insurance in one year, I will have no money whatsoever. I am too old to be on my parents’ insurance. I cannot afford the annual visits and have been self medicating my horrible allergies with otc anti histamines that don’t quite work. I’m worried that if I’m dxed with high blood pressure or diabetes (family history), my premiums will be even worse. The ACA says nothing about making insurance for preexisting conditions affordable only that you can’t be refused insurance.
At present, I have noticed no difference at best.
MattR
@Shakti:
That is not correct. The ACA says you cannot be charged higher premiums by your insurance company due to pre-existing conditions.
gene108
@Davis X. Machina:
From what I’ve gathered insurers are making up an lost money due to medical-loss ration changes by having increased sales volume. Their pricing is controlled by state regulators, so they cannot simply double what they charge for shits and giggles, unlike say a hotel or airlines, when they know they will have demand.
Also, unless Steve did not have an ACA compliant plan, when the rules kicked in for businesses in 2014, there should have been no material impact on his rate outside of normal increases permitted by state agencies. Pre-ACA we routinely had 10% to 15% premium increases every year, from about 2000 to 2009, just because that’s what medical inflation was costing insurers, so they got to pass this on to us.
An abnormal rate increase would be 20%+, which happened when we had high usage or catastrophic claims. Our premiums doubled, when we went into renewal in 2009, because of catastrophic claims and being a small to medium sized business we do not have the bodies to absorb those claims across the group.
In short, unless Steve had a non-compliant* plan, and absent any major payouts by the carrier he should not have experienced an abnormal rate increase.
Even in the post-ACA world there is still medical inflation and insurance will almost always cost more from one year to the next.
So to say your premiums went up is meaningless. Unless you are large enough to fully self-insure, your premiums will almost always go up year after year. The issue is whether they went up above what the normal rate of medical inflation is or is it in line with the standard increases in the premium.
* I will say, in the fully insured market the ACA made a lot of things as being required to be covered by insurers, that companies may have been dropping to reduce costs to save money as medical costs soared**. So when they got added back in the premiums of available plans may have increased.
** There was an ala carte structure to many plans, where employers would drop something they felt would not be used by many people to be able to offer something to the employees. You have to understand that in 10 years, from 1999 to 2009, I saw premiums double, while deductibles and co-pays kept going up to try and keep insurance costs manageable. It was a no-win situation for almost everyone involved.
EDIT: The (*) statement and what I wrote above may seem contradictory, but my overall point that “my premiums went up” is a meaningless statement still stands. We live in a society of sky high medical inflation, so premiums are always going up. Unless a person gives you specifics, his statement is meaningless.
Richard Mayhew
@Shakti: Something sounds odd about your story as I’m checking Platinum Plans for the most expensive regions in the country for a 64 year old smoker:
Below is the link for SW Georgia for 2015
https://www.healthsherpa.com/insurance_plans?zip_code=39870#c13007/ppl64t/cspremium/mplatinum/hhs1
The most expensive plan is $1,700 a month something seems very odd to me if I understand your story correctly.
Davis X. Machina
@gene108: Each company’s market returns on reserves would be earned at different rates at different times, as well. Been a good time for equities, for debts, not so much.
gene108
@Richard Mayhew:
I assumed the $2100 was her deductible limit and not the monthly premium.
Violet
@gene108: I thought Richard was right and that the $2100 was the monthly premium.
Richard, could you address the issue that Shakti says is happening to her/him–the one where you can’t be refused for pre-existing conditions but the premiums are much higher. Is that true? Do you still have to fill out the very long questionnaire asking you about everything you’ve ever had since you were born, including every scraped knee and head cold? It used to be they excluded coverage for everything you put on the form, but now they can’t do that, right? Or how does it work? Is your plan cost based on your medical history, thus your premiums are higher if you’ve had cancer or if you have a chronic condition?
I really thought all that was in the past but maybe I’ve misunderstood how it works now.
Steeplejack (phone)
@gene108:
Yeah, me, too.
Shakti
@MattR
hat is not correct. The ACA says you cannot be charged higher premiums by your insurance company due to pre-existing conditions.
I wonder how many people know that. I followed the news daily up til the bill was signed and that is not something anyone stressed.
My apologies: I should have been clearer. I would be marching in the street if $2100/month was my premium and I’d be thrilled if $2100 was my deductible limit. My deductible is $5,000. My actual premiums come out to $2124 per year. The federal exchange plan were all higher with higher deductibles like $10,000 for the bronze plan. This is up 33% from 2012. I realize that counts as a success under the ACA and that many people would be thrilled to pay that much, but I’m back in school right now, and in previous years I made only $9/hr. Between that and my car insurance (my rate tripled since I moved states, ha ha, no accidents and I shop around every year) I’m spending over $3000 on legally mandated insurance.
Now, I have no idea why my premiums went up. Is it because I aged? Is it because of regulations? I don’t actually know. It’s hard to theorize what my rate increase would have been sans ACA.
Honoré De Ballsack
Shakti wrote: My actual premiums come out to $2124 per year.
Really? I’m incredibly curious as to what kind of ACA-compliant plan can possibly have premiums that low–even the cheapest Bronze plans are in the $300/month range. Can you provide some details?
Violet
@Shakti: The rate of increase of health costs has slowed. Doesn’t mean it hasn’t gone up. It will continue to go up, including your premiums.
Yes, if you have a birthday and move into a different age category then your premiums are higher.
Steve
Belafon—–Lol at all who have never run a business nor provided benefits or borrowed on a personal credit card on a Friday afternoon to make a payroll. Until ACA I provided what was undoubtedly a Cadillac plan and my employees contributed nothing to their monthly premiums. I and my partners paid it all. After ACA, the coverage downgraded, I was forced to provide, and pay for, certain coverages I had for which I had no need, I.e pediatric dental, and my employees deductibles went up. All this for less than two percent of the population. Doesn’t matter tho, next Supreme Court ruling may very well tank the whole thing. Great.
gene108
@Shakti:
Could be your answer as to why your health insurance went up. Some states (cities, counties) have more expensive providers than others.
Richard has written about the use of narrow networks to reduce premium costs. I am not sure, if you have looked into this, but it may help in your situation to have a smaller network of providers that may lower your costs.
gene108
@Steve:
There are some good new self-insurance options available for small to mid-size business that do not mandate the ACA required coverages, so you could drop stuff your employee pool does not need, and they operate from the employers point of view like a fully insured product (less the run out period).
I’d assume, if your employees had kids some might consider this important. Also, dental insurance is not required to be provided by the ACA. Only medical insurance. You should check with your insurance and/or broker as to why they are stacking dental provisions onto health insurance.
Maybe you are being taken for a ride, by getting stuck with a lot of add-ons that are not needed, so your insurance provider / broker can bilk a few more bucks of commission out of you.
Chyron HR
@Steve:
Well, his story checks out.
Steve
Chyron—Hardly big business…10 total families in the group…Gene—after a quarter of a century doing business I hardly think I’m being taken for a ride. The ACA sucks. Would have been best to leave it all the way it was and pass a law mandating coverages for pre-existing conditions. Again all this crap for less than 2 percent of the population.
Chyron HR
@Steve:
Democrats didn’t force you guys to nominate a loser in 2012, Steve. Blame the GOP if you don’t like the tyranny of Obamacare.
Shakti
@Honoré De Ballsack: As I said in my first comment, it was a pre ACA plan. a bronze plan $3600/ a year is not affordable on what I make now nor is it likely to be affordable on any income I make in the near future. I asked Blue Cross about it; they said it was “grandfathered in.” I had hoped that with the passage of the ACA that I’d be able to get insurance that 1)would actually pay for basic care and 2)I’d actually be able to afford to use. When I signed up for the plan in 2008, they were gender rating to the tune of 30% (my brother has the exact same plan) and they supposedly covered mental illness. I made the mistake of admitting that I had gone to therapy within the prior five years and they had me sign a specific rider denying me mental health coverage. This also excluded abortion (because conservative state) and prenatal care(obvs) and contraception. Now I know they haven’t jacked up my brother’s premiums 30% to make up for the gender rating prohibition under the ACA.
Other than depression, my only other issues are severe allergies, and really bad eyesight which I correct with glasses (glasses are not covered under traditional insurance and still aren’t so wev) which run me at least $300 because I have super high astigmatism and would be legally blind without vision correction. I have never smoked and I have a normal weight.
I would buy the different age category explanation if the premiums didn’t keep going up every damn year and I didn’t cross a decade threshold.
I had hoped I’d be able to get better insurance or at least insurance that served my needs after the ACA, or not rely on the whims of an employer to pay me enough or have me at full time. I could distinguish between the ACA or the whims of the state legislature (most people in that situation wouldn’t tbh) but in the end it makes no material difference to my health care situation right now.
Steve
Chyron- I care little about the past and who forced anybody to cause the disaster that is ACA. I do care about my business , my employees and my family. The ACA is a frickin disaster. It’s hurting the 98 percent!
fuckwit
Meh.
It’s more like POOR-PEOPLE success, RICH-PEOPLE opposition.
agorabum
So…how much of the media is going to be saying “Obamacare is really a great success story. Uninsured rates are down, costs are down, people’s lives have been saved.” Becuase they sure aren’t saying that.
When the narrative remains “Obamacare is a ‘troubled’ program, a ‘controversial’ program, and is ‘under assualt’ and is ‘hated by many'” then yeah, it doesn’t get broad support.
But whatever. Both sides…
Richard mayhew
@Steve: that won’t work on its own as prices spike
stinger
I keep seeing the phrase “less than 2 percent of the population”. That’s 6 million people. Six million Americans who no longer have to rely on the emergency room (at the expense of those of us who are insured) for basic health care.
Major Major Major Major
@Steve:
For somebody who’s run payroll you seem to have only a tenuous grasp on how compensation works.
Jaye
@Morat20: the drug companies use these as a way to charge high prices without scaring off people with high deductibles and/or co pays. Basically, say there’s a biological drug called kromaldimub (and there may well be.) it costs $4000/month retail, so let’s say the insurance companies negotiate that down to $3000. For people with first dollar, or at least low deductible plans, or plans where their prescriptions are a fixed dollar copay, this is no big deal. Pay your $100 specialty drug copay and move along. It’s expensive, but for most people with this kind of coverage (these tend to be employer provided policies) you pay up and move on. Kromaldimub is more expensive than an older alternative, but not crushingly so.
Then look at someone who has either a high deductible or a 50% copay for specialty drugs. Or both. This is not uncommon for exchange plans. If kromaldimub costs $3000 or $1500 out of pocket, at least for the first couple of months (after whch, our hypothetical consumer will have hit their out of pocket limit) and the older alternative that works almost as well costs $10/month, whch drug are they going to try. Obviously, the old one.
By subsidizing the copay or deductible, the pharmaceutical company gets paid some percentage of their retail price by the insurer, and insured customers are much more likely to use their medication.
It’s worth noting that these programs aren’t available for the most part to people who are uninsured. In those cases, there is no payer paying at least some of the cost, and the pharmaceutical company is actually giving away the medications. Programs to help the uninsured with pharmaceutical costs almost always have income limits. The “discount” cards never do.