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Is there any true rationale to medication pricing??? Login/Join 
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Picture of Black92LX
posted
Long story short 88 year old grandpa has dementia recent stint in the hospital and rehab facility he was prescribed oxicodone for some back pain.
The oxicodone seemed to exacerbate the dementia substantially.
Granny talked with the doctor and pulled him from the oxicodone and prescribed Duexis Tabs 800/26.6
My undertsnding is that this is 800mg of Ibuprufen and 26.6mg of famotidine.
I know that both of these things are available OTC. So granny goes to fill the prescription and she is told that the insurance will not cover it yet as the oxicodone was just prescribed and they won't cover both.
Granny says no big deal we'll pay for a 30 day supply till the insurance covers it. The pharmacist says no problem that will be $1,400 for the prescribed pills or you can walk out there to the shelf and grab both and will cost about $20 for the 30 days.
Fast forward 30 days insurance is covering the new pills and a 30 day supply is $3.00!!!!!!!

Seriously $1,400 from the pharmacy, $20 off the shelf, $3.00 for the prescribed from the pharmacy once the insurance covers it.

How are these numbers even generated???


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Posts: 25756 | Registered: September 06, 2003Reply With QuoteReport This Post
safe & sound
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They have to simply pull them out of their ass. There is no other rational explanation. It is also my biggest complaint with “healthcare”. There is no “price”

I’m taking a name brand medication that cost me a $50 copay. Switching to the generic would cost me $500.


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Posts: 15918 | Location: St. Charles, MO, USA | Registered: September 22, 2003Reply With QuoteReport This Post
It's not easy being me
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I could talk for days on this subject.

But, to simplify, no to a rationale, yes to deepocean's graphic.


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Posts: 2769 | Location: Middle TN | Registered: March 22, 2009Reply With QuoteReport This Post
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quote:
Originally posted by a1abdj:
They have to simply pull them out of their ass. There is no other rational explanation. It is also my biggest complaint with “healthcare”. There is no “price”

I’m taking a name brand medication that cost me a $50 copay. Switching to the generic would cost me $500.


Is it being ran through insurance? Sounds like it’s one of the new(er) programs insurance companies such as Express Scripts have out there. They get a rebate from the brand name manufacturer and it ends up being cheaper than generic.
 
Posts: 2176 | Location: St. Louis | Registered: January 28, 2006Reply With QuoteReport This Post
Cut and plug
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My daughter takes naproxen for arthritis. When she was first was prescribed it, it was a script for a liquid form as she has a hard time swallowing pills. It was $565 a month with insurance, non liquid is about $7 a month. So she learned how to swallow pills pretty quick.
 
Posts: 1148 | Location: DFW | Registered: January 12, 2009Reply With QuoteReport This Post
It's not you,
it's me.
Picture of RAMIUS
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Bwahahah! I use to be a drug rep for Duexis!

I can tell you everything.
 
Posts: 7016 | Location: Right outside Philly | Registered: September 08, 2005Reply With QuoteReport This Post
I believe in the
principle of
Due Process
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Like everything else, goods and services, infected by the government..... get the most feathers from the geese with the least hissing.




Luckily, I have enough willpower to control the driving ambition that rages within me.

When you had the votes, we did things your way. Now, we have the votes and you will be doing things our way. This lesson in political reality from Lyndon B. Johnson

"Some things are apparent. Where government moves in, community retreats, civil society disintegrates and our ability to control our own destiny atrophies. The result is: families under siege; war in the streets; unapologetic expropriation of property; the precipitous decline of the rule of law; the rapid rise of corruption; the loss of civility and the triumph of deceit. The result is a debased, debauched culture which finds moral depravity entertaining and virtue contemptible." - Justice Janice Rogers Brown
 
Posts: 48369 | Location: Texas hill country | Registered: July 04, 2005Reply With QuoteReport This Post
It's not you,
it's me.
Picture of RAMIUS
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As I said, I repped Duexis...we all know how much they were raping insurance companies for that stuff.

My bread and butter were doctors that wrote this stuff like it was nothing...$3000 per month for the rest of your life.
 
Posts: 7016 | Location: Right outside Philly | Registered: September 08, 2005Reply With QuoteReport This Post
It's not you,
it's me.
Picture of RAMIUS
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Oh, and the pricing is based on nothing more than greed.
 
Posts: 7016 | Location: Right outside Philly | Registered: September 08, 2005Reply With QuoteReport This Post
Peripheral Visionary
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Doctors who write for products like Duexis should be ashamed of themselves.




 
Posts: 11424 | Location: Texas | Registered: January 29, 2003Reply With QuoteReport This Post
It's not easy being me
posted Hide Post
quote:
Originally posted by craglawnmanor:
I could talk for days on this subject.

But, to simplify, no to a rationale, yes to deepocean's graphic.



Wait, what happened to deepocean?? Why didn't I quote his post?? The drug companies are more powerful than I even imagined!! Eek Eek


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Flammable, Inflammable, or Nonflammable.......
Hell, either it Flams or it doesn't!! (George Carlin)
 
Posts: 2769 | Location: Middle TN | Registered: March 22, 2009Reply With QuoteReport This Post
His Royal Hiney
Picture of Rey HRH
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It's based on the rationale that drugs at retail prices can only be afforded by the very rich who are self-insured and to drive everyone else to pay for insurance so that the insurance companies can get their cut.



"It did not really matter what we expected from life, but rather what life expected from us. We needed to stop asking about the meaning of life, and instead to think of ourselves as those who were being questioned by life – daily and hourly. Our answer must consist not in talk and meditation, but in right action and in right conduct. Life ultimately means taking the responsibility to find the right answer to its problems and to fulfill the tasks which it constantly sets for each individual." Viktor Frankl, Man's Search for Meaning, 1946.
 
Posts: 20180 | Location: The Free State of Arizona - Ditat Deus | Registered: March 24, 2011Reply With QuoteReport This Post
Stop Talking, Start Doing
posted Hide Post
quote:
Originally posted by craglawnmanor:
quote:
Originally posted by craglawnmanor:
I could talk for days on this subject.

But, to simplify, no to a rationale, yes to deepocean's graphic.



Wait, what happened to deepocean?? Why didn't I quote his post?? The drug companies are more powerful than I even imagined!! Eek Eek


I was wondering about that!


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Posts: 5088 | Location: The (R)ight side of Washington State | Registered: August 31, 2011Reply With QuoteReport This Post
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Based on my experience, there is a time honored and proven rationale:
Greed.


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Upper Peninsula: 4 Miles
 
Posts: 16468 | Location: Marquette MI | Registered: July 08, 2014Reply With QuoteReport This Post
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I pay for my drugs so it's Goodrx every time I refill. I go to 3 retailers because of significant differences on prices for different drugs.


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Posts: 5742 | Location: Ohio | Registered: December 27, 2008Reply With QuoteReport This Post
It's not you,
it's me.
Picture of RAMIUS
posted Hide Post
quote:
Originally posted by Rey HRH:
It's based on the rationale that drugs at retail prices can only be afforded by the very rich who are self-insured and to drive everyone else to pay for insurance so that the insurance companies can get their cut.


Not this drug. It’s just based on raping your insurance company.
 
Posts: 7016 | Location: Right outside Philly | Registered: September 08, 2005Reply With QuoteReport This Post
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It's very strange. I had a chat with my diabetes doctor over a drug called Byetta. It's been costing me 428 bucks a month, that's the co-pay. I asked if there was another drug that was cheaper, and listed the drugs on the formulary of my insurance company. She selected one, and I called the pharmacy. It's 175 a month instead of 428-and 13 less injections a week. But, for the first 2 years, they'll give 150 a month. So it's now 25 bucks a month instead of 428. And Prilosec, prescription strength, is hugely expensive. Generic is 3 bucks a month.
 
Posts: 17294 | Location: Lexington, KY | Registered: October 15, 2006Reply With QuoteReport This Post
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No rationale at all. Pure greed.

Another example is Diclegis. Used for pregnancy induced nausea.
Combo drug using two very old over the counter meds. Costs the pharmacy hundreds just to stock it. We keep the otc parts and just tell the sticker shocked moms what and how to use them.

The middle men and paper shufflers are the problem.
Pricing makes no sense. Brand companies cut deal with insurance companies to carry the brand as the preferred Med on a formulary. It still costs a small fortune but your copay is low. Patients never see the true cost just the low copay.

Drug company makes money.
Insurance company keeps rates high.
Pharmacists hear all the complaints.


GW.
 
Posts: 642 | Location: Auburn, AL | Registered: August 24, 2012Reply With QuoteReport This Post
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The “most important factor” that drives prescription drug prices higher in the United States than anywhere else in the world is the existence of government-protected “monopoly” rights for drug manufacturers. Drug manufacturers in the U.S. set their own prices, and that’s not the norm elsewhere in the world. Countries with national health programs have government entities that either negotiate drug prices or decide not to cover drugs whose prices they deem excessive. No similar negotiating happens in the U.S.


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Posts: 13868 | Location: VIrtual | Registered: November 13, 2009Reply With QuoteReport This Post
It's not you,
it's me.
Picture of RAMIUS
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Ok, here's the deal with this drug. As I said before, I was a rep for Horizon Pharma (schmoozing doctors and flirting with nurses) and sold Duexis/Vimovo/Pennsaid 2%.

Duexis is for the treatment of Osteo Arthritis and Rheumatoid Arthritis and Ankylosing Spondylosis.

Duexis is 800mg of pharmaceutical grade ibuprofen and 26.6mg of famotidine. The ibuprofen is anti-inflammatory/pain relief, the famotidine (Pepcid) is for gastro protection. This medication is to be taken 3 times per day.

The reason for the famotidine is for gastro-protection. If you're taking large amounts of ibuprofen to treat a chronic condition, you will eventually get a gastric bleed. By the time you realize you have a gastric bleed, it's usually pretty far along.

This is a fantastic product. It's actually the most commonly stolen item in offices, other than Viagra. Duexis actually works very well for what it's meant to do. It's also an amazing hangover cure!

Yes, the two components of Duexis are cheaply available at your local drug store. Probably about $20 for a month supply.

(My come back when the doctor would say this is that 1 pill is easier to take than two pills, then I'd pull out a study showing how people tend not to take that second pill after a while. While winking, I'd then ask the doctor if he'd be certain that his patients would always remember to take that all important second pill, on top of the 40 other pills they're already prescribed because "Doc, this is ultimately for patient safety...gastric bleeds are gross dude!" (I'd say it in a more professional manner).

After visiting the same doctor 3 times per week and saying the same thing (While plying the office with coffee and delicious pastries and tons of samples), maybe eventually he'd start prescribing my med, or get pissed off and tell me to never come back again. I'd still go back either way Smile

Yes, each pill costs about $30...you gotta take 3 per day usually for the rest of your life. The pricing is set by the company and is based on nothing more than them taking advantage of insurance companies to the tune of about $3,000 per month per patient prescribed.

To actually have your insurance pay for this, you need to be a special person. You have to have solid commercial insurance (no Medicaid, medicare, or Tricare). The most important part is that you have the doctor's office call it in to a SPECIALTY PHARMACY...they will handle your pissed off insurance company and mail you the medication within a day. CVS, Walgreens etc will charge you $3000 and tell you to not be an idiot while sending you to get famotidine and some ibu for $20.

The pricing for this medication is everything that's wrong with the pharmaceutical industry and I'm genuinely surprised that Horizon Pharma is still in business.

The docs who would prescribe it either didn't know about the pricing, didn't care, or prescribe in the genuine best interest of their patient, prices be damned (most common).
 
Posts: 7016 | Location: Right outside Philly | Registered: September 08, 2005Reply With QuoteReport This Post
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