Rant about prescription costs

[IdahoMtnSpyder]

At the risk of creating a storm I can't help but share what I just have seen on my medical insurance account page. My wife and I have a number of prescriptions which are covered by my Federal Blue Cross insurance plan. Here is what the dollar aspect of our prescriptions is like for 2017.

The total submitted charges to BCBS by our local corner pharmacy and our mail order pharmacy is $49,453. The amount paid by BCBS is $4,605. My copay is $533. That means that of the total submitted charges the pharmacies were paid, and accepted as payment in full, the grand sum of $5,138. That is 10.4% of the billed amount. One extreme example, for one prescription, is $4200 billed, $17 paid by BCBS, and $3 paid by me. What does this mean? Either the drug companies are grossly overcharging for drugs and the distribution network still earns a profit when the drugs leave the manufacturer at about 5% of the billed amount, or the pharmacies all lose money on my prescription orders which then are made up for by the poor schmucks who have no insurance or only weak insurance providers. If the pharmacies are not losing money on my prescriptions, and I'm getting a bargain price, and the poor schmucks with no or poor insurance are paying more, is that fair to them? I don't think so.

In contrast my medical costs are $8,936 submitted, $1094 paid by BCBS, and $491 paid by me. That's a 17.7% reimbursement rate.

Mind you, I like getting my prescriptions and medical service at a low cost, and am grateful that I do. My medical insurance for me and my wife costs around $12,000 to $14,000 between me and Uncle Sam. But I sure feel sorry for all those who have to pay a lot more than I do. The medical pricing scheme in this country is broken, badly.

Let's see if we can discuss this without becoming all roiled! It's a serious problem for our country. We need a rational solution.

 

[BLUEKNIGHT911]

BCBS perscriptions +

At the risk of creating a storm I can't help but share what I just have seen on my medical insurance account page. My wife and I have a number of prescriptions which are covered by my Federal Blue Cross insurance plan. Here is what the dollar aspect of our prescriptions is like for 2017.

The total submitted charges to BCBS by our local corner pharmacy and our mail order pharmacy is $49,453. The amount paid by BCBS is $4,605. My copay is $533. That means that of the total submitted charges the pharmacies were paid, and accepted as payment in full, the grand sum of $5,138. That is 10.4% of the billed amount. One extreme example, for one prescription, is $4200 billed, $17 paid by BCBS, and $3 paid by me. What does this mean? Either the drug companies are grossly overcharging for drugs and the distribution network still earns a profit when the drugs leave the manufacturer at about 5% of the billed amount, or the pharmacies all lose money on my prescription orders which then are made up for by the poor schmucks who have no insurance or only weak insurance providers. If the pharmacies are not losing money on my prescriptions, and I'm getting a bargain price, and the poor schmucks with no or poor insurance are paying more, is that fair to them? I don't think so.

In contrast my medical costs are $8,936 submitted, $1094 paid by BCBS, and $491 paid by me. That's a 17.7% reimbursement rate.

Mind you, I like getting my prescriptions and medical service at a low cost, and am grateful that I do. My medical insurance for me and my wife costs around $12,000 to $14,000 between me and Uncle Sam. But I sure feel sorry for all those who have to pay a lot more than I do. The medical pricing scheme in this country is broken, badly.

Let's see if we can discuss this without becoming all roiled! It's a serious problem for our country. We need a rational solution.

, If you have medicare like I do, I found the same thing - - - however I also found out that the MEDICARE was actually paying 95% of all my medical bills .....not BCBS ...... I think I'm going to OPT - OUT , now that I'm not forced into having Private insurance .....jmho , ... Mike :thumbup:

 

[IdahoMtnSpyder]

, If you have medicare like I do, I found the same thing - - - however I also found out that the MEDICARE was actually paying 95% of all my medical bills .....not BCBS ...... I think I'm going to OPT - OUT , now that I'm not forced into having Private insurance .....jmho , ... Mike :thumbup:

I have original Medicare plus the BCBS. I've often thought of dropping the BCBS but if I do I can never pick it back up again. A few years ago I looked at various options of Medicare and gap insurance and Medicare Advantage. In the end the total out of pocket cost varied only about $500 to a $1000/yr. My brother has Medicare Part B also plus private BCBS plan. He pays about the same total as I do. If you have a real major medical problem the deductible and copay for Medicare could be way more than the gap insurance premium. So it's all a gamble. Pay for the risk you are most comfortable with.

 

[ARtraveler]

Same deal with medical costs. I had almost $300,000 of surgery last year. Each one was over $75,000. Hospital & Medicare worked out the splits. I was personally responsible for about $10,000.

They used to "itemize" bills. Now it seems a fixed rate for procedure X. Anesthesia and Surgeons sent separate bills also.

Same for prescriptions.

Reason for the high prices: It costs pennies to produce pill X. Since the companies can no longer capitalize research & development--they have to charge it as it goes. That leaves a big negative hole before a drug hits the market place. They charge what the market will bear based on the type of drugs. That is why we have $1,000 pills. They are trying to make back their "loss" as quickly as possible.

My "small" pill debacle. After my stents procedure the Dr. prescribed pill X. We went to the pharmacy to pick up the 90 day supply. Pharmacist said that will be $900 please. We had to pass. Not covered by MC. Dr. found me a less expensive version. There is a point...and it was reached.

 

[SPECTACUALR SPIDERMAN]

it's not that much different then a lawyer who charges $340/hr when his legal secretary does most of the work
at $22.50/hr.

 

[Bob Denman]

But the medications and Doctor's visits are supposed to make you feel better... :thumbup:


...While Lawyers just make you feel sick to your stomach. :shocked: :barf:

 

[PrairieSpyder]

At the risk of creating a storm I can't help but share what I just have seen on my medical insurance account page. My wife and I have a number of prescriptions which are covered by my Federal Blue Cross insurance plan. Here is what the dollar aspect of our prescriptions is like for 2017.

The total submitted charges to BCBS by our local corner pharmacy and our mail order pharmacy is $49,453. The amount paid by BCBS is $4,605. My copay is $533. That means that of the total submitted charges the pharmacies were paid, and accepted as payment in full, the grand sum of $5,138. That is 10.4% of the billed amount. One extreme example, for one prescription, is $4200 billed, $17 paid by BCBS, and $3 paid by me. What does this mean? Either the drug companies are grossly overcharging for drugs and the distribution network still earns a profit when the drugs leave the manufacturer at about 5% of the billed amount, or the pharmacies all lose money on my prescription orders which then are made up for by the poor schmucks who have no insurance or only weak insurance providers. If the pharmacies are not losing money on my prescriptions, and I'm getting a bargain price, and the poor schmucks with no or poor insurance are paying more, is that fair to them? I don't think so.

In contrast my medical costs are $8,936 submitted, $1094 paid by BCBS, and $491 paid by me. That's a 17.7% reimbursement rate.

Mind you, I like getting my prescriptions and medical service at a low cost, and am grateful that I do. My medical insurance for me and my wife costs around $12,000 to $14,000 between me and Uncle Sam. But I sure feel sorry for all those who have to pay a lot more than I do. The medical pricing scheme in this country is broken, badly.

Let's see if we can discuss this without becoming all roiled! It's a serious problem for our country. We need a rational solution.

You also need to add in the costs you pay for the supplementary insurance and the cost to the government for Medicare, etc. over and above whatever you paid over your working years for Medicare.

 

[Rob Rodriguez]

Completely agree we need a rational solution. I don't think we will have one any time soon. Politicians are too busy fighting among each other and "big business" completely controls how "healthcare" works in this country. Neither gives a damn about the people that actually use healthcare and neither lives in the "real world"

Since it seems a lot of people in the USA are against a government controlled healthcare system like most other countries have I think we need to go the route of people obtaining their own insurance rather than employers providing insurance.

In my opinion employer sponsored healthcare is a major driving force in why/how the costs are out of control.

Why?

• Because most people have no idea what they are paying for health care (comes out of their check automatically) or what the true overall cost is.
• Employers have a large enough pool of money (or are able to achieve the $ required) to meet these over inflated costs year after year.

If everyone had to purchase their own health insurance on their own two thing would happen.

• People would be in shock at what health insurance really costs
• Very few would purchase health insurance because no one would be able to afford it

Insurance companies, hospitals, etc, etc would be forced to have more reasonable costs because they wouldn't be able to sell their product at current pricing.
The old,"how much does it cost?, how much do you have?" wouldn't/couldn't be the pricing model as it currently is.

Would this solve the entire issue. Absolutely not, but its a step in the right direction.

 

[UtahPete]

But the medications and Doctor's visits are supposed to make you feel better... :thumbup: ...While Lawyers just make you feel sick to your stomach. :shocked: :barf:

They say we have the best justice system that money can buy. nojoke

 

[UtahPete]

On the other hand, if your IRA / KEOUGH is invested in pharmaceuticals, you're doing quite well...nojoke

The way our healthcare payment system has evolved, there are now way too many companies and individuals profiting from the status quo for it to ever change in any meaningful way.

 

[Bob Denman]

They say we have the best justice system that money can buy. nojoke

:banghead: Ain't that the truth! :gaah::cus:

 

[R FUN]

I think we still have one of the best systems in the world no matter what some of your polatitions like to say, For an example, I went to get a stress test and the doctor said something wasnt right. He said he needed to operate and by 6;00 AM the next morning was on the operating table and they put 2 stents
in one of the main arteries.The cost to me ZERO dollars. they dont even send a bill. Cost of medication maximum $20.00 per prescription, government picks up ballance. The wife had breast cancer, they operated immediately and then went on keemo and all the treatments and is now cured and never seen a bill, also for cancer there is no cost for any medication. Yes, we pay 6% tax on most purchases of new vehicles clothing etc. but that is a small price to pay for the average person unless you want to buy expensive toys every year. This is in Saskatchewan Canada. We do not need to pay any insurance premiums etc,
Hope you all have good health in the new year

 

[UtahPete]

I think we still have one of the best systems in the world no matter what some of your polatitions like to say, This is in Saskatchewan Canada. We do not need to pay any insurance premiums etc,

I agree. But then again, you're a more egalitarian system than ours. Here, that's demonized as 'socialism'.

 

[Bob Denman]

If anybody thinks that the Canadian Healthcare system is better than ours: I'm pretty sure that they'd be happy for us to join them up there!

 

[UtahPete]

If anybody thinks that the Canadian Healthcare system is better than ours: I'm pretty sure that they'd be happy for us to join them up there!

It's too damn cold; otherwise I'd take advantage of my dual citizenship! Anyway, I don't think any of the comments so far have implied we have an inferior healthcare system. Our way of paying for healthcare (including meds) is at question here. It's simply unsustainable; something is going to break and it won't be the 1% who will suffer the consequences.

 

[johnsimion]

it's not that much different then a lawyer who charges $340/hr when his legal secretary does most of the work
at $22.50/hr.

Having been in private practice ... if your lawyer is charging $340 an hour for work actually done by his/her legal secretary, that is absolutely fraud and you have a legitimate complaint to the local Bar association. You are entitled to an itemized bill showing what the lawyer did to earn the $340 an hour. Not only that, but they would have to produce time slips showing what they did, when they did it, and how long it took them. I'd bet that if you asked for such an accounting, the first response you'd get is an offer to simply cut the bill in half. Thing is, most people are too shy to ask for such an accounting ... and there are some lawyers who know this and depend on it. When I was licensed back in 1982, we had an honorable profession. Now it's 90% ambulance chasers. This kind of thing drove me crazy in short order which is why I spent most of my career in the Army and Air Force, both in uniform as a JAG and as a civilian attorney.

 

[RinconRyder]

The same type of "overcharging" is being done with surgeries as well as Rx's.

I had two cataract surgeries this year (one per eye) and got a detailed billing for each one:

Surgery as billed by doctor = $2,400. Accepted by doctor (insurance payment): $600 Yep, 25% And that $600 includes three follow up visits post-op.

 

[johnsimion]

The total submitted charges to BCBS by our local corner pharmacy and our mail order pharmacy is $49,453. The amount paid by BCBS is $4,605. My copay is $533. That means that of the total submitted charges the pharmacies were paid, and accepted as payment in full, the grand sum of $5,138. That is 10.4% of the billed amount.

Here's one easy solution that neither party will ever talk about. Why are drugs expensive? The drug companies CONSTANTLY advertise prescription drugs on TV ... "Ask your doctor about ..." Why should patients ask their doctor about "X" drugs? It's legitimate to advertise to the doctors who actually prescribe the drugs, but advertising to the patients to beg their doctors to prescribe the drugs makes the patient into the doctor and artificially increases demand. Higher demand = higher prices. Then there's the fact that we don't allow the same drugs that are made overseas to be sold here, limiting supply. So if you have increased demand and limited supply, what do you get? High prices.

The laws of economics also don't seem to apply to medical insurance and the medical profession. People don't seem to understand that higher medical costs lead to higher insurance costs, and that's going to be true under *****care or any other system. Until people make that connection, medical insurance costs are going to rise. So what to do about it? Here in Las Vegas we sometimes have to wait 3 months to see a general practitioner. Why? Not enough doctors. Too much demand, not enough supply, so they can and do charge $300 for a 5 minute office visit. My wife had a panic attack and I took her to the ER and they ran some tests and decided she was okay. Billed the insurance company $14,000. When medical costs are that much, that's why health insurance is so darned expensive. So WTH don't we graduate more doctors and allow more foreign doctors to immigrate here? Because that means less money for doctors and less money for insurance companies.

Then we have the ambulance-chasing lawyers who advertise constantly and unnecessary lawsuits do, I'm sure, also contribute to high medical insurance costs. Why do we allow this?

One thing is for sure, 30 years ago we did not have prescription drugs being advertised on TV, we did not have ambulance-chasing lawyers advertising on TV, and you didn't have to wait 3 months to see a doctor. And health insurance cost a fraction of what it does now. Am I wrong to see a connection?

 

[nhoj]

You are always welcome here Bob

If anybody thinks that the Canadian Healthcare system is better than ours: I'm pretty sure that they'd be happy for us to join them up there!

Come on up any time Bob. You are always welcome. I'll even subscribe to Fox News for you

 

[Bob Denman]

Thanks! :thumbup: