I finally understand what "CVS Caremark" is-- (it's not CVS stores) basically it's a service used by a number of huge healthcare plans to manage approved drugs and secure prices. It has its own network of pharmacies that goes way beyond just CVS.
This is why no one at your health insurance knows anything about why X drug wasn't approved.
I thought it was CVS stalking me trying to get me to go there for years, but my charmingly dysfunctional pharmacy is a "caremark" pharmacy.
Anyone who says that "government health care would mean bureaucracy" hasn't dealt w/ CVS caremark-- then there is the way that my doctor calls my insurance by one name, my work uses another, the pharmacy yet another & the insurance itself uses none of those.
Doctor "Do you have Earl Fiefdom Plus?"
Pharmacy "Is this ABC NYC XYZ Insurance?"
Insurance Co. "Thank you for calling HealthClub Go, the RTFM Plan. Please hold. [abominable music][audio cracks] Thank you for ..."
Feel like its on purpose.
Oh I have a single card... and happily just one member number, but the thing on the card isn't the same as what anyone I talk to calls it.
I just start listing all the names at this point.
Earl Fiefdom Plus, ABC NYC XYZ, HealthClub Go, the RTFM Plan Caremark Affiliated TGIF OMG WFT BBQ
I'm still angry I had to learn what a "formulary" was. 😡
In theory they monitor the prices drug companies charge and add and remove and "reschedule" drugs to minimize costs.
COSTS.
See... a health insurance company, in theory, should also be concerned with ... health. Maybe spending more now saves later.
But with Americans having so little job security where is the incentive to take care of your members "for the future?"
So it's all about cost and trying to avoid bad publicity.
"Maybe spending more now saves later"
That only works if they have to pay for those later costs as well.
(you're giving me flashbacks to when the Netherlands privatized its health insurance decades ago, and my parents (GPs) got letters from insurance companies saying things like "we can learn a lot from the US!" - even as a teenager I already knew they meant how to make a profit at the expense of everything else)
@futurebird It's absolutely on purpose, since if things were easy to connect it would be easier to actually approve things, which means more expense to the companies.
I honestly don't understand how anyone who's ever dealt with large private companies can complain about government bureaucracy being somehow atypically horrible. It's often *typically* horrible, sure, but nobody does bureaucracy better and more extensively than the paying-out-money part of private companies.
@futurebird Oh god with the names..I have SEVEN cards for one insurance plan. There's the medical card and the dental card and the vision card...but then there's also the prescription card and the separate prescription *discount* card...and then during the pandemic they added a telehealth card, and now they've spun off a separate surgery card. These are all from the same company. All part of one plan. Why the fuck is it seven different things??
Meanwhile when I actually need service...I remember being extremely sick a few years back (well before COVID), couldn't even get out of bed...called the doctor and got told it was probably the flu and they could schedule me for a flu test. Then they tell me the next available appointment is in nine months.
People talk about "waiting in line for healthcare" in socialist systems while here in the US we get told to wait months FOR A DAMN FLU TEST!! The only damn things these companies can provide in a timely fashion is baffling piles of plastic trash!
That's how I ended up going to Urgent Care three times over 3 months for a bad asthma reaction. Finally got in to see a pulmonologist, and he fixed me up in a few weeks.
It was a miserable 3 months of a deep, racking cough. The Urgent Care physicians assistants were prescribing steroid doses that didn't taper, and one prescribed an inhaler that wasn't suitable.
No criticism of the PAs -- they aren't specialists. I should have been able to get in to see a pulmonolgist!
@admin
Meanwhile, when my ex had breast cancer in 2018, her diagnosis was confirmed one week after her mammogram, and she had surgery one month later. She had home care visits for two weeks after that, and the pathology report on the mass came back three weeks later. The only treatment she required (Tamoxifen) was provided at the same appointment as the pathology results.
In just over two months she went from discovering she had cancer to being cancer-free.
During that period, we went to about half a dozen appointments totaling around eight hours, not including the day in hospital for her surgery.
Our out-of-pocket expenses came up to $9 for hospital parking and $20 because we ate lunch there once.
This is the scary Canadian socialist medical system.
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