Silliness of our Healthcare System

[jebmke]

The US doesn't have a health care system, it has a health care industry. Once you realize that, everything makes cents.

 

[disneysteve]

She said that they have all of the various discount drug companies and their pricing in their computer at a couple of keystrokes. That's service IMO.

And yet, they don't volunteer that information. You have to ask about it. Why not just let them fill the prescription for the lowest possible price? That would be service.


This ties in to what I said in the incompetent worker thread. It's all corporate malfeasance, focused on profit over people.

 

[Car-Guy]

We use Aetna/Express Scripts, but not because we like them so much. As a retiree from Mega Corp, we get a great subsidy by staying with the companies plans. Aetna has been a real PIA to deal with and Express Scripts isn't any better.

Every year Express Scripts tightens the screws. Either dropping coverage on some drugs and/or "requiring" us to use generics, which I'm absolutely convinced don't work as well, "in many cases". Ordering drugs by mail order from Express Scripts has gone from "pretty good" ten years ago to terrible these days. Ten years ago delivery was made in one to two days. Now it's 10 to 14 days. OTOH, drug pricing/discounts/subsidies is still very good/exceptional, even for brand named stuff.

 

[ShokWaveRider]

Clark Howard has a segment on this, go forward to minute 25.

 

[disneysteve]

Every year Express Scripts tightens the screws. Either dropping coverage on some drugs

This used to drive us crazy in our practice every January. All of a sudden, dozens of patients were calling to let us know their medicine was no longer covered. We had to switch drug A to drug B. And then a year later, it happened again and we had to switch drug B back to drug A.


None of it had anything at all to do with efficacy or safety or quality. It was purely about which company they negotiated the best deal with that year. If company B was a penny cheaper, they got the contract for the year.


We and our patients were the ones dealing with the fallout. Someone whose blood pressure was well-controlled before now had to be adjusted again, which often meant 2 or 3 extra visits which the same insurance company had to pay for, so did they really save anything?

 

[audreyh1]

^^^^^^ this but you can refuse to pick up and transfer to another pharmacy.

You’re ok until you pay for it and receive it.

 

[badatmath]

This is why I like paper prescription.
Then I take it to various pharmacies to get an acceptable price if the first one is crazy expensive.

This reminds me of a story. I once asked for a paper prescription. The doctor was slightly reluctant so I asked why. He said they got "dinged" for not having a certain % of the Rx sent direct so he then explained to me he would give me the paper and send an online Rx to a pharmacy far from my home which of course I would not pick up and they'd have to put back on the shelf. . .

I haven't asked for a paper one since. I get one of my drugs mail order - so much nicer IMO. But unfortunately I change other meds constantly and so can't really mail order those.

We use Aetna/Express Scripts, but not because we like them so much. As a retiree from Mega Corp, we get a great subsidy by staying with the companies plans. Aetna has been a real PIA to deal with and Express Scripts isn't any better.

Every year Express Scripts tightens the screws. Either dropping coverage on some drugs and/or "requiring" us to use generics, which I'm absolutely convinced don't work as well, "in many cases". Ordering drugs by mail order from Express Scripts has gone from "pretty good" ten years ago to terrible these days. Ten years ago delivery was made in one to two days. Now it's 10 to 14 days. OTOH, drug pricing/discounts/subsidies is still very good/exceptional, even for brand named stuff.

My retiree insurance uses a different mail order company than this but when I called them recently I was told they change their drug lists 3 times per year. The rep said some accounts change even more often.

 

[Midpack]

I use CVS (inside a Target retail store) for my pharmacy as it is a preferred pharmacy of my Part D plan. I recently had the need for a prescription. Before I went to pick it up, I checked online for both my plan's price and the GoodRX price. Not surprisingly the GoodRX was considerably lower than my plan's negotiated price. When I told the pharmacist that I wanted the GoodRx price and not to go thru my insurance, she voluntarily looked on her computer and found an even lower price for me. She said that they have all of the various discount drug companies and their pricing in their computer at a couple of keystrokes. That's service IMO.

Yep, we’ve had that experience at CVS and Harris Teeter pharma. All you have to do is ask, and they’ll help you out. Harris Teeter pharma looked without asking on our last purchase. These are for profit businesses, I wouldn’t expect them to find better prices without even being asked. YMMY

 

[tenant13]

Meantime....

Some cancer drugs are in short supply, putting patients' care at risk. Here's why

Pharmaceutical trade group sues US over Medicare drug price negotiation plans

 

[kwise]

The US doesn't have a health care system, it has a health care industry. Once you realize that, everything makes cents.

+1

 

[aja8888]

I have been on Medicare for 14 years now and have seen it all.

When DW, who passed away in December, had COPD and a bunch of other illnesses, she was on 13 different drugs (inhalers, stuff for HBP, anxiety, lipid problems, etc). That was an annual sideshow when I shopped Part D plans for her.

I take one prescription. With my new Cigna Part D plan, my premium is $13.10 per month and the drug cost is $31.00 for 90 generic pills. I use GoodRx and get the 90 day supply for $11.00. Love it!

 

[CardsFan]

Just had weird one today. DW got a new script for a different dose of something she has been taking. The Dr's office sent the script to a CVS, which is what they had on record from her previous Part D supplier. CVS is NOT a preferred pharmacy for her current plan. I got on line to see how much more it was going to be. If it was a lot more we figured she could call and re-direct the script.

Lo and behold, CVS was almost half the price as the "Preferred" pharmacy. So I guess when they say "Preferred", they mean they prefer you pay a higher percent of the cost

 

[Dash man]

Just had weird one today. DW got a new script for a different dose of something she has been taking. The Dr's office sent the script to a CVS, which is what they had on record from her previous Part D supplier. CVS is NOT a preferred pharmacy for her current plan. I got on line to see how much more it was going to be. If it was a lot more we figured she could call and re-direct the script.



Lo and behold, CVS was almost half the price as the "Preferred" pharmacy. So I guess when they say "Preferred", they mean they prefer you pay a higher percent of the cost

FYI, you can just ask the pharmacy you decide to use to call and have a prescription transferred. No need to contact your doctor.

 

[Koolau]

What gets me is difference in price at the same pharmacy for the same drug time to time. I know the "donut hole" can be involved, but not EVERY time a different price (by a large amount.)

 

[youbet]

What gets me is difference in price at the same pharmacy for the same drug time to time. I know the "donut hole" can be involved, but not EVERY time a different price (by a large amount.)

Sometimes your Part D EOB explains the sharp differences in price over the coverage year. Are you in the deductible stage, the coverage stage, the donut hole, etc.? It's still whacky but the EOB seems to at least outline the whackiness.

 

[zippy2020]

There is good and bad about HMOs, but our experiences with the Kaiser HMO system has been pretty satisfactory overall. Their early move to electronic records predated the fed requirement; it took them a number of years to changeover, in phases.

But now it's seamless to the patient and works really well, although getting a specialist can still mean jumping thru hoops. Not all the GPs (meaning new employees) seem to know the "ins and outs" of how to bypass the more time-consuming, "is this critical or not?" routine appt process. But even that isn't difficult to handle.

Kaiser runs its own hospitals and pharmacies. Once you understand how it works, it's a fast, responsive system. Vaccines are a breeze with Kaiser; only a few need MD referral. A phone call request can set that up quickly and they'll let you know when you can go to their pharmacy to pick up. If it's a shot, you set it up at a convenient time/date on their website, go in and get the shot in a few minutes.

Cost depends on type of plan, since they offer several. Can range from zero to $25.

 

[NXR7]

Chlobetasol, an eczema cream, is $21.99 at Costco, $47.84 at the local grocery pharmacy, and $99.41 at CVS. CVS actually dropped their price $20 from what they used to charge. All of those places are within three miles of us.

CVS is always the most expensive by far. My Part D is $7 a month and uses CVS but at least I get my Tier 1 high BP pills for "free".


My wife pays $1,104 a month for Obamacare, an HMO with the Cleveland Clinic that is only valid where we live in Ohio (no PPO's in Ohio). It does not work at any other CCF locations in the country. No deductible but a 50% co-pay and an $8,000+ out-of-pocket maximum. (Going with a deductible plan did not provide any real change in the expected annual cost.)

When we snowbird in Florida for five months she has to get travel insurance for healthcare. Through Allianz, she had a $50,000 coverage limit, it's primary insurance, and covers pretty much anything medically necessary so no scheduled appointments. But Allianz even covers medically necessary dental and eye care, unlike Obamacare.

The Allianz travel policy cost her $750 this past winter. Not per month, for all 5 months.

And she even got to pay her $1,104 each month in addition just to continue the coverage when we got back.

THAT is the insanity of this so-called healthcare system/industry and it's not silliness by any means. $150/month for primary travel insurance versus $1,100 for the Unaffordable Care Act garbage.

 

[piccolopat]

This is why I like paper prescription.
Then I take it to various pharmacies to get an acceptable price if the first one is crazy expensive.

That would help some people but NY mandated electronic prescriptions in 2016 so we don't have an option here. There's really no reason for such dramatic swings in costs but that's what happens when government allows insurance companies to have preferred doctors, pharmacies and other medical facilities. Either use the preferred resource or pay thru the nose.

 

[Koolau]

Chlobetasol, an eczema cream, is $21.99 at Costco, $47.84 at the local grocery pharmacy, and $99.41 at CVS. CVS actually dropped their price $20 from what they used to charge. All of those places are within three miles of us.

CVS is always the most expensive by far. My Part D is $7 a month and uses CVS but at least I get my Tier 1 high BP pills for "free".


My wife pays $1,104 a month for Obamacare, an HMO with the Cleveland Clinic that is only valid where we live in Ohio (no PPO's in Ohio). It does not work at any other CCF locations in the country. No deductible but a 50% co-pay and an $8,000+ out-of-pocket maximum. (Going with a deductible plan did not provide any real change in the expected annual cost.)

When we snowbird in Florida for five months she has to get travel insurance for healthcare. Through Allianz, she had a $50,000 coverage limit, it's primary insurance, and covers pretty much anything medically necessary so no scheduled appointments. But Allianz even covers medically necessary dental and eye care, unlike Obamacare.

The Allianz travel policy cost her $750 this past winter. Not per month, for all 5 months.

And she even got to pay her $1,104 each month in addition just to continue the coverage when we got back.

THAT is the insanity of this so-called healthcare system/industry and it's not silliness by any means. $150/month for primary travel insurance versus $1,100 for the Unaffordable Care Act garbage.

Things should get better when you go on Medicare! Hang on.

 

[disneysteve]

My wife pays $1,104 a month for Obamacare

When we snowbird in Florida for five months she has to get travel insurance for healthcare. Through Allianz, she had a $50,000 coverage limit

The Allianz travel policy cost her $750 this past winter.

And she even got to pay her $1,104 each month in addition just to continue the coverage when we got back.

That Allianz coverage is very minimal. One hospital stay would wipe that out. So you need to continue the ACA plan because if she got sick in Florida, she'd need to go home for treatment (assuming she was stable enough to travel).


It sucks that the home plan only works at home. That's a huge problem with our insurance system being state by state. If we had universal coverage like the rest of the world, that wouldn't be an issue. It's a disgrace that we still don't have that here.

 

[NXR7]

Things should get better when you go on Medicare! Hang on.

I'm there but this is one of those complications that we never thought of way back when, the age difference and old age.

 

[NXR7]

That Allianz coverage is very minimal. One hospital stay would wipe that out. So you need to continue the ACA plan because if she got sick in Florida, she'd need to go home for treatment (assuming she was stable enough to travel).

Actually, it's not due that minimal to the negotiated pricing. My wife had a knee replacement and was certain she was going to max out her out-of-pocket but did not come close that year. The MSRP was over $25,000 but the negotiated prices were about 15% of that.

That's another crime against people. No insurance means you really get billed for the MSRP while everyone else pays way less.

It sucks that the home plan only works at home. That's a huge problem with our insurance system being state by state. If we had universal coverage like the rest of the world, that wouldn't be an issue. It's a disgrace that we still don't have that here.

There seem to be just a few states that still offer PPO's anymore.

Think about the so-called Medicare Advantage programs. People rave about them because "I pay nothing all year and I get a lot more benefits!". The only way those companies can make boatloads of money is if they have a massive difference between costs and billings.

It's like dental insurance. I don't carry it anymore and yet I am paying about the same amount of money on an annual basis as I paid for "my share" of the employer's insurance policy.

 

[Koolau]

That Allianz coverage is very minimal. One hospital stay would wipe that out. So you need to continue the ACA plan because if she got sick in Florida, she'd need to go home for treatment (assuming she was stable enough to travel).


It sucks that the home plan only works at home. That's a huge problem with our insurance system being state by state. If we had universal coverage like the rest of the world, that wouldn't be an issue. It's a disgrace that we still don't have that here.

With each state getting a chance to screw up your insurance, we eventually find out what w*rks and can spread it around. Letting one gummint (in this case the fed gummint) handle all health insurance means no "competition" very little redress, changes without much chance to complain. IOW - everything wrong with your state insurance could be wrong with the federal system - but with much less chance of fixing it.

Lots of advantages to "ONE" system run by "ONE" gummint - but lots of issues as well. I sympathize with everyone going through all these issues. Even on MC/supplement there are plenty of issues (and virtually beyond fixing in my life time) but at least states are easier gummints to effect solutions than federal gummint systems. One system sounds so wonderful - but when we get it, I'll check back (if I'm still here) to see if it's still wonderful. My guess, not so much, but YMMV.