Coupons - deep dive from one of the ex-TUD members

Type 1 & LADA
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I have never had much knowledge of coupons, but Scott S posted this today to walk people through the insulin side of things. I don’t have much need for this because I have insurance and state copay caps, but if you need it, here it is. He writes this…

“While some critics may deem this as controversial, the reality is that among prescription drug discount programs, the GoodRx-powered TrumpRx initiative offers the biggest discounts to cash-payers on Lilly’s unbranded Humalog product, at prices which are up to 65% lower than the list prices. This means the cost for one 10 mL vial is $25 each, while the cost for two to four 10 mL vials is just $35 (for pens or pen cartridges, patients would need to use manufacturer discount coupons or LillyDirect). The coupon cards are processed through GoodRx’s network, using the same BIN and PCN numbers — the codes pharmacies use to process drug discounts at the pharmacy counter.

These are cash-prices which don’t contribute towards satisfying any deductibles, but my perspective is that a discount is still a discount, and it really does not matter where it comes from; just use it and pay less. For details, and to download a coupon redeemable at pharmacies nationwide, visit Insulin Lispro on TrumpRx - TrumpRx . I do believe that discounts like this is one of the reasons we have only minimal development in lispro biosimilars, while glargine and aspart have like six or seven copies pending, while Humalog has like three.”

Scott has been doing some deep dive writing about the coupons on his blog, I guess.

”Coupons have emerged as a major force in patients’ ability to bypass PBM markups. I covered the TrumpRx offer on my blog at https://blog.sstrumello.com/2026/03/unbranded-humalog-is-cheap-on.html but if you view it from a non-mobile device, check out all of the different coupon options from manufacturer to PBM-powered coupons in the right-hand margin.”

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What I recall on this issue is what happened with blood test strips. They’re non-prescription, so we can import them legally and, anyway, this was before the ban on private import of pharmaceuticals. I could get my blood test strips on Amazon (oh, this was also before Amazon became a chemist…) for way less than I paid to get them with insurance coverage.

Of course it doesn’t count towards the “deductible”, but that is really irrelevant; what matters is the “out of pocket maximum” which became effective when the ACA rules were introduced (that took a long time for those on employer insurance). I met my “deductible” but, so what? Prior to the ACA I still got reamed for blood test strips!

In fact I did this for insulin; no point paying through the insurance. I got my insulin from Turkey (at least this is what it seemed to say on the insert).

What changed with insulin is that Congress banned private import of prescription drugs, the ACA introduced a meaningful out-of-pocket maximum and I started using the Omnipod. At this point the cost of the whole shebang exceeded the new (lowered) out-of-pocket maximum and I pretty much switched to getting everything I could on prescription through the insurance (I still can’t get blood ketone test strips…)

I think the whole thing is ridiculous. The world has moved on, Humalog is no longer regarded as the cure for diabetes and neither is Lantus; they are both ridiculous half baked attempts to half fix half of a problem.

These days I have Lantus as a backup but any old NPH would be fine. I do use Lyumjev but I’ve yet to prove to my satisfaction that it is any better than Regular (I have used Regular).

What I do know is that not having a CGM and a pump available is the biggest issue. It an option, not everyone will use either and fewer will use both both because for many diabetics diet and exercise is sufficient and because even for those of us for whom it is not sufficient it’s a choice.

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OK. There’s a lot here. I gotta eat something. Chew on this while I eat something substantial. I’m dying. FTC Chairman Andrew N. Ferguson Launches Healthcare Task Force | Federal Trade Commission

@jbowler , Does nobody order from Marks Marine Pharmacy anymore? I see they have an interesting new tariff warning. https://canshipmeds.com/

On the hardware: What Medical Device Companies Need to Know About DOJ Enforcement Med device is being hunted. You can see some reference to that here:

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I touch on this in my recent complaint (pages 9 and 10), but that isn’t posted publicly yet. Maybe this week. I’m subtle about it, but they will certainly understand. I’ll be in deep ■■■■ in this town if industry sees what I wrote.

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Well you are breaking the law, not them. The tariff page is just about the cancellation of the de minimis rule (imports below a certain value were not subject to a tariff before the change). The law according to one Canadian shipper is summarised here:

Executive summary for the TL;DR crowd:

The position of CBP is that, in virtually all instances, individual citizens aren’t allowed to import prescription drugs into the United States.

Check the ~fine print~bulleted list, particularly item(2).

I didn’t find anything to suggest otherwise, other than, obviously, from people who are prepared to send you illegal stuff…

As for your bloomberger law link, duh: “Don’t break the law” would have been a simpler conclusion, given that their examples included failing to report adverse effects and straightforward bribery.

Filing improper patents is routine Tech Bro stuff. The sole purpose of a patent is to prevent competition by making it extremely expensive. So the Biden administration did this (kind of one of those last-gasp things, it was August 2024):

There are lots of other links about that; it’s old news, most likely most of the people involved at the FTC were fired but the challenge was not exactly cancelled. An analysis of the politics is here:

The topic is abstruse; it’s not going to win votes. I understand it because I was involved, in a way, delaying with bad patents most of my paid working life.

There’s nothing here about Coupons and I raised the import issue, which was where I paid cash by choice rather than using my (pre-ACA/pre-pump) insurance.

The problem is precisely the laws which were passed to enable the problem; making insulin a prescription drug, not good (and the UK has done that, guess a lot of fat guys with Cigars drank lots of Champagne.) Insulin pumps, prescription, CGMs, prescription (except for Jocks), etc.

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I’m not 100% sure that I follow. But yes, the government is aware of the patent problem. The Government is slow. They just got 2 settlements out of drug price gouging and they are waiting on a third.

I’ve never ordered from Mark’s Marine. Just asking out of curiosity.

Here’s the coupon. You can’t use it, John. Only the uninsured can use it.

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You wanna get rid of prescriptions? I love that idea, but I’ve literally never met a single other person who is OK with that idea…until you. Maybe I gave up on it too soon. I’ll take up that cause. I hate medical paperwork. The other diabetics won’t like it. They will call that a crazy scheme that is doomed to fail.

Is your primary issue of concern (that you are writing about here and trying to address) drug importation or hardware? Let’s discuss it in a different thread and let the uninsured have this one. Make a new one and tag me.

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Here’s an article from the Beeb which brings all my points and more together while considering (and explaining, to some extent) the TrumpRx thing:

That’s paywalled on mobiles in the US but I can still read it without a subscription on my desktop. It is also accessible via the Tor browser. (The Beeb started doing this a month or so ago.) Broadly I think that covers all the many issues though I would disagree with the weight; that may simply reflect the pundits the author was able to find. I believe the word “legally” in that article was meant to be “illegally”, so far as I know GLP-1s require a prescription.

The patent issue is currently a big deal, here’s another beeb article which covered it alone:

Do you see how that segues into all the other issues?

No, it is not. There is no primary issue at all; everything relates to everything else. It’s not that a particular practice is inherently corrupt despite the apparent desperate attempt to establish so; PBMs, slap-suit patents, insurance companies, drug manufacturers. Every one a whipping boy. It is the Prince that is the problem; the system, not those who attempt to deal with it, or deal round it. Coupons solve nothing because they enable a broken system; that’s the deep dive.

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Sure, I would agree with that. I just hadn’t seen anybody that I trusted deep dive on the whole uninsured route. We should always imagine it as a system, or “the blob.” Everyone is trying to box it in, in order to exercise control or authority over it. The system needs to work in unison, in a collaborative way, in order to do that. Can they do that? Hard to say. But that’s what makes it all so interesting, right? The problem challenges the power of the nation state and of citizens. Fascinating problem. It’s THE classic problem of American power. https://www.youtube.com/watch?v=jMIBSxZVyBI It doesn’t matter how many generations your people are here, you still end up involved in the same fight/dance. The gov actually agrees with us and is trying to help, but nobody knows if they can. Look what they wrote on Friday.

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I’ve been using this to taunt and threaten industry. It’s fun to do that. We spend so much time losing that when we are winning, we might as well live it up. :sweat_smile: At least they understand the problem. That took a lot of years to explain.

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Or, for the cynical amongst us (i.e. me) is saying what we want to hear while doing something completely different. The figure is a good example of overstatement, the World Bank comes up with less than 17% of GDP:

The US figure they use is 2023 and that still includes some COVID effects. For a figure from the other political wing kff.org has this:

I think I’ve posted that before, but maybe I deleted it before posting it. If you track down you will see the Petersen-KFF charts come up with 17.2% of GDP for 2024.

Of course according to many right wing US pundits we have the best healthcare in the world, so Shirley it is reasonable to pay the most. Other charts on kff.org suggest this may not be quite so true.

Scroll down and look at the comparisons of number of procedures vs cost. Just search on that web page for " fewer coronary angioplasty"; the procedure specific data starts there.

Now here’s a quote to dwell on:

Moreover, the average cost per coronary angioplasty among U.S. private insurers was more than double the Medicare cost, which is consistent with prior KFF work and a growing body of research that has shown that private U.S. health insurers pay significantly higher prices than Medicare. Other researchers have suggested that the price disparity between public and private insurers is a key factor in explaining why the U.S. spends more on health than peer nations, as private insurers account for a larger share of health spending in the U.S. relative to peer nations.

Nothing to do with coupons of course, unless TrumpRx is offering a coupon for coronary angioplasty?

Here’s the KFF coupon analysis (front page at present):

One of the dangers of this vote-grabber is that people who do not have a PhD in medical insurance but do have a chronic condition (almost everyone reading this) will fail to understand that the OOPMax, enforced by the ACA, massively affects costs. Up front it’s loads-a-money, but by June, or, for some people March, that money has been paid and everything through December is free.

People can die because they don’t understand this.

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I got something for ya’, Bowler. I couldn’t open it, but it comes from somebody pretty respected. Its a fun little digital tool to play with. TrumpRx - Reid Strategic

Here’s his summary of the toy:

“March 24, 2026 | Read online

Introducing the TrumpRx Tracker |

Let me put this on the record: I do not believe that TrumpRx – or “pharm to table” efforts more generally – are likely to solve fundamental issues with drug access or affordability. I don’t think that TrumpRx is delivering on its promise to help users “find the world’s lowest prices on prescription drugs.”

But direct-to-patient approaches are useful in more narrow cases.

They give another option for those experiencing access issues. And even if not a single script moves through these platforms, having a clear, public price boosts transparency. (I detailed some of these pros in this Health Affairs Forefront piece with Peter Neumann back in December.)

The medicines listed on TrumpRx, specifically, illuminate where direct-to-patient approaches may benefit drug manufacturers. The 50+ medicines on the site say something about where the market is going.

Understanding those dynamics requires an understanding of the characteristics of the medicines on the TrumpRx list, so I have built out the most complete accounting of the TrumpRx: the TrumpRx Tracker.

That tool provides details on each drug, including pricing data, exclusivity status, annual sales for 2025 and estimated sales for 2026, and corresponding prices at Mark Cuban Cost Plus drugs.

A look at the Tracker suggests there are at least five different categories of medicines on TrumpRx:

  • Medicines that are often not covered by insurance, where there is a demand for cash-pay options. This is where obesity meds and fertility drugs sit, and this is the most natural direct-to-patient play.

  • Medicines that may not have broad formulary coverage, where a direct-to-patient option might help a small group of patients who struggle with access. These medicines generally have low or falling sales numbers, where TrumpRx has the potential to prompt a marginal bump in sales.

  • Medicines that have generic versions (or may soon lose exclusivity). It’s not clear how large the market is for branded versions of genericized medicines or what the benefit is to manufacturers who offer such medicines on TrumpRx, but it has the effect of making TrumpRx appear to be a more vibrant hub.

  • Medicines where there may be no cash-pay market, but where advertising a low direct-to-patient price might add beneficial transparency to the system.

  • Biosimilar versions of name-brand drugs.

Every column on the TrumpRx Tracker is sortable, and numeric columns are color-coded to make trends more apparent. “

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Now, you didn’t ask me what we won this week.
You can go all cynic on this, but I feel great about it.

Now, when they say, “upholding the free market,” they mean, “Antitrust enforcement.”

DOJ can throw executives into jail. That’s good for us. They sure sound like they intend to. FTC would do it if they could, but they can’t. It sure seems like they just got both agencies walking hand in hand for some trouble causing.

Check this out… Department of Justice (DOJ) News | iHeart

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Yeah, I’m worried I inflated this number in my last complaint to them because I’m so angry. I’ve seen estimates between 17% and 25%. I might have written, “up to 25%.” They reference 18%. I think they are being conservative. Nope! I took that stat out of the complaint entirely. Good. I don’t know that you all have been double checking my work as thoroughly as you used to. I might not have even posted it. I was in a hurry to meet deadline.

You can see the Feds hiring FBI agents to work specifically in healthcare. Postings pop up on USAJOBS. They have run some billboards ads in downtown NYC.

Let’s see what the DOJ even does. I imagine they will arrest people with guns when they don’t keep my prescription paperwork valid. That’s what I want them to do. Can they do that? Let’s find out. :rofl: