Posted on 02/08/2020 12:32:30 PM PST by karpov
According to a PBS health report about a retiree on a Medicare Advantage plan, Z. Ming Ma was issued a prescription from her physician that cost $285 for a 90-day supply. “A month later,” the article says, “Ma and his wife were about to leave on another trip, and Ma needed to stock up on her medication.”
But her 90 days weren’t up, so Anthem wouldn’t cover it. “Ma asked the pharmacist how much it would cost if she got the prescription there and paid out of pocket,” the article says.
The total cash price was about $40.
This is not uncommon. In fact, a study from USC demonstrated that nearly 25 percent of all prescriptions filled at the pharmacy cost the insurer less than what the patient paid in a copay. Yes, that means paying cash is more affordable than using your insurance card.
Over the past several decades in the United States, the health care industry has become increasingly dominated by third-party payers. An individual’s health coverage, whether it is private, Medicare, or Medicaid, can significantly influence health care decision-making — through deciding what it will, and will not, cover.
A health plan can determine which medical professional is seen, which prescription drugs are filled, and even whether a procedure can be done.
Because it increased the power of third-party payers, the Affordable Care Act was essentially a benefit to special interest groups such as insurance companies and other middlemen. The United States health care system hasn’t always been dominated by third-parties but has become distorted from many years of government regulations.
The policy makers forgot about the patients and the medical professionals who provide the care.
The response from both groups has been entirely predictable — and rational.
(Excerpt) Read more at thehill.com ...
So what cost you about $20 for a ninety day supply will cost you $150 the next time you go in. So you will need to have the prescription to a new pharmacy with a cheaper price. But you can only do that once.
Also if you have to take a name brand then the cost will be stratospheric. You can get name brand from Canada for a bit cheaper but it will still be high.
Because insurance doesn’t care what the price is. They just pay it and raise premiums to cover it. The “evil insurance companies” are a myth. It’s the medical providers that are gaming the system, big time.
My high blood pressure pills are free.
Because they are generic.
Maybe the person should ask for generic.
“Self Insurance is the way to go”
Co-insurance schemes are probably the best way to go.
Having a company and a patient both having to pay their defined shares makes both winners.
The current situation is unacceptable. It’s unfair. Making the insurance company pay raises the premiums. There cannot be two prices for the same item.
The NHS might be paying about the equivalent of $9 for an inhaler.
EU approved medications still approved in the EU should be available in the USA one year after EU approval.
I get injectable testosterone. My cash price is less than the insurance copay.
Insurers like high prices because high prices force people to buy insurance.
There’s the cost of the medicine and the cost to stuff it in bottles.
One dollar for the drug company and $3 for CVS makes for $4.
AND health care providers up and down the line take full advantage of the above fact... as would most of us if we were in that position.(the curse of 'human nature'...and why incentives matter)
When democrats talk about health care reform all they're talking about is 'who gets stuck paying the bill'... they don't care about toxic incentives, quality of care, what their system does to the doctor/patient relationship or why 'who pays' matters to the quality of healthcare. Nope, in their minds it's all the same.
It's not.
Compare statistics on doctor/patient relations, quality of care, and job satisfaction between plastic surgeons and doctors who work at the VA and you'll see where toxic incentives create nightmares. Costly nightmares and poor quality care.
I remember when an office visit was $4 and .16 sales tax. People could also make payments or provide services and goods.
In 1977 I was in the south and my son was sick on a Sunday. My SIL took me to an old country doctor who had Sunday hours. Growing up in the west, I never saw segregation and was shocked to see a Black waiting room and a white waiting room in 1977!! I asked my SIL what was up and why they let him get away with the segregated rooms and she said that people only paid what they could afford and took chickens and fresh garden produce as pay and had Sunday hours for working people. He knew most of them by name and all their families and just accepted that the doctor never changed things.
My wife uses GoodRX and is amazing how cheap she can buy prescriptions.
This article articulates something a family member who is medical practice consultant told me years ago. His daily job is trying to get around this bureaucratic corporate tyrany over doctor and patient.
Scream, yell and complain. These people are killing us and robbing us on the way to the grave.
Anthem probably paid less than $40 for the prescription.
Sometimes, you can’t even pay cash.
I pay $400+ per month in insurance premiums. I was just told by my concierge physicians group to get lost, because the no longer accept my insurance.
I tell the physicians group, fine I’ll pay cash. Their initial response “we cannot take cash, your state will not allow us to accept cash payment for services.”
After arguing, they come back and tell me they’ll take cash, but... since they no longer take my insurance, they can no longer refer me to the local hospital that accepts my insurance, they they are not longer part of that plan.
There’s no concept of grandfathering. You would think there would be a way for a (now independent) medical group to do a simple referral to an in-plan hospital.
end of rant
Mine are like $8 for 90 days with the app
Let me add to this... before gov got involved.. before insurance became part of the salary with the job... we had our own insurance.. it was called hospitalization insurance. It paid for hospitalization. We paid for our own dr visits.. which were ran from $5 to $12 a visit and when the pediatrician opened his new office, the visit was $25. We paid for own medicine either given by the dr or a prescription.. which ran from $5 to $10 usually. When pregnant, we paid the dr each visit and that part was paid by the time the baby was born and the hospitalization insurance paid for that.
Our salary then, was not near what it is now, but the prices have gone through the roof. To get a price quote from a hospital is almost impossible. I had a tooth pulled a year ago by an oral surgeon and the price WITH dental coverage, was over $2,000!
Some years ago when we had insurance with the job, I had 2 surgeries within 2 years for the same type... the first was $700 and the second was $700 again if the insurance paid... if the insurance did not pay, it was zero to me.
This is just letting you young folks know how much it’s gone UP with gov in charge. or insurance companies in charge..
Another good place to check is scripthero.com. They seem to work in conjunction with some of the drug companies and their savings plans. Simple to check to see if they cover your drug. If you are on medicare you can use it for a particular drug in place of medicare.
Well duh!
People need to understand the basic concept— you get what you pay for.
When you pay cash directly you’re eliminating layers of insurance middlemen & government bureaucrat parasites. Thats why IT’S CHEAPER!
Excellent service, I use their website. Maintenance Rx list $485, $14 or so with their coupon. Clearly regular economic rules are NOT in play here.
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