The 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
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.
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
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
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
Prevnar 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
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
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
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:
Vox got its information from the International Federation of Health Plans (IFHP)… Continue reading
And 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)
… Continue reading
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