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SmittynMo

(3,544 posts)

28. Medicare isnt the only one wanting to change the rules

Sat Feb 22, 2014, 11:55 AM

Feb 2014

My wife and I are not medicare age yet. She has a health care plan at work. Recently the following happened. I have been on a drug for acid reflux, prescribed by my doctor. It works perfect. Out of pocket costs to me were about $5.00. The insurance company recently rejected my script saying that it was available over the counter. It is not the same name and there is no guarantee that it will work. It now costs me 25.00, over the counter. If I continue to use the drug that works, and now since the insurance company will not cover it, it's 25.00 also. So the insurance company is now playing doctor, to save them money. So in an effort of the insurance company to control my prescribed meds, I get screwed.

As for Medicare, I am very concerned for both of us when we get there. I'm sure they'll play doctor again.

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Plan to Limit Some Drugs in Medicare Is Criticized [View all] anasv Feb 2014 OP

Sometimes truth is stranger than fiction pipoman Feb 2014 #1

Absolutely right. If the doctor wants to prescribe generic accupril, but THIS panel says no, you lostincalifornia Feb 2014 #2

Watch how this works... durablend Feb 2014 #10

Actually that is not the case. It looks like Democrats are uniting with repugs on this in Congress. lostincalifornia Feb 2014 #21

The screening guidelines Sgent Feb 2014 #25

Explain how mammograms and PSA cause "much harm". Enthusiast Feb 2014 #30

Keeping mind we are only talking about screening tests Sgent Feb 2014 #60

I believe the REAL reason for the arguments Enthusiast Feb 2014 #61

Cost is definitely an issue. The good news is most doctors are NOT following those recommendations, lostincalifornia Feb 2014 #69

I understand why you would think that, Enthusiast, but the concerns about the risks of mammos have DesertDiamond Feb 2014 #89

I'm not buying it. Enthusiast Feb 2014 #90

Many times when symptoms occur is too late, especially for PCa, and mamograms. The Mamogram study lostincalifornia Feb 2014 #68

I am sorry, most experts in the field of Prostate Cancer would disagree with you. What has changed lostincalifornia Feb 2014 #67

Read David Goroski on this Sgent Feb 2014 #70

No one makes a diagnosis on psa or dre alone, however if the velocity of the psa is lostincalifornia Feb 2014 #74

as far as i am concerned there is very little difference when it gets to the top. madrchsod Feb 2014 #4

And can there really be any medical rationale? Yo_Mama Feb 2014 #14

You are absolutely right. This is totally insane, and people are going to get hurt lostincalifornia Feb 2014 #23

There is no Medicare D plan that I have found that murielm99 Feb 2014 #41

Yes, they don't like the use of desicated thyroid drugs Yo_Mama Feb 2014 #83

follow the money.... madrchsod Feb 2014 #3

I 2nd that INdemo Feb 2014 #11

Yes, I see this sort of thing all the time. Yo_Mama Feb 2014 #15

Bingo jsr Feb 2014 #20

Exactly, follow the money trail, that's usually what happens with proposals like this, and RKP5637 Feb 2014 #53

The issue here is the same issue that was debated when Part D was established. Can the government okaawhatever Feb 2014 #71

Thanks. Part D was NOT an unqualified success, was reputed to be bankrupting Medicare, and many freshwest Feb 2014 #91

Never signed up for it HockeyMom Feb 2014 #95

madrchsod anasv Feb 2014 #106

bistolic(?) high blood pressure. madrchsod Feb 2014 #109

I read the whole article and now am not so sure OKNancy Feb 2014 #5

What do you see as the positive results for patients under this change? Bluenorthwest Feb 2014 #7

as I wrote I'm not sure OKNancy Feb 2014 #8

Oh, you shouldn't be confused. Yo_Mama Feb 2014 #17

Not true. Example. You have to hypertensive drugs, generic Lisinopril and generic Accurpril for lostincalifornia Feb 2014 #26

Yes, and they are talking about a very small price difference Yo_Mama Feb 2014 #84

I agree with your points of course. Maybe in the next few days we will see the accuracy of this, lostincalifornia Feb 2014 #86

Well, for schizophrenics RiverNoord Feb 2014 #6

"Incredibly stupid" Yo_Mama Feb 2014 #18

That is even more true for psychotropics where it is well known that one medicine to treat a lostincalifornia Feb 2014 #27

Preferred pharmacies already forced our last independent pharmacy to close starroute Feb 2014 #9

They'll survive fine - we have three CVS, two Walgreens and two Rite Aids... George II Feb 2014 #24

I hope RiteAid survives anasv Feb 2014 #31

My wife loves the pharmacist at our "local" Rite Aid... George II Feb 2014 #38

You have three CVS, two Walgreens and two Rite Aids within three miles of you? Enthusiast Feb 2014 #32

Actually there are FOUR CVS stores within that three mile radius (not driving miles)... George II Feb 2014 #36

Three Walgreens within three miles, ten within 8.9 miles George II Feb 2014 #39

10 Rite Aid stores within 10.45 miles! Happy? George II Feb 2014 #40

I found it to be unbelievable. Enthusiast Feb 2014 #42

No big deal, when I started counting them up I was amazed myself... George II Feb 2014 #43

Dunkin Donuts anasv Feb 2014 #94

Yeah, New Englanders drink coffee and eat donuts until they're sick.... George II Feb 2014 #99

Then you're in a city. JoeyT Feb 2014 #54

I'm about 10 miles south of Hartford George II Feb 2014 #57

The new thing is for insurers to insist you get your meds from the mail order guys; greiner3 Feb 2014 #73

Screw CVS. mimi85 Feb 2014 #76

people treating mental illness struggle every day... tomp Feb 2014 #12

What do other countries do? Oh, yeah, they don't have outrageously inflated drug prices valerief Feb 2014 #13

"an Obama administration proposal" OFFS!!!!! L0oniX Feb 2014 #16

Still think we voted for a Democrat? INdemo Feb 2014 #19

It is a stupid, penny wise pound foolish proposal. Call or write the President. Also, let your lostincalifornia Feb 2014 #29

"an Obama administration proposal." woo me with science Feb 2014 #22

Every. Single. Fucking. Day. Enthusiast Feb 2014 #33

Medicare isnt the only one wanting to change the rules SmittynMo Feb 2014 #28

Same deal here. Enthusiast Feb 2014 #34

I am looking for an "effective" acid reflux drug. Enthusiast Feb 2014 #35

Ranitidine SmittynMo Feb 2014 #48

Thanks. My wife will check out the Zantac. Enthusiast Feb 2014 #50

Ranitidine is the generic form Sgent Feb 2014 #72

Glad to know that. Enthusiast Feb 2014 #75

Milder case? SmittynMo Feb 2014 #81

But how could you know. Enthusiast Feb 2014 #88

I take generic Vicodin for chronic pain DJ13 Feb 2014 #55

SmittynMo anasv Feb 2014 #107

Truth is, we'll never get health care under control. Greed of providers, insurers, and unwillingness Hoyt Feb 2014 #37

The Obama Administration could change the rules. Enthusiast Feb 2014 #44

They are doing something for us, people just don't get it. Hoyt Feb 2014 #45

Mostly they are dedicated to protecting the profits of the pharmaceutical industry. Enthusiast Feb 2014 #46

Actually, it doesn't protect their profits, that is why drug companies are whining. Read article. Hoyt Feb 2014 #47

+10000 And just wait 'til Obama gets his TPP. woo me with science Feb 2014 #100

Hopefully we can prevent the damned TPP. Enthusiast Feb 2014 #102

They dont give a shit about "US". SmittynMo Feb 2014 #49

insurance companies should not be allowed to limit insured to their pharmacies. Sunlei Feb 2014 #51

Actually, they get better pricing and coordination of care. Saves you costs, keeps premiums down. Hoyt Feb 2014 #52

The insurance corps and the drug corps are price gouging American consumers for more profits. Sunlei Feb 2014 #56

+1 a shit load! Enthusiast Feb 2014 #58

If you go in hospital, the only way to avoid paying $800 for a $4 bag of fluid is to have insurance. Hoyt Feb 2014 #59

I know because Medicare is supposed to be nonprofit. All our healthcare *should* be non-profit. Sunlei Feb 2014 #62

Actually, that 20% covers marketing, administration, etc., nor just profits. Hoyt Feb 2014 #63

The bill was meant to limit the profits earned (by the insurance corps) to 20% of the revenues. Sunlei Feb 2014 #65

No, it was meant to limit non-medical care to 20%. That means administration, marketing, Hoyt Feb 2014 #79

CMS issues rule to empower it to negotiate drug prices, opponents immediately spin it as a negative. ProSense Feb 2014 #64

good points. Rs probably want to create cover over- President Os call to raise the minimum wage. Sunlei Feb 2014 #66

This isn't about negotiations of drug prices, it is suggesting a different drug of the same class. lostincalifornia Feb 2014 #77

PhRMA opposes the rule. From the NYT article: ProSense Feb 2014 #80

Something isn't synching right. I can only tell you my wife got a letter from Medicare a few days lostincalifornia Feb 2014 #85

This crud has become so twisted/distorted that people are now trusting BigPharm over Obama. Hoyt Feb 2014 #87

Well, we're supposed to be against Obama because the subliminals say so! n/t freshwest Feb 2014 #97

You hit it out of the park as usual. Thanks, ProSense. freshwest Feb 2014 #96

good guzman88 Feb 2014 #78

Live in low income Senior apartment building kickysnana Feb 2014 #82

I don't think that Medicare should meddle with a doctor's judgment JDPriestly Feb 2014 #92

I wish you the very best Enthusiast Feb 2014 #93

You can always pay for it yourself in that situation. Not sure what caused your situation, so maybe Hoyt Feb 2014 #98

It would be too late. JDPriestly Feb 2014 #101

That's what happens in the UK on the NHS dipsydoodle Feb 2014 #103

That's one of the reasons the NHS works there. Citizens there accept limitations that Hoyt Feb 2014 #104

The issue is some drugs which are really expensive. dipsydoodle Feb 2014 #105

WSJ, Front Page: Drugged as Children, Foster-Care Alumni Speak Out proverbialwisdom Feb 2014 #108