We all know Insurers own all the Pharmacy Benefit Managers....So I really do hope all the insurers can eat a dick when they get taken over by the Govt.

Trying to get my Type II meds....Mounjaro is back ordered locally for some fucking reason.

ANyhow Doc switched me to Rybellus....Ok..cool oral semaglutide..should be similar enough ti tirzipeptide.

So, I check my express scripts PBM website that is tied into my Insurance Coverage and I get this.

Attached File


about $150...awesome sweet...just needs pre auth..no biggied...So I get a text from my ins co saying PRE AUTH APPROVED, call your pharmacy right nao!

So I call and talk to the pharmacy lady...and tell her its approved, she them tells me it's gonna be  $990 what in tarnation!?!?!

So I tell her...hold up there sugar...let me see WTF if going on.

I then go to their website in my Rx page managemetn and see this.

Attached File




The Primary Cares and the Pharmacist are the ones trying to do the right thing and help people....but the Insuarance Cos and PBM and Pharmaceutical companies are right there fucking everyone every step of the way.

I think $990 would total my ass

Well I sure ain't the fuck paying over $10,000 a year to some fucking pharmacy company that steals all their ideas from the public forum.

Explain to me why a MRI costs $3200  but only $1100 two hours away.

You should see the shit that goes on with multiple sclerosis meds and the price differences between
the same medication in US v. Canada. It's pretty shocking.

Property and casualty insurance companies aren't fucking people, but health insurance companies definitely are. Patrick Bet David did a pretty thorough breakdown of how the health insurance company makes bank off of people's prescriptions. I hadn't even considered that being possible, but they have figured out how to monetize it.

They’re $550 at the local chain imaging place, the local hospital’s imaging center is $3k.

@himars13a

That is insane.  $450 for MRI unless you need contrast then it is $700, of course that is us paying for it instead of billing insurance.

That's because Canada bases its prices on cost to manufacture.

R&D costs? Fuck that, make the statesiders pay those. We get that free here in the Provinces.

OTOH (not really a factor for MS) here in the states we have massive advertising costs too.

Insurance Companies are our British East India Company.

Government mandated and given the profits and kickbacks they provide to the crown, they’re allowed to fuck over and abuse the populace so that those in charge can get richer.

The Constitution, a Constitutional Republic, and capitalism are compatible with a moral and liberty minded people.

Beef and chicken aren't that expensive. Done properly they also control hunger signals and lower your blood sugar.

I've been fighting the insurance company for over a year now on a $37,000 bill. I collapsed in a store from Hypokalemia. I was unconscious for a day and almost died. Internal bleeding from Esophageal cancer. It was bad.

Insurance company says hospitalization was unnecessary and Could have "monitored it at home."

I keep telling them about the part where I collapsed and was unconscious and had to be taken by ambulance, have emergency surgery, etc. but I could have "monitored it at home."

What insurance company? Blue Cross is the only one I’ll use after poor experiences with UNH.

Quit talking that healthy shit.  I wouldn’t pay anywhere near that with my health insurance.

Anthem Blue Cross

But if you're low income/ no income you'll end up with it for free ...

One reason healthcare prices are all over is welfare.  A significant portion of the recipients will never pay.  To balance the system and keep it running, they dramatically over charge others.  You're paying not only your health care, but someone else's too

My daughter is in pharmacy.  She does volunteer at a free clinic.  She's personally stuffed $20,000 retail in high end prescriptions and handed them to homeless/ migrant  individuals.  Those meds don't just pop into being.  Someone paid for them. The someone was 30 other people paying $990.

Hospital MRI time = Gold.

Imaging Center MRI time = Copper.

Too many people need a STAT head to put it aside for grandma's L2/L3 disc bulge.

Multiple times throughout the last couple years we have found that it’s far less expensive to pay cash than it is to use insurance and pay the co-pay.

It's past time for universal Healthcare, not a popular option but it's a fact.
Lobbyists and insurance companies cannot continue to rule this broken system.
You can go bankrupt for what others get for free.

The hospital Lab $3500, Lab Corp $1100.

Should amend thread title from “universal healthcare” to “no fucking healthcare and you’ll like it!”

If the founders were writing the Constitution today big business would have been treated as another threat to individual liberty like they had seen the church and crown (the state) abuse historically. MuH FrEe MaRKeT is a fairytale that lets the crony capitalist globalist elite fuck us over.

You should see the cost of many newer Rx ophthalmics (eye drops). They can run over $500 a bottle. There are “coupons “ and patients can use special online pharmacies,  but walk in with an Rx and no insurance? Stop and grab a tube of KY before you get to the pharmacy counter because you’re getting bent over

Uhh no.  The correct path is the OTHER direction.  Remove govt, welfare, insurance, and lawyers from healthcare.  Stop giving it free to people that don’t contribute.  That gets us back to what built the best health care system in the world.  Universal is simply giving up.

Fuck PBMs and Fuck health insurance companies


Why is a beer $15 at the stadium and $1.50 at Costco?

Fuck PBMs and insurance companies that run them. Legal monopolization by forcing everyone to use mail-order specialty pharmacies.

I worked at a pharmacy managing their 340b Ryan White program when I got out of college (not a pharmacist, administrative areas of the program). To continue filling the HIV meds we had to become specialty pharmacy accredited. This increased our overhead to nearly 40% of revenue and made it more difficult to actually get the meds to the patients. The claim is that by requiring the specialty accreditation quality of care is improved but all it does in reality is force people to the major players mail order pharmacies. The whole purpose of 340b is to help the local community, the new requirements significantly cut our resources to be able to do so. We had 2 separate accreditations and when you look at who was on the board you could tell why it was made intentionally difficult to continue serving local patients, with nothing but insurance companies, and major pharmacies sitting on the board.

We had a pharmacy that we had to keep open because they had a contract for a single chemotherapy med that nobody else could get. We tried to move the contract to another one of our locations and then the local hospital. We were told by the manufacturer that they were not allowing anyone else to sign a contract with them for that med and if we moved the pharmacy they would terminate the contract. I'm no longer with them but they now have a pharmacy that is basically open to fill that one prescription, for the pharmacy's sake that one med does generate enough revenue to justify the pharmacist's salary and all the accreditation overhead.

The government won't do any better. Look at what a mess DME is, universal healthcare will just be that multiplied. Ever tried calling them for clarification on a question? It's a joke.

@PikeSlayer

No idea if WI has similar insurance consumer protection laws as here in IL but it would be well worth researching options instead of fighting with a company that doesn't want to pay.  Look up bad faith denial of insurance claims, find a WI lawyer that handles that stuff and have a conversation.

Lots of drugs out-of-stock.

I had to go to two pharmacies to get one pill and another is out-of-stock with my mail order pharmacy.

Medicine shortages in America for the most common drugs?

@midcap

If you cut out the carbs and start walking every day, unless you have a heavily damaged pancreas; you can eliminate type 2 beetus.  Did it myself.  Youll be a whole lot better off if you do.

Your proposal would be preferable, but it's complete fantasy.

Mid cap is referring to the fact that he could have bought the meds for far less if he had just paid cash with no insurance. the inflated markup was applied purely so the difference could be handed to his insurance company. this is a predatory behavior that has nothing to do with drug manufacturers. its all about the greed of the insurance companies.

@stacks04

Would you please elaborate upon this? Thank you.

Nurtec ODT 16 pills $2200. Are you Fukn kidding me?

@hitchhiker

How much did you weigh when started?
How much you weigh now?
How long did you walk each day?
How much do you weigh now?

Thanks!

Hate to be this way Mid, but go keto, exercise reg and you will see a sharp decrease in avg BS within a couple of weeks.  Add in some IF for faster results.  You’ll loose the need for meds if type 2.

no we will get universal healthcare because people like Midcap want excellent healthcare but want 'someone else' to pay for it

because evil docs, hospitals, medical companies, big pharma etc

but it will be FREE -- along with people dying waiting for appointments or procedures and having no ability to switch providers

this has played out in other countries -- its not conjecture.  but hey its FREE  

How the fuck can anyone blame failures of one of the most regulated markets in this nation on the free market?

Allowing mass-market prescription drug ads was astonishingly stupid. They should renew the ban on that

Make fat shaming great again.

These drops might as well be liquid gold.

These have a relatively recent FDA approval and are for a rare condition. I’m sure it cost many millions to bring to market, but Damn!

Mounjaro is out all across the country.   I was told August by CVS.  Optum RX would not even give me a date.

LOL

The solution to a problem mostly caused by government is not more government.

Is this for metformin?

My acupuncture doctor charges a fraction of the costs he charges if paid by the insurance.  Reason?  The many extra hours needed to deal with the paperwork, phone calls and other hassles when dealing with them.

I noticed that my dentist and doctor also have several people in their offices who only push paper and hang on the phone.  When I ask they explain that's to deal with insurance companies.

Now, looking from their (medical insurance companies) side, how much of the paperwork and other hassles are due to government red tapes and other mandates and liabilities that they must deal with in order to CYA?

And yes, it will only get a lot worse when things go single payer and serviced by some AIs that will answer phone calls, review forms and other approve, or not, the requested treatments, tests and drugs.

I have worked in the healthcare business. It is a combination of things causing this:

Pharmaceutical companies that have lobbied the hell out of congress for protections on drug patents etc.

Pharmaceutical companies allowed to market in the USA (and a little bit in New Zealand) but no where else in the world.

No pricing control (I'm not saying I'm an advocate for this, just telling everyone the way it is) here in the USA when practically every other country has them.

In essence, when you fill your prescription here in the states you are subsidizing the rest of the world to receive extremely cheap drugs. The U.K. and Japan thank you for their cheap prescriptions. Make sure to tell them "You're welcome" next time you visit there.


Costs for care have ballooned due to numerous things:

Obamacare regulations forcing insurance companies to cover individuals with preexisting conditions (good or bad, not for me to say). Inevitably they HAVE to insure and cover someone who has extremely expensive health issues immediately. Thus driving UP the cost for everyone else who is healthy.

Emergency rooms being utilized for primary care services because people aren't turned away there (anyone who says we don't have universal healthcare is retarded, this is how it works in the USA). Those people rarely ever pay anything of their bill. I spoke with a couple billing managers at a hospital and they said it was less than 4% pay their ER bill. Guess what that Hospital does? They pass along the cost to the people WITH insurance, then write off the losses on their taxes. Win-win.

Wellfare programs like Medicaid don't help. While they do have their own funding mechanism, it is an overall drain on the state economy, and if you pay taxes, you are paying for their care. More and more people are on Medicaid. Especially during COVID when the feds removed the yearly qualification requirements (they have since been re-imposed).

Doctors forced to carry extreme liability insurance policies because there are no caps to medical malpractice lawsuits. (Whether you believe DR's should be able to be sued or not is irrelevant, it IS causing your healthcare premiums and copays/coinsurance to go up). There is an argument that there should be caps in place to how much someone can sue Dr's and Hospitals for (Yeah yeah I know, but what if they accidentally fuck YOU up?!?! You want to sue them for everything they're worth! Yeah well that is costing EVERYONE money).

No real transparency in how billing works and why, to the end user. It is vital the end users can call somewhere and get the price the procedure or imaging costs, whether that is insured or cash pay. But it's not and damn near impossible to get an actual answer just calling. Prices should HAVE to be plainly and easily found online for every provider. It is masked in chaos and insane initial prices that eventually are reduced to make it look like someone is getting a good deal. Let me tell you, a good deal is not a new hip replacement that the bill said was originally $213,500, but because the surgery center was feeling "charitable" they only billed your insurance $186,250. No, that's fucking insane and a better price would be $11,000 all in. You aren't getting a deal. You're getting ripped off, royally. But for reasons stated above, the price is that high.

Companies taking the approach that incentive offers to hire good employees MUST include health insurance. This has fundamentally changed how insurance works in the USA, for the worse. If everyone was forced to shop for insurance on their own and shop around, we simply wouldn't have prices like we do, because consumers would demand a change. But because it's wrapped into an incentive package at your 40hour/week job you don't think much of it. It's just there and you don't care one shit to demand better coverage from the insurance company or industry reform from elected officials. You provide ZERO pressure to insurance companies to drive costs down. You are a useful tool to the insurance industrial complex. The same as you are to the pharmaceutical industrial complex ("yeah yeah but my employer healthcare coverage is excellent" - compared to what? Seriously, cold shit compared to steaming shit is still shit).

When we get government  health care, the next step is to declare a "healthcare" crisis due to gun violence, and a ban on guns.
Been warning about this for 30+ years.

You know how I know you don't know what you're talking about?


Dammit.   Liberal propaganda wins again.

You cannot be serious.
You think adding more bureaucrats and paperwork will make healthcare cheaper?

I have several bridges as well as ocean view properties for sale here in N Idaho that I think you'd be a buyer for.

^This guy gets it.

The most regulated industry (outside of nuclear energy) in our country is not operating in the free market. Not even on the same planet.

Mounjaro is on back order because fat asses are using it off label as a weightloss drug.