[dudus]

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.

[ev1]

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?

[ineedasername]

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)

[ev1]

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.

[ericmay]

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.

[unclenoriega]

That's not really how it works with drug prices in the US. I don't know exactly how it works behind the scenes, but from the pharmacy perspective, it's basically like this:

The "sticker price" of a drug is called the "usual and customary price" (U&C). This is supposed to be what you charge for a drug, and is generally based on the "average wholesale price" (AWP) of the drug plus a dispensing fee to cover other costs. The AWP, however, may or may not (usually not in the case of generic drugs) be related to the actual acquisition cost of the drug. It tends to be substantially higher.

The pharmacy bills its U&C price to the insurance company (or, more often, a pharmacy benefit manager (PBM) contracted by the insurance company), and the insurance company tells you what it will actually pay you—this can be negative—and how much to charge the patient. Usually the pharmacy gets paid whatever the insurance company/PBM thinks it should cost to fill the prescription, and the patient pays a standard copay/coinsurance. If the patient has a large deductible or doesn't have insurance, this is where GoodRx et al. come in. They act as a PBM, allowing the patient to pay a price lower than the U&C while pocketing ~$5 or so of the "copay" for themselves (plus whatever data they get). Often independent pharmacies will just cut out the middle man and give you a better cash price (although this may violate their PBM contracts), but the big chains will need the coupon.

Depending on the difference between the AWP and the actual acquisition cost of the drug(s), this can be a substantial savings for cash patients or people with large deductibles.

[ericmay]

Sorry, I’m not sure what you mean here with “that’s not how it works”. Could you explain?

-edit-

I guess what I mean to say here is I'm not commenting on how drug prices work. It doesn't matter. I am commenting on the fact that somebody, somewhere has to pay for the drug, regardless of the price. I want to push back on this idea that drugs are "free" in Europe or elsewhere. Sure the healthcare programs appear to be better managed, higher taxes on the wealthy or corporations (although I don't know for sure) appear to be subsidizing costs for lower and middle classes, but the drugs still aren't free in any sense of the word to the society as a whole.

[ericd]

Probably some inefficiencies baked into the price? There are massive inefficiencies at every level. I probably wouldn't share this "it's the way it is because it has to be" reasoning if you've never looked into why US healthcare is as expensive as it is.

For a decent overview: https://www.pbs.org/newshour/economy/why-does-health-care-co...

"Just to give you one example, Duke University Hospital has 900 hospital beds and 1,300 billing clerks."

[ineedasername]

You need context for that because your article is incorrect about Canada. Across all of Canada, on average, there are still 1.1 clerks per bed. (1,100 clerks for every 1,000 beds) [0]

[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511963/#:~:tex....

[ericmay]

I say probably because although I’m quite sure that there are inefficiencies, I am not an expert and don’t have hard data to support my assertion.

Don’t mistake what I’ve said as support for the current system.

[93po]

Insulin that costs $500 a month after expensive insurance discounts only costs about $5 to manufacture and sells for $30 a month in Canada

[dageshi]

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.

[ev1]

These are not clickable affiliate links; when you pick your pharmacy it gives you a PDF to print out and hand the pharmacist at time of (IRL) payment.

There appears to be some tracking, as "Member ID" differs on each reload. I assume this is tied to cookies or fingerprints in the backend.

[pkaye]

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.

[canada_dry]

> what are they doing with this data?

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.

[ev1]

Amusingly, right as I read this reply, I get a chain of heavily-obfuscated JS loading with the text

Please verify you are a human

Access to this page has been denied because we believe you are using automation tools to browse the website.

Please make sure that Javascript and cookies are enabled on your browser and that you are not blocking them from loading.

[gruez]

Weird. I don't get it even though I use VPN + firefox w/ resistfingerprinting

[bqe]

> 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.

[ev1]

There is no registration or login.

[dmix]

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.