My Thoughts on Tier 4 Medications
My thoughts on tier 4 medications are somewhat different than some of my colleagues, I suppose.
As a compassionate physician, I too want my patients to have the best care possible, and I too hate seeing people suffer. But if we as a society are going to try to provide a broad variety of services to patients, whether it be under a shared-risk insurance pool, a socialistic government model like Medicare, or any other method imaginable, then costs are going to have to be controlled somehow.
By forcing individuals to share some of the expense of certain extremely expensive medications, our ability to continue to provide medical care to the masses can be maintained at a more reasonable cost. If patients want to purchase insurance that covers a complete formulary of expensive medications with only a minimal copay, then they should be able to do so, paying substantially more for the opportunity. Of course waiting to buy such insurance until they need a certain medication isn't going to cut it. You buy insurance to insure against disasters; once you already have cancer, multiple sclerosis, or rheumatoid arthritis, the levee has already broken and the water is rising. If patients want to reduce their monthly cost of health insurance, then they should be able to choose a policy that either requires high copays for certain medications, or save even more by choosing an HSA.
Medicare is different issue altogether, because it's not really insurance. It's more like a defined benefit plan with broad (essentially universal) eligibility. The only ways such a plan can stay within budget are to either raise rates (taxes) on everyone or to reduce benefits. Would it be preferable to raise the Medicare eligibility age from 65 to 70? I think that should happen too, but I suspect that concept won't be received very well either. This tier 4 pricing scheme is a way to maintain benefits while only raising rates on the users of the drugs in question. Brilliant, I say.
"But why should pharmaceutical companies charge so much for these medications?" you might ask. If these companies were denied the opportunity to profit from their research and development, then they wouldn't be bringing as many new products to the market. I think pharma companies should be allowed to reap the rewards of their research; if you take away the incentive to create new and improved products, then there won’t BE as many new and improved products. If patients were forced to settle for methotrexate instead of Remicade and repeated transfusions instead of Epogen, life would still go on.
Would it be a better life than what we have now? No.
Socialism and price controls on business just don't work well. Never have, never will.
As a compassionate physician, I too want my patients to have the best care possible, and I too hate seeing people suffer. But if we as a society are going to try to provide a broad variety of services to patients, whether it be under a shared-risk insurance pool, a socialistic government model like Medicare, or any other method imaginable, then costs are going to have to be controlled somehow.
By forcing individuals to share some of the expense of certain extremely expensive medications, our ability to continue to provide medical care to the masses can be maintained at a more reasonable cost. If patients want to purchase insurance that covers a complete formulary of expensive medications with only a minimal copay, then they should be able to do so, paying substantially more for the opportunity. Of course waiting to buy such insurance until they need a certain medication isn't going to cut it. You buy insurance to insure against disasters; once you already have cancer, multiple sclerosis, or rheumatoid arthritis, the levee has already broken and the water is rising. If patients want to reduce their monthly cost of health insurance, then they should be able to choose a policy that either requires high copays for certain medications, or save even more by choosing an HSA.
Medicare is different issue altogether, because it's not really insurance. It's more like a defined benefit plan with broad (essentially universal) eligibility. The only ways such a plan can stay within budget are to either raise rates (taxes) on everyone or to reduce benefits. Would it be preferable to raise the Medicare eligibility age from 65 to 70? I think that should happen too, but I suspect that concept won't be received very well either. This tier 4 pricing scheme is a way to maintain benefits while only raising rates on the users of the drugs in question. Brilliant, I say.
"But why should pharmaceutical companies charge so much for these medications?" you might ask. If these companies were denied the opportunity to profit from their research and development, then they wouldn't be bringing as many new products to the market. I think pharma companies should be allowed to reap the rewards of their research; if you take away the incentive to create new and improved products, then there won’t BE as many new and improved products. If patients were forced to settle for methotrexate instead of Remicade and repeated transfusions instead of Epogen, life would still go on.
Would it be a better life than what we have now? No.
Socialism and price controls on business just don't work well. Never have, never will.
Labels: health care crisis, politics
posted by scalpel at 2:02 PM
35 Comments:
Absolutely true, price controls and government interference won't work at all.
But the other side of the coin is that you're not just paying for research, you also contribute towards a large, and these days largely redundant, sales force. The same is true for medical equipment and supplies, and there is also an element of greed combined with an unwillingness to change the method of supply.
Still justified you might think - well to an extent, possibly - certainly with new products they do need an introduction to the market place, and who better than the good old fashioned sales rep?
Those new products aside, however, it is quite possible to purchase a wide variety of branded items online, without fuss or bother, safely and securely, and in only the quantities actually needed - no need to sign up to a contract which obliges you to buy vast quantities of something you might use infrequently.
All that is needed is that willingness to change, because of course now we're talking about making large numbers of traditional purchasing department staff redundant too! (the modern names "procurement" and "supply chain" are the same thing). What IS necessary, is for those responsible to become better educated in medical/surgical purchasing - they really shouldn't be the same folk who are buying baked beans for the hospital kitchens and waste paper bins for the offices.
Thinking back to the NYT article which started this discussion traveling throughout the blogosphere, I'd like to refer to Copaxone. Copaxone is a daily self-injectable disease-modifying drug for multiple sclerosis manufactured for/by Teva Neuroscience.
Why do I know anything about this? Because I have MS and I use Copaxone. My insurance policy (obtained through a major BCBS-affiliated insurance carrier in the nation's capitol and offered to self-employed individuals) does include prescription coverage....well, up to $1500 each year. So for an approved drug, which Copaxone is, my insurance covers none of the cost. And assistance is not really available until your AGI reaches 200% federal poverty level (which is actually less than the cost of the drug).
I also happen to have rheumatoid arthritis which was more difficult to diagnose because of the MS. And due to the MS, I CANNOT use any of the injectables such as Remicade or Enbrel since they are counter-indicated for MS patients. So I have to settle for using methotrexate and sulfasalazine. After my drug coverage was exhausted early last year, I searched for help with RA meds. Although financially I qualified for help, the program refused to cover methotrexate (which was listed in their program) because it was not on the RA list. ?!! But they would pay for other RA drugs, ie. Enbrel or Remicade, but only if my insurance company was still covering prescription costs.
So, a single, self-employed woman in her 30s, earning a very modest living as a musician develops MS and RA, but was wise enough to obtain insurance while completely healthy, should be expected to pony-up more money (maybe $5000-10,000) each month for premiums and drugs. All this while earning an AGI of $19,400-27,000?
This is my reality.
Sorry, I got side-tracked. The discovery of Copaxone was funded by NIH research, not by Teva. So my tax dollars went to developed the drug I now use, but the drug company continues to reap huge blockbuster profits from government research. Where's the incentive for drug company research there?
I want a Lamborghini, but I can't afford one. Well, I MIGHT be able to, but the cost-benefit ratio would be totally irresponsible for someone of my income level. So I settle for something less expensive; I don't expect others to chip in for me.
I don't get around as fast or as stylishly as I could if I had a Lambo, but I still get around.
Life isn't always fair.
Sorry if that came off a bit harsh, but my own medications cost $5000 per year, and every time I pay for them I wonder if they are really worth it.
Having some "skin in the game" is important, in my opinion. If the meds aren't worth it to you, then don't buy them.
scalpel -
Are you really comparing a car to medications that make it possible for many people to live a day-to-day life? (Y'know, like, being able to *work* and otherwise support themselves?)
Well, blogger just ate a beautifully worded response. Darn. And in my hurry, I didn't copy it.
Let's say I went shopping for a new Honda Accord with automatic transmission, power steering and windows, AC, CD player, jumper cables, spare tire, and jack. Then one day a Lamborghini slams into me and drives off. The shop says that can't repair the car, but could prescribe a remedy which should limit future damage. Shoot...that sucks, but what choice do it have?
I try to arrange to get the remedy, but the car dealer tells me that my Accord is actually a Geo Metro in disguise. What?!! My Accord is the same as my neighbors...."no, you neighbor got his Accord through his work. But here's the name of an assistance agency who could help you."
If I want the remedy, I must pay for it 100% because the assistance agency says that since I could afford an Accord, they won't help to cover the costs of the remedy for the Metro. So I put ALOT of my own skin in the game.
Then wouldn't you know it less than two years later, another Lamborghini plows into my parked car. This time I already know that I can't afford anything more than repairing the Metro, but the agency is willing to fully repair a Lexus. I don't need help with a Lexus...I need help with a Metro. No go.
So now, I'm without transportation and do my best to continue paying for the Accord, paying for the prescribed remedy for the Accord and for the Metro, while be able to earn less and less over time.
I predict that someday in the future, someone will offer me a bus pass. But at that time, I might not be able to walk any longer due to the two vicious Lamborghini's and it won't matter anyway.
This is what it feels like to consider the effects of living with progressive, debilitating, and disabling autoimmune chronic illnesses. I just joke that I was doubly lucky and came up with two autoimmune diseases, ie. multiple sclerosis and rheumatoid arthritis. I'm not a drinker, never a smoker, used to be able to swim 2 miles in one session, as well as walk 4 miles while playing a heavy musical instrument.
That's my reality. And I've got a whole lot more "skin in the game" than $5000. And I'm absolutely certain that I earn much less than you.
But you don't WANT to have skin in the game. You want society to pay for your medications.
When you are asking for handouts, a bus pass looks pretty good. Or it should anyway.
And I'm sorry, but I don't understand your predatory Lamborghini analogy.
And Hannah, yes. But people will live their everyday lives (or not) with or without these sorts of medications, just like they did before these medications were invented. Just because a medication has been invented doesn't mean that everyone is entitled to receive it regardless of their ability to pay for it.
The Lamborghini is autoimmune disease which attacks the body, not out of personal behavior.
The misconception here is that I certainly want to have skin in the game. As soon as I discussed that my BCBS insurance company would not cover my MS med at the 10% coinsurance rate which was included in my original paperwork, I looked for other options. I looked for supplemental insurance. I discussed with my insurance company the possibility of cover the MS med under major medical (as other companies often will do). Or even discussed the possibility of upgrading my policy and paying much more premiums. I was told repeatedly that my prescription rider was the standard option...and then that they only offer the standard option.
Actually, the option of having a maximum copay of $325-500 each month would be preferable to limiting income to access life preserving medication. I don't have that option. And I also don't qualify for government assistance, so I'm not asking for money from others in society. I went straight to the drug company for help. Even with the drug company, negotiations are not an option.
I have not been asking for handouts. I have been financially responsible, maintaining debt-free status through college, paid for my Honda Accord with cash, and have some (not alot) of money invested for retirement. It is these things which ensure that I will never qualify for government handouts.
I want to pay the same as Europeans pay for the same drugs. When government over there negotiates with the pharmas they negotiate on behalf of its people. Our government is in bed with the pharmas and throw barriers up to effective cost reduction. We're the chumps in this equation. I don't mind the pharmas making profits to fund their product pipeline, I just don't want to pay for it all when the rest of the West just pay the production and distribution cost.
- 241commuter
I guess the ability to compare someone's health with your material desires it what separates me from...ya'all.
I think the Lamborghini analogy is a little off base.
If we are talking about national health insurance, fine. No one person deserves a fancy car over another person. Certainly the government can't afford to give everyone Lamborghinis. But if someone has the money and wants to pay extra for the car, they have that option.
The Tier 4 scenario is a little different. Suppose there is a possibility that a gang of thugs driving Ford Mustangs was going to come driving up to your house, abduct you, torture you, and even kill you. Your only way out was to have a car that could outrun the Ford Mustangs. You knew this ahead of time, and no one could afford the Lamborghinis. So you and a bunch of your friends and co-workers decided to pool your risk and made a deal with the Lamborghini dealership: You would pay them "insurance money" every month so that you would have a Lamborghini available to you just in case you got word that the thugs were coming. Chances are that you wouldn't need the car, and if you never used it, the dealership got to keep the money. But if you did need a fast getaway, the car would be there for you.
You're paying a pretty hefty sum, so every once in a while the dealership lets you take the car out for a date. "This is cool," you think to yourself.
Then you get word that the thugs are coming for you. You call the dealer and say "I need the car - tomorrow!" The dealer then tells you "Sorry, too many people needed the Lamborghinis. We had to cut costs. We'll give you a discount if you want to go and purchase one from the manufacturer or you can have one of these MoPeds instead. Take it or leave it. You better hurry, too. The thugs are going to be there soon. Oh, by the way - good luck. We really do care about you."
Everyone - even those who don't pay into the system - deserves some basal level of care.
Those who have paid into the system deserve better than a jar of vaseline.
An expensive medication is a material desire. You can't buy health, and these medications certainly don't guarantee it. This MS medication mentioned earlier hasn't been shown to improve mortality, and at best it offers only a slight decrease in the relapse rate of one specific subset of the disease. It's not a "must-have-or-die" medication.
Want to talk about Epogen, Remicade or Neupogen next? They don't improve mortality either. They are lifestyle drugs, and as such they are not unlike my dream Lamborghini.
I bitch about free AICDs all the time, but they are a relative bargain compared to these moneypit drugs when the cost-benefit ratios are compared.
That's right. MS is not a fatal disease (except for an extremely rare and agressive subset of the disease.)
People don't regularly die from MS. They die from complications which arise from the damage which MS causes to their central nervous system and the disability which occurs throughout their body.
By limiting disease-progression and relapse rate, even if by an average of 38%, disability and physical damage is delayed or lessened.
A person which experiences less disease activity will be more able to remain physicially active and healthy. This is good for all of us. The MS patient remains a productive member of society, contributing to the financial wellbeing of society as a whole in addition to his/her own family. This more active, less debilitatingly disabled individual will be more able to prepare for future financial responsibilities including personal healthcare and retirement.
So if your stance is that the currently available MS drugs are lifestyle drugs (which I think of Viagra as fitting that category), then I suppose that yes....Copaxone does assist in maintaining a grasp on a lifestyle which more closely resembles a healthy, active individual who can MOVE and function.
It's a chance at having a life.
The other option right now is extremely controversial. The HiCy protocol out of Johns Hopkins seeks to treat MS patients, as well as other patients of autoimmune diseases. The only catch is that the patient has to completely wipe out their entire immune system, excepting for a few special stem cells remaining in the bone marrow, and allow those stem cells to repopular and rebuild the immune system from scratch.
Which option would you prefer?
"The MS patient remains a productive member of society, contributing to the financial wellbeing of society as a whole in addition to his/her own family. This more active, less debilitatingly disabled individual will be more able to prepare for future financial responsibilities including personal healthcare and retirement."
Crazy how they expect you to keep working and not indulge in the socialist welfare system, but you have to keep it up without the medications that make it possible.
"By limiting disease-progression and relapse rate, even if by an average of 38%, disability and physical damage is delayed or lessened."
Are disability and physical damage delayed or lessened enough by these medications to save the taxpayers and insurance consumers umpteen thousands of dollars per treated individual per year? MS typically strikes people at a relatively young age, and these treatments might go on for decades. Is it really worth it?
I don't make policy decisions, and I don't have any more influence than you do. I'm just asking questions. The philosophical arguments interest me as much as the specific details themselves.
I think enrollment in clinical trials is an excellent way for people to get treatment that they otherwise would not be able to afford. Perhaps you could find one that isn't so harsh.
I believe that the government has to step in a regulate drug prices. There is no other way. The pharma companies have to provide the FDA with their R and D costs, expected market size, etc and then the government can determine a fair profit for them. This happens in England and I think it is reasonable (exclusive of other "socialist" changes to health care). My wife used to work for a major Pharma company and told me how they set prices. "What will the market bear". That is the classic capitalist model which cannot work ethically with life-sustaining pharmaceuticals. You cannot compare Avonex to a Bentley!
Isn't there some middle ground between the amount of profit that pharmaceutical companies make and the good that the meds do and the money that they can save the system? It seems odd that the same Seroquel that costs $300 in the U.S. is available for $20 in Canada (with a prescription, but without insurance).
And other meds- I'm Canadian, and so have paid taxes for my family's health insurance since I started working at 16. My children also have supplementary health insurance through their father's plan (which costs him $56/month for 4 people- him and 4 children). When our daughter had cancer, she developed neutropenia after her first round of chemo. After the second round she was started on G-CSF, to boost her white cells so that hopefully we wouldn't have a recurrence. Even in Ontario this wouldn't have been covered by OHIP, and it would have cost me about $350/injection for 10 days each round of chemo without private insurance. We were lucky that it was covered as there's no way that I could have covered that cost, although I've since learned that it seems to magically appear to uninsured people when needed.
My point is that after her first round of chemo she spent 10 days in isolation as an in-patient because her white counts were so low. After she began receiving G-CSF prophylactically after each chemo round she never needed to be admitted to hospital again for neutropenia...it seems that there are some meds that can actually save the system money if they're given appropriately. From a quick search it was difficult for me to find out what "tier" G-CSF is according to U.S. insurance companies.
It just seems that from an outsider's view that there should be some consideration to how much meds may or may not save money for the system as a whole. I realize that we have a completely different pharma industry and regulations in Canada, but isn't there some middle ground who can help the people who need meds, save money for the system as a whole, and not bankrupt the poor pharmaceutical companies?
G-CSF is Neupogen, which is on the Tier 4 list.
I too am disturbed by the discrepancy in prices between the US and world markets. Maybe we could work out a trade agreement with our Canadian neighbors in which we get our expensive medications from them and they can come get their MRIs and elective surgeries from us.
If NAFTA includes motor vehicles, computers, textiles, and agriculture, why not medications?
I'd certainly like to buy into the whole safety/FDA argument, but I don't see Canadians dropping dead every day due to wrong medications or poorly-manufacured medications (China's role in manufacturing and exporting goods is a whole 'nother argument though).
As well, I'm pretty sure that the parts that go into my vehicle are just as important as the medications I may or may not ingest -- same goes with agriculture. Not everyone is on chronic medications, but most everyone drives and eats.
"Just because a medication has been invented doesn't mean that everyone is entitled to receive it regardless of their ability to pay for it."
Exactly. The government isn't going around installing airbags in every older car out there. A car without airbags is unsafe, but increased safety comes at a price. Just because something new and improved comes out doesn't mean that everyone will be allowed to get it for cheap/free. The woman in the NYT article is now thinking she might not be able to go on vacation - sometimes we have to forego luxuries in order to pay for the necessities.
"Just because a medication has been invented doesn't mean that everyone is entitled to receive it regardless of their ability to pay for it."
It would appear that by the PUBLIC advertising pharma does, they believe (or promote) differently.
"Just ASK your DOCTOR!"
IMHO, they propogate the entitlement mentality.
I'm just waiting with baited breath for narcotics ads.
The thing is that if we start down the path that no one should be entitled to high-priced medications when lower priced alternatives are "almost" good enough, where does it end?
Why give thrombolytics? Aspirin is "almost" as good for MIs and the efficacy in strokes is debatable. Glycoprotein inhibitors don't decrease mortality that much, either. Regular heparin would be just as good as Lovenox if it weren't for that dang China pig intestine thing. What do these designer BP meds have over the generic alternatives?
Why the selective insurance coverage aimed at those with chronic diseases?
I'm following this "Tier 4" trend as well, but I see it as a shrinking pie, rather than a predatory sports car.
The pie is shrinking everywhere in the developed world because of some fixed realities:
a. people are living longer due to vaccines, hygiene, work safety, intensive life-saving efforts, etc
b. there are fewer kids being born, growing up, and paying into the various systems but then conveniently dying off (see a) before expecting to get their investment back
So, the pies are shrinking- everyone's pie. This *is* about rationing care- everyone's care is rationed now, and the rations are just going to get leaner in the years to come. Each country is coming up with a different plan for what to do about it. In all the developed countries but the US, governments (and so by representation the people) are to whatever degree trying to decide how to ration their care. In the US, we're leaving those decisions to the insurance companies, who we can only influence indirectly through lawsuits and legislation ... and they seem to be quite effective at generating legislation favorable to them.
And, while I completely agree with Scalpel that a free market system encourages the most innovation and most exciting developments in the quest to improve and thus to catch market share, I think that in the US, the insurance companies no longer consider patients or employers to be the consumers whose market share they are trying to catch. Instead, *shareholders* are their targeted consumers, and so insurance companies are behaving in ways to catch shareholder market share. They believe, thus far correctly, that patients will tolerate whatever rationing policies they implement because the potential costs of being uninsured are seen to be intolerably high.
However, if developing a serious illness leads to bankruptcy whether or not you're insured, intelligent people will quickly stop buying medical insurance ... what would be the point? And, ironically, insurance companies are moving to make that the reality for most Americans unfortunate enough to get seriously ill. I hope concierge care/HSAs are the beginning of the end for health insurance as we know it. Insurance companies, if they want to continue to exist, will eventually have to return to viewing patients as their true customers and they will have to find a way to provide real value.
"The thing is that if we start down the path that no one should be entitled to high-priced medications when lower priced alternatives are "almost" good enough, where does it end?"
When they can't/won't pay for it. If there was a $500,000 cure for diabetes, should we hurry and give it to diabetic? Or should we stick with things like diet control?
"But people will live their everyday lives (or not) with or without these sorts of medications, just like they did before these medications were invented."
What if they aren't living, just surviving and suffering? There has to be some level of humanity. Or maybe we should just shoot the ones that can't make it on their own and put them out of their misery.
I work for a biotech here and we have a branch in canada. We develop clinical tests. The guys in canada get extra weeks of vacation, a full year of maternity leave, more holidays and free health care-but most of the crap we sell, sells in the US as health canada won't pick up the high costs yet.
pharma makes the big bucks in the US and then bargains around the rest of the world. A pharma employed friend pointed out that 1% of the drug price goes into the fun for when they get sued and another 25-50% is advertising/free trip/sales costs.
That means folks like Lisa suffer.
Scalpel until you have really suffered, I don't think you will understand. Folks like lisa and me live everyday to the fullest because the future is kinda headed downhill from here. Imagine not being able to walk around the block with your kids or hold a pencil anymore to write with. Imagine being a burden on those around you because you can't take care of or support yourself. I think you'd see the argument in a different light.
Tina
I take Remicade for Ankylosing Spondylitis, I was in a wheelchair 5 years ago, today you can't even tell there is anything wrong with me.
If my insurance were to calssify TNF meads as Tier 4 then the only option I would have is to go on disablility (yep, that's your dime also.)
I make over $100,000 a year and still would NOT be able to afford paying 30% of the cost.
I can sefely assume most of you do not suffer from a chronic (expensive) illness otherwise you would not be so ignorant in your beliefs. I did not ask for this horrible illness just like you did'nt ask to share in my burden of dealing with it. I hope to God that none of you ever have to experience half of the pain and suffering that I have been through in my lifetime, all 37 years of it.
What is the price cutoff that would make such a treatment too expensive?
Remicade can cost up to $50,000 per individual per year, if I'm not mistaken. What if it cost $200,000? Or $500,000?
When someone else is paying the bills, they will never have your best interests at heart, whether they are an insurance company or a nationalized health plan. They will always consider the bottom line, like Ford did with their Pinto.
The entity holding the pursestrings will decide whether it's cheaper to pay for the drug or to pay for disability payments and hospitalizations. And they will decide based upon the totality of patients under consideration, not by considering individual anecdotes of successful treatments.
It's harsh but true. Don't blame me, I don't make the rules. I'm just trying to explain them.
The entity who holds the pursestrings, with regard to expensive Tier 4 drugs, are the health insurance companies. It does not cost them money if a person ends up on disability; those costs are paid by Social Security or, if a person is fortunate enough, by disability insurance provided by a different insurer (not the health insurer). If a person becomes totally disabled, they end up on Medicare, and once again, the private health insurer would no longer have to pay for that person's medical care.
So, three costs are shifted when a person can't afford expensive medications that keep them off of disability. The first cost is disability payments, covered either by another insurer or the taxpayer through Social Security. The second cost is the person's medical care, shifted away from the private health insurer to Medicare, again to be covered by the taxpayer. Third, there's the cost in suffering, borne by the person throughout all of this.
The private health insurers are acting in their own best interests. The drug companies are acting in their own best interests. Both certainly don't care about people who can't afford expensive drugs that treat disabling diseases. They don't care about the personal cost to the person, nor about the cost-shifting to the American taxpayer when a person goes on disability.
There are other costs to be reckoned with. When a person is working, they are paying for their own housing, food, transportation, clothing. They also pay taxes. Take away their income, and the rest of society has to pick up these expenses (not luxuries).
If the drugs work for a person, they should be able to have them, though also bear a reasonable (not outrageous) amount of the cost.
Scalpal, why do you spend $5000 on medications? Can't you take some older drug(s)? Sure, they may not work so well, but hey, people got along just fine before that $5000 medication came along. They managed. So can you.
I have an HSA in which my medication expenses count towards my deductible. The most expensive of my medications has no generic or older substitute.
I can afford my medications. If I couldn't, I'd do without.
I basically think people have to play the cards they are dealt. A certain amount of legislated charity is acceptable, even necessary, but lines have to be drawn somewhere.
Here's some fun: What if the other meds don't work?
We pay for insurance just like anyone else. My sons have healthy BMIs (although they are significantly taller than their peers), and I feed them nutritionally-appropriate foods and they have always been up to date on their vaccines. They even get their flu shots every year. I do not do bullshit biomedical interventions, I have not bought into the pseudoscientific nonsense that Thimerosal or any vaccinations cause autism spectrum disorders.
I supervise them, I always make them wear their seat belts, every single time the car is in motion. I watch them when they go to the pool as if there is no lifeguard.
But they are living proof of the genetic nature of certain neurological problems.
My sons need Focalin XR. They need it. If my younger one doesn't get it, he can't function in society at all. If he has it, it is almost indistinguishable from his neurologically-typical peers, except that he is a lot smarter.
Don't blather to me about how ADHD is just "hickory deficiency syndrome," either, please, he had people in our house from the County when he was younger teaching him to swallow solid food without gagging. He has neurological problems and the ADHD is a fun side effect.
My older one is more severely-affected than the other. He is on the autism spectrum and has ADHD. Concerta and Adderall XR kept him up all night with serial panic attacks. Focalin XR? Again, it's the only stimulant that works. With it, he's functional in a mainstream classroom and even has a rudimentary social life. He is even capable of focusing during social skills training.
Without it? He's a behavioral problem on two legs.
No other medication works for either boy. I don't know why that is. I don't particularly care.
No one would be happier than me to have them on a non-Schedule II controlled substance, thanks. It's an adminstrative headache, it's expensive, and the med checks are a pain. Both boys are at the top of the growth charts and you can give them their Focalin XR in the evening and they'll sleep better.
I suppose you could call "Not being kept secreted in an attic", "not being confined to a self-contained special education program with no hope of ever learning how to integrate with others," "not being expelled from school and having homebound education," lifestyle choices. If that's true, then your definition of "lifestyle choice" has been reduced to an absurd nullity.
As a parent, I do everything right and it's absurd that Focalin XR is a hell of a lot more expensive than Ritalin.
Most folks whose ADHD kids also have Asperger spend thousands of dollars on medically-mainstream therapies for our children. Upping the price on something that will drastically-increase the odds that our children will be self-supporting adults is ridiculous.
In the meantime, I know what is involved in the entertainment budgets and advertising budgets of the pharmaceutical industry. If you medical professionals would stop indulging their non-stop party atmosphere, I'll bet stopping the free-pens and foam-rubber brains and lunches, TV commercials, magazine ads, newspaper ads, and perks from the pharmaceutical industry would decrease expenses significantly.
Meanwhile, there is a big difference between receiving charity and Paying The Same Health Insurance Premium Everyone Else Does and getting screwed at the pharmacy.
Focalin XR looks to be about $4 a pill regardless of strength. That's not even in the same league (much less the same ballpark) as Remicade and the like, so I don't see how that particular medication relates to this discussion. Focalin XR appears to be covered by many insurance plans at a discount, but even the full price isn't outrageous if it works.
All the stimulant ADD drugs are Schedule II, as they should be.
I'm excruciatingly aware of the difficulties that parents of children with ADHD and Asperger's face, by the way. That doesn't change my position on this issue.
I suspect that as costs are shifted to the consumer, we will become a more cost-conscious medical community. See www.medsane.com for cost-effective prescription options.
No-one should have to pay the full cash price for their prescriptions. I use the discount card that I found at www.rxdrugcard.com. Low membership fee. Drug prices posted. Cancel anytime. Enroll anytime. No questions about income or pre-existing conditions.
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