Rick Klau

today in US healthcare weirdness: a medication I last filled when I was still at Google had run out. I went to refill it, and was told by the pharmacist that my current insurance doesn't cover it, so it'll be $1800. Also, there's no generic.

Did some googling: found a coupon that lowers the cost to $800. Not great, but definitely better than $1800.

Then saw a link to the manufacturer's site. Through Walgreens and some independent pharmacies, I can get the prescription filled for $65.

Feb 15, 2023 at 9:06pmWeb
Show threadrickybrightFeb 15, 2023
@rklau Had one go from $9K/mo to free with a coupon. Totally normal behavior.
Show threadRick KlauFeb 15, 2023
@rickybright it's so absurd that this is how the system "works”
Show threadWilliam VambenepeFeb 15, 2023
@rklau @rickybright "absurd" is a kind way to put it. This is cruel, as it screws people who can't work the system.
Show threadNelson MinarFeb 15, 2023
@rklau I don't understand how anybody talks about US healthcare as if it had a functioning market
Show threadJoefrey Kibuule, MDFeb 15, 2023
@rklau But... but why?
Show threadRick KlauFeb 15, 2023
@jeffkibuule
Show threadRick KlauFeb 15, 2023
@jeffkibuule seriously though, no clue. None.
Show threadShe smashesFeb 15, 2023
@rklau it's just made up numbers all the way down
Show threadRick KlauFeb 15, 2023
@dbsmasher at this rate I'll find the coupon that results in me getting paid to take the meds
Show threadDarryl ShpakFeb 20, 2023
@rklau @dbsmasher I think that’s “participate in a drug trial”
Show threadFernFeb 16, 2023

@rklau I feel like I'm not alone when I say that seeing the words "healthcare" and "coupon" in the same sentence leaves me in a cold rage.

#MedicareForAll #M4A #HealthcareReform

Show threadClaire JamesonFeb 16, 2023
@fern @rklau Right?
Show threadEmber HeartshineFeb 23, 2023

@fern @rklau The fact that pharmaceutical mfgs can actually afford to charge pennies *if you jump through a bunch of hoops* but just.... choose not to if you don't know/don't have time to jump through them is fucking sickening. I was on #medicare briefly when I was younger and no private #healthinsurance has ever come close to being as comprehensive and easy to manage.

God I hate private health insurance.

Show threadAmy D Feb 16, 2023
@rklau Maybe this one has your prescription. https://costplusdrugs.com
Homepage of Mark Cuban Cost Plus Drugs

Mark Cuban Cost Plus Drug homepage. Provides safe, affordable medicine or medication with transparent low prices.

Show threadAyaFeb 16, 2023
@rklau American medical care is simply making up numbers on the spot and ppl have to pay because there is no protection against exploitation and racketeering
Show threadChris Nelder 🤘Feb 16, 2023
@rklau It's horrible and wrong. The other day I went to Walgreens to get a regular prescription filled. They said it would be $164. I knew that didn't sound right, so I left and went literally across the street and had the same prescription filled with the identical medication for $20. And that wasn't even with any coupon nonsense. Just Walgreens charging all sorts of junk fees. It's madness.
Show threadJeffy 🏳️‍⚧️🏳️‍🌈🇺🇦 ❤️🇱🇺Feb 16, 2023

@rklau But hey, don't forget the "good" billionaire Mark Cuban who's being a people's crusader and going up against all that. He's going to make just a little profit per script because "business”. All you have to do is transfer all your scripts to his mail-order company.

The prices/medications available on their formulary aren't appreciably different to inhouse Walgreens, CVS, etc. But they're mailorder-only who knows what privacy-skirting crap he might have in place?

Just another datapoint.

Show threadFerryoonsFeb 16, 2023
@rklau This is the craziness that the UK government and their US owners are intent on bringing here. @tompearce49
Show threadClaire JamesonFeb 16, 2023
@rklau It’s great that you have the know how and ability to navigate the system. Many don’t and are being fleeced.
Show threadDavid W. JonesFeb 17, 2023
@rklau If your insurer contracts with CVS as their pharmacy benefits manager, please be aware that CVS generally has the highest drug prices in the United States, and the worst customer service of any pharmacy benefits manager.
Show threadRick KlauFeb 17, 2023
@dancingtreefrog the whole PBM space confounds me. But this is (I think) slightly different. because my insurance doesn’t cover this medication, it’s $1800 at CVS. At the local pharmacy, they confirmed that my insurance excluded it, which meant it was $1800, but then applied the coupon, which meant my cost was $65.
Show threadDavid W. JonesFeb 17, 2023
@rklau Ah. Interesting. $65 is much better than $1800! Something to think about. I used to work in the medical insurance field. Most Americans get their insurance through their employers, and their employers work out what their selected medical and drug plans cover. So clearly CVS carried the drug but your insurance plan chose not to cover it. Perhaps something to push for with your employer!
Show threadDavid W. JonesFeb 17, 2023
@rklau PS My opinion of the PBM space is it exists solely to extract more profit from drugs. All the PBMs are for-profit operations, except one that Anthem and Humana launched: https://jrreport.wordandbrown.com/2021/07/27/anthem-humana-drop-nearly-140-million-to-launch-new-pbm/.
Something to think about.
Anthem, Humana Drop Nearly $140 Million To Launch New PBM

Anthem and Humana have invested nearly $140 million to form a new pharmacy benefit manager, as criticism over traditional PBMs’ operations kickstarts business at startups that promise transparency. The insurers will hold a minority stake in the new joint venture, named DomaniRx, which is being championed by SS&C Technologies. The Windsor, Conn.-based fintech company owns ...

Health Care News for Insurance Brokers | J&R Report
Show threadTanquistFeb 17, 2023
@rklau
I used to think this coupon and goodRx nonsense was just a way to tell congress there's no need to regulate prices. Now I know they do that and collect private healthcare information so they can sell it.
Show threadaburtchFeb 17, 2023
@rklau there’s two systems in this country, one for the rich and one for the poor.
Show threadRosemary McNaughtonFeb 20, 2023
@rklau I have a master’s degree in astrophysics and I find this all bewildering and frustrating. Also, having obtained said degree in Canada I know there’s a better way to live!
Show threadBagheeraAltered ​ Feb 20, 2023
@rklau that's quite the markup
Show threadedolnxFeb 20, 2023
@rklau I've dealt with this many times, and with generics! The generic of a drug I take was going to be $4k/mo, but the name brand was covered at $165/mo via UHC at my pharmacy. UHC refused to cover the generic.