Drugs.

"Full of the sound of the Gran Fury, signifying nothing." (granfury) 08/02/2019 at 09:49 • Filed to: None

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My oncologist wants to transition me from injected blood thinners to a tablet- form equivalent. I don’t have a problem with this as I’m getting rather tired of stabbing myself several times a day. But even though the pharmacy has the prescription they can’t fill it because the insurance carrier wants prior authorisation from the same doctor that prescribed the medication.

Apparently there is no generic equivalent for Xarelto, the drug they want to put me on. If there’s something else that is as effective and has a generic I wouldn’t care if they put me on that instead, but now I have to wait for the bureaucracy to do its thing and see what I’m going to get and what it’s going to cost. It shouldn't be over $25, but since I'm not working and my FSA is drained, I need to save every penny.

I’ve only had one negative side effect from a generic and it dro ve me absolutely b atty. It was for a medication to control my  epilepsy. Ringing sounds, like a phone or doorbell, would be perceived as being a few cents off; not a whole note off, just a fraction of a note. Apparently it was a known side effect and only affected about one tenth of one percent of the people that took the medication, usually those with perfect pitch. Being in an office with ringing sounds day in and day out I couldn’t handle the constant disagreement between what my brain said was normal and what I was hearing and asked to be placed back on the name brand drug even though it cost me considerably more per month.

facw > Full of the sound of the Gran Fury, signifying nothing. 08/02/2019 at 10:21

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My dad was on Xarelto after his pulmonary embolism, and it didn’t seem like there was a good generic option for him.

Check out their copay support program: https://www.xarelto-us.com/xarelto-cost , it should eat most of the copay cost provided you aren’t on Medicare/Medicaid. I’m on 4 brand name drugs and all have support programs which took my mon th ly costs from $75-$100 each to $0-$10 each. Unfortunately, I also have Express Scripts, which refuses to bill the support program (I could do the first two fills at retail, but after that I have to go through them) though Enbrel gave me a Mastercard to pay my copays, and Trintellix has a rebate program . On the plus side, I hit my out of pocket max pretty quickly paying Express Scripts full price.

Ash78, voting early and often > facw 08/02/2019 at 10:33

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I’m also on Express Scripts and generally like them OK, but I never know what something is going to cost until I’m standing at the pharmacy counter (unless I’ve done exhaustive research ahead).

Yesterday we very reluctantly got my son on his first ADHD drug before school starts. In my head, I was like “These have been around forever and have generics!”

Well, yes — like with my Ambien Rx, the regular version is a few bucks a month, but anything extended release is $50-$300 a month. It’s amazing how much more the extended release drugs are. But with kids, you don’t want them having to self-medicate in the middle of a school day. So....$60/month to start.

Another sad reality of modern healthcare: After my last doctor visit, once I realized how much Trintellix costs, I suddenly realized I wasn’t actually depressed. It’s all perspective. Yes, I’m kidding. Halfway.

Back to my son: In a perfect world, my wife could have sat down with our pediatrician yesterday and they would have had a list of drugs and a list of costs. She could have decided from there. This is exactly what all flavors of politicians had envisioned for healthcare today (both for Obamacare and High-Deductible plans) . Not reality.

The reality is that nobody has the visibility to truly shop around, especially not in the short term.

dumpsterfire! > Full of the sound of the Gran Fury, signifying nothing. 08/02/2019 at 10:36

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Without fail, whenever I prescribe Xarelto, I get a denial from the insurance, requiring a prior authorization. The benefit of no routine INR monitoring and dietary concerns of Warfarin/Coumadin is why they can charge what they do. And people get tired of Lovenox injections, as you are aware.  

facw > Ash78, voting early and often 08/02/2019 at 10:41

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It’s amazing how much more the extended release drugs are 

This is of course because of evergreening . Wait until your drug patent is about to expire, then patent an extended release version (which you probably could have done right from the start).

And yeah, that disconnect on what’s covered and how much it costs is a pain. I’ve definitely had to go back to doctors for different prescriptions because what they wrote wasn’t covered by my insurance. It would be much better if everything were integrated so that they could see what the costs would be when prescribing, and better still if we had (with either single-payer, or a more distributed system) something like the UK’s NICE which just outlined which drugs were cost effective, so that doctors could freely prescribe anything deemed ok and k now it would be covered.

Ash78, voting early and often > facw 08/02/2019 at 10:45

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Imagine a world where multiple drugs might work and the doctor could write a “conditional Rx” or something like that. Give me, say, 3 drugs and 3 dosages that I can take to the pharmacist. There we can discuss costs and coverage, rebates, and assistance plans, and make a decision from there. At that point I’m “locked in” to whatever we decided unless the doctor approves a change.

I see no ethical issues with this...makes sense to me. The one drug our doctor prescribed just HAPPENED to be the cheapest of the 4 alternatives, and by a huge margin. Why should I rely on dumb luck?

/rant over