Prescriptions On Your Phone
My partner Andy blogged this week about an investment we made earlier this year. It is called NuRx and its an entirely new way to get medications.
Here’s the value proposition (from their website):
Compare that to this (from Andy’s post):
When you need to see a doctor, there are typically 5 or 6 steps you need to take before a potential outcome: finding the doctor; finding time to schedule the appointment; visiting the doctor; getting a diagnosis and prescription; visiting a pharmacy and paying for your medication.
The efficiency of scrolling through a mobile app, finding the medication you need, filling out some information, and then having the meds show up at your door a few hours later is vastly superior to the process Andy described.
We are looking for services in health care that dramatically improve the user experience of obtaining health care services and lower the cost of providing those services. We also believe that these services, when delivered on the device you have with you all of your waking hours, will over time become an important repository of your personal heath care information. And one you control and have the primary access to.
All of these things; improved user experience, dramatically lower costs, user control over their data, portability of providers, are a direct and aggressive challenge to the existing incumbent health care system.
And I can’t think of any industry that deserves that challenge more than health care.
My question.If obviously every email I’ve ever written along with every doc has been hacked, i can modify my behavior moving forward.What will happen when peoples records are also hacked show every med and test for every thing–I don’t know–from meds for HIV, Herpes, Heart Disease, Cancer, skin conditions,Viagra–whatever?What a shit storm of recalibrating basically everything is upcoming.What’s the security promise here?
I dunno, but I hope there’s a pill for that.
Arnold, you keep forgetting we are living in a post-privacy world now. I’m pretty sure kids are posting their scripts on Facebook now. #HerpesLife #GenitalWartsWednesdays
dunno but very little has struck home with me as lastingly as the realization that I have already been hacked and every email and doc and prescription and test I’ve ever been party to is basically in the public domain.
Probably nothing. People buy and sell this data already. You can’t hire/fire people based on this data.hipaa and GINA need a rewrite, because while it’s true your insurance company can’t legally use this data to discriminate against you, you also can’t request relevant health information without craziness.Like I can’t request parts of my parents records for my records without notarized letters from them. That’s crazy. I can’t find a trusted third party to automatically compare patients like me in order to find 5 very similar patients like me who are high risk for breast cancer, ashkenazi heritage, and are either not, or highly unlikely, to be brca carriers, so I can talk to them (I only know of one other family in the entire US that is kind of similar to mine, do you know what I’d give to talk to a patient who is similar to me)The risks come from you not taking hold of the process of sharing your data.
i don’t understand the discovery process.i’m wondering how a person establishes a diagnosis to know what medication to order?where’s the knowledge base that executes that process, in the app?
Innovation on the edges is super cool and convenient, but the core of the system has to be overhauled. Obamacare is a total fail. My premiums are going up 47% this year-and Jan 1, 2016 every single doctor I had dropped me. Northwestern, UChicago and Rush all dropped people that weren’t corporate or union. I know people that are simply dropping insurance altogether and paying the tax. It’s cheaper than the high deductible and if they get something truly life threatening there is an out.
Dear Sir,The ACA is the best thing to happen to SMBs/HNWs in a very long time. It was simply marketed incorrectly, and imho, completely on purpose. If self-funded you completely bypass all regulations and gain the ability to sock away major money in an insurance policy that CANNOT be touched by law. After the ACA was established Delaware experienced a large amount of captive registrations-190+-because captives can invest in almost anything where IRA/401k’s etc cannot. Instead of paying a premium, based on the facilities you listed, I am assuming that you are in Illnois. IL law has a procedure for captives, but you could also form one in TN, GA, VT or DE. The easiest way is to join with others in similar circumstances: financial, personal or both. The IRS has a list of things that HDHP’s can pay for, including insurance premiums, and when combined with a captive strategy, WOW. An independent insurance consultant can help you with the captive formation and rules. But estimates are that doing so would result in $500K more than average retirement accounts and that money does not have to paid out, rolled over or anything else and after a certain age…that money can be spent tax-free. I have trouble linking here, but I can email you anything you want.
we disagree 1000%. It’s nice that I have to go to a consultant and pay them to tell me where to get insurance. There wasn’t a free mkt in health care prior to Obamacare, and there certainly isn’t one now. It’s failing in every single state of the union. Best way is to repeal it-and design a competitive insurance market. Far too complex for a blogpost comment.
The simplest approach would be something like a free market for those who can afford it and subsidies for those who can’t. But after decades of mass immigration, automation, and huge trade deficits, the “can’t affords” outnumber the “can affords”.If current trends continue, the likely outcome will be a two-tier system: single payer for most, with the government using monopsony power, wait lists, and death panels to hold down prices. And concierge care for those who can afford to pay out of pocket.
And that concierge care can be under a captive.
unfortunately very true. and even more unfortunate that this was all foreseen and warned against, by many people, none of whom had any special abilities aside from basic elementary level reading and math.
I didn’t mean to imply that you HAVE to do anything. If I’ve done so, then my apologies. My point was that certain individuals now have options to better structure their insurance needs and usage with their actual costs, as well as their ability to manage certain investment aspects that were not as widely available previously. The law change made it possible and many states have recognized this which is why captive law is being introduced in more and more of them. You seem to need the backdrop of the government to design these things for you; I don’t. Nor do I want it to. The ability to design a system similar to what I have proposed here appeals to me greatly. And for clarification the consultant does not tell you where to get insurance; the consultant is a reasonable precaution against improper structures via IRS rules-which is probably also a write-off.
The system prob works for those who qualify for subsidies. But if your income is beyond the max level to qualify, which I think is $45K for individuals, $95K for a family of 4 (a pretty low threshold), and you’re NOT tied to a corporate plan, you’re screwed w/ exorbitant premiums and high deductibles.
All true, but it does also work for self employed who have a childhood illness.
Yes, that is very true, good point.
Have you read Karl Denninger on health care costs?
Have you looked at policies that are off of the exchange?
I dropped my insurance. I pay out of pocket for preventative care. I decided that investing in my son’s education was more important than having insurance.BTW, I also dropped my insurance before ACA when I was unemployed. The insurance for individuals is still more affordable under ACA that it was before, even with recent rate hikes.The healthcare industry needs serious change in the U.S. but I think ACA was just dipping the toe in. The insurance industry is dictating the terms and that is why the solution/s need to be led by another industry. I often wonder if tech hasn’t really taken a serious stab at it due to the quagmire of regulation. But it’s so ripe. Waiting for some really innovative people to knock over the insurance executives. Can’t wait. Rooting for this to happen.
Sounds very efficient, however it also sounds a lot like the value prop for the pill mills that were all over the place in South Florida.
Fred makes a lot of mistakes outside his comfort zone and here is another one. Not be to critical, but he at time conflates ” a technology layer over a business” with innovation. The most important part of healthcare is continuity of care. If you want good health care find a doctor and build a relationship with him or her. You’ll be able to get meds over the phone and same-day when needed.ps Yep, could also call 1800canadianpharmacy and get any drug you desire.
I don’t think it is a mistake or bad idea by any means. It was just interesting how much the company pitch reminded me of the pill mills. . .they did not even say – “you sick? tell us what’s wrong – we can figure out the right meds.” The pain centers and pill mills down here seem to be focused on the same model – – I need so and so, irrespective of any diagnosis, etc,.
Let’s be clear, it’s a bad idea. Primary care doctors are already underpaid. They train their asses off for years and graduate with 300k of debt. Go to the fucking Doctor once a year.Sorry you dug a whole you can’t dig out of, You are on Fred’s bad side 🙂
It’s still a good deal and I don’t agree they are underpaid.1) First it’s probably closer to 200k not 300k. 2) You can make $200k a year doing primary care in most places more in other situations.3) The interest rate is reasonable and you can pay it off over 30 years. 4) The job is super secure. It really doesn’t get any better than that. The supply is constrained and will be for quite some time. Additionally years in the business and experience do count for something (unlike programming) Don’t include undergrad education, you would be paying for that anyway. So it’s the delta. Also public is fine with this you don’t need a high priced private school education for doing primary care. In my first business I bought machinery that cost in todays dollars that much, with personal guarantees and no assurance at all that I was guaranteed business. And it didn’t have a useful life of 30 years either.
If you are an awesome dedicated caring Doctor, there is a tremendous price you pay for practicing medicine that goes goes way beyond a spreadsheet.
I agree that this is an interesting area for innovation to solve existing problems. Any changes to ways in which prescription drugs are managed will be under intense scrutiny for abuse.However, let me throw out a real life example of how this type of solution can be really helpful to our society, especially as the Boomer generation is aging. We basically are facing the growth of the biggest geriatric generation ever.Here’s an example: You are helping your aging parent who has some chronic health issues which require use of prescription drugs every day for the rest of life. Your parent also faces mobility issues due to his/her chronic condition. You live in another state but your parent would like to remain living at home, in his/her community.Let’s also look at changes at prescription drug laws. Connecticut, for example, has changed it’s laws on opiates (due to the huge increase in opiate abuse). Prescriptions for these drugs now are only legally attainable for one week of medication. So, this means that a patient must go get a new prescription every single week.Connecticut law also now requires the creation of medical databases tracking all patients so any provider of prescription medications can look up each patient to insure that the person is not seeking multiple prescriptions from multiple providers (which indicates abuse or illegal activity).Now let’s go back to the use example. Can you imagine the burden of planning and travel necessary for this person, your parent, who needs medication for chronic pain?I bring all this up, because I have this parent (though I live in the same city as my Dad). If you do not have a parent or family member like this, it may be difficult for you to imagine, but the time suck is more than you can ever imagine.A solution like NuRx could have many positive benefits as well as market viability.
I don’t think you have seen the effects of opiate abuse. People get old people to get a prescription and then take their pills. The old person never gets a single pill.I feel for your situation. My mother died of cancer and needed opiates. They really need to be controlled.Here is from my city: http://www.nbcphiladelphia….
I know. Thank god for Narcan so they can live to overdose again and again.
Now let’s go back to the use example. Can you imagine the burden of planning and travel necessary for this person, your parent, who needs medication for chronic pain?Does this upside overcome the downside?And why is it “my problem” because you choose to live somewhere other than where your parent is? Isn’t that your responsibility and not societies?I am purposely stating the problem the way that I am to prove a point. Where is it someones right to foist on others the fact that they choose to live their live a certain way for their benefit?I choose to have my daughter live in NYC and help her with rent. It’s not NYC or anyone elses issue to help with this. It’s up to me to do that. If I can’t afford it then she can’t take advantage of the opportunities that are there. That is the way that I see it.You live in another state but your parent would like to remain living at home, in his/her community.Ditto for the above. I would love to do many things but have to take practical and economic concerns into account. My point is while your parent may not want to move where you are they may have to.(By the way my tone is not directed at you I fully understand what you are saying and would want the same for my parent.)
As our society sees an increase in the numbers in the aging population, many families will face all of these questions. Every family will come up with different solutions to these problems, based mainly on finances. For example, an editor at the NYT Hong Office may choose to take a different position that brings him back to NYC where he can then be closer to an aging parent who lives in NJ. Depending on that family’s finances and the exact condition of the parent, it may be far more cost effective to keep the aging parent in his home (and a wonderful side effect — pun intended — is it also healthier for the aging person).If there are innovations in services that enable families to create the living situation that is preferred, then it’s a win/win.Of course, if you chose to not care personally about how our culture as a whole treats people as they age, that’s your prerogative, but I don’t see how that affects a marketplace that creates better solutions than already exist to deal with such issues that many people face.
And there are other options suck as assisted living, at 4-8k a month, seniors and their kids should work together to find solutions
Assisted living facilities work well for these types of family issues. The problem with children of kids today is that they think it’s their birthrite to inherit their parents $. Parents would be better off spending it all and receiving good care
Aging is not a binary circumstance. And while sudden events do happen (stroke, hip break, etc.), the majority of seniors age slowly over time and much of that time can be successfully spent in the home. Certainly assisted living can be a solution, depending on the specific circumstances, but it would be negligent to put a family member in an assisted living facility if the that person could happily age at home.I don’t understand your point about finances. I personally don’t know many people who expect to inherit anything from their parents. For example, my father is a functionally illiterate former mechanic who has no assets. When he was unable to continue to live in a regular apartment due to wheelchair accessibility issues, my Mom was able to find him a spot in a senior housing complex. There he has great freedom yet there is also always someone on call at the main desk should there be a crisis. And despite the fact that he’s disabled with a chronic condition, he loves the freedom of living on his own. He converted his living room into a work area where he builds model airplanes and boats. He goes out fishing almost all year round. He comes out to family parties and picnics.My goal as a daughter is to help my Dad live happily and comfortably. For him that means creating the circumstances for him to maintain as much of his independence as possible. I think that’s what most families want for the people they love.
You are a good person. Your thoughts on your father touch me.
Thank you. I think most people feel this way about their families, though. I just used my life as an example because it was illustrative of my point. I just happen to have a lot of first hand experience in dealing with some of the challenges that we all have to face at some point. It’s complex and difficult and I think that generalizations about motivators like greed or thinking that solution choices are binary are not based in reality.
You could add technology to strengthen or augment continuity of care
ok, I have a good idea. I will call this thing a knife. It will help me build shelter, collect and prepare food and even defend myself with it. Oh wait, but then people can make their own knifes and kill other people with it. Never mind, a knife is a bad idea.What you are describing is a human problem, not a technology problem.
Your point is well made, I agree. I was just making an observation – two businesses with similar value props. One is brick and mortar, the other is online. The brick and mortar version had tons of abuse and spawned a lot of legislation to try and get it under control – too successful 🙂
Humans use technology.Human problems = technology problems.
You are right, some humans still live in caves.
Technology that makes it easy to profit by curcumventing the law, it a technology problem.
Thats a very pessimistic view, and a sad one. If it was up to this line of thinking, we will be still living in a cave. The good that comes from most technology far outshines the bad that comes with from it.
I agree. I also agree healthcare needs to be fixed, but it does not need to have the patient tell you what drugs they need because big pharma told them they needed it.In many parts of the world you go into a pharmacy say I have X, they say, well ok, here is Y. Simple and cheap.Here is what we have: https://www.youtube.com/wat…
BTW: The sad part is when I searched for this on google: purple pill three drug adds came up at the top. Nexium paid the most. See the side effects:http://www.emaxhealth.com/8…
I actually figured out a way to get off of Nexium after many many years. Not something the gastroenterologist told me either.
I’m keenly aware of opiate abuse and how it works. Not only have I seen it in my own family (my brother is an addict) but I also work professionally with the public sector on prevention awareness. But there is also great need for opiates for chronically ill people like my Dad who is a senior and many people like him. When you have a chronically ill parent you become part of the chronically ill community by default. You meet the same people over and over again in waiting rooms. These people need medication and despite the opiate crisis in the United States, we would be negligent as citizens if we did not acknowledge this.I think it is quite dangerous to assume that all chronically ill seniors are not taking their medications and selling them for profit. Though I know that it is a common occurrence for obvious reasons. However, exposing problems such as to why some seniors sell their medications (or have relatives who steal their medications to sell) is important to acknowledge so that solutions to such problems can be thought about and addressed.However, despite the obvious (and unobvious) problems in creating solutions, I think that innovative thinking about medication delivery shouldn’t be discounted just because it’s rat’s nest. I applaud any startup that is trying to solve problems that help everyday people.
Don’t get me wrong. There should be a discussion. I don’t know, maybe have somebody that administers every day at home (they better be armed). Maybe have some sort of box with a Ring Camera type device that administers one. I don’t know.I agree going into the waiting room is not the solution. I like having a discussion. I am saying administering them by phone will never work.Look up my wife (easy last name) she was one of the leading people on this until she retired.
In my personal case, my family has arranged for someone to show up each day to give my Dad his medications (My Mom does it even though she is my Dad’s ex-wife. She also happens to be a nurse).However, my particular situation aside, as we see a huge increase in the geriatric generation, I’m keenly interested in seeing solutions that address these issues. The market need is already there and it’s going to increase. If we can utilize tech to solve some of it, more power to the tech community and the U.S. as an innovator culture.
And this is where we need to have a civil discourse not a shouting match. I agree.
Pretty much. Alternatively, they won’t be able to write prescriptions to certain drugs.And Fred, you’re looking for v2 of ACT UP NY. Nothing radical in terms of how patients will be served until patients rise up and demand it, angrily, especially rewriting large chunks of HIPAA and GINA.
Working on the other side of this, ability to instantaneously facetime a doctor without prior scheduling (or login). Free for first 10 min and calls are routed to physicians outside of US.
The site is quite poor. Thought this was better[http://www.birthcontrol.com…] and possibly the single niche service to establish before walking through a minefield.
they’re creating a Beachhead. that’s startup 101.
Or UberHealth https://newsroom.uber.com/u…
Even better. Maybe we should lock in some domain names.
interested in how they have mapped out the anti-abuse protections and negligence insurance requirements.
Where is medical “care” in this transaction? Care is cure as well as preventative, and ultimately more cost effective – to people and health care providers – that drugs. my concern with a service like this is that it promotes self-diagnosis and self-medication. yes, seeing doctors is a cumbersome process (normally you’re either cured or in intensive care by the time you get an appointment) but I think fixing this is the right solution. I definitely agree that this is an industry that needs a challenge.
The (all female?) physicians are there to write prescriptions. It’s essentially a legal fig leaf. The other approach is to make more drugs available without prescriptions, as some other countries do.
Not in my world they aren’t, and they certainly shouldn’t be. In Europe there is a (in most cases) very valid, publicly-funded (in my book rightly so) relationship of care provider to members of the public. Making more drugs available without prescription can cause significant damage to patient health – resistance to antibiotics, addictions to prescription painkillers, etc. Doctors are, in most cases, better trained that operators of search engines and bloggers to provide care, advice, and (in some cases) medicines.
and their partner in bad heath the food industry.
You can already order food from your mobile phone. What’s your point? 😉
that a lot of food offered offline, online is not too healthy or outright bad for you.
“It’s a pretty cool doc” – Katy PerrySay no more.
I agree. The food industrial complex is the root of all evil in this country. The drug industry benefits since in many cases drugs are used to counter bad behavior in eating.You don’t have to look very far to see some of the whales that are at, say, Starbucks,Walmart or fast food restaurants to know that. I can’t even begin to imagine the meds they are on and what those cost and who is paying for all of that. Sure some people have medical conditions which lend themselves to being heavy but most do not. They are just pigs and use food to get pleasure and it’s an addiction. No different than alcohol or drugs. Actually different in that it’s not recognized as an addiction and there are no billboards advertising “call this number to get help!”.There really is a food addiction going on in this country. People have little will power. They will just eat themselves to death. The drugs, at great cost, just stretch this out.By the way the issue that I see is not whether food is healthy or not healthy.It’s that the food is so tasty that people can’t stop eating it. Nobody is going to overeat steamed broccoli. The unhealthy part comes from the buzz that you get because of how tasty the food is. Works on the pleasure centers in the brain. Some people get more buzzed than others and can’t stop.
Some docs are saying appetite stimulants are tossed in too
Remember MSG? I don’t mean the place they play games at. I mean the flavor enhancer. Remember those commercials that used to say “bet you can’t eat just one?”.https://www.youtube.com/wat…
Simple rule of thumb – Food does not come with a nutrition label or list of ingredients.
Sorry Tom, I didn’t understand…
Nutrition labels can also hide sugars and other junk. I believe that they’re getting a make over.
No, no….I was saying Food does NOT come with a nutrition label :-).Or, to invert it,….IF it has a nutrition label or list of ingredients, its not food.Thats a simple rule of thumb. Its obviously not one that anybody can adhere to 100% of the time…which makes it all the more valuable.Spinach does not have a nutrition label and a list of ingredients.A sweet potato does not have a nutrition label and list of ingredients.A guava does not have a nutrition label and a list of ingredients.Several years back I made a conscious choice to withdraw from Big Food materially. Withdrawing entirely may not be possible, but certainly very materially avoid it.
I’m not sure how this will dramatically lower costs, or even modestly lower them.
This post is a bit misleading. The prescription industry isn’t being upended here. At least not yet.NuRx provides “the pill” and PrEP; neither are like most drugs where a doctor has to re-evaluate you before refilling your prescription but, as regular protection against pregnancy and HIV, respectively, prescriptions are pretty much automatically refilled and you take them ad infinitum. In fact, the annoying process of obtaining drugs doesn’t even apply to the two that NuRx actually offers.So what makes you/NuRx believe this can scale to all prescriptions, considering the *very* different class of drugs currently available via the service. Why would the government ever let you get pain meds or Adderall or refill your flu medicine this way?
If you take regular meds for a chronic condition now, the refill process is already pretty smooth.
Exactly my point. NuRx is claiming to solve a problem… but offers prescriptions that don’t actually have that problem. Refilling prescriptions of this type is extremely easy. And if NuRx can only add drugs to their platform that already fit that easy-to-refill mold, then are they actually solving a problem?Probably, but it’s not a big one. It’s just the convenience of ordering delivery via phone. Big business, maybe, but nothing new or revolutionary, for sure (like most startup hype).Unless Fred forgot to tell us something…
And you can order refills by phone now with most drug store chains. It’s automated and takes a minute or two.
With many patient portals you can reorder online already. Delivery isn’t baked in, but what’s the value of that alone.For new refills the doctors are starting to get automated processing of requests to speed things up…and since it’s built into the ehr they can evaluate prior labs, recent visits, etc to make a determination on the refill. (www.healthfinch.com).I 100% agree with the sentiment of Fred’s post but I’m skeptical about this one being the answer – unless they go enterprise and white label to docs…but that would require working with the “incumbent healthcare system”
Even new scripts are easy, at least for me. Step 1, Go to doc. Step 2, pickup meds from pharamcy (on way home) that the docs office already sent over.
Yep, most insurance companies go to 90 day fills, either mail order or pick up, once you are taking the drug regularly.
Not for opiates in Connecticut. Laws are changing. It is now illegal here to prescribe for more than seven days. That means people like my Dad who is disabled and lives in chronic pain, must go through the process every single week. The time suck is beyond knowable unless you know someone affected by it.
Depends on the class of drugs.
If startups like NuRx create the necessary databases that are now being required at state level (different states are now changing laws in response to the opiate crisis), this could be very profitable, and still affordable to patients, as it scales to other drugs. Everyone posting here is forgetting about the fact that the Boomers are aging and now becoming the biggest geriatric generation ever. This market will have long term needs for prescription drugs over the remainder of their lifetimes.
And people wonder why I switched to an iud
I love that! “An aggressive challenge…” “A deserved challenge.”This industry has done so little in terms of its service improvements. NuRx sounds great!
It sounds like this particular use case is the tip of the iceberg in terms of where they might go. I’m intrigued by this statement in Andy’s blog post, “mobile medical networks for the 21st century.”
There ain’t nothing more powerful than the stench of mendacity.
The UK NHS is not efficient but I and most UK residents would fight tooth & nail to keep it.
“You Tell Us What Medication You Need”A guy on the corner of Pike & 3rd offered me the same value prop yesterday. No med school required.
I got sick in Mexico. Here’s what happened:- Wife called a local doctor.- Doctor came to my house. Did exam.- Doctor said I needed a specific medicine – it was one that had been around since WW2.- Doctor called pharmacy and ordered meds.- Pharmacy sent pills via courier on a motorcycle.- Doctor checked the bottle, then gave me the pills.Total bill for house call, prescription and delivery service was less than 40 dollars.The pills worked, it was an old sulfa drug, off patents forever, still effective.
Same thing happened to me, almost exactly, a decade ago in Central America. The drug was/is only used in the US for horses these days. 🙂
More like $4 than $40, though. 🙂
Why do people freely spend $40 on a low quality restaurant, yet complain about $40 for a medication?
perceived cost to manufacture, irrespective of development cost – which is ignored.
People are sheep
.Baaa, baaa, no we are not. Baaa.JLMwww.themusingsofthebigredca…
I think here is the problem. Just like going to the auto shop people are never sure if they are getting ripped off or not. You know with food.Did your Doctor just prescribe you that because the rep came in gave her lunch and whatever else to prescribe it? Did he do it because he doesn’t care about cost?Does it cost that much because it should or is it like Epi Pen.Basically when people think there is a chance you are ripping them off, can’t tell, and you have people in your profession that do in fact rip them off, you get painted with the same brush.I don’t know what to say. In the software world you have the same thing.
So right now I’m going to nice and open and start answering parts of this question.I’m on 3-6 drugs right now, not including an epipen that I might need to have (situation is complicated, I’m deathly allergic to sulfa antibiotics, and I created one false positive and one false negative on the blood allergy test, so it’s super unclear what I’m actually allergic to)1)Mirena Iud2)Triamcinolone Acetonide for a rash3)Albuterol inhaler for exercise and getting a cold induced asthma 4)vyvanse, an adhd drug, stimulant5)duloxetine delayed released, antidepressant snri used for anxiety 6) topiramate er, anticonvulsant used to boost the antidepressant and smooth issues with the vyvanse.I have been on other drugs do the vagaries of insurance companies and drug companies. That hasn’t gone well.the, particularly for the psychological drugs. One switch made in college that was pushed by the drug industry caused me to stop sleeping for 2 weeks and become paranoid. I don’t necessarily react well with all drugs. I expect most people are like that.Still, I also see insane pricing and insane pushback by insurance. Duloxetine only recently became generic. It’s also an isomer of a much older molecule. it’s really obvious that it was originally a push to extend a patent. And getting on it was hellish. I had to fail with an Ssri first. Even with a genetic, it’s still costly. It shouldn’t be, as it’s part of one of the most common classes of prescriptions in the country.Same with topiramate, fyi. Making it more stable in the blood make it far more costly.Finally, the oddest one is the inhaler. You’d figure that would be cheap, because there are multiple manufacturers. Nope. The cost totally isn’t linked to manufacture, or incidental marketing.I have to say that I only am taking generics (minus the mirena).We basically have a price negotiating problem
.Some of us are thoroughbreds, no?JLMwww.themusingsofthebigredca…
Some doctors will write a prescription for a patient in advance for certain drugs which they can take on a trip with them. Some doctors when they take trips have all sorts of drugs that they travel with just for that particular situation.
I guess they weren’t quite ready for the traffic you’d generate :)https://app.nurx.co/oc/startcoming up empty
Particularly the faq. Lots of unanswered questions.
The other amazing app I’ve seen in this space is Heal — https://www.heal.com/ — it’s active in parts of California — you can get a same day in-home visit from a doctor for $99. Really cool app. Uber for doctors if you will.The thing that is most interesting to me is the degree to which the doctor apparently values the level of payment. It massively cuts out costs in the middle and the doctor gets paid a great wage for the service. Pair this with NuRX and you have an amazing service — same day house call with two-hour later prescription delivered.Perhaps in the future the service will be sent by automated drone or Automated Vehicle with sensors and cameras and doctor won’t even have to travel 😀
This brings the doctor back to the patient, instead of where they’ve ended up, which is at the mercy of the insurance industry. Love it! If you look at the data the U.S. is in dire need of General Practitioners. People don’t go that route in med school anymore because you can hardly make a living at it. But imagine all the people who really want to be GPs, who are passionate about it, who now can because a service has been created that eliminates all the bullshit business stuff that a doctor must handle. Sounds utopian, but this is exactly what GPs used to do.
They are called nurse practitioners.
FYI – Their site seems to be having problems today. Lots of blank, white pages on more than one browser (especially the FAQ page).
.At first I was aghast at the proposition and then I went to the website and realized it’s only for two drugs right now and one of them is oral contraceptives.No prescription should ever be written for a patient without a doctor examining the patient and, usually, having some blood work done.States (where the regulatory locus lies) require patient-practitioner “in person” exams for the initial prescription of drugs. This varies by state and there are some weird rules pertaining to “telemedicine.” The regulatory environment is hopelessly behind the times on these things.Most prescriptions contain a limited number of refills — some automatic and some requiring verification from the doctor. In addition, a doctor can reauthorize the prescription over the phone if contacted directly by a pharmacy. He is, in essence, re-writing the prescription.How do I know this stuff?For more than a decade and a half, I have been overseeing the purchase of drugs for a relative, who now resides in a different state. They are bought from Canada Drug Center using the following methodology:1. Patient gets examined in person by their doctor where they live.2. Doctor writes a paper script. [Digital record I can access via the Internet.]3. Contact CDC, send script, copy of drivers license, check. [I usually email all of it and follow up with snail mail. They turn the check into an eCheck and cash it immediately.]4. CDC confirms everything.5. CDC sends the medicines which are sourced from Canada, Australia, New Zealand, and India. [I never accept medicines from India. Don’t know why. Probably because I am a racist or something equally vile.]6. Takes 10 days and your medicines arrive by mail in the original Merck (et al) packaging. Packaging is different than in the US and often is foil sealed individual pills.7. CDC will automatically process the script refills a month out.BIG DEAL: The total cost is about 25% of the best US prices I could find anywhere. The number of pills can be a little off. As an example, you may get 168 v 180 but they only charge you for what they send.The first time you do it, it is a pain in the ass and it seems a little odd. There is a Canadian trade association which certifies Canadian pharmacies serving the US. There are about ten such pharmacies.When I started doing this, I received legal advice it was illegal. Haven’t heard that in a while.I don’t see the attraction of any prescription service if there isn’t a huge cost savings. This cost savings indicts all the baloney our gov’t tells us about the cost of healthcare in the US.I do this routinely and save my relative more than $10K per year.Pro tip: Get your medicines 90-180 days at a time.The idea of sourcing prescriptions overseas is not a new idea.JLMwww.themusingsofthebigredca…
You said that you have your relative 10k a year on a 25% savings? If they are spending 40k a year on scripts, they far in exces of any catastrophic limit and/or they are far in excess of their 6 % AGI and therefor costs are tax dedcutable.
.Redo the math. I am saving them $10K which is costing them how much when I am paying 25% of US prices?JLMwww.themusingsofthebigredca…
25% of x = 10k don’t mess with my my math skills.
75% of x = 10K.X ~ 13,350, not 40,000.
He said he saved 10K a year
Pro tip: Get your medicines 90-180 days at a time.Pro pro tip get your doctor to prescribe the same medication for twice daily use.
When I started doing this, I received legal advice it was illegal. Haven’t heard that in a while.I am surprised that as the ‘law and order candidate’ you would skirt the law like that. Additionally you could give up some of those expensive trips to Steamboat and get the drugs from the corner CVS. $10k is only one trip, no?I wouldn’t do that of course. But then again I’m not the law and order candidate.On a serious note my concern would be the quality of the medications being manufactured. That is my big concern not the illegal part. Although it would be nice to know exactly what the legal jeopardy is by doing what you are doing who is breaking the law exactly? Are you complicit?
LE, the quality is the same most times because its the same manufacturer, e.g. Merck in US vs INDIA. A lot of times these products are made by same manufacturer but packaged and resold by different companies at different price points for different markets. US is the only country where govt doesnt negotiate prices and that is why US health care is in such dire state. A pill for HepC costs 1000USD in US manufactured by GILEAD. The same pill costs 10USD in India manufactured by bigger brands like Mylan,Abbot under license from GILEAD. 85% people are denied these medications by insurance due to cost and many people have got the meds mailed to them from India. So its not the quality that makes the high price but its greed and Govt Inability to negotiate. Hillary intends to change that.https://www.hillaryclinton….Self importation of meds from abroad is legal in US for life saving meds only.http://www.fda.gov/AboutFDA…For non life saving its a grey area but typically packages make it through without issues
https://uploads.disquscdn.c…PopycockrX is 10% of medical cost and it not the reason for the “dire state”
Good point..but its still a contributing factor. If am not hospitalised and dont need to see a doctor often, I still would be paying a fortune lifelong for medications for chronic conditions . Am sure you know the Harvoni, Epipen and Daraprim debacle.
LE, the quality is the same most times because its the same manufacturer, e.g. Merck in US vs INDIA. A lot of times these products are made by same manufacturer but packaged and resold by different companies at different price points for different markets.You have not convinced me to risk my health or my life. Why? Because you said most times. With something important I want all of the time and here is the proof. I also have (probably doesn’t apply here but I will mention) my “best production off the line” theory. That says that if Apple is buying the same parts as your shit PC clone manufacturer is buying, Apple is getting the good parts and the clone is getting the grade b parts. Or, Apple is able to exclude the sub parts from assembly. Take your pick.This theory also extends to companies that used to do work for Sears as contractors. Using them by way of Sears is not the same as using them directly. Why? They can piss you off but they can’t piss off a big referrer of business. Same as doing business off ebay and on ebay to anyone who has tried. Ebay keeps vendors in line with the rating system. You have no stick w/o them.Bottom line: YMMV I go with the sure thing. Back in the 90’s I visited a generic drug manufacturer to look at some label making equipment that I needed to buy. (I probably have video of this). I was able to walk up directly to the manufacturing line with no protection and got to observe the workers. Merely being allowed to do that (and looking around) gave me pause. This was in Northern NJ also.
JLM:”How do I know this stuff?”Your living near the border assists you in securing your meds inexpensively.
5. CDC sends the medicines which are sourced from Canada, Australia, New Zealand, and India. [I never accept medicines from India. Don’t know why. Probably because I am a racist or something equally vile.] Absolutely vile! If the guilt becomes unbearable and you need to make amends. Buy me a blue plate special at Taco Deli (adabado chicken + mojo fish) and I will vouch for your love of all Indians.
Combine with Figure 8 so nurx doctors can have a look at what’s happening to patient, if anything physically presents
VCs should be pouring money on solutions like these. http://www.skinview.com.With SkinView your smartphone becomes a Dermatologist in your pocket. Instant, accurate analysis of any skin spot, anywhere, anytime and for free, with optional second opinion confirmation for a small fee.If anyone wants to talk about it hit me up.
What is ‘Doc Slop’ Rich? Sloppy Doctor? LOL
Medicine is science, what’s the specificity and sensitivity (this ain’t groceries and a community of highly engaged users)
specificity and sensitivity of the device? Sorry am not understanding.
There are some states where pharmacists are able to prescribe drugs – I don’t think that NuRx will help there. There are a lot of complications, but the basic idea is sound. I like the idea of quickly and easily getting a prescription for birth control.
Regarding prescription-related privacy one company aggregates all US citizen prescription data (they can, do and have for years), then use their algorithms to predict one’s ailment. Who knows who they sell this data to but, let’s say a marketer – like Facebook. Wouldn’t FB then be able to port ads targeting the mental weaknesses of an individual? When that gets to political advertisers is a line there? Or, major employment agencies? This isn’t conjecture, it’s marketing and we all understand marketers will pay to gain an edge, why not ply on people’s emotional sensitivities?We should be overly cautious as we meander down the path of digitizing medical information we believe is protected by HIPPA but, in fact is in an eroded state to begin with and available for a fee to private companies. That’s not sustainable insofar as ensuring ethical-use protections. Refs: https://www.examone.com/red… and http://articles.latimes.com….
CONTRIBUTORS:JLM’s post highlights the key reasons the obstacles are an uphill battle in having this application scale.
They will need to pivot to survive.
I recently discovered a related offering: http://www.goodrx.com/ . My wife, a physician, prescribed me some generic antibiotics. As she’s not my preferred provider, I was facing paying full price. However, apparently they recommend goodrx to their patients without insurance here in Houston, so she gave it a try. She put in the drug/dosing, and my phone number. When I got to walgreens, after waiting in line (why does this take so long?), the lady looked at the text message I had gotten, pushed some buttons, and I was magically out the door for $18!?Bottom line – there’s a drug store everywhere. I don’t need delivery. It is a pain to go to the physician for some diagnoses (and not everyone has one in house), so I can see how doing a consult over the phone would be helpful. I don’t know how this would work for most prescriptions, however (beyond, e.g., birth control and non-drugs-of-abuse). It seems like the biggest and most useful hacks of the system would be (1) to cut drug $$ and (2) to get rid of the time I have to stand in line at CVS.
Good comments. With respect to this:to get rid of the time I have to stand in line at CVS.That is perhaps a feature and not a bug. Having friction in the process keeps costs down for drug companies and in theory keeps costs down for consumers (by lowering overall healthcare costs).Some drugs are essential, some are non essential, and everything else falls in between.  As such making it easier for someone to order drugs (by shortening the line in your case) or by offerings such as nurx.com in theory would lead to higher costs (assuming drug prices don’t drop on volume) because they make it easier to order (don’t have to get an office visit) by removing the friction. Well know to you I’m sure is the amount of friends and relatives who ask your wife to write a prescription for antibiotics when they possibly have a viral and not a bacterial infection.
My favorite example of friction was when I was went to the clinic as a postdoc at UCSF. The academic doctor on service that month (I think a normal GP would never do this) said, “I will give you antibiotics for your cold, but first I want you to read this recent paper with me.” She then printed out a nice study that described the distribution of average recovery time for colds (median without antibiotics was 13 days and with was 12 days or somesuch), and we looked at the figures and methods together for about 10 minutes. Then she gave me my prescription and I left.(Oh, and in this case it was an Rx for clindamycin to treat inflammation a few days after I had invaded a fire ant nest. Care to compare Texas human and non-human residents?)
Sure but that doesn’t take into account the placebo effect!  Or whatever it’s called (that got us into that mess) that makes someone feel better simply exiting the doctors office with a prescription in hand. Or maybe a variation of the Hawthorne effect.
GoodRX is broken.Three major providers have repeatedly refused to accept it, even though they are listed in the app as the lowest cost local providers (Publix Pharmacy, Kroger Pharmacy, national warehouse club)In fact, Publix states categorically that they are not suppose to be listed as they have opted out of app participation. Kroger simply declined the code as did the warehouse club.If GoodRX is going to survive (and it would be a positive if they did) it will have to correct the broken parts of their business model.
What happens when the doctors do not want to give up the reimbursement for the consultation associated with the prescription?
“And I can’t think of any industry that deserves that challenge more than health care.”I can. The politics industry.
The basic problem with this model is actually shown in their visuals which basically says: “Just tell us which meds will feed your addiction and we’ll sign off on it.”There are GOOD reasons why 4-5 steps were put in place between people and their addictions. Even so, America has a huge problem to prescribed meds; this type of technology does NOT solve public health problems and would only help big pharma.This has to be the worst analysis and most IRRESPONSIBLE investment suggestion.
It’s pretty discouraging that physicians are perceived as drug dealers rather than professionals responsible for your physical well being.
This appears to be an effective approach when dealing with low level diagnosis and low risk prescription medicine. So essentially, the service model is starting at the low end in the marketplace – sound familiar? Innovator’s dilemma thesis….Give them time to sort out the proper use case(s) and something special might emerge.
If someone could do eye exams on demand over mobile that would awesome. I just bought glasses at Warby Parker but shipment is held up due to the prescription being a few days out of date.
This “service” is so beyond fucked up. Americans don’t understand the problems they’ve created with self-medication of prescription drugs. This enterprise will be a very effective tool for ruining lives. I can’t imagine how Andy sleeps at night.
It sounds great until the day that someone gets hurt because a doctor approved a prescription without fully understanding the context.I would love to be able to ask my doctor to provide a new prescription electronically for a drug he has already prescribed before. ( today, we do it over the phone). But getting a new prescription on demand without the doctor knowing your context is tricky.It can work for certain classes of drugs ( ED may be an example), but it also carries risks, even if the terms of agreement may ask for the customer to waive all rights to sue.
have no idea about the veracity of this but well argued.
Yeah I am totally missing this one. I can only assume there is something that I don’t know. Perhaps they expect this to pay off way way in the future (but after all isn’t that always the case) and the secret sauce (regulatory caputure) is in the future. Hoping to get in front of the curve of changing regulations.The only way this even comes close to working as presented now is with offshore doctors writing the prescriptions.
You nailed the low quality Doctor aspects of this. The worst of the worst end up in this line of work. Check you doctors credentials, where did they do go medical school, residency, fellowship. Ask them why they chose the field that they did? Have they ever had their medical license suspended.
The FDA has no relevant authority here.
Geeting in front of healthcare Pharma regulations is like getting in front of an amtrack train on a bicycle. This ain’t uber and the taxi industry folks. Google Medicare fraud perscription drugs”.
That’s an adhominem attack.
! that’s not how i meant it at all.
The individual state does