Mrs twigg needs drugs each month.
Expensive drugs, the really good stuff, the Schedule 1 narcotics.
The process of getting them can be difficult. Prescriptions have to be collected in person, refills cannot be "called in" and the doctor has to see her every month. Another $50 co-pay for not very much as far as I can tell.
Her condition is a purely physical one that will not get better, only degenerate over time. It is not, and never will be life-threatening. The need for the drugs may be reduced if she has surgery, but only "may", and surgery is unlikely to be offered until she gets quite a bit worse.
She is okay with this. The pain management works, most of the time, and who the hell wants a surgeon cutting holes in their upper torso and neck to get to their C-Spine?
So we get the drugs, and we have developed a wonderful relationship with a small, local pharmacy. That wasn't easy to do, and we went through several years of trauma with CVS, Walgreens, even Walmart until we finally found a Pharmacist who cares.
One of the drugs she uses is Oxycodone. This, despite, I understand, having a fairly high "street price", is cheap and easy to get. Never a problem and the co-pay is a relatively modest $15.
The other main drug is Fentanyl. This one is much less straightforward. Fentanyl is distributed in the form of transdermal patches. It's a slow release drug which takes care of the pain twenty four hours of the day, with the oxycodone used for "breakthrough" pain relief.
With this regime, and a couple of other things to help with the side-effects of the narcotics, she leads a full and active life, holding down a stressful but rewarding job, and I never hear complaint one from her.
The issues with the Fentanyl patches are legion. First they suddenly disappear from the Pharmacies because the manufacturers struggle to get the delivery system engineered correctly!
Hello. people! These are narcotics, and quite high doses. Patients can't suddenly stop taking them because you don't have your act together!!! Have you ever seen what happens to people when narcotics are withdrawn abruptly?
Sorry. we don't have them and can't get them for a week or two is simply not an excuse that is going to fly. You simply HAVE to get them, and I don't care how you do it, this is my wife we are talking about!
One way or another we have always, thus far, managed an uninterrupted supply, but it's been "touch and go" a few times.
The second issue is the co-pay.
There are two types of patches. The brand name "Duragesic", and a couple of generics. Any of them work, and Mrs Twigg would be perfectly happy with the generics but for the Insurance Company (Community Care) and their "Formulary".
Now call me old-fashioned, but my view is that Pain Management doctors do not prescribe drugs for well-established conditions if the patient doesn't need them. And if they do that is not our problem. My wife needs these drugs, and I take the simplistic view that if that is the case, then the Insurance company should be paying for them, at their lowest tariff. It is no business of theirs to add then to a "non-formualry" list (whatever that is) and proceed to charge the highest co-pay of $65, even if she takes the generic, and regardless of the actual cost of the drug. But they do.
So we get the Brand, Duragesic because the manufacturers offer a $50 coupon every month, and always have. Well we have watched "Extreme Couponing", and our savings every month make those women appear to be amateurs ... lmao.
Here is the crux of the matter.
The base cost of the patches used by Mrs Twigg is around $1800 per month. Yeah, that was one thousand eight hundred dollars, it was not a typo. With the coupon we pay $15.
The base cost of the generic is $500 per month, but the co-pay would be $65. So we get the brand. Well you would!
If the Insurance company would consider moving the generic to the lower category, then that is what we would get. A cost saving eack month, every month, every year, for years, of thirteen hundred dollars.
That would be a cost saving to the insurers of $78000 over the five years that she has been using them.
Around here $78000 would buy a decent house, or two very nice cars, or pay for the health care of several dozen other people, or reduce insurance premiums.
If anyone really wants to know what is wrong with Healthcare in the US than all they need do is come here, and we will tell them.