Do you know your drug formulary?

drug formularyThe shrinking drug formulary

Insurance companies have several ways to cut their costs.

We are all familiar with higher premiums, higher co-pays, increased deductibles, and narrower provider networks. These will all be apparent when we look at our policies for 2017.

A lesser-known strategy is to remove high-cost drugs from the drug formulary—the list of medications that insurance will cover.

Insurance companies typically work with a pharmacy benefits manager, or PBM, which acts as the middleman to negotiate drug prices with drugmakers.

Exploding drug costs

The Affordable Care Act made it mandatory that health insurance plans offer prescription drug … Continue reading

Don’t reach for Life Line screenings

I first posted about Life Line screenings two years ago. I’m re-posting today as this post still gets a lot of traffic and I wanted to reopen the comments. 

life line screeningsOvertreating, overspending

I just received an invitation in the mail!

Not to a party or a wedding or anything fun, but to a Life Line Screening event being held at a local church. The letter says they’re holding a spot for me on this particular date, but I must call NOW to confirm and register, because spaces are LIMITED!

“These aren’t just routine medical procedures—they can help save your life”

Oh, … Continue reading

Drug commercials do more harm than good

I think it was a mistake to allow prescription drug commercials on TV. In my humble opinion, at least.

But I’m not alone in disliking these commercials, or direct-to-consumer (DTC) ads, as they’re called.

The news website Vox recently released a video that explains more about how DTC ads came to be ever present on our TVs. They attempt to be fair and present both sides of the debate, but it seems to me they lean negative. What do you think?

One of my objections to DTC ads is that these multi-billion dollar campaigns are … Continue reading

Outrageous cost of EpiPens finally getting some attention

Wow. Talk about timing.

I just posted a few weeks ago about my dread of renewing my EpiPen prescription because of its cost—over $700 without insurance, and still over $600 with my insurance!

It seems other healthcare advocates, the media, Congress and even the presidential nominees are at last realizing how insane it is to charge that much for literally a few cents worth of epinephrine.

EpiPens are not even new to the market, like so many other high-priced drugs. It’s been around for a long time, so Mylan pharmaceuticals can’t claim it’s trying to recoup R&D costs. In fact, … Continue reading

View Prevnar 13 ads with caution

prevnar 13Prevnar 13: As seen on TV

I was watching TV the other evening and, as usual, was forced to sit through multiple back-to-back prescription drug commercials.

One that caught my attention was for Prevnar 13, which is one of the pneumonia vaccines. (13 because it protects against 13 strains of streptococcus pneumonia.)

The commercial stated Prevnar 13 was for adults aged 50 and older.

That statement’s true, but needs some clarification.

Yes, Pfizer did get FDA approval a few years ago to market Prevnar 13 to adults over the age of 50. Previously, the vaccine was only used for … Continue reading

Doctors don’t know what healthcare costs

Heard on the golf course

I don’t want to reinforce the cliché that all doctors play golf, but my husband (not a doctor) plays with a lot of them.

Recently he shared with me a couple of conversations he’s had with his MD golf buddies about the cost of healthcare, specifically prescription medications.

A few weeks ago I posted about how much it costs to buy an EpiPen—over $700 for a pack of two, if you don’t have insurance. Even with insurance, it can cost well over $500.

My husband mentioned this to a friend, a urologist, during a … Continue reading

Skin cancer screening guidelines

skin cancer“Insufficient evidence”

Many years ago I had a primary care doctor who used to perform a total body skin examination (TBSE) on me every year as part of my annual exam.

Of course, those all-inclusive physicals are a thing of the past. I haven’t had a physician perform a TBSE for a long time.

I often wondered about that. A TBSE seems like a relatively easy and harmless way to quickly screen for skin cancer. The goal, of course, is to find a melanoma, the deadly skin cancer, when it’s small and possibly curable.

But the go-to source for screening … Continue reading

The high cost of healthcare in America

They say a picture is worth a thousand words, and the online news site Vox recently sought to open Americans’ eyes as to how much more we pay for healthcare compared to other countries.

America’s healthcare prices are out of control. These 11 charts prove it.

I can’t copy their charts, but basically they are bar graphs. The bar that shows how much patients in the US pay for similar drugs and services towers over the others like a skyscraper over a neighborhood of single-family homes. Like this:

healthcare costs graph

Vox got its information from the International Federation of Health Plans (IFHP)Continue reading

Prevent kidney stones

kidney stonesAnd save money!

If you’re interested in how much a kidney stone costs, read this blog post from the Costs of Care website. The author of the post gives an accounting of her physician visits, diagnostic tests and medications:

  • At least 5 sets of blood work, with CBC and chemical profiles, parathyroid studies
  • Several urine tests, including urinalysis and urine culture, and two 24 hour urine tests (a third 24 hour urine test was recommended but I declined)
  • 2 CT scans
  • 1 MRI
  • 4 specialist visits, 2 primary care visits, 2 ER visits (involving IVs, pain meds, lab studies)
  • Prescriptions
Continue reading

What is RIP Medical Debt?

rip medical debtDebt forgiveness

I recently found out about an intriguing non-profit—RIP Medical Debt.

I’ve posted many times about the high cost of healthcare, even for those of us with health insurance. Medical debt is still a leading cause of personal bankruptcies in this country.

What if those debts could just disappear?

For a lucky few, they can.

RIP Medical Debt, Inc., was founded in mid-2014 by two former collections industry executives, Craig Antico and Jerry Ashton. Having worked for decades in the medical field, the two were acutely aware of the number of Americans who shoulder the burden

Continue reading

Why are EpiPens so expensive?

epipensEpiPens – lifesaving but costly

I’m allergic to bee stings, so I keep an EpiPen handy when I’m working out in my garden this time of year.

But my EpiPens are more than 3 years old now, and it’s time to invest in a new set.

Why do I say invest? Because EpiPens are incredibly expensive!

Related post: First aid for bee stings

I didn’t know that three years ago when I bought them. At that time, my health insurance did not include coverage for prescription medications (all ACA-compliant plans must now), so I paid the full price out of … Continue reading

Obamacare premium increases for 2017

Up, up and away!

Does anyone’s income go up as fast as their health insurance premium? I wish.

11.6%. That’s how much more my current health insurance provider wants to charge for my bronze high-deductible health plan in 2017.

And although 11.6% seems like a lot to me, another company in my state is requesting a 19.9% average increase on all its plans, with a 28% increase on its gold plan!

So far, the rate increases that have been made public in other states are all pretty high, averaging well into the double digits. So at least I’m not … Continue reading

“End of the Line” for medical guidelines

Knowledge is king

That’s the take home message from Professor (of pharmacy) James McCormack’s latest parody video, End of the Line, which takes a whack at healthcare’s increasingly pervasive and rigid medical guidelines.

 

If followed to the letter, these guidelines (often based on research funded by drug companies) would have everyone diagnosed with a disease and taking one or more medications. Medical guidelines may be great for the drug business, but not so much for individualized, patient-centric care and shared decision-making.

Chronic disease state guidelines (blood pressure/lipids/glucose/bone density) do not provide clinicians with

Continue reading

Be informed – Shared decision-making

Shared decision-making makes better informed patients, and better informed patients use less health care.

…as many as 20% of patients who participate in shared decision making choose less invasive surgical options and more conservative treatment than do patients who do not use decision aids.

Which lowers health care costs.

…a 2012 study…showed that providing decision aids to patients eligible for hip and knee replacements substantially reduced both surgery rates and costs — with up to 38% fewer surgeries and savings of 12 to 21% over 6 months.

[It’s] estimated that implementing shared decision making for just 11 procedures would

Continue reading

Harken Health – Betting on primary care

I just read about health insurance giant UnitedHealth’s bold but risky new insurance plan, Harken Health:

UnitedHealthcare is betting $65 million that it can profit by making primary care more attractive.

With little fanfare, the nation’s largest health insurer launched an independent subsidiary in January that offers unlimited free doctor visits and 24/7 access by phone. Every member gets a personal health coach to nudge them toward their goals, such as losing weight or exercising more. Mental health counseling is also provided, as are yoga, cooking and acupuncture classes.

At this time, Harken Health is only available in Chicago … Continue reading