No wingnut would pay over $300 for a scrip... we're smart enough to ask Doc for something generic. Our doctors are really good by now, they don't even suggest the latest high dollar fad, they just call in the old reliable. :D
Folks with medicare get in what is called the "doughnut hole". We see it every day in home care. THey are covered from 0 to say 4K depending on thier plan. From 4K to 7 K they are responsible for at least 80%. After they reach 7K it goes back to a co-pay. It also depends on if the drug is on the covered list.
Just the other day we had a patient that needed 1gm of Azactam IV for 10m days. When we ran their insurance, it ended up that they would be responsible for $580 just for that drug. It seems that Azactam is not on the formulary for the plan that they have.
It sucks, but that is the fine plan that the congress of this US passed as medicare reform.
Patients get discharged all the time to home with home IV orders every day. Some of the plans will pay for the drugs but not the supplies that are needed to infuse the drug. We can do it for a patient for 25-40 bucks a day (different lines cost different amounts) per day. If the patient cannot pay that, they can go to the hospital every day to be infused. The hospital will charge a minimum of 300 to the govt per infusion. They also can bill a Q code for the infusion suite. What a deal. How would you like to trudge to the hospital (in rural kansas that can be a very long way away) 2 or 3 times a day. At the cost for us 25-40 we are breaking even, give us 75 -100 per day and we are in high cotton, even able to cover shipping costs. And, we save all of us tax payers money.
Health care is a mess, and it is only going to get a lot worse!!!!
Sounds like the INDIVIDUAL CONSUMERS have been removed from their role as comparative shoppers. Those affected by the decisions are far removed from the decisions themselves. How is MORE bureaucracy especially govt. bureaucracy going to help this???
The ONLY way to solve the healthcare problems we have is to let each individual look for the best plan that suits their own personal needs.
Take the employers out of the equation and especially take the govt. out of the equation. You would have to do it gradually but it must be done.
Wait.....Bush runs the pharmaceutical industry? Oh the Humanity!:eek:
So why do the doctors write the scrips for the fancy new stuff?? Because the patients generally don't care, most don't pay for their meds, anyway. If the insurance company covers med for a $25 co-pay, the patient doesn't even know that they're spending $300 to take care of an infection that $4 of penicillin could cure. Then we wonder why insurance costs so much... :rolleyes:
And here is another little tid bit. Merck ownes a huge mail in pharmacy. This mail in pharmacy has contracts with some of the larger insurance plans in the country. If you get a script written for somthing that is made by Merck, the pharmacy fills it at a significant cost savings to the pharmacy, but the pharmacy charges the insurance company regular AWP -10 plus a filling fee. The insurance company spends the same no matter where it is filled, the patient pays the same co-pay no matter where it is filled, but Merck and the Pharmacy make money because they control the product. And FYI, Merck is not the only pharmaceutical company that does that. CVS also has a deal like this set up.
And if you want to start talking about speciality drugs, (high dollar, orphan drugs, derived from blood products). the way that the producers control those products and how much they cost will make your blood boil.
If someone RX bills run 800 bucks a month, they would come out ahead by taking out a supplemental policy for another 30 or 40 bucks which would cover the doughnut hole. For example, they would hit the doughnut hole in a around 3 months. So they would be much better off taking out a supplemental policy to avoid that $4200 (doughnut hole) of RX.
The media and liberals lie so much about the Medicare Part D RX plan. The government has forced big pharma from gouging Americans because of this plan. You do not see people going to Canada and Mexico to get their drugs because you can get them just as cheap here. Prior to this plan, the pharma companies would sell the same drugs cheaper to foreign countries; so in essence Americans were subsidizing the damn foreigners.