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This seems like a pretty big deal, not sure if I missed it in here: https://www.businesswire.com/news/home/20180306005417/en/UnitedHealthcare-Launches-Expansion-Direct-to-Consumer-Pharmacy-Discounts-Millions quote:Beginning Jan. 1, 2019, and on plan renewal thereafter, people enrolled in fully insured group health benefit plans will have discounts applied to their medication cost at the point of sale. The savings will apply to plan participants who are filling a prescription for a drug where the manufacturer provides a rebate. UnitedHealthcare will apply savings from rebates upfront, at the time of sale, to ensure people are paying the lowest amount possible under their plan. Rebates are currently used to keep premiums lower for the benefit of all members and customers, rather than distributed to individual consumers. Essentially, UHC will pass along an estimate of the rebate for the drug being purchased at point of sale.
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Mar 7, 2018 22:37
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Reik posted:This seems like a pretty big deal, not sure if I missed it in here: I have uhc and they've been pretty good to me. They've covered several transition surgeries that my previous insurances considered "cosmetic". They even provide a specialist to help me navigate local surgeons and stuff.
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Mar 8, 2018 00:05
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Reik posted:This seems like a pretty big deal, not sure if I missed it in here: this is just another volley in the stupid loving proxy war between drug companies and insurance companies over co-pay cards/rebates. Drug companies offered co-pay assistance because this way they could crank up the prices on their drugs without increasing the price to consumers, and insurance companies, who were the people who shouldered most of the increased cost, loving hated it so now they're putting language in their plans that doesn't allow co-pay assistance to count towards someone's deductible, which is going to increase the amount of money that consumers have to pay for drugs that are exorbitantly priced but necessary because the more expensive a drug is, the more necessary it is for that person to live normally (generally speaking, that is). what this is then, is an insurance company attempting pass along a bit of savings to their customer while also funneling them towards the pharmacy benefit manager that is owned by the same people to get them under one roof and to make all their money go to the same place. "hey, we know you're gonna have to pay a lot more of your deductible, so why don't we help you out a bit by having a deal where if you get your drugs from this particular home-delivery pharmacy, we'll go out and look for all the rebates we can find for your drugs. please ignore that we are the reason you're going to have to pay more of your deductible and that we also own the pharmacy, you don't need to worry about those things." I say burn it all down.
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Mar 8, 2018 00:45
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More developments in PBM/insurer consolidation: Cigna to Buy Express Scripts in $52 Billion Health Care Deal With this and Aetna/CVS, there won't really be any more large independent PBMs.
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Mar 8, 2018 19:17
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Reik posted:That would make more sense. We don't really have access to absenteeism/presenteeism data on our end, so I guess they just do those studies internally or with their consulting house? We keep that far away from the actuaries. esquilax posted:More developments in PBM/insurer consolidation: Yeah, gently caress this. This and the CVS/Caremark merger should have been shut the gently caress down by the government but I guess they're just okay with letting the entire industry vertically integrate itself to death. The Phlegmatist fucked around with this message at 17:00 on Mar 11, 2018 |
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Mar 11, 2018 05:44
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By 2030 we're going to have a single payer when all the pharmacy chains/insurance claims/PBMs/hospitals combine into a for profit kaiser style operation
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Mar 11, 2018 06:56
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Peven Stan posted:By 2030 we're going to have a single payer when all the pharmacy chains/insurance claims/PBMs/hospitals combine into a for profit kaiser style operation Kaiser only works because they literally write off internal claims. All their providers are salaried and there's no adversarial pricing involved in their services. An agglomeration of for profit entities would end up in a sears like holy war of intra org billing skirmishes and fall apart. Healthcare at that scale just doesn't happen affordably if you're seeking profit, at least not in the us.
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Mar 11, 2018 23:20
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It can work, you just need a CEO that isn't a moron and is capable of understanding that yes, maybe Caremark isn't as profitable now because they're giving CVS retail pharmacies and Aetna a competitive advantage by eliminating spread and maybe that's why you guys bought them in the first place. At least Amazon didn't acquire ES, since that was a rumor going around for a while. Please keep Big Data and techbro disruption as loving far away from the healthcare industry as possible, TIA
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Mar 11, 2018 23:36
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The Phlegmatist posted:It can work, you just need a CEO that isn't a moron and is capable of understanding that yes, maybe Caremark isn't as profitable now because they're giving CVS retail pharmacies and Aetna a competitive advantage by eliminating spread and maybe that's why you guys bought them in the first place. i have extremely bad news for you about the health insurance industry, the pharmaceutical industry, and your friendly local provider network's billing department, friend
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Mar 11, 2018 23:59
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My perscription expired with last month's bottle and the specialty pharmacy did not see fit to tell me this until I had ordered the next one. In order to get delivery before I run out of pills on Friday I had to: - Order online (did this Sunday, plenty of time right?) - Answer a call from the specialty pharmacy telling me it was expired - Get them to call the doctor's office - Order a refill prescription on the doctor's online portal - Call the pharmacy again to see if it went through (lol no, the one they got needed "confirmation" for a reason they couldn't tell me) - Email the doctor's office again - Call the "liaison" to make sure he did his job talking to the doctor's office - Call the pharmacy again to make sure it would ship overnight A+ GREAT SYSTEM gently caress CVS specialty and our healthcare in general.
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Mar 15, 2018 04:54
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Defenestration posted:My perscription expired with last month's bottle and the specialty pharmacy did not see fit to tell me this until I had ordered the next one. In order to get delivery before I run out of pills on Friday I had to: I go through this every month just to get ambien. It sucks. Condolences.
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Mar 15, 2018 06:58
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My employer (a private university) recently announced that to keep costs from rising too much in 2018, maintenance prescriptions will only be available by mail order. I'm glad I'll probably be gone by the time this takes effect, since the last time I tried doing mail order it was a loving nightmare. My medication doesn't allow refills, so I had to send new prescriptions every 90 days. They repeatedly mishandled/lost them, often blaming USPS. So I started sending them in express envelopes, which took care of that issue (the first time I did it, they claimed it had not arrived, despite me having a proof of delivery. When I informed them of that, they got back to me within an hour and said that it had "just arrived"  ).The even bigger problem I still haven't found a way around is that they require signatures for delivery of my meds, and instruct their carriers to never accept notes left at the door or other people's signatures. The window for their delivery is a couple days, and they don't provide tracking. Basically they wanted me to skip a couple days of work so I can sit at home waiting for the delivery. My only option was to just wait for the attempted deliveries to fail, then track it down to whichever post office its held at afterwords. Overall, filling this prescription with CVS, from mailing the scripts to actually obtaining the meds, took 2-3 weeks, and I had to do that every 90 days. And I've been hearing rumors that 90 day scripts may not be allowed for this med in the future, so this might actually be a monthly ritual soon. 
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Mar 16, 2018 14:18
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ANIME AKBAR posted:My employer (a private university) recently announced that to keep costs from rising too much in 2018, maintenance prescriptions will only be available by mail order. I'm glad I'll probably be gone by the time this takes effect, since the last time I tried doing mail order it was a loving nightmare. My medication doesn't allow refills, so I had to send new prescriptions every 90 days. They repeatedly mishandled/lost them, often blaming USPS. So I started sending them in express envelopes, which took care of that issue (the first time I did it, they claimed it had not arrived, despite me having a proof of delivery. When I informed them of that, they got back to me within an hour and said that it had "just arrived" What state are you in?
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Mar 16, 2018 15:26
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ANIME AKBAR posted:Overall, filling this prescription with CVS, from mailing the scripts to actually obtaining the meds, took 2-3 weeks, and I had to do that every 90 days. And I've been hearing rumors that 90 day scripts may not be allowed for this med in the future, so this might actually be a monthly ritual soon. I have to take twice-daily 120mg injections of enoxaparin (Lovenox). It's $50 to fill (a 30-day supply is about $9,000 without insurance), so my doctor started writing me prescriptions for 60- or 90-day supplies, so I wasn't forking out 50 bucks a month plus having to pay for my other medications. My insurance just informed me that it will no longer cover prescriptions for anything longer than 10-day supplies.
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Mar 16, 2018 15:28
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Timby posted:I have to take twice-daily 120mg injections of enoxaparin (Lovenox). It's $50 to fill (a 30-day supply is about $9,000 without insurance), so my doctor started writing me prescriptions for 60- or 90-day supplies, so I wasn't forking out 50 bucks a month plus having to pay for my other medications. You may try sending in an exception request to see if they'll let you do longer than 10-day fills given what appears to be a very severe consequence of not having the medication. Enoxaparin doesn't seem like something that would end up on the black market so I imagine they'd be more willing to make an exception.
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Mar 16, 2018 15:34
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Reik posted:You may try sending in an exception request to see if they'll let you do longer than 10-day fills given what appears to be a very severe consequence of not having the medication. Enoxaparin doesn't seem like something that would end up on the black market so I imagine they'd be more willing to make an exception. I already got an exception because normally they don't cover it at all outside of a hospital / short-term immediately after a hospital stay situation (since enoxaparin is generally used as a bridge to warfarin, which I've failed along with the Xa inhibitors).
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Mar 16, 2018 15:36
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Timby posted:I already got an exception because normally they don't cover it at all outside of a hospital / short-term immediately after a hospital stay situation (since enoxaparin is generally used as a bridge to warfarin, which I've failed along with the Xa inhibitors). I mean, worst case scenario they reject your request and you end up right back here?
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Mar 16, 2018 15:43
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I'm going to go out on a limb and say that the insurance company would save a lot of loving money if it just approved the exception, since the alternative is "bullshit refill costs and frequency resulting in huge odds of decreased compliance leading to DVT/PE requiring hospitalization" (making an assumption about your diagnosis here). Seriously, it's loving ridiculous to burden you with that cost in both money and time, and I'm sorry you have to go through it.
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Mar 16, 2018 15:58
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tetrapyloctomy posted:since the alternative is "bullshit refill costs and frequency resulting in huge odds of decreased compliance leading to DVT/PE requiring hospitalization" (making an assumption about your diagnosis here). Correct assumption. Over a three or four-month period in 2015, I got sicker, and sicker, and sicker, eventually losing the ability to walk. Couldn't stand for more than a second. Etc. My dumbass doctor kept on thinking it was fibro, or something autoimmune or rheumatoid (because what otherwise healthy 31-year-old gets blood clots?). Eventually he sent me to the ER after a chest X-ray showed something in my lungs that he thought might be pneumonia. After being rushed into a trauma bay and then to a CT, I had a half-dozen small PEs and a whole bunch of clots in both legs, and one in my left arm. They told me I probably would have died in another day or two.
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Mar 16, 2018 16:01
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Timby posted:Correct assumption. Over a three or four-month period in 2015, I got sicker, and sicker, and sicker, eventually losing the ability to walk. Couldn't stand for more than a second. Etc. My dumbass doctor kept on thinking it was fibro, or something autoimmune or rheumatoid (because what otherwise healthy 31-year-old gets blood clots?). Eventually he sent me to the ER after a chest X-ray showed something in my lungs that he thought might be pneumonia. After being rushed into a trauma bay and then to a CT, I had a half-dozen small PEs and a whole bunch of clots in both legs, and one in my left arm. They told me I probably would have died in another day or two. To be fair to your doctor, that's a super-weird presentation for a clotting disorder, and an autoimmune or rheumatoid issue makes sense -- especially since your inflammatory markers must have been super-high! I'm trying to think what I'd do in terms of a workup, but my field approaches things differently than, well, just everyone else and it would heavily depend on what your chief complaint happened to be the day you came into the ED. (Somewhere, a radiologist is reading this and saying, "Pffft, you're an emergency doc, which means you're going to end up doing a PE study for some stupid reason or another. and figure it out through sheer luck.") Really, though, it's hard to imagine you getting a pulmonary infarct (which is what I presume he saw on the plain film, a wedge-shaped section of lung that's all inflamed because it lost blood flow due to a clot, and looks like a pneumonia) without ever having any clinical signs at all of a large-enough clot to cause it. With continuous symptoms from smaller clots, though, I could see someone missing the significance of, say, new left calf cramping or pain along the deep venous course. I'm sorry if this sounds like I'm minimizing the frustration you must have felt for all that time that your doctor missed the diagnosis, and the anger you must have felt when you discovered that the delayed diagnosis could have killed you. I just try to keep things like this in mind when I see people whose presentations just don't seem to make sense, or whose subjective symptoms are out of proportion to what I'm seeing on examination. It's really, really easy to be that rear end in a top hat who kicks you out because complaints are vague or chronic or seemingly nonsensical "because there are people with emergencies who need the bed" -- especially when we ideally see people once and they never need to go to an ED again! -- and sometimes I need a personal example to smack some jadedness out of me. A little back on track: Have you tried http://www.sanofipatientconnection.com/ ? I just wonder if they could help with some type of copay reimbursement or something.
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Mar 16, 2018 17:03
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It'd be a struggle to get a discount from the manufacturer since your insurance does technically cover enoxaparin, but not a 30-day script and you'll just confuse whatever poor dudes are working the phone lines. If you try that, just escalate until you get someone who knows what they're doing. There's also the route of discount coupons offered by pharmacies or pharmacy discount cards. I think you should be able to get enoxaparin for around $70-80/mo cash price if you don't involve your insurance company. tetrapyloctomy posted:I'm going to go out on a limb and say that the insurance company would save a lot of loving money if it just approved the exception, since the alternative is "bullshit refill costs and frequency resulting in huge odds of decreased compliance leading to DVT/PE requiring hospitalization" (making an assumption about your diagnosis here). Seriously, it's loving ridiculous to burden you with that cost in both money and time, and I'm sorry you have to go through it. Not to mention enoxaparin is actually pretty cheap (looking at what we pay for it) and three years of it would be less than a single ED visit in most cases.
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Mar 16, 2018 17:15
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Defenestration posted:My perscription expired with last month's bottle and the specialty pharmacy did not see fit to tell me this until I had ordered the next one. In order to get delivery before I run out of pills on Friday I had to: That is unfortunate, but there should be a spot on your bottle that says ZERO refills remaining. The pharmacy staff don't have the time to call every single person who is out of refills - that would take all day. At that point it is a good idea to contact your physician's office, or you are going to have to wait when you do want it refilled. Offices have a great habit of giving salt to the pharmacy, or outright ignoring the requests, so it always is often a better idea for the patient to phone themselves. Most of the time it isn't your provider who is doing anything other than a verbal authorization. The rest is done by a medical assistant (they took a course for a few weeks and are now the gatekeeper to your doctor), or if you are really lucky, an actual nurse. I do not understand your salt for the pharmacy in this case. Everyone in the pharmacy hates CVS/walgreens/the big chains, but in these cases the pharmacy can't do much other than send the request and hope it gets through.
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Mar 16, 2018 21:56
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Reik posted:What state are you in? Ohio. My family physician was on some sort of board which was responsible for shaping state laws designed to fight prescription abuse. He basically told me things were going to get a lot tougher for me, and I could tell he didn't give a poo poo. gently caress that guy.
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Mar 17, 2018 04:39
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Speaking of prescription abuse: https://twitter.com/nbcnews/status/974832235265146881?s=21 But sure, gently caress over the patients. That'll put a stop to it.
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Mar 17, 2018 05:32
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reagan posted:That is unfortunate, but there should be a spot on your bottle that says ZERO refills remaining. The pharmacy staff don't have the time to call every single person who is out of refills - that would take all day. At that point it is a good idea to contact your physician's office, or you are going to have to wait when you do want it refilled. Offices have a great habit of giving salt to the pharmacy, or outright ignoring the requests, so it always is often a better idea for the patient to phone themselves. Most of the time it isn't your provider who is doing anything other than a verbal authorization. The rest is done by a medical assistant (they took a course for a few weeks and are now the gatekeeper to your doctor), or if you are really lucky, an actual nurse. I also wanted them to tell me what they found incorrect about my doctor's first attempt to send the prescription, and what made them require a "confirmation" that held up the process. I've had nothing but problems with these guys no matter how far I plan ahead (the switchover from accredo was a nightmare)
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Mar 18, 2018 02:04
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The Phlegmatist posted:It'd be a struggle to get a discount from the manufacturer since your insurance does technically cover enoxaparin, but not a 30-day script and you'll just confuse whatever poor dudes are working the phone lines. If you try that, just escalate until you get someone who knows what they're doing. I agree, it's totally worth calling about.
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Mar 18, 2018 02:07
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I've got my own problems with prescriptions. Some of it comes from my insurance company, some of it comes from my new psychiatrist. I'm taking two alpha blockers that help me control some very painful trauma-related symptoms. I started them under my old psychiatrist. But my new psychiatrist doesn't understand just how bad the symptoms were and why the meds would help. So I've had to ask my therapist to talk to my psychiatrist about just how bad the untreated symptoms are.
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Mar 18, 2018 17:31
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RandomPauI posted:I've got my own problems with prescriptions. Some of it comes from my insurance company, some of it comes from my new psychiatrist. Having your therapist and your psychiatrist communicate with each other is just good practice, no matter the situation.
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Mar 18, 2018 17:38
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In my experience doctors are arrogant turds who need a haircut in any kind of health reform scheme (i.e. mass paycuts and loss of autonomy). My allergist is straight up a racist dickhead who talks about "those people" and probably says poo poo about his asian residents behind his back. My brother was straight up hazed by a gang of white doctors when he was doing his rotations as a pharmacist. Here is a poor naive asian resident who thought the system worked when he reported his superiors for racist harassment and vanderbuilt medical center suspended him. Doctors routinely have no idea how much things cost nor do they have any willingness to buck a system where the "business department" does all the evil so they can do all the treating without thinking of the financial costs.
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Mar 19, 2018 01:37
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quote:About 40 percent of Americans report skipping a recommended medical test or treatment and 44 percent say they didn’t go to a doctor when they were sick or injured in the last year because of cost, according to a new national poll from NORC at the University of Chicago and the West Health Institute. http://www.westhealth.org/press-release/survey2018/ From the topline results: 
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Mar 27, 2018 19:06
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I have top notch employer provided insurance. My insurance company's contract with the largest health provider network in the region is about to run out and they haven't signed a new contract. As a result, my insurance company felt necessary to change my primary care doctor. They automatically move me to one almost an hour away from where I live. If they sign a contract, I can just request to be moved to my old PCP. If they don't, I either have to stay with the one they automatically moved me to, or I have to find one close to me in network on my own. Which also means finding one that is accepting new patients. I had an annual physical scheduled for next month that I may or may not have to cancel (or that may or may not be automatically cancelled given the switch in PCP). And then it may be a while until I can get an appointment as a new patient elsewhere, and even longer for an annual. My employer and I combined pay almost $700 a month for this, and it is entirely possible that I will be without a primary care physician for a month or two, which, seeing as this is an HMO plan, would mean even longer for referrals (because no doctor is going to give referrals or renew prescriptions without an initial visit). Again, this is the good insurance from employers that people like Tim Kaine says that Americans are so happy about.
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Mar 27, 2018 20:46
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joepinetree posted:I have top notch employer provided insurance. My insurance company's contract with the largest health provider network in the region is about to run out and they haven't signed a new contract. As a result, my insurance company felt necessary to change my primary care doctor. They automatically move me to one almost an hour away from where I live. If they sign a contract, I can just request to be moved to my old PCP. If they don't, I either have to stay with the one they automatically moved me to, or I have to find one close to me in network on my own. Which also means finding one that is accepting new patients. I had an annual physical scheduled for next month that I may or may not have to cancel (or that may or may not be automatically cancelled given the switch in PCP). And then it may be a while until I can get an appointment as a new patient elsewhere, and even longer for an annual. My employer and I combined pay almost $700 a month for this, and it is entirely possible that I will be without a primary care physician for a month or two, which, seeing as this is an HMO plan, would mean even longer for referrals (because no doctor is going to give referrals or renew prescriptions without an initial visit). Have you called your insurer and asked if you can still go to your prior PCP for your already scheduled visit and have it covered? Some times they have continuity of care transition periods when stuff like this happens.
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Mar 27, 2018 22:33
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Reik posted:Have you called your insurer and asked if you can still go to your prior PCP for your already scheduled visit and have it covered? Some times they have continuity of care transition periods when stuff like this happens. We cover transition periods (60 usually, 90 for OB/GYNs) but the provider has to agree to it. And many don't, because there's financial and legal liability involved. e: and also we stopped offering HMO plans because members hated them. unsurprisingly.
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Mar 27, 2018 23:14
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Reik posted:Have you called your insurer and asked if you can still go to your prior PCP for your already scheduled visit and have it covered? Some times they have continuity of care transition periods when stuff like this happens. The letter they sent said that they allow it for PPOs but not HMOs. Reason I have the HMO instead of the PPO is that the PPO has higher out of pocket max and doesn't cover hospitalization at 100% (so the PPO plan is actually cheaper).
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Mar 27, 2018 23:52
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A couple weeks old, but the California Assembly's select committee on Health Care Delivery Systems and Universal Coverage funded a report through UCSF & UCSD on A Path To Universal Coverage And Unified Healthcare Financing In California. I have to dig in a bit more. On a surface skim, I appreciate the dual track of recommendations at the end. quote:California has made great progress in reducing the number of uninsured, but has not yet achieved universal coverage. Studies of high performing health care systems around the globe suggest that universal coverage is essential for ensuring access to care, improving outcomes, and controlling costs. A strong primary care system, a comprehensive basic benefit package, provider payments that reward better health outcomes, a strong social safety net in addition to universal health care, and administrative simplicity are other important ingredients for high performance.57 There are many pathways to achieving universal coverage and a more efficient health care system. Western European countries have taken a variety of paths to universal coverage, varying in their use of public and private sources of funds to provide universal coverage as well as in the degree to which they rely on the government to pay for services directly, versus relying on residents to make a choice among available health plans. One of the recommended elements that's pretty universally seen as a prerequisite for SP/UHC in Cali is a ballot initiative to deal with showstopping current initiatives. There's one collecting signatures, but with less than a month to go it doesn't appear to have reached 25% of the threshold. Does anyone local/more plugged in have a better feel on the status of California Healthcare Roadblock Removal Act-or if the legislature will be the ones putting it on the ballot instead?
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Mar 29, 2018 20:09
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Kaiser for all
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Mar 29, 2018 20:34
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Spazzle posted:Kaiser for all Ugh, no thanks. Every trans person I've talked to on kaiser has had an awful time.
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Mar 29, 2018 22:31
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"Walmart in Early-Stage Acquisition Talks With Humana posted:
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Mar 30, 2018 06:25
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I can't even summon enough energy to fully convey my dismay at how horrible that is guaranteed to turn out for everyone that isn't a major Walmart shareholder. Just.... lol.
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Mar 30, 2018 06:47
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cuttings costs by firing pharm techs and just making patients go fill their own scripts in the back somewhere
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Mar 30, 2018 14:51
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