> Then, a few years ago, Shire tried a new tactic: giving ever-larger discounts to pharmacy benefit managers and insurers for preferential treatment over the generics. That did not mean lowering the list price of the drug, but rather negotiating rebates that were paid not to the patients but to insurers and middlemen such as CVS Caremark.
Thanks, I did read this (and thought that it should have been put much earlier in the article and expanded on). But what was left a little unclear to me is whether the deductible calculation was based on the list price. I guess it is, but that does seem pretty dubious. I guess one of the advantages of a single-payer system is that it is a single-price system; I wonder if we don't have the political will for a single-payer system if there is any chance we could at least get a single-price system (or, failing that, at least a system where people who have insurance don't pay more for stuff out of their deductibles than their insurers will pay after they exhaust their deductibles).
I think that the insurance plans I've had have had a flat price for generic and name-brand drugs or at least a cap for each category. So yeah, this is a win for insurers and manufacturers, at the patient's expense.
