Brand Name $189; Generic $4.00

anneshirley

Brand Name $189; Generic $4.00

anneshirley

Totally off topic, but I have to tell someone.  Went to dermatologist last week--patient in his practice for +30 years but haven't seen the "big guy" in years, which is good, as I don't like him.  I've had pre-cancerous lesions on face for years--basal cell, mainly.  I've had this dry patch around nose, and when his assistant (not a nurse) asked me why I was there, I told her.  She, not a nurse, doesn't even look at the area.  And neither does he. After leaving me sitting in examining chair for 45 minutes, he finally comes in, after I poked my head outside and asked what was going on.  When I looked out, I could see him sitting at his computer, and before that I heard him gossipying about vacations with one of his staff for 15 minutes. He walks across room, never examines me (about 15 feet away), says it may be Seborrah, but if not, it's cancer.  Gives me prescription for cream and says come back in three weeks.  (I changed my appointment to be sure I didn't get him next time.)  I dropped the prescription off at Duane Reade yesterday--neither drug is in stock.  I call today and I'm told that my thyroid medication is filled (Levoxyl) and is ready for pickup--$12.00 for 90 pills. My thyroid doctor insisted on Synthyroid, but that's ok; it's cheaper as generic, so I say ok.  Then woman on phone tells me the cream for Sebborah is $189.00.  I screamed, "What!"  She says I don't know why; I'll call you back.  She just called back and says, "It's $4.00; we're giving you the generic."

The recent news about the cholesterol drug that doesn't work, that folks have been taking for years--making millions for the drug company, which surpressed findings from its trial for more than two years--tells me we have to do something about the drug problem. When I lived in Italy, all my drugs were half the price of here, and many of them much lower.  Thyroid medication was about $1.00.

How did we get into such a mess!   

wishiwere

He walks across room, never examines me (about 15 feet away), says it may be Seborrah, but if not, it's cancer. 

Are you going to get a second opinion from someone who maybe cares about the patient and his profession, I hope?

also?Anneshirley?  You might want to do some resesarch in regards to switching thyroid medications.  It's not so much that the 'generics' are not as good as it is, they are sometimes a different potency or some such thing I read.  Anyway, I've read several sites that say to at the very least, stay with one brand and get tested after switching (can't remember how long after the switch) to be sure it's working the same for you.

And yes.  The prices are outrageous.  Then again, it's outrageous too, that the ins. companies won't pay for a new drug when it comes out even if it is better, b/c of the price.  They'd rather you continue or try a less capable drug for several months first.  Kind of testing the guinea?  Stupid really. 

Good luck with your meds. 

anneshirley

Hi Wish,

You're right about the thyroid medication.  My doctor told this to me when I asked her to prescribe the generic.  However, I was just tested, and in 90 days will be tested again.  I'll put the blame on the Drug Store, which changed the prescription.  As long as my numbers stay down.  But good advice.

Also good advice about doctor.  However, he has a large practice (and is himself very well known in skin cancer field).  I'm returning to another doctor in the office in three weeks, and I like her and trust her.  I didn't exaggerate one bit.  He actually didn't look at my face.  I suppose he was annoyed that I asked why I was sitting in the exam room so long, and he's older and very well thought of by himself.

I disliked both:  drug companies and insurance companies and trust neither.  Thanks for good advice.  

Anonymous

Anneshirley, my aunt was put in a room and sat there for some time.  She finally got angry, left the room (in the nice little sexy gowns we are given to wear), knocked on the doctor's door, walked in, he was on the phone, and told him she was leaving.  Well, the doc promptly got off the phone and did his thing. 

Thanks for bringing up a memory of my aunt who took no crap off anyone. LOL  God rest her soul.

Shirley

Shirley

ravdeb

That's terrible! But..question..what cholesterol pill doesn't work that people are taking? If on a pill to bring down cholesterol, it's important to have a blood test every 3 months to make sure all is well.If it doesn't work, the cholesterol results would show that, wouldn't they?

abbadoodles

Oh, Shirley, I *loved* that story about your feisty aunt!  Thank you for giving me a really good, good feeling today. 

Up with crusty old ladies.  They shall inherit the earth. 

Tina

OneBadBoob

Zetia

http://www.nytimes.com/2008/01/15/business/15drug.html?ei=5087&em=&en=8fe3c3027641d061&ex=1200632400&adxnnl=1&adxnnlx=1200499438-XzFqKbMRi6teHNGFsANw8A

http://www.nytimes.com/2008/01/14/business/14cnd-drug.html?em&ex=1200632400&en=f08886103e399d2f&ei=5087%0A

Another one who HATES insurance companies and drug companies. . .

snowyday

When I read your posts from the US I really feel for everyone that has to pay the ridiculous prices that they charge down there.  We are lucky in Canada that the drug prices are controlled by the Gov't. In other words, we get the very same medications you get but the drug companies can't overprice like they do in the States. I've read a few post about women wondering if our drugs are just as good, and yes they are the same thing. I just wish that your government would chuck the drug company lobbiest's and give everyone in your country the a decent price range. It upsets me to no end when I see a post from a women who can't afford the medication she needs to save her life.  I honestly find it unbelievable.  We aren't perfect up here with are health system, but man I rather wait for a Doctor for a month than worry about losing my home because of the costs of Drs' appts., medications the whole shebang.  It seems to me if your Rich your okay, if your poor your covered but if your middle class you could lose it all.  My heart goes out to each and every lady who has had to make those decisions. Pearl49

Jorf

It's also outrageous how much difference you can find on the same drug at different pharmacies. If you're paying out of pocket or a percentage of your medication costs CALL AROUND!!!! One time I found the same (generic) drug costing between $25 and $125! Invariably when I've done this I've found the cheapest prices at the small, locally owned pharmacies so now, even with insurance, I always use them over the chains. In our area always the most expensive was a big chain grocery store pharmacy (Stop & Shop in Massachusetts). Target was usually second cheapest (this was before $4 generics).

Support your local privately owned pharmacies and save yourself some money all at once!

It's totally sickening. I just handed 4 sample bottles of insulin to a patient today who, with her insurance, has to pay $40 a bottle (and she takes 10 bottles per month!!!!). It was so bizarre, I said, "Here's $160!" Disgusting. At least she's someone who is somehow able to pull it off. 

*********

I just read the Zetia links - hadn't seen them. You know, there are so many drugs that are in use that have good effects on markers for disease but don't necessarily help the underlying disease - like Zetia, which decreased lipids but doesn't keep you from getting the heart attack. Like medicines for diabetes that can decrease your blood sugar but doesn't necessarily decrease complications from the disease. It's a really really sick system, especially in the US. Don't get me started because it's 12:30 and I have to start seeing patients at 8! 

Anonymous

Jane, that article made me sick!  I need to check which drug my dh is taking. 

OneBadBoob

It seems to me if your Rich your okay, if your poor your covered but if your middle class you could lose it all.

That about sums it up, Pearl.

Those of us in the middle are screwed.  I feel a rant coming on--

What good is it find new drugs that prolong DFS when our insurance companies deny benefits covering them because they are not in their "formulary?" 

What good does it do to find great anti-nausea meds, then have our US pharmacies sell them at $41.00 plus per pill that last for 8 hours?  (and, these same pills, Zofran, can be purchased at any European pharmacy, with no prescription, for 1.6 Euros per pill?)  And, if your insurance here in the US covers them, they usually will only cover 6 pills per 30 days?  Hello?  Anyone had any chemo where they had only one treatment per 30 days?

Now, the latest "scheme" these insurance companies have is using http://www.carecorenational.com/ to help them deny testing and treatments, especially in oncology--

For my $1460.00 per month premium for me and hubby, I cannot tell you the nightmare of denials of benefits I have had. 

I could rant on and on. 

anneshirley

Hi OBB,

When I was first diagnosed, a friend who had been there told me to ask for Zofran.  I did and my doctor, instead, wrote me a prescription for Compazine and also didn't give me a script for pain--said take Iubrofen. I was doing Taxol and Carboplatin.  Two days in, taking Compazine, I couldn't sit still.  Really, it was beyond description.  I went to see another doctor, with a large waiting room.  I changed chairs every minute; luckily it was almost empty, then walked around, went outside, came back, moving all the time.  When I got home, I was in pain but couldn't sit still, so my husband helped me up and down to floor, chairs, couch, etc.  I called oncologist's office and they said they'd get back to me.  In the meantime, I had had no nausea so I stopped taking that pill.  A week later, the oncologist nurse from the practice called to tell me to stop taking Compazine; I was having a reaction.  If I had still been on Compazine by that time I would have jumped out a window.  The dosage they prescribed affects 40% of people this way.  But Compazine is cheap and insurance companies will approve it.  I don't blame my doctor, much, on this one.  i think he knew the insurance company wouldn't approve Zofran.

Back to story.  So since I didn't have nausea first time around, for the second infusion they gave me nothing.  I was so sick! I think it was at that point I resolved not to do any more chemo treatments (which were not, for me, as many women have described: "very doable"), or perhaps it was the pain.  It was horrible.  I'm very careful about not taking too much pain medication, and I normally have a high threshold for pain, so I had a fair number of oxycodone pills left over from four years earlier when I had surgery on a frozen shoulder (Iubrofen did nothing to relieve the pain).  I took those but when they were gone, I remained in horrible pain until a few days before my next infusion.   End of story, I did two rounds and refused to do any more.  I was scheduled for four rounds of TCH. I should have been more forceful with my doctor to get the medication I needed, but I hate asking for anything, and to ask twice!  I couldn't do it.  Please, anyone new here, don't let them put you off.  Get what you need to make it through chemo.  Don't follow my example, which frankly was stupid.   

When we first moved to Italy in 2001, we had U.S. insurance.  I kept it just in case, and paid the $1000 a month for both of us.  Two years after we were living in italy (I had already paid $24,000 in premiums) we were dropped because we were living in Europe.  I also have an Irish passport, and as a member of the EU, I applied for Italian insurance.  When we were told what I'd have to pay in premiums a year I nearly choked.  At exchange prices then, it was $390 for the year.  When we moved to another region of Umbria a year later, it was free.  My husband who at first didn't have insurance, needed a colonoscopy; when it was finished my husband asked what he owed. His doctor said, joking:  "it was a pleasure looking at your colon, nothing."  And added, not joking, Italians don't pay and I don't think you should since you like our country enough to live here!  True story.  

We need to change things here.  There's absolutely no reason why medical costs are much higher than those in other countries where they have better care.  Italy, at the time, was rated second in quality of care by the World Health Organization.  U.S. was rated 37.

  

OneBadBoob

Oh Anne, I hear you loud and clear!!

They started up with the wrong one with me. 

My Zofran story:  After fighting with the insurance company, asking them for their f87king pre-certification for my ER visit, which I intended to make if my vommiting was not controlled, and letting them know it would end up costing them a whole lot more than 30 Zofrans, and insisting on the name of the person who deemed these pills "medically unnecessary" so I could file the appropriate complaint with the State Department of Education for this person, if they were not a physician, practicing medicine without a license, or if they were a physician, to bring a lawsuit against them for their failure to properly diagnose and treat me, and getting then names of all the people in customer service that I spoke to since I intended to name them personally as defendants in my lawsuit--

Lo and behold!  They faxed forms over to my onc to sign and approved 30 Zofran every 22 days through April, 2008.  Interesting?  Well, I finished chemo last week, but will continue to fill that Zofran script through April and donate them to my infusion center for others who need it and cannot afford it.

And, they denied my pre-cert for a CT scan, and approved the PET scan.

Here is what happened--long, but interesting: he he he--it has been approved as of Monday:

January 11, 2008

Dr. B

Greenwich, CT 06831

Attention: Vanessa

Re: Denial of Pre-certification for CT Scan by H N for Jane D

Hi Vanessa-

Just reiterating my dealing with H N today and their response and statement of what is necessary for them to pre-certify the CT scan ordered by Dr. B to take place on the same day as the PET scan, which they have pre-certified.

First, when I spoke to Veronica (would not give out her last name) at HN this afternoon, she told me indeed the PET scan was approved, but that the CT scan was not denied because no request had ever been made for pre-certification of a CT scan on me by Dr. B. That is when I called you, Vanessa, and you were kind enough to fax copies of the denial letters for the CT scans from HN.

I then called HN back with those denial letters in my hand and spoke to Jaivaer V., who also started that he could not find any request for a CT scan or denial of that request by H N.

I got quite upset and told them I was holding the H N denial letters in my hand which had been faxed to me by my physician's office, and I insisted on speaking to a supervisor, because I would not stand for either out right lies or such sloppy record keeping when it is my health and body that is at stake. After being put on hold for 20 minutes, Jaivaer came back on and said indeed the request for a pre-cert of the CT scan came in to H N and was denied. When I asked for the name of the physician who had made this medical decision, when he had reviewed my medical records, and on what he based his decision which led him to this denial, Jaivaer V. told me it was probably a nurse who made this decision. I asked for that nurse's name so I could start the appropriate proceedings against her and file the appropriate claim with the State Department of Education and Licensing for practicing medicine without a license. I then insisted on speaking with a supervisor. Jaivaer told me supervisors do call backs 48 hours later. I told him I was not getting off the phone until I spoke to someone above him in a supervisory position.

After another long period of being on hold, I was then connected to Margaret Williams of the accelerated customer service department of H N. After re-explaining the entire situation to her and again being put on hold, she told me she would do some further investigation and call me back.

Ms. Williams called back and explained to me that the reason the request for a pre-certification of the CT was denied was because it was scheduled for the same day as the PET scan. I told her I thought that was the most insane thing I had ever heard, since earlier in the morning I had a call from the Nuclear Medicine Department at Greenwich Hospital, who told me that the two tests would be done with the same piece of machinery and I would not even have to move out of it between the tests, but I would need different injections of contrast material for each test.

Again, I told Ms. Williams this was the most insane thing I have ever heard. I asked her if a pre-certification request was made to have the CT scan on the following Monday, would that be approved? She said yes, that would be approved. By this point I was nearly ranting over this insanity and mentioned to her that breast cancer involved a whole lot of anxiety and why should I be put through two separate trips to the hospital for two separate IV's, etc. And I was sure if I tried to refill my Xanax prescription early, it would be denied by H N.

Margaret Williams told me that if Dr. B faxed the reason for the medical necessity of having these two tests on the same day, they would review it and possibly approve it. The place to fax this information to is CareCore at 845-297-3940 or 845-298-1490.

Vanessa, please arrange to do this.

I told Ms. Williams that if the CT was not approved, I indeed wanted the name and telephone number of the physician denying it, and I wanted to speak to him by telephone. Ms. Williams told me the person issuing the denial will only speak to another physician, not a patient. I told her we have a daughter and son-in-law who are doctors, and if Dr. B could not speak directly with this denying physician, one of them would be more than happy to do so.

So, it looks like if your office faxes to CareCore the medical necessity of having these two tests performed on the same day (mainly my sanity, and the fact that CVS is out of Xanax) and let them know of my symptoms of bone aches, for which I am taking several Percocent daily or I cannot sleep because of the pain, and add in some shortness of breath, maybe we can get an approval and get this all done on one day.

Sincerely,

Jane D

You have to fight the insurance company tooth and nail.  They count on the majority of people just accepting the denial.  That is why they do it. 

And yes, it took me four and a half hours of phone time Friday, but I just refused to let it go.

I swear, when I get my energy back, I am going to stop rescuing cocker spanials and start some kind of advocy group for breast cancer patients in helping them fight for the benefits they have paid for!!!!!

I am on a roll with this stuff--now, today, I got back up to CT and have a phone call from a woman from HN, stating she has been appointed as my case manager and wants to help me solve any problems I am having with my coverage.

Interestingly, my attorney hubby sent them a letter informing them of our lawsuit which we will be filing, including a claim for intentional infliction of emotional distress. . .

anneshirley

May I call you Jane.  Wow, it never ends, does it?  Incredible--sounds more dramatic if you say it in Spanish.  But good for you that you persisted.  And sue the life out of them, please!

Comment: I've been having lots of discomfort (and pain) below my ribs and some times to the side, which is why I first joined this site; I wanted to ask if anyone else had this problem as well.  I called my oncologist and he said to give it six weeks (again, I don't blame him but I think he feels the insurance company will deny a request for a bone scan unless this persists for weeks), and take Ibuprofen (always spell that wrong) 3 x 3 a day (kills my stomach), that it might be inflammation of cartilege.  I started taking my husband's left over naproxen and it helps somewhat--and also discomfort is completely gone when I am in bed, so he may be correct.  I wonder if perhaps you might be having something of the same.

Other comment:  At my cancer center, they did a PET/CT scan at the same time.  Is this what your doctor wanted you to have, or is it actually first the PET and then the CT?  If this pain persists, I plan to ask for a PET/CT instead of bone scan--might as well check all the organs out so long as I'm at it.

Back to you.  I hope both scans are clean and its inflammation or one of the myriad other symptoms we now get after surgery, radiation, chemo, too many drugs, etc.  I try not to get too wound up, but I see that the remainder of my life will be a pain here, a pain there, and I'll always think the worst--someone called me a Pollyanna recently, and I thought:  You should only know!

Good health and luck! 

snowyday

Onebadboob your amazing that takes one hell of alot of patience to wait four hours on the phone, but more power to you.  Its horrible that you have to go through all that nonsense just to be treated properly and you have insurance. Scary, I hope something happens in the US in regards to insurance companies and the scams they pull on people that pay their premiums.  And the prices outrageous.  I hope you do start advocating for women with these problems. But I'm an animal lover and hope somehow you can still help the Cocker Spaniels. I just wish corporations weren't so damn greedy and thats what it is plain an simple. Again my heart goes out to all of you.Pearl49  wish I could fiquire out a way to help you guys down there?

OneBadBoob

Yup Anne, you can call me Jane--I'll keep calling you Anne till we drive together to the NJ meetup--then can I use your "other" name?

Sound to me like you could have Costochondritis (Tietze's syndrome) http://www.unboundedmedicine.com/2006/02/28/costochondritis-tietzes-syndrome/  There was a discussion thread on this recently, maybe one you started?  I had that a while back--moist heat, NSAIS's, and tincture of time were the cure.  And I had it way before the BC dx. 

BUT if you want the scans now, don't wait.  Tell your onc the pains have been for 12 weeks (and tell him why you are saying that), and have him write that on the pre-cert request.  I am learning how to get around this insurance insanity. . . 

My onc orders PET and CT scans on all his patients when they complete chemo, and he had requested them to be done at the same time.

I am not freaking out over my bone pains (yet).  I saw my rheumatogist this week, and told him me and onc think my bones have been working overtime on chemo making new blood cells (my blood counts stayed up and I did not need any neupagen, etc.) and rheumy thinks it is CMF induced arthralgias--according to rheumy, not uncommon in people undergoing CMF.

And you are so right--every little anything and we think the worst, so lets get it checked out, take a deep breath, and go onward!

Pearl, it was a pain in the butt, but I just would not let it go!

Yup, I love the cockers and animal rescue--let me share some of our Happy Tail Tales!

http://www.jamdweck.com/betsyscockerplace/before%20and%20after.htm

snowyday

Oooooh, thank you for the link, I was in tears of sadness and joy. I am an absolute animal nut, Trooper look just like a friend dog. And I'm so glad that faith had one good year.  I can't imagine you giving up such an important and gratifying cause.  I do as much as I can for the cats in my neighbourhood.  The sqirrels too, man they're so fat this winter. I watch the animal planet just about all the time last night they had a wonderful program on about Animals and the Tsunami it was so interesting.  My cat Blackie is quite the character, he's was a stray. I only take strays. But Blackie cleans my viens he really started annoying me with it about two years ago, then I found the lump and he would hold my arm or foot down and lick and lick and lick nothing would stop him, I'd go to the washroom he'd follow me and keep licking my feet or hands but really loved cleaning my arms right along the viens.  My rad Dr. was really interested in it so I showed him a video of it.  I believe they can tell well before us, it's so interesting. I'm going on and on.  I love the work your doing for your Cockers all I can say is WOW. Pearl49  And I'm glad you didn't give up and kept bothering your insurance company. They should call you Spunk.

Anonymous

I heard on the news yesterday that Zetia and Vytorin dont work as well as they thought.  Im glad my PCP uses generics.

Anonymous

Snowy, I have four cats two of which hang around me all the time.  They were adopted from cat adoption agencies. The other two cats were adopted from outdoors..strays.  Anyway, the two cats that hang with me like to lick my hand A LOT.  It does get annoying.  I've often wondered if.........OMG, don't tell me it's more cancer!  I've heard of animals that are sensitive to these things.

You think if I tell my onc she'll think I'm nuts!? LOL

Shirley

Anonymous

Jane, you must have been exhausted after that horribly long call.  It takes a lot from us.  You did good!

I think about the women that are too sick to fight for themselves thus, give up fighting the insurance thieves. 

While going through my txs I had absolutely no problem from my insurance company about ANYTHING the onc requested.  The only thing was that I couldn't take my Neulasta home with me so had to stay the night which we didn't mind.  We wrote it off our taxes.

We HAD the best insurance.  Now since AT&T has bought out Bell our insurance is maddening.  Our deductible is so high, $2200.  It was $200 for dh and $200 for me.  And this "network" crap is for the birds.  I can go out of network but it will, of course, cost us more.  I hope all my docs are in network.  So far it seems so.  No more $15 copay.  Now it's co-insurance.  And our drugs have gone up over twice the amount which is still not bad.

The Pharmas and insurance companies are crooks!  We're hearing about the "secret" the pharmas have been keeping about anti-deps and other drugs.  They should be sued!  I'm not a sueing person, but I sure thing they need to learn a lesson.  The "hit the pocket" is the best recourse.

Shirley