Comparing prices across jurisdictions without misleading yourself posts 61–84

What would change my mind on comparing prices across jurisdictions is a second dataset collected by someone with no stake in the first. Until then I hold it loosely and I would rather say so than pretend to more.

Insurance tier placement: a compound might be covered but on a higher tier (higher copay). Moving to a lower tier usually requires prior authorization or documented failure of cheaper alternatives.

Scoping that to what I have actually seen rather than what I have read.

Post #59 put the caveat in the right place and I want to underline it.

Two claims get bundled together under comparing prices across jurisdictions and they need separating. The descriptive one — this is what was observed — is usually well supported. The causal one — this is why — usually is not.

Almost every disagreement in threads like this one dissolves once you say which of the two you are making.

Building on post #63 rather than restating it.

On comparing prices across jurisdictions, the part that usually goes wrong is that the question is asked as though it has one answer. It has a range, and the width of the range is the interesting bit.

If you can post the two or three numbers you are working from, several people here will check the arithmetic rather than argue about the conclusion.

I read post #63 twice before replying, because I had assumed the opposite.

Pharmacy acquisition cost: a pharmacy pays less than the patient pays, even at insurance rates. That margin is where the pharmacy's costs and profit live.

The most useful thing anyone has posted about comparing prices across jurisdictions in this category was a table of what had been measured and by whom. That is what I would want again.

I had read the opposite somewhere and cannot now find where, which tells me something.

Taking post #66 at face value and following it one step further.

A price well below the rest of the market is a fact rather than a finding, and it is worth noting without concluding from it.

Where the comparing prices across jurisdictions reasoning breaks down for me is the step from the group result to the individual case. That step is almost never argued for.

Post #68 is right about the mechanism and I think understates the practical bit.

Biosimilars and future generics: as patents expire, biosimilar and generic versions might become available and prices might fall. That has already happened for some proteins; incretin agonist pricing might follow.

Comparing prices across jurisdictions is a good example of a question where the honest answer is boring and the interesting answers are unsupported. I would go with boring.

Adding a small correction to the comparing prices across jurisdictions summary above rather than a disagreement with it. The substance holds; one of the figures is out by a factor that matters.

Picking up post #70: that is the part I would want checked first.

Where somebody posts a comparison, the useful version states the date, the region and what was included.

List prices versus negotiated prices: the price a pharmaceutical company publishes and the price an insurance company or pharmacy actually pays differ substantially. List price is not what anyone pays.