5 ms·

It seems we really like to focus on "the evil" company, but it goes two ways. Example: A family member has serious adult scoliosis, which causes quite a bit of

It seems we really like to focus on "the evil" company, but it goes two ways. Example: A family member has serious adult scoliosis, which causes quite a bit of pain. For years she has taken Fentanyl Nasal Spray that was made by a compound pharmacist (e.g., they take the raw Fentanyl powder, and mix it with a liquid solution by hand). The retail cost of this is ~$3k for a 30 day supply. Her insurance brought that down to sub $100. 2 years ago, she received a letter from her insurance company stating that because the FDA refuses to guarantee compound (made by hand) drugs, they will no longer cover her current nasal spray and she must move to one of the alternatives. One alternative was a lollipop, which she used to take but caused her teeth to rot and she now has dentures. Another was different oral delivery system, but it was discontinued by the mfg less than 6 months after this. So far her only option is a product called Lazanda, they are individually packaged and metered glass bottles of Fentanyl nasal spray. Each bottle is roughly half a day's dose, has it's own box, literature in EACH BOX, and a month's supply is 60 of these boxes. The retail value of this? Last time I looked it was >$30,000. And the insurance just accepts it. Madness.

replicatorblog 10y ago
Often the "sticker price" is just a negotiating chip. Big drug co's and big pharma have a byzantine relationship of price hikes and rebates. I wouldn't be surprised if the price the insurer pays is not materially higher than the original $3K.
- supergeek133 10y ago
  That could be true, she has chosen to pay for the compound version with cash more than once, and the price is $3k. It provides much more relief than the packaged version. Obviously on the EOB from the insurer, they show they paid the same price the pharmacy communicates. That's pretty crazy if the TRUE price is obscure Not sure on the packaged version price if cash was paid..
  - pkaye 10y ago
    My guess is the insurer will get a rebate at the end of the year from the drug manufacturer based on volume discount.
    - supergeek133 10y ago
      Probably a safe assumption.
- pg_is_a_butt 10y ago
  sheeeeeeeeeeeit, i wouldn't be surprised if the price was less than the $100 copay, and the insurer pockets the difference on top of your premiums. you're all idiots.
wtbob 10y ago
> 2 years ago, she received a letter from her insurance company stating that because the FDA refuses to guarantee compound (made by hand) drugs, they will no longer cover her current nasal spray and she must move to one of the alternatives. I wondered who lobbied for the FDA to make such a refusal, and who lobbied the insurance companies not to cover such unguaranteed drugs.
- supergeek133 10y ago
  If I had to guess, probably the people who make Lazanda (the pre-packaged version of what she lost that doesn't work as well).
- karmelapple 10y ago
  Having a very clear version history of both the laws in place, and the bills that made those laws, would be super useful in answering this question. Are the laws / rules for that publicly accessible?
  - supergeek133 10y ago
    http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/PharmacyCompounding/ucm375804.htm http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInforma...
- BurningFrog 10y ago
  Not all government actions are caused by lobbying. "Lobbying" is not really a meaningful term for an insurance company. They probably can't cover unguaranteed drugs due to regulation.
  - metaphorm 10y ago
    what influenced the regulatory legislation though? that's what we mean by "lobbying".
    - BurningFrog 10y ago
scoot 10y ago
Why do you consider $30,000 dollars madness, but not $3,000? $100 for a single dose? Hand-shaken or not, it's still madness.
- supergeek133 10y ago
  Never said I didn't, but you have to take everything in context. If you take a pharmacist that has to be specially trained/certified to compound, plus one of the most potent/dangerous narcotic prescription painkillers out there and put them together, maybe $3,000 is the right price? I don't know how much any of those steps costs. Or what someone's time is worth there. 4-5 years ago, yes we thought $3k is obviously high, but then you put the fact that now her only answer is a $30k alternative? Context matters. The entire thing is madness back to how she ended up this way, but that's a longer story.
- philh 10y ago
  It sounded to me like $100 for a thirty-day supply.
  - metaphorm 10y ago
    it was implied that that was the insurance co-pay. her own out of pocket expense was only $100, but the overall cost of the medication was still $3000, thus $100/dose x 30 days per month = $3000/mo.
    - supergeek133 10y ago
      Yes, the co-pay was ~$100.
- BurningFrog 10y ago
  The madness is to pay $30k when the $3k solution works fine.
  - supergeek133 10y ago
    Correct.
h4pless 10y ago
I know this is beside your point and not to be the Coloradan in the room, but has she tested the efficacy of marijuana to ease her pain? I'm not a doctor, which is who she would want to talk to first, but from my understanding, pot is so harmless that can be taken in conjunction with Opiate pain killers. It's not addictive or potentially life threatening like opiates. There are strains that leave you mentally functional while killing pain. And depending on how much she needs, the retail cost would probably be in area of $70 - $200 a month and would be going to local entrepreneurs & farmers. If you grow it yourself, the cost goes down to maybe $10 - $30 a month depending on your state's MMJ regulations. Side note: https://livertox.nlm.nih.gov/Opioids.htm https://livertox.nlm.nih.gov/Opioids.htm
- supergeek133 10y ago
  I live in MN, we just recently got a full medical marijuana program.. but the paperwork is quite extensive and the approval process long. There is already quite a wait. But yes, I'm sure it would help her somehow. Although she is in remission from lung cancer as well and is on oxygen, I'm a bit ignorant to the side effects there.
  - ferentchak 10y ago
    As another Coloradoan there are extracts that can be inhaled in a vapor that could be useful if the smoke is an issue might be worth talking to your doctor. When my mother was passing from cancer she didn't like the edible formats since they take a long time to kick in and it can be hard to determine an hour out how much pain or nausea she would be experiencing. Vapor and smoking seemed to be a great way to get a fast dose to decrease suffering.

replicatorblog 10y ago

Often the "sticker price" is just a negotiating chip. Big drug co's and big pharma have a byzantine relationship of price hikes and rebates. I wouldn't be surprised if the price the insurer pays is not materially higher than the original $3K.

supergeek133 10y ago
That could be true, she has chosen to pay for the compound version with cash more than once, and the price is $3k. It provides much more relief than the packaged version. Obviously on the EOB from the insurer, they show they paid the same price the pharmacy communicates. That's pretty crazy if the TRUE price is obscure Not sure on the packaged version price if cash was paid..
- pkaye 10y ago
  My guess is the insurer will get a rebate at the end of the year from the drug manufacturer based on volume discount.
  - supergeek133 10y ago
    Probably a safe assumption.
pg_is_a_butt 10y ago
sheeeeeeeeeeeit, i wouldn't be surprised if the price was less than the $100 copay, and the insurer pockets the difference on top of your premiums. you're all idiots.

wtbob 10y ago

> 2 years ago, she received a letter from her insurance company stating that because the FDA refuses to guarantee compound (made by hand) drugs, they will no longer cover her current nasal spray and she must move to one of the alternatives. I wondered who lobbied for the FDA to make such a refusal, and who lobbied the insurance companies not to cover such unguaranteed drugs.

supergeek133 10y ago
If I had to guess, probably the people who make Lazanda (the pre-packaged version of what she lost that doesn't work as well).
karmelapple 10y ago
Having a very clear version history of both the laws in place, and the bills that made those laws, would be super useful in answering this question. Are the laws / rules for that publicly accessible?
- supergeek133 10y ago
  http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/PharmacyCompounding/ucm375804.htm http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInforma...
BurningFrog 10y ago
Not all government actions are caused by lobbying. "Lobbying" is not really a meaningful term for an insurance company. They probably can't cover unguaranteed drugs due to regulation.
- metaphorm 10y ago
  what influenced the regulatory legislation though? that's what we mean by "lobbying".
  - BurningFrog 10y ago

scoot 10y ago

Why do you consider $30,000 dollars madness, but not $3,000? $100 for a single dose? Hand-shaken or not, it's still madness.

supergeek133 10y ago
Never said I didn't, but you have to take everything in context. If you take a pharmacist that has to be specially trained/certified to compound, plus one of the most potent/dangerous narcotic prescription painkillers out there and put them together, maybe $3,000 is the right price? I don't know how much any of those steps costs. Or what someone's time is worth there. 4-5 years ago, yes we thought $3k is obviously high, but then you put the fact that now her only answer is a $30k alternative? Context matters. The entire thing is madness back to how she ended up this way, but that's a longer story.
philh 10y ago
It sounded to me like $100 for a thirty-day supply.
- metaphorm 10y ago
  it was implied that that was the insurance co-pay. her own out of pocket expense was only $100, but the overall cost of the medication was still $3000, thus $100/dose x 30 days per month = $3000/mo.
  - supergeek133 10y ago
    Yes, the co-pay was ~$100.
BurningFrog 10y ago
The madness is to pay $30k when the $3k solution works fine.
- supergeek133 10y ago
  Correct.

h4pless 10y ago

I know this is beside your point and not to be the Coloradan in the room, but has she tested the efficacy of marijuana to ease her pain? I'm not a doctor, which is who she would want to talk to first, but from my understanding, pot is so harmless that can be taken in conjunction with Opiate pain killers. It's not addictive or potentially life threatening like opiates. There are strains that leave you mentally functional while killing pain. And depending on how much she needs, the retail cost would probably be in area of $70 - $200 a month and would be going to local entrepreneurs & farmers. If you grow it yourself, the cost goes down to maybe $10 - $30 a month depending on your state's MMJ regulations. Side note: https://livertox.nlm.nih.gov/Opioids.htm https://livertox.nlm.nih.gov/Opioids.htm

supergeek133 10y ago
I live in MN, we just recently got a full medical marijuana program.. but the paperwork is quite extensive and the approval process long. There is already quite a wait. But yes, I'm sure it would help her somehow. Although she is in remission from lung cancer as well and is on oxygen, I'm a bit ignorant to the side effects there.
- ferentchak 10y ago
  As another Coloradoan there are extracts that can be inhaled in a vapor that could be useful if the smoke is an issue might be worth talking to your doctor. When my mother was passing from cancer she didn't like the edible formats since they take a long time to kick in and it can be hard to determine an hour out how much pain or nausea she would be experiencing. Vapor and smoking seemed to be a great way to get a fast dose to decrease suffering.