Obamacare

Gern Blansten · March 24

mace1229 said:

mickeyrat said:

Internal documents and former company executives reveal how Cigna doctors reject patients’ claims without opening their files.

“We literally click and submit,” one former company doctor said.

(Published March 2023 with The Capitol Forum)
https://propub.li/3Foz1f7

My wife has been on Humira for about 15+ years, since it was pretty much new. She was forced to go on the generic about 6 months ago, even though it isn't the same. Even before then she'd get periodically denied for no reason, and have to jump through a bunch of hoops to get the medication she was on for years. And has already happened with the generic once since she's been on it.
And we've been fighting to get a new med for my son covered for about a month now too. It's just so ridiculous that we can pay 2k a month in premiums just to get denied prescriptions that our doctor is giving us.
I've said before, insurance fraud should go both ways. If a company or persons are wrongfully denying coverage to save money, they should be held to the same standard of fraud as someone who is faking an injury to get money.

It's absolute bullshit. My wife does medical transcription and it's just letter after letter from doctors to insurance companies telling them to allow them to treat their patients.

mickeyrat · March 27

The FDA has found problems at an Indian factory that makes generic drugs for American patients, including one medication that was made there and has been linked to at least eight deaths.

The inspection comes after a ProPublica investigation revealed that drugs made at the plant accounted for an outsized share of U.S. recalls for pills that didn’t dissolve properly and could harm people.

Read the full story: https://propub.li/4l2Pc1N

mickeyrat · April 13

NEW: Blue Cross authorized mastectomies and breast reconstructions for women with cancer but refused to pay the full doctors’ bills.

But the insurer did make some exceptions. On several occasions, Blue Cross executives signed deals to pay for their wives’ treatment.
https://propub.li/4j7PXW9

mickeyrat · April 17

NEW: An Indian drugmaker, investigated by ProPublica last year, has recalled two dozen medications sold to U.S. patients.

The drug recalls cover a wide range of commonly prescribed medicines — including ones that treat epilepsy, diabetes, multiple sclerosis, heart disease and high blood pressure: https://propub.li/43UCoVh

mickeyrat · May 9

UnitedHealth is the nation’s largest health insurance conglomerate. ProPublica obtained what is effectively the company’s internal playbook for limiting and cutting therapy costs. Here's what we found.

From our series "America's Mental Barrier," a 2025 Pulitzer finalist: https://propub.li/4d8Kb4k

OnWis97 · May 12

If I didn't know better, I'd think that wrapping everyone's health into corporate profits was a bad idea.

Gern Blansten · May 15

This is fucking crazy. I had a blood clot in my leg a few years ago and got put on Eliquis.

Seems that I have a weird gene that makes clotting more likely. Dr told me that I would probably be on Eliquis for life.

Had a "discount" coupon from the maker for $10/month on the prescription that just ran out. Current cost is around $510/month at my pharmacy and the generic version is not available in the USA.

I signed up with a Canadian Pharmacy and will pay $173/month for the same prescription. They offered the generic for a bit less but I went with the brand for now.

The USA healthcare system is the fucking stupidest system in the world.

mace1229 · May 15

Gern Blansten said:

This is fucking crazy. I had a blood clot in my leg a few years ago and got put on Eliquis.

Seems that I have a weird gene that makes clotting more likely. Dr told me that I would probably be on Eliquis for life.

Had a "discount" coupon from the maker for $10/month on the prescription that just ran out. Current cost is around $510/month at my pharmacy and the generic version is not available in the USA.

I signed up with a Canadian Pharmacy and will pay $173/month for the same prescription. They offered the generic for a bit less but I went with the brand for now.

The USA healthcare system is the fucking stupidest system in the world.

Is it not covered by your insurance?

I will be in the same boat in a few months. A year and half ago I have multiple blood clots, including several in the lungs. Had no symptoms other than I was having difficult breathing.
Because I had no pain or symptoms, the doctor said I'll be on Eliquis for life, because next time I probably won't survive and was lucky to this time. Who knows who long I had them before I had difficulty breathing.
I have the Eliquis discount for $10, but that runs out in about 6 months. But my copay is only $60 for it when the coupon is out. Still don't want to have to pay $60/month for life though.

Funny thing is, this all happened the day after the Indy show in 2023. It was the only show I had tickets to that leg and was supposed to make the 8 hour drive. But my parents forgot they agreed to watch the kids that weekend, so I ended up selling them last minute. Had I gone, I'd been on an 8 hour car drive home on the day I ended up going to the hospital. More than likely I would have been too stubborn to stop anywhere and who knows what would have happened.

Gern Blansten · May 15

mace1229 said:

Gern Blansten said:

This is fucking crazy. I had a blood clot in my leg a few years ago and got put on Eliquis.

Seems that I have a weird gene that makes clotting more likely. Dr told me that I would probably be on Eliquis for life.

Had a "discount" coupon from the maker for $10/month on the prescription that just ran out. Current cost is around $510/month at my pharmacy and the generic version is not available in the USA.

I signed up with a Canadian Pharmacy and will pay $173/month for the same prescription. They offered the generic for a bit less but I went with the brand for now.

The USA healthcare system is the fucking stupidest system in the world.

Is it not covered by your insurance?

I will be in the same boat in a few months. A year and half ago I have multiple blood clots, including several in the lungs. Had no symptoms other than I was having difficult breathing.
Because I had no pain or symptoms, the doctor said I'll be on Eliquis for life, because next time I probably won't survive and was lucky to this time. Who knows who long I had them before I had difficulty breathing.
I have the Eliquis discount for $10, but that runs out in about 6 months. But my copay is only $60 for it when the coupon is out. Still don't want to have to pay $60/month for life though.

Funny thing is, this all happened the day after the Indy show in 2023. It was the only show I had tickets to that leg and was supposed to make the 8 hour drive. But my parents forgot they agreed to watch the kids that weekend, so I ended up selling them last minute. Had I gone, I'd been on an 8 hour car drive home on the day I ended up going to the hospital. More than likely I would have been too stubborn to stop anywhere and who knows what would have happened.

wow that's crazy....no, my insurance doesn't cover but I would be very happy with $60/month. I'm not sure if that is because of my overall deductible or what exactly.

I figure I can live with the $178/month for three months then I'll get the generic at $114/month

mace1229 · May 15

Gern Blansten said:

mace1229 said:

Gern Blansten said:

This is fucking crazy. I had a blood clot in my leg a few years ago and got put on Eliquis.

Seems that I have a weird gene that makes clotting more likely. Dr told me that I would probably be on Eliquis for life.

Had a "discount" coupon from the maker for $10/month on the prescription that just ran out. Current cost is around $510/month at my pharmacy and the generic version is not available in the USA.

I signed up with a Canadian Pharmacy and will pay $173/month for the same prescription. They offered the generic for a bit less but I went with the brand for now.

The USA healthcare system is the fucking stupidest system in the world.

Is it not covered by your insurance?

I will be in the same boat in a few months. A year and half ago I have multiple blood clots, including several in the lungs. Had no symptoms other than I was having difficult breathing.
Because I had no pain or symptoms, the doctor said I'll be on Eliquis for life, because next time I probably won't survive and was lucky to this time. Who knows who long I had them before I had difficulty breathing.
I have the Eliquis discount for $10, but that runs out in about 6 months. But my copay is only $60 for it when the coupon is out. Still don't want to have to pay $60/month for life though.

Funny thing is, this all happened the day after the Indy show in 2023. It was the only show I had tickets to that leg and was supposed to make the 8 hour drive. But my parents forgot they agreed to watch the kids that weekend, so I ended up selling them last minute. Had I gone, I'd been on an 8 hour car drive home on the day I ended up going to the hospital. More than likely I would have been too stubborn to stop anywhere and who knows what would have happened.

wow that's crazy....no, my insurance doesn't cover but I would be very happy with $60/month. I'm not sure if that is because of my overall deductible or what exactly.

I figure I can live with the $178/month for three months then I'll get the generic at $114/month

Insurance is so messed up. We never know what is covered or how much things cost up front. We just get a bill with a bunch of numbers that don't make any sense, and pay it.

Gern Blansten · May 15

mace1229 said:

Gern Blansten said:

mace1229 said:

Gern Blansten said:

This is fucking crazy. I had a blood clot in my leg a few years ago and got put on Eliquis.

Seems that I have a weird gene that makes clotting more likely. Dr told me that I would probably be on Eliquis for life.

Had a "discount" coupon from the maker for $10/month on the prescription that just ran out. Current cost is around $510/month at my pharmacy and the generic version is not available in the USA.

I signed up with a Canadian Pharmacy and will pay $173/month for the same prescription. They offered the generic for a bit less but I went with the brand for now.

The USA healthcare system is the fucking stupidest system in the world.

Is it not covered by your insurance?

I will be in the same boat in a few months. A year and half ago I have multiple blood clots, including several in the lungs. Had no symptoms other than I was having difficult breathing.
Because I had no pain or symptoms, the doctor said I'll be on Eliquis for life, because next time I probably won't survive and was lucky to this time. Who knows who long I had them before I had difficulty breathing.
I have the Eliquis discount for $10, but that runs out in about 6 months. But my copay is only $60 for it when the coupon is out. Still don't want to have to pay $60/month for life though.

Funny thing is, this all happened the day after the Indy show in 2023. It was the only show I had tickets to that leg and was supposed to make the 8 hour drive. But my parents forgot they agreed to watch the kids that weekend, so I ended up selling them last minute. Had I gone, I'd been on an 8 hour car drive home on the day I ended up going to the hospital. More than likely I would have been too stubborn to stop anywhere and who knows what would have happened.

wow that's crazy....no, my insurance doesn't cover but I would be very happy with $60/month. I'm not sure if that is because of my overall deductible or what exactly.

I figure I can live with the $178/month for three months then I'll get the generic at $114/month

Insurance is so messed up. We never know what is covered or how much things cost up front. We just get a bill with a bunch of numbers that don't make any sense, and pay it.

I'm guessing that once the block on the generic goes away in a few years that the cost will drop even further once others start making it.

It's just odd to me to pay $7/month for my bp meds and $500/month for a blood thinner.

But I want to live so I guess I'll shut up and pay.

mickeyrat · May 15

Gern Blansten said:

mace1229 said:

Gern Blansten said:

mace1229 said:

Gern Blansten said:

This is fucking crazy. I had a blood clot in my leg a few years ago and got put on Eliquis.

Seems that I have a weird gene that makes clotting more likely. Dr told me that I would probably be on Eliquis for life.

Had a "discount" coupon from the maker for $10/month on the prescription that just ran out. Current cost is around $510/month at my pharmacy and the generic version is not available in the USA.

I signed up with a Canadian Pharmacy and will pay $173/month for the same prescription. They offered the generic for a bit less but I went with the brand for now.

The USA healthcare system is the fucking stupidest system in the world.

Is it not covered by your insurance?

I will be in the same boat in a few months. A year and half ago I have multiple blood clots, including several in the lungs. Had no symptoms other than I was having difficult breathing.
Because I had no pain or symptoms, the doctor said I'll be on Eliquis for life, because next time I probably won't survive and was lucky to this time. Who knows who long I had them before I had difficulty breathing.
I have the Eliquis discount for $10, but that runs out in about 6 months. But my copay is only $60 for it when the coupon is out. Still don't want to have to pay $60/month for life though.

Funny thing is, this all happened the day after the Indy show in 2023. It was the only show I had tickets to that leg and was supposed to make the 8 hour drive. But my parents forgot they agreed to watch the kids that weekend, so I ended up selling them last minute. Had I gone, I'd been on an 8 hour car drive home on the day I ended up going to the hospital. More than likely I would have been too stubborn to stop anywhere and who knows what would have happened.

wow that's crazy....no, my insurance doesn't cover but I would be very happy with $60/month. I'm not sure if that is because of my overall deductible or what exactly.

I figure I can live with the $178/month for three months then I'll get the generic at $114/month

Insurance is so messed up. We never know what is covered or how much things cost up front. We just get a bill with a bunch of numbers that don't make any sense, and pay it.

I'm guessing that once the block on the generic goes away in a few years that the cost will drop even further once others start making it.

It's just odd to me to pay $7/month for my bp meds and $500/month for a blood thinner.

But I want to live so I guess I'll shut up and pay.

compounding pharmacy?

gimmesometruth27 · May 15

Gern Blansten said:

mace1229 said:

Gern Blansten said:

mace1229 said:

Gern Blansten said:

This is fucking crazy. I had a blood clot in my leg a few years ago and got put on Eliquis.

Seems that I have a weird gene that makes clotting more likely. Dr told me that I would probably be on Eliquis for life.

Had a "discount" coupon from the maker for $10/month on the prescription that just ran out. Current cost is around $510/month at my pharmacy and the generic version is not available in the USA.

I signed up with a Canadian Pharmacy and will pay $173/month for the same prescription. They offered the generic for a bit less but I went with the brand for now.

The USA healthcare system is the fucking stupidest system in the world.

Is it not covered by your insurance?

I will be in the same boat in a few months. A year and half ago I have multiple blood clots, including several in the lungs. Had no symptoms other than I was having difficult breathing.
Because I had no pain or symptoms, the doctor said I'll be on Eliquis for life, because next time I probably won't survive and was lucky to this time. Who knows who long I had them before I had difficulty breathing.
I have the Eliquis discount for $10, but that runs out in about 6 months. But my copay is only $60 for it when the coupon is out. Still don't want to have to pay $60/month for life though.

Funny thing is, this all happened the day after the Indy show in 2023. It was the only show I had tickets to that leg and was supposed to make the 8 hour drive. But my parents forgot they agreed to watch the kids that weekend, so I ended up selling them last minute. Had I gone, I'd been on an 8 hour car drive home on the day I ended up going to the hospital. More than likely I would have been too stubborn to stop anywhere and who knows what would have happened.

wow that's crazy....no, my insurance doesn't cover but I would be very happy with $60/month. I'm not sure if that is because of my overall deductible or what exactly.

I figure I can live with the $178/month for three months then I'll get the generic at $114/month

Insurance is so messed up. We never know what is covered or how much things cost up front. We just get a bill with a bunch of numbers that don't make any sense, and pay it.

I'm guessing that once the block on the generic goes away in a few years that the cost will drop even further once others start making it.

It's just odd to me to pay $7/month for my bp meds and $500/month for a blood thinner.

But I want to live so I guess I'll shut up and pay.

ask your doc if there is an alternative for the blood thinner. or you can download one of those coupons that makes your co-pay like $25. they can usually be found on the manufacturer's website. i also hear there is an app called goodrx or something that frequently has coupons to knock down the price of your co-pay. i am not sure how it works but i have a friend that uses it.

Gern Blansten · May 16

gimmesometruth27 said:

Gern Blansten said:

mace1229 said:

Gern Blansten said:

mace1229 said:

Gern Blansten said:

This is fucking crazy. I had a blood clot in my leg a few years ago and got put on Eliquis.

Seems that I have a weird gene that makes clotting more likely. Dr told me that I would probably be on Eliquis for life.

Had a "discount" coupon from the maker for $10/month on the prescription that just ran out. Current cost is around $510/month at my pharmacy and the generic version is not available in the USA.

I signed up with a Canadian Pharmacy and will pay $173/month for the same prescription. They offered the generic for a bit less but I went with the brand for now.

The USA healthcare system is the fucking stupidest system in the world.

Is it not covered by your insurance?

I will be in the same boat in a few months. A year and half ago I have multiple blood clots, including several in the lungs. Had no symptoms other than I was having difficult breathing.
Because I had no pain or symptoms, the doctor said I'll be on Eliquis for life, because next time I probably won't survive and was lucky to this time. Who knows who long I had them before I had difficulty breathing.
I have the Eliquis discount for $10, but that runs out in about 6 months. But my copay is only $60 for it when the coupon is out. Still don't want to have to pay $60/month for life though.

Funny thing is, this all happened the day after the Indy show in 2023. It was the only show I had tickets to that leg and was supposed to make the 8 hour drive. But my parents forgot they agreed to watch the kids that weekend, so I ended up selling them last minute. Had I gone, I'd been on an 8 hour car drive home on the day I ended up going to the hospital. More than likely I would have been too stubborn to stop anywhere and who knows what would have happened.

wow that's crazy....no, my insurance doesn't cover but I would be very happy with $60/month. I'm not sure if that is because of my overall deductible or what exactly.

I figure I can live with the $178/month for three months then I'll get the generic at $114/month

Insurance is so messed up. We never know what is covered or how much things cost up front. We just get a bill with a bunch of numbers that don't make any sense, and pay it.

I'm guessing that once the block on the generic goes away in a few years that the cost will drop even further once others start making it.

It's just odd to me to pay $7/month for my bp meds and $500/month for a blood thinner.

But I want to live so I guess I'll shut up and pay.

ask your doc if there is an alternative for the blood thinner. or you can download one of those coupons that makes your co-pay like $25. they can usually be found on the manufacturer's website. i also hear there is an app called goodrx or something that frequently has coupons to knock down the price of your co-pay. i am not sure how it works but i have a friend that uses it.

Yeah my coupon was for $10/month but expired after two years. No more coupons.

Canada for the win. It's just a shame how fucked up our system is

gimmesometruth27 · May 16

Gern Blansten said:

gimmesometruth27 said:

Gern Blansten said:

mace1229 said:

Gern Blansten said:

mace1229 said:

Gern Blansten said:

This is fucking crazy. I had a blood clot in my leg a few years ago and got put on Eliquis.

Seems that I have a weird gene that makes clotting more likely. Dr told me that I would probably be on Eliquis for life.

Had a "discount" coupon from the maker for $10/month on the prescription that just ran out. Current cost is around $510/month at my pharmacy and the generic version is not available in the USA.

I signed up with a Canadian Pharmacy and will pay $173/month for the same prescription. They offered the generic for a bit less but I went with the brand for now.

The USA healthcare system is the fucking stupidest system in the world.

Is it not covered by your insurance?

I will be in the same boat in a few months. A year and half ago I have multiple blood clots, including several in the lungs. Had no symptoms other than I was having difficult breathing.
Because I had no pain or symptoms, the doctor said I'll be on Eliquis for life, because next time I probably won't survive and was lucky to this time. Who knows who long I had them before I had difficulty breathing.
I have the Eliquis discount for $10, but that runs out in about 6 months. But my copay is only $60 for it when the coupon is out. Still don't want to have to pay $60/month for life though.

Funny thing is, this all happened the day after the Indy show in 2023. It was the only show I had tickets to that leg and was supposed to make the 8 hour drive. But my parents forgot they agreed to watch the kids that weekend, so I ended up selling them last minute. Had I gone, I'd been on an 8 hour car drive home on the day I ended up going to the hospital. More than likely I would have been too stubborn to stop anywhere and who knows what would have happened.

wow that's crazy....no, my insurance doesn't cover but I would be very happy with $60/month. I'm not sure if that is because of my overall deductible or what exactly.

I figure I can live with the $178/month for three months then I'll get the generic at $114/month

Insurance is so messed up. We never know what is covered or how much things cost up front. We just get a bill with a bunch of numbers that don't make any sense, and pay it.

I'm guessing that once the block on the generic goes away in a few years that the cost will drop even further once others start making it.

It's just odd to me to pay $7/month for my bp meds and $500/month for a blood thinner.

But I want to live so I guess I'll shut up and pay.

ask your doc if there is an alternative for the blood thinner. or you can download one of those coupons that makes your co-pay like $25. they can usually be found on the manufacturer's website. i also hear there is an app called goodrx or something that frequently has coupons to knock down the price of your co-pay. i am not sure how it works but i have a friend that uses it.

Yeah my coupon was for $10/month but expired after two years. No more coupons.

Canada for the win. It's just a shame how fucked up our system is

it is a for profit system. so some people are going to get screwed in order to make that profit. unfortunately it is you in this case. there has to be a generic equivalent that is covered by insurance.

brianlux · May 16

Medical needs are a really good reason for people to start taking a long hard look at what is happening in this country. When people get to be my age and are on a fixed income, anything can happen that could sink you. I just learned today that the medicine that could help me with my vertigo would cost more than my monthly income. That's obviously not going to fly. When I get a bad case of vertigo that is caused by vestibular migraine, I lose 24 to 36 hours of my life. I can live with that, but what if not having a certain medication meant I would lose my life? Well, yeah, I would die.

That is going to happen to some of our grandparents, great aunts and uncles, and other elders. Some people may not care. Ageism is a real thing in America today. I've seen it right here on these forums. But hey, guess what? Anyone who has been a Pearl Jam fan from the get-go is not exactly young anymore.

Look to your future. Look where you're headed. And think about how fucked you will be if things continue where they are going.

Sorry to be so blunt, but it's past time we wake the fuck up.

mace1229 · May 16

It’s been broken for a long time, it isn’t anything new.
i remember when your first kid was born i was shocked how much the bill was. Something like 8k. To get an itemized bill to explain it and make sure we weren’t getting over charged or charged for things that don’t happen was nearly impossible because the billing with insurance is so clouded. I wanted ann itemized bill because there were issues with the staff and they failed to do certain things (never got epidural, among other things). And that was 8k after having a 2k/month premium on insurance.

A couple years ago the doctor ordered a colonoscopy for him. We fought with insurance but they would only cover a small portion and we were billed 5k. They argued it was something because he was only 8. But he needed it and it’s how we found out he had celiac disease, so we paid it. For what we pay in premiums, the bills we get are ridiculous.

And medication is for profit. It costs over $100 million to develop a drug. And there are dozens that fail and dump millions into that never go anywhere. Companies know they need to recover their costs and make a profit before generics become available, so they charge ridiculous amounts.

I don’t know what the answer is. Everyone and company has a right to make money. And that money is the drive behind developing new medicine. They won’t invest hundreds of millions into medicine if there isn’t a profit to be made. But charging a ridiculous amount shouldn’t be the answer.
And if you pay your insurance, they should t be allowed to deny medication. That is ridiculous. They make billions of dollars, they can cover meds.

gimmesometruth27 · May 16

mace1229 said:

It’s been broken for a long time, it isn’t anything new.
i remember when your first kid was born i was shocked how much the bill was. Something like 8k. To get an itemized bill to explain it and make sure we weren’t getting over charged or charged for things that don’t happen was nearly impossible because the billing with insurance is so clouded. I wanted ann itemized bill because there were issues with the staff and they failed to do certain things (never got epidural, among other things). And that was 8k after having a 2k/month premium on insurance.

A couple years ago the doctor ordered a colonoscopy for him. We fought with insurance but they would only cover a small portion and we were billed 5k. They argued it was something because he was only 8. But he needed it and it’s how we found out he had celiac disease, so we paid it. For what we pay in premiums, the bills we get are ridiculous.

And medication is for profit. It costs over $100 million to develop a drug. And there are dozens that fail and dump millions into that never go anywhere. Companies know they need to recover their costs and make a profit before generics become available, so they charge ridiculous amounts.

I don’t know what the answer is. Everyone and company has a right to make money. And that money is the drive behind developing new medicine. They won’t invest hundreds of millions into medicine if there isn’t a profit to be made. But charging a ridiculous amount shouldn’t be the answer.
And if you pay your insurance, they should t be allowed to deny medication. That is ridiculous. They make billions of dollars, they can cover meds.

i'd say we can start lowering drug costs by banning medication commercials on tv. drug companies should only be able to market to prescribers. blowing 2 million for a single super bowl commercial is a waste of money. they basically tell people to go in there and tell your doctor that you want x medication. last i checked your doc should be telling you what is best for your condition, but what do i know?

mace1229 · May 16

gimmesometruth27 said:

mace1229 said:

It’s been broken for a long time, it isn’t anything new.
i remember when your first kid was born i was shocked how much the bill was. Something like 8k. To get an itemized bill to explain it and make sure we weren’t getting over charged or charged for things that don’t happen was nearly impossible because the billing with insurance is so clouded. I wanted ann itemized bill because there were issues with the staff and they failed to do certain things (never got epidural, among other things). And that was 8k after having a 2k/month premium on insurance.

A couple years ago the doctor ordered a colonoscopy for him. We fought with insurance but they would only cover a small portion and we were billed 5k. They argued it was something because he was only 8. But he needed it and it’s how we found out he had celiac disease, so we paid it. For what we pay in premiums, the bills we get are ridiculous.

And medication is for profit. It costs over $100 million to develop a drug. And there are dozens that fail and dump millions into that never go anywhere. Companies know they need to recover their costs and make a profit before generics become available, so they charge ridiculous amounts.

I don’t know what the answer is. Everyone and company has a right to make money. And that money is the drive behind developing new medicine. They won’t invest hundreds of millions into medicine if there isn’t a profit to be made. But charging a ridiculous amount shouldn’t be the answer.
And if you pay your insurance, they should t be allowed to deny medication. That is ridiculous. They make billions of dollars, they can cover meds.

i'd say we can start lowering drug costs by banning medication commercials on tv. drug companies should only be able to market to prescribers. blowing 2 million for a single super bowl commercial is a waste of money. they basically tell people to go in there and tell your doctor that you want x medication. last i checked your doc should be telling you what is best for your condition, but what do i know?

Well, to be fair, my insurance provider thinks they know better than my doctor on what I need. So maybe I should be paying attention to what big Pharma says too?

gimmesometruth27 · May 16

mace1229 said:

gimmesometruth27 said:

mace1229 said:

It’s been broken for a long time, it isn’t anything new.
i remember when your first kid was born i was shocked how much the bill was. Something like 8k. To get an itemized bill to explain it and make sure we weren’t getting over charged or charged for things that don’t happen was nearly impossible because the billing with insurance is so clouded. I wanted ann itemized bill because there were issues with the staff and they failed to do certain things (never got epidural, among other things). And that was 8k after having a 2k/month premium on insurance.

A couple years ago the doctor ordered a colonoscopy for him. We fought with insurance but they would only cover a small portion and we were billed 5k. They argued it was something because he was only 8. But he needed it and it’s how we found out he had celiac disease, so we paid it. For what we pay in premiums, the bills we get are ridiculous.

And medication is for profit. It costs over $100 million to develop a drug. And there are dozens that fail and dump millions into that never go anywhere. Companies know they need to recover their costs and make a profit before generics become available, so they charge ridiculous amounts.

I don’t know what the answer is. Everyone and company has a right to make money. And that money is the drive behind developing new medicine. They won’t invest hundreds of millions into medicine if there isn’t a profit to be made. But charging a ridiculous amount shouldn’t be the answer.
And if you pay your insurance, they should t be allowed to deny medication. That is ridiculous. They make billions of dollars, they can cover meds.

i'd say we can start lowering drug costs by banning medication commercials on tv. drug companies should only be able to market to prescribers. blowing 2 million for a single super bowl commercial is a waste of money. they basically tell people to go in there and tell your doctor that you want x medication. last i checked your doc should be telling you what is best for your condition, but what do i know?

Well, to be fair, my insurance provider thinks they know better than my doctor on what I need. So maybe I should be paying attention to what big Pharma says too?

it is the docs paid by your insurance company, employed by your insurance company, that makes the final decision.

the idea that health care decisions being between you and your doctor is a farce.

big pharma, through their commercials, is telling you what to tell your doctor. your doctor should be the one telling you. your doctor should also be telling the insurance company doctors to get fucked. which the docs i used to work for did this all the time through peer to peer appeal.

brianlux · May 16

mace1229 said:

It’s been broken for a long time, it isn’t anything new.
i remember when your first kid was born i was shocked how much the bill was. Something like 8k. To get an itemized bill to explain it and make sure we weren’t getting over charged or charged for things that don’t happen was nearly impossible because the billing with insurance is so clouded. I wanted ann itemized bill because there were issues with the staff and they failed to do certain things (never got epidural, among other things). And that was 8k after having a 2k/month premium on insurance.

A couple years ago the doctor ordered a colonoscopy for him. We fought with insurance but they would only cover a small portion and we were billed 5k. They argued it was something because he was only 8. But he needed it and it’s how we found out he had celiac disease, so we paid it. For what we pay in premiums, the bills we get are ridiculous.

And medication is for profit. It costs over $100 million to develop a drug. And there are dozens that fail and dump millions into that never go anywhere. Companies know they need to recover their costs and make a profit before generics become available, so they charge ridiculous amounts.

I don’t know what the answer is. Everyone and company has a right to make money. And that money is the drive behind developing new medicine. They won’t invest hundreds of millions into medicine if there isn’t a profit to be made. But charging a ridiculous amount shouldn’t be the answer.
And if you pay your insurance, they should t be allowed to deny medication. That is ridiculous. They make billions of dollars, they can cover meds.

Yeah, I suppose in this country everyone has the right to make more money than they can ever spend. But not everyone has the ability to afford prescription drug insurance or help fund billionaires. I certainly don't.

Asterisk on the Street · May 16

brianlux said:

Medical needs are a really good reason for people to start taking a long hard look at what is happening in this country. When people get to be my age and are on a fixed income, anything can happen that could sink you. I just learned today that the medicine that could help me with my vertigo would cost more than my monthly income. That's obviously not going to fly. When I get a bad case of vertigo that is caused by vestibular migraine, I lose 24 to 36 hours of my life. I can live with that, but what if not having a certain medication meant I would lose my life? Well, yeah, I would die.
That is going to happen to some of our grandparents, great aunts and uncles, and other elders. Some people may not care. Ageism is a real thing in America today. I've seen it right here on these forums. But hey, guess what? Anyone who has been a Pearl Jam fan from the get-go is not exactly young anymore.
Look to your future. Look where you're headed. And think about how fucked you will be if things continue where they are going.
Sorry to be so blunt, but it's past time we wake the fuck up.

Brian,

Six months ago, my dad was in the same situation for a chemotherapy medication he needed. The monthly copay through insurance was more than his monthly income. We did some research and found that many of the pharmaceutical manufacturers have programs for reduced costs or even free to patients who qualify due to fixed incomes or low incomes. We are very thankful for the Novartis program which supplies his lifesaving medication. Please check into whether your needed medication's manufacturer can help you.

brianlux · May 16

Asterisk on the Street said:

brianlux said:

Medical needs are a really good reason for people to start taking a long hard look at what is happening in this country. When people get to be my age and are on a fixed income, anything can happen that could sink you. I just learned today that the medicine that could help me with my vertigo would cost more than my monthly income. That's obviously not going to fly. When I get a bad case of vertigo that is caused by vestibular migraine, I lose 24 to 36 hours of my life. I can live with that, but what if not having a certain medication meant I would lose my life? Well, yeah, I would die.
That is going to happen to some of our grandparents, great aunts and uncles, and other elders. Some people may not care. Ageism is a real thing in America today. I've seen it right here on these forums. But hey, guess what? Anyone who has been a Pearl Jam fan from the get-go is not exactly young anymore.
Look to your future. Look where you're headed. And think about how fucked you will be if things continue where they are going.
Sorry to be so blunt, but it's past time we wake the fuck up.

Brian,

Six months ago, my dad was in the same situation for a chemotherapy medication he needed. The monthly copay through insurance was more than his monthly income. We did some research and found that many of the pharmaceutical manufacturers have programs for reduced costs or even free to patients who qualify due to fixed incomes or low incomes. We are very thankful for the Novartis program which supplies his lifesaving medication. Please check into whether your needed medication's manufacturer can help you.

Thank you. Very kind of you to mention that!

I actually just heard about that possibility and with the oh so gracious help of one of the staff at U.C. Davis Medical, have applied to the company that produces Aimovig. I hope to hear back from them sometime next week. The thought of not having to suffer another attack at home or be taken to the E.R. yet again is exciting, but I'm trying to not get my expectations up too much until I hear from them.

SPEEDY MCCREADY · May 16

I had Blue Cross for decades.
2 months ago I had to go on the marketplace for insurance(long story).

Now every prescription and every doctors visit is a 3 ring circus. Some meds covered, others not. Some procedures covered, others not. I truly had no idea how good I had it with Blue Cross.

In 6 months I qualify for Medicare. Can't want to start that adventure. Ugh

Gern Blansten · May 16

gimmesometruth27 said:

Gern Blansten said:

gimmesometruth27 said:

Gern Blansten said:

mace1229 said:

Gern Blansten said:

mace1229 said:

Gern Blansten said:

This is fucking crazy. I had a blood clot in my leg a few years ago and got put on Eliquis.

Seems that I have a weird gene that makes clotting more likely. Dr told me that I would probably be on Eliquis for life.

Had a "discount" coupon from the maker for $10/month on the prescription that just ran out. Current cost is around $510/month at my pharmacy and the generic version is not available in the USA.

I signed up with a Canadian Pharmacy and will pay $173/month for the same prescription. They offered the generic for a bit less but I went with the brand for now.

The USA healthcare system is the fucking stupidest system in the world.

Is it not covered by your insurance?

I will be in the same boat in a few months. A year and half ago I have multiple blood clots, including several in the lungs. Had no symptoms other than I was having difficult breathing.
Because I had no pain or symptoms, the doctor said I'll be on Eliquis for life, because next time I probably won't survive and was lucky to this time. Who knows who long I had them before I had difficulty breathing.
I have the Eliquis discount for $10, but that runs out in about 6 months. But my copay is only $60 for it when the coupon is out. Still don't want to have to pay $60/month for life though.

Funny thing is, this all happened the day after the Indy show in 2023. It was the only show I had tickets to that leg and was supposed to make the 8 hour drive. But my parents forgot they agreed to watch the kids that weekend, so I ended up selling them last minute. Had I gone, I'd been on an 8 hour car drive home on the day I ended up going to the hospital. More than likely I would have been too stubborn to stop anywhere and who knows what would have happened.

wow that's crazy....no, my insurance doesn't cover but I would be very happy with $60/month. I'm not sure if that is because of my overall deductible or what exactly.

I figure I can live with the $178/month for three months then I'll get the generic at $114/month

Insurance is so messed up. We never know what is covered or how much things cost up front. We just get a bill with a bunch of numbers that don't make any sense, and pay it.

I'm guessing that once the block on the generic goes away in a few years that the cost will drop even further once others start making it.

It's just odd to me to pay $7/month for my bp meds and $500/month for a blood thinner.

But I want to live so I guess I'll shut up and pay.

ask your doc if there is an alternative for the blood thinner. or you can download one of those coupons that makes your co-pay like $25. they can usually be found on the manufacturer's website. i also hear there is an app called goodrx or something that frequently has coupons to knock down the price of your co-pay. i am not sure how it works but i have a friend that uses it.

Yeah my coupon was for $10/month but expired after two years. No more coupons.

Canada for the win. It's just a shame how fucked up our system is

it is a for profit system. so some people are going to get screwed in order to make that profit. unfortunately it is you in this case. there has to be a generic equivalent that is covered by insurance.

Nope... Not in the USA

Gern Blansten · May 16

mace1229 said:

It’s been broken for a long time, it isn’t anything new.
i remember when your first kid was born i was shocked how much the bill was. Something like 8k. To get an itemized bill to explain it and make sure we weren’t getting over charged or charged for things that don’t happen was nearly impossible because the billing with insurance is so clouded. I wanted ann itemized bill because there were issues with the staff and they failed to do certain things (never got epidural, among other things). And that was 8k after having a 2k/month premium on insurance.

A couple years ago the doctor ordered a colonoscopy for him. We fought with insurance but they would only cover a small portion and we were billed 5k. They argued it was something because he was only 8. But he needed it and it’s how we found out he had celiac disease, so we paid it. For what we pay in premiums, the bills we get are ridiculous.

And medication is for profit. It costs over $100 million to develop a drug. And there are dozens that fail and dump millions into that never go anywhere. Companies know they need to recover their costs and make a profit before generics become available, so they charge ridiculous amounts.

I don’t know what the answer is. Everyone and company has a right to make money. And that money is the drive behind developing new medicine. They won’t invest hundreds of millions into medicine if there isn’t a profit to be made. But charging a ridiculous amount shouldn’t be the answer.
And if you pay your insurance, they should t be allowed to deny medication. That is ridiculous. They make billions of dollars, they can cover meds.

Right.... So that doesn't explain why I can pay 33% for the same drug in Canada. I realize it's for profit... That's the problem

Halifax2TheMax · May 16

Unintended consequences?

https://www.theguardian.com/us-news/2025/may/15/unitedhealth-group-shares-drop-medicare-fraud-investigation

Obamacare

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