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(ProPublica)   Reporter: So why's my son's medicine $15 sometimes and $30 other times? CVS: Beats us, ask the insurance company. Insurance company: Farked if we know. Federal government, throwing 30,000 pages of regulations on the table: Oh hai - we gots this   (propublica.org) divider line 93
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6608 clicks; posted to Main » on 29 Aug 2014 at 12:16 PM (3 weeks ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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ZAZ [TotalFark]
2014-08-29 08:12:47 AM
I have a prescription that costs a different amount each time I refill, but it's cheap so I haven't had any incentive to investigate.
 
2014-08-29 08:20:08 AM
I didn't see in there where federal regulations came into play, unless its supposed to be a "insurance companies are incompetent, therefore Obamacare".
 
2014-08-29 08:27:31 AM
yachts don't grow on trees.
 
2014-08-29 08:53:36 AM
csb

My wife has a prescription cream she uses on occasion.  She hasn't refilled it since our work changed insurance at the end of April from Blue Cross of Mississippi to "Anthem Blue Cross".  Normally it costs $50 for the copay.  So she goes to the pharmacy to pick it up, and the tech says "that will be $230."  To which my wife says wtf?  Let me check with my insurance.  So my wife pulls up the Anthem web site and checks prescription costs and sure enough, that cream now comes with a $230 copay.  But if you want the generic and it lists the name, it will only be $20.  So she calls up the doctors office to ask for a different cream.  The nurse says fine and rattles off another cream.  When my wife looks it up online it has a $500 copay.  So she asks the nurse for the generic of the original cream.  Telling her the name from the web.  Except the nurse has never heard of that, doesn't know what it it.  Sure it could just be the nurse being brand-ist.  But you would think they would know those things.  So my wife ended up with a scrip for a cream that works, just not as well as the good stuff.

/csb
 
2014-08-29 09:04:58 AM
Why is Hazed and Infused 6.99 a six pack at the big liquor store, but 9.99 at the liquor store by my house?

Thanks Obama.
 
2014-08-29 09:15:23 AM

enry: I didn't see in there where federal regulations came into play, unless its supposed to be a "insurance companies are incompetent, therefore Obamacare".


Federal regulations always come into play. When you see a car, you are seeing federal regulations. When you drink milk, you are seeing federal regulations. When you see local restaurant close, you are seeing federal regulations. When you want to buy your employer's plumbing business but can't because of socialism, you're seeing federal regulations. When you see an exploding fertilizer plant, you are seeing federal regulations.
 
2014-08-29 10:07:11 AM

kronicfeld: enry: I didn't see in there where federal regulations came into play, unless its supposed to be a "insurance companies are incompetent, therefore Obamacare".

Federal regulations always come into play. When you see a car, you are seeing federal regulations. When you drink milk, you are seeing federal regulations. When you see local restaurant close, you are seeing federal regulations. When you want to buy your employer's plumbing business but can't because of socialism, you're seeing federal regulations. When you see an exploding fertilizer plant, you are seeing federal regulations.


My dog has fleas! Thanks Federal regulations.
 
2014-08-29 10:56:30 AM

johnryan51: kronicfeld: enry: I didn't see in there where federal regulations came into play, unless its supposed to be a "insurance companies are incompetent, therefore Obamacare".

Federal regulations always come into play. When you see a car, you are seeing federal regulations. When you drink milk, you are seeing federal regulations. When you see local restaurant close, you are seeing federal regulations. When you want to buy your employer's plumbing business but can't because of socialism, you're seeing federal regulations. When you see an exploding fertilizer plant, you are seeing federal regulations.

My dog has fleas! Thanks Federal regulations.



The dog can count those fleas as dependents for tax purposes.
 
2014-08-29 11:12:13 AM

Snarfangel: johnryan51: kronicfeld: enry: I didn't see in there where federal regulations came into play, unless its supposed to be a "insurance companies are incompetent, therefore Obamacare".

Federal regulations always come into play. When you see a car, you are seeing federal regulations. When you drink milk, you are seeing federal regulations. When you see local restaurant close, you are seeing federal regulations. When you want to buy your employer's plumbing business but can't because of socialism, you're seeing federal regulations. When you see an exploding fertilizer plant, you are seeing federal regulations.

My dog has fleas! Thanks Federal regulations.


The dog can count those fleas as dependents for tax purposes.


And then the fleas register to vote in Chicago.

/cmon, it was teed up
 
ZAZ [TotalFark]
2014-08-29 11:16:39 AM
I expect there are thousands of pages of federal rules on proper coverage of prescriptions, but they article didn't say so.
 
2014-08-29 11:24:11 AM

BizarreMan: csb

My wife has a prescription cream she uses on occasion.  She hasn't refilled it since our work changed insurance at the end of April from Blue Cross of Mississippi to "Anthem Blue Cross".  Normally it costs $50 for the copay.  So she goes to the pharmacy to pick it up, and the tech says "that will be $230."  To which my wife says wtf?  Let me check with my insurance.  So my wife pulls up the Anthem web site and checks prescription costs and sure enough, that cream now comes with a $230 copay.  But if you want the generic and it lists the name, it will only be $20.  So she calls up the doctors office to ask for a different cream.  The nurse says fine and rattles off another cream.  When my wife looks it up online it has a $500 copay.  So she asks the nurse for the generic of the original cream.  Telling her the name from the web.  Except the nurse has never heard of that, doesn't know what it it.  Sure it could just be the nurse being brand-ist.  But you would think they would know those things.  So my wife ended up with a scrip for a cream that works, just not as well as the good stuff.

/csb


A lot of creams have to be made by the pharmacist on site these days. Narcotic pain creams are becoming a cash cow. They usually run at least ten times more than the oral medication.
 
2014-08-29 11:38:09 AM
Interesting that once again the headline isn't even tangentially related to what the article actually says.
 
2014-08-29 11:50:45 AM

ZAZ: I expect there are thousands of pages of federal rules on proper coverage of prescriptions, but they article didn't say so.


Falls under the heading of "should be obvious to the casual observer".
 
2014-08-29 12:18:33 PM
Why are PBR tallboys $2 all day at some bars and $2 only during happy hour at other bars?

Thanks, Obama.
 
2014-08-29 12:22:49 PM
Why does it take 45 minutes to fill a prescription? It takes that long to take pills from a big bottle and put them in a little bottle? And what's the deal with airline food?
 
2014-08-29 12:25:00 PM
Why is a Twinkee free if I steal it, but if I pay for it, it'll cost me $2.99? Thanks, Obama!
 
2014-08-29 12:25:28 PM
That article had zero to do with regulations, and simply that the powdered and tablet versions have different co-pays.
 
2014-08-29 12:25:55 PM

BizarreMan: csb

My wife has a prescription cream she uses on occasion.  She hasn't refilled it since our work changed insurance at the end of April from Blue Cross of Mississippi to "Anthem Blue Cross".  Normally it costs $50 for the copay.  So she goes to the pharmacy to pick it up, and the tech says "that will be $230."  To which my wife says wtf?  Let me check with my insurance.  So my wife pulls up the Anthem web site and checks prescription costs and sure enough, that cream now comes with a $230 copay.  But if you want the generic and it lists the name, it will only be $20.  So she calls up the doctors office to ask for a different cream.  The nurse says fine and rattles off another cream.  When my wife looks it up online it has a $500 copay.  So she asks the nurse for the generic of the original cream.  Telling her the name from the web.  Except the nurse has never heard of that, doesn't know what it it.  Sure it could just be the nurse being brand-ist.  But you would think they would know those things.  So my wife ended up with a scrip for a cream that works, just not as well as the good stuff.

/csb


I would guess the patent just expired and the generic is brand new and may not have been widely diseminated.

The insurance probably has separate copays for brand names with and without generic options available.
 
2014-08-29 12:26:27 PM

tricycleracer: Why are PBR tallboys $2 all day at some bars and $2 only during happy hour at other bars?

Thanks, Obama.


Some places have hipsters without jobs, other places have hipsters with jobs.

Thanks, Hipbama.
 
2014-08-29 12:26:42 PM
My wife has a medicine that we used to buy from Walmart.  It cost $600, but they would be kind enough to discount it to $340.  At Walgreens it costs $240.
At Costco it costs $120.

How is a 500% price difference even possible?
 
2014-08-29 12:28:12 PM
csb:

When our newborn needed an expensive prescription made at a compounding pharmacy / formulary (I remember these names but fuzzy on the whos and whats. Was a while ago) the insurance co-pay was $N.  But a week or whatever later the pharmacy or insurance company contacted us and said whoops, it's not actually covered, so we need to pay the full amount. And by "full amount" we mean  "full amount", not the originally negotiated price with the insurance company ($3N) that our co-pay was applied to. Which instead was like $8N.

Another reason people without insurance, usually the poorest and least able, are legally robbed by insurance companies and lawyers.
 
2014-08-29 12:28:17 PM

MrSplifferton: My wife has a medicine that we used to buy from Walmart.  It cost $600, but they would be kind enough to discount it to $340.  At Walgreens it costs $240.
At Costco it costs $120.

How is a 500% price difference even possible?


Like I said: Having the pharmacist mix it up to order versus pills manufactured off site. I represent a lot of clients who deal with covering prescription benefits and they are alarmed at what they have been seeing lately with this stuff.
 
2014-08-29 12:29:08 PM
MY farking insurance provider arbitrarily decided last month that, oh what the hell, this month we're going to deny all of your claims from here on out and see if you notice.  Oh, and to boot, we're going to send you letters that were written by the monkeys we keep the basement pounding on typewriters so we can pretend we told you why; when, in fact, nowhere in the letter will we actually tell you why your claims were denied.

Actually, the reason is this:  were the farking insurance company and you're not.
 
2014-08-29 12:30:29 PM

Nabb1: MrSplifferton: My wife has a medicine that we used to buy from Walmart.  It cost $600, but they would be kind enough to discount it to $340.  At Walgreens it costs $240.
At Costco it costs $120.

How is a 500% price difference even possible?

Like I said: Having the pharmacist mix it up to order versus pills manufactured off site. I represent a lot of clients who deal with covering prescription benefits and they are alarmed at what they have been seeing lately with this stuff.


These was for generic prescription pills, not any creams or liquids mixed onsite.
 
2014-08-29 12:31:32 PM

enry: I didn't see in there where federal regulations came into play, unless its supposed to be a "insurance companies are incompetent, therefore Obamacare".


Apparently you are unaware how HHS keeps changing various ACA requirements, causing a shifting landscape for required coverages.
 
2014-08-29 12:31:36 PM

MrSplifferton: My wife has a medicine that we used to buy from Walmart.  It cost $600, but they would be kind enough to discount it to $340.  At Walgreens it costs $240.
At Costco it costs $120.

How is a 500% price difference even possible?


Somehow, Obama
 
2014-08-29 12:32:08 PM

MrSplifferton: My wife has a medicine that we used to buy from Walmart.  It cost $600, but they would be kind enough to discount it to $340.  At Walgreens it costs $240.
At Costco it costs $120.

How is a 500% price difference even possible?


I'm neither a doctor nor a financial analyst, but my recommendation is to buy it from Costco.
 
2014-08-29 12:37:47 PM

WyDave: MY farking insurance provider arbitrarily decided last month that, oh what the hell, this month we're going to deny all of your claims from here on out and see if you notice.  Oh, and to boot, we're going to send you letters that were written by the monkeys we keep the basement pounding on typewriters so we can pretend we told you why; when, in fact, nowhere in the letter will we actually tell you why your claims were denied.

Actually, the reason is this:  were the farking insurance company and you're not.


I don't really understand how an insurance company can say 'Listen, we know you pay us and we agree to pay for things but we're not going to pay for something that your doctor prescribed because of non-medical reasons (IE - no profit)'. Generally, if I fail to uphold my end (paying them) then they don't up hold their end (covering me). How is it that they can get away with not hold up their end but I still have to uphold my end?

We generally call that a scam.
 
2014-08-29 12:41:09 PM

MrSplifferton: My wife has a medicine that we used to buy from Walmart.  It cost $600, but they would be kind enough to discount it to $340.  At Walgreens it costs $240.
At Costco it costs $120.

How is a 500% price difference even possible?


Companies are in the business to make the most money possible.  Most people don't shop around for medicine and they know it.
 
2014-08-29 12:42:10 PM

MrSplifferton: My wife has a medicine that we used to buy from Walmart.  It cost $600, but they would be kind enough to discount it to $340.  At Walgreens it costs $240.
At Costco it costs $120.

How is a 500% price difference even possible?



I speculate that this reflects a area of consumer-level competitiveness that most people have not ever participated with under previous insurance models.  Under PPO-type insurance, you paid a co-pay that was typically between $20 - $40, and that was that.  You, the consumer, never had to really care about the actual cost of the prescription.  Same with most medical care in general.  A copay was a copay, and the rest of the cost didn't matter because you really didn't see it (or it was that surprise package later that came with the THIS IS NOT A BILL mail)

It looks like insurance is leaning more and more to a high-deductable structure where the consumer is responsible for an initial chunk of medical costs, with the actual insurance not really kicking in until you reach a certain minimum (mine, for example, is the first $3000 for my family or $1500 per person), including prescription costs.

There is now an incentive to shop around, but I don't think the pharmacies have completely caught up with their business models and how to reach customers.  Even moreso with doctors.

TLDR: Pharmacies haven't caught up to speed with the new incentatives for consumers to shop around for medicines, thus creating havoc and confusion for all.
 
2014-08-29 12:42:48 PM

MrSplifferton: My wife has a medicine that we used to buy from Walmart.  It cost $600, but they would be kind enough to discount it to $340.  At Walgreens it costs $240.
At Costco it costs $120.

How is a 500% price difference even possible?


Pretty easy actually if its a generic

Pharmacies get different deals from different vendors for different reasons, just because you get drug A doesn't mean it was made by the same place at the same time for the same price.
Drug prices are actually really similiar to gas prices, just a few weeks ago there was a court ruling that pushed one of two manufacturers of one drug out of the market temporarily, prices shot up 1600% that day in the course of a few weeks, we had a warehouse full of the stuff, we didn't pay 1600% price to full up those pick locations, we just had an excuse to raise prices and took it.  Prices fluctuate wildly for sometimes good, sometimes imaginary reasons,  there's always specials for some thing or others but for the large part you're at the mercy of what we charge.

your pharmacist actually does a lot to try and insulate you from the crazyness that they deal with on a daily basis and as far as I understand there aren't a whole lot of rules about how the pharmacy prices move around..
 
2014-08-29 12:44:43 PM

MyRandomName: enry: I didn't see in there where federal regulations came into play, unless its supposed to be a "insurance companies are incompetent, therefore Obamacare".

Apparently you are unaware how HHS keeps changing various ACA requirements, causing a shifting landscape for required coverages.


I am aware of it, but the insurance company never referred to changing ACA requirements or HHS in their excuses for the discrepancy.  Blame ACA for a lot of things, but that doesn't seem to be the case here.
 
2014-08-29 12:46:17 PM

Epic Fap Session: Why is Hazed and Infused 6.99 a six pack at the big liquor store, but 9.99 at the liquor store by my house?

Thanks Obama.


You I like.

Now go buy a 6 pack of Twisted Pine Blonde. If you enjoy Hazed, that will hit the spot nicely.
 
2014-08-29 12:48:45 PM

tricycleracer: Why are PBR tallboys $2 all day at some bars and $2 only during happy hour at other bars?

Thanks, Obama.



Step 1: Convince people their health plans are run inadequately
Step 2: Force people into new health plans whose rules you write
Step 3: Mock them when they point out your new health plans are even worse.
Step 4: Revel in your smugness.
 
2014-08-29 12:53:06 PM
this is the problem with the health care industry - there is no transparency.  And because of that, people can't shop for health care, so there is no downward pressure on prices.

With more transparency, people would know what they have to pay before they need to pay it and there wouldn't be this kind of confusion and ambiguity.  Government regulation plays a role, and that role has increased many-fold because of Obamacare, but insurers and doctors and hospitals are using the lack of transparency to their advantage as well.
 
2014-08-29 12:55:33 PM
The running joke at our house is whenever we take our kids to the doctor the billing person pulls out a magic 8 ball to figure out our payment.  It is different pretty much every time.  I don't even bother questioning it anymore and just wait for the bill.

/ I don't have "obamacare"
// Whatever that is
 
gja [TotalFark]
2014-08-29 12:56:01 PM
The farking tax codes here in the USA could wipe the smile off The Jokers face.
 
2014-08-29 12:56:07 PM

TNel: MrSplifferton: My wife has a medicine that we used to buy from Walmart.  It cost $600, but they would be kind enough to discount it to $340.  At Walgreens it costs $240.
At Costco it costs $120.

How is a 500% price difference even possible?

Companies are in the business to make the most money possible.  Most people don't shop around for medicine and they know it.


If I buy a bag of pita chips at Wholefoods it's 4.99, but at shop rite it's only 3.99, but if I use my bonus card it costs 2.99. The same exact pita chips in a different package at trader Joes is only 1.99, but I have to drive 25 miles out of the way to get to a trader Joes and that uses more gas.

I blame Halliburton.
 
2014-08-29 12:57:57 PM

MrSplifferton: My wife has a medicine that we used to buy from Walmart.  It cost $600, but they would be kind enough to discount it to $340.  At Walgreens it costs $240.
At Costco it costs $120.

How is a 500% price difference even possible?


Welcome to the wonderful world of health care pricing.

If you have insurance, it makes a *huge* difference if the pharmacy is in-network or out-of-network, even if the insurance isn't covering anything (e.g. you still haven't met a deductible). This is true of other health care services as well, but at least for drugs, you can find out the price before you get them. For other health care services, never ever go out of network for anything, ever.

Brand-name drugs have their prices set by the manufacturer, and so cost about the same everywhere.

For generics, it pays to shop around, because there's actual competition between manufacturers. Some pharmacies will pass the savings along to you, and some won't. And at the big chains, exploit loss leaders - I've found generics at Target that were cheaper than Express Scripts mail-order.
 
2014-08-29 12:58:10 PM

Aar1012: WyDave: MY farking insurance provider arbitrarily decided last month that, oh what the hell, this month we're going to deny all of your claims from here on out and see if you notice.  Oh, and to boot, we're going to send you letters that were written by the monkeys we keep the basement pounding on typewriters so we can pretend we told you why; when, in fact, nowhere in the letter will we actually tell you why your claims were denied.

Actually, the reason is this:  were the farking insurance company and you're not.

I don't really understand how an insurance company can say 'Listen, we know you pay us and we agree to pay for things but we're not going to pay for something that your doctor prescribed because of non-medical reasons (IE - no profit)'. Generally, if I fail to uphold my end (paying them) then they don't up hold their end (covering me). How is it that they can get away with not hold up their end but I still have to uphold my end?

We generally call that a scam.


There claim is that they are upholding their end. The contract says they pay under such and such conditions. Now you can certainly dispute whether it meets those conditions. You may also be able to claim you were mislead into signing the contract.

The thing to note is that they wrote the contract. It is designed to covertheir asses, not yours.
 
2014-08-29 12:59:37 PM
I think the actual health care (like the service) is pretty decent in the US. It's the billing and admin side that's an absolute cluster-fark.

If I go to my doctor and he recommends X, whether X be a treatment or a medication, he can't tell me the price. In fact, no one can really tell me the price until after the fact (treatment) or when I receive it (prescription).

Now think of the costs of those items, like let's say "treatment" is a heart operation. That can cost as much as a new car, but at least a car dealer can tell you the price -- your doctor (or the hospital) cannot.

What a mess. Seems ripe for innovation.
 
2014-08-29 01:00:37 PM
Heh - My whole family is locked into CVS for prescriptions, thanks to my employer's health care plans.

The CVS 'Random Wheel O' Pricing' is something we've been quite aware of - and joking about - for many years now.  It's been that way regardless of which insurer was behind the plan.

I've been saving all my receipts for years, keep meaning to someday compile a list of each medication, and how the price fluctuates randomly, or at least apparently randomly.

A swing of a few hundred percent from month to month is not unheard of, though it *does* seem to have stabilized - and lowered - somewhat, since Obamacare went into effect.

Thanks, Obama!
 
2014-08-29 01:01:34 PM

kronicfeld: enry: I didn't see in there where federal regulations came into play, unless its supposed to be a "insurance companies are incompetent, therefore Obamacare".

Federal regulations always come into play. When you see a car, you are seeing federal regulations. When you drink milk, you are seeing federal regulations. When you see local restaurant close, you are seeing federal regulations. When you want to buy your employer's plumbing business but can't because of socialism, you're seeing federal regulations. When you see an exploding fertilizer plant, you are seeing federal regulations.


www.wearysloth.com
/I know that feel, bro.
 
2014-08-29 01:02:41 PM

big pig peaches: If I buy a bag of pita chips at Wholefoods it's 4.99, but at shop rite it's only 3.99, but if I use my bonus card it costs 2.99. The same exact pita chips in a different package at trader Joes is only 1.99, but I have to drive 25 miles out of the way to get to a trader Joes and that uses more gas.

I blame Halliburton.


Jane has 10 more apples than Jimmy... wait what were we talking about?
 
2014-08-29 01:11:08 PM
You're just now seeing this?  WAKE UP, SHEEPLE!

/amIrite?
//it's been a scam since day one
///now they're working the auto repair and plumbing angles, raising the price for everyone...because they can
 
2014-08-29 01:12:14 PM
Two16: kronicfeld:  enry: I didn't see in there where federal regulations came into play, unless its supposed to be a "insurance companies are incompetent, therefore Obamacare".

Federal regulations always come into play. When you see a car, you are seeing federal regulations. When you drink milk, you are seeing federal regulations. When you see local restaurant close, you are seeing federal regulations. When you want to buy your employer's plumbing business but can't because of socialism, you're seeing federal regulations. When you see an exploding fertilizer plant, you are seeing federal regulations.


Hey!  "Zinc Oxide and You"!  I Farkin' LOVE that movie!
 
2014-08-29 01:15:47 PM

dywed88: Aar1012: WyDave: MY farking insurance provider arbitrarily decided last month that, oh what the hell, this month we're going to deny all of your claims from here on out and see if you notice.

Actually, the reason is this:  were the farking insurance company and you're not.

How is it that they can get away with not hold up their end but I still have to uphold my end?

We generally call that a scam.

The thing to note is that they wrote the contract. It is designed to covertheir asses, not yours.

 
2014-08-29 01:16:10 PM

kronicfeld: Federal regulations always come into play. When you see a car, you are seeing federal regulations. When you drink milk, you are seeing federal regulations. When you see local restaurant close, you are seeing federal regulations. When you want to buy your employer's plumbing business but can't because of socialism, you're seeing federal regulations. When you see an exploding fertilizer plant, you are seeing federal regulations.



Except when someone succeeds or does well.  They built that on their own.
 
ZAZ [TotalFark]
2014-08-29 01:20:21 PM
I see the phrase "Express Scripts" upthread and people acting like they know what they are talking about. So a question.

I have a solicitation from Express Scripts offering to sell me meds for (allegedly) better than the price I'm getting at a pharmacy. They got the prescription right so they do know what I'm buying. They may not know everything, because they only listed the cheap drug and not the vastly more expensive one I also bought recently.

How do they know what I'm buying? A lot of medical records are covered by privacy laws. Which ones aren't? Did they get to my doctor, my insurer, my pharmacist, or somebody else?
 
2014-08-29 01:28:04 PM

ZAZ: I see the phrase "Express Scripts" upthread and people acting like they know what they are talking about. So a question.

I have a solicitation from Express Scripts offering to sell me meds for (allegedly) better than the price I'm getting at a pharmacy. They got the prescription right so they do know what I'm buying. They may not know everything, because they only listed the cheap drug and not the vastly more expensive one I also bought recently.

How do they know what I'm buying? A lot of medical records are covered by privacy laws. Which ones aren't? Did they get to my doctor, my insurer, my pharmacist, or somebody else?


Do you have a discount card for your local pharmacy?  I know the CVS one blatantly says on the sign up screen that you're giving them the right to sell your purchase history.  It doesn't violate HIPAA because you have to opt-in to the program.
 
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