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Some insurers insist that patients forgo generics and buy brand-name drugs

• cbanek 9y ago
  I have United Healthcare, and I have to say I've seen this happen to me as well. I'm on a long term maintenance medication, which is delivered by patch. I was on the generic in my previous health plan, so my new doctor prescribed the same generic. I used the mail order pharmacy and they told me that a 90 day supply would cost $347. I asked why it was so much, and where my prescription benefits came in. They said they didn't cover the generic, and I said well do you cover the name brand one? They said they did, but they couldn't give it to me because my doctor had ordered the generic. If I ordered the name brand, it would be $100 for a 90 day supply, which is a huge difference. I called my doctor, and got them to change the prescription. None of the people at United Healthcare were offering any of this information, and I basically had to pry it out of them to figure out why they were trying to gouge me. Also, this was their own private mail order pharmacy, so all the money was going to them as well. Ask a lot of questions before paying a lot of money.
  • pcurve 9y ago
    "They said they didn't cover the generic, and I said well do you cover the name brand one? They said they did, but they couldn't give it to me because my doctor had ordered the generic. If I ordered the name brand, it would be $100 for a 90 day supply, which is a huge difference." 3 possibilities: 1. Your doctor wrote "dispense as written" on the script, which barred United from substituting. This is highly unlikely because doctors only do this when prescribing name brand. 2. United didn't have system rules in place to flag this type of thing because there's no financial incentive to do so for United or your employer who is actually paying for your drug. Chances are, if generic costs $347, then brand name costs more. When you pay $100, your employer is still paying the remaining, which could be $250+ When you get generic, your employer pays nothing. 3. United didn't have system rules in place to flag this because they are just incompetent. The fact that they don't cover generic means that your employer is getting rebate from brand. Unless your employer is trying to save a few bucks by intentionally screwing over their employee, United system should've flagged this an simply auto substituted to cheaper alternative. Either way, unless brand was materially different, United is within legal right to auto substitute without needing a new scripts. In short, they served you a bunch of turd sandwiches.
    • cbanek 9y ago
      I'm actually self employed, and I got this health care policy on the health care exchanges - there's no employer in the picture, which is probably why they're trying to shift the cost to me, as opposed to paying for the brand. So really, without an employer, it's just because there's no financial incentive for them to do so. Actually, it's negative incentive for them, because they tried to get me to pay for something they wouldn't have to pay anything for. Then for dispensing it, they charge me since they are also the pharmacy.
      • pcurve 9y ago
        Yes, without employer in picture, what they did was probably deliberate. They also straight up lied to you about needing a new script. I work in the industry and familiar with some of these practices, but this is pretty low.
      • drewmol 9y ago
        I understand if you don't want to answer this, but is there a subsity covering part of your plan you purchased through healtcare.gov?
        • cbanek 9y ago
          No, I pay the full price myself out of pocket (and write it off on my taxes).
          • drewmol 9y ago
            Thx for the response, wondering what UHG's potential motivations may be. I used to work in the medical billing industry, and UHG had a very poor reputation (among major insurers) with the two healthcare management consultants I worked closely with. (edit: UHC-->UHG)
            • mannykannot 9y ago
              The last paragraph in the article gets to the point: “There’s only one reason why they’re requiring you to use a more expensive product,” Mr. Frankil said. “Because somewhere down the road, somebody is earning more money.” The brand-name maker would like the generic market to dry up, so it may be as simple as the brand-name maker selling its product at a reduced price on condition that the insurer cuts off the generics. Given that some patients demand brand-name drugs and some doctors acquiesce, this may be cheaper for the insurer. My doctor has a straightforward attitude - referring to patients who demand brand-name drugs "I told them 'I take generics. My kids take generics. If you won't take generics, find another doctor!'" (that was before the practice described here emerged. I am sure he has something to say about it...)
  • secabeen 9y ago
    I had a similar situation with my mail order pharmacy. Ordered a 90-day supply of maintenance medication, was charged brand rates against my deductible. They dispensed the brand rather than the generic. Asked why, they said, well, we have a deal with the company, you get brand drugs at the cost of the generic co-pay! They neglected to understand that some of us don't have co-pays for Rx, and pay the actual cost. Solution? Go to Costco, get 30-day subscription, pay pennies per pill.
  • gambiting 9y ago
    This might be a stupid question, since I don't know how the US system works - if you have health insurance, why do you have to pay anything for drugs "covered" by your insurer? If they cover a medication, why is there anything left to be paid by you? Do you also have to pay if you have any treatment that is "covered" by your insurer?
    • adventured 9y ago
      Health insurance plans have varying coverage for drugs (and those plans can vary a lot state to state), so that's going to depend on the plan. Decent plans typically pay everything but a very small charge. Average plans often have limits to routine prescription drug coverage in a given year. A medication I took last year cost around $90-$100 or so. The insurance covered all but $10 of that.
      • lawnchair_larry 9y ago
        Many have large deductibles as well, so it's common for yearly medication costs to be out of pocket.
    • Amezarak 9y ago
      As an example, I have a 4500 dollar deductible. That means until I pay 4500 for prescriptions, doctor visits, labs, ER visits, etc., insurance pays nothing, though I do get their negotiated "discount" from the provider. After that, the insurance pays 80% of the cost until I have paid out some even larger number, at which time they pay 100% until January rolls around. This is a pretty normal plan, and the type the guy you're responding to is describing; older plans often have much lower deductibles and have copays, though premiums tend to be higher, but one they're hard to find now. It's very easy to meet a 4500 deductible. I've already done it for the year without any major health events.
      • akuji1993 9y ago
        For anyone in Europe in a normal healthcare plan, US healthcare is just a fucking joke.
  • lojack 9y ago
    Just because it's their own private pharmacy doesn't necessarily mean they follow a different set of rules. The PBM probably has that pharmacy set up like any other and treat it as a preferred pharmacy with internally negotiated discounts.
  • joshstrange 9y ago
    BriovaRx I assume? These guys are the worst. OptumRx (might be who you have through United as well) screwed me over because no one ever explained to me what the hell a "specialized" medication was. I was put on a $drug and so when asked where I wanted to fill it I told my doctor to send it to my local Kroger Pharmacy. I went and tried to use my insurance but it wouldn't run for this $drug. I called OptumRx (the number on my healthcare card) and they said it should work. I gave them all my info, they assured me Kroger Pharmacy was In-Network, and they had me stand in line again so that they could talk to the pharmacist. No one could figure out what was wrong so the pharmacist gave me 3 pills to get started and OptumRx told me it would be cleared up by tomorrow and they would call me. Day 1, no call. Day 2, no call. Day 3 I call the pharmacy and they say they haven't heard anything from OptumRx, I called OptumRx and they finally realized that this $drug is a special drug that can ONLY be filled by their online pharmacy BriovaRx. I get transferred to BriovaRx and they say they can mail me the drug in 2-3 days and I tell them that's not going to work because I took my last pill today and there aren't supposed to be any breaks in the medication. Finally they cave and call in an "override" so I can get it from Kroger this one time. They also fucked up a delivery once and told me they couldn't send more pills until they figured out what happened to the last package (which could take days) and I was 1 pill away from being out. I had to fight my way through people telling me there is nothing that could be done about it until finally, again, someone called in an override. Mail order may be nice and all but when I can't re-order until I'm less than a week out and shipping doesn't always work as expected it's a huge PITA and a big stressor. I order EVERYTHING off Amazon so trust me when I say I prefer the idea of mail order but when I need a medication I want to be able to walk down to the Kroger Pharmacy and fill it instead of waiting for something that might not come on time.
    • compuguy 9y ago
      Express Scripts is pretty bad as well. I've lost count of how many hours I've spent on having to jump through the oddies of mail order pharmacies...
      • baldfat 9y ago
        Well you saved me. I was going to do a 90 day med with them to save a trip to the pharmacy.
• tzs 9y ago
  I wonder if the guy in the article has considered buying his drug without insurance? In the case of the generic for Adderall XR it is about $70 with a GoodRx coupon at Walgreens, which is less than the $90 copay to get the brand drug with insurance. Even if your insurance company lets you use generics, it is a good idea to take a look at GoodRx, and take a look at Walmart. I've had generics where through my insurance my out of pocket was a $20 copay, but when I checked GoodRx there was a $12 coupon. I've had other generics, again with a $20 copay if I got them through insurance, where they were $4 at Walmart with no insurance or coupons.
  • brilee 9y ago
    From the article: > Then, in 2014, her pharmacist told her that her insurance plan would cover only the brand-name drug, which cost her family some $50 more a month than the generic. If she paid for the generic herself, it would not have counted toward her deductible. Ms. Freundlich complained to her insurer, UnitedHealthcare, but could not get a clear answer.
  • vm 9y ago
    This is good advice, though the article also mentions that self-paid drugs don't count toward deductibles. In addition to shopping around, patients should calculate their deductibles and estimate how that might impact their spending. ...which is a messed up, Byzantine system. I'd love a single payer system just to crush this inefficiency out of the system and make patient's lives easier. I would have thought healthcare is all about saving lives but in the U.S. it seems like a dirty busy.
    • Aloha 9y ago
      I'd love for us to so some market-based reforms to the current system before we blow it up - I concede that Single Payer is likely the only workable answer in the end. We need to do things like tort reform, the current system presumes that a doctor making a mistake is an extremely rare thing - its not, doctors are human like any other mechanic. Instead doctors over diagnose, and over treat out of fear of liability (which in most states is unlimited). we could limit liability to 2x the actuarial predicted lifetime earnings potential, and limit damages for pain and suffering to 1x that. We need to allow insurers to pool together to purchase drugs to force the price down - medicare should also be unshackled and be allowed to negotiate pricing on drugs as well. We should require cost transparency in healthcare - try asking how much a procedure is the next time you go to the doctor, you'll get a bunch of blank stares. People cant make reasonable choices if they cant perform a cost benefit analysis. Those changes alone - while they may not reduce costs would stop the increases from occurring as quickly.
• 0x10101 9y ago
  Some of this insanity is covered nicely in the econlog podcast[1] on the book Drug Wars[2]. The NY Times always wants to throw all of the blame at insurers, but they are trying to save money. The generic system is a Kafakaesque set of regulations and processes. [1] http://www.econtalk.org/archives/2017/06/robin_feldman_o.html http://www.econtalk.org/archives/2017/06/robin_feldman_o.htm... [2] https://www.amazon.com/Drug-Wars-Pharma-Raises-Generics-ebook/dp/B071RP95DN/ https://www.amazon.com/Drug-Wars-Pharma-Raises-Generics-eboo...
• zamalek 9y ago
  My sister had an acne breakout in her teen years and went on a brand-name hormone suppliment - it worked wonders. She went on the generic and only had problems - so far as I understand the situation the delivery mechanism is different across brands; though it's very rarely a problem for most people. As always, it's your health at stake - if you feel as though something is not working for you then switch.
  • btian 9y ago
    Generics mean the active ingredients are the same. Your sister's condition probably reacted to some inactive ingredients. Generic may work better just as brand name may work better in that case.
• mason55 9y ago
  Same thing for me. When I get refills I see whichever psych happens to be free that day and they always comment on how weird it is that my insurance requires the brand name. I always tell them that I assume the insurance company has cut a deal with Shire and it appears I was right. But my copay for the name brand is only $20 so it never occurred to me to complain.
• colordrops 9y ago
  I have to take levothyroxine and my endocrinologist insists that I take a particular name brand. The amounts are in micrograms and the dosage varies across brands, and since various pharmacies use different generics, the only way to get consistency is through sticking with a particular brand.
• Sindrome 9y ago
  My first software job out of college was working for a healthcare company. I worked in the Drug Comparison team (which consisted of 3 people) finding people ways to save on prescriptions by beating the system using software! Yay, helping the world and stuff. Actually, we ended up selling out and building systems that benefited healthcare provider's formulary plans. For example, not recommending generics, which was most of what we got paid 500k+ per contract to do. We did do some amazing work on Medicare Part D stuff, tho. We saved some elderly people tons of money by algorithmically reccomending them the right drugs at cheaper cost.
• broknbottle 9y ago
  I wouldn't be surprised if this was due to issues with some generics not being the equivalent. Concerta is a weird drug with the one generic actually being rebranded brand name. The other generics are not considered equivalent by the FDA but the last time I checked some pharmacy such as Walgreens carry the non equivalents. Apparently they are tied up in a court case. https://www.fda.gov/Drugs/DrugSafety/ucm422568.htm https://www.fda.gov/Drugs/DrugSafety/ucm422568.htm
• AdamN 9y ago
  The big secret is that bio-equivalent and generic drugs sometimes aren't effective! http://cmlnetwork.ca/generic-imatinib-is-it-really-the-same/ http://cmlnetwork.ca/generic-imatinib-is-it-really-the-same/ http://cml-iq.com/generic-gleevec-is-the-same-the-same/ http://cml-iq.com/generic-gleevec-is-the-same-the-same/ Frustrating that the article doesn't point that out. These new formulas do not need to prove they work, they just have to prove that their active ingredient is the same after the patent expires.
  • stuartaxelowen 9y ago
    Has there been a study that established that the drugs with the same active ingredient don't perform as well?
    • ihodes 9y ago
      There are studies showing that some generics don't perform as well as the brand name. Different formulations of the same drug (e.g. extended release medications, different sized particles in inhalers, etc) can have vastly different effects.
    • brians 9y ago
      Yes, in the specific case of Valproic Acid, a powerful mood stabilizer used for schizophrenia. The generics are different salts, metabolize differently, and different patients typically end up preferring one. If you like one of the two generics, great! If your body best tolerates the name brand... oops.
    • gumby 9y ago
      Yes, there's more to a treatment than the API (Active Pharmaceutical Ingredient) which is used to prove bioequivalence. The excipients aren't typically considered relevant, especially when they're on the GRAS list. One of my former colleagues once made a "drug" where the excipient actually was therapeutically valuable while the listed API was barely better than placebo. Luckily we didn't submit it for approval.
      • 9y ago
• kindawinda 9y ago
  The insurers often have PBM contracts that incentivize them in filling specific drugs. This is the most likely reason https://en.wikipedia.org/wiki/Pharmacy_benefit_management https://en.wikipedia.org/wiki/Pharmacy_benefit_management
  • alkonaut 9y ago
    Aren't pharmacies allowed to suggest generic replacement to the drug on the recipe (unless the prescribing doctor explicitly stated to not allow it?) Do doctors prescribe the specific brand drug and prevent changing it to generics, because the insurer tells them to? That sounds like a solvable problem: doctors that prevent swapping for generics must have valid medical reasons, not only economical reasons. Makes sense?
• Spooky23 9y ago
  I monitor my blood pressure pretty closely, and noticed when my blood pressure medication changed between generic manufacturers, one particular manufacturer was less effective, and my pressure went up 10-15%.
• crb002 9y ago
  Adderall XR and Metformin actually are better than the generic.
  • LammyL 9y ago
    Metformin is the generic. Glucophage is its equivalent brand.
    • burntrelish1273 9y ago
      I get a 30 day (1.5 grams twice per day) supply of Metformin at Walgreens for < $5.
    • dp-tyvek 9y ago
      OT, but how did the brand name Glucophage get approved? I don't see how calling a drug "glucose eater" is anything but misleading.
      • jameskraus 9y ago
        In general, stimulants were once more popular as apatite curbing agents. When the drug was developed, they probably thought people would use it to lose weight, so 'glucose eater' has the same general effect they were going for: weight loss.
• random3 9y ago
  Perhaps it's the same as with medical services? Note that providers won't typically tell you the cost of a procedure unless you give them your insurance. Don't insurers have negotiated (lower) rates with providers? Also there's typically a relatively large deductible. I'm guessing that between the negotiated price and the deductible and the non-sense of the insurer choosing something against common sense there's actually money to be made off the patient. So if you're charged $1000 for an MRI and have to co-pay 200 and the negotiated cost is $200 you actually end up paying 100% of the actual cost. You can redo the math with whatever number, but the point is the percentage you think you're insured for is not real. If insurer asks you to buy a 10x more expensive drug while they have a much smaller negotiated price, they may end up paying less or actually making money.
  • phkahler 9y ago
    My argument for years now has been that "providers" should be required to charge the same price for every patient. In other words, insurance companies should not be able to negotiate prices with them. The idea that an insured person (and his insurance company) is charged less for a procedure than an uninsured person... well that's just wrong. As usual I like to clarify - providers should be free to set their price for a service/product, but they must charge everyone the same for it. Different providers would be free to charge different prices of course.
• xenadu02 9y ago
  I've been hit by this too. The scam is really simple: Take the example in the article: Shire normally sells Adderall for $200. They offer to sell it to UHC for $50. The generic costs UHC $60. UHC takes the generic off the formulary and will only pay for Shire. For the end user the out-of-pocket cost goes from $10-20 to $50 because brand medications are in the "Premium" category. By saving $10 UHC sticks you with a $40 higher bill - literally 4x what they are saving. Targeting this specific behavior is trivially easy: change the law to require insurers to cover generic or brand for any RX at the patient's choice.
  • phkahler 9y ago
    Better yet, from the article: Then, a few years ago, Shire tried a new tactic: giving ever-larger discounts to pharmacy benefit managers and insurers for preferential treatment over the generics. That did not mean lowering the list price of the drug, but rather negotiating rebates that were paid not to the patients but to insurers and middlemen such as CVS Caremark. Just prosecute them for anti-competitive practice or even collusion. What they are doing is probably already illegal.
• hkmurakami 9y ago
  I skimmed the article, and there is another force at play that benefits insurance companies. Insurance companies have a federally mandated percentage of revenue that they must use towards the reimbursement of their policy holders' medical costs. In the past, this ratio was too low and they're been slapped with stricter conditions. But Health Insurance is an industry where you can basically pass on your costs to your policy holders with near impunity (the current "healthcare debate" rarely discusses cost control in depth, and instead spends time on the correct level of cost sharing). And if your overall costs grow, then you can raise your overall revenue. And when your overall revenues grow, you have more money to pay your executives. Consumers lose, everyone else in the healthcare value chain wins.
• denisehilton 9y ago
  What's the guarantee that branded drugs won't have any side-effects. There's none. and they're pretty expensive too.
• mnm1 9y ago
  Yet another problem that can be solved by a single payer system that can negotiate reasonable prices and doesn't need to profit off its members suffering and death. Get rid of the insurance companies and you get rid of this problem and a whole lot more.
  • briandear 9y ago
    Such a simplistic view. Cancer death rates in the UK are 255 per 100,000; in the U.S. they are about 163 per 100,000. It’s not so black and white that “single payer is better.” Health care is always going by to be a scarce resource and it follows the laws of economics just like anything else. It isn’t immune to reality just because it’s important.
    • phaemon 9y ago
      > Cancer death rates in the UK are 255 per 100,000 No they're not. Cancer mortality rates (per 100,000) are: UK: 109.97, USA: 105.78, Spain: 98.06, Australia: 96.36 > It’s not so black and white that “single payer is better.” In the vast majority of measures, it clearly is. ( Stats from: http://www.cancerresearchuk.org/health-professional/cancer-statistics/worldwide-cancer/mortality#heading-Zero http://www.cancerresearchuk.org/health-professional/cancer-s... )
• mirimir 9y ago
  It's just that drug makers cut deals with insurance companies. Drop competing generics from your formulary, and we'll give you a good price for our brands. Or maybe on a basket of products. So you get more money, both by paying less for the drugs, and by charging patients more.
• egeozcan 9y ago
  I'm relatively new in Germany. As far as I can remember, the doctors always prescribe the generic drug, but I can't verify because I never keep the prescriptions. Can someone confirm?
  • thesimon 9y ago
    Does not really matter a lot what the doctor exactly writes on your prescription, because "aut idem" will not be ticked on the prescription in most cases. The pharmacy then does most of the work and checks with your insurance which drug manufacturer has a contract with the insurer and hands you the cheapest one. This usually is a generic and you would get that even if the doctor wrote the brand-name one on your prescription. The doctor can decide to tick "aut idem" and you would get exactly the medication by that exact manufacturer prescribed, but you might have to pay extra at the pharmacy for this so this is really uncommon.
• SeanDav 9y ago
  I just don't understand medical care in the USA. Medical treatment seems enormously expensive, if you are not insured and you get ill, you die and yet getting insurance seems to be resisted (Obama-care). Would someone be able to explain (or point to an existing layman's explanation) how medical care works in the USA, the issues with insurance and strengths and weaknesses.
  • feedbeef 9y ago
    The US healthcare system is deeply burdened with the flow of money between all parties involved in it. Money is integral to the system like the blood in our veins. Without blood pumping (money flowing), the system as it exists today dies. How Americans obtain health insurance is largely dependent on their age/occupation (retired, coverage thru employer, etc) and income/assets. There is strong incentive to be insured to avoid a yearly tax penalty. People with low income qualify for partial or full subsidy of their insurance cost, largely footed by more fortunate tax- and insurance-paying Americans. But unless they are poor, they are still expected to pay for services rendered out of their deductible, a fixed ceiling in USD that they agreed upon with their insurer (a higher deductible tends to lower insurance cost). Having insurance also significantly reduces the "retail" cost of services and medicine (an uninsured billionaire may happily pay $250,000 cash for an ER visit, while an insured student may struggle to pay their $2,500 deductible for the same thing). One upside to Obamacare is that it has taken a lot of stress away from people, as they historically could have become destitute from massive healthcare bills that overran obscenely high deductibles (now capped under Obamacare). Pre-Obamacare, insurers had a deductible of their own sort, one which allowed them to deem an overrun so high, or a health condition so dire, that they could cut a person off (sort of like a bandwidth cap, but for human life, a lifewidth cap if you will). One (primarily financial) downside to Obamacare is that insurance costs have increased to pay into the subsidy and sky-high bill bucket (and the leftovers into for-profit insurance companies' pockets). So Obamacare, i.e. American healthcare today, is largely an effort to not only insure every American, but also protect them from financial ruin in a health crisis. And to accomplish that, the money must be flowing. We certainly have a lot of amazing selfless people doing their best to heal the sick, but as the players in this article, people like Shkreli, and some of our congress members make so clear, follow the money trail to its darkest depths and you will find the true face of American healthcare. It's being stymied at every turn and will continue to be until it's either rescued by reform or decimated by profiteers. This barely touches on your questions and leaves out some critical details but I hope it's of some use.
• agumonkey 9y ago
  People will anyway. You only needs the slightest derivation from one's habit and it's over.
• PaulAJ 9y ago
  You guys have the most bonkers health system anyone could imagine. 1/6 of your economy goes on "health care", but most of that doesn't actually contribute to your health, it gets skimmed off by insurers, drug companies, individual practitioners, hospitals and lawyers. Sooner or later you are going to wake up and realise that a government-run single payer scheme is the only way to go.
  • dandare 9y ago
    I totally agree with everything up to the last sentence. State can be a horrible manager too, trust me I am from Europe. Is the problem not about lack of competition and all kinds of barriers?
    • EADGBE 9y ago
      States can be horrible managers too, trust me I am from the US.
  • folli 9y ago
    I've yet to come across a health insurance scheme that I'd approve without any reservation. The British NHS that you obviously praise as the single solution is also not without its flaws regarding quality and waiting lists. An acquainted Iranian surgeon who works in England under the NHS remarked that he'd rather fly to Iran in case he should ever get a surgery because the infrastructure is more up to date and the surgeons equally well trained. The Swiss healthcare system, which I'm more familiar with (universal healthcare, with health insurance being compulsory, while the insurance companies are still private), is also not devoid of flaws. The assumed competition among the insurance companies is not working at all, resulting in rising costs since years.
    • throwawaymanbot 9y ago
      There is NO perfect healthcare system. But I feel, its fairer to consumers in Switzerland and the UK. Its kind of turned in to a sick (excuse the pun) joke here in the US.
    • 9y ago
• maxehmookau 9y ago
  American healthcare is weird. I pay £9.50 for all of my meds. The NHS decides which is the cheapest version of the drug I need. And that's what I get. It costs £9.50 regardless of the quantity, brand or anything else.
  • EADGBE 9y ago
    Most generic co-pays for medication also are about $10-$12.
    • maxehmookau 9y ago
      'Most' being the operative word. In the UK, the most basic of generic meds are this flat rate as are the latest targeted medications which could cost tens of thousands of pounds if bought with insurance. Unless it's administered in a hospital, in which case it's free. The whole US system seems designed to gouge as much money out of the 'consumer' as possible by confusing you. Similar to how we run trains the UK. Except if you miss a train, you won't die. For most europeans (especially brits), how the US manages to continue to justify the existence of such a system is baffling.
      • EADGBE 9y ago
        We'd have to compare medication to determine whether that "most" is 51% or 99%. I'm not saying it's better or worse, don't get me wrong. Is there data out there that extrapolates Single-Payer tax revenue to relate to insurance premiums? We need that to really compare the overall costs. I'd be interested in seeing that, because some days I'm all for adopting an "everyone gets it" mentality, especially if the costs are comparable. If I didn't have to deal with miscellaneous billing after the insurance pays them would negate the need for my mailbox. However, as brought up in another comment of mine, I'd still like to be able to see someone same-day for something (employers too), even if it's non-life-threatening.
        • maxehmookau 9y ago
          You're right, unfortunately I don't have that data. I can only give you my personal experience of the NHS. The often portrayed boogieman of NHS waiting lists are usually incorrect. I saw my GP this morning after ringing up 20 minutes previously and had an appointment within the hour. I was in and out within 30 minutes with a prescription that was electronically sent to my pharmacist who had filled it before I arrived later today. The whole process cost me nothing, except for the prescription fee which is capped at £120 a year for the heaviest users. Last week my wife ended up in A&E (what you call the ER). She was seen within 2 hours by a doctor who assessed her, triaged her, gave her some medications (which were free as they were in hospital) and sent her on her way. It's an insanely efficient system. Primary care in the NHS (GPs, Emergency care) is usually pretty impressive despite what many tabloid papers say. Secondary care can often have waiting lists but their length is legally enforced with the state having to pick up the tab for private care if wait times are longer than the legal maximum. America seems to think this is the way to kill your population. It's really pretty great!
• brooklyntribe 9y ago
  The mile high view of USA health care is if we can "eliminate" the poor, the old, the sick, in the long run, it will make our economy stronger. It seems to be doing it's thing. The life expectancy is coming down for the first time in decades and the stock market is at a record high. It's a "social darwinism" thing. We're a living lab to test the theory out. That's the mile high view. I'm not sure what the long term consequences are. > US life expectancy drops for first time in 22 years http://www.cnn.com/2016/12/08/health/us-life-expectancy-down/index.html http://www.cnn.com/2016/12/08/health/us-life-expectancy-down...
  • Asooka 9y ago
    And then you all die from an infected telephone booth because all the phone sanitizers have died out. Joke aside, you still need people in what are now shitty low-paying jobs for a functioning society. So if you're not going to pay the janitor enough for a middle-class life, either make a robot to do his job, or die of dysentery. Do you think USA will be able to make enough robots fast enough to realise that? And will USA society be able to tolerate everyone being upper-middle-class?
• ykler 9y ago
  This article left me confused about why this practice exists. It seems like it could only be because the insurance companies are getting some kind of kickback (maybe in the form of lower prices on drugs) in exchange for having these anti-generic rules, but I would think that would be illegal. Can someone who understands explain more clearly the situation?
  • VLM 9y ago
    The article is for lower upper class / upper middle class readers where obviously what the dr writes is what is done aside from questions about "why is money being wasted?". The actual strategy is for making money at the cost of poorer people. Lets say the name brand is $75, generic is $50. If a poor person gets the generic the insurance company is out $50, well, depending on deductible, etc. If the bureaucracy can be mysteriously blamed for not allowing the generic, at least some percentage of the poor people cannot afford the medication at $75 therefore the insurance company is NOT out $50. Its merely price based rationing. If you increase the cost of health care, some fraction of the population will be frozen out of the market, just like real estate or car prices or tuition. One of many failures of our current economic system is maximal profit does not coincide with maximal participation rate, some percentage will be frozen out for financial reasons, ranging from not too many like health care, up to most of the population WRT real estate in bubble areas. Eventually once a large enough percentage of the population is alienated and disenfranchised from the system, there will be enough support to burn it all down, until then its the existing slow boil.
    • ykler 9y ago
      Your argument doesn't make any sense. If the insurance company is paying for the drug then they would rather pay $50 than $75 for it. If the person has a deductible, it is conceivable that they would forgo treatment if the price is $75 but not if it is $50 because they didn't think they would use up their deductible, but then they ended up using it up anyway. The insurance company would then save money. But this doesn't seem like it would happen often enough to make this a good bet for the insurance company.
  • emodendroket 9y ago
• Shivetya 9y ago
  I am sure others have had the issue where you shop around for free versions of prescriptions only to have the insurer tell you to sign up for 90 day supply with a cost. They seem rather insistent on it but there have been no repercussions for my ignoring them
• alexc05 9y ago
  So I work in advertising specifically focused on pharmaceutical brands. One of my client drugs has a problem where Pharmacists are dispensing as generic where their drug has a different Mechanism of Action and is only prescribed after the generic fails. Pharmacists can actually be incentivized in some cases to give the generic when the brand-name is written. Apparently they don't even have to tell you that they're switching it. We have multiple clients who are undertaking 'dispense as written' campaigns with healthcare professionals to offset that. I'm certainly not saying that it is ALWAYS the case that a drug which vs. generic is the best choice. Sometimes they are literally the exact same molecule. Sometimes though, you're not getting the same level of care. Sometimes not even the same mechanism of action. I imagine an insurance company's position on that might be the offsetting of liability. If a pharmacist dispenses a generic when the brand-name is different and the treatment fails the insurance company bears the cost of that in the form of extended care. (and possibly other things)
  • nsnick 9y ago
    If it has a different mechanism of action it is a different drug. It sounds like your campaign is just more marketing by the pharmaceutical industry which is illegal in most countries.
    • alexc05 9y ago
      That's right. It is actually pretty shocking (to me personally) that there are Pharmacists in the USA who are able to legally give DRUG-B when the prescription written is DRUG-A and they are different molecules, different MOA and they Pharmacists are incentivized to do that. It is a different molecule. It has a different Mechanism of Action and the pharmacists STILL legally deliver a biosimilar version of a different drug and not only is it legal, they are rewarded for it. I'm a programmer and in the strategy meeting where I first learned that I asked about three times if that was true. I was stunned and mildly infuriated - but all the other people in the room were just sort of tight-lip wide eyed nodding at me. "yes that is actually what happens" It's part of the reason why we're focusing on DAW campaigns for so many brands right now. Pharmacies are a "wild west" Now this is a difference between "Generic" and "Biosimilar" - which I may have used an inaccurate term in my previous post. > Unlike generic medicines in which the active ingredients are identical to the reference small–molecule drug, biosimilars will not be identical to the reference biologics. ... A generic drug, by legal definition, is an exact copy of its reference medicine and must have the same chemical structure. Generics must be the exact same molecule. I definitely know we have numerous common cases of our client's drug being written as BRANDED-DRUG-A and the generic version of BRANDED-DRUG-B is given. Our client owns both A & B. It's shocking. In the USA it is somehow legal.
• throwawaymanbot 9y ago
  Even having health insurance is not enough to afford healthcare in America these days. The fragmentation of American Healthcare in to this S##tshow, whos only function is to gouge the consumer, is proof that the US needs single payer, like the rest of the world.
• oldandtired 9y ago
  Interesting read of comments. A head of R&D at Advertising Agency decided that he couldn't take any more of the lying and corruption that occurred in the advertising industry. so he went to work in R&D in the Medical Technology Industries Arena. Six months later he was back as head of R&D at the advertising agency. When asked why he had come back since advertising was so corrupt, he told them that the advertising industry were little children compared to the standard corrupt practises occurring in every area in the medical arena. He had delight in telling me the reaction of the advertising agency staff at his return.
• deleted 9y ago
  [deleted]
• abtinf 9y ago
  This is a straightforward consequence of Obamacare that was predicted before the law even passed. The imposition of onerous cost ratio requirements means a company can make more money only by raising costs, not eliminating them.
  • epmaybe 9y ago
    I think Obama himself recognized that the Pharma lobby is one of the hardest to beat, and decided to try and sidestep them in trying to improve access to healthcare. Clinton tried and failed due to the Pharma lobby, Bush passed Medicare Part D but wasn't able to give CMS price negotiation power. It's really quite unfortunate for healthcare consumers.