"Affordable" Care Act led to an across the board 60% increase in premiums...

For some time I didn't have any insurance, though strictly speaking I can get free medical care on a Sioux reservation. Before that I was on an insurance plan through my university, and before that I was on my parents' plan.

Remember that second example I pointed out? Her insurance didn't have anything to do with her final, proper diagnosis, other than to enable her to see a doctor willing to dig a bit deeper and look into what truly ailed her. Something she couldn't get in Canada.

Nothing like the American insurance system before the ACA.

Dad: Family history of colon cancer. Goes to primary care doctor, gets permission to go to specialist. Specialist decides due to his age he should have colonoscopy. Dad checks with primary care doctor, specialist, and insurance company to make sure everyone is on page so he can get this fun procedure at their recommendation. Procedure done, insurance company denies payment saying they do not feel procedure was needed. Both doctors want to get paid and insurance company says fuck you,. Dad gets sent to collections and has credit ruined for months while he fights with insurance company for payment they approved and wanted not him.

Mom: Has insurance and pays premiums. Breaks ankle. Goes to ER for treatment covered by insurance. ER bills insurance company. Payment denied because mom does not need her broken ankle set in cast according to insurance. Hospital sends mom to collections. Moms credit ruined for months while she fights insurance company for what they are supposed to pay for according to her contract with them.

Sister: Goes to regular check ups according to health plan. Is diagnosed pre cancer by test insurance carrier insisted on. Insurance company cancels policy. She cannot get reinsured due to preexisting condition of precancer. No treatment required because she is not sick but her son loses health insurance and his father has to get coverage because he is too young to have coverage on his own. this gets settled when ACA comes along and she has health care again.

This is american insurance. These people pay their bills all the time and believe in the system only to get screwed by the health insurance companies you feel do their job. Private for profit health insurance has one job and that is to make money for the shareholders like any corporation. everything else is secondary unless they are forced to do their contracted duty because your for profit health insurance company loses money by paying out medical costs they are contracted to. Paying the customer's medical cost is in direct conflict with the goal of any for profit corporation. This is american healthcare right now. Other countries may have other systems, but this is how american insurance operates when unregulated.

I have not answered the best part. Is there a better system aside from paying health insurance companies.

here is my experience. 0 reported income.

Start on ACA plan with insurance subsidized by government. Horrible feet pain and I know it is diabetic. Doctor sends me to a number of expensive tests includingf ultrasounbds on my legs and EKG ultrasound. Claims pain is seratonin syndrom. Never gives simple blood sugar prick test you can do for less than 50 dollars of retail equipment bought at walmart.

Health insurance expires and i am late on mailing back application so i have no insurance. Go to pay clinic drop 120 doklars and they do glocose test determining I am diabetic with immediate prescription for gabapentin and metformin both of which are free if you go to the right pharmacies because they are no longer under patent and cheap to make. if I had to pay for them they would be less than twenty a month.

Go to free clinic for monitoring since I have to now do that. Free clinic sets me up with multip0le doctors and an endocrimologist, but I have to see them when they do their hours. No emergency care. I get my blood tested for free, dietary advice for free, and even free dental. I have to apply to county health department because they may cover me until obamacare kicks in again.

Get approved by county wgho gives me free physical therapy and multiple different prescriptions and free insuling and diabetic supplies. My parents drop money on recommended endocrinologist just because. 80 dollars a vist. County even covers phychologist because i am suicidal from pain. I am paying less money flat out of pocket and getting service the health insurance people wont do because that doctor wants it to be seratonin syndrom so he can order all sorts of tests and shit.

Meanwhiole I get my blood sugar under control, find some pain relief through SSRIs and not opiod pain releif whicgh was what the obamacare doctor was thinking of doing. I get Physical therapy so I can build my muscles back up and walk again. I have testing and alk sorts of discounts on diabetic shit. i have doctors who seem to care and actually want to help rather than give me stupid tests i dont need while denyinbg the common simple answers. and they made sure I stayed with them when the obamacare kicked back in because now they can get paid.

I also priced out what the health department would charge if I had to do it on my own. They are a little less convenient but a lot more helpful, and they cost thirty to fifty percent less on procedures because it is all done onsite and they control costs. I get far better than bronze care from a non state primary physician. they link everything including eye care and dental.

I do not want the health insurance from obamacare anymore. I do not want to go to a private doctor after seeing what the public doctors are like in the US. Dude, my parents want to go to the health department doctors for their basic care. The reason why regular doctors are fucked up is because they have to be to get money from insurance. When you deal with a public option you actually get better health care, and they are multilingual and explain all the processes.

For a short version I have seen both private and public health care in the US. Private being either cash customers or health insurance and doctors that are not working with the health department. I am telling you right now the public health care system is better and covers more. Your private health insurance is confusing and you are not always sure what you get. You can barely talk to anyone and they are not in it for you to get service.

On the other side is public health insurance. They get paid and job security as they take in patients. This is the lie that public health insurance in america is going to take away service. It is wrong because public health workers guarantee tgheir job and pay by having more to do. So they are going to be there for you and give you your tests and medicine. Their budgets grow bigger by need, not by greed. Private insurance gets paid no matter what and loses money when you collect. Doctors have to fight them for profit so doctors act all stupid and prescribe high profit low work procedures because that is how they make money.

Maybe other countries have problems, but here in the US we already have a public base for health care. it works better than the private system. if we funded it for everyone we could expand it's abilities and budget for our health making it great while focussing on health and not the doctor having to make rent on his practice and his alimony and car payments. demand fuels public options better than the insurance companies cover them, You set standards by voting for better services, not some accountant at some death panel in an insurance company.

Be nice if the medical costs were just lower, wouldn't it?

Yes! Also, immortality, invulnerability, and angels.

Yeah sure that would be nice. Am I to take it you are done praising american health insurance companies?

Yeah, if only we could get Mexican laborers that live in a supply closet, or enslaved Chinese children chained to a wall to cut on our guts instead of qualified people.

Then people like you could whisper "John Galt", three times, and shoot a load in your pants.

Take that up with the pharmaceutical companies.

(This is the part where some googly-eyed libertarian 'splains to you that they "need to recoup the costs of R&D." Even if the drug in question is decades old, manufactured overseas for pennies, and marked up 500%.)

I never was to begin with.

It's funny how you make all these wrong assumptions about me.

What's really funny is how you automatically assumed you were the googly-eyed libertarian in question. I don't recall your ever making that argument. The wording of the sentence ('splains to you) should have told you I wasn't referring to you, but to people like Paladin and Volpone who've been using the R&D rationale for years.

Paranoid much?

Riiiiight....

"Oh, right. It's all about you, isn't it?"

So, @Captain X, when you get over your paranoia, feel free to let us know how you'd lower pharmaceutical costs.

Or just be another .

I'd do my best impression of TR and do a little monopoly-busting.

Excellent idea. Start by finding out which of your Congresscritters are in the pocket of Big Pharma.

Drug Costs Slowing Down, but Still High for Specialty Drugs
Alicia Ault

March 06, 2018

Two pharmacy benefit management (PBM) companies are reporting that prescription drug costs increased at historically low levels in 2017 ― after accounting for discounts and rebates negotiated with drug companies ― but that both cost and utilization of specialty drugs continued to rise.

Per-person spending in Express Scripts' commercial plans rose 1.5% in 2017, less than half the growth in 2016 and the lowest that the St. Louis–based PBM has measured since 1993, according to the company's 2017 Drug Trend Report.

Drug costs for the Medicare and Medicaid plans enrolled in Express Scripts' programs rose by 2.3% and 3.7%, respectively. Spending declined by a little more than 3% among the Affordable Care Act (ACA) health exchange plans managed by Express Scripts.

Another PBM, Prime Therapeutics LLC, said in a news release that spending didn't just slow, it was in negative territory: -0.2% for commercial plans, -0.8% for Medicare Part D, and -5.4% for Medicaid.

Express Scripts said in its report that traditional drugs made up the bulk of 2017 spending — accounting for 60% of prescription therapies. Spending on those drugs declined by a little more than 4%, mostly because of a drop in unit costs.

But spending on specialty drugs ―which made up 41% of total spending ― increased 11% in 2017. Although utilization of those products increased by 8%, unit costs rose by a relatively small 3%, in part because of special programs designed by Express Scripts to target those high-cost therapies. Unit costs were also kept in check by the availability of generic versions of imatinib mesylate (Gleevec, Novartis) and glatiramer acetate injection (Copaxone, Teva), said the company.

Similarly, Prime, which is based in Eagan, Minnesota, said that specialty spending increased 13% for commercial clients and about 4% for Medicare Part D clients. A key contributor to this was an increase in spending for drugs used to treat autoimmune conditions, such as rheumatoid arthritis and multiple sclerosis. Spending rose 16% to 25% for those products.

Similarities to 2016
Just as in 2016, specialty drugs to treat inflammatory conditions, diabetes therapies, and oncology drugs were the cost leaders in both the Express Scripts report and the Prime Therapeutics report.

Prime said the rheumatoid arthritis drugs adalimumab (Humira Pen, AbbVie) and etanercept (Enbrel Sureclick, Amgen) were the cost leaders for its commercial plans. Humira was also the top drug for its Medicaid plans, followed by the diabetes therapy insulin glargine injection (Basaglar, Eli Lilly).

Express Scripts estimated the per member, per year (PMPY) cost for anti-inflammatory specialty drugs at $157 for commercial plans, driven mostly by an 11% unit cost increase. In those plans, the the spending for diabetes drugs was $116, but for Medicare plans, diabetes drugs were the most expensive element, at $422 PMPY.

Oncology drugs came in at $70 PMPY for commercial plans, but $398 PMPY for Medicare plans. For Medicaid plans, HIV drugs were the drug spending leaders, at $218, followed by diabetes therapies, at $152. HIV drugs were the third most expensive drug category in ACA exchange plans.

Express Scripts said that drugs for cancer, inflammatory conditions, and HIV were big contributors to spending increases across all plans, mainly owing to higher unit costs. Cancer and HIV drugs are also protected from strict price management by the Centers for Medicare & Medicaid Services.

The company expects prices — and spending — to continue rising for oncology, HIV, and inflammatory drugs over the next few years. Biosimilar anti-inflammatories are still 2 years off, and new cancer drugs are commanding ever-higher prices. In addition, HIV patients are being switched to newer, more costly therapies.

Hepatitis C therapies — which have been primary drivers in rising drug costs over the past few years — dropped far down the list. Utilization fell by 40% in commercial plans and 26% in Medicaid, as patients using newer therapies completed treatment, said Express Scripts. Prime Therapeutics also said that lower utilization of hepatitis C drugs helped push its specialty spending for Medicaid to -1.8%.

Spending increases were highest for anticoagulants, which saw a 20% rise in unit cost and a 5% increase in utilization. That was driven by a move to newer, more expensive oral anticoagulants, said Express Scripts. Anticoagulants were the sixth-most-expensive products for Medicare beneficiaries managed by that PBM. Prices for that category are also expected to keep rising over the next two years, Express Scripts said.

Prime Therapeutics reported that the most expensive drug for its Medicare clients was apixaban (Eliquis, Bristol-Myers Squibb), an anticoagulant.

Driving Down Opioid Scripts
Both Express Scripts and Prime Therapeutics reported that the companies' opioid reduction programs had been successful.

At Express Scripts, individuals enrolled in the oversight program received an average of 7 days of medication, down from 18 days before the program began in September 2017. Opioid use was reduced by 10% in the commercial plans, 5% in Medicare, and 16% in Medicaid. Utilization dropped by about 17% in the health exchange plans.

Use of drugs to treat opioid dependence rose by almost 9% in the commercial plans, 23% in Medicare plans, and 18% in Medicaid plans. But there was a decline in utilization of almost 11% in the exchange plans. Express Scripts did not explain that discrepancy in utilization.

Prime Therapeutics also reported a decrease in the use of controlled substances, with a reduction of 15% for commercial plans, 12% for Medicare, and 10% for Medicaid.

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Medscape Medical News © 2018

Cite this article: Drug Costs Slowing Down, but Still High for Specialty Drugs - Medscape - Mar 06, 2018.

Don't forget they OPENLY pined for the days when you'd have to trade chickens and house painting to stay alive.