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Thursday, January 10, 2008

My Favorite New Year's Copay So Far

A new year means insurance copays and deductibles skyrocket to the realms only the super-rich can afford. My favorite copay so far was $275 for a 30-count bottle of Truvada.

For those of you who don't know, Truvada is used to treat HIV and AIDS. It is a critical component in a multi-drug cocktail necessary for many patients to keep viral loads at manageable levels.

The patient was shocked. In December the copay was $25. Hmmmm, simple computer error or insurance conspiracy cooked up by religious groups to kill AIDS patients....I wonder....

Nah, that would be too simple. It has to be a "cost saving" measure so the insurance company can stay in business and afford their lobbyists and under-the-table deals with Big Pharma.

It sucks!

I don't care how expensive it is (>$1000/bottle). It is for a life-threatening illness! The other thing that really r-e-a-l-l-y pisses me off is that in other countries (the ones without excruciatingly long patent standards) people are already able to get generic versions of many HIV/AIDS treatments along with a slew of other "still branded in America" drugs.

Thanks for f**king us all America!


pharmacygirl said...

My favorite this year has been for Solodyn (quite possibly the most expensive formulation of minocycline yet...stupid). The copay last year was $25. This year... $235. No, it wasn't a deductible. It was the COPAY.

I think ridiculously high copays for necessary and life-saving drugs like Truvada are unethical. But for drugs like minocycline (which you could buy in immediate-release formulations for around $10) the high copays make me smile. Take that, DAW-writing dermatologists.

Pharmer Mike said...

my guess is that he's got a $250 deductible and then a $25 copay. That's the breaks. He picked the shitty plan. Of course, unless he's been infected since the early to mid 80's, he knew how to prevent it. To me, this is no different than the 300 lb heffer that shows up bitching about copays on several diabetes meds and wants me to ring up the Ben & Jerry's, sugar cookies, and chocolate bars.

Also, if he'd bothered to read ANY of the papers the insurance sent him, he'd have been aware of this "surprise". I say that patients have the responsibility to know AT LEAST the basics of their plans. I would consider a yearly deductible a basic.

Joel said...

And then there are the $1000+ medications that have a 'normal' copay, yet people still lament:

A regular came through the drive-thru and was informed of the copay of $5.25 imposed by MPD for her $3700 Tarceva RX.

"FIVE DOLLARS!!?? I thought Medicare was supposed to cover ALL of that! I'm going to have to come back!"

99.86% is pretty darn close to ALL.

Big 'N Tasty RPH said...

For Tarceva I would dig $5 in change out of my car seats....

Eric, AKA The Pragmatic Caregiver said...

Hell, for $5 Tarceva, I'd dig the change out of *other people's* car seats. Even the ones in the cupholder that get that mysterious black kruft on them.

In these patients defense; I'm a plan administrator for a small group, and we *NEVER* get advance notification of the formulary changes. EVER. There was no way for me or our insureds to know, prior to Jan 1 when the new stuff was available on the website, what would be Tier 2 vs. Tier 3 vs. non-covered in the plan year. We totally buy a pig in a poke on this one.


Un-PC RPh said...

My thoughts exactly, Mike. I would bet it is a deductible plus copay, but if Mr AIDS had bothered to read his plan he would have known that before he got to your pharmacy.

Anonymous said...

Watch out when you start bashing countries with "excrutiatingly long patents". Generally, it is companies operating in these countries that invent the new molecules which become our medications. It is relatively easy to copy a dosage form once it comes out, but to bring a new molecule to market is a long, extremely costly road. Even now the drug pipeline is drying up, due to the excessively costly process of bringing a new drug to market. 1.) Molecule synthesis 2.)Pharmacological screening (animal models) 3.) Toxicology 4.)Dosgage form development 5.) Clinical trials 6.) If everything works, go to market. This process takes years and costs hundred of millions of dollars. The rip off pharma companies operating in the we-don't-respect-patents countries never bring a new life saving or improving medicine. To the layity this is a one side argument, but the reality is very different.