*** PLEASE NOTE ***


*** PLEASE NOTE *** -- I use no other social media, and my comment section here remains closed due to chronic harassment/repeat impersonations by a certain individual. Also, I rarely comment anywhere; when I do, only from this blog as "Chrysalis" or with my real name from email (see correct spelling my profile). If there is ever any question as to legitimacy, please contact myself or Mark via email or phone.


Wednesday, November 18, 2020

The Empire Strikes Back: Pfizer's New Press Release (lol)


Updated x2 :)


As I mentioned in the below post, we knew this was coming - Pfizer has responded with more info, after Moderna's more complete press release, considering Moderna went ahead and answered more questions in their initial press release than Pfizer initially did.

Pfizer just announced their late-stage trial results proved their vaccine to be 95% effective (rather than preliminary phase 2 results of 90% initially reported), had no side effects, prevented both severe and mild forms of COVID, and had long-lasting immunity.


Hmm.   

Now, that's all very interesting - because not only does their own clinical trial phase 1 study at clinicaltrials.com list "fever" as the first primary outcome, but we've seen interviews on the news of people who were part of Pfizer's vaccine study, who said they had high fevers, felt like they got hit but a truck, or like they had a "bad hangover" for a few days?

Also interesting because Pfizer imagines they have a crystal ball and can predict "long-lasting immunity" after only six months, when they couldn't possibly know that yet, no one does lol

But that's big pharma for you ;)


IMO, this doesn't help Pfizer - it actually makes their claims look more dubious - so still leaning towards Moderna, then - sorry.  

But of course, my insurance would dictate which one we get anyway, based on who offered them the best contracting/rebates ;)


As for government intervention, the federal government can't dictate which vaccines or medications that private/commercial insurance companies and doctors choose, only for public insurance like Medicare and Medicaid. 


HOWEVER, what federal government can do, and will likely do - if they haven't already - is legally mandate COVID a protected class, like cancer or HIV are now, so that commercial insurance companies will be mandated to offer all options by law, they won't be allowed to exclude any vaccine options or medications that have been FDA approved. 


This means that all options will be available on Medicare and Medicaid at a similar price  - but not necessarily the same price -  contracting/rebates are still allowed and prices still vary, the price of drugs is just held within a range.


HOWEVER -  with private commercial insurance, just because private insurance is mandated to cover all options for a certain disease (like HIV) doesn't mean at the same price, and that they won't have restrictions and step edits to force you to choose the one they want you to - they can and most certainly will, putting so many restrictions and step-throughs in place that virtually no one will get the non-preferred brand.

So having different prices for things like this sounds good in theory for free enterprise, but look what happens in practice, in America ...


The "preferred" option on commercial insurance does NOT necessarily mean the most efficacious  drug, nor even what actual participating providers prefer to prescribe  - all that "preferred" means - all things being equal/having similar efficacy on vaccines/drugs in a larger population -  is that your insurance company will then choose a "preferred" medication based solely on the contracting/rebate deal the manufacturer gave your insurance company.



And guess which manufacturers usually wins the contracting deals - big pharma, because they can afford to offer the best financial rebates ;)

This is why doctors often get up in arms about not having control over what they want to prescribe for their patients' individual/personalized needs or other comorbidities you might have in addition to that diagnosis, being at the mercy of financial deals their private insurance companies made based on similar efficacy in a larger population trial.


Now, for a vaccine, this likely means, the "preferred" option will either be offered 'free' (or covered by your premiums already) or go on a tier 2 or 3, branded with a copay, and any other options (manufacturers who did not give them the best deal) will go on specialty tier at a premium coinsurance price - usually over $100, at the very minimum.

Thus, we are then at the mercy of which company offers the best contracting deal to our insurance companies, unfortunately, and will have no say, possibly with the option of paying more out of pocket if we want another "non-preferred" brand.  


See, that's the thing that people don't understand, when it comes to having subsidized/socialized healthcare - they hear the word "subsidized" and "socialized" and panic - but it doesn't mean "socialist" in the traditional sense, there are still choices and price variations. 

It's times like these, with vaccines, when having socialized healthcare can actually help you -  you actually get more choices - plus increase the likelihood you will get the best drug for your condition and background, rather than the cheapest drug to your insurance company.

If your condition is a government-protected class (i.e. cancer, HIV), on public healthcare, all choices are allowed at a similar price (but not the same price, contracting still applies), and your doctor and you get to choose what's best for you, not the government nor your insurance company, based on contracting deals  - though some restrictions may apply, i.e., attestation/documentation of your diagnosis may still be necessary, etc. 

If your condition is not a protected class, the government may not include that particular drug on their public insurance formulary, if the price is above a certain range, until the manufacturer lowers the price within what the government has determined to be a fair-market range. 

This is opposed to our current system of private insurance company getting to dictate the "preferred" drug - again, not based on the best efficacy for you, but based on the best financial incentives/rebates for themselves.

It doesn't make us socialists, to have just our healthcare subsidized/socialized - it puts the actual health needs of our population above the almighty dollar, ensuring all options are available to your doctors and to you, at an affordable price, keeping within a particular range the cost of healthcare - and manufacturer contracting/rebates still apply, so there's still price variation. 


EXAMPLE: Let's say you're pregnant and you want the vaccine to protect yourself and your unborn. You want Moderna's vaccine because of its extra focus arm testing on safety during pregnancy.


Both vaccines have similar efficacy - and both cost $500,000 per shot (I just made up that figure, which actually isn't beyond the realm of possibility with the price of current drugs today).

Pfizer offers your insurance company a discount of 25%, plus rebates of $1000 bucks per dispense.  Moderna offers them a 20% discount with $100 rebate per dispense. Your insurance company now chooses Pfizer's vaccine as the better deal. 

Now, what happens?

Well, you can get Pfizer's vaccine for "free" (covered under the premiums you already pay), but will have to pay $1000 coinsurance to get Moderna's vaccine on specialty tier. 

Now - what CAN happen is your doctor can appeal it and file a medical exception for you because you're pregnant, based on Moderna's clinical trial and the FDA-approved label, if it mentions something about safety for pregnant women, but it will be denied the first round, then a second appeal, and it will be a fight between your doctor and your insurance company, for a couple of months before it's approved, if it is.


Also - and I doubt this would happen with COVID vaccines, but it does happen with other drugs - some less ethical insurance companies could conceivably make you "step through" Pfizer's vaccine first, and fail it - meaning you caught COVID - before getting Moderna's.


That last one is a very remote possibility with COVID vaccines, because we would hope that insurance companies would do the right thing when it comes to COVID at least, but it does happen with other drugs, quite regularly.


Not to present insurance companies as the (only) bad guy, here - insurance companies are actually trying to help control the out-of-control, skyrocketing, price-gouging costs of  drugs, in this way - but also, let's face it, still make a profit.

However, IMO, everyone does not fit the general population that participated in the trial, people are individuals with other unique mix of conditions that should be considered, and thus, it is the providers and clinicians themselves who should be making these decisions on what's best for the patient, not finance people at the insurance company.


Now, when I said "government" above, I mean rational government officials working on a task force or committee and making these decisions as a team, who do not behave like communists, fascists, or monarchs.

However,  if your name is Trump, apparently you're allowed to peddle whatever brand you have hedge fund shares in yourself or who support you politically, using false facts to sell you on it lol. 

At present, however, Trump is taking credit for both via Twitter, though he literally had nothing to do with the development of either vaccine lol


PS - 11/20/20





Updated x2 :)


As I mentioned in the below post, we knew this was coming - Pfizer has responded with more info, after Moderna's more complete press release, considering Moderna went ahead and answered more questions in their initial press release than Pfizer initially did.

Pfizer just announced their late-stage trial results proved their vaccine to be 95% effective (rather than preliminary phase 2 results of 90% initially reported), had no side effects, prevented both severe and mild forms of COVID, and had long-lasting immunity.


Hmm.   

Now, that's all very interesting - because not only does their own clinical trial phase 1 study at clinicaltrials.com list "fever" as the first primary outcome, but we've seen interviews on the news of people who were part of Pfizer's vaccine study, who said they had high fevers, felt like they got hit but a truck, or like they had a "bad hangover" for a few days?

Also interesting because Pfizer imagines they have a crystal ball and can predict "long-lasting immunity" after only six months, when they couldn't possibly know that yet, no one does lol

But that's big pharma for you ;)


IMO, this doesn't help Pfizer - it actually makes their claims look more dubious - so still leaning towards Moderna, then - sorry.  

But of course, my insurance would dictate which one we get anyway, based on who offered them the best contracting/rebates ;)


As for government intervention, the federal government can't dictate which vaccines or medications that private/commercial insurance companies and doctors choose, only for public insurance like Medicare and Medicaid. 


HOWEVER, what federal government can do, and will likely do - if they haven't already - is legally mandate COVID a protected class, like cancer or HIV are now, so that commercial insurance companies will be mandated to offer all options by law, they won't be allowed to exclude any vaccine options or medications that have been FDA approved. 


This means that all options will be available on Medicare and Medicaid at a similar price  - but not necessarily the same price -  contracting/rebates are still allowed and prices still vary, the price of drugs is just held within a range.


HOWEVER -  with private commercial insurance, just because private insurance is mandated to cover all options for a certain disease (like HIV) doesn't mean at the same price, and that they won't have restrictions and step edits to force you to choose the one they want you to - they can and most certainly will, putting so many restrictions and step-throughs in place that virtually no one will get the non-preferred brand.

So having different prices for things like this sounds good in theory for free enterprise, but look what happens in practice, in America ...


The "preferred" option on commercial insurance does NOT necessarily mean the most efficacious  drug, nor even what actual participating providers prefer to prescribe  - all that "preferred" means - all things being equal/having similar efficacy on vaccines/drugs in a larger population -  is that your insurance company will then choose a "preferred" medication based solely on the contracting/rebate deal the manufacturer gave your insurance company.



And guess which manufacturers usually wins the contracting deals - big pharma, because they can afford to offer the best financial rebates ;)

This is why doctors often get up in arms about not having control over what they want to prescribe for their patients' individual/personalized needs or other comorbidities you might have in addition to that diagnosis, being at the mercy of financial deals their private insurance companies made based on similar efficacy in a larger population trial.


Now, for a vaccine, this likely means, the "preferred" option will either be offered 'free' (or covered by your premiums already) or go on a tier 2 or 3, branded with a copay, and any other options (manufacturers who did not give them the best deal) will go on specialty tier at a premium coinsurance price - usually over $100, at the very minimum.

Thus, we are then at the mercy of which company offers the best contracting deal to our insurance companies, unfortunately, and will have no say, possibly with the option of paying more out of pocket if we want another "non-preferred" brand.  


See, that's the thing that people don't understand, when it comes to having subsidized/socialized healthcare - they hear the word "subsidized" and "socialized" and panic - but it doesn't mean "socialist" in the traditional sense, there are still choices and price variations. 


It's times like these, with vaccines, when having socialized healthcare can actually help you -  you actually get more choices - plus increase the likelihood you will get the best drug for your condition and background, rather than the cheapest drug to your insurance company.

If your condition is a government-protected class (i.e. cancer, HIV), on public healthcare, all choices are allowed at a similar price (but not the same price, contracting still applies), and your doctor and you get to choose what's best for you, not the government nor your insurance company, based on contracting deals  - though some restrictions may apply, i.e., attestation/documentation of your diagnosis may still be necessary, etc. 

If your condition is not a protected class, the government may not include that particular drug on their public insurance formulary, if the price is above a certain range, until the manufacturer lowers the price within what the government has determined to be a fair-market range. 

This is opposed to our current system of private insurance company getting to dictate the "preferred" drug - again, not based on the best efficacy for you, but based on the best financial incentives/rebates for themselves.

It doesn't make us socialists, to have just our healthcare subsidized/socialized - it puts the actual health needs of our population above the almighty dollar, ensuring all options are available to your doctors and to you, at an affordable price, keeping within a particular range the cost of healthcare - and manufacturer contracting/rebates still apply, so there's still price variation. 


EXAMPLE: Let's say you're pregnant and you want the vaccine to protect yourself and your unborn. You want Moderna's vaccine because of its extra focus arm testing on safety during pregnancy. 


Both vaccines have similar efficacy - and both cost $500,000 per shot (I just made up that figure, which actually isn't beyond the realm of possibility with the price of current drugs today).

Pfizer offers your insurance company a discount of 25%, plus rebates of $1000 bucks per dispense.  Moderna offers them a 20% discount with $100 rebate per dispense. Your insurance company now chooses Pfizer's vaccine as the better deal. 

Now, what happens?

Well, you can get Pfizer's vaccine for "free" (covered under the premiums you already pay), but will have to pay $1000 coinsurance to get Moderna's vaccine on specialty tier. 

Now - what CAN happen is your doctor can appeal it and file a medical exception for you because you're pregnant, based on Moderna's clinical trial and the FDA-approved label, if it mentions something about safety for pregnant women, but it will be denied the first round, then a second appeal, and it will be a fight between your doctor and your insurance company, for a couple of months before it's approved, if it is.


Also - and I doubt this would happen with COVID vaccines, but it does happen with other drugs - some less ethical insurance companies could conceivably make you "step through" Pfizer's vaccine first, and fail it - meaning you caught COVID - before getting Moderna's. 


That last one is a very remote possibility with COVID vaccines, because we would hope that insurance companies would do the right thing when it comes to COVID at least, but it does happen with other drugs, quite regularly.


Not to present insurance companies as the (only) bad guy, here - insurance companies are actually trying to help control the out-of-control, skyrocketing, price-gouging costs of  drugs, in this way - but also, let's face it, still make a profit.

However, IMO, everyone does not fit the general population that participated in the trial, people are individuals with other unique mix of conditions that should be considered, and thus, it is the providers and clinicians themselves who should be making these decisions on what's best for the patient, not finance people at the insurance company.


Now, when I said "government" above, I mean rational government officials working on a task force or committee and making these decisions as a team, who do not behave like communists, fascists, or monarchs.

However,  if your name is Trump, apparently you're allowed to peddle whatever brand you have hedge fund shares in yourself or who support you politically, using false facts to sell you on it lol. 

At present, however, Trump is taking credit for both via Twitter, though he literally had nothing to do with the development of either vaccine lol


PS - 11/20/20





Now, look at Pfizer, trying to get FDA approval on emergency use of their vaccine, when we don't even know the full side effects or who is eligible yet lol. 

Okay, but this is prevention, not actual treatment?


But heck, yeah, they gotta be the high-price setters -  knowing that even if others come in underneath, they'll still be able to afford giving the most rebates on contracts, plus get to that big piece of the market-share/profit pie first, and to hell with whether or not its truly safe, I guess. 

I mean, this is brand-new technology, mRNA treatment.  Five years from now, someone could develop a zombie-like appetite for human lungs, for all we know, or they care, at this point, just so long as they get to set the price and made a quick buck in the beginning lol

In addition to Moderna, AstraZeneca and DNA have released info on their vaccines, you see, and Pfizer wants first dibs on profit ;)

I don't know about y'all, but when the FDA, the CDC, the WHO, EMA and NICE, The New England Journal of Medicine, JAMA, the American Society of Infectious Diseases, Medscape, Nature Magazine  and my personal physician all agree and tell me it's safe to use, I'll consider it, but not until ...



No comments:

Post a Comment

Note: Only a member of this blog may post a comment.