from Anthem Blue Cross, dated 17-Jan-2013:
Dear SOPHIE,
We would like to follow up regarding the grievance referenced below. We appreciate your taking the time to express your concerns to us, since it is through such communication that we are able to continually improve the quality of service that is provided to our customers.
Please be assured that the issues you have brought to our attention have been reviewed and appropriately addressed.
Anthem Blue Cross (Anthem) received a grievance regarding the non-formulary status of the prescription drug Onfi. The grievance requests that we add the drug to the formulary, since it is a very expensive medication. You are now forced to go to Canada to purchase it at a reasonable price, and your doctor has included a letter of necessity.
I can understand your frustration with the classification of your prescription. Unfortunately, Anthem is unable to alter the terms of the plan for any one member. If you wish to take a medication that is non-formulary, you are certainly permitted to purchase this drug.
...
The Onfi prescription is expensive and there may be only a limited number of members who use this drug. Anthem regrets that at this time it will continue to be considered non-formulary.
...
[Blah, blah, blah]
Sincerely,
BRENDA H. SKALA
G&A Representative
Grievance and Appeals Department
Well, I guess my next step is to request that the drug be "reviewed for formulary consideration at the next quarterly meeting." I'd love to call up Ms. Skala and give her a piece of my mind, but why bother? She's probably not even a real person.
I've beaten the dead horse on this one, folks, over and over. Who the hell are these people? Why, why, why don't we have universal health coverage? Why does an insurance behemoth constantly come between us and our doctors? Why are the obscene profit margins of insurance companies not more roundly denounced? Why does a drug cost Sophie $63 a month in Canada and $990 in the United States? The same drug? Why? Could there possibly be millions of children in Canada who are on the drug and thereby the price is lowered due to demand? Why is Sophie not entitled to a medication that helps her at a reasonable price? Why do people object to entitlement when it benefits a seventeen year old disabled young woman who has grand mal seizures twice a day every single day of her life? Why?
this absolutely sucks.
ReplyDeleteHere's another "why". Why are drug companies allowed to charge such outrageous prices?
ReplyDeleteBest,
Bonnie
The drug costs less in Canada because the Canadian government sees through the bullshit and won't let the drug companies charge so much. They have decided to make up their margins (the drug company executives, I mean) by charging shitloads of money here in the states because they can get away with it. And then they use a lot of that money to pay their lobbyists to strongarm the politicians into letting them do more of the same. On and on ad nauseum.
ReplyDeleteAnd I know that "entitlement" is supposed to be a dirty word, but frankly, I think Sophie IS entitled to a medication that will help her control her seizures. And nobody but you and her doctor has any fucking right to determine that; not the insurance company, not the drug company and certainly not the government of the United States. So there!
I'm an American who lived in Ontario for 18 months and the best I could figure out about the drugs was that prescriptions weren't really covered by the province. My prescription coverage was through a supplemental insurance that my husband's employer provided. The co-pays were never very consistent either. Don't get me wrong, the system up there was tons better than here. But that is my best guess as to why they cost less up there. I wouldn't be surprised if the government subsidizes a good portion of the costs though.
ReplyDeleteThanks for your thoughts, Sarah. In speaking with the pharmacist in Canada, he assured me that IT'S THEIR POLICY to not make a profit on certain classes of drugs: those that are life-saving, those that are for chronic diseases and those that are for children. I'm not clear on whether that "non-profit" initiative is dictated by the government or the pharmacy itself, but he did tell me that the drug company charges $63.00 for the drug and the pharmacy charges that much to the consumer.
DeleteBecause the people that make the rules don't have to pay for their own coverage...most of them are covered by the most wonderful insurance program of all...the government. The congress, the senate and the big honchos in the white house and insurance companies ...they don't pay for their coverage and they get the BEST care. And I'm sorry to say this but from the president on down...they have absolutely NO idea how it is to live in the real world...they just have no idea!! Words are wonderful but... sorry..little rant of my own.
ReplyDeleteI'm not sure your charge is completely correct. I work for state government and turned down the health insurance coverage (that I would have paid for, dearly, out of my measly paycheck). Our family has an individual plan for which we pay obscene amounts, and Sophie has her own individual plan for which we pay obscene amounts. Problems still persist in the individual market because so many concessions were made to the for-profit insurance companies to get the Affordable Care Act passed. This all will change in 2014 when the health exchanges kick in, but until then, we're screwed.
DeleteElizabeth..I can't even imagine what you pay for insurance premiums...I'm sure obscene would be an understatement. I'm also pretty sure the state health care plan is a little different than what the "big boys and girls" get. They might pay a little for their own insurance but I would bet my life on it that they get a whole heck of a lot more for their buck than what I get for my $300 a month from Blue Cross...which is a $10,000 deductable..yes!!...before anything kicks in. I have about 2 more months paid up...after that I will probably let it go and take my chances..just the way it is.
DeleteI'm back because I wanted to keep up with this conversation. I agree with most of it except to say that congress, the president, the government does pay for their health care. We have that same health care and it is top notch but we pay for it. We always have a choice in open season but all of the companies do offer great coverage and the government does pay a share. That is one of the perks for government employees. I am absolutely for universal health care and would like it to be single payer.
ReplyDeleteBest,
Bonnie
Hi Bonnie...I am back also because I want to follow this conversation and read the comments. I too am absolutely for universal health care and also would like it to be single payer and I would like it to be free to everyone...Everyone deserves the same level of care. It would be so easy if they would just do that...and I hope I am wrong but what was passed as health care reform is only going to make it harder and harder for people that desparately need help...looking forward to the rest of the comments and more posts from Elizabeth on this subject.
DeleteThanks, Bonnie - I referred to that in my comment above.
DeleteThe greed of the drug companies makes me so angry. $63/$990! Why, indeed. Something has got to give but it sure as hell won't be the fucking drug companies.
ReplyDeleteThe insurance companies and pharmaceutical companies are crooks and they're in cohoots. They represent the very worst of our country.
ReplyDeleteAgreed.
DeleteI hope that what has passed as health care reform is merely a step in the right direction. Perhaps I am being simplistic but don't know why we couldn't all be covered under Medicare as the "payer".
ReplyDeleteKeep those comments coming folks--not just here but to your representatives as well.
Best,
Bonnie
Pauline: The drug companies have a powerful lobby and it has to be funded!!
ReplyDeleteBest,
Bonnie
I thought drug companies charged the most for drugs they have a patent on and when the patent runs out the generics step in and make the same drug for less and the price goes down. My question would be, why can drug companies hold a patent on a life saving drug and extort royalty money from people who just want to live. And then there's the advertising money they are willing to pay to promote their money maker - it's all a grubby greedy business. Do you need someone to go into Canada for you? I'm about 60 miles south.
ReplyDeleteMaybe I will come up to visit Portland and drive into Canada to get the medicine for Sophie. We could finally meet!
DeleteThere are a few drugs that can't be translated to generic--very few. As for the ads, they make no sense whatsoever. I've yet to see an ad that makes me, the viewer, want to phone up my doctor and ask for the drug being touted. What's that all about? Don't even get me started on the cute little drug reps that talk doctors into writing for a new and expensive drug. As a patient, we should all question what drugs we are getting and make sure there are no generics available. Yes, drug companies do need money for research and development but nowhere near as much as they are making. Most of that goes to the CEOs!!
ReplyDeleteBest,
Bonnie
I swear to god there was a letter to the editor in our local paper today warning people about how, if the government gets involved in healthcare, we won't be able to make our own decisions with our own doctors.
ReplyDeleteAs if that were possible now.
Insanity and insanity and insanity.
You've probably already tried this, but could you go directly to the pharmaceutical firm for help? My mother was once prescribed a new and very, very expensive non-formulary drug for secondary pulmonary hypertension, and her doc connected her with the manufacturer, who subsidized most of the cost. The doctor did all the legwork.
ReplyDeleteI second anonymous's suggestion. Nicholas is on a very, very expensive growth hormone medication. When several of our local parents had trouble getting some insurance companies to pay for it, the drug company actually intervened supplying free product (!) and also worked with the insurance company on the family's behalf. Very unusual I know, but may be worth a phone call if you haven't tried already?
ReplyDeleteIm sighing with you . unbelievable. i dont have anything else to offer bc i am dumbfounded by it all... xoxo
ReplyDelete