5 ms·

Some doctors are certainly corrupt, but usually they have no way of knowing how much a particular medication costs since many do not buy or handle medication be

Some doctors are certainly corrupt, but usually they have no way of knowing how much a particular medication costs since many do not buy or handle medication beyond what they would stock in their office. Your post lacks information such as whether or not the specialty medicine would’ve been approved with the proper paperwork from the doctor, but what likely happened is that someone at the pharmacy put in the effort to find a manufacturer coupon for the medicine for you. Interestingly the pharmacy doing that is generally forbidden in agreements with the insurance companies. That’s corruption imo. The insurance PBMs forcing you to use their designated specialty pharmacies is part of the massive healthcare consolidation over the last couple of decades and it’s full of corruption as well.

Consultant32452 5y ago
Of course my post lacks information. It's not a persuasive essay, it's an internet post about an experience I had. Humans tend to prefer brevity over exactness, particularly on internet posts.
- deleted 5y ago
  [deleted]
- codewiz 5y ago
  I prefer brevity over irrelevant information, but mentioning the specific type of drug, the name of the insurance and the type of coupon being applied would be highly relevant in determining whether the story has merit. Leaving it deliberately unspecified triggers all my bullshit detectors.
  - Consultant32452 5y ago
    - zdragnar 5y ago
      You alledge "multiple layers of corruption" when the reality is that manufacturers of specialty medicines often offer steel discounts to patients whose insurance companies don't cover their cost. For example, I took Taltz injections; my insurer wouldn't cover them unless I first tried cheaper options with much more serious side effects. Even if they did cover it, the co-pay would have been cost prohibitive for me. The reason my doctor prescribed it is simple- the manufacturer had a program that let you get it for $25 a dose if your insurance didnt cover it, or would cover all but $5 of the co-pay if you did. To be blunt, there's no conspiracy or corruption here. You don't get to throw out wild allocations with no specifics.
      - saghm 5y ago
        You didn't name the type of insurance despite the fact that you argued the parent comment not naming the type of insurance as evidence their story was "bullshit". I point this out not because I'm saying your story is bullshit, but to point out the unnecessarily high standard you put on them. If you don't even remember to do it merely minutes after calling someone else for it, how could you possibly require that standard on a complete stranger who _hasn't_ brought that up as a standard when starting their own discussion?
        PebblesRox 5y ago
        You're accusing zdragnar of hypocrisy but it was codewiz who called bullshit on the lack of insurance details.
        zdragnar 5y ago
        Type of insurance is irrelevant to getting the manufacturer discount. If you dont have any insurance at all, you still get it. The point is if you are going to claim that there is corruption, it needs to be backed up by something. Serious claims require serious evidence.
        alphabettsy 5y ago
        > Type of insurance is irrelevant to getting the manufacturer discount. This part isn’t true most of the time. Generally Medicaid and/or Medicare recipients aren’t eligible for these coupons. See these Terms and Conditions for example: https://www.gileadadvancingaccess.com/copay-coupon-card https://www.gileadadvancingaccess.com/copay-coupon-card
  - klyrs 5y ago
    Please familiarize yourself with the site guidelines. > Have curious conversation; don't cross-examine. > Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith.
- alphabettsy 5y ago
  It wasn’t intended as criticism. I thought it was clear I offered that bit because I was speculating based on the information given.
ddingus 5y ago
Many insurers have rosters of meds they approve. Kaiser is one, just for a specific example. Everyone in the system is encouraged to prescribe from that list, even to the point of making clear medical trade-offs to do so. This was all explained to me when we had to switch plans, ended up with Kaiser for a while, and needed to renew blood pressure meds for my wife. She was in good control, no side effects, on meds for a decade. Those were not on the list. Rather than prescribe off list, that doctor increased her risk to benefit Kaiser, not her. And this was even made clear at the time! (maddening) Just to be ultra clear, it was that doctors "opinion" the various meds were all equivalent. For a lot of reasons, none of which are medical, we went with it, and sure enough, she was not in good control, and had side effects. Went back, got the meds that worked prescribed, (which cost me visit co-pays and some non trivial time and effort to basically demand the medication needed and proven) and found ourselves in the same "coupon" scenario above. Base cost of the medication was quite expensive, and a "coupon" was found to bring it roughly in line with the "on list" meds tried earlier. Of course, that all had to be done at another, outside pharmacy, due to the Kaiser one not carrying what they consider special order meds. That isn't a super big deal, but the whole mess involves bulk buying to gain price advantages, and the real worry point is cost being primary, with medical being secondary. The whole thing caused me to very seriously question the strength of "medical opinion", given patient history, a routine request to simply continue proven treatment turned into a risk scenario for no reason other than the tangled mess of insurers, agreements, drug manufacturers, and the like all more focused on profit than they are patient health. In my case, the pharmacy was Walgreens and yes they signed me up for some plan or other, GoodRX or the like, handed me a card and said I needed to use it to get the much better price. Was on the order of a few hundred dollars being discounted to a few tens of dollars... Have had similar experiences at CVS, Bi-Mart, Safeway... Indie pharmacies, usually niche places that offer things like compounding, are particularly good at this sort of thing and it's one of the ways they attract and keep patients. I used a good one for years, until I moved. Miss those people. They would do that automatically for anyone struggling with med costs of any kind.
- ThrustVectoring 5y ago
  > The whole thing caused me to very seriously question the strength of "medical opinion", given patient history, a routine request to simply continue proven treatment turned into a risk scenario for no reason other than the tangled mess of insurers, agreements, drug manufacturers, and the like all more focused on profit than they are patient health. The flip side of this is the "pharmaceutical representative" entire job description. Basically, your doctor has a wide range of words they use to describe how to treat you. Some of them wind up with the insurance company paying $15 for generic medication, while others wind up doing something like spending $400 on something under patent protection. Pharma's reps jobs are to talk to physicians and educate/convince them to use the expensive words instead of the cheap words out of force of habit. Anyhow, that's why HMOs and insurers have approved medication lists - to push back against doctors writing down a $400 word instead of a $15 because a pharma representative said that FooBar XR treats Baz syndrome and the doctor wrote that down instead of the generic BarFoo.

Consultant32452 5y ago

Of course my post lacks information. It's not a persuasive essay, it's an internet post about an experience I had. Humans tend to prefer brevity over exactness, particularly on internet posts.

deleted 5y ago
[deleted]
codewiz 5y ago
I prefer brevity over irrelevant information, but mentioning the specific type of drug, the name of the insurance and the type of coupon being applied would be highly relevant in determining whether the story has merit. Leaving it deliberately unspecified triggers all my bullshit detectors.
- Consultant32452 5y ago
  - zdragnar 5y ago
    You alledge "multiple layers of corruption" when the reality is that manufacturers of specialty medicines often offer steel discounts to patients whose insurance companies don't cover their cost. For example, I took Taltz injections; my insurer wouldn't cover them unless I first tried cheaper options with much more serious side effects. Even if they did cover it, the co-pay would have been cost prohibitive for me. The reason my doctor prescribed it is simple- the manufacturer had a program that let you get it for $25 a dose if your insurance didnt cover it, or would cover all but $5 of the co-pay if you did. To be blunt, there's no conspiracy or corruption here. You don't get to throw out wild allocations with no specifics.
    - saghm 5y ago
      You didn't name the type of insurance despite the fact that you argued the parent comment not naming the type of insurance as evidence their story was "bullshit". I point this out not because I'm saying your story is bullshit, but to point out the unnecessarily high standard you put on them. If you don't even remember to do it merely minutes after calling someone else for it, how could you possibly require that standard on a complete stranger who _hasn't_ brought that up as a standard when starting their own discussion?
      - PebblesRox 5y ago
        You're accusing zdragnar of hypocrisy but it was codewiz who called bullshit on the lack of insurance details.
      - zdragnar 5y ago
        Type of insurance is irrelevant to getting the manufacturer discount. If you dont have any insurance at all, you still get it. The point is if you are going to claim that there is corruption, it needs to be backed up by something. Serious claims require serious evidence.
        alphabettsy 5y ago
        > Type of insurance is irrelevant to getting the manufacturer discount. This part isn’t true most of the time. Generally Medicaid and/or Medicare recipients aren’t eligible for these coupons. See these Terms and Conditions for example: https://www.gileadadvancingaccess.com/copay-coupon-card https://www.gileadadvancingaccess.com/copay-coupon-card
- klyrs 5y ago
  Please familiarize yourself with the site guidelines. > Have curious conversation; don't cross-examine. > Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith.
alphabettsy 5y ago
It wasn’t intended as criticism. I thought it was clear I offered that bit because I was speculating based on the information given.

ddingus 5y ago

Many insurers have rosters of meds they approve. Kaiser is one, just for a specific example. Everyone in the system is encouraged to prescribe from that list, even to the point of making clear medical trade-offs to do so. This was all explained to me when we had to switch plans, ended up with Kaiser for a while, and needed to renew blood pressure meds for my wife. She was in good control, no side effects, on meds for a decade. Those were not on the list. Rather than prescribe off list, that doctor increased her risk to benefit Kaiser, not her. And this was even made clear at the time! (maddening) Just to be ultra clear, it was that doctors "opinion" the various meds were all equivalent. For a lot of reasons, none of which are medical, we went with it, and sure enough, she was not in good control, and had side effects. Went back, got the meds that worked prescribed, (which cost me visit co-pays and some non trivial time and effort to basically demand the medication needed and proven) and found ourselves in the same "coupon" scenario above. Base cost of the medication was quite expensive, and a "coupon" was found to bring it roughly in line with the "on list" meds tried earlier. Of course, that all had to be done at another, outside pharmacy, due to the Kaiser one not carrying what they consider special order meds. That isn't a super big deal, but the whole mess involves bulk buying to gain price advantages, and the real worry point is cost being primary, with medical being secondary. The whole thing caused me to very seriously question the strength of "medical opinion", given patient history, a routine request to simply continue proven treatment turned into a risk scenario for no reason other than the tangled mess of insurers, agreements, drug manufacturers, and the like all more focused on profit than they are patient health. In my case, the pharmacy was Walgreens and yes they signed me up for some plan or other, GoodRX or the like, handed me a card and said I needed to use it to get the much better price. Was on the order of a few hundred dollars being discounted to a few tens of dollars... Have had similar experiences at CVS, Bi-Mart, Safeway... Indie pharmacies, usually niche places that offer things like compounding, are particularly good at this sort of thing and it's one of the ways they attract and keep patients. I used a good one for years, until I moved. Miss those people. They would do that automatically for anyone struggling with med costs of any kind.

ThrustVectoring 5y ago
> The whole thing caused me to very seriously question the strength of "medical opinion", given patient history, a routine request to simply continue proven treatment turned into a risk scenario for no reason other than the tangled mess of insurers, agreements, drug manufacturers, and the like all more focused on profit than they are patient health. The flip side of this is the "pharmaceutical representative" entire job description. Basically, your doctor has a wide range of words they use to describe how to treat you. Some of them wind up with the insurance company paying $15 for generic medication, while others wind up doing something like spending $400 on something under patent protection. Pharma's reps jobs are to talk to physicians and educate/convince them to use the expensive words instead of the cheap words out of force of habit. Anyhow, that's why HMOs and insurers have approved medication lists - to push back against doctors writing down a $400 word instead of a $15 because a pharma representative said that FooBar XR treats Baz syndrome and the doctor wrote that down instead of the generic BarFoo.