Drug prices

[Timeshare Von]

Well many of us don't have much in the way of medical insurance options. My company SUCKS and is pretty much the only one I can use in Milwaukee County. It is less expensive than "the other one" but hardly what I'd call "affordable." If my employer wasn't reimbursing me monthly for my premiums, there's no way we could afford the amount we're paying monthly!

 

[WinniWoman]

I just yet again this evening went through health insurance hell- this time my husband's part D plan for NH that we had to go through VIA benefits to change from NY to NH since we moved. Wellcare sends a letter stating the plan he enrolled in at our NH ADDRESS does not cover our area! Call to verify address or will be dis enrolled before the 3/1 effective date. What the?

I call VIA benefits- they don't get it. I ask to speak with a supervisor. Well- they always try to get out of that one. On hold, FOREVER- rep does a 3 way call with Wellcare. Wellcare rep dumb as a box of rocks. Switches us to another dept that says they have to change the plan or a code or some crazy thing and proceeds to do another application! The VIA Benefits rep is nervous for me because it doesn't make sense and we need to have their agent # retained on the application for my husband to get the HRA contribution. On the phone now for 2 hours! I kid you not!

Speaking with this robot I lost it completely and demanded a supervisor. On hold again. Get one. Mind you could barely understand any of them as they had heavy foreign accents. He then tells me after 3 HOURS NOW! that the letter was to just verify we moved. Wait! What? The letter states our NEW address is outside the NH Wellcare plan service area! It says my husband will be dis-enrolled. OMG. I just can't take it anymore. The rep before him had me on the phone for 1/2 hour like doing an entire application over again! Insisting that is how she has to change the address. It was a nightmare!

Honestly- you cannot make the sh08938654T up!!! OMG!The Via Benefits rep even could not believe it. She set up a case just in case of anything and I filed a formal complaint with Wellcare. I even had to tell the rep to take our payment now since March 1st is right around the corner. Had him put it on automatic. Asked for an email verification of everything which I have not received as of yet.

In NY I went through another issue with Wellcare - And VIA BENEFITS with my husband's Medigap plan, which they never enrolled him in (good thing I caught it)- and I filed formal complaints with the state government agencies and the BBB! Now here I am again dealing with all this incompetence.

I am telling you all this health insurance stuff is ruining my life. Taking away my life energy and time. Making me unhappy. I can't seem to get out from under it. I think it is all finally settled and then - Everytime I see a mailpiece from one of these companies I get a pit in my stomach wondering what kind of BS it will contain and thinking I will now have to make more phone calls. I told the Wellcare supervisor who kept apologizing for the "inconvenience' that this was more than inconvenience- this was absolute hell- like being tortured in a 3rd world country prison camp!

I told my husband I cannot take much more of dealing with this health insurance stuff. Instead of health it is making me so stressed out I will get sick. Something has to change... and I am smart- maybe that is the problem. Maybe I should just throw out all my mail or ignore it like the stupid people do. Maybe just have no insurance. That's the ticket. It shouldn't be this hard. I was better off working and having an employer insurance plan and that takes a lot for me to say.. At this rate, I will have no real retirement life.

 

[Krteczech]

I feel your frustration. My husband an I experienced house sale, retirement and moving from state to state about two years ago. We applied for Medicare before SS and to date I am not sure how much I overpaid.... it took good six months to get all necessities under control, but we survived and put stress behind us. Hope they will not worn you out to the point that you cannot enjoy your newly gained freedoms at your new house. Cheer up!

 

[Fredflintstone]

I have a sad story to share regarding drug prices.

I went to Algodonos a few years back. It’s a Mexican border town not far from Yuma, AZ.

I parked at an Indian parking lot against the border and was amazed at the number of Seniors going across. I later found out that many do a regular pilgrimage to Algodones to buy their meds, get dentures, receive dental work and buy glasses.

As I was walking, there was an elderly man in his 80s literally crawling to the border. He was in obvious distress. He had a walker and was clearly struggling.

I asked him if I could help him and he started to cry. This poor buggar needed his heart and diabetes medicine and couldn’t afford US pricing. Yet, he needs his medications or he will be in even more dire straits than he already was in.

I told him to just give me the list of his meds and I will go and get them. He was hesitant but reluctantly agreed. I helped him to his car and told him to wait and I will be right back. He told me to just buy a very small amount as he only has 20 dollArs. I told him to not worry about it.

Anyway, I bought him a six months supply. He initially panicked because he had so little money. I told him to forget about paying me. He was so grateful he cried again.

That should never happen in such a rich, beautiful country like the US. BTW, the six month supply was 150 USD. I checked at Wal greens and the same amount would have cost 4500. With copay it was, as I recall, 850.




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[Brett]

I have a sad story to share regarding drug prices.

I went to Algodonos a few years back. It’s a Mexican border town not far from Yuma, AZ.

I parked at an Indian parking lot against the border and was amazed at the number of Seniors going across. I later found out that many do a regular pilgrimage to Algodones to buy their meds, get dentures, receive dental work and buy glasses.

As I was walking, there was an elderly man in his 80s literally crawling to the border. He was in obvious distress. He had a walker and was clearly struggling.

I asked him if I could help him and he started to cry. This poor buggar needed his heart and diabetes medicine and couldn’t afford US pricing. Yet, he needs his medications or he will be in even more dire straits than he already was in.

I told him to just give me the list of his meds and I will go and get them. He was hesitant but reluctantly agreed. I helped him to his car and told him to wait and I will be right back. He told me to just buy a very small amount as he only has 20 dollArs. I told him to not worry about it.

Anyway, I bought him a six months supply. He initially panicked because he had so little money. I told him to forget about paying me. He was so grateful he cried again.

That should never happen in such a rich, beautiful country like the US. BTW, the six month supply was 150 USD. I checked at Wal greens and the same amount would have cost 4500. With copay it was, as I recall, 850.

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wow

 

[Talent312]

DW's Wellcare story:
Aetna sold her Plan D to Wellcare and they raised the premium for 2020.
During OE, we went to Medicare.gov and chose a cheaper Wellcare plan.
A month later, Wellcare sent her ID's and welcome letters for both plans.

"Your new plan will start in January. You can trash the old plan ID stuff."

Then we get a notice from SS that they'll deduct for the old pricey plan.
"That's just old information. Don't worry. The new one starts in January."
Everything worked out, but gawd.
.

 

[WinniWoman]

DW's Wellcare story:
Aetna sold her Plan D to Wellcare and they raised the premium for 2020.
During OE, we went to Medicare.gov and chose a cheaper Wellcare plan.
A month later, Wellcare sent her ID's and welcome letters for both plans.

"Your new plan will start in January. You can trash the old plan ID stuff."

Then we get a notice from SS that they'll deduct for the old pricey plan.
"That's just old information. Don't worry. The new one starts in January."
Everything worked out, but gawd.
.

This Wellcare is the pits. I am sorry we chose them. Would have been worth it to pay a bit more premium and go with another company maybe. When I gave the so called supervisor my credit card he started to recite the premium for the NY plan! I had to interrupt him to tell him it was the wrong premium!

The scary thing is these imbeciles are responsible for people's lives. I don't blame them, however. I blame management and the entire system which has made things so convoluted no one can know their as4$^ from their elbow.

I will tell you one thing- my husband could never deal with this. He has no knowledge of anything about anything with health care and no desire to learn. Plus he is hard of hearing and if the phone reps have heavy accents and/or talk fast on top of it, forget it- he's done for.

 

[WinniWoman]

I have a sad story to share regarding drug prices.

I went to Algodonos a few years back. It’s a Mexican border town not far from Yuma, AZ.

I parked at an Indian parking lot against the border and was amazed at the number of Seniors going across. I later found out that many do a regular pilgrimage to Algodones to buy their meds, get dentures, receive dental work and buy glasses.

As I was walking, there was an elderly man in his 80s literally crawling to the border. He was in obvious distress. He had a walker and was clearly struggling.

I asked him if I could help him and he started to cry. This poor buggar needed his heart and diabetes medicine and couldn’t afford US pricing. Yet, he needs his medications or he will be in even more dire straits than he already was in.

I told him to just give me the list of his meds and I will go and get them. He was hesitant but reluctantly agreed. I helped him to his car and told him to wait and I will be right back. He told me to just buy a very small amount as he only has 20 dollArs. I told him to not worry about it.

Anyway, I bought him a six months supply. He initially panicked because he had so little money. I told him to forget about paying me. He was so grateful he cried again.

That should never happen in such a rich, beautiful country like the US. BTW, the six month supply was 150 USD. I checked at Wal greens and the same amount would have cost 4500. With copay it was, as I recall, 850.




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This really is sad and a good story for me when arguing with others about the Canadian Health system. They are always telling me people from Canada come down here for surgeries and such, which I am sure some do, but it is not like they come down in droves. Now I can tell them people from the USA go down to Mexico for health care and medicine.

 

[joestein]

So talking about Health Insurance......

I was in pain in Nov and ended up going to the local hospital and having my gallbladder removed. Since then I have been trying to stay a little better on top of my health. I recently went to the Gastrologist and they sent me for bloodwork. I went to Quest like I always do and they took my blood.

Just yesterday, I got a letter from Anthem that says Quest is out of network. Really? Where else do you go for bloodwork?

From my surgury... They said the Hospital and my Surgeon were out of Network. We have gone to the hospital numerous times in the last 5 years and it has always been in network. Luckily my Hospital only charged me $800 instead of the thousands Anthem said I owed them. I still haven't heard from the Surgeon. They said that he billed 20K for the operation and that the insurance would only allow $6K, but since he is out of network and the $6K is less than the $18K out of network deductible, they paid nothing. They actually said that I would owe the surgeon 20K.

All these monies are on top of the $11K we pay towards health insurance with my wife's firm.

Joe

 

[WinniWoman]

So talking about Health Insurance......

I was in pain in Nov and ended up going to the local hospital and having my gallbladder removed. Since then I have been trying to stay a little better on top of my health. I recently went to the Gastrologist and they sent me for bloodwork. I went to Quest like I always do and they took my blood.

Just yesterday, I got a letter from Anthem that says Quest is out of network. Really? Where else do you go for bloodwork?

From my surgury... They said the Hospital and my Surgeon were out of Network. We have gone to the hospital numerous times in the last 5 years and it has always been in network. Luckily my Hospital only charged me $800 instead of the thousands Anthem said I owed them. I still haven't heard from the Surgeon. They said that he billed 20K for the operation and that the insurance would only allow $6K, but since he is out of network and the $6K is less than the $18K out of network deductible, they paid nothing. They actually said that I would owe the surgeon 20K.

All these monies are on top of the $11K we pay towards health insurance with my wife's firm.

Joe

This would do me in altogether! It is so out of control it is not even funny. I don't know who these politicians say are the people who like their health insurance and want to keep it but I don't know of any.

From now on we are going to ask BEFORE every single time we get any health care what is and is not covered. We don't get the care unless we get the answer beforehand or unless we are in an emergency situation, and even then......

 

[bogey21]

Back when I was covered via my Employer's plan I had issues from time to time which I attributed to my Employer being fixated keeping their cost as low as possible. Since I went on Medicare about 20 years ago I have only had one problem which was caused by mis-coding by the Doctor's Office. Otherwise zero problems. I attribute this to staying away from Medicare Advantage Plans (I use Standard Medicare) and base my decision on which companies from which to purchase my Supplement and Part D Prescription Coverage on the claims paying and customer service reputation of the Companies rather than price...

George

 

[Fredflintstone]

This would do me in altogether! It is so out of control it is not even funny. I don't know who these politicians say are the people who like their health insurance and want to keep it but I don't know of any.

From now on we are going to ask BEFORE every single time we get any health care what is and is not covered. We don't get the care unless we get the answer beforehand or unless we are in an emergency situation, and even then......

Sigh, one should not need to figure out if they can or cannot afford a certain health care procedure.

I can see it now.

So, Doc I need.... done?

Hang in, how much?

Insurance covers how much?

What do I need to pay?

Ok, I’ll go to my bank to figure out if I can afford it or not...

Say, do you take Visa?

My, my, my.


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[Fredflintstone]

I checked out Los Algodones on Wikipedia.

Have a read on health care....

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[VacationForever]

The downside of "free" medicine can be experienced in HMO systems where the approved drugs are from many generations ago and very cheap for the HMO to fill and free to the patient. Doctors in the HMO system generally do not prescribe better drugs that are more expensive that are not in the system's "formulary". If the patients know about such drugs, doctors can prescribe them but the patients need to pay for them out of pocket. What I like is having choice - if we are willing and can afford to pay for such drugs, doctors should inform us of the options. My husband took a very cheap diabetic medication that is detrimental to the pancreas for years while we were at Kaiser. We moved out of state and his new PCP explained to us why he should stop that medication and get on a more expensive drug, a Tier 3 on his plan, but only if we are willing to pay for it. We opted for this better drug option. Similarly for me with my health condition, where Kaiser overdosed me 16X total on 4 over the counter drugs because Kaiser did not need to pay for any of them and my illness was still not under control. My current allergist stopped these drugs and replaced with a single more expensive prescription drug and I am finally healthy again.

 

[bogey21]

If we are willing and can afford to pay for such drugs, doctors should inform us of the options.

Being able to do this is why I avoid Medicare Advantage HMO and PPO plans and have Standard Medicare + Supplement + Plan D Prescriptions. My health is more important to me than keeping the cost down for the Insurance Companies...

George

 

[bluehende]

This would do me in altogether! It is so out of control it is not even funny. I don't know who these politicians say are the people who like their health insurance and want to keep it but I don't know of any.

From now on we are going to ask BEFORE every single time we get any health care what is and is not covered. We don't get the care unless we get the answer beforehand or unless we are in an emergency situation, and even then......

This is absolutely no guarantee either. Our company just changed from Aetna to BCBS. We have called about 4 different things. Twice we got wrong answers or more accurate dodgy answers that would have cost us money if we had just assumed they were right. We probably have 6 hrs on the phone also with various insurers and dr offices. This is the main reason we have a huge overhead cost in our health care.

 

[bluehende]

The downside of "free" medicine can be experienced in HMO systems where the approved drugs are from many generations ago and very cheap for the HMO to fill and free to the patient. Doctors in the HMO system generally do not prescribe better drugs that are more expensive that are not in the system's "formulary". If the patients know about such drugs, doctors can prescribe them but the patients need to pay for them out of pocket. What I like is having choice - if we are willing and can afford to pay for such drugs, doctors should inform us of the options. My husband took a very cheap diabetic medication that is detrimental to the pancreas for years while we were at Kaiser. We moved out of state and his new PCP explained to us why he should stop that medication and get on a more expensive drug, a Tier 3 on his plan, but only if we are willing to pay for it. We opted for this better drug option. Similarly for me with my health condition, where Kaiser overdosed me 16X total on 4 over the counter drugs because Kaiser did not need to pay for any of them and my illness was still not under control. My current allergist stopped these drugs and replaced with a single more expensive prescription drug and I am finally healthy again.

Our not so free POS (point of service but the acronym for something else does apply) has the same problem. 2 hrs on the phone to get a prescription filled because it was not on the preferred list.

 

[VacationForever]

Health care costs are the same and it is a matter of who pays for it. Socialism and Communism have alot of similarities - what is yours is mine and vice versa. It leaves very little motivation to innovate, create, and push ourselves to excel. No good things can come out of it.

 

[bluehende]

Health care costs are the same and it is a matter of who pays for it. Socialism and Communism have alot of similarities - what is yours is mine and vice versa. It leaves very little motivation to innovate, create, and push ourselves to excel. No good things can come out of it.

Cutting out a middleman and a whole ton of overhead most certainly changes the cost structure. That is the main reason the rest of world pays roughly 1/2 of what we do.

 

[VacationForever]

Cutting out a middleman and a whole ton of overhead most certainly changes the cost structure. That is the main reason the rest of world pays roughly 1/2 of what we do.

Current system is providing a choice - I can go to a better doctor or getting my surgery scheduled sooner.

"The rest of world" which pays roughly 1/2 of what we do are not all single payer systems. Our high costs are not the result of not having a single payer. Take Singapore as an example. It is a first world country and with higher per capita income than the US. Their health care cost is lower than the US. They have public and private hospitals and clinics. Private hospitals/clinics are unsubsidized and anyone who can afford can go there, whether it is private pay or through purchased health insurance. Public hospital and clinics charge by tiers. If you want to stay at a lower tier class, say B class with 4 person room, you can pay an unsubsidized rate or get a subsidized rate with proof of lower income. "A" class in a public hospital is not subsidized but cheaper than private hospital. In a public hospital, you get the same specialist / surgeon who will treat you regardless of whether you are in a A, B or C class bed. If I need a bypass heart surgery and with low income, I will stay in C class room but with the same top surgeon while paying close to none for the surgery.

 

[Luanne]

I got a shock yesterday when I went to refill my prescription for Eliquis. The last time I refilled (which was only the first time I had refilled since I'd gotten the prescription) it was $138 for a 90 day supply. Yesterday it was $486! I went ahead and paid for it since I need the prescription. Then I called Silver Script. Turns out I have some kind of deductible and since this was the beginning of the year I hadn't met it. It was definitely met with this payment and future refills will be $141. It was still about half the cost of retail, but those prices are ridiculous.

 

[Rolltydr]

Health care costs are the same and it is a matter of who pays for it. Socialism and Communism have alot of similarities - what is yours is mine and vice versa. It leaves very little motivation to innovate, create, and push ourselves to excel. No good things can come out of it.

Well, except fewer people would die simply because they can’t afford healthcare.


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[bluehende]

Current system is providing a choice - I can go to a better doctor or getting my surgery scheduled sooner.

"The rest of world" which pays roughly 1/2 of what we do are not all single payer systems. Our high costs are not the result of not having a single payer. Take Singapore as an example. It is a first world country and with higher per capita income than the US. Their health care cost is lower than the US. They have public and private hospitals and clinics. Private hospitals/clinics are unsubsidized and anyone who can afford can go there, whether it is private pay or through purchased health insurance. Public hospital and clinics charge by tiers. If you want to stay at a lower tier class, say B class with 4 person-bed, you can pay an unsubsidized rate or get a subsidized rate with proof of lower income. "A" class in a public hospital is not subsidized but cheaper than private hospital. In a public hospital, you get the same specialist / surgeon who will treat you regardless of whether you are in a A, B or C class bed. If I need a bypass heart surgery and with low income, I will stay in C class room but with the same top surgeon while paying close to none for the surgery.

With a quick look at their system it looks like they have national healthcare and you can pay for additional levels of care. Hard to compare a country that seems to have it together with a integrated national care/additional care system with ours that has no public option. Again all of this insurance is based on a national healthcare cost structure. IMHO this is the way to go. Some form of basic health care provided with the option to either pay out of pocket for higher levels of care or insure yourself for this cost.

 

[WinniWoman]

And then there’s this. We just moved here and intended to use this pharmacy for hubby’s high blood pressure meds as they are a preferred pharmacy for his Part D plan. Bad enough there’s been issues getting it for over a year due to recalls. Mail order and physical stores. Now this. Things are getting worse and worse every day. What are the hell are people suppose to do? https://www.laconiadailysun.com/new...cle_46f68f68-4f71-11ea-b754-d3b0099737f7.html

 

[simpsontruckdriver]

If you haven't done so, you could read through my epic post about Medicare. In terms of Medicare Part-D, if you have Medicare PFFS (Paid Fee For Service, aka "Basic") and Part-D, you can lower costs in one way: mail-order pharmacy. I know Humana and United Healthcare have their own, Aetna uses CVS, etc. There's not many savings available above that, since those on Part-D can't use GoodRX or other savings. But, people can talk to the drug companies to see if there are anything they can do. For instance, back in 2014, I trained for that type thing for Xeljanz, a small pill that stops (possibly reverses) Rheumatoid Arthritis, with a side-effect that those with Allopecia grow hair. The company looks up what their insurance pays, and they pay the rest depending on income.

TS