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Author: Jeanwa Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: of 4314  
Subject: Prescription Drugs Date: 9/22/2012 2:22 PM
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I don't know if this is the right board....

I have a friend that works in the foster care field. She coordinates the foster parents and children. They mostly work with hard to work with children.

She went to pick up a prescription for the medication vyvanse. The pharmacist made the statement that it must be for a medicaid or medicare patient. She asked how they knew that. They said it was an expensive drug and medicare and medicaid are the only one that cover it.

I asked what other people got...she said cheaper meds for the same purpose. The prescription was for vyvanse. She said it also required a paper prescription, the doctor couldn't just call it in.

http://www.vyvanse.com/

She said there were several drugs that were more expensive that only medicare/medicaid covers, but couldn't remember their names.

How can I find out how to verify this?

Jean
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Author: steross Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 3889 of 4314
Subject: Re: Prescription Drugs Date: 9/23/2012 3:45 AM
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I don't think it is possible for you to fully verify this. All third party payers have their preferred medications and it is doubtful you could prove that none cover it other than medicaid.

This lady is claiming that her private insurance covered it then she could not get it covered when she switched to medicaid:
http://www.healthcentral.com/adhd/c/question/178285/52272

The doctor could not just call it in because it is an amphetamine and is DEA schedule II.

steross

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Author: Jeanwa Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 3890 of 4314
Subject: Re: Prescription Drugs Date: 9/23/2012 4:14 AM
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Thanks,

It sounds like maybe the pharmacist was just guessing.

My friend is a bit of a conspiracy theorist so I wondered. The drug companies and the government are in cahoots kind of thing.

One more thing. If a drug is still in the trial stage the parent and/or patient has to be informed of that, right?

Jean

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Author: Hubris Three stars, 500 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 3891 of 4314
Subject: Re: Prescription Drugs Date: 9/23/2012 11:23 AM
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If a drug is still in the trial stage the parent and/or patient has to be informed of that, right?

Sort of. A drug has to be officially approved by the FDA before it can be prescribed in the US. If a drug was not FDA-approved (i.e. still in phase III clinical trials) you'd only be able to get it in the context of a formal trial, and have to sign an informed consent. However, once a drug has been approved for one indication, it can be prescribed for anything (also known as "off label use" the label in this phrase being the official FDA indication). So a drug can be prescribed for indications where there is little or no evidence to support its use.

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Author: pauleckler Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 3892 of 4314
Subject: Re: Prescription Drugs Date: 9/23/2012 2:48 PM
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For what it's worth, I think you are talking about one aspect of "rationing" in the political dialogue on health care. Insurance companies encourage use of generics and favored brands with schedules that offer better coverage and hence lower cost for drugs on their list, and no or lower coverage for non-preferred drugs.

That is fine as long as the patient is well cared for. But some claim reactions to one drug and not another. Or that brand x is more effective than the generic. Similarly doctors are often more familiar with certain drugs and prefer to prescribe them. But that is often influenced by advertizing, sales persons, and various incentives.

Freedom to choose is great, but it does waste money and increases costs that ultimately all of us must pay.

Allowing Medicare to negotiate price deals for pharmaceuticals would save, but that is always strongly opposed by the pharmaceutical companies--even though it is done by the Veterans Administration and in Canada.

Giving patients freedom to choose lower cost drugs is generally good. When all costs are paid by someone else there is no incentive to save. This way is at least voluntary. And patients still have the option to pay full price for their drugs if they so choose.

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Author: erikinthered100 Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 3893 of 4314
Subject: Re: Prescription Drugs Date: 9/24/2012 9:56 PM
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Allowing Medicare to negotiate price deals for pharmaceuticals would save, but that is always strongly opposed by the pharmaceutical companies--even though it is done by the Veterans Administration and in Canada.

Medicare "negotiating" a price deal is essentially the same as the Corleones making an offer "you can't refuse." Medicare's bargaining position is too powerful to allow any real "negotiating." So you basically end up with a price set by government, otherwise known as a price control. Pharmaceutical companies will then just try to make up the difference by charging even higher prices to those without such bargaining power - or they will just stop making certain drugs (drugs that some people might need or benefit from). This is a recipe for an even more dysfunctional pharmaceutical market.

Giving patients freedom to choose lower cost drugs is generally good. When all costs are paid by someone else there is no incentive to save. This way is at least voluntary. And patients still have the option to pay full price for their drugs if they so choose.

Yes, allowing people greater control over their hard-earned money (in this case, their health care dollars) generally results in better use of that money. This is basic human nature and economics. Unfortunately, health care "reform" in the form of Obamacare pushes us in the other direction - towards greater third party payment.

dave

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Author: pauleckler Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 3894 of 4314
Subject: Re: Prescription Drugs Date: 9/25/2012 2:30 PM
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Medicare "negotiating" a price deal is essentially the same as the Corleones making an offer "you can't refuse." Medicare's bargaining position is too powerful to allow any real "negotiating."

How is this different from negotiating with Walmart? Of 30 brands of detergent, Walmart gives shelf space to the 8 it feels will serve 80% of the market. People who find the other 22 brands preferable for one reason or another can still buy them. But they usually cost more due to lower volume.

If several drugs are available for the same treatment, why should Medicare not encourage the use of the most cost effective drug. Others are still available for those who prefer them, but the patient--not the govt--pays more for that choice. Competitive bidding between those several drugs is a good thing. If they match each others pricing, then cover all of them.

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Author: Donna405 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 3895 of 4314
Subject: Re: Prescription Drugs Date: 9/25/2012 4:07 PM
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It is my understanding that when Medicare was established, I believe, under Lyndon Johnson, Congress decided that the US would not be negotiating on price for drugs for seniors. All it would take is for the "do nothing" Congress to change that. However, considering (in my opinion) that members of the "do nothing" Congress are collecting donations from the drug lobby, such members are not in the least bit interested in doing something for their constituents. If they were, they would have done it long ago. We must look to the VA to see what a benefit this could be. If seniors wish to have a different drug that is listed with Medicare, then they could pay for it.

I find that generics (except one) work well for me. However, if my doctor prescribes a prescription for which there is no generic, it is up to me to decide to pay for it.

Donna

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Author: erikinthered100 Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 3896 of 4314
Subject: Re: Prescription Drugs Date: 9/25/2012 8:12 PM
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How is this different from negotiating with Walmart? Of 30 brands of detergent, Walmart gives shelf space to the 8 it feels will serve 80% of the market. People who find the other 22 brands preferable for one reason or another can still buy them. But they usually cost more due to lower volume.

Walmart is not the government with a legally coerced near monopoly over a certain market (in this health care for the elderly). That's a HUGE difference.


If several drugs are available for the same treatment, why should Medicare not encourage the use of the most cost effective drug. Others are still available for those who prefer them, but the patient--not the govt--pays more for that choice. Competitive bidding between those several drugs is a good thing. If they match each others pricing, then cover all of them.

I agree that government health care systems should not be paying for higher priced drugs or treatment when less expensive options exist. Ideally, they should be a safety net paying for basic care. If the patient wishes to pay more for cadillac care or pricey drugs, they should make up the difference. Failure to place even reasonable limits on what government will pay for is literally bankrupting us.

The debate over whether Medicare can "negotiate" drug prices misses the underlying problem - the lack of a free market in health care. In an adequately functioning health care market, drug prices would already be at an appropriate point determined by supply and demand. Unleashing the power of government to control drug prices will only lead to more dysfunction in the health care market.


dave

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Author: pauleckler Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 3897 of 4314
Subject: Re: Prescription Drugs Date: 9/25/2012 9:30 PM
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In an adequately functioning health care market, drug prices would already be at an appropriate point determined by supply and demand.

I think this works quite well already in the case of generics. Your pharmacy has several suppliers to chose from and makes the best deal they can. I notice the tablets change shape and color from time to time indicating they have changed suppliers.

Of course, brand name suppliers play numerous games to convince you that their more costly, version is better. Advertizing, incentives to prescribers, and even reformulating the product--usually as a combination of medicines to keep it from becoming generic. (Prilosec becomes Nexium).

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Author: pauleckler Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 3898 of 4314
Subject: Re: Prescription Drugs Date: 9/25/2012 9:40 PM
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I find that generics (except one) work well for me. However, if my doctor prescribes a prescription for which there is no generic, it is up to me to decide to pay for it.

My Medicare Pt D plan has 3 tier coverage. Generics are almost free after deductible and monthly premium, preferred brands get better coverage than unpreferred brands.

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Author: Donna405 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 3899 of 4314
Subject: Re: Prescription Drugs Date: 9/26/2012 7:06 PM
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Paul: <<My Medicare Pt D plan has 3 tier coverage. Generics are almost free after deductible and monthly premium, preferred brands get better coverage than unpreferred brands. >>

I have Humana (through Wal-Mart) for my Pt. D, and have been very, very pleased with it. I take only one Rx on a continual basis, and like you, it is almost free (no deductible on the one I take). Of course, I must pay my monthly premium ($15.10) as of today.

Donna

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Author: pauleckler Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 3900 of 4314
Subject: Re: Prescription Drugs Date: 9/26/2012 10:57 PM
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Hi Donna. I too have the Humana service, but use their mail order service, Right Source, most of the time. But I use Walmart for short term trials, drug changes, etc.

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Author: Donna405 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 3901 of 4314
Subject: Re: Prescription Drugs Date: 9/27/2012 6:54 PM
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I also use RightSource, and have been mostly pleased with it. However, my doctor changed by Semvastatin to 20 mg per day, and RightSource cannot get the Rx right. It appears I will have to go obtain a hard copy of the Rx and mail it to RightSource.

Donna

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Author: pauleckler Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 3902 of 4314
Subject: Re: Prescription Drugs Date: 9/28/2012 11:56 AM
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Yes, I have troubles with Right Source too. They refill prescriptions OK, but renewals seem clunky and take phone calls. Plus I'd like to get all four of my prescriptions synchronized so I can refill them all on one visit to their webpage. In addition, some on line pharmacies can renew a prescription with one click of the mouse. I presume they fax the request to your doctor who faxes back a prescription.

Right Source will have none of this. I get robo calls telling me it is time to refill my prescription, only to find that one of them cannot be filled yet.

There always seem to be hassles renewing a prescription. I have to call my dr., tell her what I need, and have her fax it. Too much potential for mix ups.

And most recently one of the renewal drugs was out of stock and refilling was delayed.

I keep hoping Right Source will get its act together, but the fact that it is clunky makes me consider changing Pt D providers.

Plus I read that Pt D recipients are in for a major increase in premiums next year.

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Author: Donna405 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 3903 of 4314
Subject: Re: Prescription Drugs Date: 9/28/2012 4:46 PM
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Look what I found: http://www.q1medicare.com/PartD-2013MedicarePartD-PlanStatis...

It looks like Humana will be lowering the Part D premium to $15.00 from $15.10; however, many other plans are increasing the premium.

Donna

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Author: Donna405 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 3904 of 4314
Subject: Re: Prescription Drugs Date: 9/28/2012 4:54 PM
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Oops, it looks like Humana is increasing its rates in SC to $18.50; however, the AARP plan will be $15.00. Since 10/15 is the date to change the plans, I have requested e-mail info regarding the AARP plan. If there is a more efficient mail-order availability, I probably will go with that.

http://www.q1medicare.com/PartD-SearchPDPMedicare-2013PlanFi... Gap Coverage

You can go to your state and get info.

Donna

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Author: alstroemeria Big gold star, 5000 posts Top Recommended Fools Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 3905 of 4314
Subject: Re: Prescription Drugs Date: 9/30/2012 11:06 AM
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I agree that government health care systems should not be paying for higher priced drugs or treatment when less expensive options exist. Ideally, they should be a safety net paying for basic care. If the patient wishes to pay more for cadillac care or pricey drugs, they should make up the difference. Failure to place even reasonable limits on what government will pay for is literally bankrupting us.

I agree in theory, but in practice not so black & white. I tried several steroid nasal sprays for severe allergies/sinus probs, but the only one that works for me (the others actually stuff me up more than I am to begin with) is Nasonex, for which my insurer makes me pay $150 for a 3-month supply as it's non-preferred. SO I make it last 6 months by using it on alternate days, alternating with an herbal concoction, which isn't strong enough to use all the time, but it helps a little (not nearly as good as Nasonex, but unlike other prescriptions, at least it doesn't make my problem worse). I pay full price for it as it's OTC. I take a different germ-fighting herbal nasal spray in the daytime, which seems to avoid getting so many respiratory infections. Also pay full price as it's OTC.

SO...I don't want the pricy nasal spray because I feel entitled to "cadillac care" (what is that, anyway?). I merely think I'm entitled to breathe.

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Author: Donna405 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 3906 of 4314
Subject: Re: Prescription Drugs Date: 9/30/2012 5:12 PM
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Hi, girlfriend. I, too, have allergies, albeit not as bad as yours. (By the way, I snore, so be prepared when Linda and I go to visit you. That's why I volunteered for the airbed.) I have found that using either a neti pot or a saline nasal spray does the trick. I do take Mucinex at night about 50% of the time, which reduces the snoring somewhat, along with using a special pillow.

Donna

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Author: alstroemeria Big gold star, 5000 posts Top Recommended Fools Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 3907 of 4314
Subject: Re: Prescription Drugs Date: 10/1/2012 5:19 PM
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neti pot or a saline nasal spray

I'm askeered of pouring water up my nose ;-) but my alternative nasal sprays are both based on saline. The daytime germ-fighting one includes grapefruit seed extract, and the alternative night-time one has various herbs and smells like eucalyptus.

Looking forward to seeing you again in a few weeks, Donna.

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Author: Donna405 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 3908 of 4314
Subject: Re: Prescription Drugs Date: 10/1/2012 5:56 PM
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Astroe: Where did you find the night-time nasal spray that smells like eucalyptus. Eucalyptus candles, other than balsam, are the only ones I can burn in my house, due to my allegies. I LOVE the scent of eucalyptus.

Donna (who can't wait to see you two, and meeting Linda)

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Author: pauleckler Big funky green star, 20000 posts Top Favorite Fools Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 3909 of 4314
Subject: Re: Prescription Drugs Date: 10/1/2012 9:29 PM
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You can get eucalyptus oil at your local drug store, or if not from Amazon.

Eucalyptus oil probably won't be soluble in your saline solution, but may mix well enough. If not try adding a few drops of detergent.

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