Obamacare Plans Bring Hefty Fees for Certain Drugs(hosted.ap.org)
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Obamacare Plans Bring Hefty Fees for Certain Drugs
http://hosted.ap.org/dynamic/stories/U/US_HEALTH_OVERHAUL_PRESCRIPTION_COSTS?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT
6 comments
Ok so under the ACA she now pays less for her medications (Celebrex does not yet have a generic, i know because i'm on it as well). The headline is link bait: Before the ACA she was paying entirely out of pocket, and now she isn't but it's still expensive. I have very expensive insure and it only brings it down to $50/mo so $85/mo seems reasonable for a cheap plan.
Anyway, to back up what i just said, here's the unabridged 2nd paragraph: "Under the plan, her Celebrex would have cost $648 a month until she met her $1,500 prescription deductible, followed by an $85 monthly co-pay."
followed by the following in the 5th paragraph: "Before the federal health law took effect, Mason paid slightly more for her monthly premium on a plan that didn't cover her arthritis or pain medications and some routine doctor's visits."
A lot of the other examples they have are "patient was trying to get name brand drug rather than the available generic". Now for some meds (birth control for example) the exact brand can be important, but for most it doesn't.
Anyway, to back up what i just said, here's the unabridged 2nd paragraph: "Under the plan, her Celebrex would have cost $648 a month until she met her $1,500 prescription deductible, followed by an $85 monthly co-pay."
followed by the following in the 5th paragraph: "Before the federal health law took effect, Mason paid slightly more for her monthly premium on a plan that didn't cover her arthritis or pain medications and some routine doctor's visits."
A lot of the other examples they have are "patient was trying to get name brand drug rather than the available generic". Now for some meds (birth control for example) the exact brand can be important, but for most it doesn't.
You are right that the situation for the first woman is better overall.
I think the point of the article is that for those who were previously insured who are moving to exchanges may find that the benefit design is very different than their old coverage. In order to keep premiums low, insurers are keeping closed formularies and a very limited list of covered medicines.
I think this is one of those "buy beware" stories. Make sure you know what you're paying for.
I think the point of the article is that for those who were previously insured who are moving to exchanges may find that the benefit design is very different than their old coverage. In order to keep premiums low, insurers are keeping closed formularies and a very limited list of covered medicines.
I think this is one of those "buy beware" stories. Make sure you know what you're paying for.
I don't understand the point of these articles.
The first example in the story is a woman that went from more expensive minimal coverage that didn't include the drugs she was using, to better coverage overall with no mention whatsoever as to how much she used to pay for the drugs before (which is presumably nearly full price or some sort of discount through the manufacturers which isn't cheap either).
The other examples were also of people that have apparently never changed health insurance plans or gotten prescriptions that weren't covered under their previous insurance plans. Or even actually read what their insurance covers.
I've had individual health insurance forever since both my parents and I were and are self employed business owners. Welcome to the world I lived in before Obamacare. Welcome to the world I live in now. I have wasted many days negotiating with insurance companies and doctors' offices in the past for both myself and my parents over drugs that were minimally covered. Think along the lines of $500+ worth of glaucoma prescriptions in a month that insurance only covered $5 of....yes, $5. And then a week without any prescriptions and dangerously high intraocular pressure trying to get the doctor to prescribe something cheaper when they themselves don't know how much anything costs and will just throw the whole medicine cabinet at you in hopes that something sticks. Or how I have a prescription for Adderall and every refill used to be an exercise in explaining to the pharmacist that they should call my insurance company because I already have a pre-authorization filed with them so I pay $20 instead of paying $300 every time.
My silver-level ACA insurance plan isn't the best ever and it's a bit pricey (well, so were my previous insurance plans), but I no longer stress out about losing my insurance coverage, I have a good idea as to what is covered and what isn't, and my insurance company and doctors and pharmacists do the best they can to accommodate my requests. I even keep running into _pharmacy techs_ that ask me with a priceless facial expression if I really, really, really want the specific asthma inhalers and quantity that I'm picking up because they keep experiencing sticker shock - "I can ask the pharmacist and your doctor to get you a different one" naw, they're all expensive, they were always expensive, and nothing will change it. Welcome to my world. 8)
ACA isn't perfect but it's a hell of a lot better than the state of things before and here's to better healthcare reform in the future.
The first example in the story is a woman that went from more expensive minimal coverage that didn't include the drugs she was using, to better coverage overall with no mention whatsoever as to how much she used to pay for the drugs before (which is presumably nearly full price or some sort of discount through the manufacturers which isn't cheap either).
The other examples were also of people that have apparently never changed health insurance plans or gotten prescriptions that weren't covered under their previous insurance plans. Or even actually read what their insurance covers.
I've had individual health insurance forever since both my parents and I were and are self employed business owners. Welcome to the world I lived in before Obamacare. Welcome to the world I live in now. I have wasted many days negotiating with insurance companies and doctors' offices in the past for both myself and my parents over drugs that were minimally covered. Think along the lines of $500+ worth of glaucoma prescriptions in a month that insurance only covered $5 of....yes, $5. And then a week without any prescriptions and dangerously high intraocular pressure trying to get the doctor to prescribe something cheaper when they themselves don't know how much anything costs and will just throw the whole medicine cabinet at you in hopes that something sticks. Or how I have a prescription for Adderall and every refill used to be an exercise in explaining to the pharmacist that they should call my insurance company because I already have a pre-authorization filed with them so I pay $20 instead of paying $300 every time.
My silver-level ACA insurance plan isn't the best ever and it's a bit pricey (well, so were my previous insurance plans), but I no longer stress out about losing my insurance coverage, I have a good idea as to what is covered and what isn't, and my insurance company and doctors and pharmacists do the best they can to accommodate my requests. I even keep running into _pharmacy techs_ that ask me with a priceless facial expression if I really, really, really want the specific asthma inhalers and quantity that I'm picking up because they keep experiencing sticker shock - "I can ask the pharmacist and your doctor to get you a different one" naw, they're all expensive, they were always expensive, and nothing will change it. Welcome to my world. 8)
ACA isn't perfect but it's a hell of a lot better than the state of things before and here's to better healthcare reform in the future.
IIRC my celebrex prescription (i don't have receipts on me) costs around $800/mo pre-insurance
The jury is still out on ACA. It relies on young people buying expensive plans instead of paying the relatively small fines. The switchover itself was undeniably a complete disaster and makes the midterms look grim for the Dems. On the plus side, at some point in the future we could have the GOP support single payer just because it would save money.
You're right. It also doesn't help that people keep putting out stories like the one above that make ACA sound terrible even though I'll bet that the woman in the example ends up paying less out of pocket over the course of a year than she used to. Like people expect ACA to be some magical cure for expensive and/or chronic illnesses - nope, it just makes it a little bit more bearable.
Like, I still just paid $40 for an office visit and some tests/xrays and another $200 for meds this month where when I had the same problem (bronchitis+asthma exacerbation) in ~2010 I was out like $400 with samples for the same drugs (that would have doubled the cost) and that was without the hour of tests and coaching with a wonderful respiratory therapist last week (which was, I'm convinced, the only reason I wasn't totally fucked up in a bunch of different ways leading up to and during my wedding on Saturday).
Your theoretical sounds hysterical and amazing if it actually happens, but I'm not holding my breath. I don't know what it will take for people to start supporting single payer but I hope it happens soon. Maybe if everyone just gets seriously sick or knows an immediate family member that is sick? Too many people seem to be in denial about the fact that we need serious reform still.
Like, I still just paid $40 for an office visit and some tests/xrays and another $200 for meds this month where when I had the same problem (bronchitis+asthma exacerbation) in ~2010 I was out like $400 with samples for the same drugs (that would have doubled the cost) and that was without the hour of tests and coaching with a wonderful respiratory therapist last week (which was, I'm convinced, the only reason I wasn't totally fucked up in a bunch of different ways leading up to and during my wedding on Saturday).
Your theoretical sounds hysterical and amazing if it actually happens, but I'm not holding my breath. I don't know what it will take for people to start supporting single payer but I hope it happens soon. Maybe if everyone just gets seriously sick or knows an immediate family member that is sick? Too many people seem to be in denial about the fact that we need serious reform still.
> It relies on young people buying expensive plans instead of paying the relatively small fines.
IIRC, the fines are only temporarily small.
IIRC, the fines are only temporarily small.
This is actually a huge issue in the drug industry right now.
Most of the plans on the exchanges, but particularly the lower priced ones, have very large patient cost-sharing obligations. And it makes sense, if you pay a smaller premium each month, you'll have to pay a great share of the costs when the they do occur.
However, I don't think this will work out in the long run. It's one thing to ask a patient to pay 50% of a $300/month prescription (even though that's too much for many patients), but it's another to ask for 50% of a $10,000/month prescription (not uncommon for cancer).
The ACA did put a total cap on patient-cost sharing at $6,350 per individual or $12,700 per family [1]. This is a good thing since many plans prior had no limit on out of pocket costs. However, $6,350 is still a lot to ask lower income patients to pay.
One interesting outcome of this is that most drug companies are stepping up and offer patient assistance with these costs. For example, you might get a debit card that pays anything over $20, which makes it much more affordable. The funny part is that insurance companies typically hate patient co-pay cards since they defeat the purpose of co-payments (drugs the insurance company don't want you to use are more expensive). However, for the really expensive drugs, insurance companies are not complaining at all. In the end, it just results in a discount by the manufacturer, in a roundabout way.
[1]https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...
Most of the plans on the exchanges, but particularly the lower priced ones, have very large patient cost-sharing obligations. And it makes sense, if you pay a smaller premium each month, you'll have to pay a great share of the costs when the they do occur.
However, I don't think this will work out in the long run. It's one thing to ask a patient to pay 50% of a $300/month prescription (even though that's too much for many patients), but it's another to ask for 50% of a $10,000/month prescription (not uncommon for cancer).
The ACA did put a total cap on patient-cost sharing at $6,350 per individual or $12,700 per family [1]. This is a good thing since many plans prior had no limit on out of pocket costs. However, $6,350 is still a lot to ask lower income patients to pay.
One interesting outcome of this is that most drug companies are stepping up and offer patient assistance with these costs. For example, you might get a debit card that pays anything over $20, which makes it much more affordable. The funny part is that insurance companies typically hate patient co-pay cards since they defeat the purpose of co-payments (drugs the insurance company don't want you to use are more expensive). However, for the really expensive drugs, insurance companies are not complaining at all. In the end, it just results in a discount by the manufacturer, in a roundabout way.
[1]https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...
I'm always amazed at the astronomical prescription prices in the US, even with insurance. Here in the UK it's capped at £7.85 (~$13) per medication per time period, which is usually about a month - with many people on low incomes or lifelong medical conditions receiving them entirely for free.
I'm sure if it routinely cost hundreds or even thousands of pounds per month just to receive the drugs necessary to stay alive and well, I'd have been to a lot more funerals by now.
I'm sure if it routinely cost hundreds or even thousands of pounds per month just to receive the drugs necessary to stay alive and well, I'd have been to a lot more funerals by now.
That's because we're paying the money for the development and approval of these drugs, which for each successful one has historically roughly tracked the cost of a single strategic bomber. In a Tragedy of the Commons method monopsonies like your NHS then dictate prices not far about cost of materials and production, vs., to put it pejoratively, paying your "fair share" for the existence and availability of the drug in the first place.
Don't worry, the way things are going, bit by bit, sooner or later, the US will "fix" this problem and there will be no new drugs (aside from the occasional totally politicized efforts). And people will relearn what it's like to live in a world where bacterial infections are well nigh untreatable.
Don't worry, the way things are going, bit by bit, sooner or later, the US will "fix" this problem and there will be no new drugs (aside from the occasional totally politicized efforts). And people will relearn what it's like to live in a world where bacterial infections are well nigh untreatable.
This gets brought up and debunked in every single thread on this topic.
I'd be interested in seeing the data to support your claim.
Turn it around: it's well established that bringing a drug to market costs 100s of millions of USD (R&D, Phase 1-3 trials, the long time and limited patent protection from that, all the failures along the way, etc.). Drug companies do not make large profits compared to other companies. Where does the money come from? Where can it come from?
I understand your argument, but the assumption it's based on - that pharmaceutical industry income is disproportionally financed by the USA when compared (per treatment) to other developed nations - requires supporting data.
Some sure indicates there are price controls, although curiously not in Germany per: http://www.taylorwessing.com/synapse/regulatory_pricecontrol...
NHS price controls are set below (much of?) the rest of the EU, resulting in diversion and shortages. Also, as is not surprising with monopsonies, some companies are ripping off the NHS on generics. You can find items on both with this search: https://www.google.com/search?q=nhs+drug+price+controls
NHS price controls are set below (much of?) the rest of the EU, resulting in diversion and shortages. Also, as is not surprising with monopsonies, some companies are ripping off the NHS on generics. You can find items on both with this search: https://www.google.com/search?q=nhs+drug+price+controls
According to the association that represents the pharmaceutical industry in Britain, the shortages you refer to were due to pharmacies taking advantage of exchange rate differences to sell medicines abroad rather than supply the UK market[1]. This would imply that the costs of medicine are not usually significantly lower than the rest of the EU, at least when the currency markets are not in flux.
There is some information available on the cost of prescription medicines in the UK (see [2]) but I don't know where the equivalent datasets would be for other countries. Would be interesting to do a comparison.
[1] http://www.abpi.org.uk/our-work/news/2012/Pages/280212.aspx
[2] http://www.hscic.gov.uk/searchcatalogue?q=title:"prescriptio...
There is some information available on the cost of prescription medicines in the UK (see [2]) but I don't know where the equivalent datasets would be for other countries. Would be interesting to do a comparison.
[1] http://www.abpi.org.uk/our-work/news/2012/Pages/280212.aspx
[2] http://www.hscic.gov.uk/searchcatalogue?q=title:"prescriptio...
The biggest part of the story, somewhat hidden, is that only after expert intervention can a charge for $1,400 be reduced to $112.
But he was shocked when the pharmacy said he would have to pay $1,400
out of pocket for a 90-day supply. ...
"...If I've got to pay $1,000 more dollars for drugs ... then it's
not worth it," he said.
Fortunately, Hurd called his doctor and was able to switch to a
cheaper brand of insulin and ended up paying only $112.
People pay $800 monthly premiums in America?! And they still say that their system is better than "socialised" health care systems? Madness. Why not just pay our relatively low national insurance (12.5% of your pay check) and get free health care for everything. It would save you all money.
But I know what you are thinking... socialism is evil!
But I know what you are thinking... socialism is evil!
You're talking about the UK? It's not 12.5%:
http://www.hmrc.gov.uk/ni/intro/basics.htm#4
"If you earn more than £149 a week and up to £797 a week, you pay 12 per cent of the amount you earn between £149 and £797. If you earn more than £797 a week, you also pay 2 per cent of all your earnings over £797"
http://www.hmrc.gov.uk/ni/intro/basics.htm#4
"If you earn more than £149 a week and up to £797 a week, you pay 12 per cent of the amount you earn between £149 and £797. If you earn more than £797 a week, you also pay 2 per cent of all your earnings over £797"
Thank you for the correction.
That's nothing compared to before. Before ACA, the offers I got was between 1K-2K a month. I couldn't afford it at all.
After ACA, I can grab 200-500$ a month depending on which metal plan I want. If my income was lower by $1K, it'd be 50-300$ a month. Makes me want to ask for a pay cut with the rest made up in perks instead.
After ACA, I can grab 200-500$ a month depending on which metal plan I want. If my income was lower by $1K, it'd be 50-300$ a month. Makes me want to ask for a pay cut with the rest made up in perks instead.
The gov't does control medicine prices. However, unlike some other countries (e.g. the UK), they don't pay anything to the manufacturers, that price is all they get.
I'm pretty sure if Pfizer weren't making a profit they would withdraw the drug from the market.
Celebrex doesn't cure anything, it only relieves the symptoms of joint pain. If you can't afford it you're unlikely to die, so it's a perfect candidate for the extortion racket that is the US healthcare system.