Even with insurance, the cost of essential drugs is too high. Our whole healthcare system consists of the care providers billing crazy, unjustifiable amounts to Insurance, followed by insurers paying out a percentage of that.
Showing prices up front would be the very least we could do to start to clean up this fraudulent billing mess that is healthcare here in the US.
> Medicare is not a decision making body. What are you talking about?
CMS absolutely is a "decision making body", with direct authority over a whole number of matters.
But even beyond its office authority granted by Congress, Medicare (both the people who run it and the people who generally support it) are incredibly influential as well, and they would use that influence to block any policy that would affect Medicare so negatively (even if it would be good for the public at large)
> but in the United States it remains quite expensive if you don’t have insurance.
Not really - Gilead provides assistance programs for people who have private insurance, for people on public insurance, and for people who are uninsured (there are three separate assistance programs). The plan for people who have private insurance is the best (you end up paying $0/year for PrEP), and the plan for people who are uninsured is pretty good (not $0/year, but still pretty affordable).
I have personally paid $1700 out of pocket for a month’s supply of PrEP, despite insurance AND membership in Gilead’s “advancing access” co-pay assistance program.
Gilead intended the program to cover about $300/mo, in order to cover your co-pay until your deductible is satisfied. That worked fine until this year, when UnitedHealthcare decided to re-class my card from co-pay assistance to a “manufacturer’s coupon” — thus accepting Gilead’s money while it lasted but still expecting me to pickup the full tab until my deductible.
The prices were similar here in Australia, friends who are on it were given instructions by their doctor on websites in South Africa and a particular brand name to purchase along with a prescription to get around it. Generic version but equally as effective. I believe now it is on the PBS here!
The manufacturer charges a higher price to the insurer and pays for the consumers copay so they are not impacted by price sensitivity. Kind of like business travels tend to spend more because it is the companies money vs their own. If the copay is too high, consumers might shop for cheaper alternatives instead of the "latest and best".
The sticker price is negotiating leverage for use against organisations with money, the insurance companies and Medicaid and Medicare. They don’t pay the sticker price either but they come much closer because they’re price insensitive. All costs get passed on, on average to the actuarial customer.
Showing prices up front would be the very least we could do to start to clean up this fraudulent billing mess that is healthcare here in the US.