102 replies to this topic

[chriskuo]

DJ5627,

The reason drug pricing is not illegal is that under free market capitalism the government does not interfere with pricing.

Of course, the government does make exceptions and does set prices for medical procedures under Medicare. Of course, the
current party in control was not in control when Medicare was enacted.

Setting prices is anathema to the politicians who are now in control.

The people who say that politics should be set aside are completely wrong. This situation is the most political
situation you can imagine. It goes to the core beliefs of the controlling party. The only way the situation will change is
through political activism. Remember, they have not acknowledged that health care is a right.

[shweflen]

I checked the same thing.  I got on Cigna's website and, according to their formulary, 100 mg imatinib is quantity limited to 60 pills per month.  Since I take 300 mg per day that wouldn't work for me.  I called Cigna and they told me I could get a waiver to the quantity limit but the only way to know if they will grant the waiver is to enroll in the plan and then ask.

 

The last two months, WalMart has increased the cost of imatinib to me from 5% of $1593.82 to 5% of $5044.87 because they had to buy from Sun instead of Apotek

I just talked to the pharmacy manager at WalMart.  The prescription I was going to fill for next month was going to cost me $349.70 or 5% of $6994 and that was from Apotex.  In August the cost from Apotex was $1593 and now in October the cost is $6994.  How does that make sense?  I called Express Scripts and they explained to me that the pharmaceutical companies are allowed to raise rates based on their ingredients costs.  What a crock of B.S.

[shweflen]

Shweflen, imatinib 400 mg is on the formulary for 30 per month, so it seems strange that they won't allow 300 mg. I bet with the oncologist's authorization, you can get it. My one remaining concern is the rating. It's only 2 out of 5. Express scripts is 4 out of 5.

I'm still waiting for someone around here with real experience with Cigna to give me positive or negative recommendations.

I too think that that Cigna would probably grant the quantity limit waiver based on the oncologist's recommendation but the only way to find out is to commit to their policy for a year and that maybe more risk than I want to take.

[Buzzm1]

I just talked to the pharmacy manager at WalMart.  The prescription I was going to fill for next month was going to cost me $349.70 or 5% of $6994 and that was from Apotex.  In August the cost from Apotex was $1593 and now in October the cost is $6994.  How does that make sense?  I called Express Scripts and they explained to me that the pharmaceutical companies are allowed to raise rates based on their ingredients costs.  What a crock of B.S.

What a ripoff.  Sounds like a case of collusion between Sun, Teva, and Apotex.  The only thing you, and others can do, is contact your Congressperson.  They are supposed to be looking into the increasing drug prices. To increase the price of a generic more than fourfold is an outrage.  If you let me know who your Congressperson is, I'll post their website, Facebook, and Twitter links.

[shweflen]

What a ripoff.  Sounds like a case of collusion between Sun, Teva, and Apotex.  The only thing you, and others can do, is contact your Congressperson.  They are supposed to be looking into the increasing drug prices. To increase the price of a generic more than fourfold is an outrage.  If you let me know who your Congressperson is, I'll post their website, Facebook, and Twitter links.

I sent an e-mail to Susan Brooks, my Representative and will follow up with a phone call to her office.  I gave them the specifics of my situation and told them there are many others experiencing the same insane pricing.  I also told them that if the estimates on the Medicare Plan Finder are meaningless because the manufacturers can change prices at will then there is no way for any of us on Medicare to make rational choices about insurance coverage.  I asked to meet with someone from her office to discuss further and will pass along anything I hear.  I'm sure it's "we are aware of the situation and will continue to monitor it, blah, blah, blah"

[ROMO]

During the GW Bush years when Medicare Part D was passed a provision that the

government would not be able to negotiate Medicare drug bulk buying price was

included. This has not changed. The provision remains. The Affordable Care Act did not

change it, the repeal of the ACA will not change it. The machine only does what it wants.

 

Bristol Meyer lost it's patient for Sprycel in Europe because of improper patient filling.

The price for Sprycel will not change in the US. Even though a generic version should be

available in Europe. At least goes the prediction.

 

Google  "Youtube Prescription Drug  Evergreening." And you'll see just how deep the

swamp is.

 

The price for Gleevec will remain high because we are only 100K strong. According to

the CML society there are only that many of us. Not enough to change an election.

 

Get your Doctor to give you the highest dose possible. Break it in half and buy the drug

every other year. Other than that everything else is a snail's pace.

 

We are our own Doctors.

 

 

Romo

[Buzzm1]

I sent an e-mail to Susan Brooks, my Representative and will follow up with a phone call to her office.  I gave them the specifics of my situation and told them there are many others experiencing the same insane pricing.  I also told them that if the estimates on the Medicare Plan Finder are meaningless because the manufacturers can change prices at will then there is no way for any of us on Medicare to make rational choices about insurance coverage.  I asked to meet with someone from her office to discuss further and will pass along anything I hear.  I'm sure it's "we are aware of the situation and will continue to monitor it, blah, blah, blah"

Congresswoman Susan Brooks

Facebook https://www.facebook...anSusanWBrooks/

Twitter https://twitter.com/SusanWBrooks

Website https://susanwbrooks.house.gov

Email https://susanwbrooks...ontact/email-me

Office locations and phone https://susanwbrooks...contact/offices

 

Using all methods of contact at your disposal is more likely to draw a response

On twitter, putting your message in front of @SusanWBrooks makes it public, rather than private 

 

i.e. Apotex just increased the price of 300mg Imatinib mesylate (generic for Gleevec) from $1593 to $6994/mo. . @AARP @SusanWBrooks 

[chriskuo]

It will be interesting to see how Brooks responds.  Republicans generally had no problem voting for the ACA replacement which would have put under-65s with pre-existing conditions in dire straits.  She will probably think $5K-$10K in drug costs for a senior is no big deal.

[Buzzm1]

Medicare Part D shweflen's 2018 cost if 300mg generic Imatinib mesylate is $6994/mo.

 

assumed nondeductible = $400

25% of next $3350 = $837.50

44% of next $8551.14 = $3762.50
5% of next $1686.86 = $84.34

Total for months 1 and 2 = $5084.34

Total for year $5084.34 + (10 X $349.70) = $8581.34 out-of-pocket

[Buzzm1]

Medicare Part D shweflen's 2018 cost of 300mg Gleevec priced at $9065.75/mo.

 

assumed nondeductible = $400

25% of next $3350 = $837.50

35% of $4426.47 = $1549.26 (50% manufacturer credit)

5% of $889.28 = $44.64

Total for month 1 = $2831.40

 

Total for the year $2831.40 + (11 X $453.29) = $7817.59

 

https://www.rxpricequotes.com

[r06ue1]

 

 

In a 2012 TED Talk, Lee Cronin of the University of Glasgow describes a new approach to 3D printing that could potentially enable patients to print their own medicines at home. What's needed, he explains, is a universal set of "chemical inks" as well as a way to 3D print the lab instruments and these chemical inks at the same time. In essence, this would let 3D printers catalyze the chemical reactions in order to print drugs at the point of need.

 

https://www.washingt...m=.f84f140f2781

 

FDA Approved 3D Printed Drug Available In The US

https://www.forbes.c...s/#77b3cea0666b

 

 

Eventually, price will not be an issue, since you will be able to print your medicine at home.

[Antilogical]

I wrote letters on this topic to my congressman and both senators.  I received what I assume to be a form letter from each that DID NOT address the content of my letter.

[Buzzm1]

I wrote letters on this topic to my congressman and both senators.  I received what I assume to be a form letter from each that DID NOT address the content of my letter.

That's typical Antilogical ... I'd suggest posting on their Facebook pages, or tweeting them publicly.  

[snowboots]

I am going through the first-time medicare nightmare also. I called Novartis yesterday to inquire about their $10 co-pay plan. The flyer that comes with Gleevec says it is not valid for Medicare, but I spoke to them about this and they said that as long as you have your own Part D insurance, and that Medicare is not paying for your drugs, the co-pay is good. They are sending me a card, but I am still skeptical about this, so just wondering if anyone else has tried to use this. I have an appt. with the onc next week and they have their own pharmacy, so I am going to try to check it out with them.

[Dom]

I'm not sure what you mean by "...as long as you have your own Part D insurance, and that Medicare is not paying for your drugs."

Part d is Medicare. Of course I don't know the ins and outs here, so maybe I'm wrong.

[Buzzm1]

I found this: 

Does the CBO now support co-pay cards for Medicare Part D?

 

Last week, the Congressional Budget Office (CBO) released an important new memo: Offsetting Effects of Prescription Drug Use on Medicare's Spending for Medical Services.

After reviewing the evidence, the CBO concluded that prescription drugs can reduce overall healthcare costs—at least in Medicare. The CBO can now officially account for prescription drugs' beneficial effects in budget forecasts. For example, the cost of closing the Medicare Part D coverage gap just dropped by 41%!

But by supporting the economic benefits of prescription drugs, the CBO may have inadvertently provided an argument to reverse the long-standing federal program ban on co-pay offset programs, a.k.a., co-pay cards, co-pay coupons. Two-thirds of Medicare Part D prescription drug plans (PDPs) have five-tier designs with high out-of-pocket co-insurance. Does the CBO's change of heart mean co-pay offset programs should be encouraged, not banned, from federal programs? 

 

Read more: http://www.drugchann...-cards-for.html

 

Personally I don't think Medicare allows the use of copay cards, despite what Novartis says ... 

I think they are trying to exploit an alleged loophole.

[Buzzm1]

MyMedicare.gov Live Chat Transcript ---------------------

Live chat Date:11/3/2017

Start Time:5:43:59 pm

End Time:5:51:33 pm

-----------------------------------------------------------------------------

 

 

[5:43:59 pm]: Thank you for contacting MyMedicare.gov Live Chat. 

[5:44:02 pm]: Does Medicare Part D allow for the use of a Novartis copay card for the purchase of a Tier 5 drug? in this case Gleevec priced at almost 11,000 per month 

one of our LLS Chronic Myeloid Leukemia discussion forum Medicare members said Novartis told her she could use their copay card with Medicare Part D  

[5:44:03 pm]:  Please wait while you are connected to an agent. 

[5:44:19 pm]: You are now connected with MyMedicare.gov Live Chat.

 

Thank you for contacting MyMedicare.gov Live Chat. My name is Rene. For privacy purposes, please do not disclose any personal information such as your Social Security Number, Medicare ID, or any other sensitive medical or personal information. 

[5:44:35 pm]: thank you Rene 

[5:46:16 pm]: Rene Thank you for your patience and I apologize for the inconvenience. I will be happy to assist you. Please wait one moment while I read your statement and respond to your question. 

[5:46:33 pm]: thank you Rene 

[5:47:18 pm]: Rene Thank you for your patience. One moment while researching that information. 

[5:48:53 pm]: Rene Thank you for your patience. Some drug manufacturers sponsor programs that help people pay for the drugs they make. Income and resource limits vary by program and are usually higher than the limits for other types of Extra Help and low income assistance. Because these manufacturer-sponsored programs work outside of Medicare prescription drug coverage, claims for drugs covered by these programs won't be sent to your Medicare prescription drug plan. 

[5:49:41 pm]: Rene Thank you for your patience. Generally, payments made by your manufacturer-sponsored program do not count toward your true out-of-pocket costs. However, if the manufacturer-sponsored program charges a small copayment, this can count toward your true out-of-pocket costs. For your plan to apply the copayment amount, you will have to submit the documentation directly to your plan. You should contact your plan for more information. Please go to medicare.gov/pharmaceutical-assistance-program/index.aspx for a list of names and phone numbers for pharmaceutical assistance programs (PAPs). You can use this list to refer the caller to the appropriate PAP or to verify that a program is a PAP. 

[5:50:33 pm]: Rene Thank you for your patience. Please explore the pharmaceutical assistance programs.  

[5:50:44 pm]: Rene Do you have any other MyMedicare.gov questions that I can help you with? 

[5:51:22 pm]: Thank you Rene ... I'll pass this information on ... that's all for now  

[5:51:33 pm]: Rene You're welcome. 

[chriskuo]

Basically, these are charity programs with strict income limits.  Medicare sort of looks the other way that the charities may be mostly funded by the drug companies themselves.

[snowboots]

To clarify, the rep from Novartis explained it this way: as long as you are buying private prescription drug insurance the co-pay card should be valid. This would be if you had a Medicare Supplement plan (not an Advantage plan where prescription coverage is included), and pay for a separate drug plan like SilverScript, Express Scripts, Envision, etc.. He said there were no income limitations. We will see if he knew what he was talking about. I'm checking into it further.

[chriskuo]

I'm pretty sure those plans you mention are Medicare Part D plans.  Without the Medicare subsidy, the over-65 drug plans would be incredibly expensive.