

Obamacare Plans Bring Hefty Fees for Certain Drugs - ytNumbers
http://hosted.ap.org/dynamic/stories/U/US_HEALTH_OVERHAUL_PRESCRIPTION_COSTS?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT

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olliej
Ok so under the ACA she now pays less for her medications (Celebrex does not
yet have a generic, i know because i'm on it as well). The headline is link
bait: Before the ACA she was paying entirely out of pocket, and now she isn't
but it's still expensive. I have very expensive insure and it only brings it
down to $50/mo so $85/mo seems reasonable for a cheap plan.

Anyway, to back up what i just said, here's the unabridged 2nd paragraph:
"Under the plan, her Celebrex would have cost $648 a month until she met her
$1,500 prescription deductible, followed by an $85 monthly co-pay."

followed by the following in the 5th paragraph: "Before the federal health law
took effect, Mason paid slightly more for her monthly premium on a plan that
didn't cover her arthritis or pain medications and some routine doctor's
visits."

A lot of the other examples they have are "patient was trying to get name
brand drug rather than the available generic". Now for some meds (birth
control for example) the exact brand can be important, but for most it
doesn't.

~~~
refurb
You are right that the situation for the first woman is better overall.

I think the point of the article is that for those who were previously insured
who are moving to exchanges may find that the benefit design is _very_
different than their old coverage. In order to keep premiums low, insurers are
keeping closed formularies and a very limited list of covered medicines.

I think this is one of those "buy beware" stories. Make sure you know what
you're paying for.

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silencio
I don't understand the point of these articles.

The first example in the story is a woman that went from more expensive
minimal coverage that didn't include the drugs she was using, to better
coverage overall with no mention whatsoever as to how much she used to pay for
the drugs before (which is presumably nearly full price or some sort of
discount through the manufacturers which isn't cheap either).

The other examples were also of people that have apparently never changed
health insurance plans or gotten prescriptions that weren't covered under
their previous insurance plans. Or even actually read what their insurance
covers.

I've had individual health insurance forever since both my parents and I were
and are self employed business owners. Welcome to the world I lived in before
Obamacare. Welcome to the world I live in now. I have wasted many days
negotiating with insurance companies and doctors' offices in the past for both
myself and my parents over drugs that were minimally covered. Think along the
lines of $500+ worth of glaucoma prescriptions in a month that insurance only
covered $5 of....yes, $5. And then a week without any prescriptions and
dangerously high intraocular pressure trying to get the doctor to prescribe
something cheaper when they themselves don't know how much anything costs and
will just throw the whole medicine cabinet at you in hopes that something
sticks. Or how I have a prescription for Adderall and every refill used to be
an exercise in explaining to the pharmacist that they should call my insurance
company because I already have a pre-authorization filed with them so I pay
$20 instead of paying $300 every time.

My silver-level ACA insurance plan isn't the best ever and it's a bit pricey
(well, so were my previous insurance plans), but I no longer stress out about
losing my insurance coverage, I have a good idea as to what is covered and
what isn't, and my insurance company and doctors and pharmacists do the best
they can to accommodate my requests. I even keep running into _pharmacy techs_
that ask me with a priceless facial expression if I really, really, really
want the specific asthma inhalers and quantity that I'm picking up because
they keep experiencing sticker shock - "I can ask the pharmacist and your
doctor to get you a different one" naw, they're all expensive, they were
always expensive, and nothing will change it. Welcome to my world. 8)

ACA isn't perfect but it's a hell of a lot better than the state of things
before and here's to better healthcare reform in the future.

~~~
happyscrappy
The jury is still out on ACA. It relies on young people buying expensive plans
instead of paying the relatively small fines. The switchover itself was
undeniably a complete disaster and makes the midterms look grim for the Dems.
On the plus side, at some point in the future we could have the GOP support
single payer just because it would save money.

~~~
silencio
You're right. It also doesn't help that people keep putting out stories like
the one above that make ACA sound terrible even though I'll bet that the woman
in the example ends up paying less out of pocket over the course of a year
than she used to. Like people expect ACA to be some magical cure for expensive
and/or chronic illnesses - nope, it just makes it a little bit more bearable.

Like, I still just paid $40 for an office visit and some tests/xrays and
another $200 for meds this month where when I had the same problem
(bronchitis+asthma exacerbation) in ~2010 I was out like $400 with samples for
the same drugs (that would have doubled the cost) and that was without the
hour of tests and coaching with a wonderful respiratory therapist last week
(which was, I'm convinced, the only reason I wasn't totally fucked up in a
bunch of different ways leading up to and during my wedding on Saturday).

Your theoretical sounds hysterical and amazing if it actually happens, but I'm
not holding my breath. I don't know what it will take for people to start
supporting single payer but I hope it happens soon. Maybe if everyone just
gets seriously sick or knows an immediate family member that is sick? Too many
people seem to be in denial about the fact that we need serious reform still.

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Nizumzen
People pay $800 monthly premiums in America?! And they still say that their
system is better than "socialised" health care systems? Madness. Why not just
pay our relatively low national insurance (12.5% of your pay check) and get
free health care for everything. It would save you all money.

But I know what you are thinking... socialism is evil!

~~~
goatforce5
You're talking about the UK? It's not 12.5%:

[http://www.hmrc.gov.uk/ni/intro/basics.htm#4](http://www.hmrc.gov.uk/ni/intro/basics.htm#4)

"If you earn more than £149 a week and up to £797 a week, you pay 12 per cent
of the amount you earn between £149 and £797. If you earn more than £797 a
week, you also pay 2 per cent of all your earnings over £797"

~~~
Nizumzen
Thank you for the correction.

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refurb
This is actually a huge issue in the drug industry right now.

Most of the plans on the exchanges, but particularly the lower priced ones,
have very large patient cost-sharing obligations. And it makes sense, if you
pay a smaller premium each month, you'll have to pay a great share of the
costs when the they do occur.

However, I don't think this will work out in the long run. It's one thing to
ask a patient to pay 50% of a $300/month prescription (even though that's too
much for many patients), but it's another to ask for 50% of a $10,000/month
prescription (not uncommon for cancer).

The ACA did put a total cap on patient-cost sharing at $6,350 per individual
or $12,700 per family [1]. This is a good thing since many plans prior had no
limit on out of pocket costs. However, $6,350 is still a lot to ask lower
income patients to pay.

One interesting outcome of this is that most drug companies are stepping up
and offer patient assistance with these costs. For example, you might get a
debit card that pays anything over $20, which makes it much more affordable.
The funny part is that insurance companies typically _hate_ patient co-pay
cards since they defeat the purpose of co-payments (drugs the insurance
company don't want you to use are more expensive). However, for the really
expensive drugs, insurance companies are not complaining at all. In the end,
it just results in a discount by the manufacturer, in a roundabout way.

[1][https://www.healthcare.gov/glossary/out-of-pocket-maximum-
li...](https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/)

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quasque
I'm always amazed at the astronomical prescription prices in the US, even with
insurance. Here in the UK it's capped at £7.85 (~$13) per medication per time
period, which is usually about a month - with many people on low incomes or
lifelong medical conditions receiving them entirely for free.

I'm sure if it routinely cost hundreds or even thousands of pounds per month
just to receive the drugs necessary to stay alive and well, I'd have been to a
lot more funerals by now.

~~~
hga
That's because _we 're_ paying the money for the development and approval of
these drugs, which for each successful one has historically roughly tracked
the cost of a single strategic bomber. In a Tragedy of the Commons method
monopsonies like your NHS then dictate prices not far about cost of materials
and production, vs., to put it pejoratively, paying your "fair share" for the
existence and availability of the drug in the first place.

Don't worry, the way things are going, bit by bit, sooner or later, the US
will "fix" this problem and there will be no new drugs (aside from the
occasional totally politicized efforts). And people will relearn what it's
like to live in a world where bacterial infections are well nigh untreatable.

~~~
quasque
I'd be interested in seeing the data to support your claim.

~~~
hga
Turn it around: it's well established that bringing a drug to market costs
100s of millions of USD (R&D, Phase 1-3 trials, the long time and limited
patent protection from that, all the failures along the way, etc.). Drug
companies do not make large profits _compared to other companies_. Where does
the money come from? Where _can_ it come from?

~~~
quasque
I understand your argument, but the assumption it's based on - that
pharmaceutical industry income is disproportionally financed by the USA when
compared (per treatment) to other developed nations - requires supporting
data.

~~~
hga
Some sure indicates there are price controls, although curiously not in
Germany per:
[http://www.taylorwessing.com/synapse/regulatory_pricecontrol...](http://www.taylorwessing.com/synapse/regulatory_pricecontrol.html)

NHS price controls are set below (much of?) the rest of the EU, resulting in
diversion and shortages. Also, as is not surprising with monopsonies, some
companies are ripping off the NHS on generics. You can find items on both with
this search:
[https://www.google.com/search?q=nhs+drug+price+controls](https://www.google.com/search?q=nhs+drug+price+controls)

~~~
quasque
According to the association that represents the pharmaceutical industry in
Britain, the shortages you refer to were due to pharmacies taking advantage of
exchange rate differences to sell medicines abroad rather than supply the UK
market[1]. This would imply that the costs of medicine are not usually
significantly lower than the rest of the EU, at least when the currency
markets are not in flux.

There is some information available on the cost of prescription medicines in
the UK (see [2]) but I don't know where the equivalent datasets would be for
other countries. Would be interesting to do a comparison.

[1] [http://www.abpi.org.uk/our-
work/news/2012/Pages/280212.aspx](http://www.abpi.org.uk/our-
work/news/2012/Pages/280212.aspx)

[2]
[http://www.hscic.gov.uk/searchcatalogue?q=title:"prescriptio...](http://www.hscic.gov.uk/searchcatalogue?q=title:"prescription+cost+analysis")

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porlw
30 200mg Celebrex (genuine, non generic) capsules cost about $20 in South
Africa.

The gov't does control medicine prices. However, unlike some other countries
(e.g. the UK), they don't pay anything to the manufacturers, that price is all
they get.

I'm pretty sure if Pfizer weren't making a profit they would withdraw the drug
from the market.

Celebrex doesn't cure anything, it only relieves the symptoms of joint pain.
If you can't afford it you're unlikely to die, so it's a perfect candidate for
the extortion racket that is the US healthcare system.

