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This is why healthcare costs are so ridiculous
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<blockquote data-quote="susiestar" data-source="post: 367152" data-attributes="member: 1233"><p>The reason insurance companies pay more to get the same medications is because the people at the top get HUGE kickbacks from the pharmaceutical companies. It is not called a kickback, because those are illegal, but it is the same thing. MANY insurance companies are major, but hidden, shareholders in pharmaceutical companies, or the top execs/shareholders at the ins co are top execs or shareholders at the pharmaceutical companies. It is largely hidden under different company names, etc.... but when traced back it has been found to all be the same in many cases.</p><p></p><p>NONE of the ins cos and pharm cos are running things with the good of anything but the almighty dollar in mind. With many drugs, the profit from one year of their protected sale under the brand name, when no generics are permitted, can pay off the cost of research and development for that drug. Then they have many years of pure profit before they are eligible to become generic. There are some drugs that have taken more than 1 year to pay the costs, but I doubt any of them took the full amount of time they are protected. Once the timeline for brand name protection is about to run out the company can extend that pure profit timeline by finding an alternate use for the medication. If they can prove that a blood pressure medication can prevent migraines, for example, they get more years before it is available in generic. This happens even though the migraines are prevented because the medication lowers blood pressure, NOT because it does something else in the body. It is an economic disaster for those who need that specific medicine - many cannot pay for it. </p><p></p><p>husband was put on lexapro for some problems quite a few years ago. From the beginning I kept urging him to ask the doctor if there was a generic that was roughly the same. Of course there was. Lexapro came out because the older drug started being available in generic. The makers changed it a tiny bit saying it has radically fewer side effects and is more effective and sold it as lexapro. FINALLY, about two months ago I went with him to the doctor for his skin cancer removal and I asked the doctor to switch him. husband was truly shocked that we are saving about $40 a month by not using the insurance we pay through the nose for and by going to walmart to get the medication. He has since gone through ALL of his medications with the doctor to make sure he is on the cheapest version of all of them. He was esp surprised that the older medication seems to have fewer side effects than the lexapro.</p><p></p><p>I cannot wait until the kids are switched over to medicare. Or whatever the state kids insurance is. We have had a hard time getting it processed, having sent the forms in several times already. Finally we did them at the office in front of a worker. Should hear something this week. It will mean we have NO copays. The docs seem to like it because there are few limits on the medications they can rx, unlike private insurance with their formularies. Many medications contract with medicare because they can reach a huge market that otherwise they couldn't access. We figure we will save about $200-$300 per MONTH in copays for visits and medications because each kid has some medical issues. Heck, we will automatically get a new nebulizer for T because he is under age 16 and has asthma. They used to send one every year, now it is every 2 years. In the past I have tried to send them back because the old one still worked and they wouldn't take them. So I have passed at least three of them, with tubing, on to friends who have private insurance. It seems stupid to have more than one of them in the house. At least it does to me. He will get the neb and the medications in addition to the inhaler he uses. I do NOT understand it and often do not fill the neb medications more than once. It is handy to have them on hand for when he gets colds because it does work better than the inhaler. But it is not as convenient to use. </p><p></p><p>The specialist that Jess will see in Texas even takes our state's medicare. I was happily surprised. They told me they have less hassle getting paid by medicare than getting paid by our private insurance, and that medicare covers more!! I was shocked.</p><p></p><p>I think that the entire insurance industry/healthcare industry needs to be revamped into a system that is less profit based. Not sure how to do that though. </p><p></p><p>When I run the world it will be different. LOL.</p></blockquote><p></p>
[QUOTE="susiestar, post: 367152, member: 1233"] The reason insurance companies pay more to get the same medications is because the people at the top get HUGE kickbacks from the pharmaceutical companies. It is not called a kickback, because those are illegal, but it is the same thing. MANY insurance companies are major, but hidden, shareholders in pharmaceutical companies, or the top execs/shareholders at the ins co are top execs or shareholders at the pharmaceutical companies. It is largely hidden under different company names, etc.... but when traced back it has been found to all be the same in many cases. NONE of the ins cos and pharm cos are running things with the good of anything but the almighty dollar in mind. With many drugs, the profit from one year of their protected sale under the brand name, when no generics are permitted, can pay off the cost of research and development for that drug. Then they have many years of pure profit before they are eligible to become generic. There are some drugs that have taken more than 1 year to pay the costs, but I doubt any of them took the full amount of time they are protected. Once the timeline for brand name protection is about to run out the company can extend that pure profit timeline by finding an alternate use for the medication. If they can prove that a blood pressure medication can prevent migraines, for example, they get more years before it is available in generic. This happens even though the migraines are prevented because the medication lowers blood pressure, NOT because it does something else in the body. It is an economic disaster for those who need that specific medicine - many cannot pay for it. husband was put on lexapro for some problems quite a few years ago. From the beginning I kept urging him to ask the doctor if there was a generic that was roughly the same. Of course there was. Lexapro came out because the older drug started being available in generic. The makers changed it a tiny bit saying it has radically fewer side effects and is more effective and sold it as lexapro. FINALLY, about two months ago I went with him to the doctor for his skin cancer removal and I asked the doctor to switch him. husband was truly shocked that we are saving about $40 a month by not using the insurance we pay through the nose for and by going to walmart to get the medication. He has since gone through ALL of his medications with the doctor to make sure he is on the cheapest version of all of them. He was esp surprised that the older medication seems to have fewer side effects than the lexapro. I cannot wait until the kids are switched over to medicare. Or whatever the state kids insurance is. We have had a hard time getting it processed, having sent the forms in several times already. Finally we did them at the office in front of a worker. Should hear something this week. It will mean we have NO copays. The docs seem to like it because there are few limits on the medications they can rx, unlike private insurance with their formularies. Many medications contract with medicare because they can reach a huge market that otherwise they couldn't access. We figure we will save about $200-$300 per MONTH in copays for visits and medications because each kid has some medical issues. Heck, we will automatically get a new nebulizer for T because he is under age 16 and has asthma. They used to send one every year, now it is every 2 years. In the past I have tried to send them back because the old one still worked and they wouldn't take them. So I have passed at least three of them, with tubing, on to friends who have private insurance. It seems stupid to have more than one of them in the house. At least it does to me. He will get the neb and the medications in addition to the inhaler he uses. I do NOT understand it and often do not fill the neb medications more than once. It is handy to have them on hand for when he gets colds because it does work better than the inhaler. But it is not as convenient to use. The specialist that Jess will see in Texas even takes our state's medicare. I was happily surprised. They told me they have less hassle getting paid by medicare than getting paid by our private insurance, and that medicare covers more!! I was shocked. I think that the entire insurance industry/healthcare industry needs to be revamped into a system that is less profit based. Not sure how to do that though. When I run the world it will be different. LOL. [/QUOTE]
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