2025 Rx $2,000 "light bulb" moment

[sshafran]

I've had at least 8 clients with "light bulb" moments this year in talking about the new $2k max (often, $750-1750 out of pocket).

Those hitting catastrophic will ask something like, what if I get prescribed more?

Well, nothing if it's on their list. You hit the max.

I can almost see them salivating over more medication.

I've literally had a few say something along the lines of "this is awesome, I'm going to start (or start back on) ____."



This won't backfire.

 

[InsuranceGuy29]

I've had at least 8 clients with "light bulb" moments this year in talking about the new $2k max (often, $750-1750 out of pocket).

Those hitting catastrophic will ask something like, what if I get prescribed more?

Well, nothing if it's on their list. You hit the max.

I can almost see them salivating over more medication.

I've literally had a few say something along the lines of "this is awesome, I'm going to start (or start back on) ____."



This won't backfire.

In my opinion, it's terrible. The goal of healthcare is to be healthy and OFF of prescriptions. The goal isn't to get excited that they're gonna be cheaper and get MORE.

All this legislation did is subconsciously encourage seniors to "ask their doctor" about more of the meds (many of which are toxic) they see in the brainwashing commercials.

Big Pharma is responsible for something like 70% of all TV station revenue. There were other ways to help seniors that need (<----very key word) to be on many high-priced meds, due to it being ABSOLUTELY medically necessary.

And then people wonder why preauthorizations exist. Because so many people are on meds that they absolutely do NOT need to REALLY be on.

The doctor just has backdoor deals in place with the pharmaceutical reps that are routinely in their offices/the pharmaceutical companies.

Without some preauthorizations, healthcare would cost us all 5x more of what it is already. It would be completely unaffordable for absolutely everyone.

I have run into SO many people in the past year that are on Ozempic. Before this year, I never even heard of it. Why? Because they are pushing this drug on commercials LIKE CRAZY.

Why? Because they own the patent and it's expensive as f*ck. You certainly don't see them pushing generics that will do virtually the same thing.

And then people call me and wonder why the copay is $150/month. Ma'am...Sir....because it's a $1,300/month drug with no generics for its particular brand. That's why.

Then I, the agent, and the insurance company have to take the brunt of the anger. Ask your doctor who is getting paid off to find something cheaper.

You have to keep these doctors at least somewhat in check and let them know that you're paying attention to their prescribing habits.