I saw this on BlueSky this morning and nodded:
Talked to my dotcom editor about a tariff story for the Healthy Returns newsletter and she said, “It’s funny how every beat reporter is now a tariff expert.”
So are US COOs and their staffs these days! One device maker CEO told me they’ve formed a whole tariff task force to navigate it all.— Bertha Coombs (@berthacoombs.bsky.social) April 15, 2025 at 7:35 AM
What I’m really curious about is how do tariffs, the threat of tariffs, and supply chain disruptions impact prior authorizations?
BELOW THIS POINT I AM SPECULATING WILDLY
Prior authorization is a utilization management technique used to reduce/eliminate cost ineffective treatments and protocols. Most prior authorizations are not ad hoc. Someone spent serious time looking at the claims data, the comparative effectiveness, the legal liability and the ability of the claims system to do what the analyst wants it to do. This is not done on a whim. Substantial chunks of the US medical field use imported goods. Some of these goods will be exposed to 10% tariffs, some to 25% tariffs, some to 100%+ tariffs and all to who the hell knows what will happen tomorrow/next week/month/quarter.
In the before times (1/19/25) it was quite possible to say that A was more cost-effective than B as a first line treatment so B should be prior-authorized.
Now who knows?
Is B mostly American made? Is A coming from countries with low tariffs or high tariffs and how do those costs flow through the contract chain?
Is this something that we can measure and analyze?
On The Road – lashonharangue – Botswana – Makgadikgadi Pans National Park
twbrandt
I have no idea what the answers to your questions are, other than great, here’s another thing to worry about.
Enhanced Voting Techniques
going by the place I work, one of the solutions is for US companies selling over seas is to outsource the manufacturing of the product.
Jackie
@twbrandt: Yup.
HinTN
@twbrandt: Yep, especially since my indispensable pancreatic enzyme replacements come from the pancreae of German porkers (“everything but the squeal”), I would very much like to know if analysis can provide valuable insight into my insurer’s willingness to cover said meds.
oldster
As always, David, your expertise gives me an angle on things that I wouldn’t find elsewhere. Thanks.
frosty
This should be required for every op-ed piece.
KayInMD (formerly Kay (not the front-pager))
I have knee replacement surgery scheduled for the end of June, and I’ve been wondering how it will be affected. My knee is in bad enough shape that it won’t be cancelled (my doc says I should have addressed it ~20 years ago), but will he decide to change the model of replacement joint? Will his preferred replacement even be available?
schrodingers_cat
Are we still in the WTO?
Professor Bigfoot
“Well I picked a fine time to have a heart attack.” ;) :(
RaflW
@schrodingers_cat: It’s the World Tariff Org now :/
YY_Sima Qian
The PRC retaliatory tariffs come at a bad time for U.S. brands (gift link to WSJ article):
Aside from nationalist sentiments, Chinese brands are simply catching up on quality, design &, most importantly, marketing (creating compelling brand stories that speak to the targeted consumer groups). The domestic brands also have a more intimate understanding of Chinese consumers, & can more frequent refresh their products catered to the specific desires of these consumers. Chinese brands have even started to encroach on the luxury segment, hitherto dominated by European & American brands.
European & Canadian brands are also under pressure from this dynamic, but American brands that manufacture in the U.S. will see an accelerated decline in the PRC market.
RevRick
MrsRev and I recently watched a series on Great Courses+ that explored Austrian and German cities along the Danube, Rhine, and Elbe, and there is a city in Baden-Wurttemberg that produces an astounding percentage of medical instruments, because a knife-maker set up shop there in the early 1800s.
Mr. Mack
I don’t have anything on the tariff side of this…but my wife works with this on a daily basis, as a UM specialist at our well known childrens hospital. Her job is to review charts of very sick children and to make sure the treatment given/proposed is well and properly documented so the hospital has a good chance at getting reimbursed for the procedures. One daily frustration is that the insurers make the UM staff jump through ridiculous hoops just to file said documentation or to get prior authorization. Horribly slow websites or none at all, requiring faxes or email chains that makes the process cumbersome at best. I keep saying this is a feature not a bug. I don’t know why the hospital puts up with this, it spends a fortune trying to get paid for treatments and procedure clearly covered under the contract. My question: Do all these delaying tactics serve a purpose? Is there enough money at stake that even just a day or two worth of interest on cash in hand at these corps offsetting costs?
piratedan
let me simplify this for you all, tariffs are exactly as what Trump says they are, all institutions are bent to his will as evidenced by the law, the government, the media and now the world economy.
There are loads of awesome people in this country (and on this blog), lamentably none of us are in a position of power to exercise the sanity needed. For fucks sake, we STILL have Democratic Party Senators and Congresspeople voting for GOP sponsored candidates put forth by this crime syndicate.
RevRick
@schrodingers_cat: It’s now the WTF.
Jeffg166
I lifted this from the overnight comment section of Joe.My.God.
Well, this is a stressful time…
At the start of March I was told my contract was guaranteed to continue until the end of the 3rd quarter as planned. YAY! So I started working on my resume in preparation and looking to see what the job market looked like and things looked awesome. I had six months to prepare for a new opportunity so I wasn’t worried, Then on March 27th, at the end of the day, I was told March 28th would be my last day because of budget issues. I’ve been unemployed since. I am so scared because there is literally no work out there. When I was looking at the job market a month ago thinking I didn’t have to worry until September there was a plethora of opportunities. Now there is now nothing. I mean abso-fucking-lutely NOTHING out there. I think the Trump economy has scared everyone, and they pulled all of their job listings. We, as a country, and as individuals are all fucked.
On a happy note I spent the last three days working on our motorcycles. My husband loves to tell everyone that he married his mechanic. I used to be a professional mechanic and I still love wrenching to this day. I added new speakers and an amp to his bike and I finally did a brake job on my touring bike. Speaking of stress, a brake job is a 15 minute job, but mine took about an hour because when I removed the front brake pads on the right side (I have 2 calipers on my front motorcycle wheel) the pads were so thin even hubby knew they were dangerously worn out so I got a lecture about him understanding I’ve been alone all my life but now I have a family and to never let that happen again. MY GOODNESS I LOVE HIM! He’s right, I now have a husband, step children, and grandchildren. Brakes are important. Ya think?
Anyway, wish me luck on the job search.
BarcaChicago
If you want to see a highly educated adult start crying, sneak up behind a physician and whisper “prior auth” in their ear. Signed, former hospital social worker.
narya
@Jeffg166: Good luck . . . what kind of work do you do, if you want to share?
W/r/t tariffs, I went ahead and ordered a new phone. My current one is nearly 3 years old and needs a new battery, which I would normally just replace, but I don’t have faith that the old phone will last through all of the fuckery and I expect replacement costs to only increase. I even sprung for the insurance, which I almost never do. I’m fortunate to have the consulting work right now, so I’m using that fortune to prepare myself as best I can.
Redshift
@HinTN: There was a WaPo article this week about heparin, which is in a similar situation. Heparin is made here but the active ingredient is only available from China, so while pharmaceuticals in general are still exempt, it’s being hit. The article explained it the right way, with story about people who will die without it.
BarcaChicago
… also “peer to peer call”. How many times did I see the cardiologists that I worked with fight with some unknown insurance company “peer” to obtain appropriate care, particularly when discharge planning, for a patient that has had their chest opened up and a LVAD stuck in there. Good times! I will always consider health insurance companies to be criminal organizations.
japa21
@Mr. Mack:
I can partially answer that question.
I was a Utilization Reviews specialist for an insurance company. Although my specialty was mental health and substance abuse, I had a very good understanding of the medical side as well.
As David said above, this isn’t some haphazard process. Very concrete criteria have been set up that should be followed. The reality is that a lot of unnecessary and overly costly treatments had been used, sometimes merely for the financial gains of the providers, be they doctors or hospitals.
Unfortunately, just as the provider side took advantage of lackadaisical and loosely defined rules for treatment, insurance companies started to overdo the authorization side.
Authorization companies sprang up which sold themselves to insurance companies as money saving options. But to prove they could actually save money, they had to start denying services.
What had gone too far one way had now gone too far in the other direction.
There was a point where an equilibrium was reached. Providers came to understand the rules of the game, became aware of what the criteria were and kept themselves to the rules. Reviewers came to actually bend a little bit more in approving.
There are now specific areas where conflict seems to arrive most often. Imaging services are one of them. Very specialized and expensive drugs are another.
IOW, a good system was developed, but it requires some degree of work on both sides.
lowtechcyclist
My WAG would be: not without a hell of a lot of proprietary knowledge.
suzanne
I will note that I have seen projections from national-level GCs about the impact of tariffs on healthcare and laboratory buildings, and it appears to be roughly in the neighborhood of 5% increase to construction cost. Which will, of course, be passed down to Medicare, Medicaid, insurance companies….. and thus, all of us.
WTFGhost
Not while the Trump administration is acting completely brainlessly on tariffs. You could measure and analyze only if there was some rationality to the tariffs – if only you could say “because of X trade barriers, and Y tariffs on our products, plus other trade violations, we know CountryZ will get hit hard,” – then you could attempt to measure and analyze.
It’s hard to analyze, for scientific, economic, or even visual clarity, anything that is pulled straight from Trump’s ass, unless it’s his well-worn copy of the Constitution.
YY_Sima Qian
@Redshift: Tariffs on pharmaceuticals, including intermediaries, w/ the idea of forcing a rapid withdrawal from PRc made products. We’ll see how quickly Trump caves on those once it becomes clear that it will shut down pharmaceuticals production in the U.S.
twbrandt
I ordered a new phone a few weeks ago, I also bought some new audio equipment earlier than I had intended. Fortunately, my 7-year-old car with >90k miles runs like a top. Hopefully that continues for another 7 years and 90k miles.
Redshift
@BarcaChicago: Ms. Redshift has a prescription last year with a prior authorization (if I recall correctly, for a more expensive secondary antibiotic after the first one didn’t work.) It had two refills so she could continue taking it if necessary, but it turned out the prior authorization didn’t cover the refills, because it was set to expire sooner than the refill period, so she had to wait for a new in to be approved.
Stopping an antibiotic and starting it again doesn’t cause any problems, right? Luckily she didn’t end up breeding drug-resistant bacteria as far as we know, but geez.
Jeffro
for the life of me, I still can’t figure out why everyone is going to the trouble of dealing with trumpov’s tariffs when we could be (metaphorically) beating on Congress to take back its tariff authority
same thing with the law firms and universities: tell him to go fuck himself, and start squeezing the appropriate members of Congress to do their jobs
Jeffro
@YY_Sima Qian: I thought I saw someplace that we don’t even make our own *penicillin*
good luck, Orange Clown
Ohio Mom
It strikes me that all this preparatory purchasing — we bought a washer/dryer combo over Thanksgiving because we were anticipating the prices going way up after Trump was sworn in — and narya buying a new phone ahead of her regular schedule — may be giving the economy something of a sugar high. Which means things are probably much worse than they look. iANan econimist though.
WTFGhost
@BarcaChicago: Back when the Clintons were trying to fix health care, I saw a bit that said “in the US, doctors talk to insurance companies for N hours a week. Canadian doctors talk to insurance companies maybe 15 minutes a week.”
Now, that said, I’m sure that Canada, the UK, the rest of Europe, I’m sure they all have some price controls, somewhere. I remember a poor woman who *probably* needed surgery for sleep apnea, but had to take an 8-10 week course on using her CPAP first. Me, I could understand the goal (NB: didn’t say “approved of” – just “understood”), don’t do an expensive surgery, when a $500 class might – repeat, might – do as much good, for some.
I’d just want to see as many skinny chicks and dudes diverted, so I know it’s not just for patients who are overweight or obese, or who otherwise fit prejudices of a doctor.
RaflW
@piratedan: “all institutions are bent to his will as evidenced by the law, the government, the media and now the world economy”
Good lord.
Oh, I see WG has just put up a thread about Harvard and the co-signatories putting up institutional resistance to both the threat and to (hopefully) test the legality of all these bullshit E.O.s that overreach like fucking crazy, so I’ll just stop right here and head there.
Shakti
@Ohio Mom: But how many people did or had done preparatory buying, though?
Everyone I mention scope limited concerns waved me off or waves me off, unless they’re politically active hippies.
For Betty Cracker and others, every goddamn day feels like waiting for a hurricane.
Specifically this tariff bullshit feels like I’m buying for a hurricane on top of buying for a hurricane. And I have enough problems trying to do hurricane prep as it is, trying to buy stuff and prep and drag people kicking and screaming when we need to evacuate. I don’t know what to do or buy for which emergency (chuckles).
And god help the people who need to do home repairs or have their apartments repaired before hurricane season
Hurricane season in Florida runs from June to the end of October? Milton took me by surprise (lmao), because usually by the start of October the weather has cooled and we haven’t gotten hurricanes that late.
RaflW
@japa21: I’ve had the same overall health ins. company for 28 years (eghad). Health Partners is, by MN law, a mutual insurance company. They tried prior authorizations for a while, c. year 2000 if I remember correctly.
It was an abomination. I remember having to call some person utterly unknown to me and tell them my symptoms before I could get an appt. Did I want to talk about my testicles to a stranger? I very seriously did NOT!
I feel like the prior auth thing lasted just a couple of years, and within a decade swung to the reverse such that we don’t even need a referral from our PCP to see a specialist any more (because that probably wasted a lot of PCP time saying “yep, your sinuses are a god dammed mess and you should seen an ENT”).
Their main cost control is a fairly narrow network, just Health Partners clinics, Park Nicollet clinics (which merged in years ago) and their associated specialty centers and hospitals. But there are a lot of great providers in that network (except in sleep disorders, and I’ve not ben thrilled with their Dr.s of Optometry, but that’s a sidenote) , so it mostly works quite well just letting us request the services we know we need.
Enhanced Voting Techniques
@YY_Sima Qian: Yep, shocking that the pharmaceutical industry is centered on the country with the world’s largest socialized heath care. Sneaky how China stole that from the US.
And there is this word salad from Trump about Xi visiting Vietnam and totally NOT mean girl Trump sulking he’s not with the cool kids….
IDK I think if Xi did a state visit to Europe Trump’s brain would explode the jealously.
sab
@Ohio Mom: We bought a new car about 5 years ahead of schedule. I noticed during tax prep this tax season that so did a lot of our clients and three of my co-workers.
YY_Sima Qian
@Jeffro: Trump Administration is telegraphing tariffs on semiconductors & drugs (gift link to NYT article):
suzanne
@Ohio Mom: We bought a refrigerator and a new furnace because we knew tariffs were coming.
BarcaChicago
@Redshift: Oh LORD, that’s what is known as “step therapy”: often people have been using a certain medication for many years that stabilizes a chronic condition when suddenly the health insurer decides they need to change to the cheapest iteration of treatment and slowly work their way back to the effective medication, and if the patient happens to die on their way back – oopsie! I’m not kidding when I talk about insurance companies killing and harming people through delaying and denying care. Thank God in Illinois we OUTLAWED “step therapy”.
schrodingers_cat
@Ohio Mom: We bought an electric car because we thought that the federal subsidies would go away.
sab
@Redshift: I’d wondered where my husband heard about that. I remember the heparin from a couple of years ago when we were having to do in-home IV antibiotics for my husband after he caught MRSA from his back surgery.
Basically if you don’t get heparin during IV therapies then you will probably die from an embolism when your blood clots to protect you from the what your body thinks is an invasion.
YY_Sima Qian
@Enhanced Voting Techniques: Apparently, Xi does not want to visit Brussels, so von der Leyen (President of European Commission) & António Costa (President of European Council) are going to Beijing later this year for a summit. The EU Commissioner for Trade Šefčovič just came back, as was Spanish PM Sanchez. Macron is visiting in the 2nd half of the year.
The UK’s Chief of Defense Staff (which definitely raised eye brows) & Minister for Trade & Economic Security were also just in Beijing.
Here is another headline that raises eyebrows (Newsweek citing Xinhua, so take it for what it’s worth):
BarcaChicago
My three years working as a hospital social worker in a fancy research hospital in Chicago was the worst experience of my life. I lived in a constant state of rage, horror and frustration due to our lack of a health care system and social services, hospitals run like unethical corporations with highly-paid C suites and the criminality of the health insurance industry. Patients and their families; life, death and illness; pain, sadness, anger – that was the beautiful part because that’s the part where you can be with people during some of the most difficult times of their lives. It’s deeply meaningful and an honor. And it’s something that is forced to the side because you spend most of your time fighting with people‘s insurance to get them authorized for rehab after having their chest opened and a pump stuck into their heart. Sorry about the rant, I’ll never get over it.
Professor Bigfoot
@Jeffro: A few months ago I found myself munching a bag of cookies that were “Product of India.”
That drove home to me how much we live in a GLOBAL economy; where it’s profitable to bake COOKIES in INDIA and sell them here.
I don’t believe there’s really ANYTHING available on the market in America today that doesn’t have SOMETHING that’s passed at least one border along the way.
and these stupid MFs… grrrrr
JaneE
@schrodingers_cat: I don’t think so. Trump declared we were no longer a member. A few weeks ago I think.
Frank Wilhoit
Before I would care about the effect of tariffs on the relative cost of pharmaceuticals from different countries of origin, I care about the quality control on imported pharmaceuticals. Everything that I know about anything tells me that there is no quality control, that this is purely a matter of enforcement by US domestic agencies rather than of any processes at the point of production, and that the domestic enforcement had already been torn out long since, with perhaps some shreds remaining for RFKJr to sweep away. Meanwhile, imported turmeric — some level of etiquette forbids me to say whence — has already been found to be cut with lead chromate, which, apparently if surprisingly, is cheaper. And there again, everything that I know about anything tells me that that is one loose scale on the back of a feather mite feeding off a seagull on the tip of the iceberg. Meanwhile my doctor prescribes this, and that, and my insurance cheerfully pays whatever opaquely-negotiated amounts for them, and they are imported from The Place That May Not Be Named, and Christ only knows what may be in them so long as it is roughly the right color.
schrodingers_cat
@JaneE: We have stopped funding it but not yet officially withdrawn. World’s policeman has gone rogue.
Martin
“Is this something that we can measure and analyze?”
In a regime that had an honest interest in the economic consequences of these things (even GWB), I’d say probably. But this regime does not and is likely dismantling the mechanisms that would allow for that. This is what we see now in the educational space – very nearly all mechanisms to get a national view of that information has been dismantled. HHS got rolling on that dismantling a bit later, plus they’d need a big lift from Commerce probably requiring a build-out of staffing there to do the breakdown of that data. The codes for tariff schedules are not that fine-grained (the ICD-10 of the trade community), so it’s like not possible just from that data to figure out where all the varied tariffs are being applied within the medical space. It would need additional analysis from that data, which will need a certain expertise and just given the volume, likely a lot of additional staffing. And then HHS would similarly need that build-out when they have just been gutted of this kind of expertise and staffing.
Most importantly, they don’t care. And of course, the ground would have to not be shifting for a long enough period of time for the analysis to take place to have any utility, and I don’t think that’s going to happen while he’s in office.
bluefoot
@BarcaChicago: this happened to me when I changed jobs and had a new insurance company. I had to basically start back from square one since I was not on first line standard of care. It messed up my health (autoimmune condition) for quite a while.
I saw something similar nearly kill someone I know.
Mr. Mack
@japa21: Likely a dead thread, but I appreciated the response (I get so few) so here is my response back: Right. I understand that it is a well honed process. When there are legit disagreements as to care, as you know, at some point the specialists will get their doctors involved and they will hash it out. I was speaking more to the simple, guaranteed to be approved things that are a bear to get processed. It is beyond cumbersome and I think it’s by design. Thanks for your input and we are in agreement with respect to how the insurers approach the process.
Chris T.
“Who knew
healthcare wastariffs were so complicated?”