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Post by Deleted on Apr 9, 2015 14:50:36 GMT -5
That helps.. also I didnt get this... The coverage gap starts when your total drug costs—including what you and your plan have paid for drugs—reaches a certain amount since the start of the calendar year. In 2015, this amount is generally $2,960.
When you reach this amount, you hit the coverage gap. As a result of health reform, you get discounts to help you pay for your drugs during the coverage gap. In 2015, there is a 55 percent manufacturer's discount on most brand-name drugs. This means you pay 45 percent for brand-name drugs listed on your Part D plan's formulary, and the manufacturer plus the federal government pay 55 percent. For generic drugs, the government provides a 35 percent discount in 2015. You pay the remaining 65 percent of the cost.
Shouldnt that be the PBM rather than the manufacturer? why Would SNY bear the cost?
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Post by me on Apr 9, 2015 15:48:58 GMT -5
thekindaguyiyam, The Dexilant costs the insurance company $205/month x 12 or $2460. Afrezza will be $235 x12 or $2820. So without counting my other 3 generic drugs, Spiro is already $1280 into the doughnut hole. Spiro wants to know if they sell glazed donuts in Siberia? Spiro here Hard to believe.... you know I do. But the insurance companies are outrageous Hey guys (and gals), I think what Spiro is referring to is the doughnut hole in the Medicare Part D plan design. This is the CMS plan design, not the insurance company's plan design. There was actually a much larger out-of-pocket liability until the Part D plan was modified under ObamaCare.
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Post by thekindaguyiyam on Apr 9, 2015 15:53:10 GMT -5
Hard to believe.... you know I do. But the insurance companies are outrageous Hey guys (and gals), I think what Spiro is referring to is the doughnut hole in the Medicare Part D plan design. This is the CMS plan design, not the insurance company's plan design. There was actually a much larger out-of-pocket liability until the Part D plan was modified under ObamaCare. thanks for the confirmation. appreciated. btw... welcome to the board. You have made some valuable contributions and I appreciate it. Thanks.
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Post by me on Apr 9, 2015 16:04:32 GMT -5
That helps.. also I didnt get this... This means you pay 45 percent for brand-name drugs listed on your Part D plan's formulary, and the manufacturer plus the federal government pay 55 percent.
Shouldnt that be the PBM rather than the manufacturer? why Would SNY bear the cost? In this 55% discount for 2015, the manufacturer picks up 50% and the government, 5%. Keep in mind that this is a discount off retail. A manufacturer's cost of drugs is way less than 50% of full retail. This adjustment to the doughnut hole was how the Obama administration got the pharma manufacturers on board with ObamaCare. This "cost" was a drop in the bucket for them and in return, they dodged all the silliness that has devastated the medical side of healthcare. By the way, the AMA was also "convinced" to support ObamaCare, even though their membership got screwed. And why? The AMA has the exclusive rights to ICD-X codes that are required to be used. And, AARP was "convinced" to support ObamaCare, even though their membership got screwed. And why? AARP's MedSupp plans became much more attractive because of the severe limits that ObamaCare put on Medicare Advantage plans.
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Post by spiro on Apr 9, 2015 16:40:48 GMT -5
One glazed Krispy Creme donut has 22 grams of carbs. Spiro used to snack on 4 of them at a time. 4 donut holes makes a lot better sense now.
Spiro here, a soon to be reformed fatso.
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Post by thekindaguyiyam on Apr 9, 2015 16:57:42 GMT -5
One glazed Krispy Creme donut has 22 grams of carbs. Spiro used to snack on 4 of them at a time. 4 donut holes makes a lot better sense now. Spiro here, a soon to be reformed fatso. ironic how we have to compromise our passions to live. if it ever came down to it; you could leave this existence with a bakers dozen. In the meanwhile; your presence is appreciated and fresh fruit can taste unbelievable sweet. me. I don't want to give up red wine and single malts. Wish Spiro Good luck for me.
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Post by savzak on Apr 9, 2015 21:24:15 GMT -5
That helps.. also I didnt get this... This means you pay 45 percent for brand-name drugs listed on your Part D plan's formulary, and the manufacturer plus the federal government pay 55 percent.
Shouldnt that be the PBM rather than the manufacturer? why Would SNY bear the cost? In this 55% discount for 2015, the manufacturer picks up 50% and the government, 5%. Keep in mind that this is a discount off retail. A manufacturer's cost of drugs is way less than 50% of full retail. This adjustment to the doughnut hole was how the Obama administration got the pharma manufacturers on board with ObamaCare. This "cost" was a drop in the bucket for them and in return, they dodged all the silliness that has devastated the medical side of healthcare. By the way, the AMA was also "convinced" to support ObamaCare, even though their membership got screwed. And why? The AMA has the exclusive rights to ICD-X codes that are required to be used. And, AARP was "convinced" to support ObamaCare, even though their membership got screwed. And why? AARP's MedSupp plans became much more attractive because of the severe limits that ObamaCare put on Medicare Advantage plans. Me, why do you know so much about the ins and outs, the winners and the losers, the cronyism and patronage of Obamacare? Seriously interested. Send a PM if you'd prefer. Thanks.
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Post by me on Apr 10, 2015 6:13:49 GMT -5
In this 55% discount for 2015, the manufacturer picks up 50% and the government, 5%. Keep in mind that this is a discount off retail. A manufacturer's cost of drugs is way less than 50% of full retail. This adjustment to the doughnut hole was how the Obama administration got the pharma manufacturers on board with ObamaCare. This "cost" was a drop in the bucket for them and in return, they dodged all the silliness that has devastated the medical side of healthcare. By the way, the AMA was also "convinced" to support ObamaCare, even though their membership got screwed. And why? The AMA has the exclusive rights to ICD-X codes that are required to be used. And, AARP was "convinced" to support ObamaCare, even though their membership got screwed. And why? AARP's MedSupp plans became much more attractive because of the severe limits that ObamaCare put on Medicare Advantage plans. Me, why do you know so much about the ins and outs, the winners and the losers, the cronyism and patronage of Obamacare? Seriously interested. Send a PM if you'd prefer. Thanks. You have mail.
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Post by jimbering on Apr 14, 2015 0:54:27 GMT -5
Not that gutsy really. We prescribe off label all the time. It is even routine for many parts of what doctors do. For paediatrics doubly so. Nothing or almost nothing is studied for kids. There is no financial incentive to do so for most big pharma as there is barely a market. I doubt even the Mannkind trial for kids will get done quickly. If the endos don't want to prescribe Afrezza to adults what company would risk doing a study for kids? I think the only paediatric access for Afrezza will be off label for a very long time... A lot of endos don't want change or innovation (unless it comes with a needle!). Read more: mnkd.proboards.com/thread/2169/doughnut-hole#ixzz3XGCHJUJn
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Post by mnholdem on Apr 14, 2015 8:42:03 GMT -5
I luv bakers dozens, but by the time I get them home, they're just regular dozens. Unfortunately, the fresh "freebies" that somehow disappear during the drive back home from the bakery, still come with the price of loads of calories and sugar (sigh).
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