Insurance or Life?

A month ago I received a call from my doctor that the insurance company no longer covers my anti-depressant. They would cover a generic of a different drug, however. I made the change since I can't afford the $475/month to cover the original drug and went through withdrawl of the old drug and adjustment to the new drug. (Against all medical best practice, I might add) All is finally better and I have not dug my fingernails into anyone's face in at least a week.

Today, I got a notice that they are no longer allowing two more of my drugs, drugs prescribed as a result of my heart attack two years ago.

Aside from the research that drug companies do (which, I am assuming are in our best interests in the long run) why are drugs so expensive that insurance companies won't cover them? Advertising? CEO's bank accounts? Others?

I wish I did not have to take drugs of any kind, but I do, at least for now.

Do I have a question here? Hmmmmm - No, just a fine whine, I guess.

Anno...I'll listen to you whine. Insurance is a huge hole into which money is poured. I am constantly looking for decent insurance that's also affordable. HA! Might as well spend my time looking for the Holy Grail.

Anno, I have bronchitis. I went to the doctor. The doctor prescribed an anti-biotic. I have insurance via husband's work. Our co-pay for prescriptions is usually $20.00. When the clerk at the drug store handed me my prescription, she said that it was $90.00. I balked. The clerk said that the doctor had prescribed a newer anti-biotic. I said I would wait while the pharmacist called my doctor to get an equally effective yet inexpensive anti-biotic. 20 minutes later, I had an anti-biotic for $7.00, under the cost of a co-pay. On the same day, my husband's work place (he is a restaurant manager) was catering an event set-up by pharmaceutical companies at the same health agency where I saw the doctor! So it's true that the drug companies woo the doctors so the doctors will prescribe their latest drugs. who pays? we pay!

Thanks for the reminder Princess Lenora. I went to the doctor with my mom last fall, and while waiting to see the doctor, we saw 4 drug sales people going in and out of the office. They spent fewer than 5 minutes with the doctor and I am sure left plenty of samples.

That is their job. They are in sales. I have no problem with that, yet ...... the doctor is then giving those samples to someone who may not be able to afford them, or, like me, someone whose insurance will not cover them.

I hate to think all of this is about money. But, my common sense says, at least a part of it is about money.

Tonight on ABC 20/20 is an episode titled "Tragic Pharmacy Mistakes" and behind the counter scams at drugstores and pharmacies.

Anno, some of the drug companies have free or at-cost meds for people who can't afford them, but you have to write the drug companies directly and ask.

Baffling, Anno. I have become unfamiliar with insurance law in the US but surely, insurance companies, once insurance is taken with them, bear a duty to allow you to continue with medication which is suitable for your treatments regardless of costs. That is the risk they take and that is what your premiums are all about. I don't understand how they can move goalposts mid-stream of a treatment. I can understand where they can shift positions for new ones, but not with ongoing medical cases. It does not make business sense as well if the more expensive medication allows relief and the generic one takes longer to settle with. Is there a way where you can speak to your insurance company directly for future reference?

good set of questions lola, especillie with essential mediasions like hart effecting drugs....

i cant belive but do belive the £90. --£7.00 diffrences in antibioticks....

the system baffles me and its diffrent heer so is stay out of it but it seems like a streange situasion anno.

Hi, Celtic: We do have a counterpart in the UK where the NHS determines the costs for treatments. There are cases where the individuals become dependent on an expensive drug or course of treatments which the NHS refuses to cover at first instance or withdraws at mid-treatment because of costs. The argument always falls on duty rather than economics because the NHS is bound by an obligation and specific performance is compelled on that basis.

Thanks Lola

I have contacted the insurance company and was told that I could purchase the original at a higher co-pay. Fifty dollars a month. That would be an extra $600 for each drug. $1200 total. This would be on top of my already $1500 a year minimum co-pay for drugs alone.

Meridith, I did not know of drug companies doing this. I will check, but the thing is, I can afford the drugs, I just don't feel I should have to pay this much. There are many people that truly do not have the money for the drugs they need. I am whining for me, but they are the people that I am really concerned about. This is unfair.

A friend was telling me about a woman in her 90s that pays out more for her drugs than she takes in through social security. This is not right!

Anno, I can understand the increased costs but, only if the medication itself has raised its retail price or even a changed feature of a new insurance coverage presuming that is what you meant when you said "changed". My main concern is where they can unilaterally opt out of your benefit to two other medications. The insurer is required to pay the benefits under the insurance contract if the insured has paid the premiums and met certain other basic provisions. It might help to consult with the NABBW experts on this. If you don't feel the insurers are right, then they may pretty well not be on the right.

The insurance companies can change their formulary at any time for whatever reason. The drug companies are charging outrageous prices for many of their drugs. They claim it's because of the costs of research and development. Bull! It's so the CEO's can get their bonuses and stock options and all the other perks they get every day. Most of the research on new drugs and treatments isn't done by the drug companies; it's done on University campuses and partially funded with taxpayer dollars. Many countries have caps on the cost of drugs - the US doesn't. Some organizations, such as the VA, are allowed to negotiate drug prices, while others, such as Medicare, aren't allowed to negotiate. We need to change that by bombarding Congress and telling them to change the regs.

Okay, done ranting.

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The insurance companies can change their formulary at any time for whatever reason.

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Is there any test case in the US which has formally challenged this position in court? That conduct could be cited as a breach of contract law here. What an appalling personality US insurance companies have evolved into in the years since I have been away.