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Post by kball on Apr 27, 2015 19:29:22 GMT -5
Havent read other posts but i do find the OP an interesting topic, especially as it mirrors mine. Also asthmatic, different med...Serevent still. Was a $60 copay last year with no deductable. This year i have a $600 deductable and then its a $70 copay.
Individual plan with a huge insurer...so i also am paying much more to have an illness this year. and they also jacked me up $25 a month premium.
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Post by liane on Apr 27, 2015 19:42:02 GMT -5
kball,
You echo what's going on all over the country thanks to the (un)Affordable Care Act. Higher premium, deductibles, copays, and coinsurances. Many patients I see (mistakenly) select a higher deductible plan to lower the premium, but then when they have some significant medical bills, they learn just what that $10000 deductible means. I switched carriers last year for myself and my employee. This lowered my premium and deductible. The current carrier seems to accomplish this by paying less to the providers (as I know from being on the other end of this deal). And it's just going to get worse...
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Post by Deleted on Apr 27, 2015 19:45:19 GMT -5
Na. I didnt' say I wanted to discuss the balance sheet. Boring and dry and if you've reviewed it in detail it would benefit neither of us to discuss it so I have no interest. But I would hope everyone has taken a good look and understands it. Why would it have to be angled negatively? You don't know me yet you have no problem attacking me on a regular basis as if I'm the cause of all your problems. So you question people's knowledge of the balance sheet and when I challenge you on it you call it boring? Ok, I get it now. I suggested people review it. Pretty straightforward. Please stop the pointless jabbing. I'm not your enemy.
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Post by gomnkd on Apr 27, 2015 19:52:52 GMT -5
I've a big deductible and pay through the nose until I meet it. My prescription Lovaza for triglyceride costs $500 for 3 months when I've not met it. It really upsets me. I cant imagine what other folks do. when people talk about costs, it reminds me of Ballmer's comment about iPhone when it was launched. You don't see these about new Afrezza pt. a) The short term and long term savings to ins. companies. this is through compliancy, being in the zone, less worry, lower DKA, hypos, long term complications etc. What I hope is someone will crunch the numbers after 6 months or 1 yr , do a comparison study and calculate the savings. When it happens, insurance co's will mandate Afrezza use unless you've the contra-indicators (maybe after 1-2 yrs, dont hold your breath). b) you see pt tout the benefits, but not something like "I didn't get admitted bcos of low hypos or DKA". The latter is the value to ins. co's. Then drug co's are getting smarter about their portfolio and pricing it right (or some say usurious, predatory..). Read today's wSJ www.wsj.com/articles/pharmaceutical-companies-buy-rivals-drugs-then-jack-up-the-prices-1430096431We are now in no mans land where benefits show in pt that insu. cos don't care about in short term, cost is apparently higher, lack of awareness, being in Tier 3, .........We are in the Afrezza's dark ages. Ben Graham says price is what you pay and value is what you get. Once pt see value, they'll pay up.
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Post by jpg on Apr 27, 2015 20:13:10 GMT -5
Can't get this to post... Sorry
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Post by james on Apr 27, 2015 20:25:02 GMT -5
As long as tier coverage has been brought up, I have a question for those with more experience. Now, while I can understand that some payers automatically place a new drug at a lower tier level at launch, how long do these new drugs typically have to stay at the lower tier? Until the benefits are fully known, which could take years? One year? Six months? Is there even a "typical" when it comes to Payers' coverages of new drugs? I ask the question as some patients are posting problems getting covered by their insurance companies. I hope Sanofi is diligently working with Payers to get the better tier coverage for Afrezza and that this jumping through hoops is typical of most new drugs. Note: I still have problems accepting the premise that human insulin is a new drug. Poking about, it looks like these are not straightforward questions to answer. I checked on 6 insurance companies and did not find Afrezza listed. However this is not the end of the question as the documents typically state that they only publish the status for the most commonly prescribed drugs. I did find a committee document with Express Scripts that shows the drug was evaluated in September, although it states nothing about the outcome of the evaluation. www.express-scripts.com/aboutus/formularyinformation/pt/ptSummary_09_11_14.pdfEvidently, phone calls would be required to develop complete, more current, information. The only other thing I noted was that it appears many brand drugs would likely land on tier 4 at first evaluation (phrases here like 'specialty' and 'no therapeutic advantage' - keep in mind this is the insurers perspective). Elevation to higher tiers is on a cost/benefit basis with the bar to get on tier 3 not seeming particularly high (phrases here like 'non-preferred') and tier 2 being rather selective ('preferred', 'select', etc.). Low cost generics are much more readily found on the top tiers and almost exclusively comprise tier 1. Lantus and Humalog seem to land mostly on tier 3 and sometimes on tier 2 (small sample size). My experience with negotiating insurance coverage levels is from the provider side as a give and take affair that occurs annually; mostly regarding the allowable amounts. So, not that this is news, but Sanofi can influence this both by competing on price or showing clinical benefits and they may have limited occasion to do this outside of an annual process once the first evaluation has been completed. I'm no expert here, so feel free to correct anything that misrepresents the environment.
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Post by brentie on Apr 27, 2015 20:40:53 GMT -5
kball, You echo what's going on all over the country thanks to the (un)Affordable Care Act. Higher premium, deductibles, copays, and coinsurances. Many patients I see (mistakenly) select a higher deductible plan to lower the premium, but then when they have some significant medical bills, they learn just what that $10000 deductible means. I switched carriers last year for myself and my employee. This lowered my premium and deductible. The current carrier seems to accomplish this by paying less to the providers (as I know from being on the other end of this deal). And it's just going to get worse... Liane, should I start looking for a different avatar?
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Post by Deleted on Apr 27, 2015 21:08:46 GMT -5
MMIT shows a lot of insurance companies covering.
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Post by mnholdem on Apr 27, 2015 21:23:49 GMT -5
brentie, is that avatar chewing a Mallomar? spiro may want to adopt it if that's the case.
Regarding payer coverage, I was going to post an example of a biotech on my watch list (I don't recall which one at the moment) that recently launched its drug and, in the absence of any news while waiting for sale$ figures, their Investor Relations Department regularly issues PR every time they are made aware that an insurance payer has agreed to cover the drug.
A great use of PR. I may have sent the company's name to Matt along with a suggestion or two (chuckle).
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Post by dreamboatcruise on Apr 27, 2015 21:38:57 GMT -5
Whatever changes there are, someone with a chronic disease like diabetes is likely to be hitting their max out of pocket regardless of whether it is treatment with Afrezza or the existing treatments. So I don't really see Afrezza as changing that equation. If you're suggesting that the overall market for diabetes meds will be significantly impacted by shifting more costs to patients, that seems a bit of a stretch as diabetes is probably one of the last conditions people would think of shortchanging their health to save money (though some might really have no choice), but to the extent that does happen I think the addition of more people to the healthcare rolls due to more gov subsidies would more than offset. At the macro level of the amount spent on diabetes, I cannot fathom that doing anything but increasing. With the benefits of Afrezza, it should capture a sizable share. True, although the coverage tier may be different between medications for a given insurance and patients are definitely discussing the cost implications as a factor in choosing whether to use Afrezza. So, a list comparing coverage level for Afrezza to competing prandials would be useful to follow in this discussion, even if incomplete. I'm not sure where one would get started with that... Seems very tedious, but this could be a starting point... www.fingertipformulary.com/drugs/A/Google probably has my entire life stored in tabular format somewhere, you'd think they could do this for drugs.
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Post by spiro on Apr 27, 2015 21:48:19 GMT -5
Spiro would like to clarify his insurance coverage of Afrezza.
1st month, Spiro was told Afrezza was covered for a $30. co-pay, pharmacy said it was $50. Ok, no problem
2nd month, Insurance coverage denied, Spiro used discount coupon, Afrezza cost was $115. no problem, Spiro and Doctor appealed denial.
3rd month, Appeal granted, coupon would not work, Spiro will pay $50 co-pay for next 10 months. Ok, no problem
Spiro here, they are paying for it, but they they sure made it difficult.
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Post by babaoriley on Apr 27, 2015 21:56:47 GMT -5
brentie, is that avatar chewing a Mallomar? spiro may want to adopt it if that's the case. Regarding payer coverage, I was going to post an example of a biotech on my watch list (I don't recall which one at the moment) that recently launched its drug and, in the absence of any news while waiting for sale$ figures, their Investor Relations Department regularly issues PR every time they are made aware that an insurance payer has agreed to cover the drug. A great use of PR. I may have sent the company's name to Matt along with a suggestion or two (chuckle). Thinking of EXAS, holdem?
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Post by savzak on Apr 27, 2015 22:00:26 GMT -5
when the SP is languishing or going south is exactly when I want to be armed with a better understanding of the risks .[/quote]
Look, most everyone here has been tested by the fires of the Yahoo board. You are completely transparent and polluting thus once fine board. We can all take, even appreciate, honest negative analysis. What I personally cannot take, the reason I left Yahoo, is liars...people pretending to be one thing when they are another.
Thie quoted passage above tells all I need to know. When honestly invested as a long, any logical person wants to understand both the risks and the potential rewards as much as possible. The notion that the degree to which one needs an understanding of the risks (or potential benefits) of holding a stock is dependent on the recent price action is ignorant. You write something like that with the hope that no one will think about it and take the time to come to the realization of what what a load of garbage it is. An investor always needs the best information he can get as to the risks of holding a long position regardless of the recent price action. The fact that a stock has been doing well is no reason to disregard risk. Example, Enron.
You are Yahoo. Go away.
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Post by mnholdem on Apr 27, 2015 23:09:25 GMT -5
brentie, is that avatar chewing a Mallomar? spiro may want to adopt it if that's the case. Regarding payer coverage, I was going to post an example of a biotech on my watch list (I don't recall which one at the moment) that recently launched its drug and, in the absence of any news while waiting for sale$ figures, their Investor Relations Department regularly issues PR every time they are made aware that an insurance payer has agreed to cover the drug. A great use of PR. I may have sent the company's name to Matt along with a suggestion or two (chuckle). Thinking of EXAS, holdem? It might very well be the one, baba, as EXAS is on my watch list along with a dozen other bio techs.
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Post by cubonwallstreet on Apr 28, 2015 7:07:42 GMT -5
What is a balance sheet?
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