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Old 06-19-2019, 07:08 PM   #21
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The ugliest part of the doughnut hole is you do not know when you hit it until it is too late.It is based on the total cost of the prescriptions, not your OOP.
It kicks in at $3820 and ends at $5100.
here is the ugly part:
Total drug cost- $3820, your OOP may only be $1000
You will have to pay another $4100 to get out of the doughnut hole.
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Old 06-19-2019, 07:22 PM   #22
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Would you believe that there is a federal law forbidding Medicare from negotiating prices on the drugs it pays for? Gee, wonder how that happened.
I think I remember when that law went into effect. Was it sometime between 2000 & 2008 ?
I'd like to say more, & I'm guessing you would as well, but God forbid, that might involve politics, & we know how taboo that subject is here.
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Old 06-19-2019, 07:33 PM   #23
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I was taking Teveten for BP it went from 30.00 month to 158.00 . The pharmacy was absolutely NO help . I went my doctor and explained the jump . He said the Pharma . were trying to force me into a more common drug . Something about these drugs if they have been around a long time the patent expires and everyone and their brother will be making it . So the name brand mfg. wants to make their last buck. He changed my RX . Now I pay nothing. a common drug . Have you ever heard of compounding ??
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Old 06-19-2019, 08:06 PM   #24
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Would you believe that there is a federal law forbidding Medicare from negotiating prices on the drugs it pays for? Gee, wonder how that happened.
It is pretty unbelievable. I read 'An American Sickness' by Dr. Elisabeth Rosenthal a couple of years ago so I did know this - and many other incredible things regarding how healthcare and drug reforms are stymied in America.

I've been thinking of starting a mail order drug service as a retirement side gig! And for the record, I'm glad you clarified regarding your statement on Canada.
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Old 06-19-2019, 08:47 PM   #25
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We are moving toward Pharmacare in Canada. Similar to universal health insurance. The medical profession has been recommending this for years.

The pharma companies, patent and generics, are pulling their collective hair out and knashing their teeth over this. As are the insurance companies and pharmacies..
And here is the thing -- the more Canada and other countries do this, the more they will jack up the prices on US consumers, insurers and Medicare -- because they can, and that is the only way they can satisfy their investors.

When the USA joins the rest of the world in saying "enough is enough" about prescription drug prices, it will be interesting to see what happens. It will certainly help US consumers with existing medications, but a small part of me wonders if this will discourage R&D for some future potential blockbusters that are very expensive to develop.
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Old 06-19-2019, 08:51 PM   #26
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I'd be talking to that pharmacist to see if there are any alternative drug or drugs to replace the meds that prices have gone out of sight on.

We went to my wife's Pain Clinic today, and she was informed that her main pain medicine (taken for 15+ years) is going to be changed in an effort to reduce her opioid intake by 30%. The order came from The State who has been auditing their patients' medical records. (This is not even the state we live in.) The anesthesiologist with a fellowship in pain management has no say so in the state's decision, and a bunch of bureaucrats are essentially making some of his medical decisions in patient care.

We chased around to 4 major pharmacies trying to find the drug, and no one even stocks the stuff. We eventually found it at a small, independent pharmacy and Medicare with a Supplement paid for it. If a drug is going to be prescribed, especially if it's so time sensitive, at least the pharmacies should be notified to begin stocking it.

Politics is such a number's game, and The State wants to say prescriptions of controlled substances are down "X"%, even if it causes pain and suffering by the chronically ill.
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Old 06-19-2019, 08:53 PM   #27
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Originally Posted by Souschef View Post
The ugliest part of the doughnut hole is you do not know when you hit it until it is too late.It is based on the total cost of the prescriptions, not your OOP.
It kicks in at $3820 and ends at $5100.
here is the ugly part:
Total drug cost- $3820, your OOP may only be $1000
You will have to pay another $4100 to get out of the doughnut hole.
Is this how it works? I've never quite understood the 'doughnut hole' calculation. If this is correct, the explanation is quite clear......although the reality of the OOP is scary !! Thanks for your help.
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Old 06-19-2019, 09:34 PM   #28
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Why should Canadians pay so much less? That is the question I want answered. Along with why our elected representatives at all levels seem oblivious to this difference in price.

We get adulterated blood pressure medicines approved by the FDA from overseas sources, yet we are warned about the dangers of buying drugs from the Canadians. Go figure.
The drug company has to make a ROI on its investment in getting that molecule from the lab to the market and generate profits to return to the shareholders - think of this entire cost as the air in a long skinny balloon.

With me so far?.. Good now visualize Canada grabbing one end of balloon and squeezing it and saying "We are only paying so much for this drug", and the NHS of UK squeezes the balloon and so does every other country in the world.

Now the air in the balloon forms an enormous bulb at the other end and THAT represents the cost the US consumer has to pay because we did not negotiate with the drug company (you know "free markets" and all).

So we have allowed ourselves to get screwed (If you were able to form a mental image of the aforesaid balloon, which now looks like a d* - how appropriate) by the Pharma companies because we have gutless politicians and have bought into the idea that new drug development will stop unless we allow unconstrained price growth.

Time to squeeze back and get other developed countries to pay their fair share for drug development.
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Old 06-19-2019, 10:11 PM   #29
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Time to squeeze back and get other developed countries to pay their fair share for drug development.
Fair share? A drug like methotrexate costs much less than a penny a pill to manufacture and was developed in the 1940s. That people who need it are being charged $175 for a 3 month supply is ridiculous. I am definitely not going to be extorted by drug companies and their shareholders if I can avoid it.
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Old 06-20-2019, 07:58 AM   #30
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I take a drug called Welchol, which is normally used for people with high Cholesterol.

I take it as a binding agent---- due to mold exposure issues that have occurred in our house reno.

Until May, the charge paid by Aetna/Caremark under my previous FEHB retiree policy was around $700 for the 3 months. With a $2 copay and $10 shipping.

In May we switched to a different FEHB retiree policy. The charge paid by Aetna/Caremark when to over $1400 for a 3 month supply. With a $2.50 copay and $0 shipping.

Hard to understand how 2 policies administered by the same company, getting the refill from the same RX filler can have such a different price.
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Old 06-20-2019, 09:17 AM   #31
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Talked to my Compounding Guy . If you have a good script for the Methotrexate and call him he can help . He does not have the buying power of Walmart but it won't be outrageous . ( Pure Pharmacuticals Houston Texas ) he could not understand the high price .


He can buy the chemicals and make the tablet . He said the injections are more expensive because of the machines required. On the Welchol he said only one company makes the chemical. Can't help.
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Old 06-20-2019, 10:00 AM   #32
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......... but a small part of me wonders if this will discourage R&D for some future potential blockbusters that are very expensive to develop.
Yes, I wonder that too.

Having our Fed Gov't dictate prices for drugs (another way of saying what "negotiated" prices will be.....) will insert politics into the resource allocation process. And that could be a good thing, or perhaps more like a good thing with potential unintended consequences.

An obvious positive would be some assurance that non-USA, gov't insurance customers would be paying a so-called "fair share." Since I doubt that the USA gov't agencies would want to explain why the price they negotiated is higher than that paid by other countries, I'd expect some price equalization.

An obvious downside is that there would likely be less incentive and resources for drug R and D. With over population being an oncoming problem here on planet earth, maybe this wouldn't be such a bad thing?
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Old 06-20-2019, 10:09 AM   #33
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Talked to my Compounding Guy . If you have a good script for the Methotrexate and call him he can help . He does not have the buying power of Walmart but it won't be outrageous . ( Pure Pharmacuticals Houston Texas ) he could not understand the high price .


He can buy the chemicals and make the tablet . He said the injections are more expensive because of the machines required. On the Welchol he said only one company makes the chemical. Can't help.
Thanks Breedlove. DH was able to find the Methotrexate tablets for $40 for 3 months ("cash price") at a local independent pharmacy which is close to what the Canadian pharmacy charges and we can live with that cost. We have a compounding pharmacy we have used the past, we can look into also in the future. Thanks for your offer.

We could certainly afford $170 for this drug that DH desperately needs but my issue is the huge price increase from one quarter to the next--$14 to $175 and neither the pharmacist or the Part D insurance company could explain the increase.
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Old 06-20-2019, 10:11 AM   #34
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Yet another Tick in the box for Universal Healthcare, all the other countries mentioned have it, that is why their costs are so much cheaper. One stop shopping so to speak. If Medicare did the negotiating for it's members then it would achieve a similar goal. But it is farmed out to Part D Insurance companies, so there are no rules.
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Old 06-20-2019, 10:12 AM   #35
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Originally Posted by Souschef View Post
The ugliest part of the doughnut hole is you do not know when you hit it until it is too late.It is based on the total cost of the prescriptions, not your OOP.
It kicks in at $3820 and ends at $5100.
here is the ugly part:
Total drug cost- $3820, your OOP may only be $1000
You will have to pay another $4100 to get out of the doughnut hole.
OP here--We checked with DH's part D insurance company to see if he had gone in the donut hole and they said no. We asked why the huge increase in the cost of the Methotrexate and they could not explain it.
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Old 06-20-2019, 10:35 AM   #36
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Harllee. Compounding seems to be helping us and I am glad you have found it cheaper . My guy explained that Metho is a trade name . For example my DW takes a Hormone ( Evamist ) . Now the company that makes Evamist does not own the chemicals . So he can sell her the same product Estradol for 12.00 a month from 90.00 a month. Just like buying from Canada .
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Old 06-20-2019, 12:57 PM   #37
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Heck the nearest drug store for me is half a mile from Mexico. I have Aetna 'D" and it is still cheaper or free so I use CVS.
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Old 06-20-2019, 01:37 PM   #38
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...but a small part of me wonders if this will discourage R&D for some future potential blockbusters that are very expensive to develop.
I used to buy into that but given that drug companies spend on marketing over twice what they spend on drug development I don't think so anymore.
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Old 06-24-2019, 12:58 PM   #39
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I know it will be unpopular, but let me suggest the following: Buy drug stocks! IF (yeah, really, IF) the drug companies have the power I sense our members think they have to inflate prices as much as they want (at will), then why would you NOT buy their stock?

By the way, I've been hit hard by price increases and I have been just as angry about it. BUT, I think it's a bit more complicated than raising prices because they can. Oh, and I only buy drug stocks in my large-cross-section stock mutual funds.

Remember when the oil companies were "gauging"? Did you buy their stocks? If so, I hope it wasn't in the early 80's, mid 90's or just before 2008. Again, I am NOT defending ANYONE. Just sayin' - it may be a bit more complicated than it sounds. As always, YMMV.
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Old 06-24-2019, 01:25 PM   #40
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OldShooter, very interesting thoughts. Prescription drugs are not like most consumer products. Supply and demand theories don't really apply. For someone like my DH, you can't just say I won't buy this drug, it costs too much. If he did not have Methotrexate (and Humira, that is a whole different story) DH's knees would swell so much he would not be able to walk. We are grateful for the drugs that help DH and we are willing to pay for them, I just can't understand the huge price increase. If the drug could be sold for $14 in 2018 why is the cost in 2019 $175 for the exact same thing?
Because in the meantime lawsuits have been allowed to proceed against Methotrexate and if you have potential for several thousand people receiving 2 million each for being prescribed without adequately being told risks and being able to prove you informed patients of the risk, it doesn't make much sense to sell it for $14.
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