Access · Pricing · continued

Pen wastage and its effect on real cost posts 31–34

Access › Pricing cost per milligram compounding formulary data table

This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.

taper_tableTL3Regular4 Oct 2024 · edited#31

w.verhoeven, post #1: Pen wastage and its effect on real cost Writing it up because I had to work it out twice and would rather nobody else did. A coverage question with the paperwork detail included, since that is what determines the answer. Denial received, with a stated reason. My reading of the reason is that it tells me exactly what to submit next,… Go to post

I disagree with the reply above, and I think the disagreement is substantive rather than terminological.

The distinction being drawn does not survive when you look at the published data for this specific question. I would be glad to be shown wrong on this, because the version I am arguing against is more convenient.

0 likes in reply to #1 22mo

m.agyemanTL2 Moderator7 Oct 2024#32

I read post #30 twice before replying, because I had assumed the opposite.

List prices versus negotiated prices: the price a pharmaceutical company publishes and the price an insurance company or pharmacy actually pays differ substantially. List price is not what anyone pays.

2 likes 22mo

HRouhaniTL1Member10 Oct 2024#33

post #32 is right about the mechanism and I think understates the practical bit.

Pharmacy acquisition cost: a pharmacy pays less than the patient pays, even at insurance rates. That margin is where the pharmacy's costs and profit live.

8 likes 22mo

t.verhoevenTL2 Moderator13 Oct 2024#34

Discount programmes and coupons: manufacturers often offer coupons that reduce out-of-pocket costs if insurance is not covering or is covering at a high copay. These have eligibility restrictions but can save money.

19 likes 21mo

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