Remix.run Logo
koolba 4 days ago

And that’s exactly what the ACA did to health insurance too with its “profit percentage caps”. Your insurer can only make more money if the price of healthcare goes up. And if they are predominantly passing the cost on to you, they pretty much want that to happen.

supertrope 4 days ago | parent | next [-]

They got around that rule by buying out pharmacy benefit managers (PBMs), hospitals, doctor's offices, and pharmacies. While the health insurance side of UnitedHealthCare is capped at 20% or 15% overhead, they can realize their earnings by marking up the price of drugs through their pharmacy subsidiary OptumRx. They steer customers toward OptumRx by structuring their health insurance to favor that pharmacy.

CVS bought Aetna [health insurance]. CVS also owns CVS Caremark a PBM. If your employer picked Aetna as your health insurance you must fill your meds at a CVS.

lotsofpulp 4 days ago | parent | prev | next [-]

That must be great for pharmaceutical companies/doctors/hospitals/pharmacists since they can just arbitrarily increase prices and charge whatever they want and the managed care organization will pay it.

And MCO’s are incentivized to approve all claims, so doctors and patients won’t complain about denied coverage.

4 days ago | parent | prev [-]
[deleted]