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Re: The high cost of drugs!!

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Message 41 of 55

@retiredtraveler wrote:

"...Seems the drug companies rip us off with pricing....".

 

     I am no fan of the drug industry, but you do realize that you are paying for R&D on these drugs which costs the company millions. 

      On the other hand, we know the meds are not as expensive outside the U.S. I been using a pharmacy in Canada for some time now.


With the billions that they are making, what they spend on Research and Developement is miniscule.

The drug companies and the insurance companies are in this together. As far as AARP goes, they endorse United Health Care. United Health Care in Florida and from what I understand in other states where there is older populations they dropped at least fifty percent of the doctors that participated in the plan. Four of my doctors were dropped, So I had to change to Blue Cross and Blue Shield, which had higher co payments on both drugs and doctors. I had to go that way though, I wasn't about to try to find new docs after using and feeling comfortable with the physicians I was using.  I called AARP, and the person I talked to said what can I say, They can drop doctors and their drug coverages can change as they see fit. Basically that person could care less about my complaint, but I constantly receive begging letters from AARP for contributions. I really don't care that I can now get fifteen percent off at Denny's all day long now as oppossed to the only after four pm prior to that big change. I would think they would look for better carriers for them to endorse.  

 

As to what you do about your high cost of drugs I also use a Canadian Pharmacy, But  now the doctors write prescriptions electronically to the drug store in their files. One of my doctors did not want to give me a written prescription for me to bring to the Canadian Pharmacy. I talked him into doing it after saying I would write blasting reviews about him on social media sites. As far as I am concerned every one in the medical field is in cahoots with each other. Also the Canadian Pharmacies cannot order everything I need. but on the things I can get from them It is a major savings. Now I am in the donut hole. Fortunately I am in the financial position that I can pay for whatever drugs I take, But for the people that can't they do have a major problem and all these stupid discount cards that you see  in Doctors offices and Pharmacies don't work if your on Medicare or a Medicare Choice plan. 

 

The entire system is corrupt and I don't see anyone including AARP doing a thing to help since they still run ads for United Health Care

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Re: Medicare and Big Pharma

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Message 42 of 55

Gail, Med . D may cover all drugs, but the insurers 'tiers" sure make costs almost prohibitive. They do negotiate with pharma ,but not necessarily pass on their savings to us.

The basic problem is still the way pharma sets prices with little regard to true costs. They spend more on advertising ,lobbying and doctor promotions than research. Much research is government funded,directly or indirectly .

Karl

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Re: Medicare and Big Pharma

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Message 43 of 55

GailL1 wrote:
No one seems to remember why this choice was made.
So I went back to a 2005 NYT article explaining why the law was issued without any negotiation clause.

It was because Medicare D virtually covers EVERY drug.
But not every plan covers EVERY drug. Since 2010, I had a heck of a time finding one particular drug on the formularies. And now that drug went generic and it still costs a bunch compared to other generics. It is only about $10 less for 3 months than brand on my plan. Why? because it works well and they can get away with it.

CMS tried to change this THIS year, they tried to limit the number of them in specific categories but there was such an out cry from BOTH parties they pulled the changes in March 2014.

If you want Medicare to negotiate for drug prices, then the very 1st step is to dwindle down the list.

That is the trade off .
The VA does not cover every drug, for those that they don't cover, the beneficiary pays for it. The VA is also much stricter on step therapy - you have to try drug (A) before getting drug (B)' etc.
A few of my drugs require step therapy in several different Part D plans so it's not just the VA.

Would it confuse older folks when their generics for whate come looking differently? Like for one 90-day period you get a generic for lowering your cholesterol and then when reordered, you get another generic that looks completely different than the previous because they are both the same drug generic. Negotiations often win different results especially over a period of time.
Well, for many many years one of my generics came as a little green pill. Then low and behold, one day it came as a little yellow pill. I looked it up on a pill identification website and it is the the same drug just a different manufacturer. All the plans that have mail order have phone numbers to talk to a pharmacist so I think people can deal with different colors of pills if it saves them money.


Look back in history
NYT 06/15/2005. Medicare Officials Insisting on Wider Choices in Drug Benefits
http://www.nytimes.com/2005/06/15/health/15drug.html?pagewanted=print&_r=0

Ok so let's negotiate - but understand that this will be a trade off because Medicare will not be able to negotiate on every drug, so the list has to get shorter.
Right now it is the Part D insurance companies negotiating the prices.

 

Another article to read.

 

http://www.ncpssm.org/DesktopModules/SunBlog/Handlers/Print.aspx?id=2061


 

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Re: Medicare and Big Pharma

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Message 44 of 55

Inkwell, "Interesting points.
You mentioned that no one negotiates with Medicare.
Any opinion as to why Medicare was not given the authority to negotiate best pricing for many of these insanely priced meds?
Thanks."

Thanks for the kind words.  I think Gail's answer is more comprehensive than my ideas will be.

 

For Physician 'Buy & Bill' meds, under Part B, the doctor get's a tiny mark up while the bulk of the Allowable goes to the Pharma manufacturer.  (Herein addressing cost of drugs thru non part D benefit, if you will.) The proportion of the doctors' payment to the Pharma mfr that is profit is a difficult debate, while it appears to be very high but may not be.

 

My friends who use generic Reclast / zoledronic acid 5 mg I.V. / for osteoporosis related conditions, paid about $1100. per vial to Novartis. The generic is at or under $400. and the newer makers did not have the economy of scale of original maker Novartis. But Novartis had to recover costs of R & D and FDA testing for approval which I'm pretty sure were hundreds of millions of dollars not expended by the generics makers.  Very tough issue.

 

Please consider development & production of Biologics, using bioreactors / monoclonal antibodies / & recombinant DNA, are regulated as intensely as nuclear reactors, and have costs in the billions of dollars.  Investors and dedicated teams of scientists have to collect a kings ransom for there to be any future of new breakthrough products.  These meds fall into both the Part D & Part B category, with some that are available in both.

 

My conviction is that other countries -- those where the drug was not developed -- should pay nothing less than their prorated share of the development cost. This should be applied whether it is the USA, France, Germany, Holland or whatever country of origin. The idea that Canada & Europe can buy an American developed specialty med at less cost than Americans is pretty much unfair & hard to justify.  Humanitarian/charitable donations are not part of this complaint.


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Re: Medicare and Big Pharma

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Message 45 of 55
No one seems to remember why this choice was made.
So I went back to a 2005 NYT article explaining why the law was issued without any negotiation clause.

It was because Medicare D virtually covers EVERY drug.

CMS tried to change this THIS year, they tried to limit the number of them in specific categories but there was such an out cry from BOTH parties they pulled the changes in March 2014.

If you want Medicare to negotiate for drug prices, then the very 1st step is to dwindle down the list.

That is the trade off .
The VA does not cover every drug, for those that they don't cover, the beneficiary pays for it. The VA is also much stricter on step therapy - you have to try drug (A) before getting drug (B)' etc.

Would it confuse older folks when their generics for whate come looking differently? Like for one 90-day period you get a generic for lowering your cholesterol and then when reordered, you get another generic that looks completely different than the previous because they are both the same drug generic. Negotiations often win different results especially over a period of time.
Look back in history
NYT 06/15/2005. Medicare Officials Insisting on Wider Choices in Drug Benefits
http://www.nytimes.com/2005/06/15/health/15drug.html?pagewanted=print&_r=0

Ok so let's negotiate - but understand that this will be a trade off because Medicare will not be able to negotiate on every drug, so the list has to get shorter.
Right now it is the Part D insurance companies negotiating the prices.
* * * * * * It’s Always Something - Roseanne Rosannadanna
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Re: Medicare and Big Pharma

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Message 46 of 55
Interesting points.

You mentioned that no one negotiates with Medicare.

Any opinion as to why Medicare was not given the authority to negotiate best pricing for many of these insanely priced meds?

Thanks.
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Re: Medicare and Big Pharma

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Message 50 of 55

Just so you know, massive waste, fraud & abuse is committed hourly by Medicare under it's MAC contractors. They insanely declared items to be 'included' that were purchased separately by your providers. Major injection requiring Marcaine anesthetic? Defund the marcaine, let the patient scream or commit extortion against the doctor to provide it free.

 

Your Specialist is 100% 'by referral, writing a Consult report back to the PCP. Medicare declares it is not a Consult & should be funded at the lower 'New Patient Visit' coding**. This absolves the Consulting specialist from the full standard of care. They can coordinate care as mandated for a Consult, or not since it cannot be coded or funded as a Consult. // Proven fraud by a Physician Med Director of Trailblazer (region now covered under Novitas) occurred several years back; he was defeated in the Admin. Law Judge Forum conducted by phone in Miami. No penalty or sanction, the Medical Board of Texas didn't have jurisdiction, & he is now in the northwest illegally denying coverage over similar issues. I petitioned to place him on the OIG Exclusion list, but no...this is better.

 

60 Minutes doesn't always have 60 seconds of integrity. No one 'negotiates' with Medicare; if they could, then the doctors wouldn't have to choose between being robbed by them or denying visits to Medicare patients. Ever hear of a prior auth? Can't be done with Medicare. Your doctor will not engage high stakes poker for a buy & bill office admin drug you need without a prior auth, unless your Part D coverage will send it as a 'Brown Bag' access.

 

ASP + 6% -2% Sequestor = Medicare formula to 'reimburse' cost of office admin (Buy & Bill) drugs.

Imagine your roofer, chef, gardener, etc. taking a markup of 4%  IF all the semicolons are aligned & approved by a federal government program.  This "mark up" is a joke; it is underwater funding that ignores overhead costs of complex coding, licensing, liability insurance, training, paperwork, & appeals.  The services are still sometimes done because: 1.) services for non Medicare may be diluted with reduced quality & quantity, 2.) the referring doctor may be grateful for the charitable sacrifice and refer paying coverage cases that have Aetna, 3.) the provider is a liberal martyr who will typically cheat by illegally reimporting thru Canada and Mexico under questionable sourcing/storage/shipping conditions.

 

**If a private insuror did this before CMS, they would have been prosecuted & possibly called in for Congressional hearings, which occur over smaller affairs.

 

Did you catch Steve Kroft's puff piece, sitting as a potted plant thru Pres. Obama's false statements?

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Medicare and Big Pharma

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Message 52 of 55

Does anyone know where AARP's stands on getting Congress to change the legislation that prohibits Medicare to negotiate the cost of what they (and we) have to pay for Drugs?

 

Hopefully you saw the 60 minute segment last night that shows just how unethical the Big Pharma Companies are. If you haven't it's definitely worth looking up.

 

Thanks.

Inkwell99

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Re: The high cost of drugs!!

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Message 47 of 55

"...What value do you put on a medicine if it only has been documented to add a few months to a cancer patients life ? That is also an important part of the discussion on the cost of these types of medications depending upon the stage and the progression....

 

   Yeah. The endless question.  I hope I have the intestinal fortitude, should I be put in this position in the future, to just say no.  When I was a CNA, I worked for over a year on the oncology floor.  Saw a great many situations including people who returned every 3-6 months, sicker than the last time. I think about that job, and specific patients, every time I sit here at my PC planning trips for the next year and talk about 'the good life'. So many people who had their retirement robbed by disease with no idea why it was them.

    The problem, to me, is always the uncertainty. We know the projections by docs about how a disease will progress and how long you have to reach 'x' stage, are educated guesses. And there is always someone who 'beats the odds'.

   Not meaning to be facetious, but I agree with comments made in an old Startrek film talking bout the 'barbaric treatments' we have. Drugs that just rack the body with side effects and often, limited efficacy. But, we pay dearly for them.


"...Why is everyone a victim? Take personal responsibility for your life..."
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Re: The high cost of drugs!!

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Message 48 of 55

Astraea, "... why should it cost $700 for an ultrasound, or $4,500 for biopsies of several tissue samples?"  

 

I am not a doctor, but rather a practice administrator & family member of a Specialist in Texas.

 

Part of the cost might be to recover from the massive unfunded sacrifices entailed in 4 yrs undergrad/4 yrs Med School/ about 3 yrs for Internship & Residency/ & then about 3 more years for Fellowship for Specialists. The loans for Med school alone could easily be $200,000 before interest.  So we could punish those who had the gumption to do this by bankrupting them, in order to only reward those who took government assistance and defaulted on their loans. 

 

The full billed charges are intended to be double or triple the typical insurance Allowable so as not to undercut oneself as a charge below Allowable will be funded at the billed charge if it is lower.  Why reduce what they are willing to pay which is normally a very thin margin over cost & is often below cost? We absolutely have to be overpaid for some things to offset other things we cannot control that are underpaid; it's just a fact of life.

 

And why are overhead costs high? Ask your doctors what the rent costs, then look at a page or 2 of the bookkeepers checks to cover equipment, maintenance, computers, traininng, software, work comp, benefits, OSHA compliance, etc. Find out how many hours per week the doctors work, and whether it is more or less than before Electr. Med records. You can go to offices where the staff know less than the fry cook at Dairy Queen; that is the case for a large primary care group managed by the hospital where I work. They discussed my 'strange' question whether they were "In Netword" sic. network. So help me God.

 

High financial risk ensues treating uninsured or underinsured, so they cannot be afforded the Insurance rate for that reason. They can get a Point of Service discount if they pay at the time of service; this would typically be at half off of the full billed rates, so their net cost which bypasses any insurance premium is greatly below that of Insured patients. 

 

Deadbeats cannot ethically be rewarded and so when they defraud the insurance  (bounce or don't pay Premium check) & Provider, these large full billed charges can be turned over to Collections agency, such that if the deadbeat doesn't even try to negotiate a deal in "good faith" a day late & a dollar short, then even if they pay nothing there is a well deserved ding against their credit to increase the interest rates for car/home/etc.  

 

Our biggest deadbeat zero pay loss was about $28,000. for a religious woman who signed a fraudulent face sheet on insurance when she checked in. She was seen daily for almost a month & a half, 7 days a week. The whole family prayed to Jesus & Jesus told them not to pay.  Under insurance, the Allowable would have been roughly $9,000. And that's the rough amount to be recovered from you and other responsible active patients who have discretionary services such as medical questionnaires for short or long term disability, or fee for service issues not under insurance. The example is about liars & thieves & has far less to do with poverty than the craven contempt of sociopaths.

 

Many Providers would write off thousands in charges (we sure have) if the patient simply showed respect and character by calling to discuss it.

 

Typically, the non insurance mistake costs more over time than the premiums would have cost. It's like saying the person who spent a few hundred dollars on tattoos, marijuana, and liquor couldn't possibly cover their copay.  But now, the excellent High Risk pool products so many people needed to only cover major surgeries are not compliant with PPACA strait jacketing, so perfectly reasonable people are going without the high premium high deductible inadequate coverage compliant with the PPACA.

 

Take away one asset, such as greatly reduced malpractice cost in Tort Reform states, or add one liability such as mandating participation in Medicaid, and a sizable number of private practices would go under. When your independent Provider who has private practice becomes the puppet of a hospital system........well, you can judge for yourself. The fry cook can discuss your dyslipidemia, as they work with fat all day.

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