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General discussion

What a surprise (NOT!) -- many insured quitting expensive drugs

Dec 3, 2003 9:33PM PST

Hi, All.

Most folks use the increasing %age of uninsured to demark the affordability crisis of health care in this country -- a crisis that is doubtless killing tens of thousands annually. But, surprise -- even many of the insured are going off life-saving prescription meds as insurance covers an ever smaller part of the cost, while drug company and insurance company profits soar. But hey -- we have a "free market," and that's all that matters, right?
For the gory details, see Study says many quit pills in 3-tier prescription plan.
The copays on our Rx drugs this year will be well over $2,000 -- when we started working in 1980, there were no copays. Is it any wonder the WHO ranked the U.S. health-care system 71st in the world in their last survey (and we've doubtless dropped a few slots since...)
-- Dave K.
Speakeasy Moderator
click here to email semods4@yahoo.com

The opinions expressed above are my own,
and do not necessarily reflect those of CNET!

Discussion is locked

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There is no simple answer to your question ...
Dec 6, 2003 11:37AM PST

Evie may know more of the specifics than I do since she used to work in the industry.

The FDA does carefully monitor the manufacture, quality control process and clinical testing of prescription medications. They also have jurisdiction over some non-prescription drugs, but IIRC the rules are a bit different. The FDA has very limited jurisdiction over 'dietary supplements' as a result of a successful lobbying campaign on the part of supplement manufacturers.

When the FDA approves the distribution of a generic form of a prescription medication it does require a certain amount of testing to establish 'equivalence' between the generic and the original. The FDA also requires testing to confirm that the original drug (and also the generic drug) have more-or-less stable composition, bioavailability and so forth over time. So in theory each batch of medication should be interchangeable with any other batch and generic medications should be interchangeable with branded medications. It's a nice theory and it may even be correct but there has been a certain amount of controversy regarding generics for years.

There have been a few situations in which physicians or pharmacologists have noted unexpected events that may (or may not) be related to differences between generic and branded drugs. The FDA investigates these reports and thus far the official verdict is that there are no systematic differences between generics and brand name drugs. I'm speaking here only of generics that are expected to be identical to the brand name product (the "AB rated" generics).

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Part 2 ...
Dec 6, 2003 11:38AM PST

I have seen a SMALL number of patients who may have truly responded differently to one brand of a medication vs another brand of the same medication. I have seen a LARGE number of patients who are convinced for no apparent reason that generic drugs are obviously inherently inferior. The situation I've encountered most often that MAY represent a true difference involves side effects that are possibly due to minor differences in the binders or other inert ingredients. But these situations are uncommon.

On the whole there is very little reason to prefer brand name vs generic for any given medication.

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Part 3 ...
Dec 6, 2003 11:48AM PST

The really difficult issue in these tiered formularies comes up because the tiers are usually constructed along the lines of: cheapest = generics; middle tier = "approved" brand name drugs for which no generic is available; most expensive = "non-approved" brand name drugs, or brand name drugs for which a generic is available.

For the most part I think that if there is an AB rated generic but the patient insists on brand name the patient should pay the extra cost. There are some difficult situations that come up if there is a generic version of the drug that is different from the brand name (eg: bupropion vs Wellbutrin SR, which is a time release form not available in generic)

The harder question comes up regarding how drugs get shuttled around between the 'approved' vs 'non-approved' lists. The decisions are not usually driven by purely objective criteria. In many cases the decisions are based on strict economic criteria, and in some cases the decisions are based on financial incentives that the drug manufacturer pays to the insurance company. These incentives are legal, but I am concerned that they tend to distort the decision-making process.

Most patients can be adequately treated using medications in Tier 1 or Tier 2 of the typical formularies, but patients with multiple drug allergies or other special situations may be ill served by this tiered system since most insurance companies do not grant special exceptions from the formularies. If you really do need a tier 3 drug you have to pay the higher co-payment regardless of why you need it.

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(NT)Thx for the insights, more evidence there is no easy answers to the disagreements.
Dec 6, 2003 1:42PM PST

.

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Re:What a surprise (NOT!) -- many insured quitting expensive drugs
Dec 7, 2003 9:23PM PST
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I heard about this on network news last night, (long rant, both sides take your shots)
Dec 7, 2003 10:35PM PST

And it's proof how the government never gives something without taking something.

I can understand the claim that -

"Health economists have long asserted that when beneficiaries are insulated from the costs, they tend to overuse medical services. "

But even recognizing it may be, probably is, true with many with unusually good insurance (top management mostly), I seriously doubt it's as true for the retired population. And I'm afraid that bearing part of the cost as defined by this bill is actually going to mean bearing more.

I?ve avoid this debate mostly, because like others here, most people take either extreme position and throw rocks at the other side. Some seem to want a government that will guarantee most of your expenses, health wise and more. Others seem to want to society to completely stay out of everyone?s lives, no matter what goes wrong or right. Both sides, IMO, are BS. Maybe I?m just simple minded, but it seems to me that anyone should be able to acknowledge that neither extreme is viable under current conditions. Our health care is often compared to what other nations provide. Well, how many of the more socialistic nations have expended national wealth over and over to help militarily and otherwise to try to stop atrocities and rebuild other nations? You can argue that a lot of our intervention is wrong, that doesn?t change the cost. The USSR before it began to breakup was the only other nation near our size in both land and population. Does anyone care to address the cost of infrastructure and government as the physical size and population increases?

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Part 2
Dec 7, 2003 10:37PM PST

I wonder what we pay in taxes now, if you total the income taxes, property taxes, excise taxes, higher costs of products to cover business taxes, fees for drivers licenses, automobile registrations, etc, etc. I wonder how it compares with the taxes in cradle to grave government parenthood countries. I have to wonder about costs to businesses in those countries too, and of costs to business in this country vs. others regarding regulations and bookkeeping to prove compliance of all the rules.

The idea that we can afford to guarantee total insurance for everyone is BS, without giving up way over half our individual income and probably many if not most of us getting less care is just as large a delusion. On the other hand, a family of 3 or 4 with a household income of $20K or $30K will have real difficulty in paying a couple of hundred of dollars a month for chronic medical care. Depending on where you live, any housing can eat up a lot of that income. And catastrophic care will break them every time. Local charity doesn?t work as well as it did when everyone grew their better than half their food in the backyard and every neighborhood had someone raising chickens and a few hogs. Families use to care for most of their own in hard times. Now families, pursuing careers or even plain jobs are scattered all over the country. Many households are trying to raise kids, send them to college, and have elderly parents living with them and dependant on them.

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Re:Part 3
Dec 7, 2003 10:37PM PST

Wake up folks, ignoring the costs of centralized bureaucracy taking care of us would be one more overwhelming tax burden. Ignoring that a lot of people can?t handle the cost is just as irresponsible. As far as the elderly, the costs are so high because of medicines and procedures that were not even available a couple of decades ago. People survive medical problems that would have killed them 20 years ago. Better care, longer lives, any wonder health care costs are a primary concern for people as they age? I asked around once to different insurance companies about a health insurance plan built on the old whole life insurance structure. I?d pay premiums for 20 or 30 years without a benefit, and then when I retired the policy would cover xx% of my health costs. Guess what, no one offered such an idea. Why? Because they knew they couldn?t forecast the costs well enough to be sure the premiums and money made from investing the premiums would make them a profit.

Some feel discouraged from saving for retirement when they see people that did save all their life and retire cautiously secure, then have a heart attack or stroke, or any other attack. They see most of their savings gone in a couple of years.

Insurance is two things people mostly don?t want to admit. It?s a bet, life insurance is betting they will make more off your premiums and investments with it, than they?ll have to pay out when you die. Health insurance is betting the same thing, they?ll make more by investing your premium than you?ll cost them. Insurance companies lost their shirts in the stock market in 2002 and 2003 also, and they?re scrambling to make it up anyway they can, higher premiums, denying claims on any excuse, etc. The second thing about insurance is that people tiptoe around admitting is that it?s purpose is to spread one person?s cost out over many.

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Re:Re:Part 4
Dec 7, 2003 10:39PM PST

If the government takes over any basic insurance, you?ll see corporations gradually reduce their coverage. Smaller business will stop offering basic insurance, after all you already have that. Anyone that believes otherwise IMO is deluding themselves.

You want to discuss national health insurance? First thing is to wake up, face facts, and define what coverage you?re talking about furnishing. The elderly are a hot topic because of their voting block, and both sides know it. The most cost-effective area for government to be involved perhaps would be medical care from birth to 20 years old. (No benefit to me, I don?t have any children nor plan to at this late stage in my life.)

Ok, both sides can shoot away at me now. I'm done with it.


roger

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Re: medicare "reform."
Dec 8, 2003 12:22PM PST

Hi, Mary Kay.

The really obscene part of this legislation (which folks had a chance to read for about 36 hours before voting on) is the banning of medicap coverage to pay the Rx costs not paid by medicare. That's essentially a direct attack on retired folks whose medigap coverage is paid by their employers -- they currently have zero drug costs, and will soon have up to $3600 per person drug costs. Talk about robbing Peter (those fortunate enough to be well covered now) to pay Paul! Except, in this case it's not even that, as Paul doesn't get the difference!
-- Dave K.
Speakeasy Moderator
click here to email semods4@yahoo.com

The opinions expressed above are my own,
and do not necessarily reflect those of CNET!