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Cancer patients are being denied drugs, even with doctor prescriptions and good insurance

Dittohead not!

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[h=3]Cancer patients are being denied drugs, even with doctor prescriptions and good insurance[/h]
But that insurance didn’t ensure Smith would get the drugs she needed when facing CVS Specialty Pharmacy – the pharmacy their insurance required them to use. Cancer drugs prescribed by Smith’s oncologist were denied because they didn’t follow the standard protocol sequence of medications that Smith’s pharmacy benefit manager, CVS Caremark, had in their guidelines.
That means pharmacy benefit managers have the authority to trump a doctor’s medical judgment without seeing patients or knowing their full medical history, and without accountability for the consequences of what happens to sick people.

"Pharmacy benefit managers," not doctors, get to decide on which drugs a patient can have. While they decide, and appeals are made, cancer patients get sicker and sicker.

Cancer drugs are very expensive, into the hundreds of thousands of dollars. That's one part of the problem. The other part is managing care for the benefit of the pharmacy, rather than the benefit of the patient.
 
Anti-American drivel.

This is what “freedom” is all about and speaking against it is nothing but communist propaganda.
 
Death Panel that is what that is
 
[h=3]Cancer patients are being denied drugs, even with doctor prescriptions and good insurance[/h]


"Pharmacy benefit managers," not doctors, get to decide on which drugs a patient can have. While they decide, and appeals are made, cancer patients get sicker and sicker.

Cancer drugs are very expensive, into the hundreds of thousands of dollars. That's one part of the problem. The other part is managing care for the benefit of the pharmacy, rather than the benefit of the patient.

Argument for universal health care.
 
Anti-American drivel.

This is what “freedom” is all about and speaking against it is nothing but communist propaganda.

Freedom is about letting people die from cancer while a representative of the pharmaceutical company decides whether or not to treat them?

That's freedom to you?
 
Freedom is about letting people die from cancer while a representative of the pharmaceutical company decides whether or not to treat them?

That's freedom to you?

Of course.

I mean what’s freedom if massive corporations can’t screw over cancer patients?

What, you wanna be like Venezuela?

Demanding an affordable and better healthcare system such as those that work in every other industrialized nation and more reasonable drug prices is nothing but anti-American and communist propaganda.

Hail the aristocracy!

(Try reading it again mate).
 
Of course.

I mean what’s freedom if massive corporations can’t screw over cancer patients?

What, you wanna be like Venezuela?

Demanding an affordable and better healthcare system such as those that work in every other industrialized nation and more reasonable drug prices is nothing but anti-American and communist propaganda.

Hail the aristocracy!

(Try reading it again mate).

Sometimes, reality is so absurd that satire is difficult to detect.
 
Seeing not 1 but 2 loved ones suffer through the effects of cancer drugs and die anyway, I'm not so sure the OP is a bad thing...years and years of research and this is all we got to treat cancer? if I came down with it tomorrow, I would take my chances without subjecting my body to the added poisons of cancer treatments...
 
Seeing not 1 but 2 loved ones suffer through the effects of cancer drugs and die anyway, I'm not so sure the OP is a bad thing...years and years of research and this is all we got to treat cancer? if I came down with it tomorrow, I would take my chances without subjecting my body to the added poisons of cancer treatments...

I'm very close with someone who underwent chemo from the very drugs mentioned in the OP, and has now been in remission for two years. Will the cancer come back? Doctors say yes, but she can fight it once again.

Or, you can just give up and let the cancer take you to your grave.
 
[h=3]Cancer patients are being denied drugs, even with doctor prescriptions and good insurance[/h]


"Pharmacy benefit managers," not doctors, get to decide on which drugs a patient can have. While they decide, and appeals are made, cancer patients get sicker and sicker.

Cancer drugs are very expensive, into the hundreds of thousands of dollars. That's one part of the problem. The other part is managing care for the benefit of the pharmacy, rather than the benefit of the patient.

This is a very good discussion point here.

First.. The decision here is based on saving money. First.. its money for the insurance company.. and the insurance company is using the pharmacy PBM... to manage the healthcare so that its less costly. So..the pharmacy.. is using the PBM... because the insurance company gives them a better rate.. or exclusive contract if they manage their costs better. (I believe this patient is required by the insurance to use CVS)//

So whats driving this is frankly lowering healthcare costs. And the reason is that they are using the pharmacists managers.. to make sure that the DR. is not simply ordering the most expensive drug off the bat.. before using other drugs.. which are cheaper and have been shown to be as effective.. or in some cases more effective .

OR that the DR is not choosing a drug that he can charge more for because its an infusion (and he owns the infusion clinic).. or its a drug that he gets a kickback for.

Secondly: This is exactly how other countries get a good portion of their healthcare savings.. exactly like this. Its kind of funny watching folks here post about "this is why we need Bernie or universal healthcare".

This kind of cost containment is EXACTLY how most countries get a significant portion of their healthcare savings. For the vast vast majority of people.. the standard of care.. which is what the pharmacy wanted her to do.. works for people. In fact.. its probably a very effective form of care. and is well documented.

The problem is.. this lady is an outlier. She had a reaction to the typical drug treatment. She is different. And because she does not fall within the norms.. she is having difficulty getting her medications.. and she is having to prove failure.. before she qualifies.. So as the doctor said.. its like she has to have liver failure before I can say the drug isn't working and get her the drug she needs.

This is one of the trade offs with a healthcare system.. particularly like other countries.. that is aimed at reducing healthcare costs. For the vast majority of individuals.. the drug regimen authorized probably works great. In fact.. its probably a standard of care.. and its also cheaper.
So better healthcare and cheaper...

UNLESS you are an outlier.. and then.. the system is not so good for you. In America.. we have generally opted for taking care of those outliers... so folks like this lady would likely get the drug they need... but it would mean other folks who would not have needed this expensive drug.. would have gotten it also... thus rising the overall cost of healthcare.

This is what I mean by "no free lunch".. when it comes to healthcare reform.
 
This is a very good discussion point here.

First.. The decision here is based on saving money. First.. its money for the insurance company.. and the insurance company is using the pharmacy PBM... to manage the healthcare so that its less costly. So..the pharmacy.. is using the PBM... because the insurance company gives them a better rate.. or exclusive contract if they manage their costs better. (I believe this patient is required by the insurance to use CVS)//

So whats driving this is frankly lowering healthcare costs. And the reason is that they are using the pharmacists managers.. to make sure that the DR. is not simply ordering the most expensive drug off the bat.. before using other drugs.. which are cheaper and have been shown to be as effective.. or in some cases more effective .

OR that the DR is not choosing a drug that he can charge more for because its an infusion (and he owns the infusion clinic).. or its a drug that he gets a kickback for.

Secondly: This is exactly how other countries get a good portion of their healthcare savings.. exactly like this. Its kind of funny watching folks here post about "this is why we need Bernie or universal healthcare".

This kind of cost containment is EXACTLY how most countries get a significant portion of their healthcare savings. For the vast vast majority of people.. the standard of care.. which is what the pharmacy wanted her to do.. works for people. In fact.. its probably a very effective form of care. and is well documented.

The problem is.. this lady is an outlier. She had a reaction to the typical drug treatment. She is different. And because she does not fall within the norms.. she is having difficulty getting her medications.. and she is having to prove failure.. before she qualifies.. So as the doctor said.. its like she has to have liver failure before I can say the drug isn't working and get her the drug she needs.

This is one of the trade offs with a healthcare system.. particularly like other countries.. that is aimed at reducing healthcare costs. For the vast majority of individuals.. the drug regimen authorized probably works great. In fact.. its probably a standard of care.. and its also cheaper.
So better healthcare and cheaper...

UNLESS you are an outlier.. and then.. the system is not so good for you. In America.. we have generally opted for taking care of those outliers... so folks like this lady would likely get the drug they need... but it would mean other folks who would not have needed this expensive drug.. would have gotten it also... thus rising the overall cost of healthcare.

This is what I mean by "no free lunch".. when it comes to healthcare reform.

You make some good points. Of course, the insurance company wants to reduce costs in order to increase their bottom line, but they are trying to control costs.

Health care reform is a complicated process. Who knew?
 
You make some good points. Of course, the insurance company wants to reduce costs in order to increase their bottom line, but they are trying to control costs.

Health care reform is a complicated process. Who knew?

Exactly. And when you think about it.. when they are using pharmacists.. they are at least using professionals that understand the medications... unlike some bean counter who does know the difference between Prozac and Pantoprazole.

There is a trade off when it comes to reducing healthcare costs. When you try to reduce overutilization.. you are going to potentially cause problems with your outliers.

In the US.. we have always been more geared to what is best for the individual.. and less for the group. We would rather see that the kid with the weird cancer is saved.. rather than 500 people have cheaper healthcare.

Healthcare reform in a lot of ways is not as complicated as you think.. but we have to be willing to 1. Be truthful... Whether that's yelping about "Obamacare has death panels"... or screaming that healthcare is "bankrupting us we need single payer".

Neither is really based on the truth


We need to be honest with ourselves with what we want. Do we want a healthcare system that reduces the insurance for most americans.. to get insurance for the 10% that don't have insurance.


Do we want to reduce the cost of healthcare.. and thus reduce our GDP by 6% or more (more than the last recession).


Do we want a system that has less access for most people.. but has increased access for a few?
 
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i hope to live long enough to see American's health care system approach what other first world countries have been doing for decades.
 
i hope to live long enough to see American's health care system approach what other first world countries have been doing for decades.

So you agree with what happened to the woman in the OP?

If you think that's okay.. then you would be in support of what other first world countries have been doing for decades.
 
Freedom is about letting people die from cancer while a representative of the pharmaceutical company decides whether or not to treat them?

That's freedom to you?

It’s a pharmacy benefit manager. NOT a pharmaceutical company.

Believe me, we in pharma are really happy if you can get our drug easily.
 
It’s a pharmacy benefit manager. NOT a pharmaceutical company.

Believe me, we in pharma are really happy if you can get our drug easily.

I believe you.

I see the pharmacy benefit manager as a bureaucrat bean counter trying to improve the bottom line of the insurance company. Maybe that's just cynical, I don't know.
 
Exactly. And when you think about it.. when they are using pharmacists.. they are at least using professionals that understand the medications... unlike some bean counter who does know the difference between Prozac and Pantoprazole.

There is a trade off when it comes to reducing healthcare costs. When you try to reduce overutilization.. you are going to potentially cause problems with your outliers.

In the US.. we have always been more geared to what is best for the individual.. and less for the group. We would rather see that the kid with the weird cancer is saved.. rather than 500 people have cheaper healthcare.

Healthcare reform in a lot of ways is not as complicated as you think.. but we have to be willing to 1. Be truthful... Whether that's yelping about "Obamacare has death panels"... or screaming that healthcare is "bankrupting us we need single payer".

Neither is really based on the truth


We need to be honest with ourselves with what we want. Do we want a healthcare system that reduces the insurance for most americans.. to get insurance for the 10% that don't have insurance.


Do we want to reduce the cost of healthcare.. and thus reduce our GDP by 6% or more (more than the last recession).


Do we want a system that has less access for most people.. but has increased access for a few?

Unfortunately, today's political climate won't allow for an in depth discussion of the best way to approach the issue of health care. Ranting about death panels is more the level of discourse.

Now, those pharmacy benefit managers: Are they professional pharmacists, or are they bureaucrats?
 
I believe you.

I see the pharmacy benefit manager as a bureaucrat bean counter trying to improve the bottom line of the insurance company. Maybe that's just cynical, I don't know.

Yes and no.

They’re actually getting paid by the insurance company. But they really are contracting organizations that put the squeeze on reimbursement and steer patients to specific therapies for rebate dollars.
 
You didn't answer my question..

Are you okay with what happened to the woman in the OP..

IF you okay with it. that's what other first world countries have been doing for decades..

fake news.
 
Unfortunately, today's political climate won't allow for an in depth discussion of the best way to approach the issue of health care. Ranting about death panels is more the level of discourse.

Now, those pharmacy benefit managers: Are they professional pharmacists, or are they bureaucrats?

Both? It depends.. sometimes they are licensed pharmacists.. and bureaucrats.


Its like me.. I am a doctor.. and I own a business. SO.. I get placed in the position of whats best one particular patient.. whats best for patients overall.. and whats best for business. Resources are limited. Sure.. I can say use all the resources for one patient.. and its good for them... but it may mean that I have to delay treatment for 10 others just as worthy.. etc.

These relationships with the insurance companies are variable. Some of the pharmacy benefit managers work for a contractor.. that contracts with the insurance company.. and then the insurance company.. requires participating pharmacies.. to adhere to the decisions of the benefit manager.

Sometimes.. the benefit managers.. work for a company.. that owns a pharmacy chain... sooo.. the pharmacy chain.. will get exclusive access to an insurance companies clients.. because the pharmacy chain.. uses the pharmacy benefit managers to control cost for the insurance company. .
 
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