Trumpcare - Making It Great Again

[kgmom219]

If they won't shop drug prices I doubt they will shop around for brain surgery.

But I could be wrong.

Why shop? The copay is the same everywhere. Why should I care that it costs my insurance company (that is making billions in profit) more for me to go to Walgreens, while I am sweating my monthly premium?

Or....I HAVE to go to the MRI store where my doctor recommended. It must be the best one, otherwise he wouldn't have recommended it. It doesn't matter that it costs twice as much as the place that's closer to me and that its the same machine and the results will be sent to same radiologist. (Or that my doctor owns the facility.)

(The above two statements show why we really need a sarcasm font!)

Price transparency IS reasonable. But the docs don't want it because everyone will find out how much money they make. The carriers don't want it because the providers will find out how wide a discrepancy there is in the contracts.

We have a hospital group around here with around 20 facilities. The one in Dallas has contract with the local Blue is $5200 for a "normal" childbirth delivery. The hospital in the suburb, which is 20 miles north, has a contract with Blue for $2500 on a normal delivery. Are there valid reasons for it? Sure. But how many women know that they are paying an extra $2700 to deliver in Dallas?

Having said that...we can't keep complaining about premiums and then have even more requirements. MACRA is going to be a huge deal, with the provider requirements. And those costs are going to covered by even higher premiums

 

[somarco]

The copay is the same everywhere.

Yes, the copay is the problem, but for Medicare, the copay will vary according to the pharmacy and in some cases, mail order vs retail. It isn't quite the same for group & IFP.

But the Rx copay is what started the drug explosion. First with HMO plans that then became PPO plans. Then Foremost McKesson put together an Rx copay plan it sold to carriers. Group plans that formerly required saving Rx receipts until you hit your deductible now offered Rx copay with $1 generics and $3 - $5 brand names.

Almost overnight we saw group plans see Rx utilization spike and Rx claims jumped from 12% of total claim dollars to 18%.

Add DTC advertising a few years later and suddenly everyone is an expert on what is wrong and which pill they need to fix the problem.

 

[kgmom219]

Yes, the copay is the problem, but for Medicare, the copay will vary according to the pharmacy and in some cases, mail order vs retail. It isn't quite the same for group & IFP.

Hmmm...not true. BCBSTX Indy and Small Group 2016 plans have lower copays if you use CVS or Walmart. And Prime Therapeutics is required for the Tier 4's. Both BCBSTX and UHC have offered pharmacy specific pricing for self funded plans for 20+ years.

I totally agree with RX is driving the inflation trend, no question. Part of it is copays, part of it is the doc trips to the Bahamas based on your script writing (and please, no one tell me that its illegal. Its happening, legal or not.). Part of it is that Merck wrote then damn Part D law. Part of it is Americans refusing to use generics. (And that the FDA doesn't require AB equivalency on generics. Just one or the other. States can enforce AB, but its not Federal, which causes even more problems.)

And I thought PCS was the first PBM? Funded by EDS?

The advertising makes me ill. Literally.

 

[somarco]

Well . . . you (kg) said the copay was the same. I have been out of group (small, large, self funded, in between) for years and out of IFP since 2014 so I took you at your word.

McKesson's history . . .
History of McKesson Corporation | McKesson

I was a group rep with Penn Mutual mid 80's when they introduced the F-M Rx copay. Can't say if that pre-dates PCS or not.

When I run PDP's for clients I rarely see brand name med's if there is a generic equivalent. Do recall seeing Synthroid on a list a month or so ago and was told specifically DO NOT change to generic. Believe I sent her to BlueSky.

 

[kgmom219]

Well . . . you (kg) said the copay was the same. I have been out of group (small, large, self funded, in between) for years and out of IFP since 2014 so I took you at your word.

McKesson's history . . .
History of McKesson Corporation | McKesson

I was a group rep with Penn Mutual mid 80's when they introduced the F-M Rx copay. Can't say if that pre-dates PCS or not.

When I run PDP's for clients I rarely see brand name med's if there is a generic equivalent. Do recall seeing Synthroid on a list a month or so ago and was told specifically DO NOT change to generic. Believe I sent her to BlueSky.

The only reason I know about PCS and EDS is because my high school job was as a pharmacy tech at a Plano TX Eckerds in 1986. And EDS was literally down the street.

Synthroid is one of the drugs that I believe you should only take brand on. And at $30 for a months supply, its not worth the Canada hassle.

However, I sent everyone to Canada for Premarin

 

[Key2Success]

I didnt read the article, but a big component of what Trump wants to do is move most everyone over to HD Plans and move them away from Co-Pay Plans. He wants everyone to have some skin in the game in some form or fashion.

I agree with everything that was listed except for #2. But I doubt it would happen unless insurers were forced to do so. Notice they always say "allow", and not "make". Blues SC is not going to offer policies to people in CA or NYC. If they did it would be a bloodbath on the claims. So they wont...

At most we might see some regional expansion... which might not be that terrible of a thing. But certainly is not a huge "cure" like the politicians claim it is.

As you stated......you didn't read the article

 

[FLM2]

As you stated......you didn't read the article

Did you? It's basically the same as posted by the OP with a very short explanation of some of the bullet points.

You are such a troll...

 

[Key2Success]

Did you? It's basically the same as posted by the OP with a very short explanation of some of the bullet points.

You are such a troll...

Yes sir....I did read it. That was my point.

 

[Cenla Agent]

People who live check to check are sure to be overjoyed with HDHPs and tax deductions.

 

[taterpeeler]

People who live check to check are sure to be overjoyed with HDHPs and tax deductions.

Ding Ding Ding!!!!! you hit the nail on the head...... I call them silent voters