4 ms·

This happens across the board. I have psoriasis and psoriatic arthritis. The barriers to getting a prescription for an effective (and expensive) biologic medic

by pacaro 7y ago

This happens across the board. I have psoriasis and psoriatic arthritis. The barriers to getting a prescription for an effective (and expensive) biologic medication can be crazy. When I've been forced to use a "specialty pharmacy", they require that the medication be shipped overnight (it has to be refrigerated) which is clearly more expensive than picking it up at a neighborhood pharmacy, that shipment has to be arranged every month, which means a phone call, waiting on hold, passing a quiz on my condition, surviving attempts to upsell supplies I don't need. They also won't ship "too soon", which inevitably means that the monthly refills slightly more slowly than once a month I've also had insurance demand that I take ineffective but cheap medication for 3 months before I can get the stuff that works -- ostensibly they want to see if the cheap methotrexate (daily nausea, waves of fatigue) is effective. In the 11 years since my diagnosis I've managed to be regularly on an available effective medication about 60% of the time, mostly because of this nonsense. 40% of the time I'm in pain

fromthestart 7y ago
Look into Kratom for the in-between. Its cheap if you get it online, seems to be pretty safe, and works comparably to opoids for pain while being only minimally habit forming. Edit: people don't seem too happy with this comment but it's a chance at legitimate relief from chronic pain with millions of daily doses in the US and no documented fatalities, excluding a handful of reports where other illicit substances were consumed simultaneously.
- rhexs 7y ago
  Beware: “minimally habit forming” is anecdotal. There are many other anecdotes of it being quite addictive. See quitting kratom on reddit for more info.
qrbLPHiKpiux 7y ago
A patient was on Humira then went on medicare. Medicare would not cover Humira and this patient had to go on Remicade. The difference? Humira is able to be given by self at home. Remicade requires an infusion by a nurse.
- rosser 7y ago
  I was once dating a woman who had vertically contracted Hepatitis C during her birth. We had an accident before I had completed my normal vaccination course. The first-line treatment in those cases is a dose of immunoglobulin containing the relevant antibodies. My insurance gave two choices: pay $800 out of pocket for the drug at any pharmacy that carries it (zero coverage offered, no recourse), take it to my doctor's office by hand, and get it injected there; or go to the ER and have it done one-stop there (at a cost of $300 to me and at least $3000 to them). Fine, guys. It's your money...
  - alistairSH 7y ago
    Fine, guys. It's your money... Except it's not their money. It's all of our money, as the whole point of insurance is pooling resources to hedge against any individual risk. Not that I blame you - the implementation of some policies is completely asinine.
    - rosser 7y ago
      It's "theirs" in that they're the ones with absolute discretion over its disposition. It's a turn of phrase, and not meant to be taken strictly literally.
      - alistairSH 7y ago
        Sure, but the fact remains that by sending you to an ER instead of a GP's office caused an increase in cost to everybody in your risk pool. It's an inefficiency that shouldn't exist.
        rosser 7y ago
        > It's an inefficiency that shouldn't exist. I completely agree. I think it's an absurdity that shouldn't exist. My point in sharing my anecdote was to validate the prevalence of the absurdity that my comment's parent observed, though I probably could have been more explicit about that.
wsc981 7y ago
Did you consider treatment at the Dead Sea in Israel? From what I've read it has helped many people that are dealing with psoriasis and perhaps in the long run it might be cheaper than buying medicine? One example story (but you can find many more I'm sure): http://www.papaa.org/articles/dead-sea-personal-report http://www.papaa.org/articles/dead-sea-personal-report
zdragnar 7y ago
I'm in the same boat. Currently taking Taltz, but only until their $25 copay program kicks me off in 18 months. After that, my insurance copay goes up to $600 a month (actual cost to them is $5k). I have no idea what I'll do after that.
mindslight 7y ago
Much of your ongoing annoyances sound like customer service problems. Can you shop around for a different specialty pharmacy? In my (limited) experience with CVS [0], they do offer to ship to a local store for pickup. I've no idea if they'd be setup to do this with refrigerated medicine, although it seems better for them than relying on a commercial carrier that will happily leave a missed-delivery tag and let the package sit over a weekend. Perhaps you could also get your doctor to write a new prescription a week earlier, so you'd have more of a buffer. [0] Just to be clear, I'm not trying to sing any praises of CVS. I've only dealt with them because they just bought out another specialty pharmacy which I also had a short experience with. That consolidation is presumably another symptom/cause of the ongoing dumpster fire. I'm just trying to offer pragmatism to perhaps better cope within this broken system. addendum: I've no idea why I'm being downvoted. Is the only goal of sharing personal situations simply to pile on the outrage party? Obviously OP has been at it for a while, and in that sense should have their own situation figured out the best for themselves. But OP is probably overloaded with stress due to the situation and is just thankful it "works" at all, which results in clinging to local optima. shrug, I see another comment referencing that CVS is mentioned in the article (my "article" says "Access Denied"), so perhaps pointing out that they do actually do their job some times clashes with that.
- pacaro 7y ago
  Part of the problem is that insurance has typically mandated which specialty pharmacy, and the two different ones I've used have had almost identical behavior. It's nothing overt, but the pattern seems so consistent and the end result is filling my prescription at a slightly slower rate than as prescribed, which clearly offers them a saving which probably more than offsets the overnight shipping costs. In terms of shopping around, the most effective tactic for me is to find the job with the best insurance
  - mindslight 7y ago
    I agree that the pattern is likely deliberate. If not explicitly designed, then at least constructively where rules kept getting added to optimize the amount paid out, leading to novel ways of saving money such as kind-of reneging on the contract. I had thought there would be more specialty pharmacies, with the real need for them just being that those drugs wouldn't be stocked at every single branch in case someone needs them. I've personally seen competing offers (in my situation, the PBM is not CVS, and has its own mail-order pharmacy so it encourages you to switch), but haven't had to investigate them because CVS is still working fine. But why would CVS be buying up other "specialty pharmacies" if they weren't a racket of one kind or another. Maybe insurance companies act less shitty when they're tied to Medicare (this is actually for my father), or maybe I'm also in a glass box and haven't yet noticed the walls. Which well, is the general problem with all the ongoing political dumpster fires. "Looks fine to me" say the people who just haven't run aground yet. I do apologize if I came off that way.

by pacaro 7y ago

fromthestart 7y ago

Look into Kratom for the in-between. Its cheap if you get it online, seems to be pretty safe, and works comparably to opoids for pain while being only minimally habit forming. Edit: people don't seem too happy with this comment but it's a chance at legitimate relief from chronic pain with millions of daily doses in the US and no documented fatalities, excluding a handful of reports where other illicit substances were consumed simultaneously.

rhexs 7y ago
Beware: “minimally habit forming” is anecdotal. There are many other anecdotes of it being quite addictive. See quitting kratom on reddit for more info.

qrbLPHiKpiux 7y ago

A patient was on Humira then went on medicare. Medicare would not cover Humira and this patient had to go on Remicade. The difference? Humira is able to be given by self at home. Remicade requires an infusion by a nurse.

rosser 7y ago
I was once dating a woman who had vertically contracted Hepatitis C during her birth. We had an accident before I had completed my normal vaccination course. The first-line treatment in those cases is a dose of immunoglobulin containing the relevant antibodies. My insurance gave two choices: pay $800 out of pocket for the drug at any pharmacy that carries it (zero coverage offered, no recourse), take it to my doctor's office by hand, and get it injected there; or go to the ER and have it done one-stop there (at a cost of $300 to me and at least $3000 to them). Fine, guys. It's your money...
- alistairSH 7y ago
  Fine, guys. It's your money... Except it's not their money. It's all of our money, as the whole point of insurance is pooling resources to hedge against any individual risk. Not that I blame you - the implementation of some policies is completely asinine.
  - rosser 7y ago
    It's "theirs" in that they're the ones with absolute discretion over its disposition. It's a turn of phrase, and not meant to be taken strictly literally.
    - alistairSH 7y ago
      Sure, but the fact remains that by sending you to an ER instead of a GP's office caused an increase in cost to everybody in your risk pool. It's an inefficiency that shouldn't exist.
      - rosser 7y ago
        > It's an inefficiency that shouldn't exist. I completely agree. I think it's an absurdity that shouldn't exist. My point in sharing my anecdote was to validate the prevalence of the absurdity that my comment's parent observed, though I probably could have been more explicit about that.

wsc981 7y ago

Did you consider treatment at the Dead Sea in Israel? From what I've read it has helped many people that are dealing with psoriasis and perhaps in the long run it might be cheaper than buying medicine? One example story (but you can find many more I'm sure): http://www.papaa.org/articles/dead-sea-personal-report http://www.papaa.org/articles/dead-sea-personal-report

zdragnar 7y ago

I'm in the same boat. Currently taking Taltz, but only until their $25 copay program kicks me off in 18 months. After that, my insurance copay goes up to $600 a month (actual cost to them is $5k). I have no idea what I'll do after that.

mindslight 7y ago

Much of your ongoing annoyances sound like customer service problems. Can you shop around for a different specialty pharmacy? In my (limited) experience with CVS [0], they do offer to ship to a local store for pickup. I've no idea if they'd be setup to do this with refrigerated medicine, although it seems better for them than relying on a commercial carrier that will happily leave a missed-delivery tag and let the package sit over a weekend. Perhaps you could also get your doctor to write a new prescription a week earlier, so you'd have more of a buffer. [0] Just to be clear, I'm not trying to sing any praises of CVS. I've only dealt with them because they just bought out another specialty pharmacy which I also had a short experience with. That consolidation is presumably another symptom/cause of the ongoing dumpster fire. I'm just trying to offer pragmatism to perhaps better cope within this broken system. addendum: I've no idea why I'm being downvoted. Is the only goal of sharing personal situations simply to pile on the outrage party? Obviously OP has been at it for a while, and in that sense should have their own situation figured out the best for themselves. But OP is probably overloaded with stress due to the situation and is just thankful it "works" at all, which results in clinging to local optima. shrug, I see another comment referencing that CVS is mentioned in the article (my "article" says "Access Denied"), so perhaps pointing out that they do actually do their job some times clashes with that.

pacaro 7y ago
Part of the problem is that insurance has typically mandated which specialty pharmacy, and the two different ones I've used have had almost identical behavior. It's nothing overt, but the pattern seems so consistent and the end result is filling my prescription at a slightly slower rate than as prescribed, which clearly offers them a saving which probably more than offsets the overnight shipping costs. In terms of shopping around, the most effective tactic for me is to find the job with the best insurance
- mindslight 7y ago
  I agree that the pattern is likely deliberate. If not explicitly designed, then at least constructively where rules kept getting added to optimize the amount paid out, leading to novel ways of saving money such as kind-of reneging on the contract. I had thought there would be more specialty pharmacies, with the real need for them just being that those drugs wouldn't be stocked at every single branch in case someone needs them. I've personally seen competing offers (in my situation, the PBM is not CVS, and has its own mail-order pharmacy so it encourages you to switch), but haven't had to investigate them because CVS is still working fine. But why would CVS be buying up other "specialty pharmacies" if they weren't a racket of one kind or another. Maybe insurance companies act less shitty when they're tied to Medicare (this is actually for my father), or maybe I'm also in a glass box and haven't yet noticed the walls. Which well, is the general problem with all the ongoing political dumpster fires. "Looks fine to me" say the people who just haven't run aground yet. I do apologize if I came off that way.