Price controls

[jerseygirl]

Medicare for 2025 is restricting drug costs to $2000 out of pocket. Jerseyguy takes a very expensive drug ($12000/month) for lymphoma. This year the Genentech Foundation is covering all costs (Genentech is drug company). Since next year the cost will be $2000, the formula determines we can afford this so we’ll need to pay $2000. So the price control results in us spending more!
Price controls usually end up doing worse for people. Rent control in NYC has resulted in many empty apartments since it would cost landlords more to put in renovations needed for codes and the mandated rents won’t cover the costs
Now there is talk of price controls on groceries(due to inflation caused by huge spending). Grocery stores only make a small profit of 1 to 2%. Don’t see this turning out well. Also some talk of rent controls nationwide?!
Of course the Star example for price controls is the communist countries prior to some capitalist reforms. Resulted in shortages, long lines etc

[Opti]

Aug 24, 2024 12:05:31 GMT -5 jerseygirl said:

Medicare for 2025 is restricting drug costs to $2000 out of pocket. Jerseyguy takes a very expensive drug ($12000/month) for lymphoma. This year the Genentech Foundation is covering all costs (Genentech is drug company). Since next year the cost will be $2000, the formula determines we can afford this so we’ll need to pay $2000. So the price control results in us spending more!
Price controls usually end up doing worse for people. Rent control in NYC has resulted in many empty apartments since it would cost landlords more to put in renovations needed for codes and the mandated rents won’t cover the costs
Now there is talk of price controls on groceries(due to inflation caused by huge spending). Grocery stores only make a small profit of 1 to 2%. Don’t see this turning out well. Also some talk of rent controls nationwide?!
Of course the Star example for price controls is the communist countries prior to some capitalist reforms. Resulted in shortages, long lines etc

I'm guessing Genentech Foundation does not want to pay full freight for Jerseyguy's very expensive meds next year so its using the Medicare OOP to set your costs. Like any program some people will do worse, and some will do better. Compared to poor people struggling to pay for their diabetes meds and stay housed, it seems a little weird to read that paying $2000 next year for $144,000 worth of retail drugs is a harbinger of anything. Whatever it is, it must be fully under patent and available to very few people.

Given the nice trips you go on, it amazes me he qualifies at all. 

Don't confuse what the USSR did during food shortages, some of which they caused, with companies still price gouging for profit here. You might want to look at food manufacturer profits and food processor profits - those are the companies that are raking in the money even with supply chain improvements. 

[Sharon]

How many of the drug plans will just drop the super expensive medications from their formularies so then they won't have to cover it at all?

[Opti]

Jerseygirl, years ago someone started a price comparison with a basket of goods on the P&M thread. It was amazing how regional some prices were.

Potato chips are a go to for many people and tend to be bought out during storms near me including peanut butter etc.
One grocery store currently has a 8 ounce bag of store brand chips for $1.99, regularly $2.49
Lays must be having a buy a lot special as one bag at 7.75 ounces is $2.99 if you meet the deal terms, or $4.99 regular price
Ruffles is on sale for $4.99, regular price $5.99 for a 8.5 ounce bag


There are all sorts of examples like this which is why this particular grocery chain is going all out on new and expanded store brand offerings. They are sick of losing money and shoppers over high brand name product prices.

[jerseygirl]

Most pharma companies have programs to cover meds that people have problem buying.
I worked on an orphan drug that was very expensive when approved, partly difficult to manufacture partly because only small numbers of people would use it cause it was for an unusual medical condition. The company pledged all patients would be able to get the drug either with their insurance (often Medicaid)or through foundation sponsored by the company

Believe me I’m not complaining about paying $2000 for a drug that would cost $144000. Just the strangest of a drug control causing us to pay $2000 when we weren’t prior. And $144000 isn’t something we could afford opti

[jerseygirl]

Aug 24, 2024 12:52:28 GMT -5 Sharon said:

How many of the drug plans will just drop the super expensive medications from their formularies so then they won't have to cover it at all?

Or what many companies (and people in R&D) worry is a limit on drug costs will inhibit research on drugs that they know will be expensive. Often orphan drugs used for medical conditions that are severe but only affect small numbers of people ( or children)

Most people don’t understand the very risky and expensive drug development process. About 90% of drugs fail in clinical trials and only about 10% of drugs in preclinical go on to clinical trials. Lots of money and highly educated people needed all through the process. So if risk isn’t rewarded? Less risk will be taken

[haapai]

Aug 24, 2024 12:05:31 GMT -5 jerseygirl said:

Medicare for 2025 is restricting drug costs to $2000 out of pocket. Jerseyguy takes a very expensive drug ($12000/month) for lymphoma. This year the Genentech Foundation is covering all costs (Genentech is drug company). Since next year the cost will be $2000, the formula determines we can afford this so we’ll need to pay $2000. So the price control results in us spending more! 

Do you pay attention to what you are typing?  You are getting a 98.6% discount and yet you are still complaining?  The amount in question is $2K, and yet you have no shame about that?  You can afford that much. 

You did not even attempt to argue that other folks in worse positions might not be able to afford even $2K out of pocket.  I award you zero pity points and I'm ignoring your economic analysis since "us" seems to be the only thing that you care about. 

[pulmonarymd]

Aug 24, 2024 13:10:41 GMT -5 jerseygirl said:

Aug 24, 2024 12:52:28 GMT -5 Sharon said:

How many of the drug plans will just drop the super expensive medications from their formularies so then they won't have to cover it at all?

Or what many companies (and people in R&D) worry is a limit on drug costs will inhibit research on drugs that they know will be expensive. Often orphan drugs used for medical conditions that are severe but only affect small numbers of people ( or children)

Most people don’t understand the very risky and expensive drug development process. About 90% of drugs fail in clinical trials and only about 10% of drugs in preclinical go on to clinical trials. Lots of money and highly educated people needed all through the process. So if risk isn’t rewarded? Less risk will be taken

Plenty of countries other than the US control the cost of medications. Just about all of them have better life expectancies than the US. Not sure that having the US consumers and insurance companies be the ones who supply all of a drug company’s profits is the best approach for the US. Since drug companies only make money by having a pipeline of drugs to replace the ones that come off patent, i seriously doubt they will stop R and D.

Paying $2000 for a drug that costs $144000 is a bargain. Not sure what you are complaining about. I have plenty of young people with asthma who need medications that cost $5-10k per month in addition to their inhalers that cost over $500 a month. Drug companies are playing games with the supply of generic medications. Flovent is generic now, but Glaxo pulled it from the market and it is no longer available, forcing me to prescribe and insurers to cover brand name inhalers, increasing costs for everyone. Spare me the crocodile tears for the pharmaceutical companies, especially since Purdue Pharm is singularly responsible for the opioid epidemic

[Opti]

Aug 24, 2024 12:57:13 GMT -5 jerseygirl said:

Most pharma companies have programs to cover meds that people have problem buying.
I worked on an orphan drug that was very expensive when approved, partly difficult to manufacture partly because only small numbers of people would use it cause it was for an unusual medical condition. The company pledged all patients would be able to get the drug either with their insurance (often Medicaid)or through foundation sponsored by the company

Believe me I’m not complaining about paying $2000 for a drug that would cost $144000. Just the strangest of a drug control causing us to pay $2000 when we weren’t prior. And $144000 isn’t something we could afford opti

I understand, and I worked in Pharma for a few years on the IT side, so I am aware of some things. Its not the government causing you to pay $2K. Its the foundation that is covering his meds. Much like how I was discussing CC changes I was seeing personally. Part of it was due to a consumer law going into effect in September so each company chose how they were going to make up the shortfall in income if they couldn't charge as much as they had in certain fees. Both Kohl's and TJX upped their interest rates to go into effect in September and TJX added that they would now charge consumers for printed statements if the balance forward was more than $2.50 . CC companies still make most of their money off late fees and interest charges, so they all upped the interest rates. It will be interesting to see how quickly they cut those rates once the fed starts reducing interest rates.

The time I looked into getting assistance with a more common drug, I did not qualify, and I currently fall into the very low-income group for my area of NJ. For super common drugs, you might not get any assistance at all unless your income is near the federal poverty line.

Imagine try to live on this in NJ if you rent, The federal poverty level is $14,580 for an individual. My yearly rent is more than that and I now have one of the cheapest rents in the area that is not subsidized and is not a room or apartment in someone's rental house. A 1 bedroom condo, you'd be lucky to rent for 7 months with an income like that.

[Opti]

Aug 24, 2024 13:10:41 GMT -5 jerseygirl said:

Aug 24, 2024 12:52:28 GMT -5 Sharon said:

How many of the drug plans will just drop the super expensive medications from their formularies so then they won't have to cover it at all?

Or what many companies (and people in R&) worry is a limit on drug costs will inhibit research on drugs that they know will be expensive. Often orphan drugs used for medical conditions that are severe but only affect small numbers of people ( or children)

Most people don’t understand the very risky and expensive drug development process. About 90% of drugs fail in clinical trials and only about 10% of drugs in preclinical go on to clinical trials. Lots of money and highly educated people needed all through the process. So if risk isn’t rewarded? Less risk will be taken

I think some people do, I am quite aware. But that's why some of these expensive meds have foundations supporting their cost to get some market share. The med DH is on, will it ever be widely used?

[jerseygirl]

I AM NOT COMPLAINING! I’m grateful that we only will pay and can afford $2000 for the med. I just thought it is ironic that a cost control will cause us to pay instead of being no cost. That’s it - the irony

We are also extremely grateful that such a drug exists that is keeping Jerseyguy relatively healthy and alive.

[Opti]

Aug 24, 2024 14:51:36 GMT -5 jerseygirl said:

I AM NOT COMPLAINING! I’m grateful that we only will pay and can afford $2000 for the med. I just thought it is ironic that a cost control will cause us to pay instead of being no cost. That’s it - the irony

We are also extremely grateful that such a drug exists that is keeping Jerseyguy relatively healthy and alive.

Its not irony. The cost control is the government for Medicare. You don't know if you would only pay $1000 next year if Medicare had a different cap. That's why I am trying to point out while they are related, correlation does not equal causation. Why would the higher cap mean you would pay less for this specific drug through this specific foundation of that drug company? Maybe that drug company projects less profit for 2025 or set aside less money for the foundation. That is something to look at first before blaming Medicare for what a private company chose to fund or not.
Understand?


www.cms.gov/files/document/lower-out-pocket-drug-costs-2024-and-2025-article.pdf


• Most people with Medicare drug coverage (Part D) don’t reach either the coverage gap

phase or the catastrophic coverage phase. However, those who do reach the catastrophic

coverage phase in 2024 will get significant savings.


• For 2024, the new prescription drug law places a cap on annual out-of-pocket costs

on Part D drugs if you reach the catastrophic coverage phase, which begins at a

threshold of $8,000 in what’s called true out-of-pocket (TrOOP) costs. For most

people, you’ll contribute roughly between $3,300 and $3,800 toward the cap of

$8,000, and then pay $0 for your covered Part D drugs for the rest of the year.

Previously, if you had Medicare Part D drug coverage and reached the catastrophic

coverage phase, you continued to pay 5% of your drug costs for the rest of the year. Now

you’ll save, on average, hundreds of dollars in copayments in 2024.


• In 2025, you’ll pay no more than $2,000 in out-of-pocket costs.

[busymom]

Help paying for prescription medications varies by state, too.  DS got put on a newer anti-seizure med when we were in Florida.  Insurance refused to pay for it, and it was just over $1,000 a month.  Of course, this all happened around the time Covid was cranking up, and DH (although considered an "essential employee") got his hours reduced.  If it wasn't for the mercy of the drug company, dropping the price down to between $200 & $250 a month, we would've had a problem.  Once we moved back to our home state, we discovered our state subsidized that particular drug, so the cost wasn't an issue.  I know, strange.  

[TheOtherMe]

One of the considerations for my friend's wife when she was dying of cancer was a $30,000 per month cost of chemotherapy that she was told gave her a 50% chance of survival.  It wasn't covered by insurance because it was experimental.  Her oncologist was trying to get her into a study.

She did two doses of the chemo.  She had one decent week after the chemo, then got sick enough to spend two weeks in the hospital and recover a bit at home before the next dose.

After two doses, she said she had no quality of life and chose to stop it in part because of the cost.  

[Cheesy FL-Vol]

Aug 24, 2024 15:40:48 GMT -5 busymom said:

Help paying for prescription medications varies by state, too.  DS got put on a newer anti-seizure med when we were in Florida.  Insurance refused to pay for it, and it was just over $1,000 a month.  Of course, this all happened around the time Covid was cranking up, and DH (although considered an "essential employee") got his hours reduced.  If it wasn't for the mercy of the drug company, dropping the price down to between $200 & $250 a month, we would've had a problem.  Once we moved back to our home state, we discovered our state subsidized that particular drug, so the cost wasn't an issue.  I know, strange.  

Well, Flori-duh, yanno? 

[NoNamePerson]

Aug 24, 2024 17:01:51 GMT -5 TheOtherMe said:

One of the considerations for my friend's wife when she was dying of cancer was a $30,000 per month cost of chemotherapy that she was told gave her a 50% chance of survival.  It wasn't covered by insurance because it was experimental.  Her oncologist was trying to get her into a study.

She did two doses of the chemo.  She had one decent week after the chemo, then got sick enough to spend two weeks in the hospital and recover a bit at home before the next dose.

After two doses, she said she had no quality of life and chose to stop it in part because of the cost.  

My mother was tentatively diagnosed with PSP and she would have been alive but not living. Big difference. Hard decision of DNR, feeding tube and oxygen. Meds were not a factor since no known cause or cure. 

[seriousthistime]

Aug 24, 2024 12:05:31 GMT -5 jerseygirl said:

Medicare for 2025 is restricting drug costs to $2000 out of pocket. Jerseyguy takes a very expensive drug ($12000/month) for lymphoma. This year the Genentech Foundation is covering all costs (Genentech is drug company). Since next year the cost will be $2000, the formula determines we can afford this so we’ll need to pay $2000. So the price control results in us spending more!
Price controls usually end up doing worse for people. Rent control in NYC has resulted in many empty apartments since it would cost landlords more to put in renovations needed for codes and the mandated rents won’t cover the costs
Now there is talk of price controls on groceries(due to inflation caused by huge spending). Grocery stores only make a small profit of 1 to 2%. Don’t see this turning out well. Also some talk of rent controls nationwide?!
Of course the Star example for price controls is the communist countries prior to some capitalist reforms. Resulted in shortages, long lines etc

Yes, it can work that way.

The famous Trump tax cuts caused me to pay MORE in income taxes due to the cap on deducting state and local taxes.  And that's a gift that keeps on giving, at least until they decide whether to extend it beyond 2025. 

[busymom]

Aug 24, 2024 18:26:37 GMT -5 seriousthistime said:

Aug 24, 2024 12:05:31 GMT -5 jerseygirl said:

Medicare for 2025 is restricting drug costs to $2000 out of pocket. Jerseyguy takes a very expensive drug ($12000/month) for lymphoma. This year the Genentech Foundation is covering all costs (Genentech is drug company). Since next year the cost will be $2000, the formula determines we can afford this so we’ll need to pay $2000. So the price control results in us spending more!
Price controls usually end up doing worse for people. Rent control in NYC has resulted in many empty apartments since it would cost landlords more to put in renovations needed for codes and the mandated rents won’t cover the costs
Now there is talk of price controls on groceries(due to inflation caused by huge spending). Grocery stores only make a small profit of 1 to 2%. Don’t see this turning out well. Also some talk of rent controls nationwide?!
Of course the Star example for price controls is the communist countries prior to some capitalist reforms. Resulted in shortages, long lines etc

Yes, it can work that way.

The famous Trump tax cuts caused me to pay MORE in income taxes due to the cap on deducting state and local taxes.  And that's a gift that keeps on giving, at least until they decide whether to extend it beyond 2025. 

     Well, we all know that man is no rocket scientist.  Even though he always claims to be the smartest man in the room.  I'm sure the billionaires he helped appreciated your money.  

[Mardi Gras Audrey]

One thing you are overlooking is that the manufacturer’s program is voluntary and can taken away at any time. There is no guarantee they continue it or they continue it with a zero dollar cost share. So you could have gone from zero yo $12k with no recourse/option.

Additionally, I’m sure there were people who were paying for the med and insurances that were paying also (including Medicaid and Medicare- we the people paying). For all those payers, the cost has gone down.

With the price control, it levels out the payts across different payers/patients. It also guarantees that you won’t pay more than $2k and aren’t dependent on the “mood/generosity “ of the drug manufacturer.

I would take that guarantee instead of the risk the price could change to full price at anytime

[Mardi Gras Audrey]

Aug 24, 2024 18:26:37 GMT -5 seriousthistime said:

Aug 24, 2024 12:05:31 GMT -5 jerseygirl said:

Medicare for 2025 is restricting drug costs to $2000 out of pocket. Jerseyguy takes a very expensive drug ($12000/month) for lymphoma. This year the Genentech Foundation is covering all costs (Genentech is drug company). Since next year the cost will be $2000, the formula determines we can afford this so we’ll need to pay $2000. So the price control results in us spending more!
Price controls usually end up doing worse for people. Rent control in NYC has resulted in many empty apartments since it would cost landlords more to put in renovations needed for codes and the mandated rents won’t cover the costs
Now there is talk of price controls on groceries(due to inflation caused by huge spending). Grocery stores only make a small profit of 1 to 2%. Don’t see this turning out well. Also some talk of rent controls nationwide?!
Of course the Star example for price controls is the communist countries prior to some capitalist reforms. Resulted in shortages, long lines etc

Yes, it can work that way.

The famous Trump tax cuts caused me to pay MORE in income taxes due to the cap on deducting state and local taxes.  And that's a gift that keeps on giving, at least until they decide whether to extend it beyond 2025. 

Our taxes went up under the trump tax cuts also- similar reasons. I wouldn’t have minded so much if we were paying down the country debts or using the $$ to help needy people but the fact that we added to the debt and my “extra” is going to subsidize businesses is irritating 🤔

[Opti]

Aug 24, 2024 18:15:59 GMT -5 NoNamePerson said:

Aug 24, 2024 17:01:51 GMT -5 TheOtherMe said:

One of the considerations for my friend's wife when she was dying of cancer was a $30,000 per month cost of chemotherapy that she was told gave her a 50% chance of survival.  It wasn't covered by insurance because it was experimental.  Her oncologist was trying to get her into a study.

She did two doses of the chemo.  She had one decent week after the chemo, then got sick enough to spend two weeks in the hospital and recover a bit at home before the next dose.

After two doses, she said she had no quality of life and chose to stop it in part because of the cost.  

My mother was tentatively diagnosed with PSP and she would have been alive but not living. Big difference. Hard decision of DNR, feeding tube and oxygen. Meds were not a factor since no known cause or cure. 

Sorry NNP. 

[jerseygirl]

I had meant for this post to discuss price controls but responses focused on the cost of the medicine

I’m uneasy with the discussions in politics starting about price controls to counteract inflation
In general inflation is too much money chasing too little goods
Price controls would seem to inhibit growth not stimulate
I

[Opti]

Aug 25, 2024 11:36:44 GMT -5 jerseygirl said:

I had meant for this post to discuss price controls but responses focused on the cost of the medicine

I’m uneasy with the discussions in politics starting about price controls to counteract inflation
In general inflation is too much money chasing too little goods
Price controls would seem to inhibit growth not stimulate
I

We can't really discuss price controls without knowing what currently exists compared to a price control proposal. Medicare tweaks things every year to keep costs down and in response to new legislation. Right now, it's too early to discuss since Harris's campaign is so new that policy positions need to be hammered out and then made accessible somewhere. Unless the Trump campaign has a policy on this?

[Mardi Gras Audrey]

The problem is that medicine and medical billing are not a true market economy.

You already have a version of price controls with payers deciding what they will/won’t pay and international companies dealing with price controls in some markets and not in others (if Canada and Europe have price controls and the US is the only one that doesn’t, having the US subsidize profit for the whole world).

This is aggravated by the imbalance of payer or product bargaining power (are substitutes available? Can the payer/patient afford the cost?), etc.

The other big issue is that lack of being able to afford the product can lead to death or disability. For most people (myself included), subjecting someone to death or disability because they couldn’t pay is not humane and isn’t right. Not getting a Louis Vuitton purse because you can’t afford it, oh well. Dying because you can’t by cancer med? Messed up

[Opti]

President Joe Biden signed a law in 2022 that will cap prescription drugs at $2,000 a year by 2025 for people who have the prescription drug benefit, Medicare Part D.
From Google and Politifact

So this 2025 Medicare cap was passed into law in 2022, so its not part of any planned price controls by Harris/Walz.

[Mardi Gras Audrey]

Aug 25, 2024 11:36:44 GMT -5 jerseygirl said:

I had meant for this post to discuss price controls but responses focused on the cost of the medicine

I’m uneasy with the discussions in politics starting about price controls to counteract inflation
In general inflation is too much money chasing too little goods
Price controls would seem to inhibit growth not stimulate
I

My understanding is that we already have price controls/subsidies on some products. An example of this is milk. The govt is involved in the pricing and determining how much will be produced because it is a product that they want to be available to the citizens (and not just those who can pay $100 per gallon(.

The issue with relying on a totally market system is that there may be products (healthcare, food, etc) that you want people to be able to get, even if they aren’t in the Elon musk/Jeff bezos asset level…

Opinions can vary in this though

[pulmonarymd]

Inflation will surely improve with the new tariffs that Trump plans to impose. Price controls may not be a wise idea, but let’s not kid ourselves that inflation will improve under Trump, since he has a shaky understanding of economics at best. Tax cuts just add to the “too much money chasing too few goods” as well as needing to borrow more to fund the increase in deficits,.

[jerseygirl]

Will tariffs or increased taxes on business help? One more or worse than other? Both would impact (increase costs) on the population but would one help or hinder new or existing businesses in the US?
In general I think better business profits help workers in that business If a business is failing or unprofitable it’s bad for the people investing and working for that company

[thyme4change]

I’m not sure our food market is a free economy either. I can say the words farm subsidies- but beyond that I have no intelligent input.

Excess profit taxes would definitely help. The food manufacturers would have to decide what is the best way to spend that money - lowering prices, more marketing, better wages for the working folks or just paying the taxes. The only thing that wouldn’t help the economy is if they just doubled executive compensation.

I thought I understood rent control in NY - but what you are describing is different. Are there really hordes of empty apartments in NY?

As for medical costs - I knew there were programs, but I never really understood how many people they actually helped. If they did a really good job, there wouldn’t be so many people unable to afford their meds.

[jerseygirl]

What or who decides is an ‘excess’ profit? If a company is selling goods at an excessive cost resulting in ‘excess’ profits, the free market usually will have another company stepping in to this niche to undercut or people stop buying
Industries also have differences. In the food industry profits are generally much lower than say software
Price controls hinder the marketplace working out the costs