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Chiming in as someone who works at an insurer in clinical analytics.

There's a few ways we can pay less for a compound where there are generics/biosimilars. We could contract with a hospital group saying we will pay a small % markup on the cheapest drug to treat each condition - i.e. they can use the cheapest generic/biosimilar and make profit, or use a more expensive one and make a loss. They naturally shift all volume to the cheaper one. That then makes demand very elastic to price, and so encourages a lower price from manufacturers. We do see some compounds all sit at the same lowest price and not shift - that does suggest collusion - potentially tacit collusion though. An alternative is to contract with one pharma company to get a rebate if we push volume to their drug. We could then mandate to providers that we'll only pay for that drug.




So why not do this? Seems low risk, and these drugs are regulated to be identical. Plus you aren't the govt - you are allowed to pick winners.


They do that, or contract with companies (like PBMs) to do so. That's been the way this works forever. Asymptotically no one pays the ~$40k+/mo list price.


You mean no one that has insurance pays that price. Those without insurance don't have anyone making these agreements and are SOL.


Not necessarily true. I know a diabetic who gets her insulin for free through hardship programs she qualifies for with the drug manufacturers.


You just have to live in poverty, one way or the other.




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