The Hollow Men of Hims

> Regulatory arbitrage disguised as innovation, dressed in the fashionable vocabulary of patient empowerment while serving no master but the quarterly earnings call.

No masters except the patients that are literally being empowered to make choices about their medical care and are paying a substantial premium (in many cases) to do so.

I would happily be empowered by my doctor and UnitedHealthcare instead, but sadly that’s not on the table.

Try getting tretinoin from a real doctor; I’ve been written prescriptions multiple times, never once succeeded in actually getting it, because insurance is a fucking nightmare. And I’m not on a cheap plan.

Also note that the compounded semaglutide is superior because it comes in adjustable dose vials, unlike the pens. But I’m sure the author would claim that taking a smaller dose to reduce side effects is “a dangerous and unproven approach to medicine that puts patient lives on the line purely for profit”.

Tretinoin is easily prescribed by seeing a dermatologist. What do you mean it’s a nightmare to get even with a prescription? I think a tube of cream cost like $10 at Costco. You don’t even need to use your own insurance to buy things from the pharmacy as long as you have a prescription. I never once had a problem filling it before I switched to Accutane.

I'm confused. An insurance company cannot reject a prescription. They can only reject paying for it.

So if you're paying for it with Hims why wouldn't you be willing to pay for the medication the doctor prescribes to you if the insurance company is refusing to pay for it?

> An insurance company cannot reject a prescription. They can only reject paying for it.

That's a distinction without meaning. Say an insurer won't pay for cancer treatments. Although they're not technically telling you that you can't have the treatment, for all practical purposes they absolutely are (unless you're so rich you can eat the cost).

The article talks about Semaglutide, which is $750/month from a traditional pharmacy after UnitedHealthcare rejects paying for it, or $300/month from Hims. If you believe the medicine's substantially the same between those sources, why wouldn't you take the $5400/year out of pocket discount?

The egregiously heinous thing, in my view, is how a half dozen states still have some kind of health insurance mandate in their laws, and up until 2019 the ACA required all Americans carry it.

I was able to buy it two times from an Indian website. I have no concerns about its safety profile.

Fuck the AMA gatekeepers. Bodily Autonomy means I should get to buy and use any medicine I decide it worth my personal risk assessment.

> Try getting tretinoin from a real doctor; I’ve been written prescriptions multiple times, never once succeeded in actually getting it, because insurance is a fucking nightmare. And I’m not on a cheap plan.

Deviated septum with 90% occlusion in one nostril, see an ENT, also on a "platinum" plan. "Great, let's schedule surgery." ENT: "Hold fast. First, I'm going to prescribe you these two nasal sprays so you can come back to me in four weeks and tell me that, to our mutual surprise and disappointment, they didn't realign the cartilage, and that way, insurance will pre-authorize the surgery."

Yeah, please don't repeat this. This is the same thing that insurers say to Congress for other things too. "We're not denying care, we're just not going to be the ones paying for it", be it cardiac surgery, or (in the case of United) even Heli EMS from MVAs, because it wasn't "pre-authorized".

I’m not sure what exactly the issue is. The doctor prescribes and the prescription never gets filled. I assume the insurance said no and the pharmacy just decided not to fill it, they’re pretty inconsistent about what information they give out.

Meanwhile with hims I order it and I get it.

My doctor keeps prescribing it and the pharmacy keeps not filling it. I’m not really sure what’s going wrong, I haven’t taken the time to debug the situation. I shouldn’t need to, and I’ve never needed to with hims.