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I was just thinking about all the drugs that are so popular, even if they have little or no proven benefit. I wondered why the insurance companies are so happy to pay for them. They won't pay for natural supplements -- but drugs, however expensive, are just fine.
So I thought maybe the drug companies pay the insurance companies to cover the drugs. And I looked it up in Google and what do you know -- drugs companies give big rebates to the insurance companies for covering their drugs.
I'm not sure this is true. If I'm sick my doctor prescribes what I need.
I'm not sure this is true. If I'm sick my doctor prescribes what I need.
Mine too. Heck, my RA doc advised me NOT to take the new meds until they had a more proven track record. With him, I told him what meds (he encouraged this) I wanted to try for RA and FM. Some he said no and told me why, others he felt were a good choice.
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Location: Finally the house is done and we are in Port St. Lucie!
3,487 posts, read 3,336,915 times
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Aetna won't cover the name brand of a certain cholesterol med. Hubby had to go with one that the insurance company would cover.
Yes, we've had instances where the doctor's office knew what meds are covered by what insurance.
If you think your doctor is prescribing what he feels you need, you might want to rethink that. Before you even see a new doctor, you always give them the name of your insurance carrier. This helps them determine what meds that ins will cover.
This came to light when we saw the same doctor but our insurance switched. The company hubby works for always shops insurance every damn year. One med was ok to prescribe with BC&BS (covered the whole prescription) but Aetna wouldn't let the doc prescribe it without a huge out of pocket for us. They would cover a different one.
After reading these links, it now makes more sense.
I really despise the greed in the pharmaceutical and the insurance companies.
It's all about business and profit. It no longer is about getting people well. To no longer need medications.
I was just thinking about all the drugs that are so popular, even if they have little or no proven benefit. I wondered why the insurance companies are so happy to pay for them. They won't pay for natural supplements -- but drugs, however expensive, are just fine.
So I thought maybe the drug companies pay the insurance companies to cover the drugs. And I looked it up in Google and what do you know -- drugs companies give big rebates to the insurance companies for covering their drugs.
Yeah, because everything posted on the Internet is true
Location: Finally the house is done and we are in Port St. Lucie!
3,487 posts, read 3,336,915 times
Reputation: 9913
And to be clear: I think doctors hands are really tied. They so want to help us in the best possible way but when insurance companies only let them do so much.....
I do not blame the doctors, I lay the blame exactly where it should be placed.
“We regret that our programs did not keep pace with the evolving health-care system, and, as a result, some patients are facing out-of-pocket costs that were never intended, potentially leading to stress upon them and their families,” Mylan said in a letter last month to Congress, which objected to the $600 price for two EpiPens.
My DOCTOR prescribes medicine and my insurance covers it - none of the rebates influence what my doctor chooses (he would probably have no knowledge of the rebates as it is given to the insurance company). I don't think I have EVER had insurance NOT approve the doctor's recommendation.
Also, please note, a lot of the rebate amounts ARE going back to the patients, just not in some situations which makes a greater hardship on some families.
You have a better healthcare plan than many do. I am disabled and have been consigned to the innermost circle of hell which is called medicaid. Medicaid insurers have all sorts of whimsical rules about which medications they will and will not cover, and my primary care doctor is very well aware of them since it's pointless to prescribe medications that his patients can't obtain because they can't afford to pay out of pocket. For example, if you have a severe cold with a bad cough that keeps you awake at night, medicaid won't cover the cost of a prescription for cough syrup with codeine. Instead, my doctor is forced to prescribe tylenol #3 tabs for patients who are hacking up their lungs in colds and flu season. Also, any number of medication require "pre-authorization" which means that the doctor not only has to write you the prescription, his office must also call up the insurance company and tell them that yes, he really means it and wants you to take that medication. My doctor is aware of those potential pitfalls, as well.
Your doctor would be highly unusual if he refuses appointments with reps from big pharma who are happy to spring for lunch and numerous free samples and glossy info sheets on the latest and greatest snake oil that the pharmaceutical industry is creating an artificial demand for at the moment. Those free samples make it very easy for a doc to prescribe the medication and hand you a temporary 30 day supply, but after that your insurance may or may not cover it. It's a jungle out here in America's heartland. Count your lucky stars that you have decent health insurance, but don't assume that the rest of us do.
If an insurance company gets a rebate that means that it has in essence negotiated a discount on the cost of the drug. It does the same thing with doctor fees and hospital charges. However, the insurance company should pass the discount on to the patient by keeping the copayment down for the medication. Sometimes simply using the insurance company's mail in pharmacy will result in much lower out of pocket cost. Deductibles are a different issue and are now out of control and unsustainable. However, many employers do offer a choice of plans with different premiums and deductibles. The lady with the diabetic daughter needs to lobby the employer to offer a plan with better drug coverage.
Often when a company prefers one drug in a class over another the preferred drug will work just as well. If a trial on it is unsatisfactory, the prescribing doctor can ask for approval of a different one.
Anyone paying out of pocket for a medication should shop for the best price, too, as cost can vary tremendously from pharmacy to pharmacy. GoodRx is a good source to do comparisons.
I was just thinking about all the drugs that are so popular, even if they have little or no proven benefit. I wondered why the insurance companies are so happy to pay for them. They won't pay for natural supplements -- but drugs, however expensive, are just fine.
So I thought maybe the drug companies pay the insurance companies to cover the drugs. And I looked it up in Google and what do you know -- drugs companies give big rebates to the insurance companies for covering their drugs.
The do not cover "natural supplements" because "natural supplements" do not have to be shown to be effective. Prescription drugs do, despite your assertion otherwise.
After reading the latest comments and hearing others' stories and how they see thru it all with this Industry, I'm so grateful that I went the alternative route over 25 yrs and continue. I've had my share of side effects and hospital ER's due to medications but I'm happy to pay my $150 or so every 60-90 days for my alternatives. I pay for no prescription D insurance as my few meds are mostly older class and so affordable.
One has to figure it out for themselves IF they are willing to do the work for themselves. I feel there are remedies for just about every health condition out there...I deal with advancing OA but work with remedies to keep myself as comfortable as possible without the harsh drugs causing more complications.
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