Vegas Free-for-All - Speaking of Drugs

malibber

Jul 26, 2011
5:20am

I recently obtained health insurance and I was mortified when I discovered that on my 3 $4 Wal-Mart prescriptions the insurance company pays nothing as it is below the co-pay on prescription pharmaceuticals. I thought long and hard about this and decided that Wal-Mart was really inconvenient for me and I didn't like the really long lines at their pharmacy even when I called ahead. It also required I spend about about $25 in gas round trip.

When I saw my Doctor yesterday I had her change all my prescriptions back to my small town pharmacy and I also had her change them back to the latest and greatest formulation the pharmaceutical industry recommends instead of the old but reliable versions of the drugs available at the Wal-Mart pharmacy for $4. Now instead of paying nothing the insurance company is gonna have to shell about $600 per-month month in and month out because I no longer want to be inconvenienced, and I decided the newer formulations that provide well less than 1% in increased therapeutic value were important to me. Isn't the American health care system great?

And the priceless part is the perverse delight I take in screwing the insurance company as hard as I can.

drmilled

Jul 26, 2011
5:30am

Block User

Not to rain on your parade, but just where do you think the insurance companies will get the funds needed to pay for your prescriptions? They sure aren't going to take a hit on their bottom line- the additional monies will be funded by increased policy premiums to those who are insured. I am sure that the policy holders will revel in your joy.

malibber

Jul 26, 2011
5:57am

Block User

I am well aware of how it works and I would be delighted if they have to raise premiums to the point where nobody can afford them anymore and all the private insurance companies went broke. They way I see it is they screwed themselves. They could provide an incentive for people to get the cheap $4 prescriptions at CVS or Wal-Mart by waving the co-pay and being out $4 or they can keep the system they have where the doctor prescribes the latest and greatest formulation of a drug the pharmaceutical company rep is pushing that has a cash price of $200 or more. The only reason I got the $4 prescriptions in the first place is that I specifically asked for them after I researched which ones I could substitute for what I was currently taking. I find most physicians are clueless when it comes to how much something costs the patient. The truth is a lot of common ailments could be treated with inexpensive drugs, but the close physician/pharmaceutical company relationship is designed to steer patients away from inexpensive alternatives.

Quote

Originally posted by: drmilled
Not to rain on your parade, but just where do you think the insurance companies will get the funds needed to pay for your prescriptions? They sure aren't going to take a hit on their bottom line- the additional monies will be funded by increased policy premiums to those who are insured. I am sure that the policy holders will revel in your joy.

Dan Svatass

Jul 26, 2011
6:26am

Block User

The free market isn't good at some things. It's great at allocating most things (syrups, tattoos, socks) but not everything (firemen, pollution, pharmaceutical safety).

Health care is one thing that the free market is awful at allocating. Mostly because people are awful at accurately assessing their likely needs and planning accordingly before its too late.

Thanks for providing yet another example to the mountain of evidence we all see all around us, if we're bright enough to look.

hoops2

Jul 26, 2011
7:23am

Block User

And of course medicare/medicaid are shining examples of cost efficiency

lostlockee2

Jul 26, 2011
7:39am

Block User

I'll set you up with a scenario that will probably play out for you in the sometime future. Life will go on and you will get accustomed to getting the "latest and greatest $600+ per month medications". Then one day you will step into the pharmacy and the tech will tell you.

"Sorry sir, you're insurance is now requiring a prior auth for your medication and are now not covering it"

Or perhaps a worse scenario, when it comes to renew your contract next year those drugs that you have been so accustomed to taking will now be off formulary and when you go to pick up, the tech will tell you.

"Sorry sir, you're medication is not covered now."

At this point you will say:

"WHAT!! I HAVE HEALTH INSURANCE. HERE IS MY INSURANCE CARD. ARE YOU STUPID? IT IS COVERED. MY MEDICATION IS COVERED!!! IT WAS $10 LAST MONTH"

"sorry sir, now your insurance is no longer covering your medication this month. We are sending a message to the doctor to contact the insurance to get it covered once again or asking him for a change of medication to something your insurance does cover."

"I NEED THIS MEDICATION NOW!!!! I AM NOT PAYING $200 FOR THIS MEDICATION!! IT WAS $10 LAST MONTH. YOUR PHARMACY NOT SELLING ME THIS MEDICATION WILL CAUSE ME TO DIE!! IT IS ON YOUR HANDS IF I DIE!!!!!! I NEED THE MEDICATION NOW."

"sorry sir, either you need to wait for the insurance to work out things with the doctor and the medication gets covered or you have to pay cash price or you wait for the doctor to change the medication"

At this point, you curse out a storm to the pharmacy tech. Scream at everyone at the pharmacy and tell them they are all incompetant losers and they need to get a life and you are calling corporate on them. All while a line of 5+ people are forming behind you. You then walk away, raging and pissed. You blame the f-ed up united states insurance companies, the f-ed up pharmacy, and the f-ed up health system. You blame everyone but yourself.

drmilled

Jul 26, 2011
7:46am

Block User

I believe that scenario is currently in place in Texas if you are an elderly tax paying citizen. If you are an illegal alien these "rules" do not apply.

chefantwon

Jul 26, 2011
9:03am

Block User

Quote

Originally posted by: malibber
I am well aware of how it works and I would be delighted if they have to raise premiums to the point where nobody can afford them anymore and all the private insurance companies went broke. They way I see it is they screwed themselves. They could provide an incentive for people to get the cheap $4 prescriptions at CVS or Wal-Mart by waving the co-pay and being out $4 or they can keep the system they have where the doctor prescribes the latest and greatest formulation of a drug the pharmaceutical company rep is pushing that has a cash price of $200 or more. The only reason I got the $4 prescriptions in the first place is that I specifically asked for them after I researched which ones I could substitute for what I was currently taking. I find most physicians are clueless when it comes to how much something costs the patient. The truth is a lot of common ailments could be treated with inexpensive drugs, but the close physician/pharmaceutical company relationship is designed to steer patients away from inexpensive alternatives.

Quote
Originally posted by: drmilled

My doctor and nurses were well aware of what generic meds I could use that would be the lowest cost. I use the CVS drug plan and it typically runs between $10 to $15 for both of my meds.

malibber

Jul 26, 2011
10:36am

Block User

It simply will not happen. I was on those other latest and greatest drugs for two years before my insurance ran out. The insurance company, the doctor or even the pharmacy never told me hey do you know you can get this drug that is 99.9% as effective as the one your using now for $4. Nobody ever questioned it. I had a $15 co-pay so I never questioned it either. The bottom line is if you want to know one of the areas where all the money is being sucked out of the health care system this is one of those areas. The pharmaceutical companies slightly tweak an existing drug, call it something new and then send their sales minions out to whine, dine and even 69 doctors to get them to prescribe their new drugs instead of the older cheaper ones.

The insurance companies won't complain even if they don't like it because all three groups are in symbiotic relationship (some might call it a circle jerk) with each other to maximize their respective profits by fleecing the general public.

Quote

Originally posted by: lostlockee2
I'll set you up with a scenario that will probably play out for you in the sometime future. Life will go on and you will get accustomed to getting the "latest and greatest $600+ per month medications". Then one day you will step into the pharmacy and the tech will tell you.

"Sorry sir, you're insurance is now requiring a prior auth for your medication and are now not covering it"

Or perhaps a worse scenario, when it comes to renew your contract next year those drugs that you have been so accustomed to taking will now be off formulary and when you go to pick up, the tech will tell you.

"Sorry sir, you're medication is not covered now."

At this point you will say:

"WHAT!! I HAVE HEALTH INSURANCE. HERE IS MY INSURANCE CARD. ARE YOU STUPID? IT IS COVERED. MY MEDICATION IS COVERED!!! IT WAS $10 LAST MONTH"

"sorry sir, now your insurance is no longer covering your medication this month. We are sending a message to the doctor to contact the insurance to get it covered once again or asking him for a change of medication to something your insurance does cover."

"I NEED THIS MEDICATION NOW!!!! I AM NOT PAYING $200 FOR THIS MEDICATION!! IT WAS $10 LAST MONTH. YOUR PHARMACY NOT SELLING ME THIS MEDICATION WILL CAUSE ME TO DIE!! IT IS ON YOUR HANDS IF I DIE!!!!!! I NEED THE MEDICATION NOW."

"sorry sir, either you need to wait for the insurance to work out things with the doctor and the medication gets covered or you have to pay cash price or you wait for the doctor to change the medication"

At this point, you curse out a storm to the pharmacy tech. Scream at everyone at the pharmacy and tell them they are all incompetant losers and they need to get a life and you are calling corporate on them. All while a line of 5+ people are forming behind you. You then walk away, raging and pissed. You blame the f-ed up united states insurance companies, the f-ed up pharmacy, and the f-ed up health system. You blame everyone but yourself.

BobOrme

Jul 26, 2011
11:38am

Block User

Quote

Originally posted by: malibber
It simply will not happen. I was on those other latest and greatest drugs for two years before my insurance ran out. The insurance company, the doctor or even the pharmacy never told me hey do you know you can get this drug that is 99.9% as effective as the one your using now for $4. Nobody ever questioned it. I had a $15 co-pay so I never questioned it either. The bottom line is if you want to know one of the areas where all the money is being sucked out of the health care system this is one of those areas. The pharmaceutical companies slightly tweak an existing drug, call it something new and then send their sales minions out to whine, dine and even 69 doctors to get them to prescribe their new drugs instead of the older cheaper ones.

The insurance companies won't complain even if they don't like it because all three groups are in symbiotic relationship (some might call it a circle jerk) with each other to maximize their respective profits by fleecing the general public.

I'm trying to figure out why you feel good that anyone is getting fleeced by your own admitted intentional actions to increase costs to someone somewhere in the chain. It wouldn't make me feel good. It might make it hard for me to sleep at night....

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