Screw Obama-care! Help!

Diabetes Technology Insulin Pumps
21
So what seems to have happened is nothing to do with Obamacare

Well, of course, the truth is we can't know this without knowing the internal factors that led to these changes at the insurers. These changes might just as well be 100% because of Obamacare.

To point out that nothing in the law directly mandates these changes is disingenuous. I hope that's not the argument you are making. In fact, Occam's Razor -- it is highly likely that these changes are a direct result of Obamacare, as insurers seek any way they can to stay profitable under the new Obamacare requirements, disbursements, etc.

In fact, we already know that they are not able to stay profitable with what we're currently seeing as a coverage "landscape"; the Fed had to kick in with their "risk corridor" payments to insurers. When those end in another year or two, we should all be prepared for another shock in cost increases.

22

Phooey, this is all silly.

Ask the insurer the question and you will get the answer, rant on about politics and you will just get high blood pressure.

I telephoned my insurer today, the phone call cost me $0.0996 and 9:22 minutes of my time (most, I admit, on hold, there was one caller ahead of me.) I found, for my marketplace, ACA conformant "Gold" policy (from moda):

Humalog is classed as a "preferred tier-1 generic" and will cost me $10/month.
Novolog is classed the same and would cost me $10/month.
Lantus is classed as a "preferred tier-2 brand" and costs me $30/month (same as my test strips). I use so little of it that the additional cost doesn't worry me and I don't have a choice about the test strips.
My plan has a "non-preferred tier-3 brand" class and the co-pay on that would be 50% of the cost, so if they were to class Lantus that way it would cost me $196/month, rather than $30/month. At that point I might be looking for a new plan or a different drug, or I could just buy it in a different country and run the risk of US Customs confiscating it on the way back.

I mean, we wouldn't buy a new car without checking out what it was likely to cost us to run it, would we? I'm sure people who can use the marketplace do now check how much it will cost, not just the premiums; I certainly do. People on employer plans have to do the corresponding thing and check how much the drugs will cost before actually getting the doctor to prescribe them.

Incidentally I always did this; I always had to decide whether my, inflated, insurance cost was lower than the on-line cost. Typically they were suspiciously close.

John Bowler

23

It sounds like your insurance's formulary changed, NOTHING to do with Obama, stop trying to blame the president for everything that happens in this country at every second when your insurance is to blame here, not him. Insurance formulary changes happened before Obama. Chances are Novolog was either put up a tier or removed from your formulary. Not Obama's fault, it's your insurance's fault

24

Gosh with some of these posts and comments we need a dislike button so some decorum might be achieved.

25

The title of the discussion isn't decorous; it's hardly false advertizing.

26

I don't get it...

Lantus and Huma/Novolog are two different insulin types. Why is one Tier 1 and the other Tier-2?

I guess I could understand the comparison between Lantus and, say, Ultra-Lente (which I love, and I wish they would make again for when I go pump-less).

I get what you're saying, but the way I read it was, with the OP post that there's a different type of the same class of insulin could be used.

My insurance payer (the company actually uses BC/BS for processing; they're self-insured) classes Humalog as Tier 1, Novolog and Apidra as Tier 3.

27

We recently had to buy insulin for our cat. The cost for a tiny vial was indeed stunning. But our vet had coupons for us that we could use that brought the cost down from hundreds of dollars to 11.99. We did inquire! She said something about the manufacturers trying to squeeze every cent out of their product before the generic form kicks in. Might this be a contributing factor? It was the same insulin brand I have heard many of you talk about. I'm sorry I can't remember which one at the moment......Blessings

28

Yep, getting it is apparently not part of what we signed up for ;-)

On my plan humalog and novalog are both tier 1, this is because the Humalog (and, I assume Novalog) patents expired last year - May, this is when my copay went down from $30 for Humalog to $10. My guess is that this is because Eli Lilley promptly reclassified their product as a "generic". I should add that Walmart (before I swapped to Walgreens) were claiming they paid $478.02 for 15ml/5 Humalog 3ml QuikPens, for which I paid $10. So I guess when Eli Lilley reclassified it as a generic they had already doubled the price (it was $289 in 2012). We're waiting for the generic still; cm'mon, GM isn't that hard!

Meanwhile Lantus, a tier 2 drug manufactured by Sanofi, has a US patent that only expires on 12/2/2015 (US format: February). In the rest of the world the patent has already expired (Nov. 2014). Sanofi got a patent extension to permit this to happen (it was meant to expire in 2009 outside north america, but 11/2014 in NA, so that makes some sense):

http://www.genericsweb.com/index.php?object_id=1135

NOTE: the dates in that article are all in the normal "little-endian" European (semi-Arabic) format.

At this point Walgreens claim they are paying $391.99 for 5x3ml Solostar pens of Lantus.

My guess is that if I had waited a month I could have got my Lantus for $10, not $30, because it would have been NA generic by then, but since I was about to use stuff that nominally expired in 2013 I thought that maybe I should refresh my stock now.

The Novolog patent apparent expires in 2014, but the actual expiration date is somewhat irrelevant because the two drugs are equivalent for almost everyone and all it takes is for someone else, using the information in the Humalog patents, to produce an identical protein, then it's $nothing for any amount: E Coli are cheap.

The two choices I've experienced for processing are BCBS (for Oregon) and Aetna (Microsoft). I'm using moda now (which is actually an insurer, not a processor). Your experiences with BCBS seem to match the OPs with Aetna (I assume, to be confirmed); i.e. the OP has Novolog on tier 3 (now) and probably has Humalog on tier 1. moda has both on tier 1.

I hadn't worked out the classification scam before; it's pretty obvious, if you have a drug that is out of patent you reclassify it as "generic" and rake in the cash until someone else (some dratted commie entrepreneur in China with a big vat of E. Coli just like yours probably) starts producing it too.

The good thing is that since these drugs are going generic the price will drop to something reflecting the real (non-existent) manufacturing costs. The bad news is that in NA we will be privileged to enjoy the NA legal circus as it ensures that no dratted products enter our sacred lands without first being reamed of large amounts of money, which we will pay.

29

I think a strong case can be made that the reason HC costs went up form most is because the ACA required coverage for children (college students) up to age 25, and also made them cover people with preexisting conditions. Before, the insurance companies were going through medical records looking for reasons to block people from getting coverage when they got really sick.

As for the getting something for free....it wasn't like the poor weren't getting HC in the US. Instead of getting preventative care relatively cheaply at a PCP, they were going to the ER.

JMHO, the real problem with our HC system is an insurance industry/beurocracy that is eating up about 50% of the costs and a pharmaceutical industry that charges whatever the hell they want. ACA handed those bastards the keys likely because they wrote the law.

As for Canada and the UK, they pay like half of what we pay. they are some of the cheapest socialized systems. But I think I'd prefer to have less access to the latest and greatest if I didn't have to spend hours each month fighting the insurance co for pharmaceuticals every month.
30

Yes. The price is being manipulated. I had assumed that Humalin was still at the, shall we say, "regular" price, but the price I have (about $18) was one from memory of about 2000. Apparently the cost in 2009 was about $24/vial:

http://www.diabetesdaily.com/forum/type-2-diabetes/70445-cost-s-insulin-you-gotta-kidding-me-2

Try Mexico; insulin (including Humalin) is a non-prescription drug, you can buy it there and bring it back without any fear of US customs legally confiscating it (which they can for *Humalog* the GM variant).

Given that you are caring for a cat it can be a *lot* cheaper to pay for a vacation in Baja. No healthcare.gov for cats.

You can also ask your vet about using something other than human insulin; pig or cow. There's no particular logic to giving a cat human insulin rather than pig. I don't think pig/cow is available any longer in the US except on a very very expensive basis for those humans who show resistance to human insulin, but it might be available overseas.