> Amazon claims Prime members will be able to save “up to 80 percent off generic and 40 percent off brand name medications when paying without insurance.
This was buried in the article, but is IMO a bigger deal. In the long run, this could really drive down drug prices.
I'm not surprised, there's some serious shenanigans on medicine pricing and insurances.
Medicine prices are clearly inflated when you can buy at a huge discount using insurance, but then you can get apps like GoodRX, which is free and give you coupons that far exceed my insurance discount on every single time I had to fill a prescription. To the point that I don't even bother going through insurance anymore.
I saved thousands on medicine by just checking on GoodRx before buying it.
I'm curious who or what the end goal of GoodRx is. They pay for expensive ($$$$$$) cloud anti-bot/anti-scraping, captcha you after a few requests if you run adblock, they pay for extensive browser/device (attempting to reidentify a user across multiple devices/multiple browsers) fingerprinting services and Fastly. The site loads a dozen trackers, googletagmanager, branch, segment, what are they doing with this data? How much money are they spending handing out coupons?
The coupons aren't unique or require a login, why go through all of this? All the services they use are "request demo / contact us for enterprise pricing", not free-to-sign-up SaaS either. Just who is paying for all this and with what?
Their end-game is collecting user data & collecting a referral fee when people use their "insurance". (The coupons generally are not actual coupons, they present as an insurance coverage policy & code that pharmacies use the same way they would your normal insurance card). That's how they make their money.
Personally, for me, the data they can collect off of me when I go to their site is worth the ~$2,000 I save every month. (actually I don't have to use them: I am prudent, and part of my contingency planning for losing my job is to know exactly what expenses I could strip away, and how (and for how long) I could continue to pay for the bare essentials. GoodRx is part of that planning for the healthcare end of things)
As a European now living in the US, my first thought is that the $2,000 shouldn't even exist to be collected, especially by invasive data broker rent seekers.
It’s collected (generally speaking) one way or another. Unfortunately right now it’s collected from the lower and middle classes, but no matter what you do drugs, treatments, doctors, hospitals, etc. cost money. It’s never, ever, ever “free”. If a drug costs $2,000/month there are probably some inefficiencies baked into the price, but even if it were $500/month, that $500 has to come from somewhere.
Usually coupon sites are very profitable because they signal immediate intent to purchase, I assume they have affiliate links for whoever they're providing coupons for, any kind of coupon site is usually in fierce competition.
As for all the bot countermeasures, the reason for that isn't immediately obvious to me, I assume it must be due to that competition.
GoodRx doesn't pay for the medicines. They just offer the copay discount cards already available from manufacturers. The manufacturers have a fake prices they use as a negotiating point with insurance companies to maximize their profit.
As a company selling via the internet it would be handy to know what drugs/prescriptions a prospective client (via fingerprinting) is taking... it would certainly change what/if I marketed to them.
Of course the concept of retail companies having even the slightest access to a customer's medical/health/drug information for marketing purposes is a compelling plot for Black Mirror.
> They pay for expensive ($$$$$$) cloud anti-bot/anti-scraping, captcha you after a few requests if you run adblock, they pay for extensive browser/device (attempting to reidentify a user across multiple devices/multiple browsers) fingerprinting services and Fastly.
This sounds like a great anti-account takeover program. I imagine with all of the various compliance programs they have to deal with and the legal risk, these are prudent measures.
Just like school tuition. The more gov subsidized debt that can't be bankrupted the more admins they keep hiring and the bigger the cost/shit rolls down hill.
Combine that with a culture that overvalues all university diplomas as equal, while disregarding the economic opportunities of at least half of them are almost nil, and you have a great recipe for massive failure for a big percentage of the young population.
The half baked social programs always do this. Same with how rent control in NYC and Toronto in the 1970s ended up significantly reducing the supply of low-income housing because it stopped incentivizing developers from building cheap houses in cities that had it (they just went elsewhere) while also ghettoizing a bunch of neighbourhoods because there was zero incentive to maintain buildings (which led to mass arsons in places like harlem).
If you're going to socialize it either go all the way and nationalize it/fully fund it or find a way that doesn't fuck the citizens over (like these glorified schemes to hand money over to politicially-connected middlemen like big pharma and diploma mills). OR in most cases just let the market do it's job. Like letting generic drug makers take over markets way sooner, without the multitude of government protection rackets that protect big pharma (including FDAs giant backlog). Meanwhile (social) media blames capitalism for every expensive drug or tuition price... like it actually makes sense for ANY market to charge a working class person $1000/pill.
These flaws seem so obvious to me but are repeated in so many western countries, not just the US. While blame goes in so many randomly misguided directions. Often heavily greased by the people who benefit from these schemes.
This is very similar (and really interesting) though I’m not sure if Walmart has a special condition on use of insurance.
Amazon appears to be incentivizing customers to not use insurance to pay for their drugs. I’m not sure if Walmart does the same. If so, that’s also noteworthy.
Discount programs everywhere focus on the uninsured (the insured have the insurance company also paying discounted rates, generally, but those are individually negotiated; the sticker price is just to have a starting point for negotiations with deep pocket public and private insurers.)
In many cases, the discounts in the discount programs are subsidized by the drug companies for uninsured patients.
Yep, for full disclosure, I work in healthcare pricing and payments and adjust claims myself.
While discount programs focus on the uninsured, this is the first time I’m seeing the discount being framed in such a way that it effectively incentivizes paying out of pocket. It’s an important incentive if your goal is to decouple routine drugs from the third-party-payer model of insurance.
Health insurance in the US is actually 3 different services bundled into one: (1) risk sharing for catastrophic care, (2) access to low prices (called "fee schedules"), and (3) tax advantaged pre-payment for non-catastrophic care. 40-80% discount on drug prices essentially competes with insurance company fee schedules, i.e. service (2). By offering what amounts to insurance rates without charging insurance premiums, Amazon is essentially decoupling the fee schedules from risk sharing. That's a really underrated side effect of this product offering, and can have long run impacts on the industry (IMO for the better).
I would add a 4th service for health insurance in the US to be a way for healthy, young people to pay for the care of sicker, old people due. AKA, a tax, due to the following stipulations of the ACA.
3) Elimination of pre-existing conditions, i.e. accepting all lives no matter how costly
4) The recently eliminated mandate to purchase health insurance.
The above conditions mean that premiums from healthy people that don't use healthcare is used to pay for the healthcare for sick people. It gets a little complicated with the ability for employers to silo their employees' lives from the rest of the population, but in general, US health insurance premiums are basically a tax on the healthy to pay for the healthcare for the sick.
As a Canadian, I believe that the Patented Medicine Prices Review Board [1] does quite a good job, judging from the cost of medication up here (broadly speaking).
Australia has a similar mechanism in the Pharmaceutical Benefits Scheme. Drugs are selected based on cost-effectiveness analysis and subsidised price is negotiated with pharmaceutical companies.
If anything, Australia is quite generous to pharmaceutical companies. New Zealand's Pharmaceutical Management Agency has much less negotiating power but still manages to obtain substantially lower prices.
For myself I can't help but wonder if lump-sum licensing might not be more effective. Pharmaceuticals are a bit like software: very high R&D cost, but the marginal cost to manufacture is very small. A one-time payment to sink a large chunk of R&D for a drug might be quicker and easier than guessing at a price. On the other hand, I have no experience in health economics, so it's possible this is a terrible idea.
> For myself I can't help but wonder if lump-sum licensing might not be more effective. Pharmaceuticals are a bit like software: very high R&D cost, but the marginal cost to manufacture is very small. A one-time payment to sink a large chunk of R&D for a drug might be quicker and easier than guessing at a price.
Don't they do a better job in lots of other countries? I'm not an expert, but my understanding is that a lot of the countries with socialized medicine such that their government is the one negotiating with drug manufacturers pay substantially less for drugs than customers in the US.
In other countries, government “negotiation” is just a euphemism for price controls. An example of this is Canada’s Patented Medicine Prices Review Board, which regulates drug prices. This isn’t “negotiation”, this is just centralized policy-driven price control.
The US could very well institute their own price controls on drugs, but it wouldn’t invalidate the value in services like Amazon’s, especially if the price controls in question do not create a lower bound on prices, but instead focus on setting upper bounds.
I support price controls in the US, and the government manufacturing generics if necessary (stepping in if the private sector won't due to it not being profitable enough).
EDIT: I removed an unrelated paragraph about Planned Parenthood and drug supply chain I thought was out of scope.
These companies are international so they can choose to not do business with a country. It is a negotiation, just one that governments tend to do better at. If Blue Cross North Dakota sits down at the negotiating table and then Aetna New York sits down at the negotiating table and then Canada sits down and then the European Union sits down, who is going to win a good deal and who is going to get screwed?
You can say it's cheating when governments win lower prices for their citizens like this but I'm not much inclined to care. I don't want to subsidize the continuation of our more-market-based-than-usual health care experiment when the results have been clear for decades. Compared to our peers, we're in a hole. Let's stop digging.
I've been reading some books on the medical industry and one of the things pointed out is that the price controls will often not provide enough profit to R&D new drugs. That the US ends up subsidizing a lot of R&D cost that everyone benefits from.
If this is the case, I wonder what would happen to drug development if that goes away.
Note, I'm not saying there's not too much profit from drugs. These statements don't have anything to do with that.
Initial discovery research is pretty much entirely tax payer funded. There's then a second phase, moving from that discovery to POC, that is extremely underfunded, and which a lot of charity and such funding goes toward. It's only the last phase, taking POCs -> product, that companies really invest in. https://www.ncbi.nlm.nih.gov/books/NBK50972/
Note, too, that private companies tend to fund research toward common first world diseases, since they're profit driven, and far less to niche and/or common third world diseases. So not only do they not fund early discovery (government does that), nor generally moving those discoveries to POCs ('valley of death', and charitable foundations and the like do that), they also leave plenty of potential meds untouched, since the likely profitability is low.
I've heard that argument, not sure how much I buy it. Seems the drugs that get developed tend towards niche applications, while common diseases that affect mostly uninsured people are addressed by places like the Gates foundation.
That’s why we should tie our drug prices to the prices other countries pay. I believe Trump did that (or talked about doing it?) for Medicare, but it’s absolutely insane we haven’t done it across the board.
Republicans would be hesitant due to “regulations bad,” and Democrats don’t want to improve our current system because they’d rather throw it out. And of course both sides get donations from pharma.
Better than the farce that is "competitive market forces." I have more faith in government than corporate structures delivering optimal cost pricing to consumers as opposed to optimizing their profit margins.
Competive forces only work while there's competition, the second competition declines, rest assured consumer pricing is the first to take a hit.
Competitive forces in the health care market in the US don't function (pretty much at all) because of government induced market distortions and regulatory capture. FDA certification enormously drives up the cost of medicines and medical devices; government bureaucrats have no incentive to balance safety with time to market, price, availability, supply, or diversity of sources; most of these represent risk to the people making the decisions. Most US consumers don't pay for their own medical care, they pay for insurance that pays for their medical care. Often their employer pays some of the costs of insurance. Insurance usually fixes the cost that the consumer has to pay, e.g. a $10 copay. So there's little incentive for consumers to shop around for medical care, meaning that consumers can't drive prices down with normal market decisions. States and the federal government put enormous restrictions on insurance, driving up the cost of insurance. Health insurance doesn't function as in other sectors, where payouts are rare- most insurance is a bet - I'll bet you $3000 a year my house burns down - I'll bet you $400000 it doesn't. Health insurance is more like a discount plan, kind of like a CostCo membership. AMA and insurance companies lobby for limiting supply of doctors and hospitals, respectively, which drives costs up. They do this under state licensure laws purporting to improve quality or safety. Bottom line is that almost every single aspect of the US health care market has had government intervention effectively disable any market based control. The situation would fix itself quickly if we deregulated EVERYTHING regarding healthcare, and restricted insurance to catastrophic event coverage. Businesses would quickly come up with ways to serve the market in a market-friendly fashion. Worried about pre-existing conditions? We'd see businesses like "diabetes maintenance organzations" where you pay a monthly fee and you get all the treatment you need related to that condition. Accidents would still be covered by insurance. You'd pay privately for things like doctor visits for the flu, etc., but supply and consumer choice would drive those costs down, e.g. if I have a sprained ankle I could just use an app on my phone to summon a military vet who was a battlefield medic to treat it, rather than pay for 15-30min of time of someone with 24 years and half a million dollars worth of education. What about quacks/frauds? We know how to deal with them - reputation (AngiesList, Consumer Reports, Google Reviews) on the front-end, courts on the back-end.
The pentagon wastes more money than any other government agency. And I don't mean waste as in spending money on something I don't like, I mean waste as in buying one thousand nails and then throwing 999 of them into the lake because they only needed one and they have a quarterly budget they need to burn. Billions and billions of dollars go unaccounted for every year, their books are a mess, and congress just lets them essentially steal from the taxpayer, year over year.
Lack of choice; the government has captured the "market", and "consumers" can't choose to go anywhere else. Compare to the service (and especially customer service) offered by your cable/internet provider where you have not choice. The cable companies vie for literally worst customer service of all businesses year in and year out.
And we know that the government is doing an awful job in regulation of healthcare. I've got kind of a front-row seat to this and see things that most might not, since my wife's whole career has been in healthcare finance, and in particular around how Medicare reimburses hospitals for services.
She's currently working with one client hospital for whom their Medicare cost report still hasn't been resolved for some years back even before 2010. How can a business operate efficiently when they don't know what their expenses are going to be - not just in the future, but even historically, more than 10 years into the past?
Worse, the way the government forces hospitals to report this stuff is extremely specific, and optimized for how Medicare wants to run things - which is why Medicare can claim to spend less on administration: they just force hospitals to do all the administration for them. And hospitals can't say "no", with Medicare (together with Medicaid, which generally rides on Medicare's regulatory coattails) comprising a plurality of the market, if not an outright majority. The result of this is that hospitals have a choice of either running two separate accounting systems (one for what Medicare demands, and another to do rational cost accounting), or more likely, to just do the one for Medicare and muddle along as best they can. And that's a major reason why hospitals can't operate more efficiently.
And my wife's currently involved in a battle with them over some detailed rules they posted early in the summer. She's been working all summer for her client hospitals based on what the government posted on their website. Last week they changed the rules posted (you can even see the "last changed" date). But the change was in a way that contradicts their previous statements, and invalidates much of what she did all summer - and worse, they're lying about it, not admitting to what the previous version of the page said. Unfortunately the wayback machine didn't track that site, and while she's got her own records quoting the page, the gov't won't acknowledge it.
So there's a clear explanation for why it can get bad, and tons of evidence that it really is bad.
> which is why Medicare can claim to spend less on administration
In addition to this, it's worth pointing out that the idea that Medicare is the solution to all of our problems because of the cost savings of administration is way over-stated.
Administrative costs make up a tiny percentage of the overall cost differential. You could basically zero it out, and it would still hardly make a dent on the overall cost difference.
You really think that? The US spends more on its military per capita than just about any other country, save for Israel. The F-35 has been one of the US military's more noteworthy embarrassments, chronically behind schedule and over budget.
Outside of raw warfare, the military runs almost entirely on cost-plus, which results in over-spending of contract money for boondoggles that just entrench the military industrial complex.
Outside of the US military, you have systematic inefficiencies like this across most major agencies.
NASA's planned SLS moon mission is a bit of a disaster — way over budget and way behind schedule. Because the boosters aren't reusable, each launch is expected to cost $1B (with a B) dollars — EACH launch! Meanwhile SpaceX's target cost-per-launch is $50M.
In healthcare, Medicare has actually been running a fairly interesting A/B test. When you turn 65, you have the option to enroll either in "Original Medicare", which is what we usually think of when we talk about "single payer healthcare in America", or you can enroll in Medicare Advantage (aka Medicare "Part C"), where the premiums that would go to the CMS instead go to private insurers like Humana, United, Oscar Health, Clover, etc. These plans replace Original Medicare, also cover Part D prescription drug benefits, and often include supplemental benefits that Original Medicare doesn't already cover. The outcomes are fairly interesting:
- 36% of Medicare beneficiaries are on private Medicare Advantage plans instead of the public "Original Medicare". Because everyone is entitled to "Original Medicare", this is purely voluntary. This number has been growing so rapidly, that we expect by 2025, more seniors to be on a private plan than the public one. There's also great variance by State. In Florida, Pennsylvania, Wisconsin, Michigan, Minnesota, Oregon, Alabama, Hawaii, and Connecticut — over 40% of beneficiaries are on Medicare Advantage. By 2022, we expect more seniors in those States to be on a private plan than a public one. https://www.kff.org/medicare/issue-brief/a-dozen-facts-about...
- In Urban areas, Medicare Advantage costs less per capita to administer than Medicare — and that's not including the extra Medicare Part D insurance that you would have to buy if you're on the Original Medicare plan. https://www.commonwealthfund.org/publications/issue-briefs/2... From this same research, public "Original Medicare" is still cheaper in rural areas, but not by a whole lot.
So yeah, while the governments of a lot of countries are fairly robust and efficient, I think that suspicion is warranted, especially in the US.
Yes. Governments do a better job everywhere from Cuba to Britain. Americans do not have the highest life expectancy but do have the highest healthcare costs. Private firms might have a part to play, in the same way contractors can fix roads, but free markets are not efficient when people’s lives are on the line.
Governments certainly can do, although the US government seems to be permanently hobbled by about half of its leaders having built their identity on the idea that government is incompetent and a bad idea; I'm not surprised it's dysfunctional when the people inside it have their sense of self wrapped up in being shit at their own jobs.
If the difference between affording a car and not being able to afford a car would kill me, then maybe I would like the government to step in to negotiate on behalf of all of its citizens.
Not being able to afford food can also kill you (you would starve to death). Is that a sufficient justification for the government to step in to negotiate food prices on behalf of its citizens?
There are merits to government price controls and there are certainly countries that have employed them successfully. That said, it isn’t the only solution to bending the cost curve, and there are also downsides to price controls. It’s complicated.
I agree on the wider point but in case you or some other reader were unaware...
Government does that in the US (and the EU and Canada and basically every first world nation that's not a city state). The department of agriculture and others spend somewhere between 10s and 100s of billions every year to make sure that food (and other crop) prices stay within carefully set, tightly defined limits.
It may not directly negotiate the prices of food, and that's fine: If there's another form of intervention that would provide healthcare to people without directly negotiating the price, I'd be fine with that too. However, the government has not subsidized the healthcare industry to the point where healthcare is as accessible as food.
Healthcare is not just a demand-side issue. There is also constrained supply. I'd be happy to see the government subsidize supply production (building new medical schools etc) in a similar way that it subsidizes food production.
I'm by no means advocating government negotiation or single-payer or medicare-for-all as the thing the government must do on this issue. I'm fine with a form of intervention that allows the market forces to go the last mile in this.
> Is that a sufficient justification for the government to step in to negotiate food prices on behalf of its citizens?
Yes? We already do this? For many years directly in the postwar period and now indirectly through agriculture subsidies and programs like SNAP. Making sure everyone has enough to eat is step one of having any kind of functioning society and why it’s always been a source of massive government intervention in the economy.
I do not think this is the best smell test for government involvement.
Not being able to afford health care in no way condemns one to being killed. It's obviously not advisable, but plenty of people do just fine without regular doctor checkups because they keep healthy and live balanced lives. And, interestingly, given how many each year die in traffic accidents, it's not such a stretch that being _able_ to afford a car would kill you.
We all have really different reasons for wanting health insurance and owning a car. We have different components, considerations, and properties, which we value about these decisions. Given this, it seems ludicrously complex, inefficient, and cruel to subject all citizens of a nation to the same exact process of obtaining and using health care.
We all know how bad of an idea it is to centralize services, but because some linguistic jokesters have gotten the phrase "healthcare is a human right" to be passed around the globe enough times, people seem to drop context when it comes to this discussion.
As soon as youtube-dl got hit with its recent DMCA takedown request, GitHub obliged and the whole dang HN community lost their collective minds. "Decentralize your git repos" we all saw people writing - and they weren't wrong. But for reasons that continue to escape me during these awful lockdowns we're all facing, people don't seem to think that their government-provided healthcare workers and price negotiators will do anything of the sort.
You can guarantee universal healthcare (and medication) without top-down control of pricing, or at least not total control. Most drugs aren't making headlines, so you can control the x% that matter while still getting cheaper prices for most consumers by letting the outlets compete.
Your website suggests you are American, so I recommend taking a look at the various healthcare systems on display in Europe, they're not all made equally (i.e. Some do more on behalf of their citizens than most). In my experience of watching American discussing healthcare in the EU, the subtleties are often lost, sadly.
The free market has a tendency to optimize for profit, and fairly often short-term profit. Yes, that necessarily means companies must have customers willing to pay them, and so a certain amount of quality of product & service must be present, but it does not optimize for everyone to own specific product even if everyone wants that product.
Saying the market can solve the problem of healthcare for everyone is a bit like saying it should be able to solve the problem of providing flagship-quality phones for everyone. But in fact, given the "law" of supply & demand, a product like healthcare which is in demand by literally every single person, yet constrained by supply, the solution the market converges on is going to extract the most amount of money it can from however many customers can be served by the available supply.
Supply constraints are also one of the problems I would, given complete faith in market forces, expect the market to solve but it has not done that either. Market forces did not prevent or resolve the dumping of cancer-causing chemicals, or known cancer-causing product like cigarettes to be removed, or any number of other undesirable things whose costs end up being paid by society as a whole rather than a given individual(s) responsible for the problem. When the market fails to solve a problem, some other force needs to intervene.
Maybe a free market purist would say we didn't give it long enough to solve these problems. I don't believe that, but let's say it's true: Saying the market will eventually solve a problem, when human lives or suffering are at risk, is a bit like saying evolution will eventually solve a problem. It may be true, but the timescales involved are sufficiently long to render their eventual solution irrelevant to the people who die or suffer before it materializes.
I don't claim to know the best way to do this, and perhaps my analysis above is incomplete or over-simplified, but the point stands that the market has not solved this problem, and does not show signs of doing so.
Most US healthcare is neither free nor particularly a market. Most healthcare in the EU has a significant market element to it, and it works just fine (and usually costs less per capita)
Yes, the government has a stronger negotiating position than me, for obvious reasons.
The concept of "markets" is not useful in a discussion about healthcare, because unlike other markets, a participant will often die unless they immediately purchase a good from the seller physically closest to them, regardless of price.
Walgreens has an insurance plan too. It was cheaper for me to buy Walgreen's insurance and then my drugs than it was to just use my own insurance, and I had Platinum+ insurance at the time.
When I signed up it estimated that I would be paying whatever my co-pay is for each of my prescriptions which is a great deal more than what I pay just going through Walmart. Like more than double more.
So I signed up to see. As far as I can tell I can't get a quote on my scripts without transferring them. I'm not doing that. Every other pharmacy I can enter my dosages or call someone and get a quote.
Just a heads up, if you use this service PillPack and Amazon Employees have full access to your entire prescription history. Full name, social everything - it was common for employees to look up the info of celebrities / other employees for fun.
Any prescription / healthcare info you give them will be sold back to SureScripts and used to sell you more garbage from Amazon ;)
What is your source for the claim that Amazon - PillPack employees commonly accessed prescription info "for fun?"
I worked at PillPack for over 3 years, and while I haven't been there for a while this seems like a very bold claim that is wildly inconsistent with the sort of practices I saw followed in my time there.
I don't think using a throwaway to throw shade like this is the right way to handle such a serious matter, but whatever -- if you do legitimately want to address this issue let me know; I could point you to a contact at the company and/or outside of it that would take it seriously and investigate it, as this is very alarming and unacceptable (speaking also as a customer whose data is there).
Far be it for me to dispute the knowledge of a random throwaway, but I'd be surprised if there Amazon didn't have access controls to prevent looking up customer prescription history.
I know the hoops I have to go through just to access customer resource metadata in AWS Support. There are multiple, auditable checks that force you to provide access justification to resources -- and the process is routinely modified to make it more onerous and restrictive.
If we have dual control mechanisms to access routine information about a customer's VPC, I'd be shocked if Amazon didn't have auditable controls on Amazon Pharmacy.
Nope. Any PillPack developer can look up any customer in seconds. Other employees have more limited access, but generally quite a bit of access. Access is logged in production, but developers can also get a clone of the entire production database pretty easily.
That's not necessarily a problem or a HIPAA violation, depending on how it's used, although the opportunity for abuse exists. They cover their ass with annual HIPAA training.
I feel like if this were true HIPPA/HHS would have asses in slings. I've worked in a couple of places that worked with HIPPA-adjacent data and boy howdy you don't not mess with them.
It's HIPAA, and there's no such meaningful category as HIPAA-adjacent data. Data is either PHI held by HIPAA covered entities or it's not, and consumer health and wellness data that one would see as being equally sensitive but that involves consumer transactions with an entity which is not a “covered entity” as defined in HIPAA (including where the consumer takes information from a covered entity and provides it to the service, so that the service is engaged by the consumer but has no business relation to the covered entity) is simply not PHI protected by HIPAA.
On the other hand, the information you describe from a pharmacy customer isn't “HIPAA adjacent”, it's just plain HIPAA PHI. on the gripping hand, lots of places have fairly weak internal controls on access to PHI; there is no required independent certification of practices, only after-the-fact enforcement when an unauthorized use occurs, is reported, and is investigated. And lots of places that haven't been caught out yet have training in what your not allowed to do with data, but inadequate controls on what you can do and inadequate auditing of what you have done.
> Minor quibble - HIPAA and HITECH are not the same thing
They are separate legislative actions, but HITECH is largely amendments to HIPAA, and can't really be considered in isolation. References to what HIPAA requires generally refer to not only the original HIPAA enactment but subsequent amendments (such as, but not limited to, those in the ACA and HITECH), and regulations and guidance adopted under HIPAA (as amended). Distinguishing HITECH from HIPAA makes sense in terms of discussing legislatibve history, but less so in terms of discussing current rules.
It is also not accurate to draw the division as HIPAA being "general policy" and HITECH being "how that policy can be implemented in technology." Its true that HITECH (more precisely, guidance/regulation mandated by and adopted subsequently to HITECH's amendments to HIPAA) provides more technical specificity in some areas, particularly privacy/security, than was in HIPAA (and regulations under HIPAA) prior to HITECH, but HITECH also amended aspects of HIPAA that fall into the general policy area (for instance, direct liability of Business Associates), and there were specific technical standards adopted under HIPAA prior to HITECH and also under mandates stemming from post-HITECH (notably, ACA) amendments to HIPAA.
I worked on this project and can tell you this is absolutely false. All user info is obfuscated and we have procedures in place to ensure we do not have access to information without express consent from the user. Furthermore, we dont even use surescript anymore. Lastly, all data is walled off from amazon. There is no way for amazon to even know if you are signed up for pharmacy.It is a separate account with a separate cart and all amazon metrics are blocked from this ecosystem.
I’m a fan of giving the belief of innocent until proven guilty. You have a firm who’s aligned to cvs making accusations. A firm who’s likely long term going to loose money if Amazon succeeds here.
From that article, “Surescripts did, however, inform CVS and Express Scripts ahead of time about its plans to go public with its decision, the spokesmen said.”
Going to need some much stronger proof than hearsay.
My clients in the financial services industry take their PCI and critical risk data access very seriously. Those clients had to share with me the software, controls and training they put into place to enforce those access rules, and I confirmed with long-time employees they've walked staff out of call centers summarily fired for joy-riding the data. I can believe the situation at hospitals can be looser, but financial services being more strict than pharma fulfillment or PBM's would be news to me. I've only had two clients in the PBM space, and they didn't seem to take their infosec lightly either, but that is a much smaller sample space so I'd be interested to hear from those who work in the trenches in PBM's or pharma fulfillment what it is like for them.
I worked for amazon for 10+ years. Sure, in the beginning, a lot of people had access to customer accounts. However, all that was locked down, I wanna say before 2010. Strictly need to know and every access logged.
So, if I wasn't able to look what book a customer purchased, I highly doubt I could see anyone's RX, especially since HIPAA is very clear on those points.
Sterile medical supplies listed as "new" that I have ordered were delivered open box & repackaged instead, so it wouldn't surprise me to see that with medication too.
That's my question, and no way in hell I'm buying meds or supplements on Amazon. Nothing that goes in my body. They blew their trustworthiness on that a long, long time ago.
> How will Amazon use the tracking information from drug purchases?
Likely not at all. HIPAA comes into play here. Typically any information provided under a HIPAA context cannot be used for solicitation or marketing purposes. For non-USA amazon users, I'm sure other laws apply.
Source: used to work at a big retailer and had to remind managers of this frequently when they wanted to "integrate data from all these systems".
Amazon has a history of taking patented designs, copying them, selling them for less with better visibility, and threatening patent holders. This is an element that speaks to the character of the organization.
So, that makes me wonder...
> Typically any information provided under a HIPAA context cannot be used for solicitation or marketing purposes.
I wonder if they could put in their terms & conditions that you give them permission to do it.
I believe patent protection on medicine is strong - because it's possible to write strong patents , because those companies have big pockets and because, like you said, regulators(FDA) will in all likelihood won't be happy.
Just wondering why couldn’t Walgreens do this? During covid, Walgreens is still one store that you must visit physically to get your prescription. I always thought there was some crazy health care regularization that prevented medicine delivery.
I'm not as much having issues with PHI as much as just the thought of handing controlled substances to strangers. Sure, there's probably background checks or whatever, but still...
> I always thought there was some crazy health care regularization that prevented medicine delivery.
Nope. Both major pharmacy chains (Walgreens, CVS) and pharmacy startups (Capsule, Alto) have been around for years.
I used to collect from CVS in person because they were downstairs from my office, but they nagged me constantly to switch to mailed pharmaceuticals. Now that I'm WFH I use Alto, who deliver.
Not neccessarily. There has been a push in the past ten years for mail order handled by Pharmacy Benefit Managers. PBM's are entities that work directly with the drug manufacturer to purchase in bulk, then delivering straight to the consumer at a lower cost than the pharmacy. The retail pharmacy industry, both chain and independent, absolutely despise PBM's and fight vociferously against them because it gives consumers the option not to go to the pharmacy. I predict Amazon will face the same attacks.
Much to a larger issue, though, is the question: Do we really need pharmacists that much anymore? Vending systems would accomplish the same task, for less money. I contend most people don't even speak to a pharmacist anymore.
> I contend most people don't even speak to a pharmacist anymore.
While compounding pharmacists are still useful for those esoteric formularies, I would wager "normal" US pharmacists are still relied upon by the vast segment of the US population who are near-functionally illiterate and innumerate, on a big combination of drugs (don't get me started on how unhealthy swathes of the US population are), and cannot be bothered to work out for themselves drug interactions (much less how to get off of the drugs if possible). The disjointed nature of the US healthcare system promotes such inefficiencies.
Just because you don't speak to them or see them doesn't mean they don't do work. They still have the responsibility of spotting known complications.
Theoretically it could be replaced with a large database but that is a major undertaking to encode once, let alone keep it up to date. In practice there are also trade-offs and judgement calls like "Yeah this may cause kidney failure but living on dialysis is better than dying of cancer."
Huh? Every major pharmacy in the US offers home delivery, including Walgreens, as well as discount pharmacies like Costco and Walmart. None of them even charge extra for it either.
My local pharmacy ships all my meds overnight at no additional cost and they're cheaper than Wal-Mart. If it's got a DEA # then I need to show my ID and sign for it. It's usually shipped USPS but they also have couriers. I haven't had any meds that required refrigeration but I imagine they just use a courier for that too.
My local CVS is .75mi from me, but if I can avoid standing in line (see also: COVID)... I will. They mail my meds.
Once a month they text me saying "hey, your 'script is ready", I click the link, put in my CCV... and 2 days later my meds show up at my house. Every month, like clockwork.
Medicine delivery is very common for local mom & pop pharmacies, though it may depend on state/municipality. I know DoorDash was working on getting their pharmacy delivery operations up and running at one point, but I'm not sure what the current status of that is.
I've gotten pharmacy delivery from Walgreen before. I don't think they publicize it very much, but like a couple months ago I called into check the status of a prescription and they just brought it.
I'm waiting for the moment when they say Amazon launches on another planet. They seem to be doing everything. It's only time before they cover quite literally every product and service on the earth. At which point there's nothing to conquer except space.
I tried to go to their site to look up a drug that my spouse takes - you can't look up prices without signing up and you have to give them your phone number...NOPE!
I've been a PillPack customer for the past six months, since my local pharmacy closed (apparently for good) because of COVID19. It would be nice to be able to fine-grain adjust the monthly delivery date, and/or get more than a 30-day supply at a time, but I have no complaints.
> A monopoly (from Greek μόνος, mónos, 'single, alone' and πωλεῖν, pōleîn, 'to sell') exists when a specific person or enterprise is the only supplier of a particular commodity. This contrasts with a monopsony which relates to a single entity's control of a market to purchase a good or service, and with oligopoly and duopoly which consists of a few sellers dominating a market.[1] Monopolies are thus characterized by a lack of economic competition to produce the good or service, a lack of viable substitute goods, and the possibility of a high monopoly price well above the seller's marginal cost that leads to a high monopoly profit.[2]
For example, almost everyone can get their medication at Costco, Walmart, CVS, and Walgreens.
I know what the legal and colloquial definitions of a monopoly are. It obviously needs to change. I cannot fathom how one company with all these varied interests and capabilities are somehow "good for consumers", which is exactly the spirit of anti-trust law.
At one point in American history we were far too loose and reckless with what a monopoly was defined as. Now, nothing is a monopoly. I can't imagine how this is much better.
Arguments should be made about the harmful aspects of those, which Amazon actually is. Perhaps one can make the case that conglomerates inevitably leads to monopolies, and on that basis one can argue against the development of conglomerates.
It's a pity you got downvoted (due to an immediate first reply -- happens more and more), but my first reaction was exactly the same as yours. Amazon got richer during COVID19. Bezos got way richer. To be honest, I am not actually convinced that monopolies are by definition bad, but Amazon strikes me evermore as a bad instantiation of it.
Horror story: imagine the Amazon Pharmacy being flooded with Chinese sellers. This is also why I don’t like to shop on Amazon anymore. You can find the same sellers on AliExpress – cheaper and from the same source, if that’s what you want (and sometimes, it is what you want). (Even if you'd want to offer as a counterpoint their other ventures in e.g. cloud, one could offer a rebuttal again in the way how they're treating their engineers.) I was a huge Amazon customer in the past, but I implicitly feel less and less inclined to buy there. The only benefit for me is the very forthcoming customer support (if you chat with a rep and honestly complain about a bad product, they’ll go all the way -- in fact it's only lately I've seen other local web shops finally approach this central point).
It’s always the same with them: “look, here’s this new innovative thing where we streamlined the product and ignored the possible ways to game it.” Great on the former, why didn’t you care about the latter.
Also: what I find funny is that everyone defending Amazon today as a shining example of capitalism, often the same types being against that “horrible” communism, might find it interesting to ponder the question how Amazon is organized and how much revenue they’re generating. It’s a planned economy. Not by a state, but by a company. With one head at the top.
I wonder if AMZN stock has priced in the possibility, perhaps likely outcome, of tens of millions of Americans getting a substantial portion of their healthcare through "Prime Health" within ten years.
Kind of astounded at the responses in this thread insisting on believing Amazon wouldn't do anything nasty or obviously illegal with an individual's healthcare data. They've done nasty and obviously illegal things with all of the other data that passes through their systems, and yet here we are defending and getting excited about them further intruding into our lives.
HIPAA fines are large and per violation, and downright strict - "reasonable cause" is a category of violation.
And what do you mean by "obviously illegal"? What is "obvious" or "common sense" about the law can be very wrong with a little research. Cocaine is obviously illegal! Except for the fact it is Schedule 2 and has niche legitimate medical uses and is important enough emergency rooms keep it on hand.
I wonder if Amazon will have sufficient buying clout to get better medication prices that they can pass along to consumers. That's been a huge benefit of centralized universal healthcare buying in other countries.
Now, that was a fascinating read! Can't believe I've never heard of this guy.
The most interesting part to me: "...Le Roux decided to diversify and expand into illegal activities around 2007..." I guess I've never really thought about how people end up in these criminal enterprises, but I certainly didn't think they just decide to one day.
I personally already use PillPack, but what I am more curious is this line that so far I can only find on the verge and not any of the Amazon pages.
"Prime members will also be able to save on medication bought in person from over 50,000 pharmacies across the US, including Rite Aid, CVS, Walmart, and Walgreens."
I assume that means that Amazon actually worked with all of these companies? Does anyone see that on any of the Amazon pages?
Given the issue with counterfeit material in their warehouses, I don’t even know what they could do to make me trust their control of the drug supply chain.
The counterfeit merchandise is a problem caused by Amazon having third party sellers ship their inventory to Amazon warehouses for faster delivery to customers.
Unless something has gone horribly wrong, I doubt Amazon Pharmacy is looking to be a "marketplace" with third party sellers like that.
That may all be true, but for me the trust is long gone. That's the price they pay for not taking the counterfeiting problem seriously. They've literally demonstrated that they prioritize sales and shipping efficiency over honesty.
Yeah, if Amazon is doing this right, they're basically channeling the big three pharma wholesalers (AmerisourceBergen, Cardinal Health, McKesson) and no one else.
Such knowledge could tempt some hostile action - for example some disgruntled employee could pull a list of people with nut allergy and the same day send them a box of peanuts. With the delivery so quick, nobody could stop such attack.
As an American resident, I couldn't be more excited for Amazon to disrupt the reprehensible anti-customer practices endemic to the US healthcare system.
Recently, I had a runny nose and no fever and thought, "what the heck, let's get a COVID test", and found out they are $200+ here in Austin.
Your county isn't doing free COVID testing?!?! In my county in Maryland every day there are about 10 sites you can get free testing (though they are not all open all day, but at any given time between 7a-6p you can get tested at least one or two places). There are also private practices where you can pay extra to get the results back 1-2 days earlier.
I had a secondary exposure and my rapid test was $400. Thankfully I have really good insurance and didn't pay anything.
My alma mater has an endowment of multiple tens of billions of dollars and was forcing students to pay for COVID tests after having on-campus lectures.
>Thankfully I have really good insurance and didn't pay anything.
For the lolz.
You are paying for it, you just don't get an itemized bill. It comes at the cost of extremely high 'insurance'. And if you think you're employer just absorbs that cost, realize that the extra cost would be in your pocket as wages if it weren't going towards healthcare.
Yes, if you want to get pedantic, I pay $300 a month (pretax) for very good insurance that covers both me and my wife. Given that we both got tested, that $300 seems a bit cheaper than $800.
> And if you think you're employer just absorbs that cost, realize that the extra cost would be in your pocket as wages if it weren't going towards healthcare.
lolz. This is quite the assumption. Wages have been holding steady despite massive corporate tax breaks. Why? Because corporations pocket the saved money without passing the savings onto employees. If I didn't get health insurance, it's quite unlikely that the savings would be passed onto me in the form of wages.
And even if I was given the wages:
1.) Wages are taxable. My healthcare is pre-tax.
2.) There's absolutely no way I could get the healthcare I currently enjoy for $300 a month on the open market. The risk pool for my company (Amazon) is so large that it effectively subsidizes my insurance.
Why? We have prescriptions here and it's a service that needs disrupting. My Dad has a monthly prescription he has to pick up from Boots because no delivery service he has ever used has been reliable. The branch he goes to is 10 miles from his home because every other branch nearer to him has let him down badly in the past with missing items he has had to chase up for days afterwards.
We're talking about picking 6 labelled items from a shelf and putting them in a paper bag. How someone can get that wrong over and over again baffles me?
Companies that big should not be allowed to operate. They will have too much personal data and incredible unfair competitive advantage on the market. It's when capitalism doesn't work and where it needs to have emergency stops. Amazon needs to be split into independent companies. Now that Amazon will also know your medical history, know what you are talking about at home, all your preferences, who you meet, what are your problems, probably they know even more that Google. This should be stopped. We shouldn't be trading freedom for a notion of convenience.
However, in this case, the US healthcare system is so terrible and, in some respects, evil that I'm glad Amazon is working to disrupt (what'll probably end up being) large portions of it.
That's a problem right there that a small company couldn't challenge it. Healthcare also is in a desperate need of a reform, as currently is just a gravy train for fat cats meanwhile people are suffering and going bankrupt.
US healthcare is terrible because of system effects, not the profit motive. Most hospitals are run as non-profits and yet their spending is INSANELY out of control.
It all depends on your point of view. You can look at the scale and cry wolf, or you can wander about all the possibilities it creates.
If Amazon can listen to my breathing through Alexa, forecast an imminent health issue, and then Prime some pills to me before I even need them, that's a pretty awesome future.
We need to find a way to keep them from becoming evil and shipping me pain meds on subscription if I don't actually need them, sure, but technology has always been making the world better, and Amazon has the power to make it better on steroids.
Check out the Boots Riley directed movie Sorry To Bother You [1], they have a big company in that movie, called WorryFree, that is similar to Amazon where they offer lifetime labour contracts, it’s a very promising future! /sarcasm
Threat to democracy and monopoly have been so bastardized by propaganda that they essentially colloquially mean "I don't like their speech/influence and want them to be illegal." and "They are big and I don't like them and think they shouldn't be allowed to exist!" respectively. They are soft eliminationism essentially.
This strikes me as a tone deaf move for Amazon. They're increasingly losing consumer confidence and are starting, anecdotally at least, to be regarded as closer to a flea market or eBay than a trustworthy retailer. They really need to shore up the issues with tainted supplies in their core retail business before I would ever consider them for something as sensitive as pharmaceuticals, regardless of how much they promise its handled differently.
I'm not sure that's true. In 2019 there were many articles in mainstream news outlets about Amazon's counterfeit problem, including a major (front page, I believe?) article from the Wall Street Journal [0].
They also received major negative publicity about the "Solar Eclipse Glasses" they sold that damages many people's eyes in 2017 [1]. I think it has cooled as a news topic, given the plethora of topics in 2020, but (again, anecdotally) I don't think the opinion has restored. At least it hasn't in my social and family groups.
This was buried in the article, but is IMO a bigger deal. In the long run, this could really drive down drug prices.