Posted on 12/27/2011 3:05:12 PM PST by Nachum
Be prepared to bribe your doctor and local politicians to get your meds. :(
Haven't private insurance companies done this already?
The goal of the research, part of a little-known provision of President Barack Obama’s health care law, is to answer such basic questions as whether that new prescription drug advertised on TV really works better than an old generic costing much less.
The FDA has already spent BILLIONS of taxpayer dollars doing this exact same thing. They already have determined that generics work just as well.
I have an excellent, long-term relationship with my physician. I consider him a friend. Being self-employed for years, I’ve taken a different approach to my health care. My situation is unlikely to change all that much, if any. But for most people using a traditional hc delivery model and the likely, unholy future one if this OC thing plays out, I think it’s important to secure the future services of a good primary doctor that knows you (and vice versa) and your personal history. End runs will be the order of the day someday.
I am self employed and my business is barely hanging on as it is.”
We just returned to Texas from a two week trip to Colorado. I was amazed at the number of stores that are going out of business with a lot of empty spaces for lease. Was going to do some Christmas shopping after Christmas but there was little left. One owner said it was because they simply didn’t buy much Christmas merchandise because of the economy. Spent a morning in Santa Fe, New Mexico on the way back because I hadn’t been there for ten years. Talked with several shop owners in the town square who are folding up their tents on 12/31. Lots of people but no one is buying anything. Saw more people from India and Asia than ever before. Didn’t realize how much our population has changed. I am in the healthcare business and, like you, very frightened about the future.
And you can believe it or not, but, from this point in time forward, it is only going to get worse. As Limbaugh said, the Republican Party does not believe that we are in dire straits. It is worse than a crisis.
Bought our first persc. drug of the year............organic tier 2 was 18$ for 90 days.....NOW is tier 3..and will now cost 115.00.
Tier 3 is for name brand drugs............btw all other organic drugs like this are now tier 3............?
What Are Formulary Tiers?
Tiers are groups of drugs that fall within description and pricing groups:
Tier 1 or Tier I: Tier 1 drugs are usually limited to generic drugs, the lowest cost drugs. Sometimes other, regularly lower price branded drugs will fall into this tier, too. Tier I drugs cost us the lowest co-pays, usually $10 to $25.
Tier 2 or Tier II: Tier II is usually comprised of brand name drugs or more expensive generics. If you must take a brand name drug, your payer will have a list of branded drugs it prefers (because their cost is less, explained below.) These preferred brands are found in Tier 2. Tier II drugs cost us a middle-value co-pay, usually $15 to $50.
Tier 3: or Tier III: The more expensive brand name drugs, and usually the ones your insurance company doesn’t want you to get a prescription for (because their cost is higher, explained below) are also considered non-preferred. They are found in Tier 3. Tier III drugs will cost us even more than the lower tiers, usually $25 to $75 co-pay.
Tier 4 or Tier IV, also called specialty drugs: These are usually newly approved pharmaceutical drugs, and are so expensive that your payer wants to discourage prescriptions for the drug. Tier IV is a newer designation, first used in 2009.
A Tier IV designation seems to be a catch-all for expensive drugs. Rather than assign a specific dollar co-pay, payers will assign a percentage, like 60%. For example, a very expensive chemo drug, priced at $1,000 may cost the patient $600.
Why Are Drugs Listed in Tiers?
This is a one word answer: money.
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