Health Insurance Rates

[bobpbx]

I take Toprol xl, a brand name drug. I tried the generic, but it did not work the same. So, I pay $106 out of pocket for my 90 day supply. Now, my insurance company is adding some real stringent conditions on using brand name drugs in 2018:

"If your brand name prescription has a generic equivalent, you'll pay more if you choose to use the brand name drug. You'll pay the brand name cost share plus the difference between the cost of the brand name and the generic drug".

In other words, unless your doctor specifies the brand name, we are going to tax you to your knees until you give in and use generic. Luckily, my doctor specifies brand name, but it won't be long before they twist his arm too. Of course, his small practice was bought by a big health care conglomerate (Barnabas), so now there is likely to be some arm-twisting from corporate after lobbying by the insurer.

 

[Teegate]

I have taken a maintenance drug for 35 years and my doctor was always getting letters from the insurance company telling him to start using generic for me. He would always check "No Substitution" because he swore the patented capsule released the drug more efficiently. Then one day my drugs came in the mail and they were generic. I notified my doctor and he responded saying I would be fine with generic. That was that. I guess he finally was tired of fighting. And I have been fine so it must have not mattered anyway.

 

[Teegate]

Ben,

Jessica was recently at the emergency room and for 3 hours it was $6000. She has insurance with a high co-pay and because the hospital agreed to accept what the insurance company would pay the bill was only $1300. Unfortunately, she has to pay that and the insurance company is not paying anything. All they did was get the bill lowered and Jessica must pay it.

 

[46er]

I tried the generic, but it did not work the same.

There were a number of recalls for metoprolol succinate, the generic for Toporol XL; some from large companies as there are quite a few making the generic. Your pharmacist and doctor should have been made aware of all of them. We usually choose the generic when they are available, it depends on the company manufacturing it. Only take the name brand if from the company I retired from as it is no cost. There is a database of recalls that can be searched. Before I have a new prescription filled I research the heck out of it, especially side effects. A glaring example of cost differences is in Alzheimers meds; there are 2 drugs commonly used that cost roughly $16/30 days. There is also a once a day capsule, which contains those same 2 drugs, that costs $408/30 days. Convenience can be expensive. A drug stays on patent to the developing company for 20 years from submission of the patent. The FDA does very little to ensure the efficacy of a generic, that is left mostly to the manufacturer, so choose wisely.

https://www.recallguide.org/drug/metoprolol-succinate/

If you get a big bill from a healthcare provider, always call, they almost always will negotiate the amount and/or offer payment plans.

 

[bobpbx]

Then one day my drugs came in the mail and they were generic. I notified my doctor and he responded saying I would be fine with generic. That was that. I guess he finally was tired of fighting. And I have been fine so it must have not mattered anyway.

When mine did not work the same, I sent one to the company making the brand and they said they could find no issue. Three years later the generic company was found to have been making them wrong.

https://www.peoplespharmacy.com/201...eals-serious-flaws-with-fdas-generic-process/

https://www.peoplespharmacy.com/201...ecall-reveals-the-dark-side-of-generic-drugs/

 

[this_is_nascar]

Yep, it's out if control. The providers charging the insurance companies 10x what something should cost, because they know the insurance companies will only pay them a fraction of what they're asking for.

Just within the last 9-months, I've had a cervical spine fusion, as well as a lumber spine fusion. Good news, bad news. I met my maximum out of pocket expenses after the first procedure.

 

[bobpbx]

There are a lot of hidden costs too. I now get medical statements with 4 additional pages at the end. It is simply a statement that if you need an interpreter to understand the bill, one will be provided free of charge. It is in 36 different languages. Imagine the printing bill, in addition to the interpreter costs.

Madness.

 

[46er]

There are a lot of hidden costs too. I now get medical statements with 4 additional pages at the end. It is simply a statement that if you need an interpreter to understand the bill, one will be provided free of charge. It is in 36 different languages. Imagine the printing bill, in addition to the interpreter costs.

Madness.

Yep, mandated by the goobermint, not for anything medical, but for civil rights complaints.